Five Cases Of Membranous Nephropathy After Allogeneic Haematopoietic Stem Cell Transplantation:Clinicol Analysis And Literature Review

Objective:To investigate the clinical manifestations, pathological features, experience of diagnosis and treatment, and outcome of membranous nephropathy after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods:Analysis were carried out based on a total five cases of renal complication after allo-HSCT in the Nephrology Center between February2007to February2011. Clinical manifestations, pathological characteristics and response to treatment were summarized, and probable factors that may influence the incidence were described.Results:All of the five cases present as late-onset nephrotic syndrome (NS). Renal pathologies were all showed membranous nephropathy (MGN). The incidence of NS/MGN after allo-HSCT in our ceter was about1.9%. All of the cases were suffered from chronic graft-versus-host disease (cGVHD). Immunohistochemistry mainly displayed that the immunoglobulin (Ig) of immune complex deposition were IgG, IgM and C3. Cytomegalovirus antigen (CMV) was positive in all cases. ANA were positive in three cases. Serum Ig was normal in all of the patients. Treatment base on glucocorticoids combined with cyclosporine (CsA)/tacrolimus (FK506) showed effective, if necessary, plus mycophenolate mofetil(MMF) as a stepped-up strategy. All of the five cases were in complete remission, while there were individual differences of the onset time.Conclusion:The renal pathology of late-onset NS after allo-HSCT mostly was MGN. The pathogenesis might associate with abnormality of humoral immunity. Treatment regime base on glucocorticoids combined with calcium calcineurin inhibitors (CNI), such as CsA or FK506, if necessary, plus MMF, showed a well curative effect. It is expected to carry out a further research on relationship between the prevention of cGVHD and the incidence of nephropathy after allo-HSCT.