Membranous glomerulopathy associated with graft-versus-host disease following allogeneic stem cell transplantation: a case report / 中华器官移植杂志

ABSTRACT

Objective To sum up the clinical experience of the diagnosis and treatment of membranous glomerulopathy associated with chronic graft-versus-host disease(cGVHD) following allogeneic stem tell transplantation(alloSCT).Methods One case of acute acute lymphoblastic leukemia(received) HLA complete matched alloSCT and subjected to methopterin and Tacrolimus(FK506)postoperatively for prevention of GVHD.Nineteen days after operation,the patient suffered from(acute) GVHD and recovered by using methylprednisolone.On the day of 182 and 235 after transplantation,FK506 and prednisone were withdrawn.Five days later,cGVHD occurred,showing liver(dysfunction) and nephrotic syndrome.Membranous glomerulopathy(stage II) was pathologically (diagnosed) and treated with FK506 and prednisone.Results In membranous glomerulopathy,the(patient) got albuminuria(++++),leukocytes 75/?L,epicytes(359.5)/?L,pathological casts(+),24-h urine protein(4.28) g.Renal biopsy revealed that glomeruli were slightly enlarged,partial(capillary) compressed to be closed,glomerular basement membrane(GBM) was slightly thickened and mesangium slightly proliferate.Masson stain indicated the deposition of pink material along the glomerular capillary walls.And IgG(+++),C3(+++) and IgA(++) were detected at the GBM in a granular pattern by immunofluorescent stain.Electron microscopy showed numerous subepithelial(deposits).After treatment with prednisone and FK506 for 2 months,proteinuria was gradually(decreased).Conclusions GVHD associated membranous glomerulopathy should be considered when the patient got nephrotic syndrome or proteinuria after alloSCT.Renal biopsy is beneficial to the diagnosis of GVHD.Glucocorticoid and FK506 is effective in the treatment of GVHD.