Glomerular disease in chronic graft versus host disease

Area of Science:

• Nephrology
• Hematology
• Immunology

Background:

• Allogeneic hematopoietic progenitor cell transplantation is a common procedure.
• Graft-versus-host disease (GVHD) is a frequent complication post-transplant.
• Glomerular involvement secondary to GVHD is exceptionally rare.

Purpose of the Study:

• To characterize the clinical and histopathological features of glomerular disease in patients with GVHD.
• To evaluate treatment outcomes for GVHD-associated kidney disease.

Main Methods:

• Retrospective review of the Uruguayan registry of glomerulopathies.
• Identification of renal biopsies from patients with confirmed GVHD.
• Analysis of clinical presentation, histopathology, treatment, and outcomes.

Main Results:

• Seven patients with GVHD-related glomerular disease were identified.
• Nephrotic syndrome was the most common clinical presentation.
• Histopathological findings included membranous glomerulonephritis, focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis, and thrombotic microangiopathy.
• Treatment with corticosteroids and immunosuppressors (mycophenolate mofetil, rituximab) led to remission in six out of seven patients.
• Corticosteroids combined with rituximab demonstrated a favorable response in patients with podocytopathy.

Conclusions:

• Glomerular disease is an exceptional but recognized complication of GVHD.
• Nephrotic syndrome and membranous glomerulonephritis are key presentations.
• Combination therapy, particularly with rituximab, appears effective for GVHD-induced podocytopathies.