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Kidney non-tumor

Associated with systemic conditions

Bone marrow transplant nephropathy

Reviewer: Nikhil Sangle, M.D. (see Reviewers page)
Revised: 5 September 2012, last major update September 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● May be due to total body irradiation (similar to radiation nephropathy, (eMedicine), although controversial if total body irradiation is risk factor for renal dysfunction (Radiother Oncol 2009;90:242)
● Delayed renal insufficiency (occurs in 20%), hypertension and anemia out of proportion to azotemia; possibly hemolytic uremic syndrome
● May have a long latency period between exposure to radiation and the development of radiation nephritis
● Treatment with angiotensin-converting enzyme inhibitor may be useful (Clin Exp Nephrol 2006;10:78)

Treatment
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● Supportive therapy

Case reports
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● 27 year old man with renal impairment after bone marrow transplant for CML (Arch Pathol Lab Med 2004;128:233)

Micro description
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● Early changes: related to acute tubular necrosis, infection, nephrotoxic drugs, graft versus host disease, tumor lysis syndrome, marrow infusion toxicity, hepatic venoocclusive disease or interstitial nephritis
● Late changes (3 months after bone marrow transplant): prominent mesangiolysis, focal aneurysmal capillary dilation and variable increase in mesangial matrix; also swollen endothelial cells, widened subendothelial space, duplicated (double contour) glomerular basement membrane and focal fibrin thrombi within glomerular capillaries

Micro images
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Left: mesangiolysis and extreme widening between endothelium and glomerular basement membrane; right: hypocellular glomerulus, increased mesangial matrix


Nephropathy due to chemotherapy, not radiation therapy:
Figure 1: accentuation of glomerular lobules, narrowed capillary lumens, focal aneurysmal capillary dilation
Figure 2: prominent mesangiolysis and extreme widening of space between endothelium and glomerular basement membrane giving double-contour appearance (PAS-silver stain)
Figure 3: endothelial cell injury with separation of endothelial lining from basement membrane due to greatly expanded subendothelial space (arrowheads)

Immunofluorescence
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● Fibrin, IgM

Electron microscopy description
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● Endothelial injury with widened subendothelial space filled with loose, amorphous, granular material (fibrin) and new basement membrane material
● Variable red blood cell fragments

Electron microscopy images
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Extreme widening, endothelial swelling and irregularity, and no immune deposits

Differential diagnosis
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● Hemolytic uremic syndrome

End of Kidney non-tumor > Associated with systemic conditions > Bone marrow transplant nephropathy

Ref Updated: 7/24/12

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