Acute nephrotic syndrome as a manifestation of active Hodgkin's disease: Report of four cases and review of the literature

Abstract Four patients are described in whom an acute nephrotic syndrome was associated with clinical relapse of Hodgkin's disease. In three there were multiple episodes of increased proteinuria, hypoalbuminemia and edema; each of these periods was associated with evidence of recurrent growth of Hodgkin's tumor. The proteinuria was promptly relieved by effective treatment of the Hodgkin's disease with either chemotherapy or local radiation therapy delivered to areas distant from the renal bed. The data in ten similar cases of Hodgkin's disease associated with single episodes of an idiopathic nephrotic syndrome, previously reported, are summarized. In these unusual patients the nephrotic syndrome appears to be etiologically related to the presence of the Hodgkin's tumor; removal or destruction of the tumor relieves the proteinuria. It is suggested that a substance originating in tumor damages the renal glomerular basement membrane, perhaps after combining in an antigen-antibody complex.