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Lymphomas diagnosed by percutaneous kidney biopsy
Tom Törnroth1, Maija Heiro, Niels Marcussen
1Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland. tom.tornroth@hus.fi
Summary
Occult renal lymphoma often mimics kidney disease, presenting diagnostic challenges. Percutaneous kidney biopsy is crucial for diagnosing diffuse bilateral renal lymphoma, especially when acute renal failure is present.
Area of Science:
- Nephrology
- Oncology
- Pathology
Background:
- Occult renal lymphoma presents a diagnostic challenge, often mimicking renal medical diseases.
- Clinical and radiological findings are typically nonspecific, necessitating kidney biopsy.
Observation:
- Five new cases of diffuse bilateral renal lymphoma presenting with acute renal failure (ARF) were diagnosed via percutaneous kidney biopsy.
- Lymphomatous infiltration occurred in interstitial (3 cases) or intraglomerular/intravascular (2 cases) patterns, all B-cell lineage.
- Across 55 reported cases, ARF was common in interstitial (87%) and less so in intraglomerular (45%) lymphoma.
Findings:
- Interstitial lymphoma with ARF frequently showed bilaterally enlarged kidneys (95%).
- Nephrotic range proteinuria was observed in intraglomerular but not interstitial lymphoma.
- Extrarenal lymphoma involvement was noted in 44% of cases; suspicion prior to biopsy was low (18%).
Implications:
- Diffuse bilateral renal lymphoma can mimic renal medical disease, with ARF as a key presentation.
- Percutaneous kidney biopsy is the most effective diagnostic method.
- Differential diagnoses include interstitial nephritis and proliferative glomerulonephritis.