Clinical Analysis Of Acute And Chronic Kidney Injury After Allo-HSCT

Part Ⅰ Clinical features,risk factors and outcomes of Acute Kidney Injury after Allo-HSCTObjective To investigate the clinical features,risk factors and prognosis of acute kidney injury(AKI)after allogeneic hematopoietic stem cell transplantation(Allo-HSCT).Methods Prospective observation of clinical data of 497 Allo-HSCT patients completed by the First Affiliated Hospital of Suzhou University from June 2017 to May 2018.Pre-transplant baseline information,conditioning regimen,characteristics of early complications such as AKI after transplantation,relevant laboratory indicators,prognosis follow-up and so on were collected for statistical analysis and analysis.Results Follow-up until February 1,2019,a total of 159 patients with AKI,the overall incidence was 31.99%.The incidence rates of AKI stage Ⅰ,stage Ⅱ and stage Ⅲwere 20.93%,8.65%and 2.41%,respectively.The median time was 34(1～99)days after transplantation.Sepsis(OR:0.165;95%CI:0.047-0.575;P=0.005),aplastic anemia(AA)transplant patients(OR:0.37;95%CI:0.159-0.860;P=0.021),diabetes(OR:0.331;95%CI:0.125-0.874;P=0.026)and AKI history before transplantation(OR:0.562;95%CI:0.321-0.983;P=0.043)were independent risk factors for AKI.The overall survival(OS)of patients with AKI stage Ⅱ and stage Ⅲ after Allo-HSCT was significantly lower than that of patients without AKI(P=0.025,P=0.003).Conclusions AKI is a common early complication after Allo-HSCT.Stage Ⅱ and ⅢAKI significantly reduce OS in patients.Septicemia,AA transplant patients,diabetes,and pre-transplant AKI history are independent risk factors for AKI.Part Ⅱ Clinicopathologic Analysis of Chronic Kidney Disease after Allo-HSCTObjective To analyze the clinical and pathological features of chronic kidney disease(CKD)after Allo-HSCT.Methods The clinical and pathological features of 24 patients with complete pathological data obtained from Allo-HSCT and CKD after percutaneous renal biopsy were retrospectively analyzed from November 2005 to December 2018.Among them,22 patients underwent renal biopsy at the National Center for Kidney Disease Clinical Research in the General Hospital of the Eastern Theater(formerly Nanjing Military Region General Hospital),one patient underwent renal biopsy at the Children’s Hospital of Suzhou University,and the remaining one underwent renal biopsy at the First Affiliated Hospital of Wenzhou Medical UniversityResults Renal biopsy data of 25 patients with CKD after Allo-HSCT(including patient 8 received twice renal biopsies).There are 17 males and 7 females.The median age was 43.8(7.2 to 54.3)years old.The median time from Allo-HSCT to renal biopsy was 17.2(2.0 to 74.6)months,and 20(83.3%)patients coexisted with graft-versus-host disease(GVHD).A large number of proteinuria(24-hour urine protein>3.5 g/L)was the main manifestation in 6 cases,serum creatinine level was increased(SCr>110 μmol/l)in 8 cases,and 4 cases showed these two manifestations.The main pathological findings were:GVHD(7 cases),membranous nephropathy(MN,5 cases),thrombotic microangiopathy(TMA,4 cases),BK viral nephropathy(2 cases),ischemic nephropathy,chronic interstitial Nephritis,microscopic lesions(MCD),GVHD with TMA,MN with focal segmental glomerulosclerosis(FSGS),MCD with acute tubular injury,BK viral nephropathy with calmodulin inhibitor,renal injury in one case.Eighteen patients were followed up completely,one died and the rest survived.The median follow-up time was 18.3(12.3～120.2)months.Five patients(29.4%)had an estimated glomerular filtration rate(eGFR)of less than 60 ml/(min·1.73m2),4 patients(23.5%)had moderate amounts of proteinuria,and 3 patients(17.6%)had eGFR of less than 60 ml/(min·1.73m2)combined with moderate amount of proteinuria,the remaining patients with eGFR greater than 60 ml/(min·1.73m2)and/or continued micro-proteinuria.One patient died of central nervous system tumor infiltration,one patient had small lymphocytic lymphoma,and one patient had a second transplant after recurrence.Conclusion The most common clinical manifestations of CKD after Allo-HSCT are elevated SCr and/or abnormal urine test.The most common pathological types are GVHD,MN and TMA.