Renal function in long-term survivors of stem cell transplantation in childhood. A prospective trial

The aim of this prospective study was to assess glomerular and tubular rena l function before, and 1 and 2 years after hematological stem cell therapy (HSCT) in children and adolescents, 137 consecutive patients undergoing HSC T, for malignant diseases, were included in a prospective trial. Forty-four patients were followed for up to 1 year after HSCT and 36 for up to 2 year s, without relapse. Ninety healthy school children were used as a control g roup. The following parameters were investigated: inulin clearance (GFR), u rinary excretion of albumin, alpha -microglobulin (alpha -MG), calcium, bet a -N-acetylglucosaminidase (beta -NAG) and Tamm-Horsfall protein (THP), tub ular phosphate reabsorption (TP/Cl-cr) and percent reabsorption of amino ac ids (TAA). Significantly lower GFR was found 1 and 2 years after HSCT but w ithin the normal range in the period before HSCT. There was no correlation between GFR within the first month after HSCT and long-term outcome of GFR. Tubular dysfunction was found in 14-45% of patients 1 and 2 years after HS CT depending on the parameter investigated, Pathological values 1 and 2 yea rs after HSCT were found for alpha (1)-MG excretion in 40% and 39%, respect ively, for TP/Cl-cr in 44% and 45%, for beta -NAG in 26% and 19%. Median TP /Cl-cr was significantly lower 2 years after HSCT than before, TAA was mild ly impaired in 7/14 patients before, in 5/29 one and in 9/29 2 years after HSCT, but median TAA was within normal range at all times. The median excre tion of albumin, THP and calcium was within the normal range at all investi gations. No influence of ifosfamide pre-treatment on the severity of tubulo pathy was found. The investigation of tubular renal function should be part of a long-term follow-up in children after HSCT.