Nephrotic syndrome with crescent formation and massive IgA deposition following allogeneic bone marrow transplantation for natural killer cell leukemia/lymphoma.
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.
Kimura
Shinya
S
Department of Transfusion Medicine, Kyoto University Hospital, Kyoto, Japan. shkimu@kuhp.kyoto-u.ac.jp
Horie
Akeyo
A
Hiki
Yoshiyuki
Y
Yamamoto
Chie
C
Suzuki
Satoru
S
Kuroda
Junya
J
Deguchi
Masayo
M
Kato
Gen-ichi
G
Karasuno
Takahiro
T
Hiraoka
Akira
A
Yoshikawa
Toshikazu
T
Maekawa
Taira
T
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
D007070:Immunoglobulin A