[Renal manifestations of Hodgkin's disease]

The occurrence of renal manifestations of Hodgkin's disease may result from multiple physio-pathological processes: mechanical, by obstruction of the vessels or excretory systems of the kidneys; specific, by lymphogranulomatous infiltration of the parenchyma; immunological, as immunune complex glomerulonephritis or, more frequently, as amyloid disease; infective or metabolic as a complication of long term corticosteroid or immunodepressive therapy. These various causes of renal problems during Hodgkin's disease lead to the observation of three principal clinical pictures: acute renal failure, chronic renal failure and permanent proteinuria with or without nephrotic syndrome. Acute renal failure generally results from a severe infection with toxi-infective shock. More rarely it is related to thrombosis of the renal veins, with a grave prognosis, or to unreteral compression with anatomical or functional exclusion of the contralateral kidney. Chronic renal failure may be caused either by distension of the excretory pathways, progressively obstructed or invaded by the Hodgkin's process and requiring specific therapy to relieve the obstruction (cobaltotherapy, chemotherapy), by specific infiltration of the renal parenchyma or by amyloid disease. Permanent proteinuria, with or without nephrotic syndrome, may be the presenting feature of renal vein thrombosis, amyloidosis or paraneoplastic nephrotic syndrome.