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Chronic kidney disease (CKD), defined by structural damage or GFR <60 mL/min/1.73m² for >3 months, is a common (18–42%) late effect in children and kidney damage can be associated with acute kidney injury (AKI), thrombotic microangiopathy (TMA), hemorrhagic cystitis, proteinuria, and hypertension [65–69]. Relevant exposures include chemotherapy (alkylators, fludarabine), radiation, CNIs, nephrotoxic antimicrobials, BK viremia or adenoviremia. There was a 4‐fold higher rate of CKD at 1 year among those with albuminuria and 6‐fold higher rate of non‐relapse mortality if overt proteinuria was present at day 100. Annual urinalysis for proteinuria (microalbuminuria), serum BUN, creatinine, electrolytes is standard, with reflexive nephrology consultation when abnormalities are found. Survivors should be screened for hypertension defined as average SBP and/or diastolic BP (DBP) that is ≥95th percentile for gender, age, and height on ≥3 occasions [67,68]. Major risk factors for idiopathic CKD are GVHD, acute renal failure, and after nonmyeloablative regimens, additional risk factors include long‐term use of calcineurin inhibitors and previous autologous HCT. Though hypertension after HCT has most commonly been treated with a long‐acting calcium channel blocker, blockade of the renin‐angiotensin axis using angiotensin‐converting enzyme inhibitors (ACEI) alone or in combination with angiotension II receptor blockers (ARB) may be a better choice in patients with idiopathic CKD. This concept is based upon studies using ACEI and ARBs in animal models of radiation‐induced injury, and upon recent clinical experience [70]. In addition to controlling blood pressure, ACEI and ARB might exert additional positive affects by reducing inflammation and inflammatory markers [71,72]. Extrapolating from studies in the diabetic population, in conjunction with the observation that albuminuria is frequent after HCT, raises the possibility that these agents might slow progression of CKD in patients with albuminuria after HCT. Controlled trials using ACEI or ARB after HCT are needed [70].