Nuguri Swapna, Swain Meenakshi, Padua Michelle De, Gowrishankar Swarnalata
Department of Pathology, ESIC Medical College, Sanathnagar, Hyderabad, Telangana, India.
Department of Histopathology, Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana, India.
Indian J Nephrol. 2022 Jul-Aug;32(4):342-347. doi: 10.4103/ijn.ijn_345_21. Epub 2022 May 7.
Renal manifestations associated with hematolymphoid malignancies are known. Primary or secondary involvement of the kidney by lymphomatous infiltration has various clinical presentations. Acute kidney injury is not an uncommon finding in relation to lymphomatous interstitial infiltration proven on kidney biopsy. However, diagnosing it solely on renal biopsy remains a challenge and needs expertise and aid of immunohistochemistry as the prognosis is dismal.
This is a retrospective study of kidney biopsy-proven cases of renal lymphoma presenting with acute kidney injury.
The study included 12 patients with ages ranging from 4 to 50 years who presented with serum creatinine ranging 2.1-9.6 mg%. Renal biopsy findings showed interstitial lymphomatous infiltrate. Two cases were diagnosed as primary lymphoma and the other 10 as secondary lymphomas. Among the 12 cases, nine were B-cell non-Hodgkin lymphoma, of which diffuse large B-cell lymphoma was diagnosed in six (50%), low-grade B-cell type in two (16.6%), chronic lymphocytic leukemia in one (8.3%), and three were T-cell-type. Two were acute T-cell lymphoblastic lymphoma and one other was a high-grade T-cell lymphoma. Four patients succumbed. The other four patients are alive; one is on chemotherapy, while two of them are on hemodialysis.
Acute kidney injury as a presenting feature with lymphomatous infiltration of renal parenchyma is not uncommon. The patchy involvement makes it challenging on kidney biopsy with definitive diagnosis being made with the help of immunohistochemistry. Appropriate multidisciplinary involvement improves patient outcome.
与血液淋巴系统恶性肿瘤相关的肾脏表现已为人所知。淋巴瘤浸润导致的肾脏原发性或继发性受累有多种临床表现。急性肾损伤在经肾活检证实为淋巴瘤性间质浸润的病例中并不少见。然而，仅依靠肾活检来诊断它仍然具有挑战性，需要专业知识和免疫组织化学的辅助，因为预后不佳。
这是一项对经肾活检证实的以急性肾损伤为表现的肾淋巴瘤病例的回顾性研究。
该研究纳入了12例年龄在4至50岁之间的患者，其血清肌酐范围为2.1 - 9.6mg%。肾活检结果显示间质淋巴瘤浸润。2例被诊断为原发性淋巴瘤，其他10例为继发性淋巴瘤。在这12例中，9例为B细胞非霍奇金淋巴瘤，其中弥漫性大B细胞淋巴瘤6例（50%），低级别B细胞型2例（16.6%），慢性淋巴细胞白血病1例（8.3%），3例为T细胞型。2例为急性T细胞淋巴细胞白血病，另1例为高级别T细胞淋巴瘤。4例患者死亡。其他4例患者存活；1例正在接受化疗，其中2例正在接受血液透析。
急性肾损伤作为肾实质淋巴瘤浸润的一种表现并不少见。局部受累使得肾活检具有挑战性，需要借助免疫组织化学进行明确诊断。适当的多学科参与可改善患者预后。
