Department of Radiology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, China.
Department of Hematology and Oncology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China.
Biomed Res Int. 2020 Nov 17;2020:3687134. doi: 10.1155/2020/3687134. eCollection 2020.
The study was aimed at assessing renal functions of children with acute lymphoblastic leukemia (ALL) after induction therapy by Tc-DTPA renal dynamic imaging Gates method (GFR) and investigating whether renal function after induction therapy will affect the occurrence of high-dose methotrexate- (HDMTX-) induced acute kidney injury (AKI).
Children with newly diagnosed ALL were enrolled. Renal functions before the administration of HDMTX were assessed by estimated glomerular filtration rate (eGFR) and GFR, respectively, before the first cycle of HDMTX after induction therapy. The areas under the ROC curve were used to assess covariates' ability to predict HDMTX-induced AKI.
102 children with ALL were included in the study. A stepwise backward binary logistic regression showed that only standardized GFR was an independent risk factor for HDMTX-induced AKI ( = 0.018, odds ratio 0.985, 95% CI 0.972-0.997). The area under the ROC of standardized GFR was 0.679 ( = 0.012, 95% CI 0.554-0.804).
Standardized GFR showed that the normal renal function of children is not enough to be used as a cutoff point to predict HDMTX-induced AKI in ALL children receiving HDMTX. More attention and supportive care should be given to the children with standardized GFR lower than the cutoff value to avoid the HDMTX-induced AKI.
本研究旨在通过 Tc-DTPA 肾动态成像门控法（GFR）评估诱导治疗后急性淋巴细胞白血病（ALL）患儿的肾功能，并探讨诱导治疗后肾功能是否会影响大剂量甲氨蝶呤（HDMTX）诱导的急性肾损伤（AKI）的发生。
纳入新诊断为 ALL 的患儿。在诱导治疗后第一个 HDMTX 周期前，分别通过估算肾小球滤过率（eGFR）和 GFR 评估 HDMTX 前的肾功能。使用 ROC 曲线下面积评估协变量预测 HDMTX 诱导 AKI 的能力。
研究纳入 102 例 ALL 患儿。逐步后退二项逻辑回归显示，仅标准化 GFR 是 HDMTX 诱导 AKI 的独立危险因素（ = 0.018，优势比 0.985，95%CI 0.972-0.997）。标准化 GFR 的 ROC 曲线下面积为 0.679（ = 0.012，95%CI 0.554-0.804）。
标准化 GFR 表明，正常肾功能不足以作为 ALL 患儿接受 HDMTX 时预测 HDMTX 诱导 AKI 的截止值。对于标准化 GFR 低于截止值的患儿，应给予更多关注和支持性护理，以避免 HDMTX 诱导的 AKI。
