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Acute kidney injury during leukocyte engraftment after autologous stem cell transplantation in patients with light‐chain amyloidosis
Author(s) -
Irazabal Maria V.,
Eirin Alfonso,
Gertz Morie A.,
Dispenzieri Angela,
Kumar Shaji,
Buadi Francis K.,
Lacy Martha Q.,
Hayman Suzanne R.,
Dingli David,
Hogan William J.,
Gastineau Dennis A.,
Glavey Siobhan V.,
Amer Hatem,
Leung Nelson
Publication year - 2012
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.22202
Subject(s) - medicine , acute kidney injury , transplantation , rash , gastroenterology , population , autologous stem cell transplantation , amyloidosis , environmental health
Engraftment syndrome (ES) is a complication of hematopoietic stem cell transplantation characterized by fever, rash, and non‐cardiogenic pulmonary edema. Acute kidney injury (AKI) has been recognized but is considered a minor criterion in one and excluded another definition of ES. We have noted a high incidence of AKI in patients with immunoglobulin light‐chain amyloidosis (AL) undergoing autologous stem cell transplant (ASCT) around the time of leukocyte engraftment. This study was conducted to further investigate the relationship between AKI and ES. Data were collected from 377 AL patients who underwent ASCT from 7/1997 to 10/2009. Patients who experienced an elevation of serum creatinine >0.5 mg/dL within 4 days of leukocyte engraftment and anyone who presented with signs associated with ES regardless of renal manifestations were included. Forty‐one patients met criteria. Twelve were excluded for positive cultures (10), acute interstitial nephritis (1), and acute cellular rejection (1). In addition to AKI (93.1%), patients also exhibit fever (82.7%), hypotension (51.7%), rash (48.2%), edema (93.1%), diarrhea (69.0%), conjunctival hemorrhage (31.0%), pulmonary edema (31.0%), pulmonary hemorrhage (13.8%), and transient encephalopathy (17.2%). Patient with pulmonary involvement were more likely to require dialysis but was not statistically significant. AKI was very common during leukocyte engraftment in AL patients. While infectious etiology accounted for some of the AKI, most appeared to be associated with ES. After infection is ruled out, ES should be considered in the differential diagnosis when evaluating AKI in this population. Am. J. Hematol., 2012. © 2011 Wiley Periodicals, Inc.