[Clinical analysis of late-onset nephrotic syndrome after allogenic hematopoietic stem cell transplantation].
OBJECTIVE
To investigate the clinical manifestations, pathology, diagnosis, treatment, and pathogenesis of late-onset nephrotic syndrome (NS) after allogenic hematopoietic stem cell transplantation (allo-HSCT).


METHODS
NS post-HSCT was investigated in 167 patients with hematopoietic malignancies who survived more than 3 months after allo-HSCT. The clinical manifestations, pathology, diagnosis, and treatment were investigated in a retrospective study. The association of the onset of NS post-HSCT with sex, age, transplant type, conditioning regiments, human leucocyte antigen (HLA) matching, donor-recipient relationship, acute graft versus host disease (aGVHD), chronic graft versus host disease (cGVHD), and cytomegalovirus infection were analyzed.


RESULTS
Five patients (2.99%) were diagnosed as with NS post-HSCT, 4 with membranous glomerulonephritis (MGN) and 1 with minimal change disease (MCD). Immunohistochemistry of glomerular lesions revealed that the immunoglobulin (Ig) of immune complex deposition included IgG in 3 patients, IgM in 1 patient, and co-existence of IgG/IgM in 1 patient. Serum ANA was positive in 2 patients and serum IgG and IgM were in high levels in 2 patients. Glucocorticoid combined with cyclophosphamide (CTX) was fundamentally effective treatment for NS post-HSCT. 1 patient got complete response, 3 got partial response, and 1 was stable after the treatment. Binary logistic regression showed that the he onset of NS post-HSCT was not significantly associated with sex, age, transplant type, conditioning regimen, HLA matching, donor-recipient relation, aGVHD, cGVHD and CMV infection.


CONCLUSIONS
The predominant pathological type of NS post-HSCT is MGN, followed by MCD. The pathogenesis of NS post-HSCT may be related to the abnormality of humoral immunity. Glucocorticoid combined with CTX is an effective treatment.
Luo
Xiao-Dan
XD
Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Liu
Qi-Fa
QF
Ning
Juan
J
Wei
Yong-Qiang
YQ
Fan
Zhi-Ping
ZP
Zhang
Yu
Y
Sun
Jing
J
D000293:Adolescent; D000328:Adult; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000209:etiology / Q000276:immunology / Q000473:pathology; D006086:Graft vs Host Disease / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism; D007075:Immunoglobulin M / Q000378:metabolism; D007150:Immunohistochemistry; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D012189:Retrospective Studies
D007074:Immunoglobulin G; D007075:Immunoglobulin M