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The following is a summary of “Steroid-resistant nephrotic syndrome due to renal-limited thrombotic microangiopathy and membranous nephropathy after allogeneic hematopoietic stem cell transplantation successfully treated with calcineurin inhibitors,” published in the January 2025 issue of International Journal of Hematology by Okada et al. 

Transplantation-associated thrombotic microangiopathy (TMA) is a severe complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) with high mortality. Renal-limited TMA, without the classical triad, is rare after allo-HSCT, and its optimal management remains unclear. 

Researchers conducted a retrospective study on 3 cases of renal-limited TMA after allo-HSCT presenting with nephrotic syndrome. 

They performed renal biopsy, which showed TMA and concurrent membranous nephropathy. All patients were refractory to glucocorticoid monotherapy, and the addition of CNI led to complete remission of nephrotic syndrome. 

The results showed renal-limited TMA after allo-HSCT may present as nephrotic syndrome with distinct pathophysiological features from recipients with non-allo-HSCT. 

Investigators suggested that renal-limited TMA after allo-HSCT is associated with renal graft-vs-host disease. Calcineurin inhibitors (CNI) treatment may have been useful, even with concurrent membranous nephropathy. 

Source: link.springer.com/article/10.1007/s12185-025-03930-4