Early diagnostic markers for detection of aki in the setting of allogenic hematopoietic stem cell transplantation

Acute kidney injury (AKI) is an important complication due to the its close association with chronic kidney disease and mortality. Hence, early diagnosis and management of AKI is important for prevention of long-term poor outcomes. Acute kidney injury is a common complication after allogenic hematopoietic stem cell transplantation (AHSCT).Fifty patientshospitalized at Gazi University Faculty of Medicine Bone Marrow Transplantation Department for AHSCT were included in this study. Serial measurement of serum creatinine and creatinine clerance were obtained at the days of pre-transplant, infusion day, +7.+14,+21 and +28th days. Also blood and urine samples were obtained for measuring blood cystatine-C and urine N-GAL at the days of pre-transplant, infusion day, +6.+13,+20 and +27th days. During the median follow up of 25 days, AKI developed in 19 patients. Ten of them had stage 1, 7 had stage 2 and 2 had stage 3 AKI according to the AKIN classification. The serial measurement of blood cystatine-C levels showed significant positive correlation with serum creatinine levels and significant negative correlation with creatinine clearance levels at each time point (p<0.001 for both analyses). Although there was a positive correlation between urinary N-GALand creatinine levels and negative corelation with creatinine clearance, these associations did not reach statistical significance. Multivariate cox regression model showed that sinusoidal obstruction syndrome was independent risk factor for AKI. Blood cystatine-C levels were independent predictor for AKI. Although higher urine N-GAL levels were seem to be predictor, it did not reach statistical significance. As a result, blood cystatine-C level may be useful marker for early detection of AKI at the AHSCT setting. However, larger studies are needed for evaluation of urine N-GAL levels in this patient group.