A case of membranous nephropathy as a manifestation of graft-versus-host disease

Abstract

Nephrotic syndrome (NS) rarely occurs after hematopoietic stem cell transplantation (HSCT) as a late manifestation of graft-versus-host disease (GVHD). Herein, we report a case of HSCT-associated membranous nephropathy in a female patient with aplastic anemia. The patient received an allogeneic HSCT from her human leukocyte antigen-identical brother following myeloablative conditioning chemotherapy. NS occurred 21 months after HSCT without any concurrent features of chronic GVHD. The patient was treated with prednisolone and cyclosporine after renal biopsy confirmed membranous nephropathy, and achieved complete remission. Our report contradicts previous assumptions that concomitant chronic GVHD is responsible for the development of NS, suggesting that NS can develop as a new, independent manifestation of GVHD.

Keywords: Graft-versus-host disease; Membranous nephropathy; Nephrotic syndrome.

Figure 1

Pathologic findings in a patient with membranous nephropathy as a manifestation of graft versus host disease. (A) Light microscopy shows normal appearance of glomeruli without thickened basement membrane (original magnification ×400). (B) Immunohistochemical staining identifies CD3+, suggesting infiltration of T cells in the interstitium (original magnification ×100). (C) Immunofluorescence staining shows granular pattern of IgG (2+) deposition along the peripheral capillary wall. (D) Electron microscopy shows numerous nodular electron-dense deposits in the subepithelial space.