Membranous glomerulopathy associated with graft-versus-host disease following allogeneic stem cell transplantation - Report of 2 cases and review of the literature

We report two cases of nephrotic syndrome presenting 18 and 20 months after allogeneic stem cell transplantation (alloSCT) with chronic myelogenous le ukemia. Both patients had acute and chronic graft-versus-host disease (GVHD ) and renal biopsy findings of membranous glomerulopathy (MG). A review of the literature revealed 10 additional cases of immune-complex-mediated glom erular disease following alloSCT, 8 of which were diagnostic of MG. All pat ients showed evidence of acute or chronic GVHD. Patients typically presente d with preserved renal function (mean creatinine 1.2 mg/dl) and full nephro tic syndrome including heavy proteinuria (mean 9.2 g/24 h), edema, hypoalbu minemia (mean 2.1 g/dl) and hypercholesterolemia (mean 472 mg/dl). Most pat ients showed stabilization of renal function and significant decreases in p roteinuria when treated with steroids and/or cyclosporine. The close tempor al association as well as evidence from murine models of GVHD support a pat hogenetic association between GVHD and the development of MG. Copyright (C) 2001 S. Karger AG, Basel.