Pathological evaluation of renal complications in children following allogeneic hematopoietic stem cell transplantation: a retrospective cohort study
Abstract Background Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative therapy for hematologic malignancies and non-malignant disorders, such as aplastic anemia, fanconi anemia, and certain immune deficiencies. Post-transplantation kidney injury is a common complication and...
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | BMC Pediatrics |
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| Online Access: | https://doi.org/10.1186/s12887-023-03996-1 |
| _version_ | 1797840882920062976 |
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| author | Ru-Yue Chen Xiao-Zhong LI Qiang Lin Han-Yun Tang Ning-Xun Cui Lu Jiang Xiao-Mei Dai Wei-Qing Chen Fan Deng Shao-Yan Hu Xue-Ming Zhu |
| author_facet | Ru-Yue Chen Xiao-Zhong LI Qiang Lin Han-Yun Tang Ning-Xun Cui Lu Jiang Xiao-Mei Dai Wei-Qing Chen Fan Deng Shao-Yan Hu Xue-Ming Zhu |
| author_sort | Ru-Yue Chen |
| collection | DOAJ |
| description | Abstract Background Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative therapy for hematologic malignancies and non-malignant disorders, such as aplastic anemia, fanconi anemia, and certain immune deficiencies. Post-transplantation kidney injury is a common complication and involves a wide spectrum of structural abnormalities, including glomerular (MSPGN, mesangial proliferative glomerulonephritis; FSGS, focal segmental glomerulosclerosis; MPGN, membranoproliferative glomerulonephritis; MCD, minimal change disease), vascular (TMA, thrombotic microangiopathy), and/or tubulointerstitial (TIN, tubulointerstitial nephritis; ATI, acute tubular injury). Renal biopsy is the gold-standard examination for defining multiple etiologies of kidney impairment. Although kidney injury following HSCT has been studied, little is known about the effects of allo-HSCT on renal pathology in pediatric patients. Methods We retrospectively analyzed renal biopsy specimens from children with kidney injury after allo-HSCT and correlated results with clinical data in the last 10 years. Results Among 25 children (18 males and 7 females), three patients had proteinuria indicating nephrotic syndrome (24-hour urinary total protein/weight > 50 mg/kg/d), nine patients had severely reduced estimated glomerular filtration rate (eGFR < 30 ml/min/1.73 m2) and four patients received kidney replacement therapy (KRT). The main pathologies identified from kidney biopsies were MSPGN (n = 12), FSGS (n = 12), MPGN (n = 5), TMA (n = 4), MCD (n = 3), diffuse glomerular fibrosis (DGF, n = 2), ATI and TIN, in isolation or combined with other pathologies. The median follow-up time was 16.5 (0.5 ~ 68.0) months. Three patients died of recurrent malignancy and/or severe infection, one child developed to end-stage renal disease (ESRD), six patients (24%) had elevated serum creatinine (SCr > 100µmol/l) and nine patients (36%) still had proteinuria. Conclusions This study evaluates histomorphologic findings from kidney biopsies of pediatric recipients following allo-HSCT. Detailed evaluation of renal biopsy samples is helpful to elucidate the nature of renal insult, and may potentially identify treatable disease processes. |
| first_indexed | 2024-04-09T16:22:00Z |
| format | Article |
| id | doaj.art-ce2310a0e4664e5e88befd56f0e134a7 |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-04-09T16:22:00Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj.art-ce2310a0e4664e5e88befd56f0e134a72023-04-23T11:28:21ZengBMCBMC Pediatrics1471-24312023-04-0123111110.1186/s12887-023-03996-1Pathological evaluation of renal complications in children following allogeneic hematopoietic stem cell transplantation: a retrospective cohort studyRu-Yue Chen0Xiao-Zhong LI1Qiang Lin2Han-Yun Tang3Ning-Xun Cui4Lu Jiang5Xiao-Mei Dai6Wei-Qing Chen7Fan Deng8Shao-Yan Hu9Xue-Ming Zhu10Department of Nephrology and Immunology, Children’s Hospital of Soochow UniversityDepartment of Nephrology and Immunology, Children’s Hospital of Soochow UniversityDepartment of Nephrology and Immunology, Children’s Hospital of Soochow UniversityDepartment of Nephrology and Immunology, Children’s Hospital of Soochow UniversityDepartment of Nephrology and Immunology, Children’s Hospital of Soochow UniversityDepartment of Nephrology and Immunology, Children’s Hospital of Soochow UniversityDepartment of Nephrology and Immunology, Children’s Hospital of Soochow UniversityDepartment of Nephrology and Immunology, Children’s Hospital of Soochow UniversityDepartment of Nephrology and