الفهرس 
HEMATOPOIETIC STEM CELL TRANSPLANTATIONOnly 14 pages are availabe for public view
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Abstract
Acute kidney injury (AKI), in the setting of pediatric HSCT, is a common recognized and devastating complication, with increased mortality and morbidity. It can be caused by a range of factors such as GVHD, SOS, thrombotic microangiopathy (TMA), hemorrhagic cystitis, sepsis, and nephrotoxic drugs. Also, transplant type (allogenic or autologous), concomitant hypertension, and other underlying chronic diseases are important risk factors for HSCT-related AKI.
Data on AKI in pediatric HSCT patients is very limited; only few studies have been published discussing AKI in pediatric HSCT patients and most studies were conducted on a small number of patients with variable confounding factors.
This study aimed primarily to shed light on the incidence of AKI in pediatric HSCT patients in our center, in addition to studying the relationship of most risk factors in the setting of HSCT with the development of AKI, whether clinic-demographic, nephrotoxin mediated, their duration of use and other acute complications. By identifying the risk factors associated with AKI, we can take steps to minimize complications and improve outcomes for these patients.
This study was a retrospective pilot study, which was conducted at bone marrow transplantation (BMT) unit, Children’s Hospital, Faculty of Medicine, Ain Shams University, over a period of 1 year, that included all patient who had undergone HSCT during the period between April 2011 to February 2020. Data were collected from patients’ medical records of 29 cases, who were admitted to BMT during the study period.
In our study, AKI incidence in the first 90 days following transplant was 79.6%. It was correlated to younger age at time of HSCT, development of aGVHD, infections whether bacterial, viral or fungal, and nephrotoxic medications used in combination as (piperacillin-tazobactam and vancomycin), (colistin and meropenem) and (vancomycin and amphotericin B).
Our study focused on the fact that AKI was prevalent among pediatric HSCT patients and that there was no correlation between its incidence and clinico-demographic or primary diagnosis for which they needed HSCT or other acute complications as CNS complications, thrombocytopenia nor hypertension. Neither conditioning regimen nor GVHD prophylaxis medications had affected the prevalence of AKI.
Unfortunately, there are limited reports in literature regarding the relation between development of AKI in pediatric HSCT patients and gender, and no reports in literature that study the development of AKI in pediatric HSCT patients and certain nephrotoxic drugs used in combinations. In our study there was no significant association between development of AKI and gender. And there was a significant correlation between use of nephrotoxic drugs in combination and development of AKI, owing to the multiple pathophysiology of renal insults caused by these drugs occurring at the same time.
There should be Regular follow up of kidney function tests and urine output is needed for HSCT pediatric patients for early detection of AKI and prevention of further complications. pRIFLE criteria is recommended for use for early and accurate detection and management of AKI in pediatric HSCT patients. Further multi-center studies are needed to detect incidence of AKI in pediatric HSCT patients and correlate it with various factors in the setting of HSCT and different common acute complications that can happen in this period.
CONCLUSION
AKI was common in pediatric patients underwent HSCT, with strong association to several factors including the young ages, nephrotoxic medications, in addition to the development of infections and aGvHD, which were major complications that occurred during HSCT.
RECOMMENDATIONS
The results of the current study propose anticipation of AKI in pediatric HSCT population and frequent follow-up of serum creatinine levels and daily urine output and fluid balance charts, together with using standardized AKI criteria such as pRIFLE criteria, to detect early AKI and for early proper management; to prevent associated morbidity and mortality.
In addition to using some feasible guidelines for controlling the development of AKI in HSCT pediatrics, such as prevention of dehydration and maintenance of euvolemia to ensure proper renal perfusion.
Identifying and limiting the use of nephrotoxic medications, including aminoglycoside antibiotics, combinations of Vancomycin and piperacillin-tazobactam, Colistin and Meropenem, and Amphotericin and Vancomycin. If possible, select alternate drugs that have a lower risk of renal toxicity. In addition, adjust drug dosages according to renal function; once it’s compromised.
Attempting to implement stringent infection control methods to limit the risk of sepsis and eventual AKI would be highly recommended.