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Kidney Biopsy Findings Among Allogenic Hematopoietic Stem Cell Transplant Recipients With Kidney Injury: A Case Series

RATIONALE AND OBJECTIVE: The incidence of kidney disease is high in patients after allogeneic hematopoietic cell transplantation (aHCT). Although rarely performed, kidney biopsy may be useful to make a precise diagnosis because several mechanisms and risk factors can be involved, and to adjust the t...

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Autores principales: Roy, Guillaume, Iordachescu, Ilinca, Royal, Virginie, Lamarche, Caroline, Ahmad, Imran, Nadeau-Fredette, Annie-Claire, Laurin, Louis-Philippe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10363560/
https://www.ncbi.nlm.nih.gov/pubmed/37492111
http://dx.doi.org/10.1016/j.xkme.2023.100674
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author Roy, Guillaume
Iordachescu, Ilinca
Royal, Virginie
Lamarche, Caroline
Ahmad, Imran
Nadeau-Fredette, Annie-Claire
Laurin, Louis-Philippe
author_facet Roy, Guillaume
Iordachescu, Ilinca
Royal, Virginie
Lamarche, Caroline
Ahmad, Imran
Nadeau-Fredette, Annie-Claire
Laurin, Louis-Philippe
author_sort Roy, Guillaume
collection PubMed
description RATIONALE AND OBJECTIVE: The incidence of kidney disease is high in patients after allogeneic hematopoietic cell transplantation (aHCT). Although rarely performed, kidney biopsy may be useful to make a precise diagnosis because several mechanisms and risk factors can be involved, and to adjust the treatment accordingly. This case series aimed to report the spectrum of biopsy findings from patients with kidney injury after aHCT. STUDY DESIGN: Single-center retrospective case series. SETTING AND PARTICIPANTS: All individuals who underwent a native kidney biopsy, among all adult patients who received aHCT in a tertiary hospital in Montreal (Canada) from January 1, 2010, to December 31, 2020, were identified, and the clinical data were extracted from their medical records. RESULTS: A total of 17 patients were included. Indications for biopsy included acute kidney injury (n=6), chronic kidney disease (n=5), nephrotic syndrome (n=4), and subnephrotic proteinuria (n=2). Pathologic findings from the kidney biopsy were heterogenous: 10 patients showed evidence of thrombotic microangiopathy (TMA), 5 of acute tubular injury, and 4 of membranous nephropathy. Cases of acute interstitial nephritis, BK virus nephropathy, immune complex nephropathy, focal and segmental glomerulosclerosis, minimal change disease, and karyomegalic-like interstitial nephritis were also described. LIMITATIONS: There was no systematic kidney biopsy performed for all patients with kidney injury after aHCT. Only a small proportion of patients with kidney damage underwent biopsy, making the results less generalizable. CONCLUSIONS: Kidney biopsy is useful in patients with kidney disease after aHCT to make a precise diagnosis and tailor therapy accordingly. This series is one of the few published studies describing pathologic findings of biopsies performed after aHCT in the context of acute kidney injury and chronic kidney disease. TMA was widely present on biopsy even when there was no clinical suspicion of such a diagnosis, suggesting that the current clinical criteria for a diagnosis of TMA are not sensitive enough for kidney-limited TMA.
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spelling pubmed-103635602023-07-25 Kidney Biopsy Findings Among Allogenic Hematopoietic Stem Cell Transplant Recipients With Kidney Injury: A Case Series Roy, Guillaume Iordachescu, Ilinca Royal, Virginie Lamarche, Caroline Ahmad, Imran Nadeau-Fredette, Annie-Claire Laurin, Louis-Philippe Kidney Med Original Research RATIONALE AND OBJECTIVE: The incidence of kidney disease is high in patients after allogeneic hematopoietic cell transplantation (aHCT). Although rarely performed, kidney biopsy may be useful to make a precise diagnosis because several mechanisms and risk factors can be involved, and to adjust the treatment accordingly. This case series aimed to report the spectrum of biopsy findings from patients with kidney injury after aHCT. STUDY DESIGN: Single-center retrospective case series. SETTING AND PARTICIPANTS: All individuals who underwent a native kidney biopsy, among all adult patients who received aHCT in a tertiary hospital in Montreal (Canada) from January 1, 2010, to December 31, 2020, were identified, and the clinical data were extracted from their medical records. RESULTS: A total of 17 patients were included. Indications for biopsy included acute kidney injury (n=6), chronic kidney disease (n=5), nephrotic syndrome (n=4), and subnephrotic proteinuria (n=2). Pathologic findings from the kidney biopsy were heterogenous: 10 patients showed evidence of thrombotic microangiopathy (TMA), 5 of acute tubular injury, and 4 of membranous nephropathy. Cases of acute interstitial nephritis, BK virus nephropathy, immune complex nephropathy, focal and segmental glomerulosclerosis, minimal change disease, and karyomegalic-like interstitial nephritis were also described. LIMITATIONS: There was no systematic kidney biopsy performed for all patients with kidney injury after aHCT. Only a small proportion of patients with kidney damage underwent biopsy, making the results less generalizable. CONCLUSIONS: Kidney biopsy is useful in patients with kidney disease after aHCT to make a precise diagnosis and tailor therapy accordingly. This series is one of the few published studies describing pathologic findings of biopsies performed after aHCT in the context of acute kidney injury and chronic kidney disease. TMA was widely present on biopsy even when there was no clinical suspicion of such a diagnosis, suggesting that the current clinical criteria for a diagnosis of TMA are not sensitive enough for kidney-limited TMA. Elsevier 2023-05-16 /pmc/articles/PMC10363560/ /pubmed/37492111 http://dx.doi.org/10.1016/j.xkme.2023.100674 Text en © 2023 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research
Roy, Guillaume
Iordachescu, Ilinca
Royal, Virginie
Lamarche, Caroline
Ahmad, Imran
Nadeau-Fredette, Annie-Claire
Laurin, Louis-Philippe
Kidney Biopsy Findings Among Allogenic Hematopoietic Stem Cell Transplant Recipients With Kidney Injury: A Case Series
title Kidney Biopsy Findings Among Allogenic Hematopoietic Stem Cell Transplant Recipients With Kidney Injury: A Case Series
title_full Kidney Biopsy Findings Among Allogenic Hematopoietic Stem Cell Transplant Recipients With Kidney Injury: A Case Series
title_fullStr Kidney Biopsy Findings Among Allogenic Hematopoietic Stem Cell Transplant Recipients With Kidney Injury: A Case Series
title_full_unstemmed Kidney Biopsy Findings Among Allogenic Hematopoietic Stem Cell Transplant Recipients With Kidney Injury: A Case Series
title_short Kidney Biopsy Findings Among Allogenic Hematopoietic Stem Cell Transplant Recipients With Kidney Injury: A Case Series
title_sort kidney biopsy findings among allogenic hematopoietic stem cell transplant recipients with kidney injury: a case series
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10363560/
https://www.ncbi.nlm.nih.gov/pubmed/37492111
http://dx.doi.org/10.1016/j.xkme.2023.100674
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