{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T09:07:31Z","timestamp":1784020051303,"version":"3.55.0"},"reference-count":11,"publisher":"SMC Media","issue":"7","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction:\u00a0Acute lymphoblastic leukaemia (ALL) is an aggressive hematologic malignancy, with T-cell ALL (T-ALL) accounting for approximately 25% of adult cases. Renal infiltration is recognized but rarely presents as isolated bilateral nephromegaly with acute kidney injury (AKI) in adults. Case description:\u00a0A 32-year-old previously healthy man presented with progressive bilateral flank pain, abdominal heaviness, fatigue, intermittent fever, night sweats, and unintentional weight loss. Physical examination revealed large bilateral flank masses without peripheral lymphadenopathy. Laboratory tests initially showed normal blood counts but significant renal impairment (creatinine 3.5 mg\/dl, urea 82 mg\/dl). Imaging demonstrated massive bilateral kidney enlargement (~20 \u00d7 20 cm). Percutaneous renal biopsy revealed diffuse infiltration by medium-sized lymphoblasts expressing CD3 and TdT, confirming T-ALL. Within 1-week, hematologic abnormalities developed, including leucocytosis, anaemia, and thrombocytopenia, alongside worsening renal function and tumour lysis syndrome, necessitating dialysis and allopurinol therapy. The patient was started on a pre-phase corticosteroid regimen followed by intensive hyper-CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin [Adriamycin], and dexamethasone) induction chemotherapy. Initial radiologic improvement occurred; however, the clinical course was complicated by neutropenic sepsis, ultimately resulting in death. Conclusion:\u00a0This case highlights a rare adult presentation of T-ALL in which renal involvement preceded hematologic abnormalities. Clinicians should consider hematologic malignancy in adults presenting with unexplained bilateral nephromegaly and AKI, even if initial blood counts are normal. Early recognition and timely intervention are critical to improve renal and overall outcomes.<\/jats:p>","DOI":"10.12890\/2026_006944","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T13:15:31Z","timestamp":1783602931000},"source":"Crossref","is-referenced-by-count":0,"title":["Isolated bilateral nephromegaly as the initial presentation of acute lymphoblastic leukaemia: a rare case and review of the literature"],"prefix":"10.12890","volume":"13","author":[{"given":"Rawan","family":"Hamdan","sequence":"first","affiliation":[{"name":"Department of Hematology, Al-Mouwasat University Hospital, Damascus, Syria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2148-2921","authenticated-orcid":false,"given":"Mais","family":"Musleh","sequence":"first","affiliation":[{"name":"Department of Hematology, Al-Mouwasat University Hospital, Damascus, Syria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0607-0889","authenticated-orcid":false,"given":"Mahmoud","family":"Alhamadeh Alswij","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Hematology Department, Al Mouwasat University Hospital, Damascus, Syria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yara","family":"Ibraheem","sequence":"first","affiliation":[{"name":"Department of Nephrology, Al-Mouwasat University Hospital, Damascus, Syria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7902-0956","authenticated-orcid":false,"given":"Miriam","family":"Laflouf","sequence":"first","affiliation":[{"name":"Department of Hematology, Al-Mouwasat University Hospital, Damascus, Syria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulhalim","family":"Mohamed Alyousef","sequence":"first","affiliation":[{"name":"Department