Minimal Change Nephrotic Syndrome after Allogenic Hematopoietic Stem Cell Transplantation

Sato, Yuji; Hara, Seiichiro; Fujimoto, Shouichi; Yamada, Kazuhiro; Sakamaki, Hisashi; Eto, Tanenao

doi:10.2169/internalmedicine.43.512

Cited by 19 publications

(13 citation statements)

References 9 publications

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“…Non-immune complex-mediated glomerular injuries in HCT patients include MCD, FSGS, and pauci-immune crescentic GN (13)(14)(15)(16)(17)(18)(19)(20)(42)(43)(44)(51)(52)(53). The finding of FSGS has been reported in non-HCT patients with IFN therapy and high-dosage chemotherapy for chronic myeloid leukemia (54), which provides evidence that high-dosage chemotherapy alone may be sufficient to result in severe podocyte injury.…”

Section: Discussionmentioning

confidence: 88%

“…Many pharmacologic agents, such as cyclosporine and tacrolimus, have been linked to thrombotic microangiopathy (TMA) (2). A range of glomerular injury processes, such as membranous nephropathy (MN) (3)(4)(5)(6)(7)(8)(9)(10)(11)(12) and minimal-change disease (MCD) (13)(14)(15)(16)(17)(18)(19)(20), have been observed in the setting of HCT, primarily as individual case reports. We conducted a clinicopathologic study of HCT patients with renal dysfunction to document the histopathologic spectrum of renal manifestations that can occur in this unique clinical setting.…”

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confidence: 99%

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Spectrum of Renal Pathology in Hematopoietic Cell Transplantation

Chang

Hingorani

Kowalewska

et al. 2007

Clinical Journal of the American Society of Nephrology

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Background and Objectives: Hematopoietic cell transplantation is a common treatment option for a variety of hematopoietic malignancies. As a result of the use of total body irradiation and/or chemotherapeutic agents, renal dysfunction often ensues. Many pharmacologic agents, such as cyclosporine and high-intensity conditioning regimens, have been linked with thrombotic microangiopathy. In addition, an association between membranous nephropathy and graft-versus-host disease has been reported in this clinical setting.Design, Setting, Participants, and Measurements: A study of autologous and allogeneic hematopoietic cell transplantation patients with renal dysfunction was conducted to document the spectrum of renal manifestations. The pathology files at the University of Washington and University of Chicago Medical Centers were reviewed, and 20 patients with a kidney biopsy after hematopoietic cell transplantation were identified. The histologic findings were correlated with relevant clinical information.Results: A wide spectrum of renal diseases could be classified into four categories: (1) Complications related to hematopoietic cell transplantation (conditioning regimen, immunosuppression, or posttransplantation complications), (2) podocytopathy, (3) membranous nephropathy, or (4) recurrence or persistence of original hematologic disease. Pathologic diagnoses included thrombotic microangiopathy, polyoma virus nephropathy, acute kidney injury/acute tubular necrosis, acute and chronic interstitial nephritis, minimal-change disease, "tip" variant of focal segmental glomerulosclerosis, membranous nephropathy, amyloidosis, and myeloma cast nephropathy. Membranous nephropathy, minimal-change disease, and amyloidosis were common causes of severe proteinuria. Because of the conditioning regimens, posttransplantation complications, and potential nephrotoxic agents used during hematopoietic cell transplantation, it was difficult to attribute the subsequent renal dysfunction to specific factors.Conclusions: The renal biopsy remains essential for diagnosing the underlying injury that can affect one or more compartments of the kidney in this unique clinical setting.

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Section: Discussionmentioning

confidence: 88%

mentioning

confidence: 99%

Spectrum of Renal Pathology in Hematopoietic Cell Transplantation

Chang

Hingorani

Kowalewska

et al. 2007

Clinical Journal of the American Society of Nephrology

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“…Like membranous glomerulonephritis, minimal change disease may be associated with graft-versus-host disease-like autoimmunity, and T-cell alloreactivity has been hypothesized as a cause of minimal change disease. 5,47 Indeed, the patient with minimal change disease had a positive ANA, other autoimmune manifestations, and responded to immunosuppressive therapy. Chang et al 18 described six autologous hematopoietic cell transplant recipients in their case series, and found thrombotic microangiopathy, polyoma virus nephropathy, tubulointerstitial nephritis, and recurrent amyloidosis, but no other glomerular pathology.…”

Section: Discussionmentioning

confidence: 99%

Renal pathology in hematopoietic cell transplantation recipients

et al. 2008

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“…Other publications (44,45) refer to additional cases, but the details are too scarce to take these patients into account for detailed analysis in this review. In an additional case, NS developed after bone marrow nephropathy was found on renal histology, but the patient did not undergo biopsy again (46). A cohort study (43) of nonmyeloablative HCT listed seven patients with NS, three of whom did not receive a histologic diagnosis and therefore were not included.…”

Section: Analysis Of the Literature And Discussionmentioning

confidence: 99%

Nephrotic Syndrome after Hematopoietic Cell Transplantation

Brukamp¹,

Doyle²,

Bloom³

et al. 2006

Clinical Journal of the American Society of Nephrology

138

134

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Glomerular disease associated with nephrotic syndrome has rarely been recognized as a distinct complication of allogeneic hematopoietic cell transplantation. Case reports in the English and Japanese literature since 1988 have described variable glomerular histology, comprising mainly membranous glomerulonephritis (MGN) in almost two thirds and minimal change disease (MCD) in nearly one quarter of patients. Review of the literature reveals a close temporal relationship between the development of nephrotic syndrome shortly after cessation of immunosuppression and the diagnosis of chronic graft-versushost disease (GVHD). An association of glomerular disease with simultaneous GVHD was seen in 47% of patients overall. Nephrotic syndrome followed GVHD within 5 months in 60% of the combined MCD and MGN reports. A decrease in immunosuppressive medication use was linked to nephrotic syndrome occurrence within 9 months in 63% of patients with MCD and MGN. MCD occurred earlier after hematopoietic cell transplantation, was diagnosed sooner after medication change, and exhibited a better prognosis in comparison with MGN. Glomerular lesions after hematopoietic cell transplantation may therefore represent the renal manifestation of GVHD. Further studies are warranted to delineate the pathogenesis of this complication.

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Minimal Change Nephrotic Syndrome after Allogenic Hematopoietic Stem Cell Transplantation

Cited by 19 publications

References 9 publications

Spectrum of Renal Pathology in Hematopoietic Cell Transplantation

Spectrum of Renal Pathology in Hematopoietic Cell Transplantation

Renal pathology in hematopoietic cell transplantation recipients

Nephrotic Syndrome after Hematopoietic Cell Transplantation

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