Paediatric cancer survivors demonstrate a high rate of subclinical renal dysfunction

Mudi, Abdullahi; Levy, Cecil; Geel, Jennifer; Poole, Janet

doi:10.1002/pbc.26132

Cited by 21 publications

(13 citation statements)

References 27 publications

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“…94,95 Cancer therapeutic agents may produce dose and/or duration-related kidney damage with a higher risk for CKD associated with high-dose cisplatin, carboplatin, and/or ifosfamide therapy. 96,97 Kidneys may inadvertently be exposed during radiation therapy for abdominal or retroperitoneal malignancy causing interstitial fibrosis and loss of renal function. Pediatric cancer survivors have high rates of subclinical renal dysfunction, and as many as 30% to 50% will develop CKD in their lifetime.…”

Section: Resultsmentioning

confidence: 99%

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Are My Pediatric Patients at Increased Risk of Developing Chronic Kidney Disease?

Primack

Kleeman

Boineau

et al. 2020

Clin Pediatr (Phila)

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Chronic kidney disease (CKD) is an underrecognized and often undiagnosed cause of morbidity and mortality. Many children and adolescents are at increased risk of developing CKD as they mature and age, secondary to conditions commonly cared for by pediatric health professionals. Prematurity, diabetes mellitus, hypertension, congenital heart disease, sickle cell disease and trait, severe obesity, cancer chemotherapy, other drug toxicities, and systemic situations that may cause acute kidney injury such as sepsis or extracorporeal membrane oxygenation therapy predispose to potential CKD. Clinicians should be aware of these conditions in order to screen for CKD, choose non-nephrotoxic treatments for these children whenever possible, and treat or refer those who have early signs of CKD.

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Section: Resultsmentioning

confidence: 99%

“…Pediatric cancer survivors have high rates of subclinical renal dysfunction, and as many as 30% to 50% will develop CKD in their lifetime. 97 In cancer survivors, MA is significantly more prevalent on urine screening than either hematuria or proteinuria. 98 Aminoglycoside antibiotics and antifungals such as amphotericin can cause AKI.…”

Section: Resultsmentioning

confidence: 99%

Are My Pediatric Patients at Increased Risk of Developing Chronic Kidney Disease?

Primack

Kleeman

Boineau

et al. 2020

Clin Pediatr (Phila)

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“…They found no changes in GFR in survivors treated previously with high doses of MTX [ 1 ]. In another study by Mundi et al in which the majority of participants were also patients after leukemia treatment, eGFR reduction, electrolyte disturbances, proteinuria, hematuria and/or hypertension after treatment with ifosfamide or nephrectomy were observed [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Urine NGAL and KIM-1: tubular injury markers in acute lymphoblastic leukemia survivors

Latoch

Konończuk

Taranta-Janusz

et al. 2020

Cancer Chemother Pharmacol

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Introduction Nephrotoxicity is a potential adverse effect of anticancer treatment in childhood. Cytostatics, abdominal radiotherapy, total body irradiation (TBI) and some agents used in supportive care may induce acute kidney injury (AKI) or lead to chronic kidney disease (CKD). The aim of this study was to test the hypothesis whether urinary kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) are increased in acute lymphoblastic leukemia (ALL) survivors. Method The study cohort consisted of 86 patients (42 females) previously treated for ALL. The median time after cessation of treatment was 6.55 (IQR: 1.96–9.93) years and median age at the time of study: 12 (IQR: 6.76–16.00). The control group included 53 healthy peers. Immunoenzymatic ELISA commercial kits were used to measure urine KIM-1 and NGAL levels. Results The median levels of urine uNGAL (p < 0.05), uNGAL/creatinine (cr.) ratio (p < 0.0001) and uKIM-1/creatinine ratio (p < 0.0001) were significantly higher in ALL survivors in comparison with healthy controls. Female patients had significantly higher levels of NGAL and NGAL/cr. than males (mean 8.42 ± 7.1 vs. 4.59 ± 4.5 ng/mL and 86.57 ± 77 vs. 37.7 ± 37 ng/mg, respectively; p < 0.01). Of all the study participants, 11 (13%) presented eGFR below 90 mL/min/1.73 m2. The NGAL/cr. ratio seemed to be the best predictor of decreased eGFR (AUC = 0.65). The cumulative dose of methotrexate and cyclophosphamide did not predict the values of the urine NGAL, NGAL/cr., KIM-1/cr. and eGFR. Five years after the end of treatment, the patients had higher levels of uKIM-1 (1.02 ± 0.8 vs. 0.62 ± 0.6 ng/mL, p < 0.01), uNGAL (7.9 ± 6.7 vs. 4.6 ± 5 ng/mL, p < 0.01) and lower eGFR (114 ± 29 vs. 134 ± 35 mL/min/1.73 m2, p < 0.01) in comparison with ALL survivors with the observation period of less than 5 years. Conclusion We demonstrated that ALL survivors have higher levels of urine NGAL, NGAL/cr. and uKIM-1/cr. ratio as compared to the control group. Further long-term follow-up studies are necessary to assess the significance of the NGAL and KIM-1 and their relationship to kidney damage after anticancer treatment in childhood.

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“…Glomerular dysfunction may occasionally cause abnormally elevated plasma urea and creatinine levels, suggesting transitory or persistent glomerular injury. However, such changes only appear in a minority of patients [ 2 , 4 , 13 , 14 ]. How to recognize early stages of post-chemotherapy nephrotoxicity remains a challenge.…”

Section: Discussionmentioning

confidence: 99%

“…The evaluation of nephrotoxicity has been frequently based only on the determination of plasma urea and creatinine concentrations, as well as urinary protein excretion [ 1 , 2 ]. However, subclinical renal dysfunction is not uncommon in cancer survivors, and these previously mentioned tests are not able to detect early changes in kidney function [ 4 ]. Therefore, potential biomarkers of early renal injury should be evaluated in cancer survivors, mostly in children.…”

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confidence: 99%

Glomerular Hyperfiltration and β-2 Microglobulin As Biomarkers of Incipient Renal Dysfunction in Cancer Survivors

et al. 2018

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Herein, we aimed to evaluate the occurrence of impaired renal function after cancer treatment with potentially nephrotoxic chemotherapy in children. A cross-sectional study was performed in 41 cancer survivors after chemotherapy with potentially nephrotoxic drugs. 26 (63.4%) children were detected with glomerular hyperfiltration, and urinary levels of β-2 microglobulin (B2MG) were higher than reference range in all patients. Levels of B2MG were positively correlated with plasma creatinine and negatively correlated with glomerular filtration rate. Plasma creatinine, systolic blood pressure and cholesterol were independently associated with B2MG values. The final multivariate model for glomerular hyperfiltration risk included plasma levels of urea and of magnesium. Urinary levels of B2MG and glomerular hyperfiltration may emerge as potential biomarkers of early renal dysfunction in childhood cancer survivors.

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Paediatric cancer survivors demonstrate a high rate of subclinical renal dysfunction

Cited by 21 publications

References 27 publications

Are My Pediatric Patients at Increased Risk of Developing Chronic Kidney Disease?

Are My Pediatric Patients at Increased Risk of Developing Chronic Kidney Disease?

Urine NGAL and KIM-1: tubular injury markers in acute lymphoblastic leukemia survivors

Glomerular Hyperfiltration and β-2 Microglobulin As Biomarkers of Incipient Renal Dysfunction in Cancer Survivors

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