Spontaneously remitting minimal change nephropathy preceding a relapse of Hodgkin's disease by 19 months

A 35-year-old women was diagnosed as suffering from Hodgkin's disease, lymphocytic predominant, based on a biopsy of an enlarged axillary lymph node. She was classified as stage IIA. Subtotal nodal irradiation resulted in a full remission. Ten months later she presented with a full blown nephrotic syndrome. Renal biopsy disclosed minimal change nephropathy. Despite extensive investigation no evidence of a relapse of the lymphoma was found. Whilst undergoing the investigation her proteinuria began to decrease and during the next 5 months it totally disappeared with no specific treatment being administered. Fourteen months after complete cessation of the proteinuria a left parasternal mass appeared. Biopsy confirmed a relapse of Hodgkin's lymphoma. The patient fully responded to chemotherapy and local irradiation. Noticeably, during the relapse and currently after a 3.5 year follow up period the patient has remained free of proteinuria. A review of the literature yielded altogether 14 cases in which the course of minimal change nephropathy did not run in parallel to that of the lymphoma. These are discussed in detail.