Department of Pediatrics, Division of Hematology/Oncology, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
Department of Pediatrics, Division of Nephrology, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
Pediatr Nephrol. 2021 Sep;36(9):2675-2686. doi: 10.1007/s00467-020-04842-7. Epub 2021 Jan 7.
Pediatric oncology and hematopoietic cell transplant (HCT) patients are susceptible to both acute kidney injury (AKI) and chronic kidney disease (CKD). The etiologies of AKI vary but include tumor infiltration, radiation, drug-induced toxicity, and fluid and electrolyte abnormalities including tumor lysis syndrome. HCT patients can also have additional complications such as sinusoidal obstructive syndrome, graft-versus-host disease, or thrombotic microangiopathy. For patients with severe AKI requiring dialysis, multiple modalities can be used successfully, although continuous kidney replacement therapy (CKRT) is often the principal modality for critically ill patients. While increasing numbers of pediatric cancer and HCT patients are now surviving long term, they remain at risk for a number of chronic medical conditions, including CKD. Certain high-risk patients, due to underlying risk factors or treatment-related complications, eventually develop kidney failure and may require kidney replacement therapies. Management of co-morbidities and complications associated with kidney failure, including use of erythropoietin for anemia and potential need for ongoing cancer-related treatment while on dialysis, is an additional consideration in this patient population. Kidney transplantation can be successfully performed in pediatric cancer survivors, although additional features such as specific cancer diagnosis and duration of remission should be considered.
儿科肿瘤学和造血细胞移植（HCT）患者易患急性肾损伤（AKI）和慢性肾脏病（CKD）。AKI 的病因多种多样，包括肿瘤浸润、放疗、药物诱导的毒性以及包括肿瘤溶解综合征在内的液体和电解质异常。HCT 患者还可能有其他并发症，如窦状隙阻塞综合征、移植物抗宿主病或血栓性微血管病。对于需要透析的严重 AKI 患者，可以成功使用多种方法，尽管连续肾脏替代治疗（CKRT）通常是危重症患者的主要方法。虽然越来越多的儿科癌症和 HCT 患者现在能够长期存活，但他们仍然存在许多慢性疾病的风险，包括 CKD。某些高危患者由于潜在的危险因素或治疗相关的并发症，最终会发展为肾衰竭，可能需要肾脏替代治疗。在这一患者群体中，还需要考虑与肾衰竭相关的合并症和并发症的管理，包括贫血时使用促红细胞生成素以及在透析时是否需要持续进行癌症相关治疗。儿童癌症幸存者可以成功进行肾脏移植，但应考虑到特定的癌症诊断和缓解持续时间等其他特征。
