Membranous Nephropathy in Chronic Graft Versus Host Disease after Allogeneic Hematopoietic Stem Cell Transplantation: A Case Report and Literature Review
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Abstract
Hematopoietic stem cell transplantation (HSCT) is one of the most effective therapeutic modalities for malignant and non-malignant hematologic diseases. Although HSCT can result in satisfactory patient outcomes, complications during the procedure are not uncommon. Graft versus host disease (GVHD) is a serious complication in HSCT that may result in death of the recipients. GVHD is categorized into acute and chronic variants depending on the time of onset. The acute presentation occurs during the first 7-100 days and the chronic presentation occurs after 100 days of HSCT. GVHD may affect several organs including the kidneys. Most patients present with nephritic or nephrotic syndrome. Although the incidence of membranous nephropathy is low, it is the most common cause of glomerular disease after HSCT and is associated with chronic GVHD. A proposed mechanism of membranous nephropathy in this setting is immune dysregulation from B-cells and T-cells. Autoantibodies induced by donor immune cells can target podocyte antigens of the recipients. Treatment decision normally depends on the severity of the disease. Rituximab has become the initial immunosuppressive therapy of choice among those with severe presentation. Cyclosporine or tacrolimus with steroid is another alternative treatment regimen.
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