Kidney nontumor
Associated with systemic conditions
Bone marrow transplant nephropathy

Author: Nikhil Sangle, M.D. (see Authors page)

Revised: 21 March 2018, last major update September 2012

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Bone marrow transplant nephropathy [title]

Cite this page: Sangle, N. Bone marrow transplant nephropathy. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/kidneyBMtransplant.html. Accessed October 16th, 2018.
Definition / general
  • May be due to total body irradiation (similar to radiation nephropathy, (eMedicine: Radiation Nephropathy [Accessed 17 January 2018]), 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
  • Supportive therapy
Case reports
Microscopic (histologic) description
  • 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
Microscopic (histologic) images

Images hosted on other servers:

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