title: Membranous nephropathy as a manifestation of graft-versus-host disease: association with HLA antigen typing, phospholipase A2 receptor, and C4d.
abstract: Glomerulopathy is an uncommon but increasingly recognized complication of hematopoietic cell transplantation. It typically manifests as membranous nephropathy, less commonly as minimal change disease, and rarely as proliferative glomerulonephritis. There is evidence to suggest that these glomerulopathies might represent manifestations of chronic graft-versus-host disease. In this report, we focus on membranous nephropathy as the most common form of glomerulopathy after hematopoietic cell transplantation. We present a case of membranous nephropathy that developed 483 days post-allogeneic hematopoietic stem cell transplantation in a patient with a history of acute graft-versus-host disease. We also share our experience with 4 other cases of membranous nephropathy occurring after allogeneic hematopoietic stem cell transplantation. Clinicopathologic correlates, including the association with graft-versus-host-disease, HLA antigen typing, glomerular deposition of immunoglobulin G (IgG) subclasses, subepithelial colocalization of IgG deposits with phospholipase A2 receptor staining, C4d deposition along the peritubular capillaries, and treatment, are discussed with references to the literature.
authors.affiliation: Renal Pathology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Cathryn J
authors.initials: CJ
authors.lastname: Byrne-Dugan
authors.affiliation: Renal Pathology, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors.forename: A Bernard
authors.initials: AB
authors.lastname: Collins
authors.affiliation: Renal Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Albert Q
authors.initials: AQ
authors.lastname: Lam
authors.affiliation: Renal Pathology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Electronic address: ib2349@cumc.columbia.edu.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Batal
mesh_terms: D000328:Adult; D015935:Complement C4b; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D015433:Glomerulonephritis, Membranous / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D006086:Graft vs Host Disease / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D006680:HLA Antigens / Q000097:blood; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000737:chemistry; D008297:Male; D010446:Peptide Fragments / Q000097:blood; D017433:Protein Structure, Secondary; D054507:Receptors, Phospholipase A2 / Q000097:blood
chemical_list: D006680:HLA Antigens; D007074:Immunoglobulin G; D010446:Peptide Fragments; D054507:Receptors, Phospholipase A2; D015935:Complement C4b; C032261:complement C4d
keywords: HLA serological subtypes; Membranous nephropathy; complement C4d; glomerulonephritis; graft-vs-host disease; hematopoietic stem cell transplantation; membranous; phospholipase A(2) (PLA(2)R); receptor