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      Renal infiltration presenting as acute kidney injury in Hodgkin lymphoma – A case report and review of the literature

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          Abstract

          Renal involvement in Hodgkin lymphoma (HL) is rare, although extralymphatic disease is usually found. Acute kidney injury is a recognized presentation of non-Hodgkin lymphoma, with bilateral kidney involvement, promptly requiring specific treatment. Regarding to HL, this manifestation is extremely rare and lacks pathologic description and management experiences. Herein, we describe a case of HL with atypical presentation as well as its management, current evaluation by PET-scan and histologic findings. This case report highlights clinical presentation and a successful experience on managing these cases. Moreover, it is important to drive biologic insights for understanding of kidney infiltration mechanism in HL.

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          Most cited references 11

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          Hodgkin Lymphoma: Diagnosis and Treatment.

          Hodgkin lymphoma is a rare B-cell malignant neoplasm affecting approximately 9000 new patients annually. This disease represents approximately 11% of all lymphomas seen in the United States and comprises 2 discrete disease entities--classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Within the subcategorization of classical Hodgkin lymphoma are defined subgroups: nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte-rich Hodgkin lymphoma. Staging of this disease is essential for the choice of optimal therapy. Prognostic models to identify patients at high or low risk for recurrence have been developed, and these models, along with positron emission tomography, are used to provide optimal therapy. The initial treatment for patients with Hodgkin lymphoma is based on the histologic characteristics of the disease, the stage at presentation, and the presence or absence of prognostic factors associated with poor outcome. Patients with early-stage Hodgkin lymphoma commonly receive combined-modality therapies that include abbreviated courses of chemotherapy followed by involved-field radiation treatment. In contrast, patients with advanced-stage Hodgkin lymphoma commonly receive a more prolonged course of combination chemotherapy, with radiation therapy used only in selected cases. For patients with relapse or refractory disease, salvage chemotherapy followed by high-dose treatment and an autologous stem cell transplant is the standard of care. For patients who are ineligible for this therapy or those in whom high-dose therapy and autologous stem cell transplant have failed, treatment with brentuximab vedotin is a standard approach. Additional options include palliative chemotherapy, immune checkpoint inhibitors, nonmyeloablative allogeneic stem cell transplant, or participation in a clinical trial testing novel agents.
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            Renal lesions associated with malignant lymphomas.

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              Clinical review: Specific aspects of acute renal failure in cancer patients

              Acute renal failure (ARF) in cancer patients is a dreadful complication that causes substantial morbidity and mortality. Moreover, ARF may preclude optimal cancer treatment by requiring a decrease in chemotherapy dosage or by contraindicating potentially curative treatment. The pathways leading to ARF in cancer patients are common to the development of ARF in other conditions. However, ARF may also develop due to etiologies arising from cancer treatment, such as nephrotoxic chemotherapy agents or the disease itself, including post-renal obstruction, compression or infiltration, and metabolic or immunological mechanisms. This article reviews specific renal disease in cancer patients, providing a comprehensive overview of the causes of ARF in this setting, such as treatment toxicity, acute renal failure in the setting of myeloma or bone marrow transplantation.
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                Author and article information

                Contributors
                Journal
                Leuk Res Rep
                Leuk Res Rep
                Leukemia Research Reports
                Elsevier
                2213-0489
                29 August 2018
                2018
                29 August 2018
                : 10
                : 41-43
                Affiliations
                [a ]Discipline of Hematology, Faculty of Medicine of University of São Paulo (FMUSP), Av. Dr. Arnaldo, 251, 1° andar, ZIP: 01246-000, Brazil
                [b ]Discipline of Nephrology, Faculty of Medicine of University of São Paulo (FMUSP), Brazil
                [c ]Radiology and Oncology Department, Faculty of Medicine of University of São Paulo (FMUSP), Brazil
                [d ]Pathology Department, Faculty of Medicine of University of São Paulo (FMUSP), Brazil
                Author notes
                [* ]Corresponding author. valeria.buccheri@ 123456hc.fm.usp.br
                Article
                S2213-0489(18)30014-1
                10.1016/j.lrr.2018.07.003
                6138943
                © 2018 The Authors. Published by Elsevier Ltd.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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