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709 Minimal proteinuria (190 mg/d) and hematuria (8–10 red blood cells/high power field) were pres‐ ent. Renal ultrasound was normal. The patient did not receive any new medications or supple‐ ments in the last 6 months. Despite achieving eu‐ volemia, kidney function did not improve, and re‐ nal biopsy was performed. Light microscopy re‐ vealed 9 glomeruli (3 atherosclerotic; 6 without pathologic findings) and diffuse lymphomatous infiltration of the interstitium, which was partial‐ ly nodular (FIGURE 1A). The nodular regions were positive for CD20, CD5, and cyclin D1 (a highly specific marker of MCL) (FIGURE 1B). There were also features of acute tubulointerstitial nephri‐ tis (ATIN): infiltration of the interstitium with CD3 ‐positive T lymphocytes. On the other hand, staining for CD3 was negative in the previous‐ ly mentioned nodular areas (FIGURE 1C). Based on these findings, the patient was diagnosed with ATIN associated with MCL. Steroid therapy was initiated and a rapid improvement of renal func‐ tion was noted (serum creatinine levels decreased Mantle cell lymphoma (MCL) is a rare subtype of mature B ‐cell non–Hodgkin lymphoma. The pathogenesis of MCL is associated with gene translocation, which leads to overexpression of cyclin D1.1 Even though half of cases have kidney infiltration present at autopsy,2 renal involvement in living patients is rare. A 74 ‐year ‐old woman with a 9 ‐year history of MCL was admitted to our hospital due to acute kidney injury. Over the years, several episodes of recurrence had been diagnosed, and each time she was treated according to guidelines. The last course of chemotherapy ended 10 months be‐ fore current hospitalization, and complete re‐ mission was achieved. On physical examination, the patient showed signs of volume depletion and no palpable peripheral lymphadenopathy. Laboratory findings revealed serum creatinine level of 5.93 mg/dl (vs 2.2 mg/dl 2 weeks earli‐ er), normocytic normochromic anemia (hemo‐ globin, 9.5 g/dl), and C ‐reactive protein level of 15.51 mg/l without any clinical signs of infection. CLINICAL IMAGE

One kidney biopsy—double trouble: acute tubulo-interstitial nephritis associated with mantle cell lymphoma