Renal Complications After Pediatric Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study

Abstract

Background/Objectives: Kidney-related complications contribute substantially to morbidity in children undergoing hematopoietic stem cell transplantation (HSCT), although evidence in pediatric populations remains limited. This study aimed to evaluate the incidence of acute kidney injury (AKI), chronic kidney disease (CKD), and hypertension within the first two years following HSCT and to investigate factors associated with these complications. Methods: We retrospectively analyzed 70 pediatric patients who underwent HSCT at the İnönü University Pediatric Bone Marrow Transplantation Unit between November 2017 and December 2023; patients who died during follow-up were excluded. Renal function was assessed using serum creatinine, the glomerular filtration rate was measured by 24-h urine collection or estimated using the Schwartz formula, and renal imaging was performed. The Acute Kidney Injury Network criteria were used to classify AKI, whereas CKD was defined according to the Kidney Disease Outcomes Quality Initiative criteria. Associations with demographic characteristics, primary disease, conditioning regimen, nephrotoxic drug exposure, graft-versus-host disease, veno-occlusive disease, and infections were evaluated. Results: AKI occurred in 54.3% of patients during the first 100 days, comprising stage 1 in 30.0%, stage 2 in 17.1%, and stage 3 in 7.1%. Primary diagnosis, conditioning regimen, nephrotoxic drug use, and transplantation-related complications were not significantly associated with AKI. Hypertension developed in 32.9% of patients, with most cases occurring during the early period after transplantation. A significant association was observed between hypertension and myeloablative conditioning without total body irradiation (p = 0.014). CKD was present in 45.7% of evaluated patients at month 6 and 44.6% at month 12. Amphotericin B use was significantly associated with CKD at month 6 (p = 0.015). No patient developed end-stage kidney disease or required dialysis. Conclusions: Renal complications were common after pediatric HSCT. AKI occurred frequently during the first 100 days, while CKD remained prevalent at 6 and 12 months. Younger age and amphotericin B exposure were associated with CKD in this cohort. Early recognition of renal injury and long-term kidney follow-up are warranted after pediatric HSCT.

The authors' abstract, as published at the source. Journal of Clinical Medicine, 2026 · DOI ↗