Differential Diagnosis of Membranous Nephropathy Occurs after Bone Marrow Transplantation and Renal Transplantation
1Kidney Disease Center, First Affiliated Hospital of Zhejiang University, Hangzhou, China, 2First Affiliated Hospital of Zhejiang University, Hangzhou, China
Meeting: 2019 American Transplant Congress
Abstract number: C78
Keywords: Autoimmunity, Graft-versus-host-disease
Session Information
Session Name: Poster Session C: Kidney Complications: Late Graft Failure
Session Type: Poster Session
Date: Monday, June 3, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Membranous nephropathy (MN), considered as a rare autoimmune kidney disease, often occurs in synchronization with manifestation of chronic graft-versus-host disease after transplantation. After bone marrow transplantation (BMT), nearly 15%-20% of patients might develop kidney disease, including MN, which is rare. The recurrence rate of MN after renal transplantation (RT) is higher, approximately 42%, leading to proteinuria, graft dysfunction, and increased risk of graft failure. The pathogenesis of MN after transplantation remains unclear. Differential diagnosis of MN that occurs after different organ transplantations may help to identify the underlying pathogenesis.
*Methods: We analyzed all patients who had MN after BMT (n=8) or RT (n=14) from 2000 to the present in our hospital. The laboratory test, histopathologic evaluation of these patients was retrospectively reviewed. We compared age, duration of MN occurred after transplantation, clinical manifestation at proteinuria onset as well as renal biopsy, histopathologic evaluation (including anti-PLA2R antibody, IgG, C3, C1q, IgA, C4D and etc.) in two groups.
*Results: Patients received BMT at an earlier age than patients underwent RT (34.25 ± 3.369 vs. 38.71 ± 2.896, p<0.3455), and may rapidly develop a MN, while patients with RT took a much longer time to develop MN (1.500 ± 0.3780 vs. 5.143 ± 1.084, p=0.023). MN after BMT usually associated with a heavy proteinuria and normal blood creatine level while MN after RT often observed as an elevated creatinine with light proteinuria. In renal biopsy, we observed a large number of immune complexes deposited in the basement membrane in both two groups. Most MN after RT showed a strong positive (+++) of PLA2R and more C1q, IgA and C4D deposit in basement membrane. However, MN after BMT was less likely to be PLA2R positive with a significantly increased deposit of IgG and C3 in base membrane. Some cases presented glomerulitis and tubulitis in MN after RT.
*Conclusions: Our results suggest a different underlying pathogenesis of MN after BMT and RT.
To cite this abstract in AMA style:
Guo L, Wang H, Tan Y, Shen J, Wang R, Wu J, Chen J. Differential Diagnosis of Membranous Nephropathy Occurs after Bone Marrow Transplantation and Renal Transplantation [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/differential-diagnosis-of-membranous-nephropathy-occurs-after-bone-marrow-transplantation-and-renal-transplantation/. Accessed May 11, 2025.« Back to 2019 American Transplant Congress