Abstract
A 48-year-old Japanese woman, who had been diagnosed with smoldering adult T-cell leukemia, was admitted to our hospital for hematopoietic stem cell transplantation (HSCT) because of an acute exacerbation of her disease. After myeloablative conditioning procedures, comprising cytarabine with cyclophosphamide and total body irradiation, the HLA-matched unrelated bone marrow stem cells were infused (day 0). Her serum creatinine concentration, having been 0.6 mg/dL at baseline, began to increase from day 1 and was 2.3 mg/L on day 7. Hemodialysis was required to treat fluid overload and worsening uremia on days 8 and 9. On day 10, she presented with refractory hypotension and died due to multi-organ failure on day 12. Renal pathology at autopsy showed no specific histological changes to which her clinically severe acute kidney injury (AKI) was attributable. This case suggests that post-HSCT AKI is not necessarily accompanied by apparent renal histologic damage, even if it is clinically serious.
References
Hingorani S. Chronic kidney disease in long-term survivors of hematopoietic cell transplantation: epidemiology, pathogenesis, and treatment. J Am Soc Nephrol. 2006;17:1995–2005.
Zager RA. Acute renal failure in the setting of bone marrow transplantation. Kidney Int. 1994;46:1443–58.
Schrier RW, Parikh CR. Comparison of renal injury in myeloablative autologous, myeloablative allogeneic and non-myeloablative allogeneic haematopoietic cell transplantation. Nephrol Dial Transplant. 2005;20:678–83.
Parikh CR, Schrier RW, Storer B, Diaconescu R, Sorror ML, Maris MB, Maloney DG, McSweeney P, Storb R, Sandmaier BM. Comparison of ARF after myeloablative and nonmyeloablative hematopoietic cell transplantation. Am J Kidney Dis. 2005;45:502–9.
Parikh CR, McSweeney, Schrier RW. Acute renal failure independently predicts mortality after myeloablative allogeneic hematopoietic cell transplant. Kidney Int. 2005;67:1999–2005.
Parikh CR, Yarlagadda SG, Storer B, Sorror M, Storb R, Sandmaier B. Impact of acute kidney injury on long-term mortality after nonmyeloablative hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2008;14:309–15.
Lopes JA, Gonçalves S, Jorge S, Raimundo M, Resende L, Lourenço F, Lacerda JF, Martins C, do Carmo JA, Lacerda JMF, Prata MM. Contemporary analysis of the influence of acute kidney injury after reduced intensity conditioning haematopoietic cell transplantation on long-term survival. Bone Marrow Transplant. 2008;42:619–26.
Caliskan Y, Besisik SK, Sargin D, Ecder T. Early renal injury after myeloablative allogeneic and autologous hematopoietic cell transplantation. Bone Marrow Transplant. 2006;38:141–7.
Hingorani SR, Guthrie K, Batchelder A, Schoch G, Aboulhosn N, Manchion J, McDonald GB. Acute renal failure after myeloablative hematopoietic cell transplant: incidence and risk factors. Kidney Int. 2005;67:272–7.
Parikh CR, Coca SG. Acute renal failure in hematopoietic cell transplantation. Kidney Int. 2006;69:430–5.
Ando M, Mori J, Ohashi K, Akiyama H, Morito T, Tsuchiya K, Nitta K, Sakamaki H. A comparative assessment of the RIFLE, AKIN and conventional criteria for acute kidney injury after hematopoietic SCT. Bone Marrow Transplant. 2010;45:1427–34.
Mori J, Ohashi K, Yamaguchi T, Ando M, Hirashima Y, Kobayashi T, Kakihana K, Sakamaki H. Risk assessment for acute kidney injury after allogeneic hematopoietic stem cell transplantation based on Acute Kidney Injury Network criteria. Intern Med. 2012;51:2105–10.
El-Seisi S, Gupta R, Clase CM, Forrest DL, Milandinovic M, Couban S. Renal pathology at autopsy in patients who died after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2003;9:683–8.
Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, Kellum JA. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care. 2006;10:R73–82.
Travis LB, Curtis RE, Glimelius B, Holowaty EJ, Van Leeuwen FE, Lynch CF, Hagenbeek A, Stovall M, Banks PM, Adami J, Gospodarowicz K, Wacholder S, Inskip PD, Tucker MA, Boice JD Jr. Bladder and kidney cancer following cyclophosphamide therapy for non-Hodgkin’s lymphoma. J Natl Cancer Inst. 1995;87:524–30.
Takatsuka H, Takemoto Y, Yamada S, Wada H, Tamura S, Fujimori Y, Okamoto T, Suehiro A, Kanamaru A, Kakishita E. Complications after bone marrow transplantation are manifestations of systemic inflammatory response syndrome. Bone Marrow Transplant. 2000;26:419–26.
Seconi J, Watt V, Ritchie DS. Nephrotic syndrome following allogeneic stem cell transplantation associated with increased production of TNF-alpha and interferon-gamma by donor T cells. Bone Marrow Transplant. 2003;32:447–50.
Zager RA, O’Quigley J, Zager BK, Alpers CE, Shulman HM, Gamelin LM, Stewart P, Thomas ED. Acute renal failure following bone marrow transplantation: a retrospective study of 272 patients. Am J Kidney Dis. 1989;13:210–6.
Rosen S, Stillman IE. Acute tubular necrosis is a syndrome of physiologic and pathologic dissociation. J Am Soc Nephrol. 2008;19:871–5.
Langenberg C, Bagshaw SM, May CN, Bellomo R. The histopathology of septic acute kidney injury: a systematic review. Crit Care. 2008;12:R38.
Bonventre JV, Weinberg JM. Recent advances in the pathophysiology of ischemic acute renal failure. J Am Soc Nephrol. 2003;14:2199–210.
Acknowledgments
We thank Drs. Masaki Hara and Taku Morito at Division of Nephrology for their pertinent comments and practical help with writing this case report.
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Honda, K., Ando, M., Tsubokura, M. et al. An autopsy case that manifested no convincing histological changes of severe renal failure after hematopoietic stem cell transplantation. CEN Case Rep 3, 34–39 (2014). https://doi.org/10.1007/s13730-013-0080-3
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DOI: https://doi.org/10.1007/s13730-013-0080-3