Kidney Res Clin Pract.  2013 Sep;32(3):121-126.

De novo glomerulitis associated with graft-versus-host disease after allogeneic hematopoietic stem cell transplantation: A single-center experience

• Cho YH
• Kang SH
• Kim Y
• Lee MH
• An GH
• Chung BH
• Choi BS
• Yang CW
• Kim YS
• Choi YJ
• Park CW

Abstract

BACKGROUND
Nephrotic syndrome (NS) and proteinuria are uncommon, often unrecognized manifestations of graft-versus-host disease (GVHD) after hematopoietic stem cell transplantation (HSCT). Only a few isolated case reports and case series involving smaller number of patients who developed NS after HSCT have been published.
METHODS
We reviewed the renal histopathological examination findings and clinical records of 15 patients who developed proteinuria after HSCT at Seoul and Yeouido St. Mary's Hospital (Seoul, Korea). We also measured the anti-PLA2 Rantibodies (M-type phospholipase A2 receptor) in the serum samples from the seven patients at the time of renal biopsy.
RESULTS
All patients had GVHD. The most common indication for biopsy was proteinuria ( > 1 g/day), with nine patients having nephrotic range proteinuria. The most common histopathological finding was membranous nephropathy (MN; n = 12).Other findings were membranoproliferative glomerulonephritis, C1q nephropathy, and diabetic nephropathy. Eleven patients were treated with immunosuppressive agents, and three patients were treated only with angiotensin II receptor blocker. The overall response rate, including complete remission (urinary protein level < 0.3 g/day) and partial remission (urinary protein level = 0.31-3.4 g/day), was 73%. The mean follow-up period was 26 months, and none of the patients developed end-stage renal disease. All of the seven patients with MN had negative findings for anti-PLA2R antibodies, measured using an enzyme-linked immunosorbent assay kit.
CONCLUSION
In this study the findings of 15 renal biopsies were analyzed and to our knowledge this is the largest clinicopathological study of GVHD-related biopsy-proven nephropathy. Approximately 80% of the patients were MN and 73% responded either partially or completely to immunosuppressive treatment. Currently, there is an increase in the incidence of GVHD-mediated renal disease, and therefore, renal biopsy is essential for diagnosing the nephropathy and preventing the progression of renal disease.

Keyword

Allogeneic hematopoietic stem cell transplantation; Graft-versus-host disease; Membranous nephropathy; Proteinuria

MeSH Terms

Antibodies
Biopsy
Diabetic Nephropathies
Enzyme-Linked Immunosorbent Assay
Follow-Up Studies
Glomerulonephritis, Membranoproliferative
Glomerulonephritis, Membranous
Graft vs Host Disease*
Hematopoietic Stem Cell Transplantation*
Hematopoietic Stem Cells*
Humans
Immunosuppressive Agents
Incidence
Kidney Failure, Chronic
Nephrotic Syndrome
Phospholipases A2
Proteinuria
Receptors, Angiotensin
Antibodies
Immunosuppressive Agents
Phospholipases A2
Receptors, Angiotensin