Spectrum of renal involvement in hematolymphoid neoplasms: Renal biopsy findings of 12 cases

Abstract

Spectrum of causes for renal dysfunction in patients with hematolymphoid malignancy (excluding plasma cell dyscrasia) is varied. A retrospective evaluation of “native” renal biopsies referred to our institute during the period from January 2010 to December 2013 revealed 12 cases. Age ranged between 7 and 69 (median 54.5) years. All patients were males. The neoplasms included non-Hodgkin lymphoma, chronic lymphocytic leukemia, acute lymphoblastic leukemia, Burkitt's lymphoma, intravascular lymphoma, Hodgkin lymphoma and chronic myeloid leukemia. Proteinuria was noted in 66% of the patients (nephrotic range in 5, subnephrotic range in 3). Renal insufficiency was noted in 100% patients. Malignancy-related kidney injury was noted in 75% of the cases. Renal histology showed lymphomatous infiltration (8), membranoproliferative glomerulonephritis (MPGN) (3), intracapillary monoclonal deposit disease (1) and intravascular lymphoma (1). Distribution of lymphomatous infiltration was diffuse in 50% and focal in 50%. We observed that renal dysfunction was predominantly a direct effect, that is, lymphomatous invasion. Paraneoplastic glomerulopathic changes occur in the form of MPGN. Proteinuria of >2 g/day correlated with glomerular disease.

Renal Intravascular Large B-cell Lymphoma: A Case Report and Review of the Literature

“…IVLBCL renal involvement is rarely described. Since the first description by Jothy et al in 1981 ( 8 ), only 39 cases have been published (the present case included) ( 8 - 41 ) ( Table 2 ). Among them, 52% were limited to the kidney at the initial diagnosis.…”

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

“…In our case, there was severe renal impairment and dialysis requirement. The possible explanation for kidney dysfunction is an elevated pressure in renal parenchyma caused by lymphocytic infiltration leading to compression of tubules and modifications in microvascular structure [4] , [5] , [6] . Another hypothesis suggests that cytokines produced by lymphoma cells may cause tubular injury and interstitial fibrosis [12] .…”

“…Extralymphatic involvement is much less common in HL than in non-Hodgkin lymphoma (NHL), and commonly includes liver, lungs, and bone marrow [1] , [2] , [3] . Kidneys are commonly affected in patients with hematolymphoid neoplasms by various mechanisms including paraneoplastic glomerulopathy, acute tubular necrosis (ATN), chronic interstitial nephritis (CIN), post-renal causes and lymphocytic infiltration of kidney parenchyma (LIK) [4] , [5] , [6] . However, LIK associated with HL is extremely rare being rather perirenal without parenchymal involvement [5] .…”

Nephrotic syndrome and acute renal failure as a presenting symptom of acute lymphoblastic leukemia

“…[ 3 4 ] The renal dysfunction because of the leukemic infiltration of the kidneys is uncommon but should be suspected in patients presenting with ARF and diffusely enlarged kidneys. [ 4 5 ] The tubular or glomerular injury because of tumor cells or immune complex deposition and paraneoplastic manifestation of leukemia can lead to renal dysfunction. [ 5 ]…”

“…[ 4 5 ] The tubular or glomerular injury because of tumor cells or immune complex deposition and paraneoplastic manifestation of leukemia can lead to renal dysfunction. [ 5 ]…”