Renal Pathology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Renal Pathology, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Am J Kidney Dis. 2014 Dec;64(6):987-93. doi: 10.1053/j.ajkd.2014.09.001. Epub 2014 Oct 8.
Glomerulopathy is an uncommon but increasingly recognized complication of hematopoietic cell transplantation. It typically manifests as membranous nephropathy, less commonly as minimal change disease, and rarely as proliferative glomerulonephritis. There is evidence to suggest that these glomerulopathies might represent manifestations of chronic graft-versus-host disease. In this report, we focus on membranous nephropathy as the most common form of glomerulopathy after hematopoietic cell transplantation. We present a case of membranous nephropathy that developed 483 days post-allogeneic hematopoietic stem cell transplantation in a patient with a history of acute graft-versus-host disease. We also share our experience with 4 other cases of membranous nephropathy occurring after allogeneic hematopoietic stem cell transplantation. Clinicopathologic correlates, including the association with graft-versus-host-disease, HLA antigen typing, glomerular deposition of immunoglobulin G (IgG) subclasses, subepithelial colocalization of IgG deposits with phospholipase A2 receptor staining, C4d deposition along the peritubular capillaries, and treatment, are discussed with references to the literature.
肾小球病是造血细胞移植后一种不常见但日益被认识到的并发症。它通常表现为膜性肾病，较少表现为微小病变病，很少表现为增生性肾小球肾炎。有证据表明，这些肾小球病可能代表慢性移植物抗宿主病的表现。在本报告中，我们重点关注造血细胞移植后最常见的肾小球病形式——膜性肾病。我们报告了 1 例在急性移植物抗宿主病病史患者中，在异基因造血干细胞移植后 483 天发生的膜性肾病病例。我们还分享了另外 4 例异基因造血干细胞移植后发生的膜性肾病病例的经验。讨论了临床病理相关性，包括与移植物抗宿主病的关联、HLA 抗原分型、免疫球蛋白 G (IgG)亚类在肾小球中的沉积、IgG 沉积与磷脂酶 A2 受体染色的上皮下共定位、沿肾小管毛细血管的 C4d 沉积以及治疗，并参考文献进行了讨论。
