Medical College of Wisconsin
CTSICores SearchResearch InformaticsREDCap

Late renal dysfunction in adult survivors of bone marrow transplantation. Cancer 1991 Jun 01;67(11):2795-800 PMID: 2025844

Pubmed ID

2025844

Abstract

Until recently long-term renal toxicity has not been considered a major late complication of bone marrow transplantation (BMT). Late renal dysfunction has been described in a pediatric population status post-BMT which was attributable to the radiation in the preparatory regimen. A thorough review of adults with this type of late renal dysfunction has not previously been described. Fourteen of 103 evaluable adult patients undergoing allogeneic (96) or autologous (7) bone marrow transplantation, predominantly for leukemia and lymphomas, at the Medical College of Wisconsin (Milwaukee, WI) have had a syndrome of renal insufficiency characterized by increased serum creatinine, decreased glomerular filtration rate, anemia, and hypertension. This syndrome developed at a median of 9 months (range, 4.5 to 26 months) posttransplantation in the absence of specific identifiable causes. The cumulative probability of having this renal dysfunction is 20% at 1 year. Renal biopsies performed on seven of these cases showed the endothelium widely separated from the basement membrane, extreme thickening of the glomerular basement membrane, and microthrombi. Previous chemotherapy, antibiotics, and antifungals as well as cyclosporin may add to and possibly potentiate a primary chemoradiation marrow transplant renal injury, but this clinical syndrome is most analogous to clinical and experimental models of radiation nephritis. This late marrow transplant-associated nephritis should be recognized as a potentially limiting factor in the use of some intensive chemoradiation conditioning regimens used for BMT. Some selective attenuation of the radiation to the kidneys may decrease the incidence of this renal dysfunction.

Author List

Lawton CA, Cohen EP, Barber-Derus SW, Murray KJ, Ash RC, Casper JT, Moulder JE

Author

Colleen A. Lawton MD Vice Chair, Professor in the Radiation Oncology department at Medical College of Wisconsin




Scopus

2-s2.0-0025810093   84 Citations

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Biopsy
Bone Marrow Transplantation
Humans
Kidney
Kidney Diseases
Kidney Glomerulus
Leukemia
Middle Aged
jenkins-FCD Prod-353 9ccd8489072cb19f5b9f808bb23ed672c582f41e