title: Diffuse lymphomatous infiltration of kidney presenting as renal tubular acidosis and hypokalemic paralysis: case report.
abstract: We report the case of a 22-year-old woman who presented with acute onset flaccid quadriparesis. Physical examination showed mild pallor with cervical and axillary lymphadenopathy, hepatomegaly, and bilateral smooth enlarged kidneys. Neurological examination revealed lower motor neuron muscle weakness in all the four limbs with hyporeflexia and normal sensory examination. Laboratory investigations showed anemia, severe hypokalemia, and metabolic acidosis. Urinalysis showed a specific gravity of 1.010, pH of 7.0, with a positive urine anion gap. Ultrasound revealed hepatosplenomegaly with bilateral enlarged smooth kidneys. Renal biopsy was consistent with the diagnosis of non-Hodgkin lymphoma (B cell type). Metabolic acidosis, alkaline urine, and severe hypokalemia due to excessive urinary loss in our patient were suggestive of distal renal tubular acidosis. Renal involvement in lymphoma is usually subclinical and clinically overt renal disease is rare. Diffuse lymphomatous infiltration of the kidneys may cause tubular dysfunction and present with hypokalemic paralysis.
authors: Maulana Azad Medical College, 110002 New Delhi, India.
authors: Rajat
authors: R
authors: Jhamb
authors: Naresh
authors: N
authors: Gupta
authors: Sandeep
authors: S
authors: Garg
authors: Sachin
authors: S
authors: Kumar
authors: Sameer
authors: S
authors: Gulati
authors: Deepak
authors: D
authors: Mishra
authors: Pankaj
authors: P
authors: Beniwal
mesh_terms: D000136:Acid-Base Equilibrium; D000141:Acidosis, Renal Tubular / Q000209:etiology* / Q000473:pathology; D000328:Adult; D018941:Antigens, CD19 / Q000378:metabolism; D018951:Antigens, CD20 / Q000378:metabolism; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001706:Biopsy; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use; D004317:Doxorubicin / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006529:Hepatomegaly / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007008:Hypokalemia / Q000188:drug therapy / Q000209:etiology*; D007668:Kidney / Q000000981:diagnostic imaging / Q000601:surgery; D007680:Kidney Neoplasms / Q000175:diagnosis*; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis*; D018908:Muscle Weakness / Q000209:etiology; D010243:Paralysis / Q000209:etiology*; D011189:Potassium Chloride / Q000627:therapeutic use; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D011859:Radiography; D013163:Splenomegaly / Q000000981:diagnostic imaging / Q000473:pathology; D016896:Treatment Outcome; D014463:Ultrasonography; D014750:Vincristine / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D018941:Antigens, CD19; D018951:Antigens, CD20; D014750:Vincristine; D011189:Potassium Chloride; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone