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Clinicopathologic analysis of renal biopsies after haematopoietic stem cell transplantation.
Nephrology (Carlton). 2008 Jun; 13(4):322-30.N

Abstract

AIM

The ever-growing number and increasing survival of haematopoietic stem cell transplantation (HSCT) allow better recognition of its associated renal injuries. We aimed to study the clinicopathologic features of renal biopsies after HSCT by reviewing 13 percutaneous renal biopsies in our institute (Queen Mary Hospital).

METHODS

A retrospective clinicopathologic study of all renal biopsies archived to the Department of Pathology, Queen Mary Hospital during the period January 1999 to December 2006 was performed. Biopsies from patients with HSCT were selected. Clinical data on presentation and follow up were retrieved from hospital records and physicians.

RESULTS

In the 8-year period, a total of 2233 native renal biopsies were archived. Thirteen renal biopsies were selected from 12 patients with HSCT (11 allogeneic, one autologous). All but one patient were male. The age at renal biopsy ranged from 7 to 63 years (median: 32 years). The median interval of renal biopsy after HSCT was 24 months (range 1-134 months). Evidence of graft-versus-host disease was found in nine patients. The most common presentation was significant proteinuria (10 cases) and renal impairment (eight cases). The predominant histological changes were membranous glomerulonephritis (n = 4) and thrombotic microangiopathy (n = 4). One case of focal segmental glomerulosclerosis, IgA nephropathy, minimal change disease, acute tubular necrosis and hypertensive nephrosclerosis were also recorded. Four of our patients died at 0-11 months after renal biopsy. Of the remaining eight patients with a mean follow up of 43.6 months (range, 10-98 months), chronic renal impairment were found in three (37.5%) patients and significant proteinuria also persisted in three. One patient had cytogenetic evidence of relapse of underlying haematological malignancy after HSCT.

CONCLUSION

Among the various renal lesions after HSCT, membranous glomerulonephritis and thrombotic microangiopathy were the most common. Mechanisms of renal injury varied from graft-versus-host disease-associated immune complex deposition to non-immune complex injury on endothelial cells, glomerular epithelial cells and tubular epithelium. Pathologists and clinicians should attend to the histological and temporal heterogeneity of renal injury when managing patients after HSCT.

Authors+Show Affiliations

Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong. gavinchansw@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18221254

Citation

Chan, Gavin S W., et al. "Clinicopathologic Analysis of Renal Biopsies After Haematopoietic Stem Cell Transplantation." Nephrology (Carlton, Vic.), vol. 13, no. 4, 2008, pp. 322-30.
Chan GS, Lam MF, Au WY, et al. Clinicopathologic analysis of renal biopsies after haematopoietic stem cell transplantation. Nephrology (Carlton). 2008;13(4):322-30.
Chan, G. S., Lam, M. F., Au, W. Y., Chim, S., Tse, K. C., Lo, S. H., Fung, S. H., Lai, K. N., & Chan, K. W. (2008). Clinicopathologic analysis of renal biopsies after haematopoietic stem cell transplantation. Nephrology (Carlton, Vic.), 13(4), 322-30. https://doi.org/10.1111/j.1440-1797.2007.00915.x
Chan GS, et al. Clinicopathologic Analysis of Renal Biopsies After Haematopoietic Stem Cell Transplantation. Nephrology (Carlton). 2008;13(4):322-30. PubMed PMID: 18221254.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinicopathologic analysis of renal biopsies after haematopoietic stem cell transplantation. AU - Chan,Gavin S W, AU - Lam,Man Fai, AU - Au,Wing Yan, AU - Chim,Stella, AU - Tse,Kai Chung, AU - Lo,Stanley H K, AU - Fung,Shing Hoi, AU - Lai,Kar Neng, AU - Chan,Kwok Wah, Y1 - 2008/01/23/ PY - 2008/1/29/pubmed PY - 2008/6/27/medline PY - 2008/1/29/entrez SP - 322 EP - 30 JF - Nephrology (Carlton, Vic.) JO - Nephrology (Carlton) VL - 13 IS - 4 N2 - AIM: The ever-growing number and increasing survival of haematopoietic stem cell transplantation (HSCT) allow better recognition of its associated renal injuries. We aimed to study the clinicopathologic features of renal biopsies after HSCT by reviewing 13 percutaneous renal biopsies in our institute (Queen Mary Hospital). METHODS: A retrospective clinicopathologic study of all renal biopsies archived to the Department of Pathology, Queen Mary Hospital during the period January 1999 to December 2006 was performed. Biopsies from patients with HSCT were selected. Clinical data on presentation and follow up were retrieved from hospital records and physicians. RESULTS: In the 8-year period, a total of 2233 native renal biopsies were archived. Thirteen renal biopsies were selected from 12 patients with HSCT (11 allogeneic, one autologous). All but one patient were male. The age at renal biopsy ranged from 7 to 63 years (median: 32 years). The median interval of renal biopsy after HSCT was 24 months (range 1-134 months). Evidence of graft-versus-host disease was found in nine patients. The most common presentation was significant proteinuria (10 cases) and renal impairment (eight cases). The predominant histological changes were membranous glomerulonephritis (n = 4) and thrombotic microangiopathy (n = 4). One case of focal segmental glomerulosclerosis, IgA nephropathy, minimal change disease, acute tubular necrosis and hypertensive nephrosclerosis were also recorded. Four of our patients died at 0-11 months after renal biopsy. Of the remaining eight patients with a mean follow up of 43.6 months (range, 10-98 months), chronic renal impairment were found in three (37.5%) patients and significant proteinuria also persisted in three. One patient had cytogenetic evidence of relapse of underlying haematological malignancy after HSCT. CONCLUSION: Among the various renal lesions after HSCT, membranous glomerulonephritis and thrombotic microangiopathy were the most common. Mechanisms of renal injury varied from graft-versus-host disease-associated immune complex deposition to non-immune complex injury on endothelial cells, glomerular epithelial cells and tubular epithelium. Pathologists and clinicians should attend to the histological and temporal heterogeneity of renal injury when managing patients after HSCT. SN - 1440-1797 UR - https://www.unboundmedicine.com/medline/citation/18221254/Clinicopathologic_analysis_of_renal_biopsies_after_haematopoietic_stem_cell_transplantation_ L2 - https://doi.org/10.1111/j.1440-1797.2007.00915.x DB - PRIME DP - Unbound Medicine ER -