A 7-year-old boy with renal insufficiency and proteinuria after stem cell transplant for T-cell acute lymphoblastic leukemia.
A 7-year-old boy with renal insufficiency and proteinuria after stem cell transplant for T-cell acute lymphoblastic leukemia.
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DOI：
10.5414/cn107767
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发表时间：
2014-09
影响因子：
1.1
通讯作者：
Moeckel G
中科院分区：
文献类型：
--
作者：
Goodwin JE;Palmer M;Pashankar F;Tufro A;Moeckel G
慢性肾脏疾病是常见的儿童患者造血干细胞移植后。其病因可能是多因素的，取决于预处理方案、免疫抑制治疗和移植后预防性药物。Graft-vs。-宿主病（GVHD）是一种常见的造血干细胞移植后遗症，并与肾病综合征（NS）相关。我们在此报告一例小儿干细胞移植后出现蛋白尿和肾功能不全的病例。肾活检显示慢性间质性肾炎和广泛的足突消退，这可能是GVHD的后遗症。此外，我们发现间质浸润中CD4和CD3淋巴细胞计数减少，表明异常淋巴细胞反应可能在GVHD后足细胞损伤中起作用。本病例说明了肾活检在评估干细胞移植介导的肾功能衰竭中的重要性。
Chronic kidney disease is common in pediatric patients following hematopoietic stem cell transplant. Its etiology is likely multifactorial and depends both on pre-conditioning regimens as well as immunosuppressive therapy and post-transplant prophylactic medications. Graft-vs.-host disease (GVHD) is a common sequela of hematopoietic stem cell transplant and has been associated with the nephrotic syndrome (NS). Here we report a case of a pediatric patient who developed proteinuria and renal insufficiency after stem cell transplant. A kidney biopsy showed chronic interstitial nephritis and extensive foot process effacement, which are likely sequelae of GVHD. Moreover we show decreased CD4 and CD3 lymphocyte counts in the interstitial infiltrate, suggesting that abnormal lymphocyte response might play a role in podocyte injury following GVHD. This case illustrates the importance of the kidney biopsy in the assessment of stem cell transplant-mediated renal failure.