Nasr SH, Leung N, Said SM, et al. - Findings imply that membranous nephropathy with extensive tubular basement membrane (TBM) deposits represents a distinctive clinicopathologic lesion related to allogeneic hematopoietic cell transplant. Chronic graft-vs-host disease-driven antibodies against glomerular and TBM components (the identity of which remains to be elucidated) are probably implicated in the pathogenesis.

• TBM deposits very rarely occur in non-lupus membranous nephropathy.

• A total of 5 patients with membranous nephropathy and extensive TBM deposits after allogeneic hematopoietic cell transplant were studied.

• On kidney biopsies, presence of global subepithelial and extensive TBM immune complex deposits was evident which was accompanied by acute tubular injury (n=4) and tubulointerstitial inflammation (n=4).

• Proteomic analysis of glomeruli was done in 4 cases, showing spectra for PLA2R in 1 and absence of significant protein spectra for PLA2R, THSD7A, EX1/2, NELL-1, PCDH7, NCAM1, or SEMA3B in the remaining 3.

• Follow up (mean 42 months) revealed that 4 cases had complete and 1 partial remission after prednisone and/or rituximab therapy.