Renal function after hematopoietic stem cell transplantation in children.
OBJECTIVE
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 ((99m)Tc-DTPA), urinary excretion of beta(2)-microglobulin (beta(2)M), beta-N-acetylglucosaminidase (beta-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 (99m)Tc-DTPA-based GFR of patients after HSCT showed a statistically significant decrease when compared with pre-transplant values. beta-NAG excretion was significantly elevated in the first 30 days after HSCT.


CONCLUSIONS
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.
Akdeniz University Faculty of Medicine, Department of Pediatric Hematology & Oncology, BMT Unit, Antalya, Turkey. hazar@akdeniz.edu.tr
Volkan
V
Hazar
Ozgul
O
Gungor
Ayfer Gur
AG
Guven
Funda
F
Aydin
Halide
H
Akbas
Firat
F
Gungor
Gulsun
G
Tezcan
Sema
S
Akman
Akif
A
Yesilipek
D058186:Acute Kidney Injury / Q000209:etiology; D002648:Child; D005260:Female; D005919:Glomerular Filtration Rate; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D019172:Transplantation Conditioning