title: Membranous glomerulopathy associated with graft-versus-host disease following allogeneic stem cell transplantation. Report of 2 cases and review of the literature.
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.
authors.affiliation: Division of Nephrology, Department of Medicine, Columbia University, New York-Presbyterian Hospital, New York, N.Y., USA. jlin11@partners.org
authors.forename: J
authors.initials: J
authors.lastname: Lin
authors.forename: G S
authors.initials: GS
authors.lastname: Markowitz
authors.forename: M
authors.initials: M
authors.lastname: Nicolaides
authors.forename: C S
authors.initials: CS
authors.lastname: Hesdorffer
authors.forename: G B
authors.initials: GB
authors.lastname: Appel
authors.forename: V D
authors.initials: VD
authors.lastname: D'Agati
authors.forename: D G
authors.initials: DG
authors.lastname: Savage
mesh_terms: D000208:Acute Disease; D000328:Adult; D002908:Chronic Disease; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000209:etiology*; D006086:Graft vs Host Disease / Q000209:etiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000628:therapy; D008297:Male; D008875:Middle Aged; D013577:Syndrome; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents