The Hidden Host – Hematolymphoid Malignancies Presenting with Direct Renal Infiltration – A Case Series

Acute kidney injury secondary to direct lymphocytic infiltration in hematologic malignancies is rare and often underrecognized. This case series presents five patients with hematolymphoid malignancies which includes two patients with mantle cell lymphoma, two patients with diffuse large B-cell lymphoma(DLBCL) and one with chronic myeloid leukemia(CML) in extra-medullary blast crisis (EBC). Each presented with renal dysfunction primarily due to parenchymal infiltration. Patient ages ranged from 33 to 75 years, with a male-to-female ratio of 3:2. Common clinical features included pedal edema, abdominal pain, lymphadenopathy, and splenomegaly. Laboratory findings demonstrated anemia, abnormal leukocyte and platelet counts, and significantly elevated serum creatinine levels (3.5–11.4 mg/dL). Hypocomplementemia and glomerulonephritis were present in two cases. Imaging revealed bulky kidneys and organomegaly in some patients. Histopathological evaluation through kidney biopsies played a crucial role in diagnosing mantle cell lymphoma, DLBCL, and CML with renal blast crisis, particularly in cases where bone marrow and lymph node biopsies were nondiagnostic. All patients underwent chemotherapy. Outcomes were mixed with recovered renal function in two patients, two died, and one was lost to follow-up. This case series underscores the diagnostic value of renal biopsy in hematologic malignancies with renal manifestations, particularly when systemic diagnostic evidence is lacking. Given the variability in presentation, histology, and outcomes, early biopsy is essential for recognition of such atypical presentations with direct implications for prognosis and therapeutic decisions.