Acute kidney injury in hematopoietic stem cell transplantation: A review

Vinod Krishnappa, Mohit Gupta, Gurusidda Manu, Shivani Kwatra, Osei Tutu Owusu, Rupesh Raina

Research output: Contribution to journalReview article

7 Citations (Scopus)

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.

Original languageEnglish (US)
Article number5163789
JournalInternational Journal of Nephrology
Volume2016
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

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Hematopoietic Stem Cell Transplantation
Acute Kidney Injury
Hepatic Veno-Occlusive Disease
Tumor Lysis Syndrome
Bone Marrow
Graft vs Host Disease
Cyclosporine
Sepsis
Incidence
Thrombotic Microangiopathies
Thalassemia
Lymphoproliferative Disorders
Acyclovir
Aplastic Anemia
Liver
Aminoglycosides
Amphotericin B
Transplants
Mortality
Therapeutics

ASJC Scopus subject areas

  • Nephrology

Cite this

Acute kidney injury in hematopoietic stem cell transplantation : A review. / Krishnappa, Vinod; Gupta, Mohit; Manu, Gurusidda; Kwatra, Shivani; Owusu, Osei Tutu; Raina, Rupesh.

In: International Journal of Nephrology, Vol. 2016, 5163789, 01.01.2016.

Research output: Contribution to journalReview article

Krishnappa, Vinod ; Gupta, Mohit ; Manu, Gurusidda ; Kwatra, Shivani ; Owusu, Osei Tutu ; Raina, Rupesh. / Acute kidney injury in hematopoietic stem cell transplantation : A review. In: International Journal of Nephrology. 2016 ; Vol. 2016.
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