Glomerulonephritis after hematopoietic cell transplantation: IgA nephropathy with increased excretion of galactose-deficient IgA1.
We report the development of IgA nephropathy (IgAN) following full myeloablative allogeneic hematopoietic cell transplantation in two patients with human leukocyte antigen (HLA) matched sibling donors, unrelated to active or chronic graft-versus-host disease. Both recipients had elevated urinary levels of galactose-deficient IgA1, and one donor-recipient pair had elevated serum levels of galactose-deficient IgA1. We propose that IgAN developed after bone marrow transplantation due to a non-graft-versus-host-disease-related multi-hit process associated with glomerular deposition of galactose-deficient IgA1. These two cases provide unique insight into the kinetics of overproduction of galactose-deficient IgA1 and its glomerular deposition and consequential renal injury in IgAN.
Hu
Susie L
SL
Division of Kidney Disease and Hypertension, Department of Medicine, Brown University, Warren Alpert Medical School, Providence, RI, USA. Shu@Lifespan.org
Colvin
Gerald A
GA
Rifai
Abdalla
A
Suzuki
Hitoshi
H
Novak
Jan
J
Esparza
Alfredo
A
Farooqi
Shahida
S
Julian
Bruce A
BA
D000328:Adult; D005690:Galactose / Q000172:deficiency*; D005921:Glomerulonephritis / Q000209:etiology* / Q000473:pathology; D005922:Glomerulonephritis, IGA / Q000209:etiology* / Q000473:pathology; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007070:Immunoglobulin A / Q000378:metabolism*; D007668:Kidney / Q000473:pathology; D008297:Male; D008875:Middle Aged
D007070:Immunoglobulin A; D005690:Galactose