ACUTE-RENAL-FAILURE FOLLOWING BONE-MARROW TRANSPLANTATION

Acute renal failure (ARF) is one of the most frequent and potentially life threatening complications following bone marrow transplantation ( BMT). Several renal syndromes that occur are either unique or occur wi th a disproportionate frequency post-BMT, Clinically ARF can be classi fied according to the rime of onset post-BMT. Immediate ARF syndromes include tumor lysis syndrome and marrow-infusion associated toxicity, which usually occur within 5 days post-BMT. Hepatorenal-like syndrome secondary to venoocclusive disease occur within one month and is the m ost common cause of early ARF syndrome. The late renal syndromes more than 4 weeks post-BMT, include BMT-associated nephropathy, which may b e acute or chronic, and cyclosporin nephrotoxicity. Other non-specific causes of ARF such as sepsis, hypotension, volume depletion, nephroto xic agents and obstructive uropathy can also occur at any time period frequently ARF is multifactorial in these patients with complicated cl inical course. Therapeutic approach depend on the underlying etiology. Supportive treatment such as optimization of volume status and dialys is when indicated are important steps as specific therapy is rarely av ailable. Therefore, efforts should be targeted to the prevention of AR F. This includes prophylaxis for tumor lysis syndrome and marrow infus ion toxicity by hydration and alkaline diuresis, avoiding nephrotoxic agents, early recognition and treatment of infection and correction of volume depletion.