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Long-Term Kidney Complications Are Common Among Pediatric and Young Adult Cancer Survivors

Long-Term Kidney Complications Are Common Among Pediatric and Young Adult Cancer Survivors 1024 683 Pam Georgiana

Study reveals the need for improved surveillance and updated survivorship guidelines.

As pediatric cancer survival rates continue to climb, focus is shifting to enhancing the long-term health of survivors. While treatments have become more precise, their delayed effects are not yet fully understood.

A new study led by Diana Zepeda-Orozco, MD, principal investigator in the Kidney and Urinary Tract Research Center at the Abigail Wexner Research Institute, associate division chief of research and an attending physician for the Division of Pediatric Nephrology and Hypertension at Nationwide Children’s Hospital, examines kidney complications among childhood and young adult cancer survivors.

“I admire our oncology colleagues who are constantly refining therapies to save lives,” she says. “However, as treatments evolve, we also need to revisit how we follow these survivors over time to minimize complications.”

The retrospective study, published in Pediatric Blood & Cancer, reviewed records from 109 pediatric and young adult cancer survivors treated at Nationwide Children’s between 2016 and 2021. About half had leukemia or lymphoma, and the remainder had solid tumors. All patients were cancer free for at least 5 years prior and received anti-cancer therapies known to affect kidney function, including nephrotoxic chemotherapy, nephrectomy or abdominal radiation.

In their follow-up in survivorship clinic, nearly half (49.5%) of the patients had hypertension. In addition, 11.9% of patients had a low glomerular filtration rate and 22.9% showed hyperfiltration, both indicating kidney distress. Among the 64 patients with available urinalysis results, 7.8% had proteinuria, an early marker of kidney injury.

“This study tells us that even with advances in cancer therapy, long-term kidney complications remain common for this patient population,” says Dr. Zepeda-Orozco, who is also an assistant professor of pediatrics at The Ohio State University College of Medicine.

Survivors of childhood solid tumors and those who underwent nephrectomy or received carboplatin or ifosfamide were at the highest risk of reduced kidney filtration. However, even patients treated with newer, more kidney-sparing regimens were not fully protected.

“We now know that ‘kidney-friendly’ treatment does not always mean kidney-safe,” Dr. Zepeda-Orozco notes. “These therapies are needed to treat cancer, and we need to work together with oncologists to identify kidney complications and treat modifiable risk factors early in these patients.”

National survivorship guidelines currently recommend periodic kidney function tests for at-risk patients. However, they do not call for urinalysis or screening for albuminuria. Dr. Zepeda-Orozco believes that the gap is significant.

“Protein in urine (i.e., albuminuria) can signal kidney stress long before we see changes in serum creatinine or low glomerular filtration rates,” Dr. Zepeda-Orozco explains. “Catching and connecting these puzzle pieces early could change patient outcomes.”

Hypertension was another major concern. “A single blood pressure reading in the clinic isn’t enough to confirm hypertension,” she says. “We need structured follow-up to ensure timely diagnosis and treatment.”

Dr. Zepeda-Orozco and her team are developing a quality improvement initiative to improve blood pressure screening accuracy and incorporate urinalysis and albuminuria testing into survivorship workflows. The goal is to identify at-risk survivors earlier and intervene before kidney or cardiovascular disease develops.

“Long-term follow-up is essential,” says Dr. Zepeda-Orozco. “We owe it to our patients not only to cure their cancer, but also to help them live healthy, full lives after treatment.”

 

Reference:

Zeid A, Delap S, Vasquez CM, et al. Evaluation of Pediatric and Young Adult Cancer Survivors at Risk of Long-Term Kidney Complications. Pediatr Blood Cancer. 2025;72(8):e31760. doi:10.1002/pbc 31760.

Image Credit: Adobe Stock

About the author

Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.

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