Kidney disease following hematopoietic cell transplantation
- Chirag Parikh, MD, PhD
Chirag Parikh, MD, PhD
- Professor of Medicine
- Yale University School of Medicine
- Robert S Negrin, MD
Robert S Negrin, MD
- Section Editor — Bone Marrow Transplantation
- Professor of Medicine
- Stanford University School of Medicine
Hematopoietic cell transplantation (HCT) is the only cure for a variety of hematologic and oncologic diseases. However, it has been associated with the development of both acute and chronic kidney failure . (See "Preparative regimens for hematopoietic cell transplantation".)
The term "hematopoietic cell transplantation" will be used throughout this review as a general term to cover transplantation of progenitor cells from any source (eg, bone marrow, peripheral blood, cord blood). Otherwise, the source of such cells will be specified (eg, autologous peripheral blood progenitor cell transplantation). (See "Sources of hematopoietic stem cells".)
Although the requirement for dialysis following HCT is relatively uncommon (in the range of 2 to 5 percent), it is generally associated with an extremely poor prognosis. However, acute kidney injury (AKI), as defined by doubling or smaller increases in the serum creatinine concentration, is common, approaching 50 to 60 percent in several reports. There are a variety of causes of AKI following HCT and several risk factors that are associated with chronic kidney disease (CKD). In the majority of patients, renal dysfunction is temporary and returns to baseline; however, adjusting medications to avoid further damage is common.
This topic will review the epidemiology and causes of kidney injury following HCT other than sepsis or drug-induced acute tubular necrosis or tumor lysis syndrome. These include hepatic sinusoidal obstructive syndrome (SOS, formerly known as veno-occlusive disease), hemolytic-uremic syndrome or thrombotic microangiopathy, and calcineurin inhibitor nephrotoxicity. The technique and other complications associated with HCT are discussed separately. (See "Preparative regimens for hematopoietic cell transplantation" and "Hematopoietic support after hematopoietic cell transplantation".)
EPIDEMIOLOGY AND PROGNOSIS
The epidemiology and risk factors of kidney injury following hematopoietic cell transplantation (HCT) vary with the different types of regimens associated with HCT:
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- EPIDEMIOLOGY AND PROGNOSIS
- Epidemiology of acute kidney injury
- - Type of regimen
- - Prognosis
- Epidemiology of chronic kidney disease
- ETIOLOGY OF ACUTE KIDNEY INJURY
- Hepatic sinusoidal obstruction syndrome (veno-occlusive disease)
- ABO incompatible transplants
- ETIOLOGY OF SUBACUTE OR CHRONIC KIDNEY DISEASE
- Thrombotic microangiopathy
- - Treatment and prevention
- Calcineurin inhibitor toxicity
- Nephrotic syndrome
- MANAGEMENT OF PATIENTS ON DIALYSIS
- SUMMARY AND RECOMMENDATIONS