Letter to the Editor
Renal lymphomatous infiltration in patient with nefrotic syndrome
Infiltración renal linfomatosa en paciente con síndrome nefrótico
Enoc Merino García
, María Pilar Pérez del Barrio, Josefa Borrego Hinojosa, Francisco J. Borrego Utiel, María Carmen Sánchez Perales
Corresponding author
Unidad de Gestión Clínica de Nefrología, Complejo Hospitalario de Jaén, Jaén, Spain
Read
7967
Timeswas read the article
2537
Total PDF
5430
Total HTML
Share statistics
array:25 [ "pii" => "S2013251417301712" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2017.10.002" "estado" => "S300" "fechaPublicacion" => "2018-01-01" "aid" => "329" "copyright" => "Sociedad Española de Nefrología" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2018;38:92-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2673 "formatos" => array:3 [ "EPUB" => 290 "HTML" => 1867 "PDF" => 516 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0211699517300127" "issn" => "02116995" "doi" => "10.1016/j.nefro.2016.12.004" "estado" => "S300" "fechaPublicacion" => "2018-01-01" "aid" => "329" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia. 2018;38:92-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4375 "formatos" => array:3 [ "EPUB" => 306 "HTML" => 3359 "PDF" => 710 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Infiltración renal linfomatosa en paciente con síndrome nefrótico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "92" "paginaFinal" => "94" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Renal lymphomatous infiltration in patient with nefrotic syndrome" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1084 "Ancho" => 1417 "Tamanyo" => 486948 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Características histológicas de los infiltrados linfoides que afectaban tanto al parénquima renal (A: H&E, ×10) como al tejido perirrenal (B: H&E, ×10). El infiltrado linfoide destruía el parénquima dejando aislados túbulos residuales con dudosas imágenes de lesión linfoepitelial (C: H&E, ×20). La celularidad era monomorfa, de pequeño tamaño, contorno nuclear irregular, con nucléolo poco evidente y sin actividad mitótica significativa (D: H&E, ×40).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Enoc Merino García, María Pilar Pérez del Barrio, Josefa Borrego Hinojosa, Francisco J. Borrego Utiel, María Carmen Sánchez Perales" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Enoc" "apellidos" => "Merino García" ] 1 => array:2 [ "nombre" => "María Pilar" "apellidos" => "Pérez del Barrio" ] 2 => array:2 [ "nombre" => "Josefa" "apellidos" => "Borrego Hinojosa" ] 3 => array:2 [ "nombre" => "Francisco J." "apellidos" => "Borrego Utiel" ] 4 => array:2 [ "nombre" => "María Carmen" "apellidos" => "Sánchez Perales" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2013251417301712" "doi" => "10.1016/j.nefroe.2017.10.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301712?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699517300127?idApp=UINPBA000064" "url" => "/02116995/0000003800000001/v1_201801090621/S0211699517300127/v1_201801090621/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2013251417301700" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2017.10.001" "estado" => "S300" "fechaPublicacion" => "2018-01-01" "aid" => "328" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2018;38:94-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2633 "formatos" => array:3 [ "EPUB" => 288 "HTML" => 1790 "PDF" => 555 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Serratia marcescens bacteraemia outbreak in haemodialysis. Comment on “Serratia marcescens bacteraemia outbreak in haemodialysis patients with tunnelled catheters due to colonisation of antiseptic solution. Experience in 4 hospitals”" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "94" "paginaFinal" => "96" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Brote de bacteriemia por Serratia marcescens en hemodiálisis. Comentario a «Brote de bacteriemia por Serratia marcescens en pacientes portadores de catéteres tunelizados en hemodiálisis secundario a colonización de la solución antiséptica. Experiencia en 4 centros»" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Silvia González Sanchidrián, Jesús Pedro Marín Álvarez, Javier Deira Lorenzo, Pedro Jesús Labrador Gómez, Juan Ramón Gómez-Martino Arroyo" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Silvia" "apellidos" => "González Sanchidrián" ] 1 => array:2 [ "nombre" => "Jesús Pedro" "apellidos" => "Marín Álvarez" ] 2 => array:2 [ "nombre" => "Javier" "apellidos" => "Deira Lorenzo" ] 3 => array:2 [ "nombre" => "Pedro Jesús" "apellidos" => "Labrador Gómez" ] 4 => array:2 [ "nombre" => "Juan Ramón" "apellidos" => "Gómez-Martino Arroyo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0211699517300115" "doi" => "10.1016/j.nefro.2016.12.