Primary Renal Non-Hodgkin’s Lymphoma – a Difficult Differential Diagnosis

Abstract

Introduction: Primary renal lymphoma (PRL) as a clinical entity is not undisputed because the kidneys do not contain lymphatic tissue and the mechanism of development of PRLs is unclear. Most of the few cases reported showed rapid systemic progression and a poor prognosis. Although there are no clearly defined diagnostic criteria for renal lymphomas, abdominal and thoracic computed tomography as well as renal and bone marrow biopsy are recommended. 3 cases of renal lymphoma are reported and their diagnosis and management discussed. Case Reports: Between 1996 and 2001, 3 male patients with renal lymphoma were diagnosed and treated at our institution. In patient No. 1, because of persisting macroscopic hematuria a bilateral PRL was diagnosed by renal biopsy, without any detectable lesions on CT imaging. Patient No. 2 presented with a large renal mass which, on biopsy, was diagnosed as a lymphoma. Patient No. 3 showed lymphoma on renal biopsy and bone marrow involvement. All 3 patients were treated with systemic chemotherapy which resulted in death of disease in 2 patients and a complete remission in 1 patient after adjuvant radiotherapy and nephrectomy. Conclusion: PRL represents a rare entity which must nevertheless be considered in cases of unusual renal masses or otherwise unexplained renal symptoms. If diagnosed early, cure is possible, and multimodal treatment should be considered.

Patterns of glomerular injury in kidneys infiltrated by lymphoplasmacytic neoplasms

“…Acute kidney injury as a presenting symptom of lymphomatous infiltration of kidney parenchyma was reported earlier [21][22][23]. The proposed mechanisms of such clinical presentation included tubular compression and impairment of renal parenchymal blood flow and increased vascular resistance [23,24]. In our series, acute kidney injury was not associated with any specific type of glomerular injury, but was more commonly seen in cases with massive interstitial involvement associated with destruction of the normal renal architecture, similar to the previously reported cases.…”

Acute kidney injury secondary to renal large B-cell lymphoma: role of early renal biopsy

“…Pathophysiological characteristics of AKI in patients with renal involvement by non-Hodgkin lymphoma are believed to be tubular compression and impairment of renal parenchymal blood flow [2], which might have occurred from the massive lymphocytic infiltration and severe interstitial edema noted in our patient. The rapid improvement in renal function that our patient experienced after chemotherapy suggests that lymphomatous infiltration was the sole cause of her renal dysfunction.…”

“…Renal involvement can be either primary renal lymphoma (PRL) or associated with extrarenal non-Hodgkin lymphoma. PRL as a clinical entity has been disputed because the kidneys do not contain lymphoid tissue, and the mechanism of development of PRL is unclear [2]. The diagnosis of PRL should be made only in the absence of extrarenal lymphoma, paraproteinemia, and leukemic blood phase [3].…”

Primary renal lymphoma: A case report and literature review

“…It has been suggested that PRL originates from the renal capsule and infiltrates the renal parenchyma. Another explanation is that chronic inflammatory conditions of the kidney attract the infiltration of lymphoid cells and eventually evolve into lymphoma (5).…”