Emergence of Dipstick Proteinuria Predicts Overt Nephropathy in Patients Following Stem Cell Transplantation

Abstract

Background: Stem cell transplantation (SCT) places a heavy burden on the kidneys, often resulting in renal dysfunction or nephrotic syndrome. This study attempted to show that early-onset proteinuria predicts the development of overt nephropathy. Methods: A total of 831 patients who received allogeneic SCT were surveyed. Excluding those with prior kidney disease and those lacking in an observation period ≥1 year after SCT, 251 patients were eligible for the study. Dipstick proteinuria ≥1+ within 1 year after SCT was defined as ‘incident proteinuria', and subsequent persistence of an estimated glomerular filtration rate of <60 ml/min/1.73 m² at 1 year or longer after SCT was defined as ‘incident chronic kidney disease (CKD)'. Between-group differences were analyzed using the chi-square or Mann-Whitney U test. Factors associated with the incidence of CKD were investigated by multivariate Cox proportional regression analysis. Kidney-biopsied tissue was examined in all nephrotic syndrome patients. Results: The mean duration of follow-up was 4 years. Thirty-four (13.5%) and 66 (26.3%) patients developed incident proteinuria and incident CKD, respectively. Nine (3.6%) patients developed nephrotic syndrome mainly due to membranous nephropathy. The incidence of CKD was significantly greater in patients with incident proteinuria than those without (61.8 vs. 20.7%, p < 0.0001), and incident dipstick proteinuria was a significant risk for incident CKD (hazard ratio 4.39, 95% CI 2.44-7.73, p < 0.0001). Conclusion: SCT patients who manifest dipstick proteinuria are predisposed to overt nephropathy. Routine monitoring of the urine dipstick test is strongly recommended, as it facilitates early nephrology care for post-SCT patients.

Acute Kidney Injury and CKD Associated with Hematopoietic Stem Cell Transplantation

“…Incident proteinuria $11 on urine dipstick was found to be a significant risk for incident CKD as defined by a persistent eGFR ,60 ml/min per 1.73 m 2 (hazard ratio, 4.39; 95% confidence interval, 2.44 to 7.73). The authors concluded that patients who manifest dipstick proteinuria are predisposed to nephropathy and strongly recommended routine monitoring by urine dipstick (103).…”

Reactivation of resolved hepatitis B virus infection combined with nephrotic syndrome in a patient after allogeneic haematopoietic stem cell transplantation

“…According to previous reports, NS develops on average approximately 1 to 2 years after allo-HSCT [5, 7]. Its etiology may be related to drug toxicity, infection, or graft versus host disease (GVHD) [8].…”

An Overview of Kidney Disease Following Hematopoietic Cell Transplantation

“…Momoki et al ( 22 ) also reported the clinical significance of incident proteinuria less than the nephrotic range (3.5 g/day). Proteinuria was prospectively investigated in all 693 allogeneic SCT recipients over 10 years between August 2004 and July 2014 and was monitored for ≥1 year after the implementation of allogeneic SCT.…”

“…Post-SCT AKI is more challenging to treat than normal AKI because patients are in a severely immunodeficient state and manifest complications of hemorrhagic tendencies, infections, and acute graft-versus-host disease (GVHD) in this period. Nearly 1% of patients who survive without AKI develop nephrotic syndrome, which is assumed to be associated with chronic GVHD, within several years of allogeneic SCT ( 10 - 12 , 22 ). Some patients who survive AKI and nephrotic syndrome develop CKD ( 12 - 14 , 20 , 23 ), a few of whom (approximately 4-5%) ultimately advance to end-stage renal disease (ESRD) requiring chronic blood purification therapy ( 23 , 24 ).…”

“…Garcia et al ( 29 ) reported 2 nephrotic syndrome cases in 1988, showing that chronic GVHD developed in the kidneys following allogeneic SCT. Momoki et al ( 22 ) surveyed the data of 1,175 patients who underwent allogeneic SCT over a 27-year period between January 1986 and December 2013. Nephrotic syndrome, which is considered to be associated with previous SCT, developed in 9 patients (frequency: 0.77%).…”