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Graft versus host disease-dependent renal dysfunction after hematopoietic stem cell transplantation

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Abstract

Nephropathy is an important complication in hematopoietic stem cell transplantation (HSCT) wherein multifactorial causes, i.e., radiation, drug toxicity, graft versus host disease (GVHD), are thought to contribute renal dysfunction. Here, we report a 10-year-old boy with high-risk acute myelocytic leukemia and severe but partially reversible renal dysfunction. The patient initially received umbilical cord blood transplantation (UCBT) with CY 120 mg/kg and kidney unshielded 12 Gy of total body irradiation. After the leukemic relapse, he received allogenic bone marrow transplantation (BMT) 270 days after the first transplantation. Two months later, his renal function started to deteriorate and urinary protein increased gradually to 1 g/day. Four months after BMT, by the symptoms of severe GVHD, the dose of tacrolimus, utilized to avoid GVHD, was increased although his serum Cre level elevated to 2.97 mg/dL. Serum Cre level improved to 2.0 mg/dL paralleled with GVHD improvement. Renal histological findings showed severe interstitial edema, features of thrombotic microangiopathy (TMA), and C4d deposition along the glomerular capillaries and peritubular capillaries. We suggested that control of GVHD had benefitted to ameliorate renal function of the patient. Treatment for GVHD improved renal dysfunction and TMA of our patients. Moreover, renal biopsy was powerful to elucidate the exact origin of renal dysfunction after HSCT.

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References

  1. Sakai K, Usui J, Kai H, Hagiwara M, Morito N, Saito C, Yoh K, Tsuruoka W, Hirayama K, Aita K, Nagata M, Yamagata K. Secondary membranous glomerulonephritis associated with recipient residual lymphoma cells after allogeneic bone marrow transplantation. Clin Exp Nephrol. 2009;13:174–8.

    Article  CAS  PubMed  Google Scholar 

  2. Hazar V, Gungor O, Guven AG, Aydin F, Akbas H, Gungor F, Tezcan G, Akman S, Yesilipek A. Renal function after hematopoietic stem cell transplantation in children. Pediatr Blood Cancer. 2009;53:197–202.

    Article  PubMed  Google Scholar 

  3. Batts ED, Lazarus HM. Diagnosis and treatment of transplantation-associated thrombotic microangiopathy: real progress or are we still waiting? Bone Marrow Transplant. 2007;40:709–19.

    Article  CAS  PubMed  Google Scholar 

  4. Singh N, McNeely J, Parikh S, Bhinder A, Rovin BH, Shidham G. Kidney complications of hematopoietic stem cell transplantation. Am J Kidney Dis. 2013;61(5):809–21.

    Article  CAS  PubMed  Google Scholar 

  5. Cilley J, Winter JN. Radioimmunotherapy and autologous stem cell transplantation for the treatment of B-cell lymphomas. Haematologica. 2006;91:113–20.

    Google Scholar 

  6. Kempen-Harteveld ML, Brand R, Kal HB, Verdonck LF, Hofman P, Schattenberg AV, Maazen RW, Cornelissen JJ, Eijkenboom WMH, Lelie JP, Oldenburger F, Barge RM, Biezen A, Vossen JMJJ, Noordijk EM, Struikmans H. Results of hematopoietic stem cell transplantation after treatment with different high-dose total-body irradiation regimens in five Dutch centers. Int J Radiat Oncol Biol Phys. 2008;71(5):1444–54.

    Article  PubMed  Google Scholar 

  7. Huck K, Laws H-J, Meisel R, Tröger A, Bernbeck B, Schönberger S, Stackelbergv A, Pape H, Dilloo D. Three cases of renal relapse after allogeneic hematopoietic stem cell transplantation for childhood acute lymphoblastic leukemia. Haematologica. 2006;91(2):e20–5.

    Google Scholar 

  8. Mii A, Shimizu A, Kaneko T, Fujita E, Fukui M, Fujino T, Utsumi K, Yamaguchi H, Tajika K, Tsuchiya S, Iino Y, Katayama Y, Fukuda Y. Renal thrombotic microangiopathy associated with chronic graft-versus-host disease after allogenic hematopoietic stem cell transplantation. Pathol Ontario. 2011;61(9):518–27.

    Google Scholar 

Download references

Acknowledgments

The authors are deeply grateful to Shigeru Horita and Motoshi Hattori (Tokyo Women’s Medical University) for C4d staining.

Conflict of interest

All the authors have declared no competing interest.

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Correspondence to Yaeko Motoyoshi.

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Motoyoshi, Y., Endo, A., Takagi, M. et al. Graft versus host disease-dependent renal dysfunction after hematopoietic stem cell transplantation. CEN Case Rep 3, 202–205 (2014). https://doi.org/10.1007/s13730-014-0118-1

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  • DOI: https://doi.org/10.1007/s13730-014-0118-1

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