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Urolithiasis in childhood acute leukemia and nonHodgkin's lymphoma
Insights
Pediatric cancer patients undergoing chemotherapy developed kidney stones (ureteral calculi). These calcium-based stones, unlike previous uric acid stones, require prompt detection to prevent serious urinary tract obstruction.
Area of Science:
- Pediatric Oncology
- Nephrology
- Urology
Background:
- Children with acute leukemia or lymphoma undergoing remission induction therapy are at risk for developing ureteral calculi.
- Previous studies noted uric acid or xanthine stones in these patients, but recent cases show calcium composition.
Purpose of the Study:
- To report the occurrence and characteristics of ureteral calculi in pediatric patients undergoing chemotherapy for leukemia or lymphoma.
- To identify potential predisposing factors and clinical presentations of urolithiasis in this vulnerable population.
Main Methods:
- Retrospective case review of 5 pediatric patients diagnosed with ureteral calculi during or after chemotherapy.
- Diagnostic imaging included excretory urograms and computerized tomography scans.
- Chemical analysis of calculi was performed in two patients.
Main Results:
- Five children developed ureteral calculi, presenting with abdominal/back pain and gross hematuria.
- Imaging revealed obstructive uropathy in 4 patients and ureterovesical obstruction with acute renal failure in 1.
- Calculi were primarily calcium-based, not associated with urinary tract infections, and linked to corticosteroid therapy, immobilization, and urinary alkalization.
Conclusions:
- Ureteral calculi are a potential complication in children receiving chemotherapy for leukemia or lymphoma.
- Calcium stones, associated with treatment-related factors, necessitate vigilant monitoring and prompt diagnosis to prevent renal complications.
Abstract:
Ureteral calculi were found in 5 children who were receiving or had recently completed remission induction therapy for acute leukemia or lymphoma. All 5 patients had abdominal or back pain and 3 had gross hematuria. The diagnosis of urolithiasis was suggested by excretory urograms that showed obstructive uropathy (4 patients) and by computerized tomography scans that demonstrated ureterovesical obstruction (1 patient with acute renal failure and anuria). With a single exception the calculi were not associated with urinary tract infections. Chemical analyses in the 2 patients tested indicated that the stones were composed of calcium, in contrast to the uric acid and xanthine compositions of stones in earlier studies of patients with leukemia or lymphoma. Factors that might have predisposed our patients to calculi formation include corticosteroid therapy, immobilization owing to bed rest and urinary alkalization. Other possible contributing factors were urinary stasis (2 patients) and a familial tendency for renal calculi to develop. There was no evidence of idiopathic hypercalciuria in either patient tested. Prompt detection of urolithiasis in children undergoing induction chemotherapy for a malignant disease may avoid potentially serious consequences from urinary tract obstruction.