Bone marrow transplant nephropathy successfully treated with angiotensin-converting enzyme inhibitor.
We report a patient who developed chronic renal failure 11 months after an allogeneic hematopoietic stem-cell transplantation (HSCT) for Ph1(+) acute lymphocytic leukemia. Renal biopsy showed typical pathological findings compatible with a bone marrow transplant nephropathy (BMT nephropathy). The general course of BMT nephropathy is slowly progressive, eventually reaching endstage renal failure. Intervention therapy with an angiotensin-converting enzyme inhibitor (ACE-I), temocapril, was started for this patient, based on several experimental reports showing the protective effects of ACE-Is on BMT nephropathy. After the induction of ACE-I in this patient, the rate of regression of renal function was significantly reduced and his serum creatinine was maintained at almost the same level for 18 months. Although the course of observation in this patient was short, we clearly showed the effects of an ACE-I on preventing BMT nephropathy from progressing to endstage renal failure in a human rather than in an experimental model.
Division of Nephrology, Japanese Red Cross Nagoya First Hospital, Nagoya 453-8511, Japan. ichidas@nagoya-1st.jrc.or.jp
Shizunori
S
Ichida
Keiko
K
Okada
Michie
M
Itoh
Rieko
R
Okada
Noritoshi
N
Katoh
Masanobu
M
Kasai
Yukio
Y
Yuzawa
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001706:Biopsy; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D018450:Disease Progression; D006801:Humans; D007674:Kidney Diseases / Q000188:drug therapy* / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000209:etiology; D007678:Kidney Glomerulus / Q000473:pathology / Q000648:ultrastructure; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis
D000806:Angiotensin-Converting Enzyme Inhibitors