SEARCHNARRATIVE_REVIEWpediatrics, nephrology

narrative_review·pediatrics, nephrology, hematology, oncology, critical care·PMC10047595

Kidney Injury in Children after Hematopoietic Stem Cell Transplant

Current Oncology · 3 authors, 3 centres

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TL;DR

This narrative review summarizes the incidence, etiology, management, and long-term outcomes of acute and chronic kidney injury in pediatric patients following hematopoietic stem cell transplant. It highlights that AKI is common and associated with poor survival, and that long-term renal dysfunction requires specialized monitoring.

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This narrative review discusses the significant burden of kidney injury in pediatric hematopoietic stem cell transplant (HCT) recipients. It outlines the multifactorial etiology of acute kidney injury (AKI), including nephrotoxic agents, hypoperfusion, and transplant-specific complications. Management strategies involve identifying causes, adjusting medications, and supporting patients with kidney replacement therapy (KRT) when necessary, which has an estimated ICU mortality of 52–65%. For long-term outcomes, the review emphasizes that chronic kidney disease is prominent, requiring ongoing monitoring of glomerular filtration rate and microalbuminuria, as well as management of hypertension. The implications support a multidisciplinary approach to renal care in this population.

STUDY TYPE

narrative_review

SPECIALTY

pediatrics

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100% · A

ORIGINAL PAPER

PMC10047595

Kidney Injury in Children after Hematopoietic Stem Cell Transplant

Current Oncology

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ABSTRACT

Hematopoietic cell transplant (HCT), used for treatment of many malignant and non-malignant pediatric diseases, is associated with serious complications, limiting this therapy’s benefit. Acute kidney injury (AKI), seen often after HCT, can occur at different stages of the transplant process and contributes to morbidity and mortality after HCT. The etiology of AKI is often multifactorial, including kidney hypoperfusion, nephrotoxicity from immunosuppressive and antimicrobial agents, and other transplant-related complications such as transplant-associated thrombotic microangiopathy and sinusoidal obstructive syndrome. Early recognition of AKI is crucial to prevent further AKI and associated complications. Initial management includes identifying the etiology of AKI, preventing further kidney hypoperfusion, adjusting nephrotoxic medications, and preventing fluid overload. Some patients will require further support with kidney replacement therapy to manage fluid overload and AKI. Biomarkers of AKI, such as neutrophil gelatinase-associated lipocalin can aid in detecting AKI before a rise in serum creatinine, allowing earlier intervention. Long-term kidney dysfunction is also prominent in this population. Therefore, long-term follow-up and monitoring of renal function (glomerular filtration rate, microalbuminuria) is required along with management of hypertension, which can contribute to chronic kidney disease.

CITATION EXPORT

Vinson James, Joseph Angelo, Lama Elbahlawan. Kidney Injury in Children after Hematopoietic Stem Cell Transplant. Current Oncology. (2023). https://doi.org/10.3390/curroncol30030253

AUTHORS

3 · 3 CENTRES

Vinson James, Joseph Angelo, Lama Elbahlawan

1Division of Pediatric Nephrology, Department of Pediatrics, LeBonheur Children’s Hospital, Memphis, TN 38105, USA
2Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine/Texas Children’s Hospital, Houston, TX 77030, USA
3Division of Critical Care Medicine, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA