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Intravascular hemolysis and renal insufficiency after bone marrow
transplantation
EC Guinan, NJ Tarbell, CM Niemeyer, SE Sallan and HJ Weinstein
Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
02115.
Renal disease has not been considered a major late complication of bone
marrow transplantation. Of 31 evaluable pediatric patients undergoing
allogeneic or autologous bone marrow transplantation for neuroblastoma or
acute lymphoblastic leukemia, 14 developed a hemolytic anemia, microscopic
hematuria, and renal insufficiency at a median of 5 months (range, 3 to 7
months) posttransplant. Renal biopsies were performed in two patients at
the onset of kidney disease and showed mesangiolysis with intraglomerular
capillary aneurysm formation, mesangial proliferation, and focal thickening
and splitting of the glomerular basement membranes. The clinical
presentation, time to onset of renal disease, and biopsy material are
consistent with a diagnosis of radiation nephritis, a previously uncommon
finding in this patient group. The high incidence of this syndrome in the
current report may have been due to the combination of intensive
chemotherapy and total- body irradiation in the conditioning regimens.
Volume 72,
Issue 2,
pp. 451-455,
08/01/1988
Copyright © 1988 by The American Society of Hematology
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