Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Department of Pediatrics, Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey, 06100.
Pediatr Nephrol. 2023 Feb;38(2):461-469. doi: 10.1007/s00467-022-05599-x. Epub 2022 May 20.
This study aimed to determine incidence of kidney complications in pediatric allogeneic hematopoietic stem cell transplantation (HSCT) patients.
Pediatric allogeneic HSCT patients were included. Post-transplantation urinary system complications were collected from medical records and glomerular filtration rates at last visit compared with clinical parameters. Additionally, 24-h ambulatory blood pressure monitoring was performed.
The study included 165 pediatric patients. Acute kidney injury (AKI) developed in 125 (75.8%) patients of whom 54 (43.2%) had stage 1, 36 (28.8%) stage 2, and 35 (28%) stage 3 AKI. Primary malignant disease and viral infection post-HSCT were associated with increased risk of AKI (OR: 4; 95%CI: 1.2-13, p = 0.022 and OR: 2.9; 95%CI: 1.2-6.8, p = 0.014, respectively). Mean duration of post-HSCT follow-up was 4.4 ± 2.5 years, during which time 8 patients had chronic kidney disease (CKD) (stage 1, 4 patients; stage 2, 3 patients; stage 3, 1 patient). CKD incidence was higher in patients in whom stem cell product was bone marrow + cord blood and mobilized peripheral blood, compared to bone marrow alone (40-37.5% versus 5.1%, p = 0.002). Based on 24-h ABPM, 14.7% and 7.4% of patients with normal office blood pressure had pre-hypertension and hypertension, respectively. In patients with albuminuria/severe albuminuria, daytime and nighttime systolic SDS scores were higher than those without albuminuria/severe albuminuria (p = 0.010 and p = 0.004, respectively).
Incidence of AKI is higher in pediatric HSCT patients with primary malignant disease and those with documented viral infection. Our study highlights the beneficial role of 24-h ABPM as a routine part of standard care of pediatric HSCT recipients.
本研究旨在确定儿科异基因造血干细胞移植（HSCT）患者肾脏并发症的发生率。
纳入儿科异基因 HSCT 患者。从病历中收集移植后泌尿系统并发症，并将最后一次就诊时的肾小球滤过率与临床参数进行比较。此外，还进行了 24 小时动态血压监测。
本研究纳入了 165 名儿科患者。125 名（75.8%）患者发生急性肾损伤（AKI），其中 54 名（43.2%）为 1 期，36 名（28.8%）为 2 期，35 名（28%）为 3 期 AKI。原发性恶性疾病和 HSCT 后病毒感染与 AKI 的风险增加相关（OR：4；95%CI：1.2-13，p = 0.022 和 OR：2.9；95%CI：1.2-6.8，p = 0.014）。HSCT 后随访的平均时间为 4.4 ± 2.5 年，在此期间 8 名患者患有慢性肾脏病（CKD）（1 期 4 名，2 期 3 名，3 期 1 名）。与仅骨髓相比，干细胞产品为骨髓+脐带血和动员外周血的患者 CKD 发生率更高（40-37.5%比 5.1%，p = 0.002）。根据 24 小时 ABPM，血压正常的办公室患者中分别有 14.7%和 7.4%患有高血压前期和高血压。在有蛋白尿/严重蛋白尿的患者中，白天和夜间收缩压 SDS 评分高于无蛋白尿/严重蛋白尿的患者（p = 0.010 和 p = 0.004）。
原发性恶性疾病和有病毒感染记录的儿科 HSCT 患者 AKI 的发生率较高。我们的研究强调了 24 小时 ABPM 作为儿科 HSCT 受者标准护理常规的有益作用。
