Bai Ming-Chuan, Wu Jing-Jing, Miao Kou-Rong, Zhu Jing-Feng, Mao Hui-Juan
Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
World J Clin Cases. 2021 Jan 26;9(3):614-622. doi: 10.12998/wjcc.v9.i3.614.
Hematopoietic stem cell transplantation (HSCT) is widely used in the treatment of hematological diseases. However, complications after transplantation, such as acute and chronic graft--host disease (GVHD), still seriously affect the quality of life and even threaten the lives of patients. There is evidence that glomerular diseases can manifest as GVHD. However, GVHD should not occur as a result of syngeneic HSCT.
A 20-year-old male diagnosed with T lymphoblastic lymphoma (stage IIIA, aaIPI 1) in September 2013 was treated with six cycles of hyper-CVAD and achieved complete remission. He underwent syngeneic HSCT in June 2014, and had no kidney disease history before the transplant. However, nephrotic syndrome occurred 24 mo later in the patient after syngeneic HSCT. Renal biopsy was performed, which led to a diagnosis of atypical membranous nephropathy. After treatment with glucocorticoids combined with cyclophosphamide and cyclosporine, the nephrotic syndrome was completely relieved.
We report a case of delayed nephrotic syndrome after syngeneic HSCT. Antibody-mediated autoimmune glomerular disease may be the underlying mechanism. After treatment with immunosuppressive agents, the nephrotic syndrome was completely relieved but further long-term follow-up is still needed.
造血干细胞移植（HSCT）广泛应用于血液系统疾病的治疗。然而，移植后的并发症，如急慢性移植物抗宿主病（GVHD），仍然严重影响患者的生活质量，甚至威胁患者生命。有证据表明，肾小球疾病可表现为GVHD。然而，同基因HSCT不应导致GVHD的发生。
一名20岁男性，2013年9月被诊断为T淋巴母细胞淋巴瘤（ⅢA期，aaIPI 1），接受了6个周期的Hyper-CVAD治疗并获得完全缓解。他于2014年6月接受了同基因HSCT，移植前无肾脏疾病史。然而，同基因HSCT术后24个月，该患者发生了肾病综合征。进行了肾活检，诊断为非典型膜性肾病。经糖皮质激素联合环磷酰胺及环孢素治疗后，肾病综合征完全缓解。
我们报告了1例同基因HSCT术后迟发性肾病综合征病例。抗体介导的自身免疫性肾小球疾病可能是其潜在机制。经免疫抑制剂治疗后，肾病综合征完全缓解，但仍需进一步长期随访。
