Renal pathology associated with hematopoietic stem cell transplantation

Megan L. Troxell, John P. Higgins, Neeraja Kambham

Research output: Contribution to journalReview article

8 Scopus citations

Abstract

The kidney is subject to a large variety of injurious factors before, during, and after hematopoietic stem cell transplantation (HCT), leading to a high incidence of acute kidney injury in the peritransplant period. Chronic kidney disease is estimated to impact 15% to 20% of HCT recipients. Although renal biopsies may be deferred in the setting of thrombotic microangiopathy, acute self-limited impairment, or slowly progressive functional decline, in many patients renal biopsy yields important diagnostic insight to guide treatment. Light microscopic, immunofluorescence, and ultrastructural analysis often reveals a number of concurrent abnormalities in glomeruli, tubules, interstitium, and vessels. Meta-analysis of the literature reveals that membranous nephropathy is the most commonly reported glomerular lesion in the setting of HCT, followed by minimal change disease. Autopsy and biopsy studies show that clinical criteria lack sensitivity and specificity for renal acute and chronic thrombotic microangiopathy. Viral infection and other causes of interstitial nephritis and tubular injury are important findings in HCT renal biopsies, which in many instances may not be clinically suspected. Given the complexity and variability of HCT protocols, clinicopathologic correlation is needed.

Original languageEnglish (US)
Pages (from-to)330-340
Number of pages11
JournalAdvances in Anatomic Pathology
Volume21
Issue number5
DOIs
StatePublished - Sep 2014

Keywords

  • graft versus hostdisease
  • hematopoietic stem cell transplant
  • kidney
  • membranous nephropathy
  • thrombotic microangiopathy

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine

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