Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

A case of membranous nephropathy associated with chronic GVHD successfully treated with rituximab

Bone Marrow Transplantation volume 47, pages 132–134 (2012)Cite this article

The kidney is a rare target organ for chronic GVHD (cGVHD) in humans. Renal involvement in cGVHD has been reported to occur in 0.5–1.0% of hematopoietic cell transplantation recipients.1 Most cases present as nephrotic syndrome about 1–5 years after transplantation, mostly while having immunosuppressants tapered.2 Membranous nephropathy is the most common pathology on renal biopsy.2 Many cases respond well to corticosteroid therapy and non-responsive cases are usually treated with additional immunosuppressants (for example, mycophenolate, calcineurin inhibitors).

The etiology of chronic renal GVHD is not yet fully elucidated and the role of B cells as critical factors has been studied in the etiology. In this study, we describe a patient who developed chronic renal GVHD 4 years after transplantation and was successfully treated with rituximab, an anti-CD20 MoAb, which indicates the importance of B cells in the pathophysiology of chronic renal GVHD.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

References

  1. Reddy P, Johnson K, Uberi JP, Reynolds C, Silver S, Ayash L et al. Nephrotic syndrome associated with chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2006; 38: 351–357.

    Article  CAS  PubMed  Google Scholar 

  2. Troxell ML, Pilapil M, Miklos DB, Higgins JP, Kambham N . Renal pathology in hematopoietic cell transplantation recipients. Mod Pathol 2008; 21: 396–406.

    Article  CAS  PubMed  Google Scholar 

  3. Bomback AS, Derebail VK, McGregor JG, Kshirsagar AV, Falk RJ, Nachman PH . Rituximab therapy for membranous nephropathy: a systematic review. Clin J Am Soc Nephrol 2009; 4: 734–744.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Cutler C, Miklos D, Kim HT, Treister N, Woo SB, Bienfang D et al. Rituximab for steroid-refractory chronic graft-versus-host disease. Blood 2006; 108: 756–762.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Kapur R, Ebeling S, Hagenbeek A . B-cell involvement in chronic graft-versus-host disease. Haematologica 2008; 93: 1702–1711.

    Article  PubMed  Google Scholar 

  6. Shimabukuro-Vornhagen A, Hallek MJ, Storb RF, von Bergwelt-Baildon MS . The role of B cells in the pathogenesis of graft-versus-host disease. Blood 2009; 114: 4919–4927.

    Article  PubMed  Google Scholar 

  7. Nagahama K, Maru K, Kanzaki S, Chai HL, Nakai T, Miura S et al. Possible role of autoantibodies against nephrin in an experimental model of chronic graft-versus-host disease. Clin Exp Immunol 2005; 141: 215–222.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nephrology, Osaka Red Cross Hospital, Osaka, Japan

    E Iguchi & T Minakata

  2. Department of Hematology, Osaka Red Cross Hospital, Osaka, Japan

    M Tsudo

Authors
  1. E Iguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T Minakata
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Tsudo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E Iguchi.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Iguchi, E., Minakata, T. & Tsudo, M. A case of membranous nephropathy associated with chronic GVHD successfully treated with rituximab. Bone Marrow Transplant 47, 132–134 (2012). https://doi.org/10.1038/bmt.2011.4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2011.4

Search

Advanced search

Quick links