Sedhom Ramy, Sedhom Daniel, Jaimes Edgar
Clin Nephrol. 2018 Jun;89(6):389-402. doi: 10.5414/CN109276.
Advancements in hematopoietic cell transplantation (HCT) have broadened indications for its use and resulted in more long-term survivors. Stem cell transplantation is associated with several well-known toxicities, although renal complications are not well defined. Acute and chronic kidney disease remains a common complication following transplantation itself. Incidence and risk factors for the development of chronic kidney disease (CKD) is less well understood. Recent estimates suggest that nearly 15% of subjects undergoing HCT will develop CKD, a complication that can progress to end-stage renal disease (ESRD), disrupts overall quality of life, and reduces overall survival. Several commonly-reported risk factors include acute kidney injury, graft-versus-host disease, and long-term calcineurin inhibitor use. This review highlights the incidence, timeline, etiology, risk factors, and prognosis of kidney disease in the setting of hematopoietic stem cell transplantation. Investigation of the causes of CKD is needed, as are ways to prevent, mitigate, and treat kidney injury. Renal disease importantly reflects prognosis, with dialysis-requiring patients carrying greater than 80% mortality after 3 years. Although CKD following HCT is common, prospective studies are needed to confirm risk factors and better define the underlying mechanisms in order to promote therapies that prevent this complication. .
造血细胞移植（HCT）的进展拓宽了其应用指征，并使长期存活者增多。干细胞移植与多种已知的毒性反应相关，尽管肾脏并发症尚未明确界定。急慢性肾脏病仍是移植后常见的并发症。慢性肾脏病（CKD）发生的发病率及危险因素了解较少。近期估计表明，近15%接受HCT的受试者会发生CKD，这种并发症可进展为终末期肾病（ESRD），破坏整体生活质量并降低总生存率。几个常见的危险因素包括急性肾损伤、移植物抗宿主病以及长期使用钙调神经磷酸酶抑制剂。本综述重点介绍了造血干细胞移植背景下肾脏疾病的发病率、时间线、病因、危险因素及预后。需要对CKD的病因进行研究，也需要预防、减轻和治疗肾损伤的方法。肾脏疾病是预后的重要反映，需要透析的患者3年后死亡率超过80%。尽管HCT后CKD很常见，但仍需要前瞻性研究来确认危险因素并更好地界定潜在机制，以推动预防这种并发症的治疗方法。
