Membranous glomerulopathy in children given allogeneic hematopoietic stem cell transplantation.
Graft-versus-host disease (GVHD) is a common complication of allogeneic hematopoietic stem cell transplantation (HSCT), but membranous glomerulopathy (MG) has rarely been described as a manifestation of chronic GVHD. We report two cases of MG in children who underwent allogeneic HSCT. The clinical findings were characterized by edema of the lower extremities and nephrotic proteinuria in one case and hypertension, hematuria and edema with non-nephrotic proteinuria in the other one. Renal biopsy was consistent with MG and appropriate immunosuppressive therapy was prescribed. Both patients achieved complete remission and are alive without renal disease 4 and 2 years after the diagnosis of MG. The normal levels of albumin and non-nephrotic proteinuria in one of the two cases raise the question of whether the real incidence of MG after HSCT is underestimated. Therefore, we strongly suggest regular urine analysis during the follow-up of children undergoing HSCT in order to diagnose MG early.
Perrotta
Silverio
S
Department of Pediatrics, Second University of Naples, Italy. silverio.perrotta@unina2.it
Conte
Maria Luisa
ML
La Manna
Angela
A
Indolfi
Paolo
P
Rossi
Francesca
F
Locatelli
Franco
F
Nobili
Bruno
B
D000754:Anemia, Refractory, with Excess of Blasts / Q000601:surgery*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001215:Asparaginase / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D004487:Edema / Q000209:etiology; D015433:Glomerulonephritis, Membranous / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006086:Graft vs Host Disease / Q000150:complications* / Q000188:drug therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006504:Hepatic Veno-Occlusive Disease / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D015122:Mercaptopurine / Q000008:administration & dosage; D008727:Methotrexate / Q000008:administration & dosage; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000601:surgery*; D011241:Prednisone / Q000008:administration & dosage; D012074:Remission Induction; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous / Q000009:adverse effects*; D014750:Vincristine / Q000008:administration & dosage
D007166:Immunosuppressive Agents; D003561:Cytarabine; D014750:Vincristine; D003520:Cyclophosphamide; D015122:Mercaptopurine; D001215:Asparaginase; D011241:Prednisone; D008727:Methotrexate; D003630:Daunorubicin