Chronic graft-versus-host disease of the kidney in patients with allogenic hematopoietic stem cell transplant.

Allogenic hematopoietic stem cell transplant (allo-HSCT) is the treatment of choice for several hematological diseases. Although rare, patients could present nephrotic syndrome as a clinical feature of chronic graft-versus-host disease (cGVHD). The objective of our study is to screen patients with allo-HSCT to determine who developed a glomerular pathology in the context of cGVHD. We studied patients who underwent allo-HSCT treatment in our center between October 1995 and October 2012 and who developed glomerular pathology. cGVHD was defined as a pathology when it appeared after 100 d post-allo-HSCT. Five hundred eighty-three allo-HSCT were performed. The prevalence of cGVHD of the kidney was 1.03%. All patients with cGVHD of the kidney were hosts who received peripheral blood from an identical HLA match donor. GVHD prophylaxis with calcineurin inhibitors plus methotrexate was administered in five cases, and prophylaxis with sirolimus was used in another case. cGVHD of the kidney was seen to appear after the removal of the prophylaxis for GVHD, within 33 ± 11.54 months intervals after allo-HSCT in five patients and in another patient, it appeared despite immunosuppressive therapy being administered. All patients had proteinuria, within 11.82 ± 9.03 g/d ranges. The kidney biopsies revealed membranous glomerulonephritis (four patients), focal segmental glomerulonephritis (one patient) and lupus nephropathy class III (one patient). It seems, immunosuppressive therapy achieved complete remission, within the first year of treatment in four patients. Although in three of them, the proteinuria recurred when we tried to remove the therapy; two patients have recently started treatment, being in partial remission now. cGVHD of the kidney is a rare complication after allo-HSCT, related with the removal of the immunosuppression. Monitoring proteinuria in these patients may be useful. In our patients, a complete remission was achieved; although the removal of the immunosuppression may lead to the appearance of outbreaks. We must reconsider the treatment of glomerular pathology secondary to cGVHD.

Fraile P ，Vazquez L ，Caballero D ，Garcia-Cosmes P ，López L ，San Miguel J ，Tabernero JM ... -  《-》

[Clinical analysis of late-onset nephrotic syndrome after allogenic hematopoietic stem cell transplantation].

Luo XD ，Liu QF ，Ning J ，Wei YQ ，Fan ZP ，Zhang Y ，Sun J ... -  《-》

[Outcome of allogeneic hematopoietic stem cell transplantation from HLA-matched sibling donor for 41 cases of severe aplastic anemia].

Chen X ，Wei JL ，Huang Y ，He Y ，Yang DL ，Jiang EL ，Ma QL ，Zhou LK ，Lin XT ，Shen YY ，Feng SZ ，Han MZ ... -  《-》

Post-allogeneic haematopoietic stem cell transplantation membranous nephropathy: clinical presentation, outcome and pathogenic aspects.

Terrier B ，Delmas Y ，Hummel A ，Presne C ，Glowacki F ，Knebelmann B ，Combe C ，Lesavre P ，Maillard N ，Noël LH ，Patey-Mariaud de Serre N ，Nusbaum S ，Radford I ，Buzyn A ，Fakhouri F ... -  《NEPHROLOGY DIALYSIS TRANSPLANTATION》

[Liver biopsy in the management of liver dysfunction after allogeneic hematopoietic stem-cell transplantation].

Chen H ，Huang XJ ，Liu KY ，Xu LP ，Wang H ，Liu DH ，Lu J ，Lu DP ... -  《-》