Clinical analysis of six cases with the de novo glomerulitis after allogeneic hematopoietic stem cell transplantation
10.3760/cma.j.issn.0253-2727.2018.09.011
- VernacularTitle: 异基因造血干细胞移植后肾小球肾炎六例临床分析
- Author:
Jian ZHOU
1
;
Yingling ZU
;
Ruirui GUI
;
Yanli ZHANG
;
Yuewen FU
;
Fengkuan YU
;
Huifang ZHAO
;
Zhen LI
;
Quande LIN
;
Juan WANG
;
Wenli ZUO
;
Yongping SONG
Author Information
1. Department of Hematology, Affiliated Cancer Hospital Zhengzhou University, Henan Tumor Hospital, Institute of Hematology, Zhengzhou 450003, China
- Publication Type:Journal Article
- Keywords:
Hematopoietic stem cell transplantation;
Glomerulonephritis;
Graft vs host disease
- From:
Chinese Journal of Hematology
2018;39(9):757-760
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the occurrence, clinical characteristics, diagnosis and treatment of glomerulitis after allogeneic hematopoietic stem cell transplantation (allo-HSCT).
Methods:Analysis were carried out based on the clinical data of 6 patients with de novo glomerulitis following allo-HSCT hospitalized in Henan Tumor Hospital from January 2008 to December 2016, and the clinical manifestation, pathology, diagnosis, treatment and outcome were investigated.
Results:The occurrence of glomerulitis was 1.26% (6/478). The median time was 447(272-1 495) d after allo-HSCT. Proteinuria and varying degrees of edema were present in all patients. Of the 6 patients, 4 patients with impaired renal function, 3 cases of hypertension, 5 cases of urine occult blood positive, 2 cases of hyperlipidemia. 5 patients underwent acute graft-versus-host disease (GVHD), 4 patients accompanied with chronic GVHD at diagnosis. Kidney pathology showed typical features of minimal change diseases in 1 patient, membranous nephropathy in 4 patients and mesangial proliferative glomerulonephritis in 1 case. Immunohistochemistry of glomerular lesions revealed that the immune complex deposition included IgG in 4 patients, C3 in 3 patients, IgM and C1q in 1 patient. Serum ANA was positive in 2 patients and serum IgG and IgM were in high level in 1 patient, respectively. Only 1 case was effective on glucocorticoid. 5 cases treated by low dose cyclophosphamide combined with mycophenolate mofetil (MMF), 2 cases achieved complete remission, and 3 cases were partial remission. Up to now, 2 cases died with lung infection, and 4 patients survived.
Conclusion:The predominant pathological type of glomerulitis was membranous nephropathy. Low-dose cyclophosphamide combined with MMF was an effective treatment.
