Research Article - Current Pediatric Research (2025) Volume 29, Issue 1

Chronic kidney disease after pediatric hematopoietic stem cell transplantation - current knowledge

Nowadays hematopoietic stem cell transplantation (HSCT) has become well-established therapy in management of various clinical conditions. Approximately 30% of recipients undergo the procedure in childhood. HSCT may trigger life-threatening complications resulting from cytotoxic treatment, immunosuppression or graft versus host disease (GVHD). Immediate transplant related mortality has been significantly reduced during the past decades, nonetheless long-term complications are challenging with different intensity and presentation of symptoms. Acute kidney injury (AKI) and chronic kidney disease (CKD) are frequently mentioned complications. Data on CKD after bone marrow transplantation specific for pediatric patients remains limited. We reviewed literature concerning CKD in children after HSCT of past few years. Narratively we described data on epidemiology, clinical picture and recognized risk factors for CKD in children. The average incidence of CKD after pediatric HSCT is approximately 15-17%, but it varies from 0 to over 30% and it is much lower than in adults. Hypertension and microalbuminuria are often observed in these patients coexisting with diminished eGFR. Among CKD risk factors after HSCT the following are mentioned: severe AKI, chronic GVHD, chronic calcineurin inhibitors usage and total body irradiation before HSCT. Patients with thrombotic microangiopathy after HSCT have essentially worse renal outcome. In conclusion we underline that the risk for CKD in children is significant after HSCT and impairs the renal future therefore is the necessity for regular screening for early signs of this complication and identifying patients that are at risk for CKD in children after HSCT.

Author(s):

Katarzyna GÄ?sowska*, Katarzyna Zachwieja, Aleksandra Krasowska-KwiecieÅ?, Jolanta Goździk, Dorota Drożdż

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