obsolete bone marrow tansplantation nephropathy

Bone Marrow Transplantation Nephropathy: An Obsolete Condition

Bone marrow transplantation nephropathy, also known as "bone marrow transplant nephropathy," is a rare and complex condition that was previously associated with bone marrow transplantation (BMT). This syndrome was characterized by a sudden increase in creatinine levels, microangiopathic hemolytic anemia, and hypertension occurring typically after 6-12 months post-transplantation [2][8].

Causes and Pathophysiology

The exact causes of bone marrow transplantation nephropathy are not well understood. However, it is believed to evolve from the late effects of radiation therapy and cytotoxic chemotherapy on the kidneys [7]. The condition was thought to be associated with renal inflammation in the pathogenesis of proteinuria and kidney disease [10].

Clinical Features

The clinical features of bone marrow transplantation nephropathy included:

• Sudden

Common Signs and Symptoms of Obsolete Bone Marrow Transplantation Nephropathy

Bone marrow transplantation nephropathy, also known as transplant-associated thrombotic microangiopathy (TA-TMA), is a rare but serious complication that can occur after bone marrow transplantation. The condition was previously referred to as "bone marrow transplant nephropathy." Here are some common signs and symptoms associated with this condition:

• Sudden increase in creatinine: A sudden rise in creatinine levels, indicating impaired kidney function [9].
• Microangiopathic hemolytic anemia: A type of anemia characterized by the presence of schistocytes (fragmented red blood cells) in the peripheral blood smear [2][9].
• Hypertension: High blood pressure is a common symptom of this condition, occurring typically after 6-12 months [9].
• Acute respiratory failure: In severe cases, bone marrow transplantation nephropathy can lead to acute respiratory failure due to pulmonary hypertension [1].

Other Associated Symptoms

In addition to the above symptoms, patients with bone marrow transplantation nephropathy may also experience:

• Impaired spermatogenesis and erectile dysfunction: Hypogonadism is a common complication after bone marrow transplantation, affecting male patients' fertility and sexual health [4].
• Low testosterone and libido: Male patients may experience low levels of testosterone and decreased libido due to hypogonadism [4].

Risk Factors

Several risk factors have been identified for developing bone marrow transplantation nephropathy, including:

• Treatment with total-body irradiation
• Use of calcineurin inhibitors (CNIs)
• Combined use of sirolimus and tacrolimus
• Acute graft-versus-host disease (GVHD)
• Infection
• Transplant of peripheral blood stem cells

It is essential to note that these symptoms and risk factors are associated with the obsolete term "bone marrow transplantation nephropathy." The condition has been renamed transplant-associated thrombotic microangiopathy (TA-TMA) per consensus criteria.

Based on the provided context, it appears that there are several diagnostic tests and criteria associated with bone marrow transplantation (BMT) nephropathy. Here's a summary of the relevant information:

• Membranous Nephropathy: This is one of the most common forms of BMT nephropathy, accounting for two-thirds of cases [9]. It is characterized by changes in the kidney's glomeruli.
• Minimal Change Disease (MCD): This condition is responsible for nearly one-quarter of BMT nephropathy cases [9]. It is a type of kidney disease that affects the glomeruli and can cause proteinuria.
• Renal Biopsy: This is considered the gold-standard examination for diagnosing renal injury, including BMT nephropathy [11]. However, it is an invasive procedure.
• Diagnostic Criteria: The Blood and Marrow Transplant Clinical Trial Network (BMT-CTN) has developed diagnostic criteria for Thrombotic Microangiopathy (TMA), which includes BMT nephropathy [13].
• Clinical Presentation: BMT nephropathy can present with symptoms such as hypertension, disproportionate severe anemia, and sudden rise in serum creatinine [12].

It's worth noting that the incidence of BMT nephropathy is higher in older recipients, female donors to male recipients, allogeneic versus autologous transplants, and peripheral blood stem cell transplantation (PBSCT) compared to bone marrow transplantation (BMT) [9].

Treatment Options for Obsolete Bone Marrow Transplantation Nephropathy

Bone marrow transplantation nephropathy, also known as transplant-associated thrombotic microangiopathy (TA-TMA), is a rare but serious complication of bone marrow transplantation. While it has been largely replaced by newer treatments and diagnostic criteria, there are still some treatment options that were previously used to manage this condition.

• ACE inhibitors: Angiotensin-converting enzyme (ACE) inhibitors have been shown to be effective in preventing the development of radiation nephropathy after bone marrow transplantation [10][11]. These medications work by relaxing blood vessels and reducing blood pressure, which can help alleviate symptoms.
• Leflunomide: Leflunomide is an immunosuppressive drug that has been used to treat BKV-associated nephropathy after renal transplantation [12]. It may also be effective in treating TA-TMA, although more research is needed to confirm this.
• Immunosuppressants and corticosteroids: Combined treatment with immunosuppressants and corticosteroids was previously the mainstay of treatment for TA-TMA [14]. This approach involves using medications to suppress the immune system and reduce inflammation in the kidneys.

It's worth noting that these treatment options are largely obsolete, as newer treatments and diagnostic criteria have been developed. However, they may still be relevant in certain cases or situations where more modern treatments are not available.

References:

[10] Moulder JE (1997). Angiotensin-converting enzyme inhibitors can prevent the development of radiation nephropathy after bone marrow transplantation. [11] Moulder JE (1997). Angiotensin-converting enzyme inhibitors can prevent the development of radiation nephropathy after bone marrow transplantation. [12] Chen XC (2013). Leflunomide is an immunosuppressive drug with antiviral activity and has been used in treating BKV-associated nephropathy after renal transplantation. [14] Mattei D (2010). Combined treatment with immunosuppressants and corticosteroids remains the mainstay of treatment of this complication, usually associated with bone marrow transplantation.

Based on the provided context, it appears that the differential diagnosis for obsolete bone marrow transplantation nephropathy (BMTN) has evolved over time.

Historical Context The term "bone marrow transplant nephropathy" was previously used to describe late renal complications after hematopoietic cell transplantation (HCT), reminiscent of hemolytic-uremic syndrome [10]. This condition was characterized by a sudden increase in creatinine, microangiopathic hemolytic anemia, and hypertension occurring typically after 6-12 months.

Current Understanding However, with the advancement of medical knowledge, the differential diagnosis for BMTN has expanded to include other conditions. According to recent studies [9], the differential diagnosis of nephrotic syndrome (NS) in a patient with a history of hematopoietic stem cell transplantation (HSCT) includes:

• Minimal change disease (MCD) as a manifestation of lymphoma recurrence
• Membranous nephropathy, which is an uncommon but increasingly recognized complication of HSCT

Other Considerations Additionally, the association between BMTN and graft-versus-host disease (GVHD) has been reported in some cases [5]. However, this association is rare, and the pathophysiology remains unclear.

Summary In summary, the differential diagnosis for obsolete bone marrow transplantation nephropathy has evolved to include a range of conditions, including minimal change disease, membranous nephropathy, and graft-versus-host disease. Further research is needed to fully understand the pathophysiology and clinical implications of these conditions.

References: [5] Srinivasan et al. reported seven cases of nephrotic syndrome in a consecutive series of non-myeloablative HSCT recipients, and four of these patients had [10] The term bone marrow transplant nephropathy (2, 3) has thus far been used to refer to late renal complications after HCT reminiscent of hemolytic-uremic syndrome, ... The differential diagnosis of NS in a patient with a history of HL includes MCD as a manifestation of lymphoma recurrence (7, 8).