Renal function after hematopoietic stem cell transplantation in children

Area of Science:

• Pediatric Nephrology
• Hematology-Oncology
• Transplantation Medicine

Background:

• Hematopoietic stem cell transplantation (HSCT) is a critical treatment for various pediatric diseases.
• Renal complications post-HSCT can significantly impact patient outcomes.
• Assessing renal function comprehensively is essential for managing pediatric HSCT patients.

Purpose of the Study:

• To prospectively evaluate glomerular and tubular renal function in children undergoing HSCT.
• To identify potential risk factors and temporal changes in renal function post-transplantation.
• To emphasize the importance of continuous renal function monitoring in this population.

Main Methods:

• Prospective assessment of 34 pediatric patients (mean age 8.2 years) before and after HSCT.
• Evaluation of glomerular filtration rate (GFR) using multiple methods: (99m)Tc-DTPA, creatinine clearance, and cystatin C.
• Measurement of tubular function markers including beta-2-microglobulin, beta-N-acetylglucosaminidase, fractional excretion of sodium, and fractional tubular phosphate reabsorption.

Main Results:

• 26.4% of patients developed acute renal insufficiency within 100 days post-HSCT, successfully treated without renal replacement therapy.
• A statistically significant decrease in (99m)Tc-DTPA-based GFR was observed post-HSCT compared to pre-transplant levels.
• Elevated urinary beta-N-acetylglucosaminidase excretion indicated tubular dysfunction in the early post-transplant period (first 30 days).

Conclusions:

• Renal impairment, both acute and chronic, can occur after HSCT, irrespective of pre-transplant renal function or conditioning regimen (including TBI).
• Glomerular and tubular renal function assessments are vital components of long-term follow-up for pediatric HSCT survivors.
• Early detection and management of renal dysfunction are critical for improving long-term outcomes in children post-HSCT.