Introduction:
Membranous nephropathy is a rare complication of allogenic hematopoetic stem cell transplant. In a large multi-centre study of patients who underwent Allo-HSCT from January 2007 to December 2022, 31 patients were found to have nephrotic syndrome due to membranous nephropathy. Jin Y
Methods:
It is a case study, done at Artemis hospitals, Gurugram, India.
Case
We present a case of 39 year old male, who was diagnosed having Non Hodgkin’s lymphoma (DLBCL) in 2005 treated with CHOP regimen. Patient underwent autologous hematopoeitic stem cell transplant in 2008 after 2 relapses. Patient again had relapse of disease in 2017 and underwent allogenic HSCT in 2018 after remission. Patient started having features of chronic graft Vs host disease e.g. skin discoloration, diarrhea after 2 years of HSCT.
Patient presented to us 5 yrs post HSCT with a 4 month history of edema, his urine R/M showed 3+ protein with proteinuria of 22 gm/gm of serum creatinine, S. Albumin of 1.8 gm/dl and serum anti phospholipase A2 receptor antibody was negative. Renal Biopsy was s/o early membranous glomerulonephritis and was negative PLA2R, NELL1, THSD7a and Sema3b. Patient was given Inj Rituximab 2 doses.
Results:
Patient’s edema gradually subsided and proteinuria decreased to 0.4 gm/gm of creatinine in 9 months. He also had improvement in other features of cGVHD.
Conclusions:
Patients usually have been found to have antibodies against glomerular target antigen protocadherin FAT1. Due to close temporal association between the onset of membranous nephropathy and cGVHD, it has been postulated that cGVHD might trigger membranous nephropathy. There is currently limited knowledge about the pathogenesis and treatment options in such cases. However, our patient responded to rituximab.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.