Clinicopathologic analysis of renal biopsies after haematopoietic stem cell transplantation

Chan, Gavin Shueng-wai; Lam, Man Fai; Au, Wing Y.; Chim, Stephen S.C.; Tse, Kai Chung; Lo, Stanley; Fung, Shing Hoi; Lai, Kar Neng; Chan, Kwok Wah

doi:10.1111/j.1440-1797.2007.00915.x

Cited by 43 publications

(47 citation statements)

References 32 publications

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“…[7][8][9] Numerous descriptive studies, derived from groups of kidney core biopsy specimens from hematopoietic cell transplant recipients with renal dysfunction, have characterized the most common types of glomerulonephritis in hematopoietic cell transplant patients. 8,[10][11][12][13][14][15][16][17][18] These include membranous nephropathy, minimal change disease, and focal segmental glomerulosclerosis. In addition, acute and chronic thrombotic microangiopathy, or 'transplant-associated thrombotic microangiopathy,' has been shown to occur commonly in hematopoietic cell transplant recipients, 8,14,[17][18][19][20][21][22][23][24][25] with smaller reported numbers of membranoproliferative glomerulonephritis, proliferative glomerulonephritis, ANCA-associated glomerulonephritis, and IgA nephropathy.…”

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confidence: 99%

“…8,[10][11][12][13][14][15][16][17][18] These include membranous nephropathy, minimal change disease, and focal segmental glomerulosclerosis. In addition, acute and chronic thrombotic microangiopathy, or 'transplant-associated thrombotic microangiopathy,' has been shown to occur commonly in hematopoietic cell transplant recipients, 8,14,[17][18][19][20][21][22][23][24][25] with smaller reported numbers of membranoproliferative glomerulonephritis, proliferative glomerulonephritis, ANCA-associated glomerulonephritis, and IgA nephropathy. 8,18,[26][27][28][29][30][31][32][33][34][35][36][37] In studies also examining nonglomerular pathology, kidney specimens also show concomitant tubulointerstitial and vascular changes in hematopoietic cell transplant patients.…”

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confidence: 99%

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Renal pathology in hematopoietic cell transplant recipients: a contemporary biopsy, nephrectomy, and autopsy series

2016

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Renal pathology in hematopoietic cell transplant recipients: a contemporary biopsy, nephrectomy, and autopsy series

2016

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“…65 TA-TMA ensues when endothelial damage in the setting of HCT results in microangiopathic hemolytic anemia and platelet consumption, culminating in thrombosis and fibrin deposition in the microcirculation. [66][67][68] TA-TMA in HCT may be a consequence of the interaction of a combination of a number of factors that cause injury to the endothelium, including calcineurin inhibitors, mammalian target of rapamycin inhibitors, chemotherapy, GVHD and/or TBI. 54,66,69 Calcineurin inhibitor use causes endothelial injury through direct cytotoxic damage, platelet aggregation, elevated von Willebrand factor and thrombomodulin, altered complement regulator proteins, and decreased production of prostacyclin and nitric oxide.…”

