Renal lymphomatous infiltration by mantle cell lymphoma: Treatment with chemoradiation and initiation of angiotensin converting enzyme (ACE) inhibitor for renal protection

Abstract

Background: Mantle Cell Lymphoma (MCL) is a rare subtype of non-Hodgkin lymphoma (NHL) that often takes an aggressive course. Rarely, MCL may cause acute kidney injury (AKI) either by direct lymphomatous invasion or by paraneoplastic processes. Case presentation: We present a rare case of a 64-year-old-man with AKI caused by recurrent MCL infiltrating into the bilateral renal collecting systems who was treated with renal-directed low-dose radiation therapy (RT; 4 Gy) and concurrent systemic chemotherapy. In order to prevent possible radiation-induced damage to the kidneys, he was started on captopril prior to start of RT. After RT, his renal function continued to improve until returning to baseline. Conclusion: Renal-directed RT with a low-dose of radiation (4 Gy) was used successfully to treat renal MCL infiltration and reverse the effects of AKI. We would also like to highlight the potential use of angiotensin converting enzyme (ACE) inhibitors to decrease the chances of radiation-induced kidney injury.