of Hematology, National University Hospital, Damascus, Syria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10397","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"10.12890\/2026_006944_ref1","doi-asserted-by":"crossref","unstructured":"Boueva A, Bouvier R. Precursor B-cell lymphoblastic leukemia as a cause of a bilateral nephromegaly. Pediatr Nephrol 2005;20:679-682. doi: 10.1007\/s00467-004-1740-5","DOI":"10.1007\/s00467-004-1740-5"},{"key":"10.12890\/2026_006944_ref2","doi-asserted-by":"crossref","unstructured":"Asdahl PH, Warner LF, Bendix K, Hasle H. Acute renal failure and normal blood count: A rare presentation of T-cell acute lymphoblastic leukemia. Leuk Res Rep 2013;3:14-16. doi: 10.1016\/j.lrr.2013.11.002","DOI":"10.1016\/j.lrr.2013.11.002"},{"key":"10.12890\/2026_006944_ref3","doi-asserted-by":"crossref","unstructured":"Escobar H, H\u00e4ffner K, Pohl M, Hopfer H, Determann O, Lauten M. Acute renal failure associated with bilateral enlargement of the kidneys: A rare manifestation of acute lymphoblastic leukemia (ALL). Klin Padiatr 2009;221:176-178. doi: 10.1055\/s-0029-1216365","DOI":"10.1055\/s-0029-1216365"},{"key":"10.12890\/2026_006944_ref4","doi-asserted-by":"crossref","unstructured":"D\u2019Angelo P, Mura R, Rizzari C, Conter V, Bellini F, Valsecchi MG, et al. Prognostic value of nephromegaly at diagnosis of childhood acute lymphoblastic leukemia. Acta Haematol 1995;94:84-89. doi: 10.1159\/000203979","DOI":"10.1159\/000203979"},{"key":"10.12890\/2026_006944_ref5","doi-asserted-by":"crossref","unstructured":"Sherief LM, Azab SF, Zakaria MM, Kamal M, Elbasset Aly MA, Ali A, et al. Renal Presentation in Pediatric Acute Leukemia: Report of 2 Cases. Medicine (Baltimore) 2015;94:e1461. doi: 10.1097\/MD.0000000000001461. Erratum in: Medicine (Baltimore) 2015;94:1.","DOI":"10.1097\/MD.0000000000001461"},{"key":"10.12890\/2026_006944_ref6","doi-asserted-by":"crossref","unstructured":"Yoshimoto K, Maeoka Y, Kubota S, Chishaki R, Takahashi A, Osaki Y, et al. Polycythemia secondary to bilaterally enlarged kidneys in T-Cell acute lymphoblastic leukemia: a case report and literature review. BMC Nephrol 2025;26:121. doi: 10.1186\/s12882-025-04032-3","DOI":"10.1186\/s12882-025-04032-3"},{"key":"10.12890\/2026_006944_ref7","doi-asserted-by":"crossref","unstructured":"Soruna O, Qureshi M, Prabha M, Bartram J, Tsouana E. B-Cell Acute Lymphoblastic Leukaemia Presenting With Bilateral Renal Enlargement. Cureus 2025;17:e90721. doi: 10.7759\/cureus.90721","DOI":"10.7759\/cureus.90721"},{"key":"10.12890\/2026_006944_ref8","doi-asserted-by":"crossref","unstructured":"T\u00f6rnroth T, Heiro M, Marcussen N, Franssila K. Lymphomas diagnosed by percutaneous kidney biopsy. Am J Kidney Dis 2003;42:960-971. doi: 10.1016\/j.ajkd.2003.08.004","DOI":"10.1016\/j.ajkd.2003.08.004"},{"key":"10.12890\/2026_006944_ref9","doi-asserted-by":"crossref","unstructured":"Luciano RL, Brewster UC. Kidney involvement in leukemia and lymphoma. Adv Chronic Kidney Dis 2014;21:27-35. doi: 10.1053\/j.ackd.2013.07.004","DOI":"10.1053\/j.ackd.2013.07.004"},{"key":"10.12890\/2026_006944_ref10","doi-asserted-by":"crossref","unstructured":"Nuguri S, Swain M, Padua M, Gowrishankar S. Renal Lymphoma Diagnosed on Kidney Biopsy Presenting as Acute Kidney Injury. Indian J Nephrol 2022;32:342-347. doi: 10.4103\/ijn.ijn_345_21","DOI":"10.4103\/ijn.ijn_345_21"},{"key":"10.12890\/2026_006944_ref11","doi-asserted-by":"crossref","unstructured":"Prada Rico M, Rodr\u00edguez-Cuellar CI, Arteaga Aya LN, Nu\u00f1ez Chates CL, Garces Sterling SP, Pierotty M, et al Renal involvement at diagnosis of pediatric acute lymphoblastic leukemia. 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