[Chronic graft-versus-host disease presenting as nephrotic syndrome after allogenic hematopoietic stem cell transplantation]

Area of Science:

• Nephrology
• Hematology
• Immunology

Background:

• Allogeneic hematopoietic stem cell transplantation (HSCT) can lead to early (<100 days) and late (>100 days) complications.
• Chronic graft-versus-host disease (cGVHD) is a frequent late complication (60-80% of survivors), primarily affecting skin, mucous membranes, GI tract, and liver.
• Kidneys are not typically considered a target organ for cGVHD, though renal involvement has been reported.

Observation:

• A patient developed nephrotic syndrome three years after HSCT.
• Kidney biopsy revealed membranous nephropathy as the cause of nephrotic syndrome.
• This presentation suggests a potential manifestation of cGVHD in the kidneys.

Findings:

• The patient's nephrotic syndrome was attributed to membranous nephropathy.
• Treatment with cyclosporine and methylprednisolone resulted in a significant reduction in albuminuria.
• This indicates a positive response to immunosuppressive therapy.

Implications:

• This case expands the understanding of potential cGVHD target organs beyond traditional sites.
• It emphasizes the importance of considering cGVHD in patients with unexplained nephrotic syndrome post-HSCT.
• Early diagnosis and treatment of renal cGVHD may improve patient outcomes and reduce morbidity.