Membranous Nephropathy With Extensive Tubular Basement Membrane Deposits Following Allogeneic Hematopoietic Cell Transplant: A Report of 5 Cases

Am J Kidney Dis. 2022 Jun;79(6):904-908. doi: 10.1053/j.ajkd.2021.07.021. Epub 2021 Sep 8.

Abstract

Tubular basement membrane (TBM) deposits are very uncommon in non-lupus membranous nephropathy. We report 5 patients with membranous nephropathy and extensive TBM deposits following allogeneic hematopoietic cell transplant. Patients presented with nephrotic syndrome (3 also had acute kidney injury) late post-transplant in association with chronic graft-versus-host disease (cGVHD). Kidney biopsies revealed global subepithelial and extensive TBM immune complex deposits, accompanied by acute tubular injury (n = 4) and tubulointerstitial inflammation (n = 4). Proteomic analysis of glomeruli in 4 cases identified PLA2R in 1, with no significant protein spectra for PLA2R, THSD7A, EX1/2, NELL-1, PCDH7, NCAM1, or SEMA3B detected in the remaining 3. On follow-up (for a mean 42 months), 4 patients had complete and 1 partial remission following prednisone and/or rituximab therapy. We propose that membranous nephropathy with extensive TBM deposits is a distinctive clinicopathologic lesion associated with allogeneic hematopoietic cell transplant. Pathogenesis likely involves cGVHD-driven antibodies against glomerular and TBM components, the identity of which remains to be elucidated.

Keywords: Membranous nephropathy; TBM deposits; acute kidney injury (AKI); case report; graft-versus-host disease; hematopoietic cell transplant; interstitial nephritis; nephrotic syndrome; renal biopsy; tubular basement membrane (TBM).

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury*
  • Basement Membrane / pathology
  • Glomerulonephritis, Membranous* / pathology
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Humans
  • Polyesters
  • Proteomics

Substances

  • Polyesters