Kidney Complications of Hematopoietic Stem Cell Transplantation

Renal pathology in hematopoietic cell transplant recipients: a contemporary biopsy, nephrectomy, and autopsy series

“…[1][2][3][4] Although some of these current methods of hematopoietic cell transplant tend to be less toxic, many patients still experience significant renal injury because of exposure to a multitude of factors including cytotoxic conditioning agents, radiation, immunosuppression, infection, ischemia, and graft-versus-host disease (GVHD). [5][6][7][8] Acute kidney injury is associated with medications (chemotherapeutic, antibiotic, immunosuppressive), tumor lysis syndrome, renal ischemia, infections, or radiation, whereas chronic kidney injury, including glomerulonephridities, has been associated with chronic GHVD, medications, sequelae of acute injury, ischemia, other comorbidities, and recurrent/secondary malignancy. [7][8][9] Numerous descriptive studies, derived from groups of kidney core biopsy specimens from hematopoietic cell transplant recipients with renal dysfunction, have characterized the most common types of glomerulonephritis in hematopoietic cell transplant patients.…”

Graft versus host disease-dependent renal dysfunction after hematopoietic stem cell transplantation

“…BMT nephropathy is a multifactorial disorder, and each factor is related to others [4]. Our patient received melphalan 140 mg/m 2 totally before BMT, antibiotics vancomycin and antifungal agent for severe infectious disease, which might be toxic for kidney.…”

Kidney Complications Due to Hematopoietic Stem Cell Transplantation-A Disorder of an Increasing Incidence?

“…It has already been well-established that age is a risk factor for AKI. Acute kidney injury following HSCT is related to prerenal (such as fluid depletion, sepsis, drugs…), intrinsic renal (acute tubular necrosis due to ischemia, nephrotoxic drugs, acute interstitial nephritis, infection-associated kidney injury and vascular disorders) and postrenal (intratubular or extratubular obstruction) causes [2]. During the first month after HSCT the main predisposing factors for development of AKI are: sepsis, nephrotoxic drugs, obstruction, tumor lysis syndrome, hepatorenal syndrome from veno-occlusive disease, acute thrombocytopenic purpura or hemolytic uremic syndrome (TTP/HUS), acute graft-host-versus disease (aGHVD) and cytomegalovirus (CMV) reactivation.…”

“…These are usually methotrexate or the calcineurin inhibitors (CNIs) cyclosporine or tacrolimus. Using the mentioned approach many patients have now been followed for two or three decades post-transplant and are presumed to be cured [1,2]. On the other hand, a great proportion of these patients are experiencing long-term side effects after HSCT, including non-malignant organ or tissue dysfunction, changes in quality of life, infections and secondary malignancy [3].…”

“…Namely, a high-dose conditioning regimen is used in both myeloablative allogeneic and autologous HSCT and frequently in combination with high dose radiotherapy. Furthermore, myeloablative allogeneic HSCT also requires the use of immunosuppressive therapy posttransplant, most of the time with calcineurin inhibitors and this is not necessary in autologous HSCT [2,5]. Recently, a newly developed form of HSCT, a nonmyeloablative or reduced-intensity conditioning (RIC) allogeneic HSCT is being used in older patients or in those with co-morbid medical conditions.…”