Renal thrombotic microangiopathy associated with chronic humoral graft versus host disease after hematopoietic stem cell transplantation
| Autor: | Akira Shimizu, Yukinari Masuda, Arimi Ishikawa, T. Arai, Yasuhiko Iino, Kyoko Wakamatsu, Kouichi Utsumi, Akiko Mii, Tomohiro Kaneko, Yuh Fukuda, Kenji Tajika, Yasuo Katayama, Teppei Fujino |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Kidney
Pathology medicine.medical_specialty Thrombotic microangiopathy medicine.diagnostic_test Glomerular basement membrane medicine.medical_treatment General Medicine Hematopoietic stem cell transplantation Biology urologic and male genital diseases medicine.disease Peritubular capillaries Pathology and Forensic Medicine surgical procedures operative Graft-versus-host disease medicine.anatomical_structure immune system diseases Immunology medicine Renal biopsy Kidney transplantation |
| Zdroj: | Pathology International. 61:34-41 |
| ISSN: | 1320-5463 |
| Popis: | Thrombotic microangiopathy (TMA) is a known complication of hematopoietic stem cell transplantation (HSCT). The pathogenesis of TMA is controversial but considered to involve various factors such as total body irradiation, use of calcineurin inhibitors for prophylaxis against graft versus host disease (GVHD), viral infection, and GVHD. Herein we describe a case with renal TMA after HSCT, which was probably associated with antibody-mediated endothelial cell injury from chronic GVHD (termed here ‘chronic humoral GVHD’). A 49-year-old man presented two years after HSCT with renal dysfunction and proteinuria but without the clinical features of TMA. Histopathological examination of renal biopsy showed chronic glomerular endothelial cell injury with double contour of the glomerular basement membrane, microthrombi and the deposition of complement split product C4d along the glomerular capillaries. Renal tubulitis and peritubular capillaritis were also noted with a multilayered basement membrane and patchy C4d deposition on peritubular capillaries. These findings resemble those of chronic antibody-mediated rejection after kidney transplantation. Furthermore, C4d deposition suggests complement activation. Although circulating anti-blood type and anti-human leukocyte antigen antibodies were not detected, the renal TMA in this case was probably associated with chronic humoral GVHD. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text