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Focal segmental glomerulosclerosis: a very unusual complication of allogeneic hematopoietic cell transplantation (HCT)

Bone Marrow Transplantation volume 46, pages 1019–1020 (2011)Cite this article

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FSGS is an extremely rare complication of HCT. To our knowledge, to date there are only three previous reports linking FSGS to HCT, all of them occurring in myeloablative HCT.4, 6, 7 To our knowledge, the present case constitutes the first description of FSGS after nonmyeloablative HCT. The influence of the conditioning regimen on NS occurrence is controversial. A cohort study identified nonmyeloablative HCT as a risk factor for NS, because 7 of 163 patients developed this complication as opposed to none of 118 patients after myeloablative HCT, with comparable rates of chronic GVHD. Renal biopsy was performed in four cases and revealed MN.8 Because the vast majority (80%) of all cases reviewed in this study, aside from the mentioned cohort study, were myeloablative (data not shown) and the preparative regimen was not reported in several of the remaining cases, other authors claimed that a greater risk for NS posed by RIC than myeloablative preparation cannot be supported by this analysis, and hence follow-up of larger cohorts is warranted.1

In the present case, the patient coincidentally presented with cutaneous manifestations consistent with skin involvement by chronic GVHD, and NS. This suggests the possibility that NS may be a renal manifestation of chronic GVHD in an HCT patient. In fact, in almost half of the patients a concomitant temporal relationship between GVHD and NS can be observed, as NS appears simultaneously with chronic GVHD.1 The exact pathophysiology of NS associated with GVHD post-HCT remains as yet unknown and it is likely to be a consequence of the combination of complex interactions between allo-reactive T-cells, the nature of HLA mismatches, the cytokine milieu, the preparative regimen, B-cell dysregulation and perhaps even the underlying disease.2

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Acknowledgements

We thank Dr Fernanda Carvalho, Dr Helena Viana and Dr Lurdes Correia for providing the histological microphotographs.

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Authors and Affiliations

  1. Department of Nephrology and Renal Transplantation, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal

    J A Lopes, S Jorge, M J Melo & C Resina

  2. Department of Hematology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal

    C Martins, R Moreno & J Alves do Carmo

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  1. J A Lopes
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Correspondence to J A Lopes.

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Lopes, J., Martins, C., Jorge, S. et al. Focal segmental glomerulosclerosis: a very unusual complication of allogeneic hematopoietic cell transplantation (HCT). Bone Marrow Transplant 46, 1019–1020 (2011). https://doi.org/10.1038/bmt.2010.222

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