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699517300115?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301700?idApp=UINPBA000064" "url" => "/20132514/0000003800000001/v1_201802180616/S2013251417301700/v1_201802180616/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S201325141830021X" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2017.05.017" "estado" => "S300" "fechaPublicacion" => "2018-01-01" "aid" => "398" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Nefrologia (English Version). 2018;38:87-91" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1991 "formatos" => array:3 [ "EPUB" => 234 "HTML" => 1244 "PDF" => 513 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Hyponatremia in refractory congestive heart failure patients treated with icodextrin-based peritoneal dialysis: A case series" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "87" "paginaFinal" => "91" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hiponatremia en pacientes con insuficiencia cardíaca congestiva resistentes al tratamiento tratados con diálisis peritoneal con icodextrina: una serie de casos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Margarita Kunin, Liat Ganon, Eli J. Holtzman, Dganit Dinour" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Margarita" "apellidos" => "Kunin" ] 1 => array:2 [ "nombre" => "Liat" "apellidos" => "Ganon" ] 2 => array:2 [ "nombre" => "Eli J." "apellidos" => "Holtzman" ] 3 => array:2 [ "nombre" => "Dganit" "apellidos" => "Dinour" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0211699517301339" "doi" => "10.1016/j.nefro.2017.05.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699517301339?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S201325141830021X?idApp=UINPBA000064" "url" => "/20132514/0000003800000001/v1_201802180616/S201325141830021X/v1_201802180616/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Renal lymphomatous infiltration in patient with nefrotic syndrome" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "92" "paginaFinal" => "94" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Enoc Merino García, María Pilar Pérez del Barrio, Josefa Borrego Hinojosa, Francisco J. Borrego Utiel, María Carmen Sánchez Perales" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Enoc" "apellidos" => "Merino García" "email" => array:1 [ 0 => "enocmerino@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "María Pilar" "apellidos" => "Pérez del Barrio" ] 2 => array:2 [ "nombre" => "Josefa" "apellidos" => "Borrego Hinojosa" ] 3 => array:2 [ "nombre" => "Francisco J." "apellidos" => "Borrego Utiel" ] 4 => array:2 [ "nombre" => "María Carmen" "apellidos" => "Sánchez Perales" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Gestión Clínica de Nefrología, Complejo Hospitalario de Jaén, Jaén, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infiltración renal linfomatosa en paciente con síndrome nefrótico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1084 "Ancho" => 1417 "Tamanyo" => 485371 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Histological characteristics of the lymphoid infiltrates that affected both the renal parenchyma (A: H&E, ×10) and the perirenal tissue (B: H&E, ×10). The lymphoid infiltrate had destroyed the parenchyma, leaving isolated residual tubules with images that may suggest lymphoepithelial lesion (C: H&E, ×20). Cells were monomorphic, small in size, with an irregular nuclear outline, barely visible nucleolus and no significant mitotic activity (D: H&E, ×40).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We describe the case of a patient with renal disease associated with a B-cell lymphoid infiltrate, with no associated systemic disease and with the presence of monoclonal IgM-kappa paraprotein.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Renal involvement is known to be associated with lymphoplasmacytic neoplasia and is not considered rare (14–34% depending on whether the biopsy is <span class="elsevierStyleItalic">pre mortem</span> or <span class="elsevierStyleItalic">post mortem</span>), but it often goes undiagnosed due to the absence of symptoms and sometimes the lack of biopsies performed in these patients.