Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2023; 11(29): 7113-7126
Published online Oct 16, 2023. doi: 10.12998/wjcc.v11.i29.7113
Primary renal lymphoma presenting as renal failure: A case report and review of literature from 1989
Seul-Bi Lee, Young-Min Yoon, Ran Hong
Seul-Bi Lee, Department of Hemato-Oncology, Medical School, Chosun University, Gwangju 61453, South Korea
Young-Min Yoon, Department of Nephrology, Medical School, Chosun University, Gwangju 61453, South Korea
Ran Hong, Department of Pathology, Medical School, Chosun University, Gwangju 61453, South Korea
Author contributions: Hong R conceptualized and edited the article and contributed to manuscript drafting, pathologic methodology and funding acquisition; Lee SB and Yoon YM wrote the original article and analyzed the data; All authors issued approval of the final version.
Supported by the Research Fund from Chosun University, 2020, No. 2020-2.
Informed consent statement: The study was approved by the Institutional Review Board of Chosun University Hospital, Gwangju, Korea, which waived the requirement for written informed consent due to the nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ran Hong, MD, PhD, Professor, Department of Pathology, Medical School, Chosun University, No. 365 Philmundaero, Gwangju 61453, South Korea. nanih@chosun.ac.kr
Received: June 7, 2023
Peer-review started: June 7, 2023
First decision: August 4, 2023
Revised: August 21, 2023
Accepted: September 18, 2023
Article in press: September 18, 2023
Published online: October 16, 2023
Processing time: 128 Days and 12.2 Hours
Abstract
BACKGROUND

Primary renal lymphoma (PRL) is extremely rare with an incidence of 0.7% among extranodal lymphomas. Occult renal lymphoma, which mimics medical renal disease and bilateral renal involvement, presents a diagnostic challenge to nephrologists and radiologists as the clinical and radiological findings are mostly non-specific or inconclusive. Acute kidney injury (AKI) is not an uncommon finding in renal infiltration due to malignant lymphoma. However, only 14% of cases are detected before death, and the low diagnostic rate may be due to the non-specific clinical manifestations of renal involvement, with only 0.5% of these cases presenting with AKI. Moreover, PRL is difficult to diagnose based on clinical, biochemical, and radiologic features, especially, in the case of bilateral diffuse involvement.

CASE SUMMARY

Herein, we report a 74-year-old woman with primary diffuse large B-cell lymphoma who presented with AKI diagnosed by ultrasound-guided needle biopsy. We also report the clinicopathologic findings of 121 PRL cases reported since 1989, by conducting a literature review of published cases.

CONCLUSION

A timely renal biopsy provides the most expedient means of establishing the diagnosis. Thus, early identification of the disease by the clinician facilitates early diagnosis toward effective treatment.

Keywords: Lymphoma; Kidney; Acute kidney injury; Case report

Core Tip: We report a patient with bilateral primary renal lymphoma (B-PRL) presenting with acute kidney injury (AKI), and conducted a literature review of 121 cases of PRL since 1989. Among the 121 cases, 29.8% were bilateral. AKI occurred in all bilateral cases, and 71.4% of patients who died were diagnosed with B-PRL. There is a need to discuss more active treatment for B-PRL. In particular, differentiating diffuse involvement of lymphoma from other kidney diseases causing AKI is difficult clinically or radiologically; therefore, a kidney biopsy is essential for the diagnosis. Clinicians should endeavor to make a preoperative diagnosis, to avoid unnecessary surgery.