Mustafar Ruslinda, Kamaruzaman Lydia, Chien Beh Hui, Yahaya Azyani, Mohd Nasir Noor'Ain, Mohd Rozita, Cader Rizna, Wei Yen Kong
Department of Medicine, Nephrology Unit, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia.
Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia.
Case Rep Med. 2018 Aug 13;2018:8425985. doi: 10.1155/2018/8425985. eCollection 2018.
We reported a case of primary renal lymphoma (PRL) presented with non-oliguric acute kidney injury and bilateral kidney infiltrates in an individual with human immunodeficiency virus (HIV) disease. Acute kidney injury secondary to lymphoma infiltrates is very rare (less than 1% of hematological malignancy). A 37-year-old gentleman with underlying human immunodeficiency virus (HIV) disease was on combined antiretroviral therapy since diagnosis. He presented to our center with uremic symptoms and gross hematuria. Clinically, bilateral kidneys massively enlarged and were ballotable. Blood investigations showed hemoglobin of 3.7 g/L, urea of 65.6 mmol/L, and serum creatinine of 1630 mol/L with hyperkalemia and metabolic acidosis. An urgent hemodialysis was initiated, and he was dependent on regular hemodialysis subsequently. Computed tomography renal scan showed diffuse nonenhancing hypodense lesion in both renal parenchyma. Diagnosis of diffuse large B cell lymphoma with germinal center type, CD20 positive, and proliferative index 95% was confirmed via renal biopsy, and there was no bone marrow infiltrates. Unfortunately, the patient succumbs prior to initiation of chemotherapy.
我们报告了一例原发性肾淋巴瘤（PRL）病例，该患者为一名患有人类免疫缺陷病毒（HIV）疾病的个体，表现为非少尿型急性肾损伤和双侧肾脏浸润。淋巴瘤浸润继发的急性肾损伤非常罕见（占血液系统恶性肿瘤的比例不到1%）。一名37岁患有潜在人类免疫缺陷病毒（HIV）疾病的男性自诊断以来一直在接受联合抗逆转录病毒治疗。他因尿毒症症状和肉眼血尿前来我们中心就诊。临床上，双侧肾脏明显肿大且有波动感。血液检查显示血红蛋白为3.7g/L，尿素为65.6mmol/L，血清肌酐为1630μmol/L，伴有高钾血症和代谢性酸中毒。紧急开始了血液透析，随后他依赖定期血液透析。计算机断层扫描肾脏扫描显示双侧肾实质内弥漫性无强化低密度病变。通过肾活检确诊为生发中心型弥漫性大B细胞淋巴瘤，CD20阳性，增殖指数为95%，且无骨髓浸润。不幸的是，患者在开始化疗前死亡。
