Hematopoietic stem cell transplantation (HSCT) exposes the kidney to a multitude of injuries, including acute kidney injury (AKI), hypertension, glomerular disease, and chronic kidney disease (CKD).A common pathology noted in most of these patients is a renal-limited thrombotic microangiopathy (TMA).A-TMA happens typically six months to one year after patient receive a HSCT. While CNI-TMA is an idiosyncratic reaction, TA-TMA is the result of many other factors. Lactate dehydrogenase levels are in much higher range in TA-TMA compared to CNI-TMA.