Prospective study of renal insufficiency after bone marrow transplantation.
Since more and more children survive allogeneic bone marrow transplantation (BMT), knowledge of acute and late complications becomes increasingly important. Besides the major complications [(opportunistic) infections, veno-occlusive disease, graft versus host disease, and recurrence of primary disease], acute and chronic renal insufficiency are significant post-transplant complications that may contribute to transplant-related mortality. To elucidate risk factors for acute and chronic renal insufficiency post BMT, we performed a prospective study of all 66 children who received a BMT in a 2-year period at our institution; 21% had acute renal insufficiency post BMT. Risk factors for acute renal insufficiency were veno-occlusive disease, high cyclosporin serum levels, and foscarnet therapy. Of surviving patients, 11% developed chronic renal insufficiency 1 year post BMT. Acute renal insufficiency was the sole predictor of chronic renal insufficiency. In contrast to studies in adults, we did not find total body irradiation to be a risk factor for chronic renal insufficiency. Future long-term studies are needed to assess incidence and morbidity of chronic renal insufficiency in children following allogeneic BMT.
Kist-van Holthe
Joana E
JE
Department of Pediatrics, Leiden University Medical Center, The Netherlands. joana@kist.nl
Goedvolk
Charlotte A
CA
Brand
Ronald
R
van Weel
Margreet H
MH
Bredius
Robbert G M
RG
van Oostayen
Jacques A
JA
Vossen
Jacques M J J
JM
van der Heijden
Bert J
BJ
D058186:Acute Kidney Injury / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D007678:Kidney Glomerulus / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology*; D012307:Risk Factors; D013601:T-Lymphocytes / Q000502:physiology; D014463:Ultrasonography