Kidney disease after hematopoietic stem cell transplant—treatment standard

Hematopoietic stem cell transplant (HSCT) is a well-established procedure for malignant and nonmalignant conditions. Despite its therapeutic benefits, kidney disease remains a common complication that significantly affects patient outcomes. Kidney injury post-HSCT manifests as acute kidney injury and chronic kidney disease, with multifactorial causes such as conditioning regimens, nephrotoxic drugs, graft-versus-host disease (GVHD), and transplant-associated thrombotic microangiopathy (TA-TMA). Accurate diagnosis often requires a kidney biopsy due to overlapping risk factors and complex clinical presentations. This review summarizes current diagnostic and therapeutic standards, highlights advance in biomarkers and pathophysiology, and discusses targeted therapies such as rituximab for GVHD-related glomerulopathies and eculizumab for TA-TMA. Supportive care, immunomodulation, and early intervention remain critical. For patients progressing to end stage renal disease, renal replacement therapy and kidney transplantation post-HSCT offer viable long-term options. Despite these advances, challenges persist, including the need for noninvasive diagnostic tools and standardized management protocols. Future research into pathophysiology, biomarkers, and targeted therapies holds promise for improving outcomes in this field.