Minimal-change nephrotic syndrome in a hematopoietic stem-cell transplant recipient

Humphreys, Benjamin D.; Vanguri, Vijay K.; Henderson, Joel M.; Antin, Joseph H.

doi:10.1038/ncpneph0271

Cited by 8 publications

(6 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Non-immune complex-mediated glomerular injuries in HCT patients include MCD, FSGS, and pauci-immune crescentic GN (13)(14)(15)(16)(17)(18)(19)(20)(42)(43)(44)(51)(52)(53). The finding of FSGS has been reported in non-HCT patients with IFN therapy and high-dosage chemotherapy for chronic myeloid leukemia (54), which provides evidence that high-dosage chemotherapy alone may be sufficient to result in severe podocyte injury.…”

Section: Discussionmentioning

confidence: 66%

“…Many pharmacologic agents, such as cyclosporine and tacrolimus, have been linked to thrombotic microangiopathy (TMA) (2). A range of glomerular injury processes, such as membranous nephropathy (MN) (3)(4)(5)(6)(7)(8)(9)(10)(11)(12) and minimal-change disease (MCD) (13)(14)(15)(16)(17)(18)(19)(20), have been observed in the setting of HCT, primarily as individual case reports. We conducted a clinicopathologic study of HCT patients with renal dysfunction to document the histopathologic spectrum of renal manifestations that can occur in this unique clinical setting.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Spectrum of Renal Pathology in Hematopoietic Cell Transplantation

Chang

Hingorani

Kowalewska

et al. 2007

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and Objectives: Hematopoietic cell transplantation is a common treatment option for a variety of hematopoietic malignancies. As a result of the use of total body irradiation and/or chemotherapeutic agents, renal dysfunction often ensues. Many pharmacologic agents, such as cyclosporine and high-intensity conditioning regimens, have been linked with thrombotic microangiopathy. In addition, an association between membranous nephropathy and graft-versus-host disease has been reported in this clinical setting.Design, Setting, Participants, and Measurements: A study of autologous and allogeneic hematopoietic cell transplantation patients with renal dysfunction was conducted to document the spectrum of renal manifestations. The pathology files at the University of Washington and University of Chicago Medical Centers were reviewed, and 20 patients with a kidney biopsy after hematopoietic cell transplantation were identified. The histologic findings were correlated with relevant clinical information.Results: A wide spectrum of renal diseases could be classified into four categories: (1) Complications related to hematopoietic cell transplantation (conditioning regimen, immunosuppression, or posttransplantation complications), (2) podocytopathy, (3) membranous nephropathy, or (4) recurrence or persistence of original hematologic disease. Pathologic diagnoses included thrombotic microangiopathy, polyoma virus nephropathy, acute kidney injury/acute tubular necrosis, acute and chronic interstitial nephritis, minimal-change disease, "tip" variant of focal segmental glomerulosclerosis, membranous nephropathy, amyloidosis, and myeloma cast nephropathy. Membranous nephropathy, minimal-change disease, and amyloidosis were common causes of severe proteinuria. Because of the conditioning regimens, posttransplantation complications, and potential nephrotoxic agents used during hematopoietic cell transplantation, it was difficult to attribute the subsequent renal dysfunction to specific factors.Conclusions: The renal biopsy remains essential for diagnosing the underlying injury that can affect one or more compartments of the kidney in this unique clinical setting.

show abstract

Section: Discussionmentioning

confidence: 66%

mentioning

confidence: 99%

Spectrum of Renal Pathology in Hematopoietic Cell Transplantation

Chang

Hingorani

Kowalewska

et al. 2007

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…The absence of relationship between CD34 count, age, and delay of remission that may be considered as surrogate markers of the disease activity support the fact that hematopoietic stem-cell mobilization may represent an epiphenomenon due to urinary loss of an unknown regulatory protein. Nevertheless, taken together with our results, several experimental results and clinical facts suggest that it may also be linked to the primary mechanism of SSNS: (1) a few patients grafted with hematopoietic stem cells for hematological disorders have been reported to secondarily develop nephrotic syndrome mainly due to membranous nephropathy in most cases but also to minimal-change disease [15][16][17]; (2) bone marrow transplantation of normal BALB/c mice using hematopoietic stem cells coming from focal segmental glomerulosclerosis (FSGS) mice develop proteinuria and histological findings of FSGS [18]; (3) engraftment of immunocompromised mice using CD34+ cells from affected patients induces proteinuria and podocyte foot-process effacement [19].…”

