Kaçar Dilek, Özlü Sare Gülfem, Arman Bilir Özlem, Ok Bozkaya İkbal, Kanbur Şerife Mehtap, Koca Yozgat Ayça, Aksoy Özlem Yüksel, Bayrakçı Umut Selda, Özbek Namık Yaşar
Department of Pediatric Hematology Oncology & Bone Marrow Transplantation Unit, Ankara Bilkent City Hospital, University of Health Sciences, Üniversiteler Mah. Bilkent Cad. No:1 Çankaya, Ankara, Turkey.
Department of Pediatric Nephrology, Ankara Bilkent City Hospital, Ankara Yıldırım Beyazıt University, Ankara, Turkey.
Pediatr Nephrol. 2025 Aug 8. doi: 10.1007/s00467-025-06921-z.
Hematopoietic stem cell transplantation (HSCT) is an effective treatment for various childhood diseases with long-term complications, including kidney side effects.
We conducted a single-center retrospective study of 213 patients who received allogeneic HSCT between February 2011 and December 2023. Patients were followed for at least 3 months post-HSCT, with a median follow-up of 2.9 years. We evaluated pre- and post-HSCT estimated glomerular filtration rate (eGFR) and kidney complications.
After HSCT, patients showed significantly higher rates of acute kidney injury (21.6% vs. 4.1% pre-HSCT), hypertension (26.8% vs. 5.2% pre-HSCT), and tubulopathy (20.2% vs. 5.2% pre-HSCT). The median final eGFR was 144 mL/min/1.73 m, which was significantly lower than the pre-HSCT eGFR (155 mL/min/1.73 m, p < 0.0001) and negatively correlated with time after HSCT (Rs = - 0.177, p = 0.009). Eight patients (3.8%) progressed to chronic kidney disease (CKD). Factors linked to CKD included inherited bone marrow failure syndromes, anti-thymocyte globulin (ATG) conditioning, urinary tract infections (UTIs), and high urinary BK virus loads. Although the rates of glomerular hyperfiltration (GHF) did not change significantly between pre-HSCT (63.8%) and post-HSCT (62.4%, p = 0.824), GHF was notable in patients with acute lymphoblastic leukemia pre-HSCT and thalassemia post-HSCT. Seventeen patients (8.4%) needed ongoing antihypertensive treatment.
HSCT can cause various kidney complications. GHF is common both before and after transplant, and eGFR often declines over time. UTIs, ATG conditioning, and inherited bone marrow failure syndromes are important risk factors for CKD. Individual factors and infection surveillance should be considered in these patients to approach kidney health.
造血干细胞移植（HSCT）是治疗各种伴有长期并发症（包括肾脏副作用）的儿童疾病的有效方法。
我们对2011年2月至2023年12月期间接受异基因HSCT的213例患者进行了单中心回顾性研究。患者在HSCT后至少随访3个月，中位随访时间为2.9年。我们评估了HSCT前后的估计肾小球滤过率（eGFR）和肾脏并发症。
HSCT后，患者急性肾损伤（21.6%对HSCT前的4.1%）、高血压（26.8%对HSCT前的5.2%）和肾小管病（20.2%对HSCT前的5.2%）的发生率显著更高。最终eGFR的中位数为144 mL/min/1.73 m²，显著低于HSCT前的eGFR（155 mL/min/1.73 m²，p < 0.0001），且与HSCT后的时间呈负相关（Rs = -0.177，p = 0.009）。8例患者（3.8%）进展为慢性肾脏病（CKD）。与CKD相关的因素包括遗传性骨髓衰竭综合征、抗胸腺细胞球蛋白（ATG）预处理、尿路感染（UTIs）和高尿BK病毒载量。尽管HSCT前（63.8%）和HSCT后（62.4%，p = 0.824）肾小球高滤过（GHF）的发生率没有显著变化，但GHF在HSCT前的急性淋巴细胞白血病患者和HSCT后的地中海贫血患者中较为明显。17例患者（8.4%）需要持续的降压治疗。
HSCT可导致各种肾脏并发症。移植前后GHF均很常见，且eGFR常随时间下降。UTIs、ATG预处理和遗传性骨髓衰竭综合征是CKD的重要危险因素。对于这些患者，应考虑个体因素并进行感染监测，以关注肾脏健康。
