title: Nephrolithiasis in pediatric hematopoietic cell transplantation with up to 40 years of follow-up.
abstract: BACKGROUND
  Kidney stones have been reported to occur after childhood cancer, but little is known about kidney stones in children following hematopoietic cell transplantation (HCT). The objective of this retrospective study was to determine risk factors for the development of kidney stones and to describe the prevalence among survivors.
  
  
  METHODS
  The study included 1,343 childhood HCT patients. Mean follow-up was 15.8 (1.0-40.0) years. Patients were treated with total body irradiation (TBI) (n = 948) or non-TBI regimens. Methotrexate (MTX) for acute graft-versus-host disease (GVHD) prophylaxis was given as long-course (n = 360), short-course (n = 626), or none (n = 357). Prednisone for chronic GVHD therapy was received by 525 patients. Multivariate Cox regression models were used to estimate the hazard ratio (HR) of risk factors associated with kidney stones.
  
  
  RESULTS
  Kidney stones developed in 51 patients, a median of 9.9 (0.2-29.4) years after first HCT, with a 30-year cumulative incidence of 7.4%. Risk factors associated with kidney stones were TBI (HR = 2.2; P = 0.03), age at HCT (12-18 vs. <6 years, HR = 2.7; P = 0.01), MTX (long vs. none, HR = 3.6; P = 0.02), and prednisone (HR = 2.2; P = 0.008). Among 868 survivors, the prevalence of a history of kidney stones was 4.7%.
  
  
  CONCLUSIONS
  Survivors of childhood HCT have an increased risk of developing kidney stones.
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Hoffmeister
authors.forename: Barry E
authors.initials: BE
authors.lastname: Storer
authors.forename: K Scott
authors.initials: KS
authors.lastname: Baker
authors.forename: Sangeeta R
authors.initials: SR
authors.lastname: Hingorani
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D008727:Methotrexate / Q000009:adverse effects; D053040:Nephrolithiasis / Q000453:epidemiology / Q000209:etiology*; D011241:Prednisone / Q000009:adverse effects; D015995:Prevalence; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors
chemical_list: D011241:Prednisone; D008727:Methotrexate
keywords: hematopoietic cell transplantation; methotrexate; nephrolithiasis; prednisone; total body irradiation