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Renal pathology in hematopoietic cell transplantation recipients.
Mod Pathol. 2008 Apr; 21(4):396-406.MP

Abstract

Hematopoietic cell transplantation-associated renal injury may be related to a combination of factors including chemotherapy, radiation, infection, immunosuppressive agents, ischemia, and graft-versus-host disease. Renal biopsy specimens from hematopoietic cell transplant recipients at two institutions (Stanford University Medical Center and Oregon Health & Science University) were reviewed in correlation with clinical data. Fifteen cases were identified (post hematopoietic cell transplant time 0.7-14.5 years), including six with autologous hematopoietic cell transplant. Indications for renal biopsy included proteinuria (n=13; nephrotic range in 8), increased serum creatinine (n=10), or both (n=6). Many patients had multiple pathologic findings on renal biopsy. Membranous glomerulonephritis was the most common diagnosis (n=7), including two patients with autologous hematopoietic cell transplant and five with evidence of chronic graft-versus-host disease elsewhere. Four membranous glomerulonephritis patients achieved sustained remission with rituximab therapy. Other glomerular pathology included focal segmental glomerulosclerosis (n=1) and minimal change disease (n=1). Evidence of thrombotic microangiopathy was common (in isolation or combined with other pathology), as was acute tubular necrosis and tubulointerstitial nephritis. Of 14 patients with follow-up (2-64 months, mean 19 months), 6 had chronic renal insufficiency (serum creatinine >1.5 mg/dl), 2 had end stage renal disease, and 6 had essentially normal renal function. Our retrospective study shows that renal dysfunction in hematopoietic cell transplant recipients is often multifactorial, and biopsy may reveal treatable causes. Membranous glomerulonephritis is seen in autologous and allogeneic hematopoietic cell transplant recipients, and may respond to anti-B-cell therapy, which has implications regarding pathogenesis and relationship to graft-versus-host disease.

Authors+Show Affiliations

Department of Pathology, Oregon Health & Science University, L471, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA. troxellm@ohsu.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18223556

Citation

Troxell, Megan L., et al. "Renal Pathology in Hematopoietic Cell Transplantation Recipients." Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc, vol. 21, no. 4, 2008, pp. 396-406.
Troxell ML, Pilapil M, Miklos DB, et al. Renal pathology in hematopoietic cell transplantation recipients. Mod Pathol. 2008;21(4):396-406.
Troxell, M. L., Pilapil, M., Miklos, D. B., Higgins, J. P., & Kambham, N. (2008). Renal pathology in hematopoietic cell transplantation recipients. Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc, 21(4), 396-406. https://doi.org/10.1038/modpathol.3801011
Troxell ML, et al. Renal Pathology in Hematopoietic Cell Transplantation Recipients. Mod Pathol. 2008;21(4):396-406. PubMed PMID: 18223556.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Renal pathology in hematopoietic cell transplantation recipients. AU - Troxell,Megan L, AU - Pilapil,Maricel, AU - Miklos,David B, AU - Higgins,John P, AU - Kambham,Neeraja, Y1 - 2008/01/25/ PY - 2008/1/29/pubmed PY - 2008/7/23/medline PY - 2008/1/29/entrez SP - 396 EP - 406 JF - Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc JO - Mod Pathol VL - 21 IS - 4 N2 - Hematopoietic cell transplantation-associated renal injury may be related to a combination of factors including chemotherapy, radiation, infection, immunosuppressive agents, ischemia, and graft-versus-host disease. Renal biopsy specimens from hematopoietic cell transplant recipients at two institutions (Stanford University Medical Center and Oregon Health & Science University) were reviewed in correlation with clinical data. Fifteen cases were identified (post hematopoietic cell transplant time 0.7-14.5 years), including six with autologous hematopoietic cell transplant. Indications for renal biopsy included proteinuria (n=13; nephrotic range in 8), increased serum creatinine (n=10), or both (n=6). Many patients had multiple pathologic findings on renal biopsy. Membranous glomerulonephritis was the most common diagnosis (n=7), including two patients with autologous hematopoietic cell transplant and five with evidence of chronic graft-versus-host disease elsewhere. Four membranous glomerulonephritis patients achieved sustained remission with rituximab therapy. Other glomerular pathology included focal segmental glomerulosclerosis (n=1) and minimal change disease (n=1). Evidence of thrombotic microangiopathy was common (in isolation or combined with other pathology), as was acute tubular necrosis and tubulointerstitial nephritis. Of 14 patients with follow-up (2-64 months, mean 19 months), 6 had chronic renal insufficiency (serum creatinine >1.5 mg/dl), 2 had end stage renal disease, and 6 had essentially normal renal function. Our retrospective study shows that renal dysfunction in hematopoietic cell transplant recipients is often multifactorial, and biopsy may reveal treatable causes. Membranous glomerulonephritis is seen in autologous and allogeneic hematopoietic cell transplant recipients, and may respond to anti-B-cell therapy, which has implications regarding pathogenesis and relationship to graft-versus-host disease. SN - 0893-3952 UR - https://www.unboundmedicine.com/medline/citation/18223556/Renal_pathology_in_hematopoietic_cell_transplantation_recipients_ L2 - https://doi.org/10.1038/modpathol.3801011 DB - PRIME DP - Unbound Medicine ER -