Graft-vs.-Host Glomerulopathies
Anthony Chang, MD
Key Facts
Terminology
Graft-vs.-host disease (GVHD) glomerulopathy
Glomerular injury in setting of hematopoietic cell transplantation and GVHD
Clinical Issues
Proteinuria, nephrotic range
Microscopic Pathology
3 major patterns
Membranous glomerulonephritis
Minimal change lesions
Focal segmental glomerulosclerosis
Concurrent interstitial nephritis, acute tubular injury, or thrombotic microangiopathy may be present
Top Differential Diagnoses
MGN, primary
Recurrent lymphoma
 Jones methenamine silver demonstrates thick glomerular basement membrane with sparse silver staining due to the prominent extent of subepithelial immune complex deposition. |
 IgG demonstrates strong granular to confluent staining of the capillary walls in this hematopoietic cell transplant patient with MGN and GVHD. |
TERMINOLOGY
Synonyms
Graft-vs.-host disease (GVHD) glomerulopathy
Definitions
Glomerular injury in setting of hematopoietic cell transplantation
ETIOLOGY/PATHOGENESIS
Hematopoietic Cell Transplantation (HCT)
Mostly allogeneic (80-100%)
3 patterns
Membranous glomerulonephritis (MGN)
Rare report in autologous HCT
Minimal change disease (MCD)
Focal segmental glomerulosclerosis
Radiation &/or chemotherapy may be contributing factors
Experimental Model
Chronic GVHD (parent to F1 bone marrow transplant) in mice leads to MGN due to antibodies to minor MHC antigens
CLINICAL ISSUES
