Primary renal diffuse large B-cell lymphoma presenting as new-onset kidney failure

Area of Science:

• Oncology
• Nephrology
• Hematology

Background:

• Primary renal lymphoma is a rare kidney tumor, <1% of kidney masses, with few pediatric cases.
• Bilateral renal lymphoma can cause kidney failure, posing a therapeutic challenge requiring combined chemotherapy and kidney replacement therapy.

Purpose of the Study:

• To present a rare case of primary bilateral renal diffuse large B-cell lymphoma in a pediatric patient with kidney failure.
• To propose a practical approach for optimizing chemotherapy in conjunction with kidney replacement therapy.

Main Methods:

• The study involved a teenage girl with kidney failure (eGFR 7 ml/min/1.73 m²) due to primary bilateral renal diffuse large B-cell lymphoma.
• Diagnostic methods, chemotherapy adjustments, hyperhydration protocols, and tailored hemodiafiltration were employed to manage drug exposure and toxicity.

Main Results:

• The optimized approach significantly reduced chemotherapy adverse effects.
• The patient achieved remission and partial recovery of kidney function, with eGFR improving to 28 ml/min/1.73 m² at 12 months.
• Hemodialysis was discontinued after 6 months.

Conclusions:

• Managing chemotherapy in kidney failure is complex and necessitates a multidisciplinary team.
• Adjusting drug dosing and tailoring hemodialysis improves patient tolerance and maintains treatment efficacy.