Unit of Pediatric Oncology, Children's Hospital, Uppsala, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Pediatr Nephrol. 2010 Jul;25(7):1337-42. doi: 10.1007/s00467-010-1501-6. Epub 2010 Apr 8.
We evaluated renal function at a median follow-up of 18 (range 10.3-22.1) years after total body irradiation in 18 patients treated with stem-cell transplantation (SCT) (autologous SCT in 15 and allogeneic SCT in three) for hematologic malignancies and compared them with 18 healthy controls. No patient had chronic graft-versus-host disease. We found no difference in glomerular filtration rate estimated from cystatin C (105 vs 111 ml/min/1.73 m(2), p = 0.28). Patients had higher albumin excretion (0.8 vs 0.4 mg/mmol, p = 0.001), but no patient had overt albuminuria (>200 mg/L). Patients had higher diastolic blood pressure (74 vs 67 mmHg, p = 0.003). Two patients (11%) had hypertension. Patients had lower tubular reabsorption of phosphate (0.78 vs 0.91 mmol/L, p = 0.014) and higher excretion of alpha-1-microglobulin (AMG/urine creatinine, 0.4 vs 0.25 mg/mmol, p = 0.038), which correlated with time after SCT (r = 0.6, p = 0.01). We found no difference in fractional excretion (FE) of other electrolytes, amino acid excretion, or urine osmolality. We conclude that renal function was relatively well preserved at a median follow-up of 18 years after childhood SCT. The higher albumin excretion in our patients is of concern, as is the association between excretion of AMG and time after SCT, suggesting that both glomerular and tubular function may deteriorate further.
我们评估了 18 名接受干细胞移植（SCT）治疗血液系统恶性肿瘤的患者（15 名自体 SCT，3 名异基因 SCT）在总身体照射后中位数为 18 年（范围 10.3-22.1）的肾功能，并与 18 名健康对照进行了比较。没有患者患有慢性移植物抗宿主病。我们发现胱抑素 C 估算的肾小球滤过率无差异（105 与 111 ml/min/1.73 m(2)，p = 0.28）。患者的白蛋白排泄量较高（0.8 与 0.4 mg/mmol，p = 0.001），但没有患者出现显性蛋白尿（>200 mg/L）。患者的舒张压较高（74 与 67 mmHg，p = 0.003）。两名患者（11%）患有高血压。患者的磷酸盐肾小管重吸收率较低（0.78 与 0.91 mmol/L，p = 0.014），α-1-微球蛋白（AMG/尿肌酐）排泄量较高（0.4 与 0.25 mg/mmol，p = 0.038），与 SCT 后时间相关（r = 0.6，p = 0.01）。我们没有发现其他电解质、氨基酸排泄或尿渗透压的排泄分数（FE）有差异。我们得出结论，在儿童 SCT 后中位数为 18 年的随访中，肾功能相对较好地得到了保留。我们患者的白蛋白排泄较高令人担忧，AMG 的排泄与 SCT 后时间之间的相关性表明肾小球和肾小管功能可能进一步恶化。
