Summary:A 64-year-old woman underwent an ileocecal resection for ileus. The specimen revealed a diffuse large B cell lymphoma. The diagnosis was stage IIA non-Hodgkin's lymphoma. She received chemotherapy with the CHOPetoposide regimen, resulting in partial remission. Highdose etoposide was used for PBSC mobilization before auto-PBSCT. Conditioning was ranimustine, carboplatin, etoposide and cyclophosphamide. Her renal function deteriorated gradually, starting 3 months post-PBSCT. Eight months post-transplant, serum creatine concentration was 7.1 mg/dl, and BUN was 59.2 mg/dl. Her hemoglobin concentration decreased to 5.3 g/dl, with no evidence of hemolysis. Renal biopsy revealed fibrous crescent formations in glomeruli, and mononuclear cell infiltration in interstitial spaces. Renal injury in this patient differs from BMT nephropathy, which is similar to hemolytic uremic syndrome, and represents another type of late renal injury after PBSCT. Keywords: crescentic glomerulonephritis; PBSCT; nonHodgkin's lymphoma Transplantation of either allogeneic or autologous hematopoietic stem cells can be complicated by renal failure from a variety of causes. These complications include not only early but also late renal injury characterized by a syndrome similar to hemolytic uremic syndrome (HUS). [1][2][3][4][5] We report another type of late renal injury, crescentic glomerulonephritis, which developed more than 3 months after auto-PBSC transplantation (T) for non-Hodgkin's lymphoma.
Case reportA 64-year-old woman, who underwent an ileocecal resection for ileus due to an iliocecal tumor, was diagnosed with non-Hodgkin's lymphoma (diffuse large B cell type). She was referred to us in April 1996. Multiple enlarged intraperitoneal lymph nodes were observed during the operation. Her clinical stage was IIA, according to the Ann Arbor system. At the time of diagnosis, renal involvement with lymphoma was not detected, and no abnormal findings were seen on urinalysis or renal function tests. 6 She received the CHOP-etoposide regimen, consisting of doxorubicin 50 mg/m 2 on day 1, cyclophosphamide, 750 mg/m 2 on day 1, vincristine, 1.4 mg/m 2 on day 1, etoposide, 100 mg/m 2 on days 1-3 and prednisolone 60 mg/m 2 on days 1-4 repeated every 3 weeks. After five cycles of chemotherapy, she had achieved only partial remission. She therefore received high-dose etoposide (etoposide 500 mg/m 2 , days 1-3), to collect PBSC. Subsequently, PBSCT (CD34 8 × 10 6 /kg, CFU-GM 15 × 10 5 /kg) was performed after a conditioning regimen (ranimustine 200 mg/m 2 , days Ϫ8 and Ϫ3; carboplatin, 300 mg/m 2 , days Ϫ7 to Ϫ4; etoposide 500 mg/m 2 , days Ϫ6 to Ϫ4; and cyclophosphamide 50 mg/kg, days Ϫ3 and Ϫ2). 7 Her serum creatinine (Cr) concentration rose to 1.8 mg/dl (normal range 0.4-0.8 mg/dl) on day 1 (before the conditioning chemotherapy, her serum Cr was 0.5 mg/dl and her Cr clearance was 63.8 ml/min), then returned to baseline on day 6. A complete response was confirmed after Figure 1 Histopathological findings of the biopsied kidney (PAS stain, × 400...
