We report
membranous nephropathy in a 61-year-old man after allogeneic hematopoietic stem cell transplant without
chronic graft-versus-host disease. A diagnosis of
acute myeloid leukemia was made, and the patient received hematopoietic stem cell transplants, twice, from different donors. The first donor was his brother and the second donor was an unrelated man.
Human leukocyte antigens between donors and recipient were fully matched. His
clinical course was stable without acute or
chronic graft-versus-host disease or relapse of
acute myeloid leukemia with
tacrolimus after the second hematopoietic stem cell transplant. Six months after the second hematopoietic stem cell transplant,
tacrolimus was decreased gradually and discontinued because of
tacrolimus-induced
liver dysfunction. Three months after discontinuing the
tacrolimus, the patient developed
edema in his leg. The results of a blood analysis showed that
plasma albumin level was 21 g/L and plasma total
cholesterol level was 11.5 mmol/L, while results from a urinalysis showed
proteinuria of 5.6 g/d without
hematuria. No abnormalities in the skin, mucosal tissues, and other organs suggestive of
chronic graft-versus-host disease were seen. A renal biopsy was done to investigate the cause, which revealed renal disease. Electron microscopic analysis showed dense deposits in the subepithelial region in all glomeruli. Immunofluorescence analysis showed the deposition of
IgG4 and C3c in the subepithelial space of all glomeruli.
Membranous nephropathy was diagnosed. He then was administered
prednisolone at a dosage of 45 mg/d (0.7 mg/kg/d). After
prednisolone treatment, urine
protein and
hypoalbuminemia were markedly improved, and his leg
edema disappeared. These results suggest that this
membranous nephropathy may have been de novo
membranous nephropathy after hematopoietic stem cell transplant because it developed after hematopoietic stem cell transplants without
chronic graft-versus-host disease.