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Acute Kidney Injury in Stem Cell Transplant Recipients

  • Daniella Levy-Erez
  • Sangeeta Hingorani
  • Benjamin Laskin
Chapter

Abstract

Hematopoietic cell transplantation treats life-threatening disorders in children but is associated with very high rates of morbidity affecting multiple organ systems. The kidney is commonly affected in children who have received a hematopoietic cell transplant. The causes of acute kidney injury among this population are most likely multifactorial and depend on the timing of kidney injury in relation to the transplant. Patients undergoing hematopoietic cell transplant are exposed to multiple potential nephrotoxins including chemotherapy and radiation used for conditioning, antimicrobials to prevent or treat infections, and calcineurin inhibitors and other medications to prevent or treat graft-versus-host disease. Additional causes of acute kidney injury include sepsis leading to hemodynamic instability and the resulting acute tubular necrosis. Endothelial injury causing sinusoidal obstruction syndrome or thrombotic microangiopathy and graft-versus-host disease itself are other significant mechanisms for acute kidney injury after hematopoietic cell transplant. While targeted therapies for acute kidney injury are limited, management includes management of fluid and electrolyte balance and the correct dosing of medications. Severe volume overload may necessitate renal replacement therapy, which has been associated with high mortality rates after hematopoietic cell transplant. This chapter reviews the most current data on the risk of acute kidney injury in children after hematopoietic cell transplant, the presumed causes, and the approach to diagnosing and managing these complex patients.

Keywords

Hematopoietic cell transplantation Acute kidney injury Thrombotic microangiopathy Sinusoidal obstruction syndrome Graft-versus-host disease 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Daniella Levy-Erez
    • 1
  • Sangeeta Hingorani
    • 2
  • Benjamin Laskin
    • 1
  1. 1.Division of NephrologyThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Division of NephrologySeattle Children’s HospitalSeattleUSA

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