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1/9 Let’s talk about nephrotic syndrome after hematopoietic stem cell transplant (HSCT) #Tweetorial #MedTwitter @NSMCInternship
75M with myelofibrosis s/p allogeneic stem cell transplant is referred for nephrotic-range proteinuria discovered during lower extremity edema work up
75M with myelofibrosis s/p allogeneic stem cell transplant is referred for nephrotic-range proteinuria discovered during lower extremity edema work up
2/9
Labs show Cr 0.9, albumin 2.0, 24hr urine protein 12g, no RBCs in urine and unremarkable serologic work-up. You decide to pursue a biopsy.
What is the most likely pathologic finding you will find on kidney biopsy?
Labs show Cr 0.9, albumin 2.0, 24hr urine protein 12g, no RBCs in urine and unremarkable serologic work-up. You decide to pursue a biopsy.
What is the most likely pathologic finding you will find on kidney biopsy?
3/9
Read on to find the answer!
Nephrotic syndrome post-allogeneic HSCT was first described in 1988
Occurs in 0.4-6.0% of pts at a median of ~20 months
Is associated with increased risk of non-relapse related mortality
(Beyar-Katz et al. Biol Blood Marrow Transplant. 2016)
Read on to find the answer!
Nephrotic syndrome post-allogeneic HSCT was first described in 1988
Occurs in 0.4-6.0% of pts at a median of ~20 months Is associated with increased risk of non-relapse related mortality(Beyar-Katz et al. Biol Blood Marrow Transplant. 2016)
4/9
Nephrotic syndrome post-HSCT is more likely to occur in patients who receive:
A peripheral blood SCT (thought to be related to 
T-cell load)
Myeloablative conditioning (thought to be toxic to podocytes)
Nephrotic syndrome post-HSCT is more likely to occur in patients who receive:
A peripheral blood SCT (thought to be related to T-cell load) Myeloablative conditioning (thought to be toxic to podocytes)
5/9
Nephrotic syndrome post-HSCT is associated with graft-versus-host disease (GVHD).
Many experts think of Nephrotic syndrome post-HSCT as “kidney GVHD” 
Nephrotic syndrome post-HSCT is associated with graft-versus-host disease (GVHD).
Many experts think of Nephrotic syndrome post-HSCT as “kidney GVHD”
6/9
Many case series have shown that the most common pathologic findings on kidney biopsy are:
#1: Membranous nephropathy (~65%)
#2: Minimal change disease (~20%)
Many case series have shown that the most common pathologic findings on kidney biopsy are:
#1: Membranous nephropathy (~65%)
#2: Minimal change disease (~20%)
7/9
Depending on the histopathologic findings, treatment options include:
Corticosteroids (Cs)
Calcineurin inhibitors (CNIs)
Rituximab
This is mostly based on case reports and case series (see proposed treatment algorithm)
Depending on the histopathologic findings, treatment options include:
Corticosteroids (Cs) Calcineurin inhibitors (CNIs) RituximabThis is mostly based on case reports and case series (see proposed treatment algorithm
)
8/9
So let’s try this again. What is the most likely pathologic finding on kidney biopsy in patients with nephrotic syndrome post-HSCT?
So let’s try this again. What is the most likely pathologic finding on kidney biopsy in patients with nephrotic syndrome post-HSCT?
Thank you everyone for reading! Here are some pretty photos of membranous nephropathy.
Look out for my next #Tweetorial! #OncoNephrology #MedEd #FOAMed #NSMC
Look out for my next #Tweetorial! #OncoNephrology #MedEd #FOAMed #NSMC
Tagging my oncology friends @DrJonesNauseef @ECMulvey @BenDiamondMD @juanosoriomd @samyamshon @HanaILim_MD @Taha_CancerDoc @NAbuhadra
