J Korean Med Sci.  2003 Dec;18(6):901-904. 10.3346/jkms.2003.18.6.901.

Membranous Glomerulopathy as a Manifestation of Chronic Graft-versus-Host-Disease After Non-myeloablative Stem Cell Transplantation in a Patient with Paroxysmal Nocturnal Hemoglobinuria

• Lee GW
• Lee JH
• Kim SB
• Yu ES
• Lee JL
• Ryu MH
• Kim E
• Choi SJ
• Kim WK
• Lee JS
• Lee KH

• KMID: 1086753
• DOI: http://doi.org/10.3346/jkms.2003.18.6.901

Abstract

Allogeneic stem cell transplantation (allo-SCT) using related or unrelated donor could eradicate paroxysmal nocturnal hemoglobinuria (PNH) clones and may cure the disease. Chronic graft-versus host disease (GVHD) is a major complication of patients who have undergone allo-SCT. Nephrotic syndrome has been described as one of the rare manifestations of chronic GVHD following the usual myeloablative allo-SCT. We report a case of nephrotic syndrome that developed 25 months after non-myeloablative allo-SCT for PNH. The patient had grade II acute GVHD and extensive chronic GVHD after non-myeloablative allo-SCT. Typically the patient presented with preserved renal function and full nephrotic syndrome including generalized edema, proteinuria, hypoalbuminemia, and hypercholesterolemia. Renal biopsy revealed findings of membranous glomerulopathy (MG). The patient is alive with a stable engraftment and full donor chimerism under the administration of tacrolimus for control of chronic GVHD and MG without refractory hemolysis and cytopenia.

Keyword

Graft vs Host Disease; Hemoglobinuria, Paroxysmal; Glomerulonephritis, Membranous; Stem Cell Transplantation

MeSH Terms

Adult
Diagnosis, Differential
Female
Glomerulonephritis, Membranous/drug therapy/*etiology/pathology
Graft vs Host Disease/drug therapy/*etiology/pathology
Hemoglobinuria, Paroxysmal/*therapy
Human
*Stem Cell Transplantation/*adverse effects
Treatment Outcome