Post-allogeneic haematopoietic stem cell transplantation membranous nephropathy: clinical presentation, outcome and pathogenic aspects

Abstract

Our data suggest an association between cGVHD and post-HSCT MN. Treatment, mainly steroids and ciclosporin, should be aimed at the control of acute manifestations of cGVHD.

Renal pathology in hematopoietic cell transplantation recipients

“…Although other reports have demonstrated treatment response with rituximab in hematopoietic cell transplantation patients with membranous glomerulonephritis/nephrotic syndrome, many previously reported patients had only partial remission, and in one case a biopsy was not performed. 4,6,22,29 Nevertheless, resolution of graft-versus-host disease and post hematopoietic cell transplant membranous glomerulonephritis with this anti-B-cell agent supports the hypothesis that B-cell alloreactivity may play a role in both of these entities. 16,35,37 Interestingly, our study also identified two patients with biopsy proven membranous glomerulonephritis after autologous hematopoietic cell transplantation.…”

“…[4][5][6][14][15][16][18][19][20][21][22][23][24][25][26][27][28][29] In our series, among seven patients with membranous glomerulonephritis, all five patients with allogeneic transplants had evidence of chronic graft-versushost disease, (in the non-membranous glomerulonephritis cohort, only three out of eight patients had chronic graft-versus-host disease). Importantly, we also present two patients with biopsy proven membranous glomerulonephritis after autologous hematopoietic cell transplantation.…”

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

“…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.…”

“…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. 8,14,16,19,38,39 A few single-center studies of autopsy kidney specimen in the hematopoietic cell transplant population have been reported, including one large study focused primarily on thrombotic microangiopathy. 20,21,38,40 We retrospectively reviewed our single-center experience with renal pathology in specimens from three groups of hematopoietic cell transplant recipients.…”

The need for ‘onco-nephrology’ is increasing in hematopoietic stem cell transplantation

“…5 by immunodeficiency, hemorrhagic tendency, infections and engraftment syndrome (capillary leak syndrome), elevating the mortality rate to about 70%. 9 A little o 1% of survivors of AKI develop chronic GvHD-associated nephrotic syndrome within several years 10,11 and about 15-20% of them concomitantly develop CKD. 12 According to Lopes et al, 5 AKI after SCT is an important factor related to not only the mortality of patients but also the progression to CKD in the future.…”