Crescentic IgAN in Classic Hodgkin Lymphoma Leading to Irreversible Kidney Damage

Introduction: Crescentic IgA nephropathy (IgANc) has rarely been described in Hodgkin Lymphoma (HL) patients. We report the first case of IgANc leading to irreversible kidney failure in a patient with HL. Case Description: A 55-year-old male without previous comorbid conditions was admitted to the hospital with a four-month history of weight loss, pruritus, and supraclavicular lymph nodes (LN). LN biopsy confirmed classical HL, without subtype identification, high risk (International Prognostic System ≥3), Clinical stage IV (PET/CT based). Severe kidney dysfunction was observed (serum creatinine of 6.48 mg/dL), with nephrotic proteinuria (8.4 g/day), and microscopic hematuria (without dysmorphism). Investigations for serum C3, C4, ANCA, ANA, rheumatoid factor; HIV, hepatitis B and C serologies, and paraprotein screening were all negative. Computed tomography revealed normal-sized kidneys, with irregular contours, bilateral cortical scars. No urinary or systemic complaints were referred. No edema was detected. Hypertension requiring three antihypertensive medications was registered. Hemodialysis was initiated in the following days due to progressive kidney injury. Percutaneous kidney biopsy revealed crescentic IgAN with fibrocellular crescents in 70% of glomeruli (8/11) and advanced tubulo-interstitial chronicity with 60% of interstitial fibrosis. Immunofluorescence showed mesangial IgA deposits (3+), negative for the other antigens assessed (IgG, IgM, C3, C1q, kappa, lambda) (Figure). Dexamethasone 40 mg/day due to the activity of the underlying disease, followed by prednisone 60 mg daily. Despite immunosuppression, the patient remained dialysis dependent, and chemotherapy with ABVD adjusted for the context of kidney replacement therapy was planned by the Hematology team. Discussion: Although rare, IgANc can occur in HL patients. Early diagnosis and prompt chemotherapy are crucial to prevent permanent kidney failure.