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Late effects of anticancer therapy on kidney function in children with acute lymphoblastic leukemia
1Ist Children's Internal and Oncological Clinic Medical Faculty, Masaryk University, Brno, Czech Republic. lkopecna@med.muni.cz
Abstract:
THE CURRENT STATE: Children with curable cancer are potentially at risk of long-term renal sequelae. The nephrotoxicity is considered dose related and includes a variable reduction of glomerular filtration rate along with tubular dysfunction.
Subjective:
The aims of the present study were: to analyse kidney damage as well as the clinical course in children treated for ALL, to determine what type of nephrotoxic damage is most frequent in relation with the used treatment, to determine possible risks of acute and chronic nephropathy of anticancer therapy, to standardise evaluation of kidney function in children after their complex antitumourous treatment has finished.
Methods And Material:
We examined a group of 36 children (21 boys, 15 girls, average age at diagnosis of ALL 6.9 years)) treated for ALL using the therapeutical protocol ALL BFM 90. The average period after the treatment had finished was 48 month. The following parameters were examined: urinalysis and urine sediment, clearance of creatinine, tubular resorption, ultrasound of kidneys, 24 hrs proteinuria (PU) and urine concentration of albumine, transferine, alpha-1-microglobuline and Tamm-Horsfall protein. Concentration function of kidneys was examined by test with DDAPV.
Results:
After finish of cytostatic therapy had 19 patients (52.8%) PU. Glomerular PU was found in 3 children (15.8%), in 3 children (15.8%) was found mixed PU and 13 children (68.4%) had tubular PU. Reduction of GFR had 5 patients (13.9%) and 19 patients (52.8%) had reduction of DDAPV test.
Conclusion:
Sensitive laboratory analysis of proteinuria is required for timely detection of the most frequent type of kidney damage in the course of treatment with cytostatics but also other concurrently administered drugs. Thus we can reliably detect mainly patients with glomerular/mixed proteinuria who are potentially imperilled by the risk of the development of chronic renal failure. If there is higher level of glomerular/mixed proteinuria even after the treatment has finished, the patients have to undergo another nephrological monitoring. (Tab. 3, Ref. 20.)
Insights
Children treated for acute lymphoblastic leukemia (ALL) often develop kidney damage, particularly tubular proteinuria, after chemotherapy. Early detection through sensitive urinalysis is crucial for monitoring and preventing chronic kidney failure.
Area of Science:
- Pediatric Oncology
- Nephrology
- Cancer Treatment
Background:
- Children undergoing cancer treatment, particularly acute lymphoblastic leukemia (ALL), face risks of long-term kidney damage (nephrotoxicity).
- Nephrotoxicity is often dose-dependent, manifesting as reduced glomerular filtration rate (GFR) and tubular dysfunction.
Purpose of the Study:
- To analyze kidney damage and clinical outcomes in children treated for ALL.
- To identify the most common types of nephrotoxic damage related to specific treatments.
- To assess risks of acute and chronic kidney issues from anticancer therapies and standardize post-treatment kidney function evaluation.
Main Methods:
- A cohort of 36 children (average age 6.9 years) treated with the ALL BFM 90 protocol was studied.
- Kidney function was assessed via urinalysis, creatinine clearance, tubular resorption tests, kidney ultrasounds, 24-hour proteinuria, and urine protein concentrations.
- Concentration function was evaluated using the DDAVP test, with follow-up at an average of 48 months post-treatment.
Main Results:
- Post-chemotherapy, 52.8% of patients showed proteinuria (PU), with tubular proteinuria being the most common (68.4%).
- Reduced GFR was observed in 13.9% of patients, and 52.8% had an abnormal DDAVP test, indicating impaired kidney concentration function.
- Glomerular and mixed proteinuria were identified in 15.8% of patients each.
Conclusions:
- Sensitive proteinuria analysis is vital for early detection of kidney damage during and after cytostatic treatment.
- Identifying patients with glomerular/mixed proteinuria is key to predicting risk for chronic renal failure.
- Patients with persistent glomerular/mixed proteinuria require ongoing nephrological monitoring.