Case Report ARareCauseofAcuteKidneyInjury:PrimaryRenalLymphomain a Patient with Human Immunodeficiency Virus Ruslinda Mustafar , 1 Lydia Kamaruzaman , 1 Beh Hui Chien, 2 Azyani Yahaya, 3 Noor’Ain Mohd Nasir, 3 Rozita Mohd , 1 Rizna Cader , 1 and Kong Wei Yen 1 1 Department of Medicine, Nephrology Unit, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia 2 Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia 3 Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia Correspondence should be addressed to Ruslinda Mustafar; ruslinda.m@gmail.com Received 18 April 2018; Accepted 10 July 2018; Published 13 August 2018 Academic Editor: Simon Ching-Shun Kao Copyright © 2018 Ruslinda Mustafar et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We reported a case of primary renal lymphoma (PRL) presented with non-oliguric acute kidney injury and bilateral kidney infiltrates in an individual with human immunodeficiency virus (HIV) disease. Acute kidney injury secondary to lymphoma infiltrates is very rare (less than 1% of hematological malignancy). A 37-year-old gentleman with underlying human immu- nodeficiency virus (HIV) disease was on combined antiretroviral therapy since diagnosis. He presented to our center with uremic symptoms and gross hematuria. Clinically, bilateral kidneys massively enlarged and were ballotable. Blood investigations showed hemoglobin of 3.7 g/L, urea of 65.6 mmol/L, and serum creatinine of 1630 µmol/L with hyperkalemia and metabolic acidosis. An urgent hemodialysis was initiated, and he was dependent on regular hemodialysis subsequently. Computed tomography renal scan showed diffuse nonenhancing hypodense lesion in both renal parenchyma. Diagnosis of diffuse large B cell lymphoma with germinal center type, CD20 positive, and proliferative index 95% was confirmed via renal biopsy, and there was no bone marrow infiltrates. Unfortunately, the patient succumbs prior to initiation of chemotherapy. 1. Introduction Primary renal lymphoma (PRL) is one of the rare extranodal non-Hodgkin lymphoma. It is defined as non-Hodgkin lymphoma arising in renal parenchyma and not invasion from neighboring lymphomatous lesion. e first case was reported by Coggins in 1980 [1]. PRL attributes to less than 1% of all renal lesions, and bilateral kidney involvements are seen in 10–20% of the cases [2]. ere is still no clinical trial to establish a diagnostic criteria or standard treatment for PRL due to shortage of cases. In adult age from 18 to 50 years old, PRL usually pre- sented with abdominal and flank pain while weight loss and gross hematuria are seen more commonly in adults more than 50 years old [3]. Kidney involvement in lymphoma can be presented with acute kidney injury (AKI), acute tubular necrosis (ATN), renovascular disease, parenchymal in- filtration, obstructive uropathy, glomerulopathies, electro- lyte, and acid-base imbalance [4]. Kidney injury may be due to underlying malignancy or secondary to complication of therapy. 2. Case Scenario A 37-year-old gentleman with underlying human immu- nodeficiency virus (HIV) diagnosed in June 2015 was under infectious disease clinic follow-up from another center. He was started on combined antiretroviral therapy (tenofovir- emtricitabine and efavirenz) since diagnosis but defaulted treatment a month prior to his admission to our center. His CD4 count upon diagnosis was 20 cells/microliter and serum creatinine of 108 µmol/L. After 12 months of treatment, his Hindawi Case Reports in Medicine Volume 2018, Article ID 8425985, 5 pages https://doi.org/10.1155/2018/8425985