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 - 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 -