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2014 ; 3
(2
): 202-205
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Graft versus host disease-dependent renal dysfunction after hematopoietic stem
cell transplantation
#MMPMID28509199
Motoyoshi Y
; Endo A
; Takagi M
; Morio T
; Ito E
; Nagata M
; Mizutani S
CEN Case Rep
2014[Nov]; 3
(2
): 202-205
PMID28509199
show ga
Nephropathy is an important complication in hematopoietic stem cell
transplantation (HSCT) wherein multifactorial causes, i.e., radiation, drug
toxicity, graft versus host disease (GVHD), are thought to contribute renal
dysfunction. Here, we report a 10-year-old boy with high-risk acute myelocytic
leukemia and severe but partially reversible renal dysfunction. The patient
initially received umbilical cord blood transplantation (UCBT) with CY 120 mg/kg
and kidney unshielded 12 Gy of total body irradiation. After the leukemic
relapse, he received allogenic bone marrow transplantation (BMT) 270 days after
the first transplantation. Two months later, his renal function started to
deteriorate and urinary protein increased gradually to 1 g/day. Four months after
BMT, by the symptoms of severe GVHD, the dose of tacrolimus, utilized to avoid
GVHD, was increased although his serum Cre level elevated to 2.97 mg/dL. Serum
Cre level improved to 2.0 mg/dL paralleled with GVHD improvement. Renal
histological findings showed severe interstitial edema, features of thrombotic
microangiopathy (TMA), and C4d deposition along the glomerular capillaries and
peritubular capillaries. We suggested that control of GVHD had benefitted to
ameliorate renal function of the patient. Treatment for GVHD improved renal
dysfunction and TMA of our patients. Moreover, renal biopsy was powerful to
elucidate the exact origin of renal dysfunction after HSCT.