Kidney Disease in Cancer Survivors: Focus on Hematopoietic Stem Cell Transplantation

Abstract

Kidney disease and hypertension are common among children and adults with cancer, including those undergoing hematopoietic stem cell transplantation (HSCT). While survival has improved over time for patients receiving a HSCT, acute kidney injury (AKI) and chronic kidney disease (CKD) remain associated with significant morbidity and mortality. The mechanisms leading to kidney disease in this population are likely multifactorial and include chemotherapy, other nephrotoxic medications, and infections. Nevertheless, we still do not completely understand why such a large proportion of patients develop kidney disease after HSCT. The growing field of onco-nephrology allows oncologists, transplant providers, and nephrologists to learn about disease processes and treatments relevant to their respective patient populations. Accordingly, we are learning that several mechanisms of injury affecting HSCT recipients also occur in general nephrology and in kidney transplant recipients. For example, complement dysregulation leading to atypical hemolytic uremic syndrome parallels HSCT-associated thrombotic microangiopathy and BK virus nephropathy occurring after kidney transplant can also lead to CKD in HSCT recipients. This review focuses on thrombotic microangiopathy and BK virus infection as potential causes of AKI and CKD after HSCT, which are currently thought to be idiopathic. These diagnoses require a high index of suspicion, emphasizing the importance of close attention to blood pressure, proteinuria, and the measurement and estimation of kidney function in patients undergoing HSCT.