Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt.
Department of Clinical Pathology, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt.
Pediatr Res. 2022 Dec;92(6):1689-1694. doi: 10.1038/s41390-022-02015-w.
The major increase in the survival rate among children with cancer is due to improvement in the diagnosis and treatment. Despite this increase, childhood cancer survivors (CCS) are at high risk of developing late complications such as nephrotoxicity due to chemotherapy. So, we aimed to detect early subclinical kidney dysfunction among CCS.
This cross-sectional study was implemented on 52 survivors of childhood cancer recruited from Pediatric Oncology Unit, Menoufia University. Laboratory evaluations for each participant, including complete blood count, serum urea, creatinine, urinary protein, urinary calcium, uric acid, and serum cystatin C and urinary Neutrophil Gelatinase Associated Lipocalin (UrNGAL) by ELISA were obtained.
Estimated GFR was decreased in 23.1% of cases, with elevated serum cystatin C, UrNGAL and UrNGAL/Cr. There was a significant increase of Uprotein/Cr, UCa/Cr, UACR (p = 0.02), UrNGAL and UrNGAL/Cr (P < 0.001) in patients with tubular dysfunction compared without tubular dysfunction. There was a significant difference between two groups regarding cisplatin (P = 0.03) and high-dose methotrexate chemotherapy (p = 0.04). The AUCs for detecting kidney tubular dysfunction by UrNGAL and UrNGAL/Cr were 0.807 and 0.747.
A significant tubular dysfunction among childhood cancer survivors receiving chemotherapy as cisplatin and high-dose methotrexate.
Detection of kidney dysfunction mainly tubular in childhood cancer survivors after finishing chemotherapy. Urinary NGAL is a good predictor for detection of tubular dysfunction in childhood cancer survivors after finishing chemotherapy.
儿童癌症患者存活率的大幅提高归因于诊断和治疗水平的提高。尽管存活率有所提高，但由于化疗，儿童癌症幸存者（CCS）仍面临发生肾毒性等晚期并发症的高风险。因此，我们旨在检测 CCS 中早期亚临床肾功能障碍。
本横断面研究纳入了来自曼努菲亚大学儿科肿瘤病房的 52 名儿童癌症幸存者。对每位参与者进行实验室评估，包括全血细胞计数、血清尿素、肌酐、尿蛋白、尿钙、尿酸以及血清胱抑素 C 和尿液中性粒细胞明胶酶相关脂质运载蛋白（UrNGAL）的酶联免疫吸附测定法（ELISA）。
估计肾小球滤过率（eGFR）降低的病例占 23.1%，血清胱抑素 C、UrNGAL 和 UrNGAL/Cr 升高。与无肾小管功能障碍的患者相比，有肾小管功能障碍的患者的 Uprotein/Cr、UCa/Cr 和 UACR（p=0.02）、UrNGAL 和 UrNGAL/Cr 显著增加（P<0.001）。两组之间在顺铂（P=0.03）和大剂量甲氨蝶呤化疗（p=0.04）方面存在显著差异。UrNGAL 和 UrNGAL/Cr 检测肾小管功能障碍的 AUC 分别为 0.807 和 0.747。
接受顺铂和大剂量甲氨蝶呤化疗的儿童癌症幸存者存在显著的肾小管功能障碍。
检测化疗后儿童癌症幸存者的肾功能障碍主要为肾小管功能障碍。尿液 NGAL 是检测化疗后儿童癌症幸存者肾小管功能障碍的良好预测指标。
