TY - JOUR
T1 - Membranous Nephropathy With Extensive Tubular Basement Membrane Deposits Following Allogeneic Hematopoietic Cell Transplant
T2 - A Report of 5 Cases
AU - Nasr, Samih H.
AU - Leung, Nelson
AU - Said, Samar M.
AU - Alkhateeb, Hassan B.
AU - Madden, Benjamin J.
AU - Charlesworth, M. Cristine
AU - Beck, Laurence H.
AU - Larsen, Christopher P.
AU - Sethi, Sanjeev
N1 - Funding Information:
This work was supported in part by funding from the Department of Laboratory Medicine and Pathology at the Mayo Clinic, which had no role in defining the content of the report.
Publisher Copyright:
© 2021 National Kidney Foundation, Inc.
PY - 2022/6
Y1 - 2022/6
N2 - Tubular basement membrane (TBM) deposits are very uncommon in non-lupus membranous nephropathy. We report 5 patients with membranous nephropathy and extensive TBM deposits following allogeneic hematopoietic cell transplant. Patients presented with nephrotic syndrome (3 also had acute kidney injury) late post-transplant in association with chronic graft-versus-host disease (cGVHD). Kidney biopsies revealed global subepithelial and extensive TBM immune complex deposits, accompanied by acute tubular injury (n = 4) and tubulointerstitial inflammation (n = 4). Proteomic analysis of glomeruli in 4 cases identified PLA2R in 1, with no significant protein spectra for PLA2R, THSD7A, EX1/2, NELL-1, PCDH7, NCAM1, or SEMA3B detected in the remaining 3. On follow-up (for a mean 42 months), 4 patients had complete and 1 partial remission following prednisone and/or rituximab therapy. We propose that membranous nephropathy with extensive TBM deposits is a distinctive clinicopathologic lesion associated with allogeneic hematopoietic cell transplant. Pathogenesis likely involves cGVHD-driven antibodies against glomerular and TBM components, the identity of which remains to be elucidated.
AB - Tubular basement membrane (TBM) deposits are very uncommon in non-lupus membranous nephropathy. We report 5 patients with membranous nephropathy and extensive TBM deposits following allogeneic hematopoietic cell transplant. Patients presented with nephrotic syndrome (3 also had acute kidney injury) late post-transplant in association with chronic graft-versus-host disease (cGVHD). Kidney biopsies revealed global subepithelial and extensive TBM immune complex deposits, accompanied by acute tubular injury (n = 4) and tubulointerstitial inflammation (n = 4). Proteomic analysis of glomeruli in 4 cases identified PLA2R in 1, with no significant protein spectra for PLA2R, THSD7A, EX1/2, NELL-1, PCDH7, NCAM1, or SEMA3B detected in the remaining 3. On follow-up (for a mean 42 months), 4 patients had complete and 1 partial remission following prednisone and/or rituximab therapy. We propose that membranous nephropathy with extensive TBM deposits is a distinctive clinicopathologic lesion associated with allogeneic hematopoietic cell transplant. Pathogenesis likely involves cGVHD-driven antibodies against glomerular and TBM components, the identity of which remains to be elucidated.
KW - Membranous nephropathy
KW - TBM deposits
KW - acute kidney injury (AKI)
KW - case report
KW - graft-versus-host disease
KW - hematopoietic cell transplant
KW - interstitial nephritis
KW - nephrotic syndrome
KW - renal biopsy
KW - tubular basement membrane (TBM)
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U2 - 10.1053/j.ajkd.2021.07.021
DO - 10.1053/j.ajkd.2021.07.021
M3 - Article
C2 - 34508832
AN - SCOPUS:85119956526
SN - 0272-6386
VL - 79
SP - 904
EP - 908
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 6
ER -