Naruemon Naphasorn, Iamsai Piriyaporn, Ounpanyo Piyapong, Cheunsuchon Boonyarit, Vongchaiudomchoke Thanawat
Department of Internal Medicine, Lampang Hospital, Lampang, Thailand.
Department of Anatomical Pathology, Lampang Hospital, Lampang, Thailand.
Can J Kidney Health Dis. 2025 Jun 5;12:20543581251338434. doi: 10.1177/20543581251338434. eCollection 2025.
Acute kidney injury (AKI) in non-Hodgkin lymphoma has diverse etiologies. We report a case in which AKI due to light chain cast nephropathy was the initial manifestation of extranodal marginal zone lymphoma, occurring without systemic symptoms. A 64-year-old male presented with severe AKI without other symptoms. His physical examination and renal ultrasound were unremarkable. Renal biopsy revealed light chain cast nephropathy, and a subsequent bone marrow biopsy confirmed marginal zone lymphoma. The patient received R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) for a total of six cycles. The patient had a partial response to lymphoma. However, his renal function did not improve, and ultimately he progressed to end-stage kidney disease, requiring maintenance hemodialysis. This case highlights extranodal marginal zone lymphoma presenting as AKI, emphasizing its unique renal-limited manifestation in the absence of systemic symptoms and the critical role of renal biopsy in diagnosing unexplained AKI.
非霍奇金淋巴瘤中的急性肾损伤（AKI）病因多样。我们报告一例病例，其中轻链管型肾病所致的AKI是结外边缘区淋巴瘤的初始表现，且无全身症状。一名64岁男性出现严重AKI但无其他症状。其体格检查和肾脏超声检查均无异常。肾活检显示轻链管型肾病，随后的骨髓活检确诊为边缘区淋巴瘤。该患者接受了共六个周期的R-CHOP化疗（利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松龙）。患者对淋巴瘤有部分缓解。然而，其肾功能未改善，最终进展为终末期肾病，需要维持性血液透析。该病例突出了结外边缘区淋巴瘤表现为AKI，强调了其在无全身症状时独特的肾脏局限性表现以及肾活检在诊断不明原因AKI中的关键作用。
