Renal damage caused by lymphoma

　　What are the causes of the onset of kidney damage caused by lymphoma

　　The main complications of kidney damage caused by lymphoma can be due to the widespread infiltration of lymphoma cells in both kidneys, causing symptoms of renal insufficiency such as hypertension, oliguria, and elevated blood creatinine. Malignant lymphoma can cause obstructive nephropathy due to the compression of the urinary tract by enlarged retroperitoneal lymph nodes, with severe cases leading to acute renal failure. Enlarged lymph nodes of lymphoma compress the renal vein, causing unilateral or bilateral renal vein thrombosis.

　　Lymphoma kidney involvement, only a few people have symptoms before death, with reports of 423 cases of lymphoma, the clinical diagnosis rate is only 0.5%. Common clinical manifestations include:
　　1. Nephrotic syndrome:Urine protein > 3.5g/24h, plasma albumin < 30g/L, seen in the early stage of the disease. Sometimes nephrotic syndrome is the initial manifestation of lymphoma, followed by lymph node enlargement. Most of the nephrotic syndrome appears in the course of the disease and is exacerbated or improved accordingly with the progression or remission of lymphoma. Ultrasound shows enlargement of both kidneys.
　　2. Nephritis syndrome:Typical symptoms include proteinuria, hematuria (which can be gross hematuria), hypertension, edema, etc., with possible cast urine, dull pain in the renal area, and occasionally palpable mass in the renal area.
　　3. Renal insufficiency:Lymphoma cells widely infiltrate both kidneys, causing symptoms of renal insufficiency such as hypertension, oliguria, and elevated blood creatinine. Acute renal failure can occur due to obstructive nephropathy caused by uric acid obstruction. Malignant lymphoma can cause obstructive nephropathy due to the compression of the urinary tract by enlarged retroperitoneal lymph nodes, with severe cases leading to acute renal failure.
　　4. Compression symptoms:Enlarged lymph nodes of lymphoma compress the renal vein, causing unilateral or bilateral renal vein thrombosis. Currently, kidney damage caused by lymphoma has gradually received attention in China, and there have been more and more reports of malignant lymphoma complicated with kidney damage.

　　Kidney damage caused by lymphoma as one of the complications of lymphoma has a complex course. The key to preventing this disease is to prevent the occurrence of the primary disease through分级 prevention.

　　1. Primary prevention

　　The prevention of the etiology aims to prevent the occurrence of cancer. Its tasks include studying various causes and risk factors of cancer, taking preventive measures against specific carcinogenic, promoting carcinogenic factors such as chemicals, physics, biology, and pathogenic conditions inside and outside the body, and taking measures to strengthen environmental protection, appropriate diet, and appropriate sports to enhance physical and mental health.

　　1. Avoid smoking

　　Smoking has been clearly recognized as a known carcinogen, related to 30% of cancers. Tar in cigarettes contains a variety of carcinogens and cocarcinogens, mainly causing lung, pharynx, larynx, and esophageal cancers, and can also increase the risk of tumors in many other parts.

　　2. Adjusting dietary structure

　　A reasonable diet has a preventive effect on most cancers, especially in plant-based foods, where there are various anti-cancer components that are almost effective in preventing all types of cancer. Surveys show that colorectal cancer, breast cancer, esophageal cancer, gastric cancer, and lung cancer are most likely to be prevented by changing dietary habits.

　　3. Prevention of tumors caused by occupation

　　For example, lung cancer (asbestosis), bladder cancer (aniline dye), leukemia (benzene), and other diseases are related to the above factors. Some infectious diseases are also closely related to certain cancers: such as hepatitis B virus and liver cancer, human papillomavirus and cervical cancer. In some countries, significant increases in schistosomiasis parasitic infection increase the risk of bladder cancer. Exposure to some ionizing radiation and a large amount of ultraviolet light, especially ultraviolet light from the sun, can also lead to skin cancer. Commonly used carcinogenic drugs include estrogens and androgens, anti-estrogen drug tamoxifen, and so on. The estrogen widely used by postmenopausal women is related to endometrial cancer and breast cancer.

