Membranous Nephropathy With Extensive Tubular Basement Membrane Deposits Following Allogeneic Hematopoietic Cell Transplant: A Report of 5 Cases

Samih H Nasr, Nelson Leung, Samar M. Said, Hassan B. Alkhateeb, Benjamin J. Madden, M. Cristine Charlesworth, Laurence H. Beck, Christopher P. Larsen, Sanjeev Sethi

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
JournalAmerican Journal of Kidney Diseases
DOIs
StateAccepted/In press - 2021

Keywords

  • acute kidney injury (AKI)
  • case report
  • graft-versus-host disease
  • hematopoietic cell transplant
  • interstitial nephritis
  • Membranous nephropathy
  • nephrotic syndrome
  • renal biopsy
  • TBM deposits
  • tubular basement membrane (TBM)

ASJC Scopus subject areas

  • Nephrology

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