Chronic graft‐versus‐host disease of the kidney in patients with allogenic hematopoietic stem cell transplant

Abstract

cGVHD of the kidney is a rare complication after allo-HSCT, related with the removal of the immunosuppression. Monitoring proteinuria in these patients may be useful. In our patients, a complete remission was achieved; although the removal of the immunosuppression may lead to the appearance of outbreaks. We must reconsider the treatment of glomerular pathology secondary to cGVHD.

A Case of the nephrotic syndrome in bone marrow transplantation recipient, histologically showing overlapped glomerular lesions of thrombotic microangiopathy and membranous nephropathy

“…Current evidence, however, has led to the suggestion that both MN and renal TMA are glomerular manifestations of chronic GVHD . NS after HSCT usually appears in the presence of chronic GVHD during tapering of the dose of immunosuppressive agents . GVHD is an immune‐mediated disease mainly caused by donor‐derived T cells, but some investigations noted the important role of autoantibodies and B cells in the pathogenesis of GVHD .…”

“…Nephrotic syndrome (NS) after hematopoietic stem cell transplantation (HSCT) occurs rarely, but usually develops in the presence of chronic graft‐versus‐host disease (GVHD) during tapering of the dose of immunosuppressive agents . Membranous nephropathy (MN) is the most common histological pattern of post‐HSCT NS . In cases of post‐transplant MN, because most of them are at an early stage, it is difficult to detect characteristic morphological changes, such as spike or bubbling of glomerular basement membrane (GBM), by light microscopic examination .…”

“…Membranous nephropathy (MN) is the most common histological pattern of post‐HSCT NS . In cases of post‐transplant MN, because most of them are at an early stage, it is difficult to detect characteristic morphological changes, such as spike or bubbling of glomerular basement membrane (GBM), by light microscopic examination . Post‐transplant thrombotic microangiopathy (TMA) is not uncommon and generally presents as systemic disease in the early phase post‐transplantation.…”

Mesenchymal stem cells for kidney transplantation

“…There have also been positive results from experimental animal models [24] . Of greatest interest are the clinical trials that have used Tregs as a cellular therapy in graft-vs-host disease (GVHD), a major and potentially lethal transplant complication that is particularly prevalent in patients who have undergone a hematopoietic stem cell transplant (HSTC) [25,26] . With generally positive outcomes from the GVHD trials [26] , it is likely that we will see Tregs initially deployed as an adjunctive therapy in SOT before being used in patients who have a high risk of rejection or who have already experienced adverse effects from standard immunosuppression.…”

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.…”