Related Experiment Video
Updated: Jan 28, 2026
In Ovo Xenografting of Patient-Derived Acute Lymphoblastic Leukemia (ALL) Cells (PDX-ALL)
Published on: August 1, 2025
T-cell lymphoblastic lymphoma presenting with type B lactic acidosis and acute kidney injury in an adolescent
Pelin Abdal Yıldırım1, Seçil Arslansoyu Çamlar2,3, Demet Kocatepe Çavdar4
1Department of Pediatrics, Division of Nephrology, Izmir City Hospital, Bayraklı, Izmir, 35540, Turkey. pelinabdal@outlook.com.
Insights
Pediatric acute kidney injury (AKI) can rarely stem from T-cell lymphoblastic lymphoma infiltration. Prompt diagnosis via kidney biopsy and chemotherapy are crucial for treating this rare cause of AKI and lactic acidosis in children.
Area of Science:
- Pediatric Nephrology
- Pediatric Hematology-Oncology
- Oncology
Background:
- Acute kidney injury (AKI) in children is a significant cause of illness and death, often linked to dehydration, sepsis, or toxic exposures.
- While uncommon, hematologic malignancies can infiltrate the kidneys, leading to AKI.
Purpose of the Study:
- To report a rare case of pediatric AKI caused by direct renal infiltration of T-cell lymphoblastic lymphoma.
- To highlight the association between unexplained lactic acidosis, nephromegaly, and hematologic malignancy in pediatric AKI.
Main Methods:
- Case report of a 13-year-old boy with AKI, metabolic acidosis, and hyperlactatemia.
- Diagnostic workup included imaging studies and kidney biopsy.
- Treatment involved chemotherapy.
Main Results:
- Kidney biopsy revealed diffuse renal infiltration by T-cell lymphoblastic lymphoma.
- Metabolic findings indicated type B lactic acidosis, attributed to the Warburg effect.
- Lactate levels normalized rapidly after initiating chemotherapy.
Conclusions:
- Hematologic malignancy should be considered in pediatric AKI cases with unexplained lactic acidosis and nephromegaly.
- Early recognition, kidney biopsy, and prompt oncologic treatment are vital for improved outcomes in such cases.
Abstract:
Acute kidney injury (AKI) in children is a major cause of morbidity and mortality and is most commonly associated with dehydration, sepsis, or nephrotoxic exposures. In rare instances, however, hematologic malignancies may lead to AKI through direct renal infiltration. We report on a 13-year-old boy who presented with AKI, refractory metabolic acidosis, and severe hyperlactatemia in the absence of sepsis or hypoperfusion. Imaging studies revealed bilateral nephromegaly with heterogeneous renal parenchyma. Kidney biopsy demonstrated diffuse infiltration of the kidneys by T-cell lymphoblastic lymphoma. The metabolic findings were consistent with type B lactic acidosis, likely driven by the Warburg effect. Following initiation of chemotherapy, lactate levels rapidly normalized. This case highlights the importance of considering underlying hematologic malignancy in children presenting with AKI accompanied by unexplained lactic acidosis and nephromegaly. Early recognition, prompt kidney biopsy, and timely oncologic treatment are essential for accurate diagnosis and improved outcomes.
Related Concept Videos
01:22Acute Kidney Injury I: Introduction
01:29Acute Kidney Injury II: Pathophysiology
01:22Acute Kidney Injury VI: Nursing Management
01:20Acute Kidney Injury V: Interprofessional Care
01:29Acute Kidney Injury III: Clinical Manifestations
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention