Glomerular disease in chronic graft versus host disease

Allogeneic hematopoietic progenitor cell transplantation is a widely used procedure, and graft-versus-host disease (GVHD) is a common complication. Glomerular involvement due to GVHD is exceptional. Objective: to describe the clinical and histopathological presentation of patients with glomerular disease secondary to GVHD. Materials and methods: a retrospective review of the Uruguayan registry of glomerulopathies was conducted to identify renal biopsies from patients with confirmed GVHD. Results: seven patients were identified, four male, with a median age of 41 years (range 8–58). The most common clinical and analytical presentation was nephrotic syndrome. Histopathological findings included membranous glomerulonephritis (4), segmental and focal sclerohyalinosis (1), membranoproliferative glomerulonephritis (1), and thrombotic microangiopathy (1). All patients were treated with corticosteroids in combination with immunosuppressors, most frequently mycophenolate mofetil and rituximab. Five patients achieved complete remission, one had partial remission, and one did not respond. The combination of corticosteroids with rituximab showed a good response rate in those presenting with podocytopathy in the renal biopsy.