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Graft-versus-host disease of the kidney after rapid tapering of cyclosporin following reduced intensity hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 35, pages 929–930 (2005)Cite this article

Acute renal failure is a common problem after allogeneic hematopoietic stem cell transplantation (allo-SCT) and many factors contribute to its development.1 Graft-versus-host disease (GVHD) rarely involves the kidney and most physicians believe that the kidney is not target of acute GVHD. However, several case reports have been published concerning chronic GVHD of the kidney and resulting nephrotic syndrome.2, 3 We describe a patient who developed renal failure attributable to acute GVHD after rapid tapering of cyclosporin following reduced intensity stem cell transplantation (RIST). A detailed description of his clinical courses provides important information on renal involvement of acute GVHD.

The following suggest that the renal dysfunction was most likely due to acute GVHD. First, the renal dysfunction followed GVHD and improved with corticosteroid. Second, FENa was elevated when the renal dysfunction developed, supporting the concept that the renal dysfunction was not secondary to circulatory failure and that the kidney was primarily damaged. Third, the patient had received only one course of chemotherapy and had normal renal function at RIST, so the possibility that an underlying renal dysfunction was aggravated is unlikely. Finally, the duration of cyclosporin and antibiotic administration was short, and their potential for causing renal toxicity was minimized. The histopathological findings suggesting nephrotoxicity of calcineurin inhibitors such as increasing arteriolar hyalinosis, small-vessel narrowing, and progressive ischemic glomerulosclerosis were absent in the present patient.4 Although the possibility cannot be excluded that renal toxicity from medications given during the peritransplant period aggravated an underlying renal dysfunction, it is unlikely to have been the primary cause. While conditioning regimen-related toxicities mostly develop within 28 days of transplantation,5 our patient developed renal dysfunction more than 100 days after transplantation.

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Acknowledgements

We thank Dr Yugo Shibagaki (Tokyo University) and Dr Takanori Teshima (Kyusyu University).

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Authors and Affiliations

  1. Hematopoietic Stem Cell Transplantation Unit, the National Cancer Center Hospital, Tokyo, Japan

    C I Homma, M Kami, M Sakiyama, R Kojima, A Hori, Y Kishi, N Murashige, S-W Kim & Y Takaue

  2. Department of Rheumatology and Hematology, JR Tokyo General Hospital, Tokyo, Japan

    S Masuo & T Mitamura

  3. Department of Hematology, Toranomon Hospital, Tokyo, Japan

    E Kusumi

  4. Kidney Center, Toranomon Hospital, Tokyo, Japan

    H Katori

  5. Department of Pathology, Cancer Institute Hospital, Tokyo, Japan

    K Takeuchi

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  1. C I Homma
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Homma, C., Kami, M., Masuo, S. et al. Graft-versus-host disease of the kidney after rapid tapering of cyclosporin following reduced intensity hematopoietic stem cell transplantation. Bone Marrow Transplant 35, 929–930 (2005). https://doi.org/10.1038/sj.bmt.1704896

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