Late-onset renal dysfunction in a patient with non-Hodgkin's lymphoma following an autologous bone marrow transplantation.

Various types of glomerulonephropathy have been reported in patients with malignant lymphoma. The present report describes a 21-year-old man with non-Hodgkin's lymphoma who developed renal insufficiency 4 months after undergoing autologous bone marrow transplantation without combined total body irradiation treatment. At the presentation of renal dysfunction, the malignant lymphoma had been in complete remission. A renal biopsy specimen revealed glomerular changes resembling those seen in patients with hemolytic uremic syndrome. However, hematologic examinations exhibited no evidence of thrombocytopenia or thrombotic microangiopathy, such as red cell fragmentations on the peripheral blood smear. Although the etiology of this nephropathy remains unclear, the chemotherapeutic agents administered in conditioning regimens for bone marrow transplantation were suspected of contributing to the renal insufficiency. Methylprednisolone pulse therapy appeared to be effective in arresting progression of the nephropathy. This case indicates that renal function should be monitored carefully in patients with malignant lymphoma after bone marrow transplantation, even if such patients lack the signs or symptoms of thrombotic microangiopathy.