Nephropathy after combination chemotherapy of lymphoma

Two patients with malignant (Hodgkin's and non-Hodgkin's lymphoblastic type) lymphoma developed chronic renal failure following prolonged combination chemotherapy and a course of radiotherapy to the para-aortic lymph nodes. The individual drugs used in both patients are believed to have very low or no nephrotoxic potential. The kidneys were shielded in a standard manner and no more than 200 rads reached the organs. On biopsy (1 patient) and at autopsy (both patients), the kidneys demonstrated diffuse tubular atrophy, extensive interstitial fibrosis and focal glomerular changes with crescents. There were also severe sclerotic changes in the arteries. The changes bore some similarity to, but were not identical with those seen with radiation nephritis. They probably represent a radiomimetic effect produced by prolonged and repeated combination chemotherapy, perhaps potentiated by the small amount of ionizing radiation.