title: Renal insufficiency after bone marrow transplantation in children.
abstract: Between 1975 and 1988, 92 pediatric patients have undergone bone marrow transplantation (BMT) at our institution for malignant or immune deficiency disease. We evaluated in a retrospective fashion 64 of these patients who survived beyond the first 60 days post-BMT. The clinical course was divided into: less than 60 days post-BMT (early) and greater than 60 days post-BMT (late). The presence or absence of renal insufficiency was noted as well as all known potential factors predisposing to insufficiency. Step-wise regression analysis was then performed to determine which of the factors were most significantly associated with renal dysfunction during the two periods. The follow-up period was 2 months to 11 years (mean 17.5 months). The mean age of the patients was 7.6 years (1 month-18 years). Fifty percent of the patients had renal insufficiency during the early period and 28% of the patients had insufficiency after the initial 60 days. Three major predictors of renal insufficiency were discovered. Cyclosporin A or amphotericin B early or late post-BMT was independently predictive of developing insufficiency during the same period. Conditioning with total body irradiation was a predictor for insufficiency in both periods. Early insufficiency was not predictive of late insufficiency. Hypertension was present in 31% of patients during the early period and in 16% during the late period. Hypertension was strongly associated with cyclosporin use and renal insufficiency. Renal insufficiency is a frequent sequela in children following BMT and likely results from a combination of radiation injury and drug toxicity.
authors.affiliation: Department of Pediatrics, University of Wisconsin School of Medicine, Madison.
authors.forename: S K
authors.initials: SK
authors.lastname: Van Why
authors.forename: A L
authors.initials: AL
authors.lastname: Friedman
authors.forename: L J
authors.initials: LJ
authors.lastname: Wei
authors.forename: R
authors.initials: R
authors.lastname: Hong
mesh_terms: D000293:Adolescent; D000666:Amphotericin B / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003524:Cyclosporins / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D007223:Infant; D007674:Kidney Diseases / Q000139:chemically induced / Q000209:etiology*; D012044:Regression Analysis; D012189:Retrospective Studies
chemical_list: D003524:Cyclosporins; D000666:Amphotericin B