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Title: Late renal dysfunction in adult survivors of bone marrow transplantation

Until recently long-term renal toxicity has not been considered a major late complication of bone marrow transplantation (BMT). Late renal dysfunction has been described in a pediatric population status post-BMT which was attributable to the radiation in the preparatory regimen. A thorough review of adults with this type of late renal dysfunction has not previously been described. Fourteen of 103 evaluable adult patients undergoing allogeneic (96) or autologous (7) bone marrow transplantation, predominantly for leukemia and lymphomas, at the Medical College of Wisconsin (Milwaukee, WI) have had a syndrome of renal insufficiency characterized by increased serum creatinine, decreased glomerular filtration rate, anemia, and hypertension. This syndrome developed at a median of 9 months (range, 4.5 to 26 months) posttransplantation in the absence of specific identifiable causes. The cumulative probability of having this renal dysfunction is 20% at 1 year. Renal biopsies performed on seven of these cases showed the endothelium widely separated from the basement membrane, extreme thickening of the glomerular basement membrane, and microthrombi. Previous chemotherapy, antibiotics, and antifungals as well as cyclosporin may add to and possibly potentiate a primary chemoradiation marrow transplant renal injury, but this clinical syndrome is most analogous to clinical and experimental models ofmore » radiation nephritis. This late marrow transplant-associated nephritis should be recognized as a potentially limiting factor in the use of some intensive chemoradiation conditioning regimens used for BMT. Some selective attenuation of the radiation to the kidneys may decrease the incidence of this renal dysfunction.« less
Authors:
; ; ; ; ; ;  [1]
  1. (Medical College of Wisconsin Affiliated Hospitals, Milwaukee (USA))
Publication Date:
OSTI Identifier:
5545619
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cancer (Philadelphia); (USA); Journal Volume: 67:11
Country of Publication:
United States
Language:
English
Subject:
63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT.; BONE MARROW; TRANSPLANTS; KIDNEYS; BIOLOGICAL RADIATION EFFECTS; NEPHRITIS; RADIOINDUCTION; RADIOTHERAPY; SIDE EFFECTS; BIOPSY; CREATININE; LEUKEMIA; LYMPHOMAS; ANIMAL TISSUES; AZOLES; BIOLOGICAL EFFECTS; BODY; DIAGNOSTIC TECHNIQUES; DISEASES; HEMATOPOIETIC SYSTEM; HETEROCYCLIC COMPOUNDS; IMIDAZOLES; IMINES; IMMUNE SYSTEM DISEASES; MEDICINE; NEOPLASMS; NUCLEAR MEDICINE; ORGANIC COMPOUNDS; ORGANIC NITROGEN COMPOUNDS; ORGANS; RADIATION EFFECTS; RADIOLOGY; THERAPY; TISSUES; UROGENITAL SYSTEM DISEASES 560151* -- Radiation Effects on Animals-- Man