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Title of Journal: Pediatr Nephrol

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Abbravation: Pediatric Nephrology

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Springer-Verlag

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DOI

10.1002/jcp.22178

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1432-198X

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Retinoic acid may increase the risk of bone marrow

Authors: Leigh Haysom David S Ziegler Richard J Cohn Andrew R Rosenberg Susan L Carroll Gad Kainer
Publish Date: 2005/02/18
Volume: 20, Issue: 4, Pages: 534-538
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Abstract

Bone marrow transplant nephropathy BMTN classically presents more than 100 days after transplantation as an acute nephritis with hypertension azotaemia and anemia that usually results in end stage renal failure ESRF The risk of developing BMTN may be greater with the use of more intensive chemotherapy and higher total body and tumor bed irradiation Cisretinoic acid RA may further increase the risk of developing BMTN Here we report the cases of two children who developed typical clinical and biochemical features of BMTN They were both treated for stage IV neuroblastoma with chemotherapy bone marrow transplant BMT conditioning that included total body irradiation and RA therapy after BMT although the patient in case 1 had established renal insufficiency prior to the commencement of RA Renal biopsy of these children showed classical BMTN histology and the renal manifestations progressed quickly the patient in case 1 became dialysis dependent by 1 year postbone marrow transplant Recently RA has been added to the postBMT therapy in children with stage IV neuroblastoma The occurrence of BMTN in two children treated with RA in our unit is unlikely to be coincidental Although RA has been shown to confer a significant survival advantage in this disease animal studies and a previous case report have suggested it could increase the toxic effects of chemotherapy and renal irradiation It is likely that RA contributed to the deterioration in renal function in these patients

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