Renal toxicities in the peri-HSCT period

Renal dysfunction within the first 100 days post-hematopoietic stem cell transplantation (HSCT) is common. Many HSCT patients have some degree of renal dysfunction prior to HSCT, and the degree of this dysfunction impacts the extent of renal dysfunction that can occur during the preengraftment and early post-engraftment periods of the HSCT course. Renal dysfunction may be due to renal tubule damage, compromised renal blood flow, and obstruction or irritation of post-renal structures. Renal dysfunction impairs the ability of the kidneys to maintain acid-base and electrolyte balance as well as maintain fluid balance and eliminate waste. The renal complications post-HSCT are discussed in Chap. 22. The most common renal toxicities are related to medications frequently used during the peri-HSCT period. These include calcineurin inhibitors, antifungal agents, antibiotics (particularly aminoglycosides), and antiviral agents. In addition, components of conditioning regimens such as alkylators and irradiation to the bladder can cause significant renal toxicity. An infrequent but very serious renal complication is hemorrhagic cystitis which is the focus of this chapter. The remainder of HSCT-associated renal complications is addressed in Chap. 22.