造血干细胞移植相关肾脏损害

Kidney injury after hematopoietic stem cell transplantation

造血干细胞移植已广泛应用于各种疾病的治疗,与其相关的肾脏损害并不罕见,并严重影响患者的预后。预处理时大剂量化疗和(或)放疗可引起一系列病理生理改变,加上移植过程中应用钙调神经蛋白抑制剂、肾毒性药物和感染、移植物抗宿主病等多种因素的影响,造血干细胞移植后可以出现急性肾损伤、慢性肾脏病和移植相关的血栓性微血管病等,引起蛋白尿、高血压或肾功能减退,严重时需要肾脏替代治疗或肾移植。本文将对造血干细胞移植肾脏损害的临床特点及病理特征进行综述,以帮助更好地认识和处理这一并发症。

Hematopoietic stem cell transplantation has been widely applied in the treatment of different diseases,and kidney injury are not rare after the transplantation,which affects the prognosis of the patients significantly. High dose chemotherapy and( or) radiation in the preconditioning will cause a series of pathophysiological changes,and together with the use of calcineurin inhibitors and nephrotoxic agents,as well as the occurrence of infections and graft versus host disease,acute kidney injury,chronic kidney disease,and transplantation associated thrombotic microangiopathy may happen after hematopoietic stem cell transplantation and finally results in proteinuria,hypertension,or decrease in renal function. Renal replacement therapy or kidney transplantation should be carried out in severe cases. In this review,we will describe the clinical characteristics and pathological changes of the kidney injury after hematopoietic stem cell transplantation,in order to improve the management of this kind of complication and the outcome of the patients.