Abstract: SA-PO192
Graft vs. Kidney Disease in Recipients of Hematopoietic Stem Cell Transplantation: A Need for More Kidney Biopsies
Session Information
- Onco-Nephrology: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Authors
- Lubetzky, Michelle L., Weill Cornell Medical College, New York, New York, United States
- Choe, Hannah, The Ohio State University, Columbus, Ohio, United States
- Gutgarts, Victoria, Weill Cornell Medical College, New York, New York, United States
- Salvatore, Steven, Weill Cornell Medical College, New York, New York, United States
- Van besien, Koen, Weill Cornell Medical College, New York, New York, United States
- Seshan, Surya V., Weill Cornell Medical Center, New York, New York, United States
- Muthukumar, Thangamani, Division of Nephrology and Hypertension, New York, New York, United States
Background
Kidney biopsies are seldom done in patients with AKI after Hematopoietic Stem Cell transplant (HSCT). Graft versus kidney disease (GVKD) has not been well described. We aimed to assess the clinical and pathologic findings of patients with AKI after HSCT who received a kidney biopsy.
Methods
We conducted a chart review of 15 HSCT patients who underwent 17 kidney biopsies for AKI.
Results
Clinical characteristics and pathology results are listed in Table 1. Most patients who underwent kidney biopsy had both AKI and proteinuria. The most common biopsy finding was a mix of interstitial inflammatory cell infiltrate (GVKD) combined with acute or chronic endothelial injury, TMA (n=7, 41%). Other biopsy diagnoses included acute and chronic TMA, GVKD, acute tubular injury, and polyomavirus BK nephropathy. Immunohistochemical staining for C5b-9 was done on 7 biopsies with acute or chronic TMA and was positive in all 7. In 3 patients with GVKD and interstitial cell infiltrate, staining for granzyme B and CD3 was positive. Figure 1 demonstrates the pathology findings of a patient with AKI and biopsy diagnosis of GVKD with inflammatory cell infiltrate and chronic TMA. IHC was positive for both granzyme B in the interstitium and C5b-9 in the glomeruli and arterioles (Figure 1).
Conclusion
There is a range of pathologic findings in patients with AKI after HSCT. To understand the pathogenesis and explore therapies for AKI in HSCT we recommend a lower threshold for kidney biopsy in these patients.