New-onset microalbuminuria following allogeneic myeloablative SCT is a sign of near-term decrease in renal function

Area of Science:

• Nephrology
• Oncology
• Hematology

Background:

• Conditioning chemotherapy prior to hematopoietic stem cell transplantation (HSCT) can cause kidney damage.
• Microalbuminuria, the presence of albumin in urine, is an early indicator of kidney disease.
• The predictive value of microalbuminuria for renal dysfunction post-HSCT requires further investigation.

Purpose of the Study:

• To investigate whether de novo microalbuminuria following conditioning chemotherapy predicts the development of renal dysfunction in patients undergoing myeloablative allogeneic HSCT.
• To assess the association between microalbuminuria and the incidence of chronic kidney disease (CKD) after HSCT.

Main Methods:

• A retrospective cohort study of 31 patients undergoing myeloablative allogeneic HSCT.
• Albuminuria and estimated glomerular filtration rate (eGFR) were measured before conditioning and on days 0, 7, 14, and 28 post-HSCT.
• Kaplan-Meier analysis and multivariate Cox proportional hazards analysis were used to evaluate the risk of renal dysfunction.

Main Results:

• 52% of patients developed de novo microalbuminuria (albumin-creatinine ratio > 30 mg/g) at least twice after HSCT.
• Patients with de novo microalbuminuria had a significantly higher incidence of CKD (eGFR < 60 mL/min/1.73 m²).
• De novo microalbuminuria was a significant risk factor for subsequent renal dysfunction (Hazard Ratio: 7.3; 95% CI: 1.2-140).

Conclusions:

• De novo microalbuminuria emerging after conditioning chemotherapy is a critical warning sign for impending renal function loss.
• Monitoring for microalbuminuria post-HSCT is crucial for early identification of patients at high risk for renal dysfunction.
• This finding supports proactive renal protective strategies in HSCT recipients who develop microalbuminuria.