Acute Kidney Injury in Pediatric Stem Cell Transplant Recipients

DiCarlo, Joseph; Alexander, Steven R.

doi:10.1016/j.semnephrol.2008.05.008

Cited by 12 publications

(4 citation statements)

References 21 publications

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“…Known risk factors for acute kidney injury (AKI) in the pediatric HCT population include allogeneic HCT, sinusoidal obstructive syndrome (SOS), use of nephrotoxic medications thrombotic microangiopathy (TMA), prior history of AKI, decreased baseline glomerular filtration rate (GFR), total body irradiation, and myeloablative chemotherapy conditioning regimens ( 33 – 42 ). DiCarlo and Alexander described the evolution of organ dysfunction in pediatric HCT as a result of a cytokine driven process, which may first manifest as fluid accumulation ( 38 ).Acute fluid overload above specific thresholds may be associated with high mortality rates in pediatric HCT patients who require PICU admission and detection of AKI often occurs well after the window for potentially successful mitigation strategies have passed ( 43 , 44 ). The true incidence and precise impact of acute fluid overload among pediatric HCT patients who do not require PICU admission remains poorly characterized and clinical and physiological studies to date, demonstrate that the ideal fluid strategy in AKI has not been developed.…”

Section: Organ Dysfunction Syndromes Post-hctmentioning

confidence: 99%

Perspective: A Framework to Screen Pediatric and Adolescent Hematopoietic Cellular Therapy Patients for Organ Dysfunction: Time for a Multi-Disciplinary and Longitudinal Approach

Ahmad

Mahadeo

2021

Front. Oncol.

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Hematopoietic Cell Transplantation (HCT) is a potentially curative therapy for children and adolescent/young adults (AYA) with high-risk malignancies as well as some non-malignant genetic diseases. However, HCT may be associated with endotheliopathies and/or organ dysfunction that may progress to pediatric multi-organ dysfunction syndrome (pMODS) and require critical care intervention. Discipline specific scoring systems may be used to characterize individual organ dysfunction, but the extent to which they are used to prospectively monitor HCT patients with mild dysfunction is unknown. Further, separate scoring systems may be used to define risk of mortality and inform prognostication among those who require critical care support. Our understanding of the epidemiology, risk factors, morbidity, mortality, required monitoring, optimal prevention strategies and appropriate management of children undergoing HCT who develop organ dysfunction, endotheliopathies and/or progress to pMODS is poor. Discipline-specific registries and clinical studies have described improving outcomes for children undergoing HCT, including those who require critical care support; however, longitudinal studies/prospective registries that capture common data elements among HCT patients with and without organ dysfunction, endotheliopathies and pMODS are needed to facilitate inter-disciplinary collaboration and optimally characterize the risk profiles, define screening and prophylaxis regimens and mitigate toxicity.

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Section: Organ Dysfunction Syndromes Post-hctmentioning

confidence: 99%

Perspective: A Framework to Screen Pediatric and Adolescent Hematopoietic Cellular Therapy Patients for Organ Dysfunction: Time for a Multi-Disciplinary and Longitudinal Approach

Ahmad

Mahadeo

2021

Front. Oncol.

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“…The role of CRRT in pediatric post-HSCT patients has received important consideration for some time, and its potential for clinical benefit in shock sepsis is a topic of vigorous discussion (15)(16)(17)(18)(19)(20). Rationale for use of CRRT in sepsis is mostly centered around its potential for mitigating volume overload that often accompanies requisite fluid administration for hemodynamic support during sepsis and its putative role for clearing sepsisassociated inflammatory cytokines (19).…”

Section: Septic Shockmentioning

confidence: 99%

Continuous Renal Replacement Therapy: A Review of Use and Application in Pediatric Hematopoietic Stem Cell Transplant Recipients

2021

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Hematopoietic stem cell transplant (HSCT) is a curative therapy for malignant and non-malignant conditions. However, complications post-HSCT contribute to significant morbidity and mortality in this population. Acute kidney injury (AKI) is common in the post-allogeneic transplant phase and contributes to morbidity in this population. Continuous renal replacement therapy (CRRT) is used often in the setting of AKI or multiorgan dysfunction in critically ill children. In addition, CRRT can be useful in many disease processes related to transplant and can potentially improve outcomes in this population. This review will focus on the use of CRRT in critically ill children in the post-HSCT setting outside the realm of acute renal failure and highlight the benefits and applications of this modality in this high-risk population.

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“…To address the problem of FO and associated AKI, some centers have established protocols to initiate therapies at a certain level of FO in the setting of AKI. Protocols exist that recommend the administration of intravenous diuretics and inotropic therapy at 5% FO above baseline, followed by the initiation of RRT at 10% FO either with worsening AKI [54,55] or with evidence of worsening respiratory status or increasing inflammation [55]. Such an approach has been met with mixed reviews as the need for RRT has traditionally been associated with increased risk of mortality, reported to be as high as 70-80% [28,56,57].…”

Section: The Role Of Rrtmentioning

confidence: 99%

Acute kidney injury in pediatric hematopoietic stem cell transplant recipients

Fitzgerald

Williams

Laskin

2015

J Pediatr Intensive Care

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Acute kidney injury is common after pediatric hematopoietic stem cell transplant with a reported incidence of 21-55% in the first 3 mo after transplant. Acute kidney injury is associated with decreased survival and the development of chronic kidney disease in this patient population. In this review, current definitions of acute kidney injury are discussed. The epidemiology and risk factors for acute kidney injury in this patient population are described, and current hypotheses on the pathophysiology are reviewed. Current and emerging ideas about changes to management strategies to mitigate acute kidney injury are presented, and areas for further research are proposed.

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Acute Kidney Injury in Pediatric Stem Cell Transplant Recipients

Cited by 12 publications

References 21 publications

Perspective: A Framework to Screen Pediatric and Adolescent Hematopoietic Cellular Therapy Patients for Organ Dysfunction: Time for a Multi-Disciplinary and Longitudinal Approach

Perspective: A Framework to Screen Pediatric and Adolescent Hematopoietic Cellular Therapy Patients for Organ Dysfunction: Time for a Multi-Disciplinary and Longitudinal Approach

Continuous Renal Replacement Therapy: A Review of Use and Application in Pediatric Hematopoietic Stem Cell Transplant Recipients

Acute kidney injury in pediatric hematopoietic stem cell transplant recipients

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