OVERVIEW
Lymphoma renal damage is a disease in which malignant tumors of lymph nodes or other lymphoid tissues involve the kidneys and cause manifestations of renal damage. Clinical manifestations are fever, malaise, painless lymph node enlargement, hepatosplenomegaly, anemia and cachexia. It is more common in males than females, and is more frequent in 20-40 years old.
Etiology
Lymphoma renal damage is caused by the combined influence of many factors, mainly including the following aspects.
1．Lymphoma cells infiltrate the posterior peritoneum and retroperitoneal fibrosis to compress the urethra, renal artery, inferior vena cava, etc., causing renal injury.
2. Kidney damage caused by lymphocytes producing certain toxic substances, tumor-related antigen and immunoglobulin forming immune complexes and mixed cryoglobulin.
3. Renal damage caused by tumor-related hypercalcemia and hyperuricemia.
4. Renal damage caused by radiotherapy and tumor drug therapy.
Symptoms
1. Lymphoma manifestations
Primary lymphoma is the most common early manifestation of superficial lymph node enlargement. Generally there is no pressure pain, scattered, asymmetric, movable, mostly progressive and gradually enlarged. The spleen is mildly to moderately enlarged, rarely causing discomfort or pain. The late stage manifests systemic symptoms such as fever, fatigue, anemia, loss of appetite and so on.
2. Kidney damage manifestation of lymphoma
(1) Early stage can show nephrotic syndrome, 24h proteinuria>3.5g, plasma albumin<30g/L. Most of the nephrotic syndrome appears during the course of the disease, and worsens or improves with the deterioration or remission of lymphoma accordingly. ultrasound shows that both kidneys are enlarged.
(2) There may be nephritic syndrome manifestations, typical manifestations are hematuria, proteinuria, hypertension, edema, may have tubular pattern, some patients have dull pain in renal region, and occasionally a mass may be palpated in renal region.
(3) Extensive infiltration of lymphoma cells into bilateral kidneys may produce manifestations of renal insufficiency such as hypertension, oliguria and elevated blood creatinine.
(4) The enlarged lymph nodes compress the deep veins, causing unilateral or bilateral renal vein thrombosis.
(5) Some chemotherapeutic drugs, such as methotrexate and cisplatin, can cause non oliguric renal damage, and hypertension, proteinuria, progressive anemia, and renal function damage can occur in some patients receiving radiotherapy.
Examination
1. X-ray examination has the role of initial screening.
2. Pelvic and abdominal ultrasound is very helpful in detecting retroperitoneal lesions.
3. CT and magnetic resonance imaging (MRI) examination has important reference value for the diagnosis and staging of lymphoma in different parts of the body.
4．Pathologic biopsy is the most important basis for confirming the diagnosis.
Diagnosis
Pathologic biopsy is the main basis for confirming the diagnosis. Patients with nephrotic syndrome should be considered for the possibility of lymphoma. If lymphoma is diagnosed and the nephrotic syndrome worsens or improves accordingly with the worsening or remission of lymphoma, lymphoma renal damage can be diagnosed.
Differential diagnosis
It is mainly differentiated from nephrotic syndrome. If patients with nephrotic syndrome are middle-aged or elderly patients with pathologic manifestations of microscopic lesion-type nephropathy or membranous nephropathy, and there are enlarged superficial lymph nodes, increased renal volume, and hormone-resistant nephrotic syndrome manifestations, attention should be paid to exclude the possibility of lymphoma. If the possibility of lymphoma cannot be excluded, extra-renal related tests, including lymph node and bone marrow biopsy, imaging examination, etc., should be carried out promptly.
Treatment
The principle of treatment for lymphoma kidney damage is that the treatment of lymphoma is the main focus, and the treatment of kidney disease is supplementary. Radiotherapy and chemotherapy can be used to treat lymphoma in an integrated way, and the commonly used chemotherapy regimens include cyclophosphamide-doxorubicin-vincristine-borneol regimen and azithromycin-bleomycin-vincristine-dacarbazine regimen. Kidney damage is mostly reduced or cured in those with early treatment of lymphoma in remission. Those with renal failure may be given dialysis.
Prognosis
is largely determined by the degree of malignancy of the lymphoma itself and the response to treatment.