Renal function after autologous bone marrow transplantation in children: a long-term prospective study

Frisk, Per; Bratteby, Lars‐Eric; Carlson, Kristina; Lönnerholm, Gudmar

doi:10.1038/sj.bmt.1703312

Cited by 85 publications

(79 citation statements)

References 33 publications

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“…13,14 CRF post-HSCT in children as well as in adults has predominantly been associated with TBI. 11,13,[15][16][17][18][19][20][21][22][23] Nevertheless, in accordance with our previous studies 1-year post-HSCT, in the present study we did not find a relation between TBI/TAI and development of CRF. 4,5 The irradiation dose in our study was slightly different (4-8 Gy in one fraction or 12 Gy in two fractions, Table 1) compared to other pediatric studies: 10 Gy in one fraction, 2,19 12-14 Gy in 6-8 fractions 15 and 13 Gy in eight fractions.…”

Section: Glomerular Functionsupporting

confidence: 79%

Long-term renal function after hemopoietic stem cell transplantation in children

Holthe

Bresters

Ahmed-Ousenkova

et al. 2005

Bone Marrow Transplant

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Summary:Glomerular function of all long-term survivors who underwent hemopoietic stem cell transplantation (HSCT) from 1991 to 1998 (study I, n ¼ 121) was studied retrospectively. In addition, we prospectively analyzed glomerular and tubular function of all long-term surviving children who received an HSCT between 1998 and 2000 (study II, n ¼ 41). We found a lower prevalence of children with chronic renal failure (CRF) post-HSCT in our more recent cohort (study II: 10%) as compared to the older cohort (study I: 24%) 5.0 (0.7 s.d.) and 7.6 (2.4 s.d.) year's post-HSCT, respectively. Furthermore, it seems that renal function may stabilize after 1-year post-HSCT. None of the patients required dialysis or antihypertensive medication at long-term follow-up. The sole predictor of CRF in our study was high serum creatinine pre-HSCT (P ¼ 0.007), while acute renal failure within 3 months after HSCT (P ¼ 0.08) only showed a trend towards predicting CRF. We could not confirm a relation of conditioning with irradiation with CRF post-HSCT, as was shown in several other pediatric and adult studies. Proximal and distal tubular dysfunction only occurred in a minority of long-time survivors of HSCT (3-12 and 9-13%, respectively) and had no clinical consequences. Hemopoietic stem cell transplantation (HSCT) has evolved as an accepted treatment modality for a diverse spectrum of diseases in children such as hematological malignancies, bone marrow failure syndromes, immunodeficiencies and inborn errors of metabolism. The 5-year survival rates depend on the disease for which HSCT is performed and vary from 90% for immunodeficiencies to 25% for highrisk hematological malignancies. 1 As long-term survival has improved over the years, assessment of late complications becomes increasingly important. Chronic renal failure (CRF) following allogeneic HSCT is reported in children, although data on incidence and etiology in long-term survivors of HSCT are still scarce. 2,3 Understanding of the possible risk factors and the pathogenesis of acute and chronic renal failure after HSCT is required in order to reduce its incidence. We have previously shown a prevalence of 28% CRF in children 1-year post-HSCT in a retrospective study, and more recently a lower prevalence of only 11% in a prospective study. 4,5 In the current study, we investigated how renal function of these patients evolved after an extended follow-up period. Patients and methods

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Section: Glomerular Functionsupporting

confidence: 79%

Long-term renal function after hemopoietic stem cell transplantation in children

Holthe

Bresters

Ahmed-Ousenkova

et al. 2005

Bone Marrow Transplant

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“…Besides these agents, high-dose methotrexate and cyclophosphamide are known for their acute nephrotoxicity, but evidence regarding their long-term effects is lacking (11). Additionally, kidney surgery and radiation therapy may cause renal impairments, such as hyperfiltration or radiation nephropathy, characterized by hypertension, decline in GFR, and proteinuria (12)(13)(14). The long-term effect of radiation nephropathy and hypertension have not been studied previously.…”

Section: Introductionmentioning

confidence: 99%

Renal Dysfunction and Elevated Blood Pressure in Long-Term Childhood Cancer Survivors

Knijnenburg¹,

Jaspers²,

Pal³

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Little is known about renal function and blood pressure (BP) in long-term childhood cancer survivors. This cross-sectional study evaluated prevalence of these outcomes and associated risk factors in long-term childhood cancer survivors at their first visit to a specialized outpatient clinic.Design, Setting, Participants, & Measurements Estimated GFR; percentages of patients with albuminuria, hypomagnesemia, and hypophosphatemia; and BP were assessed in 1442 survivors $5 years after diagnosis. Multivariable logistic regression analyses were used to estimate effect of chemotherapy, nephrectomy, and radiation therapy on the different outcomes.Results At a median age of 19.3 years (interquartile range, 15.6-24.5 years), 28.1% of all survivors had at least one renal adverse effect or elevated BP. The median time since cancer diagnosis was 12.1 years (interquartile range, 7.8-17.5 years). High BP and albuminuria were most prevalent, at 14.8% and 14.5%, respectively. Sixty-two survivors (4.5%) had an estimated GFR ,90 ml/min per 1.73 m 2 . Survivors who had undergone nephrectomy had the highest risk for diminished renal function (odds ratio, 8.6; 95% confidence interval [CI], 3.4-21.4). Combined radiation therapy and nephrectomy increased the odds of having elevated BP (odds ratio, 4.92; 95% CI, 2.63-9.19), as did male sex, higher body mass index, and longer time since cancer treatment.Conclusion Almost 30% of survivors had renal adverse effects or high BP. Therefore, monitoring of renal function in high-risk groups and BP in all survivors may help clinicians detect health problems at an early stage and initiate timely therapy to prevent additional damage.

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“…[4][5][6][7] Although exposure of kidneys to radiation during hematopoietic cell transplantation has been hypothesized as a risk factor for bone marrow transplant nephropathy, studies have shown conflicting data regarding renal shielding and long-term renal insufficiency. 5,[8][9][10][11][12] Other causes of thrombotic microangiopathy must be considered in hematopoietic cell transplant recipients, including exacerbation of endothelial injury by chemotherapy, immune-mediated injury, and perhaps most notably, cyclosporine inhibitor toxicity, given as prophylaxis or treatment for graft-versus-host disease.…”

mentioning

confidence: 99%

Renal pathology in hematopoietic cell transplantation recipients

et al. 2008

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Renal function after autologous bone marrow transplantation in children: a long-term prospective study

Cited by 85 publications

References 33 publications

Long-term renal function after hemopoietic stem cell transplantation in children

Long-term renal function after hemopoietic stem cell transplantation in children

Renal Dysfunction and Elevated Blood Pressure in Long-Term Childhood Cancer Survivors

Renal pathology in hematopoietic cell transplantation recipients

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