Renal function following hematological stem cell transplantation in childhood

Abstract

Renal function greatly influences mortality rates in the early phase following hematological stem cell transplantation (HSCT) in childhood, as well as the quality of life in long-term survivors. Nevertheless, the number of studies in pediatric populations is limited and some important aspects of kidney function after HSCT have only been elucidated in adults. The incidence of acute renal failure (ARF) immediately after HSCT in pediatric patients is between 25% and 50%, with 5%-10% of children requiring renal replacement therapy. Doubling of serum creatinine is associated with a twofold increase in mortality. However, the need for dialysis leads to a further increase in mortality rates to 80%-90%. Specific renal syndromes appear at different times following HSCT, revealing a similar pattern in children and adult patients. In both children and adults, impaired renal function associated with liver impairment (hepatorenal syndrome) is the most important cause for ARF. Therapeutic approaches have not been able to reduce the frequency or to improve outcome so far. In adults surviving long term, bone marrow transplant (BMT) nephropathy is the most frequent renal complication, although a considerable variation in incidence (up to 70%) has been published, partly due to various definitions and manifestations. Little is known about the long-term outcome of renal function in patients treated with HSCT in childhood. However, chronic renal failure has been reported in 0%-28%, but no end-stage renal failure has been published so far. Tubular function following HSCT is rarely investigated, although its impact on long-term survivors of BMT in childhood might be of some importance, especially for growth and bone metabolism.

High incidence of acute kidney injury during chemotherapy for childhood acute myeloid leukemia

“…[24][25][26][27][28][29] More than 50% of patients with childhood AML will require an allogeneic HSCT to consolidate high-risk disease or to salvage relapse disease. HSCT is a known high-risk period for children and adults to develop AKI, [43][44][45][46][47][48][49] as recently confirmed by the University of Minnesota 50 where 174 of 205 children and adolescents (84%) developed AKI during the first year following a first HSCT.…”

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

“…5,6 In pediatric patients, the incidence of AKI following HSCT is 21%-50%, with 5%-10% of children requiring RRT. [5][6][7][8] Figure 1 illustrates the incidence of AKI by its underlying pathologies. Some studies have attempted to determine both incidence and risk factors associated with AKI following HSCT.…”

Función renal en pacientes pediátricos con trasplante alogénico de progenitores hematopoyéticos

“…Las etapas de condicionamiento y mantención se han relacionado con toxicidad, infecciones oportunistas, disfunción multiorgánica e injuria renal directa 3 . Estudios muestran hasta un 23% de compromiso renal, el que sería mayor en niños, aunque sus manifestaciones serán evidentes cuando el paciente alcanza la edad adulta 4,5 .…”

“…Los marcadores de injuria renal crónica pueden encontrarse entre 6 a 12 meses post trasplante, pudiendo ser precoz (2 meses) o tardío (10 años); puede manifestarse como enfermedad renal crónica (ERC); microangiopatía trombótica, nefropatía por radiación, daño relacionado a enfermedad injerto contra huésped (EICH), síndrome nefrótico y glomerulopatía por fármacos 2,5 .…”

“…En Chile, éste es el primer estudio que describe las alteraciones a nivel renal en niños con TPH. La prevalencia de ERC que mostró nuestro estudio es similar a la reportada en la literatura5,6 , nuestros pacientes presentaban ERC etapa I a diferencia de lo reportado en otros es-TRASPLANTE DE CÉLULAS HEMATOPOYÉTICAS Y FUNCIóN RENAL…”