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Minimal-change nephrotic syndrome in a hematopoietic stem-cell transplant recipient

Nature Clinical Practice Nephrology volume 2, pages 535–539 (2006)Cite this article

Abstract

Background A 61-year-old woman received standard immunizations, including Haemophilus influenzae type B, diphtheria, tetanus toxoid, and unconjugated 23-valent pneumococcal vaccine (Pneumovax®, Merck & Co., Inc., Whitehouse Station, NJ), 1 year after undergoing nonmyeloablative hematopoietic stem-cell transplantation for acute myelogenous leukemia. After 5 days, she developed fatigue with progressive weight gain and edema, and 14 days after immunization she presented with anasarca and was found to have acute renal failure and nephrotic proteinuria.

Investigations Physical examination, serum chemistry, examination of urine sediment, renal ultrasound using Doppler scanning, 24 h urine collection, and renal biopsy.

Diagnosis Minimal-change nephrotic syndrome with acute tubular injury.

Management Aggressive diuresis and oral corticosteroid therapy.

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Figure 1: The patient's urinary sediment and kidney biopsy findings.
Figure 2: Time course for development and resolution of proteinuria after vaccination.

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Acknowledgements

BD Humphreys is supported by NIH Career Development Award DK073628-01.

Author information

Authors and Affiliations

  1. instructor at Harvard Medical School, Boston, MA, USA

    Benjamin D Humphreys

  2. Staff Nephrologist in the Renal Division at Brigham and Women's Hospital, Boston, MA, USA

    Benjamin D Humphreys

  3. renal pathology fellow,

    Vijay K Vanguri & Joel Henderson

  4. Staff Pathologist at the Department of Pathology, Brigham and Women's Hospital,

    Vijay K Vanguri & Joel Henderson

  5. Professor of Medicine at Harvard Medical School,

    Joseph H Antin

  6. Chief of the Stem-Cell Transplant Program in the Department of Medical Oncology at the Dana Farber Cancer Institute, Boston, MA, USA

    Joseph H Antin

Authors
  1. Benjamin D Humphreys
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  2. Vijay K Vanguri
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  3. Joel Henderson
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  4. Joseph H Antin
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Corresponding author

Correspondence to Benjamin D Humphreys.

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The authors declare no competing financial interests.

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Humphreys, B., Vanguri, V., Henderson, J. et al. Minimal-change nephrotic syndrome in a hematopoietic stem-cell transplant recipient. Nat Rev Nephrol 2, 535–539 (2006). https://doi.org/10.1038/ncpneph0271

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  • DOI: https://doi.org/10.1038/ncpneph0271

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