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Review
. 2010 Nov;30(6):615-26.
doi: 10.1016/j.semnephrol.2010.09.009.

Acute kidney injury in hematopoietic cell transplantation

Amy Kogon  1 , Sangeeta Hingorani
Affiliations
Review

Acute kidney injury in hematopoietic cell transplantation

Amy Kogon et al. Semin Nephrol. 2010 Nov.

Abstract

Hematopoietic cell transplantation is becoming an increasingly common treatment modality for a variety of diseases. However, patient survival may be limited by substantial treatment-related toxicities, including acute kidney injury (AKI). AKI can develop in approximately 70% of patients posttransplant and is associated with an increased risk of morbidity and mortality. The development of AKI varies depending on the type of conditioning regimen used and the donor cells infused at the time of transplant, and the etiology often is multifactorial. Epidemiology, risk factors for development, pathogenesis, and potential treatment options for AKI in the hematopoietic cell transplantation population are reviewed as well as newer data on early markers of renal injury. As the indications for and number of transplants performed each year increases, nephrologists and oncologists will have to work together to identify patients who are at risk for AKI to both prevent its development and initiate therapy early to improve outcomes.

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Figures

Figure 1
Figure 1
Acute Tubular Necrosis. Most tubules show epithelial damage including loss of brush border, cytoplasmic decapitation and cell drop-off. Residual lining cells have increased N:C ratios or attenuated cytoplasm; a rare mitotic figure is evident (arrow). Cytoplasmic vacuolization is focal (*). (Hematoxylin & Eosin; 200X)
Figure 2
Figure 2
Kaplan-Meier curves of albuminuria and overall survival from day 100 to 1 year post-HCT. N=44 for ACR<30; N=58 for ACR 30–300; N=18 for ACR ≥ 300. Reproduced with permission from
Figure 3
Figure 3
Renal biopsy from a patient with nephrotic-range proteinuria post-HCT. A moderately intense mononuclear cell infiltrate is within the interstium and focally prominent within some tubules where it is associated with epithelial damage. Reactive, degenerative and regenerative epithelial changes are noted. (Jones Methenamine Silver; 400X).
Figure 4
Figure 4
Kaplan-Meier survival graph demonstrating a significant association of the 3 grades of grades AKI with 6-month mortality in patients after hematopoietic cell transplant. Reproduced with permission from
See this image and copyright information in PMC

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