Acute kidney injury in pediatric hematopoietic cell transplantation: critical appraisal and consensus

Raina, Rupesh; Abu‐Arja, Rolla; Sethi, Sidharth Kumar; Dua, Richa; Chakraborty, Ronith; Dibb, James; Basu, Rajit K.; Bissler, John J.; Felix, Melvin Bonilla; Brophy, Patrick D.; Bunchman, Timothy E.; Alhasan, Khalid; Haffner, Dieter; Kim, Yap Hui; Licht, Christopher; McCulloch, Mignon; Menon, Shina; Onder, Ali Mirza; Khooblall, Prajit; Khooblall, Amrit; Polishchuk, Veronika; Rangarajan, Hemalatha G.; Sultana, Azmeri; Kashtan, Clifford E.

doi:10.1007/s00467-022-05448-x

Cited by 12 publications

(41 citation statements)

References 108 publications

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“…AKI is a relatively common complication after HCT, with a reported incidence rate of 21–84% [ 1 , 2 ]. Table 1 summarizes published studies reporting AKI in the pediatric HCT population [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ].…”

Section: Acute Kidney Injurymentioning

confidence: 99%

“…In addition, children are at a higher risk of infection and subsequent sepsis due to their immune-compromised status. In many instances, the etiology of AKI is multifactorial and includes hypoperfusion in the setting of capillary leak or sepsis resulting in acute tubular necrosis, drug induced nephrotoxicity, thrombotic microangiopathy (TMA), and sinusoidal obstruction syndrome (SOS) ( Figure 1 ) [ 1 ]. Drug induced nephrotoxicity is relatively common in HCT patients.…”

Section: Acute Kidney Injurymentioning

confidence: 99%

“…Nearly one-third of patients with AKI require kidney replacement therapy (KRT) [ 1 ]. CKRT is used often in the ICU to deliver KRT because it is tolerated better than intermittent hemodialysis (IHD) in hemodynamically unstable critically ill children.…”

Section: Continuous Kidney Replacement Therapymentioning

confidence: 99%

“…ICU mortality in children post HCT requiring CKRT is estimated to be 52–65% [ 2 , 49 ]. The 1-year overall survival rate is also poor (27.4% (95% CI: 16–40.5%, p < 0.0001)) [ 1 ]. Reported factors that are associated with mortality include FO > 10%, mechanical ventilation, vasoactive support, and neutropenia at the end of CKRT [ 2 ].…”

Section: Outcomes Of Krtmentioning

confidence: 99%

“…Serum CysC levels can be altered by several factors such as corticosteroids, inflammatory status, and chemotherapy. Levels may also be elevated in patients with leukemia without any documented AKI secondary to increased cell turnover [ 1 ]. CysC can detect decline in renal function and GFR 24–48 h before serum creatinine levels.…”

Section: Biomarkers Of Aki In Children With Hctmentioning

confidence: 99%

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Kidney Injury in Children after Hematopoietic Stem Cell Transplant

2023

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Hematopoietic cell transplant (HCT), used for treatment of many malignant and non-malignant pediatric diseases, is associated with serious complications, limiting this therapy’s benefit. Acute kidney injury (AKI), seen often after HCT, can occur at different stages of the transplant process and contributes to morbidity and mortality after HCT. The etiology of AKI is often multifactorial, including kidney hypoperfusion, nephrotoxicity from immunosuppressive and antimicrobial agents, and other transplant-related complications such as transplant-associated thrombotic microangiopathy and sinusoidal obstructive syndrome. Early recognition of AKI is crucial to prevent further AKI and associated complications. Initial management includes identifying the etiology of AKI, preventing further kidney hypoperfusion, adjusting nephrotoxic medications, and preventing fluid overload. Some patients will require further support with kidney replacement therapy to manage fluid overload and AKI. Biomarkers of AKI, such as neutrophil gelatinase-associated lipocalin can aid in detecting AKI before a rise in serum creatinine, allowing earlier intervention. Long-term kidney dysfunction is also prominent in this population. Therefore, long-term follow-up and monitoring of renal function (glomerular filtration rate, microalbuminuria) is required along with management of hypertension, which can contribute to chronic kidney disease.

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