Okubo Tomoe, Hirashio Shuma, Shimizu Minako, Kuroda Yoshiaki, Doi Shigehiro, Masaki Takao
Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7348551, Japan.
Department of Nephrology, National Hospital Organization Higashihiroshima Medical Center, Hiroshima, Japan.
CEN Case Rep. 2017 Nov;6(2):140-147. doi: 10.1007/s13730-017-0261-6. Epub 2017 Jun 7.
Acute kidney injury (AKI) because of bilateral renal infiltration is an uncommon presentation of diffuse large B-cell lymphoma (DLBCL). A 52-year-old man presented to our institution with AKI and complaints of fatigue. Ultrasonography revealed a large, 15 cm granulomatous mass arising from the bilateral kidneys. The mass was biopsied laparoscopically, and histopathological analysis revealed evidence of DLBCL. The patient subsequently underwent R-CHOP therapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Chemotherapy resulted in a rapid decrease in mass size and improvement in kidney function. However, after five courses of R-CHOP, relapse was observed in the central nervous system, and the patient died 220 days after the initial onset of AKI. Post-mortem analysis of renal tissue confirmed the initial diagnosis of DLBCL-associated renal infiltration. To our knowledge, this is the first report of DLBCL presenting as bilateral renal infiltration and AKI.
双侧肾浸润所致急性肾损伤（AKI）是弥漫性大B细胞淋巴瘤（DLBCL）的一种罕见表现形式。一名52岁男性因AKI及疲劳主诉前来我院就诊。超声检查发现双侧肾脏有一个15厘米的巨大肉芽肿性肿块。通过腹腔镜对该肿块进行活检，组织病理学分析显示为DLBCL。患者随后接受了R-CHOP治疗（利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松）。化疗使肿块大小迅速减小，肾功能得到改善。然而，在接受五个疗程的R-CHOP治疗后，中枢神经系统出现复发，患者在AKI初发后220天死亡。肾组织的尸检分析证实了最初诊断的DLBCL相关肾浸润。据我们所知，这是首例表现为双侧肾浸润和AKI的DLBCL报告。
