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Acute kidney injury in pediatric hematopoietic stem cell transplant recipients

Julie C Fitzgerald1, Duane Williams2, Benjamin L Laskin3

  • 1Department of Anesthesia and Critical Care, The Children's Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.

Journal of Pediatric Intensive Care
|June 20, 2019
PubMed

Insights

Pediatric hematopoietic stem cell transplant recipients frequently develop acute kidney injury, impacting survival and leading to chronic kidney disease. This review covers definitions, risk factors, pathophysiology, and management strategies for this critical complication.

Area of Science:

  • Pediatric Hematology-Oncology
  • Nephrology
  • Stem Cell Transplantation

Background:

  • Acute kidney injury (AKI) affects 21-55% of pediatric hematopoietic stem cell transplant (HSCT) recipients within 3 months.
  • AKI in this population is linked to reduced survival and increased risk of chronic kidney disease (CKD).
  • Understanding AKI's incidence, risk factors, and pathophysiology is crucial for improving outcomes.

Purpose of the Study:

  • To review current definitions of acute kidney injury in pediatric HSCT.
  • To describe the epidemiology and risk factors associated with AKI in this vulnerable group.
  • To explore current and emerging management strategies and propose future research directions.

Main Methods:

  • Literature review of studies on acute kidney injury following pediatric hematopoietic stem cell transplant.
  • Analysis of current definitions, epidemiological data, and risk factors.
  • Synthesis of current hypotheses regarding pathophysiology and proposed management changes.

Main Results:

  • Acute kidney injury is a significant and common complication post-pediatric HSCT.
  • Established risk factors and pathophysiological mechanisms contribute to AKI development.
  • Current management strategies are evolving, with a need for further research.

Conclusions:

  • Acute kidney injury poses a substantial threat to pediatric HSCT survivors.
  • A comprehensive understanding of AKI's multifaceted nature is essential for clinical practice.
  • Further research is warranted to refine management and improve long-term outcomes.

Keywords:
Pediatric hematopoietic stem cell transplantacute kidney injurychronic kidney disease

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