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Kidney Week

Abstract: TH-PO545

Primary Bilateral Renal T-Cell Lymphoma Presenting as Rapidly Progressive Glomerulonephritis

Session Information

  • Trainee Case Reports - I
    October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Coêlho, Maria Carolina Romeiro Figueiroa Benicio, Hospital das Clínicas HC - UFPE, Recife, Brazil
  • Oliveira, Camila Barbosa lyra, Hospital das Clínicas HC - UFPE, Recife, Brazil
  • Costa, Denise Maria do Nascimento, Hospital das Clínicas HC - UFPE, Recife, Brazil
  • Vajgel, Gisele, Hospital das Clínicas HC - UFPE, Recife, Brazil
  • Sette, Luis H.B.C., Hospital das Clínicas HC - UFPE, Recife, Brazil
  • Souto maior, Marcelo, Hospital das Clínicas HC - UFPE, Recife, Brazil
  • Cavalcante, Maria Alina G.M., Hospital das Clínicas HC - UFPE, Recife, Brazil
  • Valente, Lucila Maria, Hospital das Clínicas HC - UFPE, Recife, Brazil
Introduction

Primary renal lymphoma (PRL) is a extremely rare disease defined as a non-Hodgkin's lymphoma (NHL) involving the kidney in the absence of primarily extrarenal lymphatic disease. Acute kidney injury (AKI) as the initial presentation of lymphoma is even more uncommom.

Case Description

A 43 y/o man presented with edema, weight loss, asthenia and exertional dyspnea for 1 month. Urinalysis and renal function were normal (SCr 1.0mg/dL). After 2 weeks, SCr was 3.6mg/dl and he was hospitalized. He presented microscopic hematuria and mild proteinuria (486mg/24h) with progressive oliguric AKI (SCr 4.2) requiring dialysis. US showed discrete bilateral enlarged kidneys. He received methylprednisolone IV and oral prednisone 1mg/kg/day for the clinical diagnosis of rapidly progressive glomerulonephritis. Kidney biopsy showed diffuse lymphoid intersticial infiltration and immunohistochemistry was compatible with T-Cell lymphoma (CD 3 + / Bcl 2 + / CD 20 - / CD 10 - / CD 5 + / CD 23 - / Ki 67 90%). CT of the thorax, abdomen and pelvis confirmed enlarged kidneys and excluded infiltration in other organs. Before a specific treatment, the patient had a poor outcome, dying with septic shock days after.

Discussion

Despite its rarity, PRL should be kept in mind in the differential diagnosis of AKI with bilateral enlarged kidneys. Clinical manifestations are often nonspecific, with flank pain, hematuria, and weight loss predominating. Lymphomatous infiltration causing AKI is a uncommon presenting finding and prognosis is poor. Although B-cell NHL are more commom, T-cell NHL have been described as a cause of PRL.

Intersticial lymphocytic infiltration (HE stain; magnification X 400)