Renal Complications of High-Dose Chemotherapy and Peripheral Blood Stem Cell Transplantation

Abstract

Following bone marrow transplantation, acute renal failure and proteinuria are common complications with a high mortality, particularly in patients requiring hemodialysis. Incidence, potential predisposing factors, and outcome of acute renal complications in patients with hematological malignancies receiving autologous peripheral blood stem cell transplantation were prospectively studied in 53 patients. Eight patients developed acute renal failure. Three of them required hemodialysis. Of all patients with acute renal failure, only those requiring hemodialysis died, due to nonrenal causes. Only 1 of the 45 patients without renal failure died. Mild proteinuria of predominantly tubular origin occurred in 16 patients, in 3 with and in 13 without acute renal failure. As predisposing factors for acute renal failure were identified: renal hypoperfusion due to systemic inflammatory response syndrome, sepsis or septic shock, and combined administration of nephrotoxic drugs. Especially those patients receiving high numbers of nephrotoxic drugs in combination with renal hypoperfusion were likely to develop acute renal failure. These results suggest that patients receiving high-dose chemotherapy and autologous peripheral blood stem cell transplantation have a low risk of developing acute renal failure and proteinuria.

Early renal injury after myeloablative allogeneic and autologous hematopoietic cell transplantation

“…[3][4][5][6]14,15 The mortality rate of the patients with renal dysfunction was found to be 24% in the present study. Renal dysfunction is associated with a high risk of mortality in both allogeneic and autologous HSCT.…”

“…Recent studies demonstrated that renal dysfunction after HSCT significantly occurs within the first month after HSCT. [3][4][5][6]14,15 In our study, renal dysfunction developed later in the setting of allogeneic and autologous HSCT when compared to previous studies. The early time course of the renal dysfunction after autologous HSCT when compared to allogeneic HSCT may have some explanations.…”

“…3 Acute renal failure (ARF), defined as a doubling of the pretransplantation serum creatinine in the first 4 weeks after transplantation, occurs in 5-54% of HSCT recipients. [3][4][5][6] Many factors including tumor lysis syndrome (TLS), marrow infusion toxicity, infections and nephrotoxicity of drugs contribute to ARF after HSCT. 4,7 Several HSCT-specific syndromes of organ dysfunction such as hemolytic uremic syndrome (HUS) and sinusoidal obstruction syndrome (SOS) affect the kidney.…”

Long-term renal function following bone marrow transplantation

“…Acute renal failure occurs more often than chronic renal failure, with an incidence of 15-34%. 10,30 According to some reports there is a correlation between acute and chronic renal insufficiency after BMT. 9,10 Several other authors, however, have not found that acute renal impairment predicted chronic renal failure.…”

Síndrome de lisis de glóbulos blancos después de un trasplante autólogo de células troncales hematopoyéticas en el tratamiento de la amiloidosis AL renal: Caso clínico

“…Evolución de parámetros séricos respecto al momento de la administración de melfalán (día 0) 6 . El SLGB resulta del efecto lítico del melfalán en dosis altas, en el contexto de una marcada leucocitosis inducida por el uso de factor estimulante de colonias como acondicionamiento antes de la cosecha de las células troncales 9 . No juega un rol el efecto sobre el clon de células plasmáticas amiloidogénico, ya que éste se encuentra habitualmente en bajas cantidades y no es un tipo celular altamente proliferativo.…”