Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
8431074 | Biology of Blood and Marrow Transplantation | 2016 | 26 Pages |
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 20.5Â 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; PÂ =Â .15). Patients presenting with MCD recovered at a median of 1.75Â months (range, 1 to 12) and with MGN a median of 7Â months (range, 1 to 53) (PÂ =Â .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.
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Authors
Ofrat Beyar-Katz, Etty Kruzel Davila, Tsila Zuckerman, Riva Fineman, Nuhad Haddad, Doaa Okasha, Israel Henig, Ronit Leiba, Jacob M. Rowe, Yishai Ofran,