Ms Gabriella Wong1, Dr Pranav Dorwal1,2, Professor Kevan Polkinghorne1,2
1Monash Health, Clayton, Australia, 2Monash University, Clayton, Australia
Biography:
Bio to come
Background:
Chronic graft-versus-host disease (cGVHD) is the most common late complication of allogenic haematopoietic stem cell transplantation (HSCT). Renal manifestations are rare, with an estimated prevalence of less than 0.6%, and may be underdiagnosed due to overlapping comorbidities and biopsy contraindications.
Case report:
We report the case of a 31-year-old female with a history of Philadelphia chromosome-positive acute myeloid leukaemia, who underwent a matched unrelated donor HSCT in March 2023. In October 2024, she re-presented with fever and a cough. She was incidentally found to have nephrotic syndrome with preserved renal function. Renal biopsy demonstrated features consistent with secondary membranous nephropathy. This was in keeping her being PLA2 receptor antibody negative on serology. There was no identifiable infective or autoimmune cause, favouring a diagnosis of renal cGVHD. Treatment with corticosteroids and ciclosporin led to rapid remission within two weeks.
Conclusions:
This case underscores the importance of considering renal cGVHD as a differential diagnosis in HSCT recipients presenting with nephrotic syndrome. Prompt renal biopsy and early initiation of immunosuppressive therapy can lead to favourable outcomes. Given its rarity and under-recognition, further research is needed to establish optimal long-term management strategies for renal cGVHD. Clinicians should maintain a high index of suspicion, as early diagnosis and appropriate treatment significantly improve prognosis.