Section: Discussionmentioning

confidence: 87%

Stem cell mobilization in idiopathic steroid-sensitive nephrotic syndrome

et al. 2008

View full text Add to dashboard Cite

Steroid-sensitive nephrotic syndrome (SSNS) is classically thought to be a T-cell disorder. The aim of this study was to examine whether or not thymus homeostasis was affected in SSNS. Mature and naive T cell recent thymic emigrants were quantified in the peripheral blood of nephrotic patients and controls. Because the generation of new T cells by the thymus ultimately depends on hematopoietic stem cells, CD34+ cells were also included in the study. Nineteen patients with SSNS during relapse, 13 with SSNS during proteinuria remission, and 18 controls were studied. Cell-surface markers (CD3, CD4, CD8, CD19, CD16, CD56, CD45RA, CD62L, CD34, and CD38) were analyzed by flow cytometric analysis. T-cell rearrangement excision circles (TRECs) were quantified in CD2+ cells by real-time polymerase chain reaction. Stroma cell-derived factor-1 (SDF-1) genotype and metalloproteinase-9 (MMP-9) plasma levels were also determined. Mature T cells (CD4+ and CD8+), circulating naive T cells (CD62L+ and CD3+ CD62L+), and recent thymic emigrants (CD45RA+) as well as TRECs, that measure thymus production, had a similar level in the three groups of patients. Conversely, CD34+ hematopoietic stem cells displayed a two-fold increase in SSNS patients during relapse either compared with controls or SSNS patients at remission. In addition, compared with controls, SSNS patients at remission displayed (1) a decrease in CD19+ cells (B cells) and (2) an increase in CD16CD56+ cells [natural killer (NK) cells]. In conclusion, thymus homeostasis is not significantly affected in nephrotic patients. Hematopoietic stem-cell mobilization at proteinuria relapse, as well as changes in B and NK cells during remission, suggest that SSNS might be due to a general disturbance of hematopoietic and immune cell trafficking.

show abstract

“…17,28,30,31,36,38,40,[48][49][50][51][52] Most patients are treated with immunosuppressive regimens, leading to resolution in 70% to 90% of cases. 17,28,30,31,36,38,40,[48][49][50][51][52] Most patients are treated with immunosuppressive regimens, leading to resolution in 70% to 90% of cases.…”

Section: Minimal Change Diseasementioning

confidence: 99%

“…Supplementary Table, Supplemental Digital Content 1, http://links.lww.com/PAP/ A9) 17,28,30,31,36,38,40,[48][49][50][51][52]. Like in MN, patients generally present with the nephrotic syndrome, or nephrotic range proteinuria, and many, but not all, have normal creatinine(Table 4).…”

mentioning

confidence: 99%

Renal Pathology Associated With Hematopoietic Stem Cell Transplantation

Troxell

Higgins

Kambham

2014

Advances in Anatomic Pathology

View full text Add to dashboard Cite

The kidney is subject to a large variety of injurious factors before, during, and after hematopoietic stem cell transplantation (HCT), leading to a high incidence of acute kidney injury in the peritransplant period. Chronic kidney disease is estimated to impact 15% to 20% of HCT recipients. Although renal biopsies may be deferred in the setting of thrombotic microangiopathy, acute self-limited impairment, or slowly progressive functional decline, in many patients renal biopsy yields important diagnostic insight to guide treatment. Light microscopic, immunofluorescence, and ultrastructural analysis often reveals a number of concurrent abnormalities in glomeruli, tubules, interstitium, and vessels. Meta-analysis of the literature reveals that membranous nephropathy is the most commonly reported glomerular lesion in the setting of HCT, followed by minimal change disease. Autopsy and biopsy studies show that clinical criteria lack sensitivity and specificity for renal acute and chronic thrombotic microangiopathy. Viral infection and other causes of interstitial nephritis and tubular injury are important findings in HCT renal biopsies, which in many instances may not be clinically suspected. Given the complexity and variability of HCT protocols, clinicopathologic correlation is needed.

show abstract

Minimal-change nephrotic syndrome in a hematopoietic stem-cell transplant recipient

Cited by 8 publications

References 13 publications

Spectrum of Renal Pathology in Hematopoietic Cell Transplantation

Spectrum of Renal Pathology in Hematopoietic Cell Transplantation

Stem cell mobilization in idiopathic steroid-sensitive nephrotic syndrome

Renal Pathology Associated With Hematopoietic Stem Cell Transplantation

Contact Info

Product

Resources

About