title: Acute Kidney Injury in Hematopoietic Stem Cell Transplantation: A Review.
abstract: Hematopoietic stem cell transplantation (HSCT) is a highly effective treatment strategy for lymphoproliferative disorders and bone marrow failure states including aplastic anemia and thalassemia. However, its use has been limited by the increased treatment related complications, including acute kidney injury (AKI) with an incidence ranging from 20% to 73%. AKI after HSCT has been associated with an increased risk of mortality. The incidence of AKI reported in recipients of myeloablative allogeneic transplant is considerably higher in comparison to other subclasses mainly due to use of cyclosporine and development of graft-versus-host disease (GVHD) in allogeneic groups. Acute GVHD is by itself a major independent risk factor for the development of AKI in HSCT recipients. The other major risk factors are sepsis, nephrotoxic medications (amphotericin B, acyclovir, aminoglycosides, and cyclosporine), hepatic sinusoidal obstruction syndrome (SOS), thrombotic microangiopathy (TMA), marrow infusion toxicity, and tumor lysis syndrome. The mainstay of management of AKI in these patients is avoidance of risk factors contributing to AKI, including use of reduced intensity-conditioning regimen, close monitoring of nephrotoxic medications, and use of alternative antifungals for prophylaxis against infection. Also, early identification and effective management of sepsis, tumor lysis syndrome, marrow infusion toxicity, and hepatic SOS help in reducing the incidence of AKI in HSCT recipients.
authors.affiliation: Akron Nephrology Associates/Akron General Cleveland Clinic, Akron, OH, USA.
authors.forename: Vinod
authors.identifier: 0000-0002-1697-4526
authors.initials: V
authors.lastname: Krishnappa
authors.affiliation: Department of Internal Medicine, Akron General Cleveland Clinic, Akron, OH, USA.
authors.forename: Mohit
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Onco-Hospitalist, Beth Israel Deaconness Medical Center, Boston, MA, USA.
authors.forename: Gurusidda
authors.initials: G
authors.lastname: Manu
authors.affiliation: Akron Nephrology Associates/Akron General Cleveland Clinic, Akron, OH, USA.
authors.forename: Shivani
authors.initials: S
authors.lastname: Kwatra
authors.affiliation: Department Hematology/Medical Oncology, Akron General Cleveland Clinic, Akron, OH, USA.
authors.forename: Osei-Tutu
authors.initials: OT
authors.lastname: Owusu
authors.affiliation: Department of Nephrology/Internal Medicine, Akron General Cleveland Clinic, Akron, OH, USA.
authors.forename: Rupesh
authors.identifier: 0000-0003-3892-8376
authors.initials: R
authors.lastname: Raina