Membranous Glomerulopathy Associated with Graft-versus-Host Disease following Allogeneic Stem Cell Transplantation

Abstract

We report two cases of nephrotic syndrome presenting 18 and 20 months after allogeneic stem cell transplantation (alloSCT) with chronic myelogenous leukemia. Both patients had acute and chronic graft-versus-host disease (GVHD) and renal biopsy findings of membranous glomerulopathy (MG). A review of the literature revealed 10 additional cases of immune-complex-mediated glomerular disease following alloSCT, 8 of which were diagnostic of MG. All patients showed evidence of acute or chronic GVHD. Patients typically presented with preserved renal function (mean creatinine 1.2 mg/dl) and full nephrotic syndrome including heavy proteinuria (mean 9.2 g/24 h), edema, hypoalbuminemia (mean 2.1 g/dl) and hypercholesterolemia (mean 472 mg/dl). Most patients showed stabilization of renal function and significant decreases in proteinuria when treated with steroids and/or cyclosporine. The close temporal association as well as evidence from murine models of GVHD support a pathogenetic association between GVHD and the development of MG.

Nephrotic syndrome associated with chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation

“…[16][17][18][19][20][21][22][23][24][25][26][27][28] In all these reports, similar to our series, the most common pathological finding on renal biopsy was membranous glomerulonephritis (11 of the 13) and much less commonly minimal change disease (two of 13). The diseases for which transplantation was performed included chronic myeloid leukemia, multiple myeloma, aplastic anemia and acute leukemia.…”

Renal pathology in hematopoietic cell transplantation recipients

“…[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.…”

Chronic GVHD and concurrent new-onset nephrotic syndrome in allogeneic transplant recipients. Incidence, pattern and therapeutic outcomes

“…Injection of DBA/2 donor murine lymphocytes into F1 hybrid mice produces a murine model of GVHD associated with heavy proteinuria. 3 Clinical case reports and case series have documented nephrotic range proteinuria (NRP) after allo-HCT in humans. 4 We conducted a retrospective study in all patients who underwent allo-HCT between 2005 and 2011 at our institution and subsequently developed NRP.…”