Adult Nephrotic Syndrome after Hematopoietic Stem Cell Transplantation: Renal Pathology is the Best Predictor of Response to Therapy

Ofrat Beyar-Katz, Etty Kruzel Davila, Tsila Zuckerman, Riva Fineman, Nuhad Haddad, Doaa Okasha, Israel Henig, Ronit Leiba, Jacob M. Rowe, Yishai Ofran

Research output: Contribution to journalReview articlepeer-review

Abstract

Nephrotic syndrome (NS) after allogeneic hematopoietic stem cell transplantation (HSCT) is a rare phenomenon usually associated with graft-versus-host disease (GVHD). This systematic review of post-HSCT NS cases reported in the literature aimed to identify risk factors and unique features of the disease in this clinical setting. One hundred sixteen cases of post-HSCT NS published in the English literature between 1988 and 2015 were revealed and analyzed. The median onset of NS was 20.5 months (range, 3 to 174) post-HSCT. NS development was associated with acute or chronic GVHD in 87.2% of cases. Membranous nephropathy (MGN) was the most frequent pathology (65.5%), followed by minimal change disease (MCD) (19%). Complete remission of the NS was achieved in 63.5% of patients (59.1% of MGN cases and 81.3% of MCD cases; P = .15). Patients presenting with MCD recovered at a median of 1.75 months (range, 1 to 12) and with MGN a median of 7 months (range, 1 to 53) (P = .001). NS was treated with corticosteroids alone in 16.8% of patients and with a combination of corticosteroids and other immunosuppressive agents in 73.5% of patients. Univariate analysis failed to identify a single predictive factor of response to therapy. In conclusion, post-HSCT NS usually develops concomitant to GVHD and is associated with high rates of response to therapy. Although most patients were treated with a combination of immunosuppressive drugs, single-agent therapy with steroids may be sufficient in some cases.

Original languageEnglish
Pages (from-to)975-981
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume22
Issue number6
DOIs
StatePublished - 1 Jun 2016
Externally publishedYes

Keywords

  • Allogeneic hematopoietic stem cell transplantation
  • Graft-versus-host disease
  • Nephrotic syndrome

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