Short- and Long-Term Kidney Issues in Children Treated for LeukemiaShort- and Long-Term Kidney Issues in Children Treated for Leukemia https://pediatricsnationwide.org/wp-content/uploads/2020/06/AYAyeager.jpg 720 480 Mary Bates, PhD Mary Bates, PhD https://secure.gravatar.com/avatar/c6233ca2b7754ab7c4c820e14eb518c8?s=96&d=mm&r=g
- February 15, 2022
- Mary Bates, PhD
While outcomes for childhood acute lymphoblastic leukemia (ALL) have improved, researchers are finding long-term effects on kidney function that require monitoring.
In a new study published recently in Pediatric Nephrology, researchers from Nationwide Children’s report the incidence of hypertension and kidney issues in pediatric patients diagnosed with acute lymphoblastic leukemia over a recent nine-year period. The findings suggest that long-term monitoring of blood pressure and kidney function in these patients is advisable.
Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer. Though the prognosis of ALL has improved in recent years, patients are still at risk for late effects including kidney dysfunction and hypertension, both from the disease and from its treatment.
“We are fortunate that after decades of research, we now have very effective treatments for childhood ALL, and most patients will be cured long-term,” says Suzanne Reed, MD, a physician in the Division of Hematology, Oncology and Blood and Marrow Transplant at Nationwide Children’s, an associate professor of pediatrics at The Ohio State University College of Medicine and one of the study’s authors.
“A big task in moving forward is to understand and mitigate toxicities of treatment, so that we can continue to cure kids with the least impact on their long-term health. This study contributes to this goal and provides some insight about the impact of our ALL therapies on the kidney health of our patients.”
“It’s a shame that a child could get through ALL and do well and then suffer from preventable kidney issues later in life. This is an opportunity to ensure that these patients have the best quality of life as they move into their adolescence and adulthood.” — John D. Mahan, MD
Dr. Reed and her colleagues, including Reeti Kumar, MD, a pediatric nephrology fellow at the time, conducted a retrospective cohort study of 222 pediatric patients diagnosed with ALL at Nationwide Children’s from 2008 through 2016. The follow-up period was five years on average.
“We found that the incidence of acute kidney injury is relatively high at diagnosis and during the first month of treatment, as is the incidence of hypertension,” says John D. Mahan, MD, a nephrologist at Nationwide Children’s, a professor of pediatrics at The Ohio State University College of Medicine and the study’s senior author.
“We are seeing that long-term, over an average of almost 5 years, significant rates of chronic hypertension persist in these survivors. Although we are not seeing a lot of chronic kidney disease during this relatively short follow-up period, these kids surely need to be monitored for potential kidney issues in the future.”
Dr. Mahan says that early intervention for kidney injury or hypertension is effective at preventing or minimizing long-term kidney and other organ damage. He suggests that children with ALL, even years after remission, should continue to be regularly assessed for hypertension and any evidence of kidney impairment.
“It’s a shame that a child could get through ALL and do well and then suffer from preventable kidney issues later in life,” he says. “This is an opportunity to ensure that these patients have the best quality of life as they move into their adolescence and adulthood.”
Kumar R, Reed S, Stanek JR, Mahan JD. Defining kidney outcomes in children with acute lymphoblastic leukemia in the modern era. Pediatric Nephrology. 2022 Jan 18. [Epub ahead of print]
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