Yield of Urinalysis Screening in Pediatric Cancer Survivors

Abstract

Background The Children's Oncology Group (COG) publishes consensus guidelines with screening recommendations for early identification of treatment related morbidities among childhood cancer survivors. We sought to estimate the yield of recommended yearly urinalysis screening for genitourinary complications per Version 3.0 of the COG Long-Term Follow-Up Guidelines and identify possible risk factors for abnormal screening in a survivor population. Procedure A database of pediatric cancer survivors evaluated between January 2008 and March 2012 at Children's Healthcare of Atlanta was queried for survivors at risk for genitourinary late effects. The frequency of abnormal urinalyses (protein ≥ 1+ and/or presence of glucose and/or ≥ 5 red blood cells per high power field) was estimated. Risk factors associated with abnormal screening were identified. Results Chart review identified 773 survivors (57% male; 67% Caucasian; 60% leukemia/lymphoma survivors; mean age at diagnosis, 5.7 years [range, birth to 17.7 years]; time from diagnosis to initial screening, 7.6 years [range, 2.3 to 21.5 years]) who underwent urinalysis. Abnormal results were found in 78 (5.3%) of 1484 total urinalyses. Multivariable analysis revealed higher dose ifosfamide (OR=6.8, 95% CI 2.9-16.0) and total body irradiation (OR=3.0, 95% CI 1.0-8.4) as significant risk factors for abnormal initial urinalysis screening. Conclusions Pediatric cancer survivors exposed to higher dose ifosfamide or total body irradiation may be at higher risk of abnormal findings on urinalysis screening. Targeted screening of these higher risk patients should be considered.

The Dutch Childhood Cancer Survivor Study (DCCSS)-LATER 2 kidney analysis examined long-term glomerular dysfunction in childhood cancer survivors

“…19 TBI, abdominal radiotherapy >30 Gy, and ifosfamide were associated with albuminuria. The association of TBI and HD ifosfamide with abnormal urinalysis was also observed by Ramirez et al 48 in a cohort of 773 CCS. A novel finding of this study includes exposure to HD-abdominal radiotherapy (>30 Gy) as a risk factor for proteinuria.…”

“…The prevalence in our study population is the highest to date compared with other large CCS cohorts where proteinuria was observed in 4.8%-14.5%. 10,22,48 This can be a result of more exposure to nephrotoxic agents in our cohort, as well as the longer follow-up period or differences in measurement tools. The high prevalence is worrisome, because even a mildly increased albumin-to-creatinine ratio is associated with a faster GFR decline.…”

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

“…97 In cancer survivors, MA is significantly more prevalent on urine screening than either hematuria or proteinuria. 98…”

“…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. 99 Toxic levels of the heavy metals lead, cadmium, uranium, and mercury damage the renal tubules, with resulting nephron loss.…”

Review – Late toxicity of abdominal and pelvic radiotherapy for childhood cancer

“…[31] One Cochrane review was found on the topic (updated in 2019) [32]. It identified several studies reporting on associations between RT and kidney-related outcomes such as reduced eGFR, [33][34][35][36][37] proteinuria, [33,34,38] and elevated blood pressure. [12,34,[39][40][41] Most studies did not find significant associations of RT with renal outcomes (category D, see Table 1).…”