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Iphosphamide-induced nephrotoxicity in children
R Shore1, M Greenberg, D Geary
1Division of Hematology-Oncology, Hospital for Sick Children, Toronto, Canada.
Insights
Pediatric nephrotoxicity from ifosfamide is a concern. Younger children and those previously treated with cis-platinum face higher risks, impacting growth.
Area of Science:
- Pediatric Oncology
- Nephrology
- Pharmacology
Background:
- Ifosfamide is a widely used chemotherapy agent in pediatric oncology.
- Nephrotoxicity is a known, but not fully understood, adverse effect of ifosfamide treatment.
- Identifying risk factors for ifosfamide-induced nephrotoxicity is crucial for patient management.
Purpose of the Study:
- To evaluate the nephrotoxic potential of ifosfamide in children.
- To identify patient characteristics and co-administered treatments associated with ifosfamide-induced nephrotoxicity.
- To assess the impact of ifosfamide nephrotoxicity on childhood growth.
Main Methods:
- Retrospective analysis of children treated with ifosfamide at The Hospital for Sick Children.
- Comparison of dosage, treatment cycles, and co-exposure to other nephrotoxic agents between children with and without nephrotoxicity.
- Statistical analysis to determine significant risk factors and associations.
Main Results:
- Children who developed nephrotoxicity were significantly younger than those with normal renal function.
- Prior exposure to cis-platinum was a significant risk factor for developing ifosfamide-induced nephrotoxicity.
- No significant differences in ifosfamide dose or cycles were observed between groups.
- Nephrotoxicity was associated with a significant negative impact on growth.
Conclusions:
- Younger age and prior cis-platinum treatment are key risk factors for ifosfamide-induced nephrotoxicity in children.
- Close renal function monitoring is essential for all children receiving ifosfamide.
- Special attention should be given to children under 5 years and those with a history of cis-platinum exposure.
Abstract:
The nephrotoxic potential of iphosphamide was evaluated in a retrospective analysis of all children receiving the drug at The Hospital for Sick Children in Toronto. The 25 children exhibiting nephrotoxicity did not receive more cycles or higher doses per square metre than the 78 with normal renal function. Similarly, the two groups received comparable doses and number of cycles of sodium 2-mercaptoethanesulphonate, and had similar rates of exposure to nephrotoxic drugs (except for cis-platinum). Children exhibiting nephrotoxicity were significantly younger (78.1 +/- 64.1 months) than those having normal kidney function (103.8 +/- 66.6 months) (P less than 0.05). Children exhibiting nephrotoxicity were more likely to have received cis-platinum prior to the iphosphamide (10/25, 40%) than those with normal renal function (14/73, 18%) (P less than 0.05). Nephrotoxicity was associated with a significant effect on growth. Careful follow-up of renal function should take place in children receiving iphosphamide, with special attention paid to children younger than 5 years of age and those who have received cis-platinum.