Biology of Blood and Marrow Transplantation talks about the chronic kidney diseases and thrombotic microangiopathy (TMA) seen post bone marrow transplantation. Classically, it has always thought to be multi-factorial and calcineurin toxicity being a major part of it. They are used for GVHD prophylaxis. In this study, a retrospective analysis of 100 patients was done who had undergone a T cell depleted stem cell transplant( hence not requiring CNIs). Of the 100 patients, 70 were given total body radiation without any shielding of the kidneys and they were compared to 30 patients with no total body radiation. The multivariate survival analysis showed that the exposure to radiation, older age and TMA were risk factors for CKD. The radiation group had more biopsy proven and clinically diagnosed TMA compared to NONE in the non radiation group. The incidence of hypertension was also more in the radiation group.
This study shows that in the absence of CNIs, there is TMA, HTN and CKD suggesting the major role of radiation nephropathy in these patients. A shielding of the kidneys should be examined in patients getting stem cell transplants and radiation. Some centers do shielding of the kidneys and some don't. Other studies have shown that the amount of radiation and shielding does make a difference.
A nice review on radiation nephropathy is linked here as well ( Kidney International)
Wednesday, February 17, 2010
- ► 2018 (48)
- ► 2017 (52)
- ► 2016 (45)
- ► 2015 (63)
- ► 2014 (95)
- ► 2013 (133)
- ► 2012 (201)
- ► 2011 (370)
- CLINICAL CASE 5
- Luminex Technology
- IN THE NEWS ---> CLASSIFICATION FOR DIABETIC NEPH...
- Nephrectomy or No Nephrectomy?
- CONSULT ROUNDS: ORTHOSTATIC PROTEINURIA
- TOPIC DISCUSSION Risk factors for bleeding post ki...
- New drugs for Hepatitis C
- CDC HIGH RISK DONORS
- TOPIC DISCUSSION: Peritoneal Dialysis First initia...
- CLINICAL CASE 4
- Adrenal Gland Transplantation
- IN THE NEWS --->Is BMT Nephropathy really mostly ...
- Sad News
- TOPIC DISCUSSION: Tamm Horsfall Mucoprotein
- TOPIC DISCUSSION: Re-evaluating the Role of Immuno...
- JOURNAL CLUB: DNA Methylation controls Foxp3 gene ...
- In the News: The era of epigenetics
- Sirolimus and tubular toxicity
- TOPIC DISCUSSION: FIBROTIC DISEASES
- IN THE NEWS --> IgA with ANCAs
- JOURNAL CLUB: Pirfenidone Is Renoprotective in Dia...
- IN THE NEWS- CKD and Proteinuria
- CLINICAL CASE 3
- Positive Cross Match, Desensitization
- CONSULT ROUNDS: Post Bone Marrow Transplant Thromb...
- ▼ February (25)