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> However, the occurrence of primary low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) is considered unusual.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> These tumours were initially described by Isaacson and Wright<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> in the gastrointestinal tract, and later in the thyroids, lungs and salivary glands. More recently, B-cell MALT lymphomas have been reported in a large variety of locations, including the urogenital tract, although as mentioned, their occurrence is very rare.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> The presence of a glomerular lesion associated with lymphoplasmacytic neoplasia is not uncommon, and could be the direct result of the lymphoplasmacytic disorder through deposition of a paraprotein (amyloid) or monoclonal immunoglobulin, or its origin could be mediated by an immune mechanism that causes membranoproliferative, membranous or minimal change glomerulonephritis (GN).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> There are reported cases of isolated renal involvement with no evidence of systemic disease, haematological malignancy or associated autoimmune disease which are sometimes associated with a serum monoclonal IgG or IgM-kappa component.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">This patient was a 71-year-old man admitted because oedema. He had a 1-year history of hypertension and post-traumatic subdural haematoma drained 6 years earlier. Due to the presence of renal failure (serum creatinine 2.5<span class="elsevierStyleHsp" style=""></span>mg/dL) with of nephrotic syndrome (albumin: 1.9<span class="elsevierStyleHsp" style=""></span>g/dL; total cholesterol: 315<span class="elsevierStyleHsp" style=""></span>mg/dL; urinary protein: 6.6<span class="elsevierStyleHsp" style=""></span>g/24<span class="elsevierStyleHsp" style=""></span>h) and normal-sized kidneys by ultrasound, a renal biopsy was performed. Other additional tests showed elevated beta-2 microglobulin and lactate dehydrogenase, serum protein electrophoresis and immunofixation with the presence of monoclonal IgM-kappa gammopathy (monoclonal component 0.2<span class="elsevierStyleHsp" style=""></span>g/dL) and urine negative for Bence-Jones protein. During hospitalisation, the patient presented a deterioration in renal function (Cr 3.8<span class="elsevierStyleHsp" style=""></span>mg/dL). Treatment was therefore initiated with oral prednisone at a dose of 1.5<span class="elsevierStyleHsp" style=""></span>mg/kg/day plus diuretics (furosemide and spironolactone) and angiotensin II receptor blockers in an attempt to control the proteinuria.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The renal biopsy (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>) revealed the presence of: (1) dense lymphoid infiltrates, immunophenotypically atypical, suggestive of a low-grade B cell lymphoproliferative process, and (2) mesangioproliferative glomerulonephritis, with few exudative changes and no demonstrable immune deposits.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Given the biopsy findings and the presence of monoclonal IgM-kappa gammopathy, the haematology department was consulted to assess the presence of a possible chronic lymphoproliferative process that had associated renal infiltration, as the most likely cause of the symptoms. Iliac crest biopsy was performed, with a diagnosis of mixed mature B and T cell lymphoid infiltrate, probably reactive.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patient recovered renal function quickly with oral prednisone and diuretics, achieving normal renal function (1.1<span class="elsevierStyleHsp" style=""></span>mg/dL) and a reduction of proteinuria to 260<span class="elsevierStyleHsp" style=""></span>mg/day in 2 months, despite persistence of the monoclonal IgM-kappa component (0.1<span class="elsevierStyleHsp" style=""></span>g/dL). After 9 months of follow-up by nephrology and haematology departments, he continues to have no evidence of progression of the lymphoproliferative process, with normal renal function and persistence of the monoclonal IgM-kappa component (0.1–0.2<span class="elsevierStyleHsp" style=""></span>g/dL).