Abstract: SA-PO0201
Rare Case of Renal Limited Chronic Thrombotic Microangiopathy and Membranous Nephropathy After Allogenic Hematopoietic Stem-Cell Transplant
Session Information
- Onconephrology: MGRS, HSCT, Electrolytes, RCC, and More
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Konda, Raghunandan, University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
- Fatima, Huma, University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
- Rajasekaran, Arun, University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
- Rizk, Dana V., University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
- Charkviani, Mariam, University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
- Chandramohan, Deepak, University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
Introduction
Glomerular diseases (GD) occur in approximately 1-2% of patients undergoing allogeneic hematopoietic stem cell transplantation (allo- HSCT), with thrombotic microangiopathy (TMA) being the most frequent, followed by membranous nephropathy (MN). We present a rare case featuring concurrent chronic TMA and MN identified on the kidney biopsy following discontinuation of graft versus host disease (GVHD) treatment.
Case Description
A 61-year-old female with B-cell acute lymphoblastic leukemia (BCR-ABL positive) received three cycles of CVAD therapy (Cyclophosphamide [CYC], Vincristine, Adriamycin, Dexamethasone) and maintenance dasatinib. She subsequently underwent allo- HSCT with conditioning therapy (total body irradiation and CYC) and GVHD prophylaxis (tacrolimus and methotrexate). Dasatinib and tacrolimus were discontinued due to side effects. The patient subsequently developed multisystem GVHD involving liver, skin, and joints; successfully managed with ruxolitinib for two years, achieving complete remission of leukemia and resolution of GVHD symptoms. Two months after discontinuing ruxolitinib, hypoalbuminemia was noted, progressively worsening over seven months (albumin 3.8 to 2.1 mg/dL), accompanied by nephrotic-range proteinuria (UPCR 8 g/g). Serum creatinine remained normal (0.5 mg/dL) but had reduced 24 hrs. urine creatinine clearance (46 ml/min). Extensive GD workup including autoimmune, infectious, hemolysis evaluation, and paraprotein testing were negative. Kidney biopsy revealed glomerular basement membrane wrinkling and splitting consistent with chronic TMA, along with subepithelial immune complex deposits indicative of MN, suspected secondary to chronic GVHD. She was treated with four weekly doses of rituximab.
Discussion
Kidney involvement post-HSCT, especially TMA, is increasingly recognized as a significant complication of GVHD, yet concomitant MN and chronic TMA is exceedingly rare. The kidney manifestations in this patient following discontinuation of GVHD therapy emphasize a critical yet underrecognized phenomenon after HSCT management. This case emphasizes the need for close monitoring of kidney function and potential incorporation of kidney parameters in GVHD evaluation criteria, which could significantly affect outcomes and patient care post-HSCT.