title: Nephrotic syndrome with crescent formation and massive IgA deposition following allogeneic bone marrow transplantation for natural killer cell leukemia/lymphoma.
abstract: We describe herein a case of nephrotic syndrome (NS) following allogeneic bone marrow transplantation (allo-BMT) for natural killer cell leukemia/lymphoma. Histologic studies defined the diagnosis as crescentic glomerulonephritis with massive immunoglobulin A (IgA) deposition, which has never been reported in NS cases following allo-BMT. Most of the massive infiltrated cells in the interstice were CD3(+)CD4(-)CD8(+) T cells derived from the donor. We observed mesangial deposition of Haemophilus parainfluenza outer membrane (OMHP) antigen and decreased glycosylation of the IgA1 hinge in the recipient's samples is consistent with the recently reported pathogenesis of IgA nephropathy. Further, the titer of IgA antibody against the donor serum was as high as other IgA nephropathy cases. These findings suggest that NS and crescentic glomerulonephritis in this case occurred as one of the forms of chronic graft-versus-host disease (GVHD), and that IgA deposition was associated with H parainfluenza and decreased glycosylation of the IgA1 hinge.
authors.affiliation: Department of Transfusion Medicine, Kyoto University Hospital, Kyoto, Japan. shkimu@kuhp.kyoto-u.ac.jp
authors.forename: Shinya
authors.initials: S
authors.lastname: Kimura
authors.forename: Akeyo
authors.initials: A
authors.lastname: Horie
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Hiki
authors.forename: Chie
authors.initials: C
authors.lastname: Yamamoto
authors.forename: Satoru
authors.initials: S
authors.lastname: Suzuki
authors.forename: Junya
authors.initials: J
authors.lastname: Kuroda
authors.forename: Masayo
authors.initials: M
authors.lastname: Deguchi
authors.forename: Gen-ichi
authors.initials: G
authors.lastname: Kato
authors.forename: Takahiro
authors.initials: T
authors.lastname: Karasuno
authors.forename: Akira
authors.initials: A
authors.lastname: Hiraoka
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Taira
authors.initials: T
authors.lastname: Maekawa
mesh_terms: D000328:Adult; D001706:Biopsy; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000378:metabolism*; D007668:Kidney / Q000473:pathology; D007694:Killer Cells, Natural / Q000276:immunology*; D007938:Leukemia / Q000473:pathology / Q000628:therapy*; D008223:Lymphoma / Q000473:pathology / Q000628:therapy*; D008297:Male; D009404:Nephrotic Syndrome / Q000209:etiology* / Q000276:immunology; D014184:Transplantation, Homologous
chemical_list: D007070:Immunoglobulin A