</p><p id="par0035" class="elsevierStylePara elsevierViewall">In our case, there was no evidence (clinical, analytical or imaging tests) that made us suspect renal lymphoma. The biopsy was suggestive of a low-grade B cell lymphoproliferative process together with mesangioproliferative glomerulonephritis with no demonstrable immune deposits. The literature describes the association of lymphomas with numerous forms of glomerulonephritis: membranous GN,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> membranoproliferative GN<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> and minimal change GN.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> In many cases, like ours, the clinical presentation is determined by the renal disease associated with the lymphoproliferative process, presenting nephrotic proteinuria with or without associated renal insufficiency.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Our patient started with nephrotic syndrome secondary to the presence of mesangioproliferative GN; therefore, the initiation of steroid treatment from the time at which we performed the renal biopsy and a favourable response to steroids resulted in the rapid recovery of renal function (Cr 1.1<span class="elsevierStyleHsp" style=""></span>mg/dL) with disappearance of the proteinuria (260<span class="elsevierStyleHsp" style=""></span>mg/day) in only 2 months.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Following the result of the renal biopsy, the haematology department was consulted. Having ruled out an associated chronic lymphoproliferative process, and given the absence of symptoms, we decided to adopt a watch and wait approach with close follow up of the patient's clinical progress. After 9 months, the patient remained asymptomatic, with normal renal function and no proteinuria, with persistence of the monoclonal IgM-kappa component. Although the initial diagnosis suggested a poor short-term prognosis, the absence of systemic involvement seems to have contributed to a favourable outcome.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Merino García E, Pérez del Barrio MP, Borrego Hinojosa J, Borrego Utiel FJ, Sánchez Perales MC. Infiltración renal linfomatosa en paciente con síndrome nefrótico. Nefrologia. 2018;38:92–94.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1084 "Ancho" => 1417 "Tamanyo" => 485371 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Histological characteristics of the lymphoid infiltrates that affected both the renal parenchyma (A: H&E, ×10) and the perirenal tissue (B: H&E, ×10). The lymphoid infiltrate had destroyed the parenchyma, leaving isolated residual tubules with images that may suggest lymphoepithelial lesion (C: H&E, ×20). Cells were monomorphic, small in size, with an irregular nuclear outline, barely visible nucleolus and no significant mitotic activity (D: H&E, ×40).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1769 "Ancho" => 2333 "Tamanyo" => 1121028 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The lymphoid population expressed CD20 and bcl-2, with negative staining for CD10 and other B lymphoid lineage markers. (A–C: immunohistochemistry technique indicated in figure, ×20). In preserved normal renal parenchyma, it can see lobular glomeruli with increased matrix and, to a lesser extent some mesangial cellularity with occasional images of endocapillary proliferation (D: H&E, ×40; E: PAS-diastase, ×40).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The spectrum of kidney involvement in lymphoma: a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.J. Cohen" 1 => "H.G. Reenke" 2 => "J.P. Laubach" 3 => "B.D. Humphreys" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.ajkd.2010.07.009" "Revista" => array:6 [ "tituloSerie" => "Am J Kidney Dis" "fecha" => "2010" "volumen" => "56" "paginaInicial" => "1191" "paginaFinal" => "1620" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20843590" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diversity of organ site involvement among malignant lymphomas of mucosa-associated tissues" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.J. Pelstring" 1 => "J.H. Essell" 2 => "P.J. Kurtin" 3 => "A.R. Cohen" 4 => "P.M. Banks" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Clin Pathol" "fecha" => "1991" "volumen" => "96" "paginaInicial" => "738" "paginaFinal" => "745" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1746490" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malignant