Immunology, Children’s Hospital of Soochow UniversityDepartment of Hematology, Children’s Hospital of Soochow UniversityDepartment of Pathology, Children’s Hospital of Soochow UniversityAbstract Background Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative therapy for hematologic malignancies and non-malignant disorders, such as aplastic anemia, fanconi anemia, and certain immune deficiencies. Post-transplantation kidney injury is a common complication and involves a wide spectrum of structural abnormalities, including glomerular (MSPGN, mesangial proliferative glomerulonephritis; FSGS, focal segmental glomerulosclerosis; MPGN, membranoproliferative glomerulonephritis; MCD, minimal change disease), vascular (TMA, thrombotic microangiopathy), and/or tubulointerstitial (TIN, tubulointerstitial nephritis; ATI, acute tubular injury). Renal biopsy is the gold-standard examination for defining multiple etiologies of kidney impairment. Although kidney injury following HSCT has been studied, little is known about the effects of allo-HSCT on renal pathology in pediatric patients. Methods We retrospectively analyzed renal biopsy specimens from children with kidney injury after allo-HSCT and correlated results with clinical data in the last 10 years. Results Among 25 children (18 males and 7 females), three patients had proteinuria indicating nephrotic syndrome (24-hour urinary total protein/weight > 50 mg/kg/d), nine patients had severely reduced estimated glomerular filtration rate (eGFR < 30 ml/min/1.73 m2) and four patients received kidney replacement therapy (KRT). The main pathologies identified from kidney biopsies were MSPGN (n = 12), FSGS (n = 12), MPGN (n = 5), TMA (n = 4), MCD (n = 3), diffuse glomerular fibrosis (DGF, n = 2), ATI and TIN, in isolation or combined with other pathologies. The median follow-up time was 16.5 (0.5 ~ 68.0) months. Three patients died of recurrent malignancy and/or severe infection, one child developed to end-stage renal disease (ESRD), six patients (24%) had elevated serum creatinine (SCr > 100µmol/l) and nine patients (36%) still had proteinuria. Conclusions This study evaluates histomorphologic findings from kidney biopsies of pediatric recipients following allo-HSCT. Detailed evaluation of renal biopsy samples is helpful to elucidate the nature of renal insult, and may potentially identify treatable disease processes.https://doi.org/10.1186/s12887-023-03996-1Allogeneic hematopoietic stem cell transplantation (allo-HSCT)Renal pathologyMesangial proliferative glomerulonephritis (MSPGN)Focal segmental glomerulosclerosis (FSGS)Membranoproliferative glomerulonephritis (MPGN)Thrombotic microangiopathy (TMA) |
| spellingShingle | Ru-Yue Chen Xiao-Zhong LI Qiang Lin Han-Yun Tang Ning-Xun Cui Lu Jiang Xiao-Mei Dai Wei-Qing Chen Fan Deng Shao-Yan Hu Xue-Ming Zhu Pathological evaluation of renal complications in children following allogeneic hematopoietic stem cell transplantation: a retrospective cohort study BMC Pediatrics Allogeneic hematopoietic stem cell transplantation (allo-HSCT) Renal pathology Mesangial proliferative glomerulonephritis (MSPGN) Focal segmental glomerulosclerosis (FSGS) Membranoproliferative glomerulonephritis (MPGN) Thrombotic microangiopathy (TMA) |
| title | Pathological evaluation of renal complications in children following allogeneic hematopoietic stem cell transplantation: a retrospective cohort study |
| title_full | Pathological evaluation of renal complications in children following allogeneic hematopoietic stem cell transplantation: a retrospective cohort study |
| title_fullStr | Pathological evaluation of renal complications in children following allogeneic hematopoietic stem cell transplantation: a retrospective cohort study |
| title_full_unstemmed | Pathological evaluation of renal complications in children following allogeneic hematopoietic stem cell transplantation: a retrospective cohort study |
| title_short | Pathological evaluation of renal complications in children following allogeneic hematopoietic stem cell transplantation: a retrospective cohort study |
| title_sort | pathological evaluation of renal complications in children following allogeneic hematopoietic stem cell transplantation a retrospective cohort study |
| topic | Allogeneic hematopoietic stem cell transplantation (allo-HSCT) Renal pathology Mesangial proliferative glomerulonephritis (MSPGN) Focal segmental glomerulosclerosis (FSGS) Membranoproliferative glomerulonephritis (MPGN) Thrombotic microangiopathy (TMA) |
| url | https://doi.org/10.1186/s12887-023-03996-1 |
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