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Acute kidney injury in hematopoietic stem cell transplantation

Wanchoo, Rimdaa; Stotter, Brian R.c; Bayer, Ruthee L.b; Jhaveri, Kenar D.a

Current Opinion in Critical Care: December 2019 - Volume 25 - Issue 6 - p 531–538
doi: 10.1097/MCC.0000000000000657
RENAL SYSTEM: Edited by Mitchell H. Rosner

Purpose of review Acute kidney injury (AKI) in the setting of hematopoietic stem cell transplantation (HSCT) is common in pediatric and adult patients. The incidence ranges from 12 to 66%, and development of AKI in the posttransplant course is independently associated with higher mortality.

Recent findings Patients who undergo HSCT have many risk factors for developing AKI, including sepsis, use of nephrotoxic medications, graft versus host disease (GVHD), and veno-occlusive disease (VOD). In addition, engraftment syndrome/cytokine storm, transplant-associated thrombotic microangiopathy (TA-TMA), and less common infections with specific renal manifestations, such as BK and adenovirus nephritis, may lead to kidney injury. There has been significant advancement in the understanding of TA-TMA in particular, especially the role of the complement system in its pathophysiology. The role of early dialysis has been explored in the pediatric population, but not well studied in adult HSCT recipients

Summary This review provides an update on the risk factors, causes, and treatment approaches to HSCT-associated AKI.

Video abstract

aDivision of Kidney Diseases and Hypertension

bDivision of Hematology/Oncology, Northwell Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York

cDivision of Nephrology, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA

Correspondence to Rimda Wanchoo, MD, Associate Professor of Medicine, Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA. E-mail

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