Mini-review of kidney disease following hematopoietic stem cell transplant

Abstract

Advancements in hematopoietic cell transplantation (HCT) have broadened indications for its use and resulted in more long-term survivors. Stem cell transplantation is associated with several well-known toxicities, although renal complications are not well defined. Acute and chronic kidney disease remains a common complication following transplantation itself. Incidence and risk factors for the development of chronic kidney disease (CKD) is less well understood. Recent estimates suggest that nearly 15% of subjects undergoing HCT will develop CKD, a complication that can progress to end-stage renal disease (ESRD), disrupts overall quality of life, and reduces overall survival. Several commonly-reported risk factors include acute kidney injury, graft-versus-host disease, and long-term calcineurin inhibitor use. This review highlights the incidence, timeline, etiology, risk factors, and prognosis of kidney disease in the setting of hematopoietic stem cell transplantation. Investigation of the causes of CKD is needed, as are ways to prevent, mitigate, and treat kidney injury. Renal disease importantly reflects prognosis, with dialysis-requiring patients carrying greater than 80% mortality after 3 years. Although CKD following HCT is common, prospective studies are needed to confirm risk factors and better define the underlying mechanisms in order to promote therapies that prevent this complication. .

ICU Complications of Hematopoietic Stem Cell Transplant, Including Graft vs Host Disease

“…Acute kidney injury (AKI) is common after HSCT and affects up to 40% of patients, with higher incidence after allogeneic transplant than autologous transplant [65,66]. In addition to the usual ICU causes of AKI such as septic shock, there are many specific contributors to the risk of AKI in HSCT, including preparative chemotherapeutic regimens, nephrotoxins (e.g.…”

“…In addition to the usual ICU causes of AKI such as septic shock, there are many specific contributors to the risk of AKI in HSCT, including preparative chemotherapeutic regimens, nephrotoxins (e.g. tacrolimus, cyclosporine, antimicrobials), elevated cytokine levels, GVHD, and hepatic sinusoidal obstruction [65]. Hemorrhagic cystitis arising from chemotherapy toxicity or viral infection can cause significant blood loss and obstructive nephropathy due to blood clots.…”

“…If hemorrhagic cystitis is present, continuous bladder irrigation with a three-way catheter should be considered. The requirement for renal replacement therapy is ominous and portends a high mortality rate [65].…”

“…An increasingly recognized complication of HSCT is HSCTassociated thrombotic microangiopathy (HSCT-TMA) [103], which has some features in common with betterknown microangiopathic processes such as thrombotic Patients can present to the ICU with acute kidney injury and neurologic changes in addition to hemolytic anemia and thrombocytopenia [65,104]. Management is predominantly supportive, with blood pressure control, cessation of any possible pharmacologic instigators (tacrolimus or cyclosporine), and renal replacement therapy playing major roles.…”

Umbilical Cord Blood-Derived Mesenchymal Stem Cells Transplantation Decreases Incidence of Liver Cancer in End-Stage Liver Disease Patients: A Retrospective Analysis Over 5 Years

“…Each year, numerous stem cell transplantation cases were reported globally (10). It has been demonstrated that stem cell transplantation is an effective strategy in treating a variety of diseases including severe and refractory autoimmune diseases (AD) (11), non-rhabdomyosarcoma soft tissue sarcomas (12), kidney diseases (13), and multiple sclerosis and immune-mediated neurological diseases (14). Distinct types of stem or progenitor cells were reported to be used in transplantation, among, the hematopoietic stem cells (HSC) derived from peripheral-blood those are marked with CD34 and umbilical cord blood-derived mesenchymal stem cells (UC-MSCs) were most often used (15).…”