Abstract: FR-PO1257
Relapsing and Remitting Pattern of Primary Membranous Nephropathy (MN) with Coexistent Thrombotic Microangiopathy (TMA) After Allogenic Hematopoietic Stem Cell Transplantation (HSCT) in a Patient with Acute Myeloid Leukemia (AML)
Session Information
- Onconephrology: Diagnostic Dilemmas, Therapy-Related Toxicities, and Clinical Cases
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Mir, Jawad, The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Charkviani, Mariam, The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Fatima, Huma, The University of Alabama at Birmingham, Birmingham, Alabama, United States
Introduction
Renal complications after allogeneic HSCT are increasingly recognized. Nephrotic syndrome is a rare manifestation of chronic GVHD, commonly presenting as membranous nephropathy. Post-HSCT TMA may occur as renal-limited disease without systemic features. We describe a HSCT recipient with overlapping membranous nephropathy and TMA on biopsy, showing an unusual relapsing-remitting course rarely seen in GVHD-associated membranous nephropathy.
Case Description
A 52-year-old woman with nephrolithiasis, ADHD, hemorrhoids, and APML diagnosed in 2023 underwent induction chemotherapy with idarubicin/cytarabine, later transitioned to HyperCVAD-1B because of neutropenic fever and pneumonia. She subsequently underwent matched unrelated donor allogeneic stem cell transplantation following total body irradiation/cyclophosphamide conditioning. Her post-transplant course was complicated by severe mucositis requiring analgesia, tacrolimus for GVHD prophylaxis, and CMV reactivation treated successfully with valganciclovir. Repeat flow cytometry later demonstrated minimal residual disease. In February 2025, she developed progressive refractory ascites requiring intermittent therapeutic paracentesis despite negative workup for portal hypertension. On November 17, 2025, she presented with altered mental status concerning for hepatic encephalopathy and was treated with lactulose and rifaximin. During hospitalization, she developed AKI with nephrotic-range proteinuria (UPCR 3.8 g/g, UACR 2.6 g/g). Extensive serologic evaluation was unrevealing. Kidney biopsy demonstrated membranous glomerulopathy with chronic thrombotic microangiopathy and mild chronicity. Protocadherin FAT-1 positivity on immunofixation supported HSCT/GVHD-associated membranous nephropathy. Rituximab led to marked improvement in renal function and proteinuria.
Discussion
Allogeneic HSCT can cause renal complications including nephrotic syndrome (0.4–6%) from podocyte injury. Post-HSCT TMA is a known endothelial injury syndrome, though renal-limited TMA may occur without systemic criteria. We present a rare case of chronic GVHD-associated membranous nephropathy with overlapping renal-limited TMA and a relapsing-remitting course of MN. This case highlights the value of renal biopsy for early diagnosis of subclinical renal TMA.