　　2. Secondary prevention

　　Or preclinical prevention, the goal is to prevent the development of primary diseases. This includes early detection, early diagnosis, and early treatment of cancer to prevent or slow down the progression of the disease and reverse it to stage 0 as soon as possible.

　　3. Tertiary prevention

　　For clinical (stage) prevention or rehabilitation prevention, the goal is to prevent the deterioration of the disease and the occurrence of disabilities. The task is to adopt a multidisciplinary comprehensive diagnosis (MDD) and treatment (MDT), correctly select reasonable and optimal diagnostic and treatment plans to extinguish cancer as soon as possible, strive to promote the recovery of function and rehabilitation, prolong life, improve the quality of life, and even return to society.

　　Nephrotic syndrome often appears during the course of lymphoma, but it can also occur before or several months to several years after lymphoma. The nephrotic syndrome can be correspondingly exacerbated or alleviated with the progression or remission of lymphoma. To improve the diagnostic rate of renal infiltration in lymphoma patients, close observation should be made, and renal infiltration can be considered in cases with the following abnormalities.
　　1. Laboratory examination:Abnormal urine routine examination shows proteinuria, hematuria; oliguria and increased blood creatinine, and symptoms of renal insufficiency. Urinary protein > 3.5g/24h, plasma albumin < 30g/L.
　　2. Other auxiliary examinations:
　　1. Renal pathological examination shows increased weight of the affected kidney, with multiple nodules visible to the naked eye, and a few appear normal. Under the microscope, tumor cells infiltrate diffusely in the renal interstitium, causing renal parenchymal atrophy, necrosis, and shrinkage. In cases of Hodgkin's disease complicated with glomerular disease, the pathological type is often minimal change, but there are also reports of focal nephritis, membranous nephropathy, membranoproliferative nephritis, and anti-glomerular antibody nephritis. Amyloid deposits can be found in the kidneys of patients with Hodgkin's disease. Immunofluorescence examination shows granular or lumpy deposition of IgG and C3 on the glomerular capillary wall in some cases with concomitant glomerular disease. Under the electron microscope, foot process fusion can be seen in minimal change nephropathy.
　　2. Ultrasound, intravenous pyelography, CT, or magnetic resonance imaging indicate that the kidneys are enlarged or deformed.

　　A reasonable diet has a preventive effect on most cancers, especially in plant-based foods, where there are various anti-cancer components that are almost effective in preventing all types of cancer. Surveys show that colorectal cancer, breast cancer, esophageal cancer, gastric cancer, and lung cancer are most likely to be prevented by changing dietary habits.

　　The treatment of renal damage caused by lymphoma first requires treatment of the primary disease, while treating the kidney disease at the same time.

　　1. Treatment of Lymphoma

　　Radiotherapy and chemotherapy can be used. Currently, nitrogen mustard, vincristine, procarbazine (methylbenzhydrazine), and prednisone are commonly used in combination therapy. Early treatment of lymphoma remission can reduce renal damage. When combined chemotherapy is performed in patients with malignant lymphoma, especially in patients with a large tumor burden, it is necessary to pay attention to adequate hydration and prophylactic treatment with allopurinol, and closely monitor renal function.

　　2. Treatment of Renal Damage Complicated by Lymphoma

　　In addition to effective treatment for the lymphoma itself, other treatments are basically the same as those for primary kidney disease. Nephrotic syndrome can be treated with hormones and immunosuppressants. Starch-like nephropathy should not use corticosteroids, as they may worsen kidney disease, and treatment with vincristine or dimethyl sulfoxide can be tried. Patients with renal failure can be treated with dialysis.

　　The prognosis of renal damage caused by lymphoma is largely determined by the intrinsic malignancy of the lymphoma itself, the response to treatment, and the responsiveness of nephrotic syndrome to hormones and immunosuppressants.