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International Journal of Nephrology
Volume 2016, Article ID 5163789, 13 pages
http://dx.doi.org/10.1155/2016/5163789
Review Article

Acute Kidney Injury in Hematopoietic Stem Cell Transplantation: A Review

1Akron Nephrology Associates/Akron General Cleveland Clinic, Akron, OH, USA
2Department of Internal Medicine, Akron General Cleveland Clinic, Akron, OH, USA
3Onco-Hospitalist, Beth Israel Deaconness Medical Center, Boston, MA, USA
4Department Hematology/Medical Oncology, Akron General Cleveland Clinic, Akron, OH, USA
5Department of Nephrology/Internal Medicine, Akron General Cleveland Clinic, Akron, OH, USA

Received 20 August 2016; Revised 4 October 2016; Accepted 11 October 2016

Academic Editor: Kazunari Kaneko

Copyright © 2016 Vinod Krishnappa et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.