Acute kidney injury in paediatric bone marrow patients

Bone marrow transplantation (BMT) is a life-saving intervention that has changed the prognosis of a wide range of haemato-oncologic, immunological and metabolic diseases over the last decades. The incidence of both autologous and allogenic BMT exponentially increased in both the adult and paediatric populations since the 1980s. One of the most frequent complications of BMT is renal failure, with 5% to 15% of all BMT developing acute kidney injury (AKI) and 5% to 20% of the survivors developing chronic renal failure (CRF). From those patients, about 50% will require renal replacement therapy (RRT). Risk factors for BMT-associated AKI are numerous and the pathogenesis is usually complex. Primary diagnosis, drug toxicity, total body irradiation, preexisting kidney dysfunction, veno-occlusive disease, sepsis, relative dehydration, non HLA-identical-related or matched-unrelated donors are risk factors for AKI after BMT. As AKI has been recognized to be predictive of long-term kidney dysfunction, prompt recognition and control of the risk factors are crucial to avoid increased morbidity and mortality due to CRF. With the improvement of BMT techniques, a better recognition of risk factors and aggressive management, there appears to be a steady decline with time in the occurrence of both AKI and CRF.