Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2021; 9(3): 614-622
Published online Jan 26, 2021. doi: 10.12998/wjcc.v9.i3.614
Nephrotic syndrome in syngeneic hematopoietic stem cell transplantation recipients: A case report
Ming-Chuan Bai, Jing-Jing Wu, Kou-Rong Miao, Jing-Feng Zhu, Hui-Juan Mao
Ming-Chuan Bai, Jing-Jing Wu, Jing-Feng Zhu, Hui-Juan Mao, Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Kou-Rong Miao, Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Author contributions: Bai MC, Wu JJ, Miao KR, Mao HJ wrote and revised the paper together; Zhu JF performed the pathological analysis and interpretation; Bai MC and Wu JJ contributed to this paper equally, and should be considered as co-first authors; Mao HJ was corresponding author and responsible for important intellectual content of the manuscript. All authors approved the final version of the manuscript.
Supported by the National Natural Science Foundation of China, No. 8197039; and 2017 Jiangsu Commission of Health Research Project, No. H2017023.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hui-Juan Mao, MD, PHD, Professor, Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, China. huijuanmao@126.com
Received: June 3, 2020
Peer-review started: June 3, 2020
First decision: November 14, 2020
Revised: November 25, 2020
Accepted: December 10, 2020
Article in press: December 10, 2020
Published online: January 26, 2021
Processing time: 230 Days and 5 Hours
Abstract
BACKGROUND

Hematopoietic stem cell transplantation (HSCT) is widely used in the treatment of hematological diseases. However, complications after transplantation, such as acute and chronic graft-vs-host disease (GVHD), still seriously affect the quality of life and even threaten the lives of patients. There is evidence that glomerular diseases can manifest as GVHD. However, GVHD should not occur as a result of syngeneic HSCT.

CASE SUMMARY

A 20-year-old male diagnosed with T lymphoblastic lymphoma (stage IIIA, aaIPI 1) in September 2013 was treated with six cycles of hyper-CVAD and achieved complete remission. He underwent syngeneic HSCT in June 2014, and had no kidney disease history before the transplant. However, nephrotic syndrome occurred 24 mo later in the patient after syngeneic HSCT. Renal biopsy was performed, which led to a diagnosis of atypical membranous nephropathy. After treatment with glucocorticoids combined with cyclophosphamide and cyclosporine, the nephrotic syndrome was completely relieved.

CONCLUSION

We report a case of delayed nephrotic syndrome after syngeneic HSCT. Antibody-mediated autoimmune glomerular disease may be the underlying mechanism. After treatment with immunosuppressive agents, the nephrotic syndrome was completely relieved but further long-term follow-up is still needed.

Keywords: Syngeneic hematopoietic stem cell transplantation; Nephrotic syndrome; Graft vs host disease; Cyclosporine; Autoimmune glomerular disease; Case report

Core Tip: Postoperative complications such as acute and chronic graft-vs-host disease (GVHD) seriously affect the quality of life of patients after transplantation and even threaten patients’ lives. There is evidence that glomerular diseases may manifest as GVHD. However, GVHD should not occur as a result of syngeneic hematopoietic stem cell transplantation (HSCT). We report a rare case of delayed nephrotic syndrome following syngeneic HSCT for treatment of T lymphoblastic lymphoma. Nephrotic syndrome occurred 24 mo later. Renal biopsy was performed, which led to a diagnosis of atypical membranous nephropathy. After treatment with glucocorticoids combined with cyclophosphamide and cyclosporine, the nephrotic syndrome was completely relieved. The specific pathogenesis of nephrotic syndrome in this case is unclear but some findings may support the role of induction of the autoimmune response after transplantation.