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Acute Kidney Injury in Pediatric Cancer Patients
Peong Gang Park1, Che Ry Hong2, Eunjeong Kang3
1Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Insights
Over half of children with cancer develop acute kidney injury (AKI) during treatment, impacting long-term kidney health. Early detection and management of AKI are crucial for pediatric cancer survivors.
Area of Science:
- Pediatric Nephrology
- Pediatric Oncology
- Cancer Treatment Complications
Background:
- Acute kidney injury (AKI) is a significant concern in pediatric cancer patients.
- Understanding the incidence and long-term renal effects of AKI is vital for improving patient outcomes.
Purpose of the Study:
- To determine the incidence of AKI in the first year post-cancer diagnosis in children.
- To assess the short-term and long-term consequences of AKI on renal function and proteinuria in pediatric cancer survivors.
Main Methods:
- Retrospective analysis of medical records for 1868 children diagnosed with cancer (2004-2013).
- AKI diagnosis based on Kidney Disease: Improving Global Outcomes criteria.
- Evaluation of estimated glomerular filtration rate and proteinuria in cancer survivors.
Main Results:
- 52.6% of patients experienced AKI, with a 1-year cumulative incidence of 53.6%.
- Acute myeloid leukemia patients had the highest 1-year AKI incidence (88.4%).
- 22.6% of survivors had impaired renal function; >=4 AKI episodes and nephrectomy were risk factors. 8.2% developed proteinuria.
Conclusions:
- A substantial proportion of children with cancer develop AKI during treatment.
- AKI is linked to impaired long-term renal function in pediatric cancer survivors.
Objective:
To analyze the incidence of acute kidney injury (AKI) in the first year after cancer diagnosis in children and to evaluate the short-term and long-term effects on renal function and proteinuria.
Study Design:
Retrospective review of medical records was done on children who were diagnosed and treated for cancer at Seoul National University Hospital between 2004 and 2013. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. Impaired renal function of estimated glomerular filtration rate less than 90 mL/minute/1.73 m2 and development of proteinuria of cancer survivors were also assessed.
Results:
This study included 1868 patients who were diagnosed with cancer at a median age of 7.9 years. During the course of treatment, 983 patients (52.6%) developed 1864 episodes of AKI, and the cumulative incidence at 2 weeks, 3 months, and 1 year after diagnosis was 28.9%, 39.6%, and 53.6%, respectively. The 1-year cumulative incidence was the highest in patients with acute myeloid leukemias (88.4%). In all, 6.1% of patients had more than 4 episodes of AKI and 11.8% of patients had stage 3 AKI. Among the 1096 childhood cancer survivors, 22.6% were found to have impaired renal function. A greater number of AKI episodes (≥4 times) and nephrectomy were independent risk factors of impaired renal function. Also, 8.2% of the survivors developed proteinuria among 742 childhood cancer survivors.
Conclusions:
A large percentage of children with cancer experience AKI during the course of treatment, and AKI is associated with impaired long-term renal function.
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