All feline diagnoses

Your cat was diagnosed with Renal Lymphoma. Represents ~3.6% of feline lymphoma cases. Often bilateral. High risk of CNS dissemination (~40%). Poor overall prognosis. Compare 8 treatment options for cats including L-CHOP Protocol, COP Protocol (without Doxorubicin), Corticosteroids Alone — with survival times, costs, and what to expect during treatment.

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Renal Lymphoma

extranodal (renal)

feline

Round Cell

About This Cancer

Renal lymphoma is an aggressive form of feline lymphoma in which cancer cells infiltrate one or both kidneys. It typically involves large, rapidly dividing malignant lymphocytes and frequently affects both kidneys simultaneously. A particularly concerning feature of this form is its high tendency to spread to the central nervous system — approximately 40% of affected cats will develop CNS involvement, which can cause neurological signs such as seizures or behavioural changes. Cats may present with enlarged kidneys detected on physical examination, along with weight loss, poor appetite, increased thirst and urination, and potentially signs of kidney failure. The overall prognosis is poor compared to other feline lymphoma types, and chemotherapy protocols must account for compromised kidney function.

WHO Modified Staging for Feline Lymphoma with Renal-Specific Notes

Standard WHO feline lymphoma staging system supplemented with renal-specific prognostic considerations. Renal lymphoma typically presents as extranodal disease (Stage I if unilateral/bilateral kidneys only) but frequently disseminates.

Stage ISingle tumour (extranodal) or single anatomic area. Renal-specific: unilateral or bilateral renal involvement without extra-renal spread
Stage IITwo or more tumours on same side of diaphragm
Stage IIITumours on both sides of diaphragm
Stage IVLiver and/or spleen involvement
Stage VBone marrow, blood, or CNS involvement. Renal-specific: CNS dissemination occurs in ~40% of cases and represents the most feared complication
Prognostic Factors(3)
CNS involvement~40% risk of CNS spread. Worsens prognosis significantly.(Williams et al., 2021)
Bilateral renal involvementCommon at presentation. Renal failure may limit treatment options.(Williams et al., 2021)
CNS prophylaxis with cytarabine~40% CNS dissemination risk makes CNS prophylaxis a critical consideration. Cytarabine (200-300 mg/m² SC/IV q2-3 weeks, or 600 mg/m² as 2-day continuous infusion) historically used as CNS-penetrating agent. Expert opinion is DIVIDED: some oncologists routinely add cytarabine to all renal lymphoma protocols, while others reserve it for confirmed CNS involvement or neurological signs. No randomised trial exists comparing prophylactic vs therapeutic cytarabine in feline renal lymphoma. Recent opinion has shifted toward reserving cytarabine for cats with confirmed or suspected CNS disease rather than universal prophylaxis.(Williams et al., 2021; clinical consensus)
Minimum Workup(9 steps)
1CRITICAL WARNING: Avoid administering prednisolone/prednisone BEFORE obtaining biopsy/cytology — corticosteroids can induce multi-drug resistance (MDR) and cause rapid tumour lysis, making subsequent histopathological diagnosis difficult or impossible. Complete diagnostic workup BEFORE starting any corticosteroid therapy.
2CBC, comprehensive chemistry panel (renal values critical)
3FeLV/FIV testing
4Abdominal ultrasound (bilateral renal enlargement, loss of corticomedullary distinction)
5Thoracic radiographs
6Renal FNA cytology (often diagnostic)
7Urinalysis
8Neurological examination (CNS involvement screening)
9CSF analysis if neurological signs present

Median Survival Time Comparison

How long the average patient survives with each treatment

Bar opacity reflects evidence strength
L-CHOP Protocol
~7 mo (1.5–79)
COP Protocol (without Doxorubicin)
See notes
Corticosteroids Alone
~1.7 mo (0.7–34)
Cytarabine CNS Prophylaxis
See notes
Rescue/Relapse Guidance
See notes
Lomustine (CCNU) Rescue
See notes
Single-Agent Doxorubicin Rescue
See notes
Protocol Switch (COP↔CHOP)
See notes
Reading this page: MST (Median Survival Time) is how long the average patient survives with a given treatment. ORR (Overall Response Rate) is the percentage of patients whose tumour shrank or disappeared. CR = Complete Response (tumour gone); PR = Partial Response (tumour shrank). Hover over any abbreviation for a quick explanation.
Strength of Evidence

Each treatment is rated by how much published research supports its use. Solid bars indicate stronger evidence; dashed bars mean less certainty.

StrongLarge published studies with strong agreement among veterinary oncologists.
ModerateWidely used in clinical practice, but supported by smaller or retrospective studies.
IndirectEvidence comes from a different tumour type or species and has been applied here.
LimitedVery little published data is available for this specific treatment.

Please note: All treatment data is sourced from published peer-reviewed literature. Survival times and cost figures are approximate guides. Your pet's individual factors — including tumour grade, stage, and overall health — will influence outcomes and should guide all treatment decisions. The strength-of-evidence rating reflects how much research exists, not how strongly a treatment is recommended. This tool is designed to help you have informed conversations with your veterinary oncologist, not to replace them. Costs shown are US referral centre estimates and may vary significantly by region.