Long-term renal function following bone marrow transplantation

Abstract

Renal function, evaluated as glomerular filtration rate (GFR) and effective renal plasma flow (ERPF), was investigated in 187 pediatric patients who underwent allogeneic (n ¼ 169) or autologous bone marrow transplantation (BMT). Allogeneic BMT patients were divided into three groups: hematological malignancies, aplastic anemia and non-malignant diseases, whereas autologous patients constituted a fourth group. A total of 64% received total body irradiation (TBI) as conditioning therapy, and 50 healthy children served as controls. GFR and ERPF were normal before transplantation. After 1 year, both GFR and ERPF were significantly reduced. GFR had recovered slightly after 3 years and remained stable thereafter. Recovery in ERPF was not apparent. Renal impairment was found in 41% of patients at 1 year, in 31% at 3 years and in 11% 7 years after BMT. Patients with hematological malignancies had lower GFRs than patients with non-malignant diseases at all time points. The most important risk factor as regards chronic renal impairment was TBI. Type of donor, cyclophosphamide (CY), or acute graft-versus-host disease (GVHD) did not seem to contribute to the development of chronic renal impairment. We suggest that tests of renal function should be included in long-term followup after BMT.

Critical role of sphingosine-1-phosphate receptor 2 (S1PR2) in acute vascular inflammation

“…No differences in vascular permeability were found in kidneys among these three groups, possibly because of the lack of involvement of S1PR2 in radiation-induced nephropathy, which progressively develops after total body irradiation. 25 Together, these data indicate the critical role of S1PR2 signaling in the stromal compartment in the regulation of vascular permeability and resolution of systemic inflammation during endotoxemia.…”

GVHD-associated chronic kidney disease after allogeneic haematopoietic cell transplantation

“…[29][30][31][32] In our study, TBI was not an etiological pathogenetic factor in contrast to other studies showing dose-dependent toxicity, even in children. 18,20,30,[32][33][34][35] Calcineurin inhibitors used for GVHD prophylaxis and treatment have been mainly associated with various degrees of nephrotoxicity in the majority of previous studies. 8,19,32,36 In the present study, calcineurin inhibitors as nephrotoxic agents were not evaluated per se, due to the universal administration.…”

Renal Comorbidity After Solid Organ and Stem Cell Transplantation

“…AKI represents the most important risk factor for pTxCKD after HSCT, with an incidence of 15-25% after 1 year, both in pediatric and adult patients, after either myeloablative or reduced intensity conditioning (26). However, kidney function seems to stabilize over the years, dialysis rate remains below 1%, and there is no further increase in mortality (27), probably because risk factors for CKD tend to dissolve during follow-up after HSCT. Obviously, life-long surveillance is mandatory to control for chronic conditions like hypertension, diabetes or renovascular disease, which might further compromise impaired renal function.…”