title: A 7-year-old boy with renal insufficiency and proteinuria after stem cell transplant for T-cell acute lymphoblastic leukemia.
abstract: Chronic kidney disease is common in pediatric patients following hematopoietic stem cell transplant. Its etiology is likely multifactorial and depends both on pre-conditioning regimens as well as immunosuppressive therapy and posttransplant prophylactic medications. Graft vs. host disease (GVHD) is a common sequela of hematopoietic stem cell transplant and has been associated with the nephrotic syndrome (NS). Here we report a case of a pediatric patient who developed proteinuria and renal insufficiency after stem cell transplant. A kidney biopsy showed chronic interstitial nephritis and extensive foot process effacement, which are likely sequelae of GVHD. Moreover we show decreased CD4 and CD3 lymphocyte counts in the interstitial infiltrate, suggesting that abnormal lymphocyte response might play a role in podocyte injury following GVHD. This case illustrates the importance of the kidney biopsy in the assessment of stem cell transplant-mediated renal failure.
authors: Julie E
authors: JE
authors: Goodwin
authors: Matthew
authors: M
authors: Palmer
authors: Farzana
authors: F
authors: Pashankar
authors: Alda
authors: A
authors: Tufro
authors: Gilbert
authors: G
authors: Moeckel
mesh_terms: D001706:Biopsy; D002648:Child; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000209:etiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007668:Kidney / Q000473:pathology; D008297:Male; D009395:Nephritis, Interstitial / Q000175:diagnosis / Q000209:etiology*; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000601:surgery*; D011237:Predictive Value of Tests; D011507:Proteinuria / Q000175:diagnosis / Q000209:etiology*; D012008:Recurrence; D051437:Renal Insufficiency / Q000175:diagnosis / Q000209:etiology*
references: J Clin Invest. 2009 May;119(5):1264-74
references: 19349693
references: J Clin Invest. 2009 May;119(5):1286-97
references: 19381017
references: Nihon Jinzo Gakkai Shi. 2007;49(8):999-1006
references: 18186228
references: Biol Blood Marrow Transplant. 2008 Dec;14(12):1365-72
references: 19041058
references: Clin J Am Soc Nephrol. 2006 Jul;1(4):685-94
references: 17699273
references: Nephrology (Carlton). 2008 Jun;13(4):322-30
references: 18221254
references: Kidney Int. 1989 Jun;35(6):1336-44
references: 2671466
references: J Nephrol. 2002 Jan-Feb;15(1):79-82
references: 11936432
references: Radiother Oncol. 1990;18 Suppl 1:139-42
references: 2247640
references: J Am Soc Nephrol. 2009 Jan;20(1):57-67
references: 19020006
references: Haematologica. 2005 Apr;90(4):569-70
references: 15820963
references: Am J Kidney Dis. 2005 Apr;45(4):780-5
references: 15806483
references: J Formos Med Assoc. 2000 Jun;99(6):503-6
references: 10925558
references: Br J Haematol. 2005 Oct;131(1):74-9
references: 16173966
references: Blood. 2006 Feb 15;107(4):1717-23
references: 16278306
references: Haematologica. 2005 Nov;90 Suppl:ECR31
references: 16266922
references: Int J Radiat Oncol Biol Phys. 2004 Mar 1;58(3):809-16
references: 14967438
references: Blood Cells Mol Dis. 2011 Feb 15;46(2):182-7
references: 21212006
references: Bone Marrow Transplant. 2007 Jun;39(11):717-23
references: 17401393
references: Nephrol Dial Transplant. 2007 May;22(5):1369-76
references: 17255123
references: J Am Soc Nephrol. 2006 Jul;17(7):1995-2005
references: 16723390
references: Nephrol Dial Transplant. 2009 Oct;24(10):2984-6
references: 19654228