DDx
Diagnostic Considerations
Conditions to consider in the differential diagnosis of radiation nephropathy, along with those in the next section, include the following:
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Cyclosporine or tacrolimus toxicity
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Pamidronate-induced focal glomerulosclerosis
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Nephrotic syndrome associated with graft versus host disease
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Polyoma virus nephropathy
These diagnoses must all be considered in the 15% of bone marrow transplantation (hematopoietic stem cell transplantation) survivors who develop chronic kidney disease. [15]
Differential Diagnoses
Media Gallery
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Evolution of the glomerular filtration rate (GFR) versus time in a case of nephropathy related to bone marrow transplantation (BMT). GFR may be approximated as 100/plasma creatinine on the Y axis and graphed versus time on the X axis. As is true in many cases of BMT nephropathy, the evolution appears to be biphasic, with an initial rapid decline in GFR, then a slower plateau phase. The patient whose data are shown here ultimately underwent kidney transplantation.
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Photomicrograph of a kidney-biopsy sample in a case of nephropathy associated with bone marrow transplantation (periodic acid-Schiff stain). A glomerulus is in the center and is relatively hypocellular. Increased mesangial matrix is present. The glomerular basement membranes are not thickened; in some places, however, they are separated from the capillary lumens by a low-density, matrixlike material. Interstitial fibrosis separates the tubules from each other. Arteriolar thickening and arteriolar hyalin are present.
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