ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-PO185

Haplo-Storm Induced AKI

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Bonilla, Marco A., Northwell Health, New Hyde Park, New York, United States
  • Nimkar, Abhishek, Northwell Health, New Hyde Park, New York, United States
  • Jhaveri, Kenar D., Northwell Health, New Hyde Park, New York, United States
  • Bayer, Ruthee, Northwell Health, New Hyde Park, New York, United States
  • Fishbane, Steven, Northwell Health, New Hyde Park, New York, United States
Introduction

Cytokine release syndrome(CRS) can occur after allogeneic blood or marrow transplantation, but is especially prevalent after HLA-haploidentical (haplo) peripheral blood transplantation (PBT). This is termed haplo-storm. Here we report a case of AKI associated with haplo-storm.

Case Description

A 67 year-old male with medical history of WM transformed to lymphoma was admitted for a haplo-identical peripheral blood stem cell transplant (PBSCT) from his son. He received a immunosuppressive/preparative regimen consisting of fludarabine, cyclophosphamide and IVIG prophylaxis. Day 1 post-transplant, he developed rigors, fever, tachycardia, nausea and shortness of breath. Clinically, there was concern for Haplo-storm. On day 2, AKI was noted. Vital signs remarkable for blood pressure of 155/95 mmHg, afebrile. Physical Exam was remarkable for encephalopathy, coarse breath sounds and sacral edema. Laboratory evaluation showed serum creatinine of 1.98mg/dl(baseline 1.0mg/dl). White blood cell count of <0.1 K/uL, hemoglobin of 7.2g/dl, Platelet count of 8 K/uL. Electrolytes were within normal limits. Alkaline phosphatase of 195 U/L, lactate dehydrogenase 369 U/L, phosphorous 4.8 mg/dl, uric acid 7.1mg/dl. Urinalysis was remarkable for trace protein, large blood with 461 RBC per high field power. A spot urine protein/creatinine ratio of 2.7g/g. No nephrotoxic agents, contrast agent or hypotension as observed. Kidney sonogram ruled out obstruction. Engraftment had not occurred ruling out engraftment syndrome. Tocilizumab 560mg IV X1 was administered. He was presumed to have Haplo-storm induced AKI. His kidney disease was managed with intravenous diuresis to a negative net fluid balance, further doses of cyclophosphamide were held. His kidney function improved within 7 days back to baseline. Dialysis was not necessary.

Discussion

CRS is a common complication of patients undergoing haplo-identical PBT; as high as 89% of patients. Data on Haplo-storm, a form of CRS induced AKI in HSCT is limited. Nephrologist should be aware of the risk of AKI in patients undergoing haplo-PBT, complicated by haplo-storm.

Timeline of AKI