Prospective evaluation of acute and chronic renal function in children following matched related donor hematopoietic stem cell transplantation

Abstract

Acute and chronic renal impairment are important complications after HSCT. A prospective study was conducted to investigate the glomerular renal function in children who received allogeneic HSCT from matched related donors. Non-radiation conditioning regimens were used in all but one patient. CrCl and serial measurements of serum creatinine were evaluated prior to HSCT, within the first 100 days and one yr after. AKI was defined as at least a 1.5-fold rise in pre-HSCT serum creatinine within the first 100 days and classified as grade 1 to 3 according to the new definition criteria proposed by "AKI Network." Fifty-seven patients were enrolled in the study and 24 patients (42%) had AKI. CsA, amphotericin B, and SOS were found as risk factors for AKI. One yr after HSCT five patients (10%) had CKD and none of them required dialysis. None of the parameters were found as a predictor for CKD. We conclude that AKI is an important complication of HSCT. Careful monitoring of renal function, minimizing the use of nephrotoxic medication, prophylaxis, and effective treatment of SOS might be effective preventive measures to decrease the incidence of AKI.

Acute Kidney Injury and the Risk of Mortality in Children Undergoing Hematopoietic Stem Cell Transplantation

“…This is similar to other pediatric studies reporting a prevalence of 10–11% at 1-year 20, 21 . Adult studies report a higher prevalence compared to pediatric studies 39 .…”

“…Previously, Kistvan et al 20 had reported the incidence of AKI to be 21% in their prospective study of 66 pediatric HSCT recipients. Recently, Ileri et al 21 published a prospective study of 61 pediatric myeloablative and allogenic HSCT recipients and reported the incidence of AKI to be 42% within the first 100 days posttransplant. A recent systemic review of AKI in pediatric HSCT recipients included five observational studies and concluded that one-third of pediatric HSCT recipients developed AKI 10 .…”

“…Pediatric data have identified sepsis, VOD, TBI, non-HLA-identical related or matched unrelated donors and nephrotoxicity associated with cyclosporine, amphotericin B and forscarnet as risk factors 20, 21, 27 . Although adult studies have elucidated myeloablative conditioning 28 , female sex, high-risk disease and aGVHD 29 as risk factors for AKI, pediatric data have not replicated these findings 10 .…”

A systematic review of acute kidney injury in pediatric allogeneic hematopoietic stem cell recipients

“…The time from transplant to AKI in different studies ranged from a mean of 28 ± 29 days (range 2–90) to a median of six wk (range 2–13) . Subgroup analysis completed by a single study showed that grade 3 AKI had an earlier onset than grades 1 and 2 (14.3 ± 3.2 days compared to 35.2 ± 22.5 days) .…”

Hematopoietic stem cell transplantation and acute kidney injury in children: A comprehensive review

“…found an incidence of 26% in their pediatric series, with nine patients developing SOS after HSCT. Ileri et al . examined 47 pediatric patients after HSCT, of which eight developed SOS.…”