lymphoma of mucosa-associated lymphoid tissue: a distinctive type of B-cell lymphoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.G. Isaacson" 1 => "D.H. Wright" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "1983" "volumen" => "52" "paginaInicial" => "1410" "paginaFinal" => "1416" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6193858" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patterns of glomerular injury in kidney infiltrated by lymphoplasmacytic neoplasms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Kowalewska" 1 => "R.F. Nicosia" 2 => "K.D. Smith" 3 => "A. Kats" 4 => "C.E. Alpers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.humpath.2010.09.009" "Revista" => array:6 [ "tituloSerie" => "Hum Pathol" "fecha" => "2011" "volumen" => "42" "paginaInicial" => "896" "paginaFinal" => "903" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21288559" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Membranoproliferative glomerulonephritis associated with low-grade B cell lymphoma presenting in the kidney" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.B. Stokes" 1 => "B. Wood" 2 => "C.E. Alpers" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Nephrol" "fecha" => "2002" "volumen" => "57" "paginaInicial" => "303" "paginaFinal" => "309" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12005247" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003800000001/v1_201802180616/S2013251417301712/v1_201802180616/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003800000001/v1_201802180616/S2013251417301712/v1_201802180616/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301712?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 8 | 15 |
| 2024 October | 52 | 38 | 90 |
| 2024 September | 76 | 22 | 98 |
| 2024 August | 80 | 60 | 140 |
| 2024 July | 70 | 26 | 96 |
| 2024 June | 58 | 33 | 91 |
| 2024 May | 87 | 29 | 116 |
| 2024 April | 72 | 42 | 114 |
| 2024 March | 92 | 18 | 110 |
| 2024 February | 82 | 39 | 121 |
| 2024 January | 69 | 23 | 92 |
| 2023 December | 64 | 34 | 98 |
| 2023 November | 74 | 42 | 116 |
| 2023 October | 71 | 30 | 101 |
| 2023 September | 102 | 28 | 130 |
| 2023 August | 64 | 26 | 90 |
| 2023 July | 102 | 32 | 134 |
| 2023 June | 72 | 24 | 96 |
| 2023 May | 90 | 33 | 123 |
| 2023 April | 67 | 21 | 88 |
| 2023 March | 60 | 29 | 89 |
| 2023 February | 53 | 36 | 89 |
| 2023 January | 69 | 28 | 97 |
| 2022 December | 85 | 54 | 139 |
| 2022 November | 88 | 51 | 139 |
| 2022 October | 84 | 59 | 143 |
| 2022 September | 97 | 59 | 156 |
| 2022 August | 63 | 57 | 120 |
| 2022 July | 48 | 44 | 92 |
| 2022 June | 60 | 41 | 101 |
| 2022 May | 80 | 49 | 129 |
| 2022 April | 88 | 61 | 149 |
| 2022 March | 66 | 70 | 136 |
| 2022 February | 46 | 49 | 95 |
| 2022 January | 63 | 38 | 101 |
| 2021 December | 48 | 48 | 96 |
| 2021 November | 62 | 33 | 95 |
| 2021 October | 56 | 53 | 109 |
| 2021 September | 77 | 33 | 110 |
| 2021 August | 45 | 45 | 90 |
| 2021 July | 63 | 33 | 96 |
| 2021 June | 38 | 28 | 66 |
| 2021 May | 58 | 48 | 106 |
| 2021 April | 123 | 58 | 181 |
| 2021 March | 60 | 58 | 118 |
| 2021 February | 43 | 31 | 74 |
| 2021 January | 41 | 25 | 66 |
| 2020 December | 40 | 16 | 56 |
| 2020 November | 30 | 14 | 44 |
| 2020 October | 34 | 23 | 57 |
| 2020 September | 28 | 21 | 49 |
| 2020 August | 36 | 26 | 62 |
| 2020 July | 31 | 21 | 52 |
| 2020 June | 21 | 22 | 43 |
| 2020 May | 48 | 19 | 67 |
| 2020 April | 28 | 15 | 43 |
| 2020 March | 28 | 12 | 40 |
| 2020 February | 41 | 24 | 65 |
| 2020 January | 38 | 22 | 60 |
| 2019 December | 47 | 19 | 66 |
| 2019 November | 45 | 17 | 62 |
| 2019 October | 26 | 13 | 39 |
| 2019 September | 29 | 17 | 46 |
| 2019 August | 35 | 23 | 58 |
| 2019 July | 32 | 26 | 58 |
| 2019 June | 31 | 26 | 57 |
| 2019 May | 36 | 14 | 50 |
| 2019 April | 91 | 49 | 140 |
| 2019 March | 44 | 20 | 64 |
| 2019 February | 48 | 22 | 70 |
| 2019 January | 46 | 20 | 66 |
| 2018 December | 127 | 42 | 169 |
| 2018 November | 219 | 22 | 241 |
| 2018 October | 154 | 14 | 168 |
| 2018 September | 95 | 22 | 117 |
| 2018 August | 84 | 16 | 100 |
| 2018 July | 76 | 15 | 91 |
| 2018 June | 83 | 18 | 101 |
| 2018 May | 92 | 11 | 103 |
| 2018 April | 67 | 11 | 78 |
| 2018 March | 93 | 12 | 105 |
| 2018 February | 72 | 8 | 80 |
| 2018 January | 44 | 6 | 50 |
| 2017 December | 49 | 4 | 53 |
| 2017 November | 47 | 9 | 56 |
Show all
