AimDirect kidney involvement in B‐cell lymphoproliferative disease is a rare disorder with only a few studies reported in Caucasian patients. The clinicopathological characteristics and outcome of this entity remain poorly described.MethodsWe retrospectively studied all adult Chinese patients who had histology‐proven renal parenchymal infiltration by malignant B‐cells between 1 January 2000 and 31 December 2018 at two tertiary hospitals in Hong Kong. Clinical, pathological and radiological data were collected from 20 patients. Follow‐up data were analysed until 31 December 2019.ResultsMedian follow‐up duration was 22 (1–171) months. Only seven patients (35%) had established diagnosis of haematological cancer before kidney biopsy.Diffuse large B‐cell lymphoma (DLBCL) was the most common subtype in our cohort (n = 5, 25%). Others included low‐grade B‐cell lymphoma (n = 11), intravascular large B‐cell lymphoma (n = 1), mantle cell lymphoma (n = 1) and multiple myeloma (n = 2). Fourteen patients (70%) presented with AKI while 12 patients (60%) had proteinuria. Seven patients (35%) had unilateral renal mass, one had bilateral renal masses and one had bilateral diffuse nephromegaly in computed tomography. Lymphomatous tubulointerstitial infiltration was the prevalent histological finding. Nine patients (45%) had coexisting renal lesions other than direct tumour infiltration. All but one patient received chemotherapy. Ten patients died and renal responders had a significantly better survival than non‐renal responders (p = .03).ConclusionDirect tumour infiltration can occur in a wide variety of B‐cell lymphoproliferative disorders. Coexisting immunoglobulin‐related nephropathy is frequently found. Renal biopsy is required for early diagnosis which allows timely and appropriate treatment.

Brimonidine eye drops are frequently prescribed for the treatment of glaucoma and ocular hypertension in adults. Systemic toxicities including neurological side effects have been reported with its use, especially in the paediatric population. In this report, we present a case of encephalopathy secondary to the use of brimonidine eye drops in a patient with underlying advanced chronic kidney disease, who recovered promptly after drug cessation. Herein, we also review the pharmacokinetics of eye drops leading to their systemic side effects, especially in the context of renal impairment. We also explore the possibility of extracorporeal treatment, such as by haemodialysis, for the treatment of these manifestations. This case demonstrates the need to clarify a patient's drug history and stop offending medications early on in a patient with delirium, while treatments such as antidotes or extracorporeal treatment are being considered.

What can a thrombus in the superior vena cava (SVC) do to a jugular haemodialysis catheter?An 80-year-old lady with diabetes mellitus, hypertension and ischaemic heart disease, chronic kidney disease with a baseline serum creatinine of 300 μmol/L was admitted for acute pulmonary edema secondary to acute coronary syndrome (ACS) and required noninvasive ventilatory (NIV) support. She developed acute-on-chronic kidney failure with serum creatinine rising to 500 μmol/L with oliguria and further desaturation despite noninvasive ventilatory (NIV) support and echocardiography showed global hypokinesia with ejection fraction down to 30%.She was transferred to intensive care 2 days later and underwent ultrasound-guided temporary haemodialysis catheter insertion into the right internal jugular vein (IJV) (Figure 1A). She had two CRRT sessions with net ultrafiltration of 6 L and was weaned off NIV support. She returned to the general medical ward after 3 days of ICU stay and received maintenance haemodialysis twice a week. On Day