Nephrotic Syndrome after Hematopoietic Cell Transplantation

Glomerular disease associated with nephrotic syndrome has rarely been recognized as a distinct complication of allogeneic hematopoietic cell transplantation. This review article considers whether these glomerular lesions represent renal graft-versus-host disease (GVHD). Case reports in the English and Japanese literature since 1988 have described variable glomerular histology, comprising mainly membranous glomerulonephritis (MGN) in almost two thirds and minimal change disease (MCD) in nearly one quarter of patients. The authors found a close temporal relationship between the development of nephrotic syndrome shortly after cessation of immunosuppression and the diagnosis of chronic GVHD. An association of glomerular disease with simultaneous GVD was seen in 47 percent of patients overall. Nephrotic syndrome followed GVHD within 5 months in 60 percent of the combined MCD and MGN reports. A decrease in immunosuppressive medication use was linked to nephrotic syndrome occurrence within 9 months in 63 percent of patients with MCD and MGN. MCD occurred earlier after hematopoietic cell transplantation, was diagnosed sooner after medication change, and exhibited a better prognosis in comparison with MGN. The authors conclude that glomerular lesions after hematopoietic cell transplantation may therefore represent the kidney manifestation of GVHD.

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