Association of Proteinuria With Disease Stage and Treatment Response in Patients With Lymphoma: A Prospective Cohort Study

Background Lymphomas are hematologic malignancies that may involve the kidneys, with proteinuria representing a potential manifestation of renal involvement or paraneoplastic processes. The relationship between proteinuria, disease stage, and treatment response in lymphoma remains incompletely understood. Objectives The primary objective was to assess the association between proteinuria and disease stage in patients with lymphoma. Secondary objectives included evaluating changes in proteinuria following completion of standard chemotherapy or induction remission, whichever occurred earlier. Methods This prospective cohort study included 34 adult patients with biopsy-confirmed lymphoma at a tertiary care center over 12 months. Staging was performed using PET-CT according to the Lugano classification. Twenty-four-hour urinary protein was measured at diagnosis and after completion of chemotherapy or induction remission, whichever occurred earlier. Proteinuria was defined as >150 mg/24 hours. Associations between proteinuria, disease stage, and treatment response were analyzed using appropriate statistical methods. Results Of the 31 patients included in the final analysis, proteinuria was observed in seven out of 31 (22.6%), including five out of 23 (21.7%) with non-Hodgkin lymphoma and two out of eight (25%) with Hodgkin lymphoma. All patients with proteinuria had advanced-stage disease, although this association was not statistically significant (p=0.161). Mean 24-hour urinary protein was higher in advanced-stage disease compared to early-stage disease (85 mg/day vs. 52 mg/day; p=0.069). Among patients with proteinuria, one out of seven (14.3%) died during treatment. Among the remaining patients, two out of six (33.3%) achieved a complete response, and four out of six (66.7%) had a partial response, whereas patients with normal protein levels demonstrated equal proportions of complete and partial response. These differences were not statistically significant (p=0.657). Paired analysis demonstrated a significant reduction in proteinuria following treatment (p=0.031). Conclusion Proteinuria decreased significantly following chemotherapy and may serve as a simple, non-invasive marker for monitoring treatment response in lymphoma patients. Although higher proteinuria was observed in advanced-stage disease and was associated with poorer treatment response, these findings were not statistically significant. Larger studies are required to establish the prognostic value of proteinuria in lymphoma.