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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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