Renal pathology in hematopoietic cell transplant recipients: a contemporary biopsy, nephrectomy, and autopsy series

Brian T. Brinkerhoff, Donald Houghton, Megan Troxell

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Renal injury in hematopoietic cell transplant recipients may be related to a combination of factors including chemotherapy, radiation, infection, immunosuppressive agents, ischemia, and graft-versus-host disease, and can involve glomerular, tubulointerstitial, and vascular structures. We reviewed renal pathology from 67 patients at a single institution (2009–2014), including 14 patients with biopsy for clinical dysfunction, 6 patients with surgical kidney resection for other causes, and 47 autopsy patients. Kidney specimens frequently contained multiple histopathologic abnormalities. Thrombotic microangiopathy, membranous nephropathy, minimal change disease, and focal segmental glomerulosclerosis were the most common glomerular findings. Pathologies not previously reported in the hematopoietic cell transplant setting included collapsing glomerulopathy, antiglomerular basement membrane disease, fibrillary glomerulonephritis, and in the case of two surgical resections distinctive cellular segmental glomerular lesions that defied classification. Kidney specimens frequently demonstrated acute tubular injury, interstitial fibrosis, arteriolar hyaline, and arteriosclerosis. Other kidney findings at autopsy included leukemia and amyloid (both recurrent), diabetic nephropathy, bacterial infection, fungal invasion, and silver deposition along glomerular and tubular basement membranes. Also in the autopsy cohort, C4d immunohistochemistry demonstrated unexpected membranous nephropathy in two patients, yet C4d also colocalized with arteriolar hyaline. This retrospective hematopoietic cell transplant cohort illustrates multifaceted renal injury in patients with renal dysfunction, as well as in patients without clinically recognized kidney injury.Modern Pathology advance online publication, 25 March 2016; doi:10.1038/modpathol.2016.61.

Original languageEnglish (US)
JournalModern Pathology
DOIs
StateAccepted/In press - Mar 25 2016

Fingerprint

Nephrectomy
Autopsy
Pathology
Transplants
Kidney
Biopsy
Membranous Glomerulonephritis
Hyalin
Wounds and Injuries
Thrombotic Microangiopathies
Multiple Abnormalities
Lipoid Nephrosis
Transplant Recipients
Focal Segmental Glomerulosclerosis
Glomerular Basement Membrane
Arteriosclerosis
Diabetic Nephropathies
Graft vs Host Disease
Immunosuppressive Agents
Glomerulonephritis

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Renal pathology in hematopoietic cell transplant recipients : a contemporary biopsy, nephrectomy, and autopsy series. / Brinkerhoff, Brian T.; Houghton, Donald; Troxell, Megan.

In: Modern Pathology, 25.03.2016.

Research output: Contribution to journalArticle

@article{2b330b0c1b424660bec849e480189087,
title = "Renal pathology in hematopoietic cell transplant recipients: a contemporary biopsy, nephrectomy, and autopsy series",
abstract = "Renal injury in hematopoietic cell transplant recipients may be related to a combination of factors including chemotherapy, radiation, infection, immunosuppressive agents, ischemia, and graft-versus-host disease, and can involve glomerular, tubulointerstitial, and vascular structures. We reviewed renal pathology from 67 patients at a single institution (2009–2014), including 14 patients with biopsy for clinical dysfunction, 6 patients with surgical kidney resection for other causes, and 47 autopsy patients. Kidney specimens frequently contained multiple histopathologic abnormalities. Thrombotic microangiopathy, membranous nephropathy, minimal change disease, and focal segmental glomerulosclerosis were the most common glomerular findings. Pathologies not previously reported in the hematopoietic cell transplant setting included collapsing glomerulopathy, antiglomerular basement membrane disease, fibrillary glomerulonephritis, and in the case of two surgical resections distinctive cellular segmental glomerular lesions that defied classification. Kidney specimens frequently demonstrated acute tubular injury, interstitial fibrosis, arteriolar hyaline, and arteriosclerosis. Other kidney findings at autopsy included leukemia and amyloid (both recurrent), diabetic nephropathy, bacterial infection, fungal invasion, and silver deposition along glomerular and tubular basement membranes. Also in the autopsy cohort, C4d immunohistochemistry demonstrated unexpected membranous nephropathy in two patients, yet C4d also colocalized with arteriolar hyaline. This retrospective hematopoietic cell transplant cohort illustrates multifaceted renal injury in patients with renal dysfunction, as well as in patients without clinically recognized kidney injury.Modern Pathology advance online publication, 25 March 2016; doi:10.1038/modpathol.2016.61.",
author = "Brinkerhoff, {Brian T.} and Donald Houghton and Megan Troxell",
year = "2016",
month = "3",
day = "25",
doi = "10.1038/modpathol.2016.61",
language = "English (US)",
journal = "Modern Pathology",
issn = "0893-3952",
publisher = "Nature Publishing Group",

}

TY - JOUR

T1 - Renal pathology in hematopoietic cell transplant recipients

T2 - a contemporary biopsy, nephrectomy, and autopsy series

AU - Brinkerhoff, Brian T.

