ESPN 54th Annual Meeting

ESPN 2022


 
Renal Complications at the Hematopoietic Stem Cell Transplantation Early Phase
SEÇIL KEZER MEHMET SAIT DOĞAN NIHAN BAYRAM SERRA ELIBOL YÖNTEM YAMAN MURAT ELLI SEMA ANAK CIHANGIR AKGÜN ÖNDER YAVAŞCAN

 
Introduction:

 Hematopoietic stem cell transplantation (HSCT) is a life-saving therapy for many patients with malign disease, as well as patients with some nonmalignant disorders. Renal complications directly associated with HSCT include a wide range of structural and functional abnormalities. The aim of the study is to investigate the renal complications at the HSCT early phase.

Material and methods:

 The first 3-month follow-up of 117 patients with HSCT between January 2019-December 2021 was retrospectively evaluated. Renal complications were evaluated as acute kidney injury (AKI) and non-AKI problems (hypertension, proteinuria, increased echogenicity or kidney enlargement on ultrasonography, electrolyte imbalance). Pediatric RIFLE criteria were used for the diagnosis of AKI. The patients were analyzed according to age, gender, donor type, primary diagnosis and complications of HSCT.

Results:

 Renal complications (60% male) were detected in 83 patients (AKI in 36 patients, Non-AKI in 47 patients). There was no significant relationship between age, donor type, primary diagnosis, and the presence of HSCT complications and of renal complications (Table 1). Continuous dialysis treatment was applied to only 1 patient who died due to multiple organ failure and AKI.

Table 1. Renal complications and patient characteristics

 

 

Renal Complications

p

 

+

-

 

Non AKIa

AKI

Total

(AKI+Non AKI)

 

Patient number n (%)

47

36

83 (71)

34 (29)

 

Hypertension

25

25

 

Proteinuria

18

14

 

Hyperechogenicity on US

0

8

 

Kidney enlargement on US

24

19

 

Male/Female n (%)

26/21

24/12

50(60.2)/33(30.8)

23(67.6)/11(32.4)

0.4

Age (year) n (%)

 

 

 

 

 

0-5

26

18

44 (72.2)

17 (27.8)

0.2

5-10

12

4

16 (72.8)

6 (27.2)

>10

9

14

23 (67.7)

11 (32.3)

Donor type n (%)

 

 

 

 

 

Autologous

15

7

22 (61.2)

14 (38.8)

0.2

Allogeneic

26

21

47 (77.1)

14 (22.9)

Haplo-identical

6

8

14 (70)

6 (30)

Malign/Nonmalign n (%)

21/26

15/21

36(43.3)/47(54.7)

11(32.3)/23(77.7)

0.5

Complication n (%)

 

 

 

 

 

No

26

16

42 (72.7)

21 (33.3)

0.3

GVHD

15

9

24 (77.5)

7 (22.5)

VOD

4

5

9 (64.3)

5 (35.7)

GVHD + VOD

2

5

7 (87.5)

1 (12.5)

US: Ultrasonography, GVHD: Graft versus host disease, VOD: Veno-occlusive disease

a: More than one non-AKI problem was detected in the patients.

 

 

 

 

Conclusions:

  Acute renal complications are common complication of HSCT. Multiple factors may contribute to renal complications. It is difficult to determine the cause of complications in each patient. Early diagnosis, treatment and identification of nephrotoxic agents are the most important elements of the management of the disease. 

  HSCT associated kıdney injury was important due to long-term complications (CKD, hypertension, proteinuria). CKD patients require adequate diagnosis and specific follow up. Liver and kıdney enlargement and hyphosfatemıa are early prognostıc factors for AKI.