DYNAMICS OF KIDNEY INJURY BIOMARKERS FOLLOWING HEMATOPOIETIC STEM CELL TRANSPLANTATION (PILOT STUDY)

THE AIM. To evaluate dynamics of tubular damage biomarkers (BMs) and to determine frequency of acute kidney injury (AKI) according to routine diagnostics following hematopoietic stem cell transplantation (HSCT). PATIENTS AND METHODS. The study involved 30 patients after allogeneic hematopoietic stem cell transplantation (HSCT). The urine samples were taken 7 days prior to HSCT (week 0), on the weeks 1, 2, 3 and 4. BMs concentrations (calbindin, clusterin, IL-18, KIM-1, GST-п, MCP-1) were estimated. Serum creatinine was measured at the same time periods. Clinical AKI was diagnosed according to AKIN/ KDIGO (acute kidney injury network/kidney disease improving global outcomes) classification systems. RESULTS. Clinical AKI (AKIN/KDIGO) diagnostics: the proportion of AKI (AKШN/KDIGO) cases on the weeks 1 and 2 after HSCT was 7%, on the week 3 - 17%, on the week 4- 54% (p <0.05). The frequency of cases with increase of 1 and more BMs concentrations on the week 1 following HSCT was 78%, on the week 2 - 85% and thereafter on the week 3 - 90%. The proportion of cases with simultaneous elevation of 4 and more BMs after HSCT had been progressively increasing: from 6% before HSCT to 38% on the week 4 after it. By week 4 only in 6% of cases no increase in BMs concentration was found, while the cumulative proportion of cases without clinical AKI criteria (AKIN/KDIGO) was much more higher and reached 40%. The frequency of AKI (AkIN/KDIGO) development increased in relation to the number of simultaneously increased BMs. Statistically significant direct correlations were found between BMs of proximal and distal tubules, as well as between BMs simultaneously showing the damage of both proximal and distal tubule. ROC analysis showed that BMs number has sufficient sensitivity in terms of prognosis of clinical AKI (AKIN/KDIGO) development (SAUC=0,69; p=0.006). CONCLUSION. The BMs concentration increase, showing the tubular damage following HSCT, was found in majority of patients (90%) and preceded the development of clinical AKI (AKIN/KDIGO). The evaluation of BMs concentration may be used for the assessment of subclinical tubular structural damage and prognosis of AKI.

acute kidney injury, hematopoietic stem cell transplantation, acute kidney injury biomarkers

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