title: Membranous glomerulopathy as a manifestation of chronic graft-versus-host-disease after non-myeloablative stem cell transplantation in a patient with paroxysmal nocturnal hemoglobinuria.
abstract: Allogeneic stem cell transplantation (allo-SCT) using related or unrelated donor could eradicate paroxysmal nocturnal hemoglobinuria (PNH) clones and may cure the disease. Chronic graft-versus host disease (GVHD) is a major complication of patients who have undergone allo-SCT. Nephrotic syndrome has been described as one of the rare manifestations of chronic GVHD following the usual myeloablative allo-SCT. We report a case of nephrotic syndrome that developed 25 months after non-myeloablative allo-SCT for PNH. The patient had grade II acute GVHD and extensive chronic GVHD after non-myeloablative allo-SCT. Typically the patient presented with preserved renal function and full nephrotic syndrome including generalized edema, proteinuria, hypoalbuminemia, and hypercholesterolemia. Renal biopsy revealed findings of membranous glomerulopathy (MG). The patient is alive with a stable engraftment and full donor chimerism under the administration of tacrolimus for control of chronic GVHD and MG without refractory hemolysis and cytopenia.
authors.affiliation: Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea.
authors.forename: Gyeong-Won
authors.initials: GW
authors.lastname: Lee
authors.forename: Je-Hwan
authors.initials: JH
authors.lastname: Lee
authors.forename: Soon-Bae
authors.initials: SB
authors.lastname: Kim
authors.forename: Eun-Sil
authors.initials: ES
authors.lastname: Yu
authors.forename: Jae-Lyun
authors.initials: JL
authors.lastname: Lee
authors.forename: Min-Hee
authors.initials: MH
authors.lastname: Ryu
authors.forename: Eunkyoung
authors.initials: E
authors.lastname: Kim
authors.forename: Seong-Jun
authors.initials: SJ
authors.lastname: Choi
authors.forename: Woo-Kun
authors.initials: WK
authors.lastname: Kim
authors.forename: Jung-Shin
authors.initials: JS
authors.lastname: Lee
authors.forename: Kyoo-Hyung
authors.initials: KH
authors.lastname: Lee
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D006457:Hemoglobinuria, Paroxysmal / Q000628:therapy*; D006801:Humans; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D016896:Treatment Outcome