Renal function after hematopoietic stem cell transplantation in children

Abstract

Objectives The aim of this study was to assess glomerular and tubular renal function after HSCT in children in a prospective trial. Methods Renal function was assessed prospectively before HSCT (on day −10), on days +30, +100, and at least 6 months after transplantation in 34 patients (21 females/13 males) with a mean age of 8.2 years. The following parameters were investigated: glomerular filtration rate (GFR) by creatinine clearance (CrCl), cystatin C (CysC)-based formula and plasma clearance of radiolabeled diethylenetriaminepentaacetic acid (^99mTc-DTPA), urinary excretion of β₂-microglobulin (β₂M), β-N-acetylglucosaminidase (β-NAG), fractional excretion of sodium (FE_Na) and fractional tubular phosphate reabsorption (TP/CrCl). Results Nine patients (26.4%) suffered from acute renal insufficiency within the first 100 days after transplantation. All patients who developed acute renal insufficiency were treated successfully without renal replacement therapy. Age, sex, primary diagnosis, sepsis, veno-occlusive disease, acute graft versus host disease, and use of vancomycin were not significant risk factors for the development of acute renal insufficiency. The medians ^99mTc-DTPA-based GFR of patients after HSCT showed a statistically significant decrease when compared with pre-transplant values. β-NAG excretion was significantly elevated in the first 30 days after HSCT. Conclusion Acute and chronic renal impairment can be developed in patients who undergo HSCT even though the pre-transplant renal function is in normal limits and the conditioning regimen does not include TBI. Both glomerular and tubular renal function evaluation should be part of a long-term follow-up in children following HSCT. Pediatr Blood Cancer 2009;53:197–202.