Section: Pathogenesismentioning

confidence: 99%

Acute kidney injury in HCT: an update

Lopes

Jorge

Neves

2016

Bone Marrow Transplant

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Acute kidney injury (AKI) is highly prevalent whether the patients undergo myeloablative or non-myeloablative hematopoietic cell transplantation (HCT); however, the pathogenesis and risk factors leading to AKI can differ between the two. The prognosis of AKI in patients receiving HCT is poor. In fact, AKI following HCT is associated not only with increased short-and long-term mortality, but also with progression to chronic kidney disease. Herein, the authors provide a comprehensive and up-to-date review of the definition and diagnosis, as well as of the incidence, pathogenesis and outcome of AKI in patients undergoing HCT, centering on the differences between myeloablative and non-myeloablative regimens. INTRODUCTIONHematopoietic cell transplantation (HCT) is currently used to treat numerous malignant (for example, multiple myeloma, leukemias and lymphomas) and non-malignant hematological disorders (for example, aplastic anemia, b-thalassemia, immunodeficiency disorders and inborn errors of metabolism), as well as solid tumors (for example, breast cancer and neuroblastoma), which are in other instances incurable.The two major HCT procedures, taking into consideration the conditioning regimen used, are myeloablative autologous and allogeneic HCT and non-myeloablative allogeneic HCT. On the one hand, myeloablative HCT utilizes the maximally tolerated dose of TBI with or without chemotherapy, or with chemotherapy alone. On the other hand, non-myeloablative HCT depends more on donor cellular immune effects and less on the cytotoxic effects of the preparative regimen to control the underlying disease. 1,2 It ultimately uses a lower dose conditioning regimen and can thus be offered to older patients, to those debilitated by additional comorbidities, or to high-risk, heavily pretreated patients, who would not tolerate myeloablative HCT, resulting in a consequent decrease in regimen-related toxicity and treatment-related mortality. [3][4][5] Acute kidney injury (AKI) is highly prevalent whether the patients undergo myeloablative or non-myeloablative regimens; however, the pathogenesis and risk factors leading to AKI can differ between the two. In fact, AKI in patients receiving HCT is associated not only with increased short-and long-term mortality as compared with patients with no AKI, but also with a higher rate of progression to chronic kidney disease (CKD). Herein, the authors provide a comprehensive and up-to-date review of the definition and diagnosis of AKI as well as of the incidence, risk factors, pathogenesis and outcome of AKI in patients undergoing HCT, centering on the differences between myeloablative and nonmyeloablative regimens.

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“…Studies about kidney pathology before and after liver transplant are few and sample sizes are small. [1][2][3][4][5] Chronic kidney disease affects 30% to 50% nonrenal organ transplant recipients and causes increased morbidity and mortality in these patients. [6][7][8] Chronic kidney disease also may occur before liver transplant, possibly because of hepatitis C virus-related kidney disease, cirrhotic glomerulonephritis, immunoglobulin A (IgA) nephropathy caused by liver disease, hypertensionrelated nephropathy, diabetic nephropathy, and other glomerular diseases.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2014

Exp Clin Transplant

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Objectives: The purpose of this study was to evaluate the causes of kidney impairment associated with liver transplant in patients who had kidney biopsy before or after liver transplant. Materials and Methods: In 408 patients who had liver transplant from January 1990 to December 2012, there were 10 patients who had kidney biopsy (total, 19 kidney biopsies) for evaluation of kidney dysfunction. A retrospective review of clinical records and kidney biopsies was performed. Results: There were 7 male and 3 female patients (median age at liver transplant, 43 y; range, 10 to 62 y). The most frequent reason for liver transplant were hepatitis B virus cirrhosis (4 patients). There were 3 patients who had a kidney transplant before or concurrent with liver transplant. Increased serum creatinine level was the most common clinical finding at the time of kidney biopsy. The median interval from liver transplant to kidney biopsy was 495 days (mean, 1025 d; range, 10-4980 d). The most common pathology in the kidney biopsies was immune complex glomerulonephritis (total, 7 patients: IgA nephropathy, 4 patients; lupus nephritis, 2 patients; membranoproliferative glomerulonephritis, 1 patient). There were 4 patients who had allergic tubulointerstitial nephritis, 2 patients who had chronic calcineurin inhibitor nephrotoxicity, and 1 patient who had karyomegalic nephropathy. There were 7 patients who died at mean 34 months (range, 1-70 mo) after liver transplant. The other 3 patients were alive at mean 128 months (range, 67-193 mo) after liver transplant and had a functioning liver graft and chronic kidney disease. Conclusions: Chronic kidney disease after liver transplant has a major effect on mortality. The frequency of immune complex glomerulonephritis associated with liver transplant may be greater than previously recognized.

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Clinicopathologic analysis of renal biopsies after haematopoietic stem cell transplantation

Cited by 43 publications

References 32 publications

Renal pathology in hematopoietic cell transplant recipients: a contemporary biopsy, nephrectomy, and autopsy series

Renal pathology in hematopoietic cell transplant recipients: a contemporary biopsy, nephrectomy, and autopsy series

Acute kidney injury in HCT: an update

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