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Kidney Week

Abstract: SA-PO203

AKI and CKD Prevalence in Pediatric Neuro-Oncology Survivors

Session Information

  • Onco-Nephrology: Clinical
    November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Rompies, Elizabeth Joy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Krallman, Kelli A., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Salloum, Ralph, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Background

In facing an oncologic diagnosis, the pediatric patient may face a host of concomitant diagnoses resultant of required treatments. These diagnoses will often influence life-long follow-up. The nephrologic impact of multimodal treatment regimens for childhood central nervous system (CNS) tumors is a topic of particular interest.

Methods

A pediatric CNS tumor survivor clinic follows patients who have been in remission for a minimum of 5 years. Medical records of 211 clinic patients were examined for renal sequelae of CNS tumor treatment. Patients were classified as having Acute Kidney Injury (AKI), using KDIGO definitions, if more than 2 serum creatinine (SCr) results were available over a 48hr period for trending. Patients were assessed for Chronic Kidney Disease (CKD) using nuclear or estimated GFR, positive proteinuria (PU) and/or microalbuminuria (MAU), and renal ultrasound. Stage I is defined as GFR>120, on 2+ measurements, with PU/MAU. Stage II is defined as GFR<90, and Stage III is defined as GFR<60. Patients with an abnormal renal ultrasound, or with PU/MAU but a normal or above normal GFR, were classified as having a marker of CKD.

Results

Survivors range in age from 7 to 53 years old, with the median age of 21. Eleven of the 211 patients could not be assessed for AKI due to inadequate SCr results. Of the remaining 200 patients, 11 (5.5%) experienced AKI. Evidence of CKD was observed in 62/211 patients (29.4%), six of whom previously had AKI. Of those with CKD, 15 (24.2%) had stage I, 27 (43.5%) had stage II, and 2 (3.2%) had stage III. The other 18 (29.0%) had either persistent PU/MAU with normal or above normal GFR and/or abnormal renal ultrasound.

Conclusion


Surveillance post AKI and mitigation of CKD after cancer remission helps to remove additional burden from pediatric cancer survivors. The high prevalence of CKD markers demonstrates that CNS tumor treatment regimens may cause significant subclinical renal damage during the acute treatment phase. Additional work should be done to assess the incidence of kidney disease in this population, and structure ideal follow-up.

 No CKDMarker of CKDCKD Stage ICKD Stage IICKD Stage IIITotal
No AKI1441714241200
Previous AKI5113111
Total1491815272211