De novo postallogeneic hematopoietic stem cell transplant membranous nephropathy.

We report membranous nephropathy in a 61-year-old man after allogeneic hematopoietic stem cell transplant without chronic graft-versus-host disease. A diagnosis of acute myeloid leukemia was made, and the patient received hematopoietic stem cell transplants, twice, from different donors. The first donor was his brother and the second donor was an unrelated man. Human leukocyte antigens between donors and recipient were fully matched. His clinical course was stable without acute or chronic graft-versus-host disease or relapse of acute myeloid leukemia with tacrolimus after the second hematopoietic stem cell transplant. Six months after the second hematopoietic stem cell transplant, tacrolimus was decreased gradually and discontinued because of tacrolimus-induced liver dysfunction. Three months after discontinuing the tacrolimus, the patient developed edema in his leg. The results of a blood analysis showed that plasma albumin level was 21 g/L and plasma total cholesterol level was 11.5 mmol/L, while results from a urinalysis showed proteinuria of 5.6 g/d without hematuria. No abnormalities in the skin, mucosal tissues, and other organs suggestive of chronic graft-versus-host disease were seen. A renal biopsy was done to investigate the cause, which revealed renal disease. Electron microscopic analysis showed dense deposits in the subepithelial region in all glomeruli. Immunofluorescence analysis showed the deposition of IgG4 and C3c in the subepithelial space of all glomeruli. Membranous nephropathy was diagnosed. He then was administered prednisolone at a dosage of 45 mg/d (0.7 mg/kg/d). After prednisolone treatment, urine protein and hypoalbuminemia were markedly improved, and his leg edema disappeared. These results suggest that this membranous nephropathy may have been de novo membranous nephropathy after hematopoietic stem cell transplant because it developed after hematopoietic stem cell transplants without chronic graft-versus-host disease.

[1]  D. Bhowmik,et al.  De novo membranous nephropathy after hematopoietic stem cell transplantation. , 2011, Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia.

[2]  R. Henrique,et al.  Minimal change nephrotic syndrome after stem cell transplantation: a case report and literature review , 2007, Journal of medical case reports.

[3]  B. Knebelmann,et al.  Post-allogeneic haematopoietic stem cell transplantation membranous nephropathy: clinical presentation, outcome and pathogenic aspects. , 2007, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[4]  R. Bloom,et al.  Nephrotic syndrome after hematopoietic cell transplantation: do glomerular lesions represent renal graft-versus-host disease? , 2006, Clinical journal of the American Society of Nephrology : CJASN.

[5]  D. Sinclair,et al.  Occurrence of autoantibodies in chronic graft vs. host disease after allogeneic stem cell transplantation. , 2005, Clinical and laboratory haematology.

[6]  Stephanie J. Lee.  New approaches for preventing and treating chronic graft-versus-host disease. , 2005, Blood.

[7]  Bing Li,et al.  Bone marrow cells contribute to regeneration of damaged glomerular endothelial cells. , 2005, Kidney international.

[8]  B. Nankivell,et al.  Nephrotic syndrome after stem cell transplantation , 2005, Clinical transplantation.

[9]  B. Goichot,et al.  Les manifestations d’allure auto-immune après allogreffe de moelle osseuse , 2004 .

[10]  A. Komatsuda,et al.  Distribution of glomerular IgG subclass deposits in malignancy-associated membranous nephropathy. , 2004, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[11]  B. Goichot,et al.  [Auto-immune-like disease post-bone marrow transplantation]. , 2004, La Revue de medecine interne.

[12]  R. Collins,et al.  Chronic graft-vs-host disease. , 2003, JAMA.

[13]  L. Hood,et al.  Hematopoietic stem cells contribute to the regeneration of renal tubules after renal ischemia-reperfusion injury in mice. , 2003, Journal of the American Society of Nephrology : JASN.

[14]  D. Hess,et al.  Hematopoietic origin of glomerular mesangial cells. , 2003, Blood.

[15]  R. Poulsom,et al.  Bone marrow contributes to renal parenchymal turnover and regeneration , 2001, The Journal of pathology.

[16]  A. Elmaagacli,et al.  Induction of a graft-versus-leukemia reaction by cyclosporin A withdrawal as immunotherapy for leukemia relapsing after allogeneic bone marrow transplantation , 1999, Bone Marrow Transplantation.

[17]  M. Haas,et al.  IgG subclass deposits in glomeruli of lupus and nonlupus membranous nephropathies. , 1994, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[18]  A. Woodroffe,et al.  Membranous nephropathy with graft-versus-host disease in a bone marrow transplant recipient. , 1992, Clinical nephrology.

[19]  P. Hogendoorn,et al.  Pathogenesis of experimental lupus nephritis: a role foranti‐basement membrane and anti‐tubular brush border antibodiesin murine chronic graft‐versus‐host disease , 1990, Clinical and experimental immunology.