ESPN 50th Annual Meeting

ESPN 2017


 
Acute kidney injury – rare presentation of Burkitt lymphoma
Rimantė Čerkauskienė 1 Ieva Navarackaitė 2 Sigita Stankevičienė 2 Augustina Jankauskienė 1 Jelena Rascon 2

1- Vilnius University, Faculty of Medicine, Clinic of Children Diseases and Children’s Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Coordinating Centre for Children’s Rare Diseases
2- Vilnius University, Faculty of Medicine, Clinic of Children Diseases and Children’s Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Center for Paediatric Oncology and Haematology
 
Introduction:

Burkitt lymphoma is a highly aggressive B-cell non-Hodgkins lymphoma. Bilateral renal infiltration by lymphoma cells is an unusual cause of acute renal failure (ARF) and rare manifestation of lymphoma. ARF management is focused on treatment of the malignancy because modern chemotherapy leads to a dramatic normalization of renal function.

Material and methods:

We report a 13-year-old male who presented with moderate facial edema and acute renal failure due to massive bilateral kidney infiltration of lymphoid tissue and normal urinalysis.

Results:

Laboratory evaluation revealed anaemia, increased serum creatinine level 363 µmol/l, lactate dehydrogenase (LDH) 469 U/L, uric acid 1600 µmol/l, urea 37 mmol/l, impaired renal function GFR < 15 ml/min/1,73m2. The tumour infiltration comprised 95 percent of renal parenchyma. Percutaneous renal biopsy was performed. Pathologic examination showed diffuse infiltration of the interstitium with lymphocytes and atypical cells, immunohistochemistry showed infiltrated cells positive for c-MYC translocated gene. The lymphoid cells were positive for CD19 phenotype. The final diagnosis of Burkitt lymphoma/leukemia was made. The patient was treated according to B-NHL 04 protocol including CNS-directed therapy. Six blocks of chemotherapy were released. During the first chemotherapy course the patient showed delayed methotrexate excretion requiring rescue with glucarpidase. Management of AKF involved adequate intravenous hydration, urinary alkalinisation, correction of electrolyte imbalances, forced diuresis. Renal replacement therapy was not necessary. Now the patient is in remission for 16 months. Follow up examination showed normal haematopoiesis and renal function.

Conclusions:

Renal failure manifestation of Burkitt lymphoma/leukemia is diagnostically challenging. The presence of renal enlargement, an elevated LDH, uric acid, normal urine test should suggest the diagnosis, but only renal biopsy can provide a definitive diagnosis. Lymphomatous infiltration may respond well to therapy therefore it is highly recommended to use full-dose chemotherapy in Burkitt lymphoma cases presented with severe acute renal injury.