بررسی عملکرد لوله نزدیک کلیه در کودکان تحت شیمی درمانی در بیمارستان

    Background & Aim: Chemotherapy may induce mild to moderate glomerular or tubular disorders. We evaluated tubular and glomerular function in children who underwent chemotherapy. Patients and Methods: Between 2003 and 2005 all pediatric cancer patients were entered in a cross sectional prospective study. Demographic data, cumulative doses of anticancer drugs, history of antibiotics, nephrectomy, radiotherapy, and acute renal failure were recorded. Fractional excretion of magnesium, calcium, phosphate, amylase, creatinine clearance(KL/Pcr), and urine protein to creatinine were calculated. The nephrotoxicity was graded from 0 to 9. Pvalue less than 0.05 was considered significant. Results: A total of 233 children(140 males, 93 females) aged 10.5 years(±5.5 SD) on average were enrolled in the study 154 out of 233 patients had lymphoproliferative malignancies and 79 cases has solid tumors. The mean duration of treatment was 28.65 months and the mean duration of therapy discontinuation was 25 months. According to stage of treatment three groups were identified including initial(n=22), during(n=63) and discontinuation(n=148) 28 children had hypertension. The observed renal disorders were as follows glucosuria(n=3), magnesuria(n=9), diluted urine(n=96), metabolic acidosis(n=125), creatinine clearance less than 80ml/min(n=51), phosphaturia(n=55), hypercalciuria(n=96), Amylasuria(n=36) and proteinuria(n=62). Also 207 had mild to severe renal nephrotoxicity. The grade of nephrotoxicity was higher in children<5 years, with history of nephrectomy, radiotherapy, or use of nephrotoxic antibiotics(Kendall-tau, P<0.05). Renal dysfunction was higher during chemotherapy especially with platinium, epipodophylotoxin or ifosphamide (P<0,05). Conclusion: Frequent evaluation of renal function is highly recommended in children during and after termination of chemotherapy.