Hematopoetik Kök Hücre Nakli Yapılan Çocuk Hastalarda Renal Komplikasyonların ve Hipertansiyon Sıklığının Belirlenmesi

Abstract

The aim of this study is to investigate renal complications, hypertension frequency and risk factors in patients who had hematopoietic stem cell transplantation (HSCT) during their childhood. 167 patients with allogeneic (n=165) and autologous (n=2) transplantation were investigated for renal complications. After transplantation, hemorrhagic cystitis (HC) was developed in 28 patients (%16,8). It was observed that patients who had HSCT at older ages and who had suffered from viral infection developed HC more frequently than others. Besides, patients with underlying malignant diagnosis, patients who had suffered from veno-occlusive disease (VOD) and viral infections after transplantation developed acute kidney injury (AKI-pRIFLE criteria) more frequently than others. At the last visit, 72 patients (41 boys, 31 girls) were evaluated for late-onset renal complications and hypertension. Office blood pressure (BP) measurement and ambulatory blood pressure monitoring (ABPM) were performed in these patients. Ambulatory blood pressure measurements were standardized according to age, gender and height using the least median of squares (LMS) method. According to the American Academy of Pediatrics (AAP) guidelines, among 12 patients (%19,7) with normal office BP, eight of them were diagnosed as prehypertension and four of them were diagnosed as hypertension with ABPM. According to European Society of hypertension (ESH) guidelines, among15 patients (%23,4) with normal office BP, ten of them diagnosed as prehypertension and four of them were diagnosed as hypertension with ABPM. At the last visit, when we have investigated patients with chronic kidney disease (CKD), we observed that patients whose source of hematopoietic stem cell is bone marrow and cord blood, peripheral stem cell, unrelated donor and chronic GVHD developed CKD more frequently than others. Conditioning regimen, acute and chronic GVHD were important factors that have influenced the survival. In conclusion, follow up of patients with HSCT should be done by transplant and pediatric nephrology departments for the risk of renal damage and hypertension.