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bone marrow transplant (BMT) nephropathy
Epidemiology: common in some centers
Etiology:
1) tumor lysis syndrome
2) nephrotoxicity from bone marrow infusion (early)
3) nephrotoxicity from amphotericin B
4) sepsis
5) hepatorenal-like syndrome
a) occurs 10-16 days after BMT
b) endothelial injury from chemotherapy &/or radiation
c) volume overload
d) urine [Na+] < 40 meq/L
e) pre-existing renal &/or hepatic disease are risk factors
6) signs & symptoms of hemolytic-uremic syndrome (HUS)
a) 4-12 months after BMT
b) hypertension
c) renal insufficiency
d) proteinuria
e) hematuria
f) erythrocyte casts in urine
g) signs of microangiopathic hemolytic anemia
h) thrombocytopenia
i) central nervous system dysfunction
j) cyclosporin & total body radiation may play a role in the pathogenesis
7) radiation nephropathy
8) nephrotoxic chemotherapy & immunosuppressive agents may exacerbate renal disease
Management:
1) therapy is supportive: dialysis may be necessary
Related
bone marrow transplantation (BMT)
hemolytic uremic syndrome (HUS)
hepatorenal syndrome; acute kidney injury in cirrhosis
tumor lysis syndrome
General
nephropathy
References
Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998