Renal thrombotic microangiopathy associated with chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation
| Autor: | Tomohiro Kaneko, Hiroki Yamaguchi, Kenji Tajika, Yuh Fukuda, Akiko Mii, Shin-ichi Tsuchiya, Kouichi Utsumi, Yasuo Katayama, Emiko Fujita, Teppei Fujino, Megumi Fukui, Yasuhiko Iino, Akira Shimizu |
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| Rok vydání: | 2011 |
| Předmět: |
Kidney
Pathology medicine.medical_specialty Thrombotic microangiopathy medicine.diagnostic_test business.industry medicine.medical_treatment General Medicine Hematopoietic stem cell transplantation urologic and male genital diseases medicine.disease Peritubular capillaries Pathology and Forensic Medicine Transplantation surgical procedures operative Graft-versus-host disease medicine.anatomical_structure immune system diseases hemic and lymphatic diseases medicine Renal biopsy business Kidney disease |
| Zdroj: | Pathology International. 61:518-527 |
| ISSN: | 1320-5463 |
| Popis: | Thrombotic microangiopathy (TMA) is a major complication after hematopoietic stem cell transplantation (HSCT). In this study, we examined the clinical and pathologic features of 2 patients and 5 autopsy cases with HSCT-associated renal TMA to clarify the association between graft-versus-host disease (GVHD) and renal TMA. The median interval between HSCT and renal biopsy or autopsy was 7 months (range 3-42 months). Clinically, acute and chronic GVHD occurred in 7 and 4 patients, respectively. Clinical evidence for TMA was detected in 2 patients, while chronic kidney disease developed in all patients. The main histopathological findings were diffuse endothelial injury in glomeruli, peritubular capillaries (PTCs), and small arteries. In addition, all cases showed glomerulitis, renal tubulitis, and peritubular capillaritis with infiltration of CD3+ T cells and TIA-1+ cytotoxic cells, suggesting that GVHD occurred during the development of TMA. Diffuse and patchy C4d deposition was noted in glomerular capillaries and PTCs, respectively, in 2 biopsy and 2 autopsy cases, suggesting the involvement of antibody-mediated renal endothelial injury in more than 50% of renal TMA cases. In conclusion, the kidney is a potential target of chronic GVHD that may induce the development of HSCT-associated TMA. Importantly, some cases are associated with chronic humoral GVHD. |
| Databáze: | OpenAIRE |
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