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| Nephrotic syndrome and renal failure after allogeneic stem cell transplantation: Novel molecular diagnostic tools for a challenging differential diagnosis |
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| Author(s): Romagnani P, Lazzeri E, Mazzinghi B, Lasagni L, Guidi S, Bosi A, Cirami C, Salvadori M |
| Source: AMERICAN JOURNAL OF KIDNEY DISEASES Volume: 46 Issue: 3 Pages: 550-556 Published: SEP 2005 |
| Times Cited: 14 References: 21 |
| Abstract: Background: Sudden onset of nephrotic syndrome after allogeneic stem cell transplantation is rare and has been associated mostly with membranous glomerulonephritis related to chronic graft-versus-host disease (cGVHD). We report a case of nephrotic syndrome and rapidly progressive renal failure occurring in a young woman 3 years after allogeneic stem cell transplantation from her HLA-identical brother. In the renal biopsy, a diffuse mononuclear cell infiltrate was observed. Furthermore, histological analysis, immunofluorescence, and electron microscopy of the kidney specimen defined the diagnosis as minimal change disease, a T-cell-mediated glomerulopathy associated with lymphoproliferative disorders, but that has never been described as an isolated manifestation of cGVHD. Methods: The differential diagnosis was performed by using immunohistochemistry and laser capture microdissection combined with Taq-Man quantitative polymerase chain reaction. Results: Infiltrating mononuclear cells in renal tissue consisted of T cells expressing DNA levels of a Y chromosome-specific gene quantitatively similar to those observed in a male subject, showing that these cells derived from the transplant donor and definitely excluding leukemia relapse. However, the large number of infiltrating T cells allowed the possibility that in this patient, minimal change disease could be related to an atypical form of GVHD. Conclusion: This is the first study to use molecular techniques to show the differential diagnosis of nephrotic syndrome after allogeneic stem cell transplantation. This novel method approach might represent a key tool to characterize kidney infiltrate after allogeneic stem cell transplantation. |
| Document Type: Article |
| Language: English |
| Reprint Address: Romagnani, P (reprint author), Univ Florence, Interdepartmental Lab Cellular & Mol Nephrol, Dept Clin Physiopathol, Ctr Res Transfer & High Educ DE NOVO Therapies, Viale Pieraccini 6, I-50139 Florence, Italy |
Addresses:
1. Univ Florence, Interdepartmental Lab Cellular & Mol Nephrol, Dept Clin Physiopathol, Ctr Res Transfer & High Educ DE NOVO Therapies, I-50139 Florence, Italy |
| Publisher: W B SAUNDERS CO, INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA |
| Subject Category: Urology & Nephrology |
| IDS Number: 964AF |
| ISSN: 0272-6386 |
| DOI: 10.1053/j.ajkd.2005.05.026 |
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