Renal infiltration presenting as acute kidney injury in Hodgkin lymphoma – A case report and review of the literature

Silva, Wellington F; Pinho, Laila Lopes de Farias; Farias, Cássio Lins Gil de; Torres, Verônica; Costalonga, Elerson Carlos; Filho, George Coura; Testagrossa, Leonardo de Abreu; Rocha, Vanderson; Buccheri, Valéria

doi:10.1016/j.lrr.2018.07.003

Cited by 5 publications

(5 citation statements)

References 13 publications

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“…Furthermore, MN causes increased proinflammatory cytokines such as, interleukin 1β, IL-6 and TNF-alpha. In the present patient, infiltrated DLBCL in the kidney was observed, and could directly induce renal impairment and work autoantigen (Kayataş et al 2011;Silva et al 2018). Pathological findings confirmed existing immune complexes consistent with MN.…”

Section: Discussionsupporting

confidence: 70%

Concomitant Nephrotic Syndrome with Diffuse Large B-cell Lymphoma: A Case Report

Kidoguchi

Katsuya

Ureshino

et al. 2020

Tohoku J. Exp. Med.

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Membranous nephropathy (MN) is a common glomerular disease that is characterized by diffuse thickening of the glomerular basement membrane, and a common cause of nephrotic syndrome (NS). MN is often accompanied with malignant disease; The solid tumors are commonly associated with MN, whereas hematological malignancies are rarely found in patients with MN. A 68-year-old man with a history of diabetes mellitus visited a hospital with a chief complaint of general fatigue. He was previously not diagnosed with any complications of diabetes. Computed tomography revealed a pancreatic tumor, and the pathological findings of the biopsied tumor revealed the tumor was diffuse large B-cell lymphoma (DLBCL). Concurrently, he developed severe proteinuria, hypoalbuminemia, systemic edema and hyperlipidemia, consistent with the diagnosis of NS. The biopsied renal specimen revealed minute spike lesions of glomerular basement membrane, and abnormal lymphocytes infiltrated in the kidney interstitially. Anti-glomerular basement membrane antibody, proteinase-3-/myeloperoxidase antineutrophil cytoplasmic antibody and hepatitis B antigenemia, are absent in the patient. Serum anti-phospholipase A2 receptor (PLA2R) antibody (marker for primary MN) was not detected. A diagnosis of secondary MN induced by DLBCL was made. He received rituximab containing chemotherapy for DLBCL, resulting in amelioration of both DLBCL and MN. We report the rare case of a patient co-existing NS and DLBCL. DLBCL might be pathogenesis of NS; the findings are supported by the presence of MN, an underlying malignancy (DLBCL), and the lack of anti-PLA2R antibodies. Although further investigation is warranted, our case suggests that DLBCL is a possible cause of secondary MN.

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Section: Discussionsupporting

confidence: 70%

Concomitant Nephrotic Syndrome with Diffuse Large B-cell Lymphoma: A Case Report

Kidoguchi

Katsuya

Ureshino

et al. 2020

Tohoku J. Exp. Med.

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“…Previous post mortem pathology studies have shown that asymptomatic renal involvement due to lymphomatous parenchymal infiltration by tumoral lymphoid cells is a common finding in patients with advanced lymphoma [ 22 , 58 , 59 , 60 ]. Conversely, renal biopsy-proven lymphomatous infiltration appears to be less common in patients with evident renal dysfunction.…”

Section: Lymphomatous Infiltration Of Renal Parenchymamentioning

confidence: 99%

“…In both studies, tumoral infiltration of the renal parenchyma was associated with poor prognosis (38% and 35.3% of the patients died, after a median follow-up of 21 and 29 months, respectively) [ 25 , 60 ]. Specific renal infiltration by tumoral lymphoid cells seems to be a very rare finding, but has been anecdotally reported during the course of cHL [ 58 ] and multiple myeloma ( Figure 5 ) [ 62 ].…”

Section: Lymphomatous Infiltration Of Renal Parenchymamentioning

confidence: 99%

Renal Diseases Associated with Hematologic Malignancies and Thymoma in the Absence of Renal Monoclonal Immunoglobulin Deposits

et al. 2021

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In addition to kidney diseases characterized by the precipitation and deposition of overproduced monoclonal immunoglobulin and kidney damage due to chemotherapy agents, a broad spectrum of renal lesions may be found in patients with hematologic malignancies. Glomerular diseases, in the form of paraneoplastic glomerulopathies and acute kidney injury with various degrees of proteinuria due to specific lymphomatous interstitial and/or glomerular infiltration, are two major renal complications observed in the lymphoid disorder setting. However, other hematologic neoplasms, including chronic lymphocytic leukemia, thymoma, myeloproliferative disorders, Castleman disease and hemophagocytic syndrome, have also been associated with the development of kidney lesions. These renal disorders require prompt recognition by the clinician, due to the need to implement specific treatment, depending on the chemotherapy regimen, to decrease the risk of subsequent chronic kidney disease. In the context of renal disease related to hematologic malignancies, renal biopsy remains crucial for accurate pathological diagnosis, with the aim of optimizing medical care for these patients. In this review, we provide an update on the epidemiology, clinical presentation, pathophysiological processes and diagnostic strategy for kidney diseases associated with hematologic malignancies outside the spectrum of monoclonal gammopathy of renal significance.

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“…FSGS associated with hematological tumors is infrequent, and when it occurs, it is unclear whether FSGS is related to the cancer or a coincidence. A possible explanation for the association between FSGS and hematological tumors is that vascular endothelial growth factor and heparanase have been reported to alter glomerular permeability in patients with FSGS [25]. These causes of glomerular nephritis can contribute to AKI either independently, or combined with other risk factors.…”

Section: Cancer-associated Glomerular Nephritismentioning

confidence: 99%

Acute Kidney Injury in Oncology Patients

Wang

Diao

et al. 2020

J. Cancer

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With rapid progress in cancer diagnosis and treatment in the last two decades, outcomes in oncological patients have improved significantly. However, the incidence of acute kidney injury (AKI) in this population has also increased significantly. AKI complicates many aspects of patients' care and adversely affects their prognoses; thus, accurately diagnosing the risk factors for AKI ensures appropriate management. AKI may be caused by pre-renal, intrinsic renal, and post-renal reasons, as well as for combined reasons. This review summarizes the potential etiologies of AKI according to the three classifications. For each underlying cause of AKI, the cancer itself and/or cancer treatment may contribute to a patient developing AKI. Therefore, we present disease-and treatment-related factors for each cause category, with special focus on immune checkpoint inhibitors, which are being used increasingly more often. It is important for nephrology services to be knowledgeable to provide the best level of care.

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Renal infiltration presenting as acute kidney injury in Hodgkin lymphoma – A case report and review of the literature

Cited by 5 publications

References 13 publications

Concomitant Nephrotic Syndrome with Diffuse Large B-cell Lymphoma: A Case Report

Concomitant Nephrotic Syndrome with Diffuse Large B-cell Lymphoma: A Case Report

Renal Diseases Associated with Hematologic Malignancies and Thymoma in the Absence of Renal Monoclonal Immunoglobulin Deposits

Acute Kidney Injury in Oncology Patients

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