The Incidence and Outcome of Acute Kidney Injury During Pediatric Kidney Tumor Treatment-a National Cohort Study

Overview

Journal Pediatr Nephrol

Specialties Nephrology
Pediatrics

Date 2025 Feb 18

PMID 39966140

Authors

Paulien A M A Raymakers-Janssen

Gerrit van den Berg

Marc R Lilien

Inge A van Kessel

Alida F W van der Steeg

Marc H W A Wijnen

Mieke I Triest

Sophie E van Peer

Marjolijn C J Jongmans

Harm van Tinteren

Geert O Janssens

Marta Fiocco

Roelie M Wosten-van Asperen

Marry M van den Heuvel-Eibrink

Affiliations

Soon will be listed here.

Abstract

Background: Acute kidney injury (AKI) is a serious complication of pediatric cancer treatment that is suggested to increase the risk of chronic kidney disease (CKD). Children with a kidney tumor may be at particular risk. This study aimed to determine the incidence and risk factors of AKI and its association with CKD during pediatric kidney tumor treatment.

Methods: We analyzed data from a prospective national cohort of patients ≤ 18 years old diagnosed with a kidney tumor between 2015 and 2021 in the Princess Máxima Center for Pediatric Oncology in the Netherlands. AKI was defined according to KDIGO criteria. CKD was assessed 1 year post-treatment based on proteinuria and/or decreased estimated glomerular filtration rate (eGFR).

Results: Of 147 patients, we observed AKI in 104 patients (71%) during therapy. AKI occurred most often within 48 h after tumor nephrectomy (88/104), while the rest had non-nephrectomy-related AKI from multifactorial causes. Sixteen patients experienced more than one AKI episode, and 92/104 episodes were reversible. Patients who developed AKI had a higher eGFR prior to surgery compared to those who did not develop AKI. CKD was observed in 16/120 patients (13%). Risk factors for developing CKD included the occurrence of at least 1 AKI event, the use of a > 3-drug regimen, and a lower eGFR at the start of treatment.

Conclusion: The high incidence of AKI and its association with early CKD highlights the need for early detection, prevention, and intervention strategies during pediatric kidney tumor treatment.

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