AU - Houghton, Donald

AU - Troxell, Megan

PY - 2016/3/25

Y1 - 2016/3/25

N2 - Renal injury in hematopoietic cell transplant recipients may be related to a combination of factors including chemotherapy, radiation, infection, immunosuppressive agents, ischemia, and graft-versus-host disease, and can involve glomerular, tubulointerstitial, and vascular structures. We reviewed renal pathology from 67 patients at a single institution (2009–2014), including 14 patients with biopsy for clinical dysfunction, 6 patients with surgical kidney resection for other causes, and 47 autopsy patients. Kidney specimens frequently contained multiple histopathologic abnormalities. Thrombotic microangiopathy, membranous nephropathy, minimal change disease, and focal segmental glomerulosclerosis were the most common glomerular findings. Pathologies not previously reported in the hematopoietic cell transplant setting included collapsing glomerulopathy, antiglomerular basement membrane disease, fibrillary glomerulonephritis, and in the case of two surgical resections distinctive cellular segmental glomerular lesions that defied classification. Kidney specimens frequently demonstrated acute tubular injury, interstitial fibrosis, arteriolar hyaline, and arteriosclerosis. Other kidney findings at autopsy included leukemia and amyloid (both recurrent), diabetic nephropathy, bacterial infection, fungal invasion, and silver deposition along glomerular and tubular basement membranes. Also in the autopsy cohort, C4d immunohistochemistry demonstrated unexpected membranous nephropathy in two patients, yet C4d also colocalized with arteriolar hyaline. This retrospective hematopoietic cell transplant cohort illustrates multifaceted renal injury in patients with renal dysfunction, as well as in patients without clinically recognized kidney injury.Modern Pathology advance online publication, 25 March 2016; doi:10.1038/modpathol.2016.61.

AB - Renal injury in hematopoietic cell transplant recipients may be related to a combination of factors including chemotherapy, radiation, infection, immunosuppressive agents, ischemia, and graft-versus-host disease, and can involve glomerular, tubulointerstitial, and vascular structures. We reviewed renal pathology from 67 patients at a single institution (2009–2014), including 14 patients with biopsy for clinical dysfunction, 6 patients with surgical kidney resection for other causes, and 47 autopsy patients. Kidney specimens frequently contained multiple histopathologic abnormalities. Thrombotic microangiopathy, membranous nephropathy, minimal change disease, and focal segmental glomerulosclerosis were the most common glomerular findings. Pathologies not previously reported in the hematopoietic cell transplant setting included collapsing glomerulopathy, antiglomerular basement membrane disease, fibrillary glomerulonephritis, and in the case of two surgical resections distinctive cellular segmental glomerular lesions that defied classification. Kidney specimens frequently demonstrated acute tubular injury, interstitial fibrosis, arteriolar hyaline, and arteriosclerosis. Other kidney findings at autopsy included leukemia and amyloid (both recurrent), diabetic nephropathy, bacterial infection, fungal invasion, and silver deposition along glomerular and tubular basement membranes. Also in the autopsy cohort, C4d immunohistochemistry demonstrated unexpected membranous nephropathy in two patients, yet C4d also colocalized with arteriolar hyaline. This retrospective hematopoietic cell transplant cohort illustrates multifaceted renal injury in patients with renal dysfunction, as well as in patients without clinically recognized kidney injury.Modern Pathology advance online publication, 25 March 2016; doi:10.1038/modpathol.2016.61.

UR - http://www.scopus.com/inward/record.url?scp=84961730246&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84961730246&partnerID=8YFLogxK

U2 - 10.1038/modpathol.2016.61

DO - 10.1038/modpathol.2016.61

M3 - Article

C2 - 27015134

AN - SCOPUS:84961730246

JO - Modern Pathology

JF - Modern Pathology

SN - 0893-3952

ER -