Renal pathology in hematopoietic cell transplantation recipients

Megan L. Troxell, Maricel Pilapil, David B. Miklos, John P. Higgins, Neeraja Kambham

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43 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)396-406
Number of pages11
JournalModern Pathology
Volume21
Issue number4
DOIs
StatePublished - Apr 1 2008

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Keywords

  • Calcineurin inhibitor toxicity
  • Graft-versus-host disease
  • Hematopoietic cell transplantation
  • Membranous glomerulonephritis
  • Rituximab
  • Thrombotic microangiopathy

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Troxell, M. L., Pilapil, M., Miklos, D. B., Higgins, J. P., & Kambham, N. (2008). Renal pathology in hematopoietic cell transplantation recipients. Modern Pathology, 21(4), 396-406. https://doi.org/10.1038/modpathol.3801011