Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard-Herriot, Hospices Civils de Lyon, Lyon, France.
Universidade de Caxias Do Sul, Programa de Pós Graduação Em Ciências da Saúde, Caxias do Sul, Brazil.
Pediatr Nephrol. 2022 Jun;37(6):1365-1375. doi: 10.1007/s00467-021-05319-x. Epub 2021 Nov 4.
Allogenic hematopoietic stem cell transplantation (aHSCT) remains the treatment of choice for some malignant hemopathies in children, albeit with the risk of long-term consequences, including chronic kidney disease (CKD).
In our single tertiary referral center, we retrospectively assessed the long-term renal outcome in a cohort of children and adolescents who had undergone aHSCT for malignant hemopathies between 2003 and 2017. We distinguished glomerular and tubular dysfunctions and assessed the accuracy of the most common formula(s) to estimate glomerular filtration rate (GFR) during standard clinical follow-up.
Among the 166 patients who had received aHSCT, 61 underwent kidney functional assessment 1 to 10 years post-transplantation. Twenty-seven patients (44.3%) had a CKD with glomerular impairment, including 20 patients with a GFR < 90 mL/min/1.73 m, and among these, 5 patients < 60 mL/min/1.73 m. Patients with tubular signs had a significantly higher baseline GFR: 112 mL/min/1.73 m [100; 120] versus 102 [99.0; 112.5] for patients without kidney involvement, and 76 [61; 86] for patients with CKD (p < 0.01). Schwartz, CKiDU25, and EKFC formulas significantly overestimated mGFR, with a P30% ≤ 30%, which could lead to overlooking CKD diagnosis in this population. No patient reached kidney failure.
In conclusion, our study shows that CKD represents an important long-term sequela for children and adolescents who undergo aHSCT for malignant hemopathies, either with glomerular dysfunction or with the more insidious tubular dysfunction which could potentially impact growth. These patients could benefit from specialized long-term nephrology follow-up. A higher resolution version of the Graphical abstract is available as Supplementary information.
同种异体造血干细胞移植（aHSCT）仍然是某些儿童恶性血液病的治疗选择，尽管存在长期后果的风险，包括慢性肾脏病（CKD）。
在我们的单一三级转诊中心，我们回顾性评估了 2003 年至 2017 年间因恶性血液病接受 aHSCT 的儿童和青少年队列的长期肾脏结局。我们区分了肾小球和肾小管功能障碍，并评估了最常用的公式（多个公式）在标准临床随访中估计肾小球滤过率（GFR）的准确性。
在接受 aHSCT 的 166 名患者中，有 61 名患者在移植后 1 至 10 年内进行了肾功能评估。27 名患者（44.3%）患有 CKD 合并肾小球损伤，其中 20 名患者的 GFR<90mL/min/1.73m，其中 5 名患者的 GFR<60mL/min/1.73m。有肾小管迹象的患者的基线 GFR 明显更高：112mL/min/1.73m[100；120]与无肾脏受累患者的 102[99.0；112.5]相比，以及 CKD 患者的 76[61；86]（p<0.01）。Schwartz、CKiDU25 和 EKFC 公式显著高估了 mGFR，P30%≤30%，这可能导致在该人群中忽视 CKD 诊断。没有患者达到肾衰竭。
总之，我们的研究表明，CKD 是接受恶性血液病 aHSCT 的儿童和青少年的一个重要长期后遗症，无论是肾小球功能障碍还是更隐匿的肾小管功能障碍，都可能影响生长。这些患者可能受益于专门的长期肾脏科随访。更清晰的图表版本可以在补充信息中查看。
