Renal and Genito-Urinary
Bone Marrow Transplant (BMT)
Renal damage after BMT is secondary to multiple factors:
- Conditioning therapy
- Chemotherapy - for example carboplatin
- Whole body low dose RT (also called total body irradiation or TBI)
- cGvHD
- Complications of BMT:
- Septicaemia causing hypotension in the immediate post transplant period
- Supportive therapy:
- Treatment with nephrotoxic antibiotics
- Anti-fungal therapy
- Immunosuppression after using agents like cyclosporin A
There are multiple reports documenting reduced renal function after BMT and showing that renal function in patients is usually normal going into transplant.
Renal dysfunction can occur in patients who have not received TBI. However TBI most likely significantly contributes to renal problems.
Renal dysfunction described after BMT includes:
- Persistently increased serum creatinine
- Decreased glomerular filtration rate
- Tubular dysfunction
- Clinical features:
- Anemia
- Hypertension
- Develops median of 9 months after BMT
- Affects 20 - 45% patients
Pathology features of renal biopsies from patients with chronic renal dysfunction after BMT:
- Endothelium widely separated from the basement membrane
- Extreme thickening of the glomerular basement membrane
- Microthrombi
In one study:
- Acute renal dysfunction (ARD):
- Defined as persistent elevation of serum creatinine within 90 days of transplant
- Seen in about 45% of patients
- Increased risk in young patients (less than 5 years old)
- Did not appear to be related to dose of TBI (but most of these patients had low dose TBI)
- Most patients who had ARD, also had:
- Concurrent diagnosis of veno-occlusive disease involving the liver
- cGvHD
- Other causes such as septicaemia and hypotension
- Delayed renal dysfunction (DRD):
- Defined as elevated serum creatinine after one year from transplant
- Affected about 25% of patients
- Seen in patients who had acute renal dysfunction (ARD)
- Underlying diagnosis does not appear to affect risk of DRD
Usually patients can be managed medically and the chance of chronic renal dysfunction requiring dialysis is small.
It is recommended that both glomerular and tubular function is monitored after BMT
Late marrow transplant-associated nephritis is a potentially limiting factor in the use of some intensive chemo-radiation conditioning regimens prior to BMT. Selective attenuation of RT to the kidneys may decrease the incidence of late renal dysfunction.
