Details

Autor(en) / Beteiligte

• Hiramatsu, Rikako, MD
• Ubara, Yoshifumi, MD, PhD
• Sawa, Naoki, MD
• Hasegawa, Eiko, MD
• Kawada, Masahiro, MD
• Imafuku, Aya, MD
• Sumida, Keiichi, MD
• Mise, Koki, MD
• Yamanouchi, Masayuki, MD
• Ueno, Toshiharu, MD
• Sekine, Akinari, MD
• Hayami, Noriko, MD
• Suwabe, Tatsuya, MD
• Hoshino, Junichi, MD
• Takaichi, Kenmei, MD
• Ohashi, Kenichi, MD
• Fujii, Takeshi
• Wake, Atsushi
• Taniguchi, Shuichi

Titel

Clinicopathological Analysis of Allogeneic Hematopoietic Stem Cell Transplantation-related Membranous Glomerulonephritis

Ist Teil von

• Human pathology, 2016-04, Vol.50, p.187-194

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2016

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• Summary Allogeneic hematopoietic stem cell transplantation (HSCT)-related membranous glomerulonephritis (MGN) is poorly understood. A total of 830 patients who underwent HSCT at Toranomon Hospital from 2000 to 2012 were evaluated retrospectively, including 621 patients receiving umbilical cord blood transplantation (UCBT) and 208 patients receiving unrelated bone marrow transplantation (BMT). MGN was diagnosed in 5 patients after UCBT (vs. none after BMT), and occurred concomitantly with chronic graft-versus-host-disease after cessation of immunosuppression. LM did not show any definite spikes or bubbling of the glomerular basement membrane (GBM) in all 5 patients. In 1 patient (case 5), endocapillary proliferative lesions with fibrin-like deposits were noted in addition to MGN findings. IF demonstrated granular deposits of IgG (IgG1 and IgG4) along the GBM with negativity for C3, C4, and C1q in 4 patients (cases 1-4), while case 5 showed positivity for IgG (IgG1, IgG2, IgG3, and IgG4) as well as for C3, C4, and C1q. EM revealed electron-dense deposits (EDD) in the subepithelial space of the GBM in cases 1-4. In case 5, EDD were present in the mesangium and the subendothelial space of the GBM, as well as in the subepithelial space. After treatment with immunosuppressants (prednisolone and/or cyclosporin) or angiotensin-converting enzyme inhibitors, complete remission with disappearance of proteinuria was achieved 12.2 months in all 5 patients, but nephrotic range proteinuria relapsed in two patients during follow up. Serum anti-PLA2R autoantibody was negative in three patients. HSCT-related MGN only occurred after umbilical cord blood transplantation (UCBT). We believe that there were two morphologic patterns; early MGN and membranoproliferative pattern glomerulonephritis.