Abstract
BackgroundMembranous nephropathy (MN), the leading cause of nephrotic syndrome in adults, is characterized by the deposition of subepithelial immune deposits. Most of the cases are primary, while only approximately 25% of the cases are secondary to some known diseases. Recently, MN has been considered to be a possible presentation of chronic graft-versus-host disease (GVHD) of the kidney in allogeneic hematopoietic stem cell transplantation (HSCT) patients. In autologous HSCT populations, there have been scarce reports of associated MN, as a result of immune dysregulation leading to systemic autoimmunity and miming chronic GVHD.Case presentationWe report an exceptional case of MN associated to an acute renal failure occurring within days following an autologous HSCT indicated by multiple myeloma. There was no evidence of GVHD or myeloma relapse. A complete remission of nephrotic syndrome with normalization of renal function were rapidly obtained by corticosteroid therapy.ConclusionThis is the first published case of acute renal failure due to MN occurring in the acute phase of an autologous HSCT. These findings support the antibodymediated autoimmune glomerular disease.
Highlights
Membranous nephropathy (MN), the leading cause of nephrotic syndrome in adults, is characterized by the deposition of subepithelial immune deposits
This is the first published case of acute renal failure due to MN occurring in the acute phase of an autologous hematopoietic stem cell transplantation (HSCT)
Glomerulopathies represent only a small proportion of such injury occuring in 1 to 6% of allogenic HSCT recipients [4,5,6]. They typically manifest as membranous nephropathy (MM) (64%), less commonly as minimal change disease (19%) and rarely as proliferative glomerulonephritis (17%) [7]
Summary
Post HSCT MN likely represents a late manifestation of chronic GVHD in allogeneic HSCT, it may occur after autologous HSCT. Auto immunity seems to be on the basis of its occurrence as supported by the glomerular deposition of IgG and complement components. Auto immunity could be acute and involve only the kidneys as seen in our case. Corticosteroids are the principal treatment toil and may be sufficient. Through this observation, we recommend more screening protocols of proteinuria and renal function post HSCT
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