Evaluation of kidney damage in patients with acute lymphoblastic leukemia in long‐term follow‐up: Value of renal scan

Abstract

In order to evaluate potential long-term kidney damage of childhood leukemia and risk factors affecting renal damage, we studied 116 children treated for acute lymphoblastic leukemia (ALL) using the St. Jude Total XI and XIII protocols in 1991-1998. The median follow-up period after the completion of treatment was 35 months. The following parameters were examined: urinalysis, urinary creatinine (Cr), calcium (Ca), phosphorus, b 2 -microglobulin, glomerular filtration rate (GFR), tubular phosphorus reabsorption (TPR), and renal function tests. Radiological evaluation included renal ultrasonography (US), and renal scans with DMSA or MAG-3 were performed. Blood chemistry and renal US patients were normal in all patients except two. GFR, TPR, urinary Ca/Cr, b 2 -microglobulin, and renal scan were abnormal in 19.0%, 16.4%, 13.8%, 6.0%, and 40.5% of patients, respectively. The abnormality rate in GFR was significantly higher in patients<2 years of age. TPR abnormality was found to be significantly higher in patients who did not have G-CSF. An abnormal renal scan was associated with Hb< 10 g/dL, kidney infiltration, or hypertension at presentation and also occurred patients who underwent methotrexate treatment with frequent intervals during the follow-up period. Patients should be followed-up after cessation of therapy with the conventional tests mentioned above. In case of any abnormality, further detailed tests should be performed; renal scan seems to be more predictive for renal damage. Am.

Renal function during and after treatment for acute lymphoblastic leukemia in children

“…This suggests that late renal dysfunction become evident after loading. Yetgin et al [21] observed abnormal GFR values in 19% and B2M in 6% of children Fig. 1 Correlation between cystatin C and creatinine clearance at the point B treated previously for ALL.…”

Does Antineoplasm Treatment Decrease the Glomerular Filtration Rate in Children?

“…In a 2005 study, Krawczuk-Rybak et al [17] noted normal cystatin C and creatinine serum concentrations in 37 children who had finished treatment for ALL. Similarly, Yetgin et al [18] did not observe abnormalities in the creatinine serum concentrations in children after ALL treatment, but did observe decreased GFR values (based on a 24-hour urine collection) in 19% of patients. It should be noted that the group diagnosed with ALL and NHL is the most endangered group when it comes to developing acute kidney damage during intensive chemotherapy.…”

Unusual Extramedullary Recurrence and Renal Relapse Despite Complete Chimerysm after Allografting in Ph+ ALL

“…[15][16][17][18][19] Acute renal failure due to leukemic cell infiltration into the kidney is rare in acute lymphoblastic leukemia after allogeneic-SCT, and this phenomenon might be related to kidney's role in embryonic hematopoiesis through the aorta-gonad-mesonephrons region. [20][21] Tumor infiltration into the kidneys can occur, yet this accounts for renal insufficiency in only 1% of patients.…”