Acute Kidney Injury After Hematopoietic Stem CellTransplantation

Hematopoietic stem cell transplantation is a curative intervention for various hematologic malignancies. However, it is associated with an exceptionally high rate of acute kidney injury with a cumulative incidence of 55%. The risk is highest for unmatched allogeneic transplantation involving myeloablative conditioning regimens. The need for kidney replacement therapy can approach 21% especially in critically ill recipients with unacceptably high all-cause and nonrelapse mortality. Various factors predispose to kidney injury extending from the toxicity of conditioning regimen to a myriad of complications spanning up to 100 days post-transplantation. An understanding of this timeline as well as the pathophysiology of the various processes facilitates early recognition and prompt management. Advances in therapeutics bring optimism in improving outcomes and minimizing progressive tissue injury.