Acute kidney injury in pediatric hematopoietic stem cell transplantation patients

Background
Acute kidney injury (AKI) is still a common complication in children receiving hematopoietic stem cell transplantation (HSCT), and it is an independent risk factor for survival as well as a predictor of progression to chronic kidney disease. However, the reasons for these issues are varied, often overlapping, and poorly understood.


Patients and methods
This is a retrospective analysis of children undergoing HSCT at the Pediatric Bone Marrow Transplantation (BMT) Unit, Faculty of Medicine, between April 2011 and February 2020. The development of AKI, defined according to the Pediatric Risk, Injury, Failure, Loss, and End-stage renal disease, was recorded and correlated to different demographics, medications, complications, and other risk factors.


Results
We included 29 patients (16 boys, 13 girls) with a median age of 6.2 years, where AKI developed in 22/29 (75.9%) individuals within the first 90 days of HSCT. The most predominant complication post-HSCT was infections which happened in 20/29 (69%) patients, followed by acute graft-versus-host disease (aGvHD) (19/29, 65.5%), while neurological complications (in the form of disturbed conscious level and convulsions) occurred in 6/29 (20.7%), and hematological complications (thrombocytopenia) in 1/29 (3.4%). Posttransplant AKI was linked to the age of the patients, where younger patients were more susceptible to developing AKI in addition to aGvHD and infections (P=0.03 and 0.001, respectively).


Conclusion
Posttransplant AKI was common and correlated strongly with younger age group infections, aGvHD, and combinations of antibiotic and antifungal medications. Controllable measures like reducing anti-infective doses, minimizing infections, and aGvHD incidence are required to avoid late renal injury in children posttransplantation.