Abstract: TH-PO0202
Masked by the Mass: Paraneoplastic Minimal Change Disease Revealing Classic Hodgkin Lymphoma
Session Information
- Onconephrology: Anticancer Therapies, PTLD, Paraneoplastic Diseases, and More
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Garsuta, Cani Greg, MaineHealth, Portland, Maine, United States
- Mahmoud, Hassan, MaineHealth, Portland, Maine, United States
Introduction
Paraneoplastic minimal change disease (MCD) is a cytokine-driven podocytopathy that rarely complicates classical Hodgkin lymphoma (cHL), and durable renal remission hinges on curing the malignancy rather than prolonged glucocorticoids. Documented in <1% of cHL cases, MCD may precede the lymphoma diagnosis.
Case Description
A 25-year-old man presented with three weeks of 3+ leg edema, night sweats, 4.5 kg weight loss, and pleuritic chest pain. CT angiography demonstrated a 9.5 cm anterior mediastinal mass with pleural effusion. Labs: creatinine 4.39 mg/dL, albumin 1.8 g/dL, cholesterol 348 mg/dL, UPCR >6.5 g/g, bland sediment, urine Na <10 mmol. Initial considerations included NSAID-induced acute interstitial nephritis, and high-dose prednisone was empirically started. Kidney biopsy on day 6 revealed normal glomeruli, negative immunofluorescence, and >90% podocyte foot-process effacement confirming MCD. Prednisone was tapered rapidly.
Excisional supraclavicular node biopsy proved Stage IIB nodular-sclerosis cHL (CD30/CD15) Nivolumab plus AVD chemotherapy began on day 7. By week 2, creatinine decreased to 1.36 mg/dL, albumin rose to 2.5 g/dL, and UPCR fell to 0.4 g/g. A month review showed complete resolution of edema and ongoing renal remission while he continued nivolumab-AVD
Discussion
MCD should be considered in the differential when young adults with lymphoma develop AKI and heavy proteinuria, especially in the absence of hematuria or serologic autoimmunity. The pathogenesis involves cytokine-mediated podocyte injury, including potential IL-13 pathways, leading to the destabilization of slit diaphragms and nephrotic-range proteinuria. This case reinforces several clinical pearls: 1) Biopsy early. KDIGO 2021 recommends biopsy when nephrotic syndrome coexists with AKI or systemic signs. 2) Treat the tumor. >80% remit once lymphoma therapy is initiated; relapse tracks tumor burden. 3) Use Immunosuppression Judiciously. Biopsy should guide decisions; reflex steroid use may be counterproductive.
Creatinine trend over time