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Partial reversibility of cisplatin nephrotoxicity in children
P R Brock1, D E Koliouskas, T M Barratt
1Department of Haematology, Hospital for Sick Children, London, England.
Insights
Most children recover some kidney function after cisplatin treatment, particularly if damage isn't severe. However, low magnesium levels may persist long-term in pediatric cancer patients receiving cisplatin therapy.
Area of Science:
- Pediatric Nephrology
- Oncology
- Pharmacology
Background:
- Cisplatin is a vital chemotherapy agent used in pediatric oncology.
- Long-term renal toxicity is a significant concern for children treated with cisplatin.
- Understanding the recovery trajectory of kidney function is crucial for patient management.
Purpose of the Study:
- To assess the long-term impact of cisplatin on glomerular filtration rate (GFR) in children.
- To identify persistent renal abnormalities, such as hypomagnesemia, following cisplatin therapy.
- To evaluate factors influencing renal function recovery after treatment cessation.
Main Methods:
- Longitudinal study of 40 children treated with cisplatin, with follow-up at least 18 months post-treatment.
- Glomerular filtration rate (GFR) estimated using chromium 51-labeled ethylenediaminetetraacetic acid plasma clearance.
- Serum magnesium levels measured in a subset of patients at follow-up.
Main Results:
- Most children showed improvement in GFR, especially those with less severe initial damage.
- A median GFR improvement of 22 ml/min/1.73 m2 was observed in children with end-of-treatment GFR < 80 ml/min/1.73 m2.
- Hypomagnesemia was present in 6 of 21 children, independent of GFR, and may persist.
Conclusions:
- Children generally exhibit partial recovery of cisplatin-induced glomerular toxicity.
- Renal function recovery is more likely when the initial damage is not severe.
- Persistent hypomagnesemia is a notable long-term side effect in some pediatric patients treated with cisplatin.
Abstract:
To evaluate the long-term renal toxicity of cisplatin, 40 children who had been without treatment at least 18 months (range 18 months to 7 years) were observed. In all the children, glomerular filtration rate (GFR) was estimated from the plasma clearance of chromium 51-labeled ethylenediaminetetraacetic acid, both at the end of treatment and at a median follow-up of 2 years 6 months after treatment was stopped (range 18 months to 7 years). In 21 children, serum magnesium level was also measured at follow-up. Median age at diagnosis was 15 months (range 13 days to 13 years 8 months), and median cumulative doses of cisplatin was 500 mg/m2 (range 120 to 1860 mg/m2). In 22 of 24 children with an end-of-treatment GFR of less than 80 ml/min per 1.73 m2, the median improvement in GFR at follow-up was 22 ml/min per 1.73 m2 (range 2 to 56 ml/min per 1.73 m2). Hypomagnesemia was found in 6 of 21 children and was independent of GFR. No significant correlation was found between improvement in renal function and total cisplatin dose, age, gender, tumor type, or associated nephrotoxic medication. We conclude that most children have some recovery from cisplatin glomerular toxicity, especially if damage is not severe, but that hypomagnesemia may persist.