Abstract
The emergence of microalbuminuria following conditioning chemotherapy may predict the development of renal dysfunction. To confirm this, a 1-year retrospective cohort study was conducted in 31 myeloablative allogeneic SCT patients who received five consecutive measurements of albuminuria before conditioning therapy and on days 0, 7, 14 and 28 following SCT. The cohort had neither microalbuminuria nor renal dysfunction at baseline. Microalbuminuria was defined as an albumin–creatinine (Cr) ratio over 30 mg/g, and renal dysfunction was as an estimated glomerular filtration rate <60 mL/min per 1.73 m2. Cumulative incidence of renal dysfunction over time was analyzed by the Kaplan–Meier method. Multivariate Cox proportional hazards analysis was used to examine an association of de novo microalbuminuria with the incidence of renal dysfunction. In all, 16 patients (52%) developed microalbuminuria that was positive at least two times among the four measurements after SCT. The actuarial occurrence of chronic kidney disease was significantly higher in patients who developed microalbuminuria than in those who did not. Incidence of microalbuminuria had a significant risk of subsequent renal dysfunction (hazard ratio (95% confidence interval), 7.3 (1.2–140)). In conclusion, de novo microalbuminuria following conditioning therapy is a warning of near-term loss of renal function.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Ando M, Ohashi K, Akiyama H, Sakamaki H, Morito T, Tsuchiya K et al. Chronic kidney disease in long-term survivors of myeloablative allogeneic haematopoietic cell transplantation: prevalence and risk factors. Nephrol Dial Transplant 2010; 25: 278–282.
Shimoi T, Ando M, Munakata W, Kobayashi T, Kakihana K, Ohashi K et al. The significant impact of acute kidney injury on CKD in patients who survived over 10 years after myeloablative allogeneic SCT. Bone Marrow Transplant 2013; 48: 80–84.
Fox CS, Larson MG, Leip EP, Culleton B, Wilson PW, Levy D . Predictors of new-onset kidney disease in a community-based population. JAMA 2004; 291: 844–850.
Wong G, Hayen A, Chapman JR, Webster AC, Wang JJ, Mitchell P et al. Association of CKD and cancer risk in older people. J Am Soc Nephrol 2009; 20: 1341–1350.
Cohen EP, Piering WF, Kabler-Babbitt C, Moulder JE . End-stage renal disease (ESRD) after bone marrow transplantation: poor survival compared to other causes of ESRD. Nephron 1998; 79: 408–412.
Verhave JC, Gansevoort RT, Hillege HL, Bakker SJ, De Zeeuw D, de Jong PE . An elevated urinary albumin excretion predicts de novo development of renal function impairment in the general population. Kidney Int Suppl 2004, S18–S21.
Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 2010; 375: 2073–2081.
Igaki H, Karasawa K, Sakamaki H, Saito H, Nakagawa K, Ohtomo K et al. Renal dysfunction after total-body irradiation. Significance of selective renal shielding blocks. Strahlenther Onkol 2005; 181: 704–708.
Morgenstern BZ, Butani L, Wollan P, Wilson DM, Larson TS . Validity of protein–osmolality versus protein–creatinine ratios in the estimation of quantitative proteinuria from random samples of urine in children. Am J Kidney Dis 2003; 41: 760–706.
Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 2009; 53: 982–992.
Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J et al1994 Consensus conference on acute GVHD grading. Bone Marrow Transplant 1995; 15: 825–828.
Abraham P, Indirani K, Sugumar E . Effect of cyclophosphamide treatment on selected lysosomal enzymes in the kidney of rats. Exp Toxicol Pathol 2007; 59: 143–149.
Kolli VK, Abraham P, Isaac B, Selvakumar D . Neutrophil infiltration and oxidative stress may play a critical role in methotrexate-induced renal damage. Chemotherapy 2009; 55: 83–90.
Naesens M, Kuypers DR, Sarwal M . Calcineurin inhibitor nephrotoxicity. Clin J Am Soc Nephrol 2009; 4: 481–508.
Russo LM, Sandoval RM, McKee M, Osicka TM, Collins AB, Brown D et al. The normal kidney filters nephrotic levels of albumin retrieved by proximal tubule cells: retrieval is disrupted in nephrotic states. Kidney Int 2007; 71: 504–513.
Takatsuka H, Takemoto Y, Yamada S, Wada H, Tamura S, Fujimori Y et al. Complications after bone marrow transplantation are manifestations of systemic inflammatory response syndrome. Bone Marrow Transplant 2000; 26: 419–426.
Seconi J, Watt V, Ritchie DS . Nephrotic syndrome following allogeneic stem cell transplantation associated with increased production of TNF-alpha and interferon-gamma by donor T cells. Bone Marrow Transplant 2003; 32: 447–450.
Hingorani S . Chronic kidney disease in long-term survivors of hematopoietic cell transplantation: epidemiology, pathogenesis, and treatment. J Am Soc Nephrol 2006; 17: 1995–2005.
Berhane AM, Weil EJ, Knowler WC, Nelson RG, Hanson RL . Albuminuria and estimated glomerular filtration rate as predictors of diabetic end-stage renal disease and death. Clin J Am Soc Nephrol 2011; 6: 2444–2451.
Jackson CE, Solomon SD, Gerstein HC, Zetterstrand S, Olofsson B, Michelson EL et al. Albuminuria in chronic heart failure: prevalence and prognostic importance. Lancet 2009; 374: 543–550.
Hoefield RA, Kalra PA, Baker PG, Sousa I, Diggle PJ, Gibson MJ et al. The use of eGFR and ACR to predict decline in renal function in people with diabetes. Nephrol Dial Transplant 2011; 26: 887–892.
Arnlov J, Evans JC, Meigs JB, Wang TJ, Fox CS, Levy D et al. Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals: the Framingham Heart Study. Circulation 2005; 112: 969–975.
Levey AS, de Jong PE, Coresh J, El Nahas M, Astor BC, Matsushita K et al. The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference Report. Kidney Int 2011; 80: 17–28.
Hingorani SR, Seidel K, Lindner A, Aneja T, Schoch G, McDonald G . Albuminuria in hematopoietic cell transplantation patients: prevalence, clinical associations, and impact on survival. Biol Blood Marrow Transplant 2008; 14: 1365–1372.
GISEN. Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia). Lancet 1997; 349: 1857–1863.
Cohen EP, Irving AA, Drobyski WR, Klein JP, Passweg J, Talano JA et al. Captopril to mitigate chronic renal failure after hematopoietic stem cell transplantation: a randomized controlled trial. Int J Radiat Oncol Biol Phys 2008; 70: 1546–1551.
Acknowledgements
We thank Drs Noriko Doki and Manabu Oshikawa for their invaluable participation in this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Morito, T., Ando, M., Kobayashi, T. et al. New-onset microalbuminuria following allogeneic myeloablative SCT is a sign of near-term decrease in renal function. Bone Marrow Transplant 48, 972–976 (2013). https://doi.org/10.1038/bmt.2012.271
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/bmt.2012.271
Keywords
This article is cited by
-
Early-onset acute kidney injury is a poor prognostic sign for allogeneic SCT recipients
Bone Marrow Transplantation (2015)