Minimal Change Disease Secondary to Graft-versus-Host Disease after Allogeneic Hematopoietic Cell Transplant for Myelodysplastic Syndrome

Abstract

Chronic graft-versus-host disease (cGVHD) is a leading cause of non-relapse mortality in allogeneic hematopoietic cell transplant (HCT) recipients. While the current standard of care is proactive in detecting cGVHD in the lungs, liver, and skin, cGVHD involving kidneys is an underrecognized and likely underdiagnosed cause of post-HCT renal dysfunction. Nephrotic syndrome (NS) is a very rare complication of HCT that is postulated to be a glomerular manifestation of cGVHD. Herein, we report 2 cases of post-HCT minimal change disease likely secondary to cGVHD. In both cases, the onset of NS coincided with tapering of calcineurin inhibitors, and 1 patient had previously been diagnosed with cGVHD of the lungs. One patient was treated with corticosteroids alone and the other with a corticosteroids and tacrolimus. Complete, sustained remission was achieved in both cases. Our cases illustrate the implications of the association between cGVHD and post-HCT NS for patient care, including the importance of obtaining a renal biopsy to establish an accurate histopathological diagnosis and guide-appropriate treatment.

Keywords: Allogeneic hematopoietic cell transplant; Graft-versus-host disease; Kidney biopsy; Minimal change disease; Nephrotic syndrome.

Fig. 1

a Histopathological images for Patient A; Light microscopy showing normal glomeruli. b Histopathological images for Patient A; Electron microscopy showing podocyte effacement (red arrows).

Fig. 2

a Histopathological images for Patient B; Light microscopy shows normal glomeruli. b Histopathological images for Patient B; Electron microscopy shows podocyte effacement (red arrows).