Kidney dysfunction after hematopoietic stem cell transplantation and CAR T-cell therapy

Hematopoietic stem cell transplantation (HSCT) and chimeric antigen receptor (CAR) T-cell therapy have transformed the treatment of hematologic malignancies, with expanding applications in selected solid tumors and nonmalignant hematologic conditions, but are frequently complicated by kidney dysfunction. Acute and chronic kidney disease after HSCT are often multifactorial, with several unique causes such as capillary leak syndrome, sinusoidal obstruction syndrome, transplant-associated thrombotic microangiopathy, and post-transplant nephrotic syndrome playing important roles. Key drivers of CAR T-cell therapy-related kidney disease include sepsis, cytokine release syndrome, and tumor lysis syndrome. Understanding of these injury mechanisms is critical to optimizing prevention, early detection, and management of kidney complications in these populations, with the overall goals of improving kidney and overall outcomes.