When the Podocyte Speaks First: Anti-Nephrin-Associated Diffuse Podocytopathy Preceding Hodgkin Lymphoma

We report the case of a 23-year-old woman who developed minimal change disease (MCD) in the postpartum period. Kidney biopsy findings were consistent with MCD, with positive anti-nephrin immunostaining. Her clinical course was complicated by multiple relapses and steroid intolerance, requiring treatment with multiple immunosuppressive therapies. Despite therapy, complete remission was not achieved. A year and a half after the MCD diagnosis, she was diagnosed with Hodgkin lymphoma. After chemotherapy and radiation therapy, the patient finally achieved complete remission of both MCD and Hodgkin lymphoma. This case highlights the complex relationship between MCD and lymphoproliferative disorders. It suggests that anti-nephrin positive MCD, typically considered a primary podocytopathy, may in rare instances represent a paraneoplastic manifestation. In addition, this report highlights the importance of maintaining a high index of suspicion for occult malignancy in young patients with relapsing or refractory MCD, despite biomarkers suggesting primary disease.