The spectrum of kidney involvement in lymphoma: a case report and review of the literature

Abstract

Kidney involvement is an under-recognized complication of both Hodgkin and non-Hodgkin lymphoma. The diversity of lymphoma-related renal manifestations makes diagnosis difficult. Although abrupt worsening of kidney function may be the first sign of malignant disease, renal effects can be subtle or even silent. The causes of renal involvement similarly are varied. We discuss a case of non-Hodgkin lymphoma and associated kidney failure from several distinct malignancy-related mechanisms and review the spectrum of lymphoma-related kidney involvement.

Figure 1

Light microscopy of the cortex of the kidney. The glomerulus is well preserved and shows open capillaries, mild to moderate expansion of the mesangial matrix, and delicate glomerular basement membranes. Most tubules are unremarkable. One dilated distal tubule in the left lower corner contains a PAS-positive hyaline cast. The immunofluorescence microscopy did not reveal immune deposits or monoclonal paraproteins; casts were reactive for polyclonal IgA. PAS stain. Magnification: 40x objective; final magnification on the 10 inch image is 590x.

Figure 2

Electron microscopy of the glomerular capillaries. Shown here are two glomerular capillaries with diffuse effacement of the foot processes of the visceral epithelial cells. The basement membranes are of normal thickness, and the endothelial cells appear swollen and occupy most of the capillary lumen. Electron dense deposits are not present along the peripheral capillary walls. Original magnification 5000x objective.

Figure 3

Light microscopy of the outer medulla. There is focal infiltration of the parenchyma by small lymphoid cell aggregates, strongly suggestive of a lymphomatous involvement of the parenchyma; similar aggregates of CD20-positive B-cells were also seen in the bone marrow biopsy. Hematoxylin and eosin; final magnification 292x