Kidney Problems after Childhood Cancer

Childhood cancer survivors can develop renal dysfunction years after treatment

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Children diagnosed with cancer are living longer than ever, thanks to powerfully effective treatments. Some of these treatments, though, can cause health problems later in life.

Researchers have discovered that children who received certain chemotherapy agents or had kidney surgery had elevated risks for kidney problems years after their cancer treatment.

These problems can eventually lead to kidney failure, the new study revealed.

"If you see changes in your urinary patterns, see your doctor."

Renée Mulder, PhD, research associate in the Department of Pediatric Oncology at Emma Children's Hospital/Academic Medical Center (EKZ/AMC) in Amsterdam, the Netherlands, was the lead investigator in this study.

Scientists have known that adult survivors of childhood cancers are at greater risk for kidney problems. What hasn’t been clear is when these issues begin and if they can be resolved.

The job of the kidneys is to filter out waste and extra water from the blood. Tiny clusters of blood vessels called glomeruli do the cleaning.

These filters can become inflamed, harden or stop working efficiently because of scarring and result in a number of different types of kidney disease.

The authors of this study noted that chronic kidney problems can lead to cardiovascular disease, anemia, bone disease and even malnutrition.

For this study, the researchers identified 1,122 childhood cancer survivors who visited the Late Effects of Childhood Cancer outpatient clinic at EKZ/AMC between 1996 and 2010.

Participants were anywhere from five to 42 years beyond their initial childhood cancer treatment.

Leukemia and lymphoma were the two primary childhood cancers that the participants had been treated for. The adult survivors also had been treated for brain, bone, kidney, soft tissue or liver tumors, among other types of cancers.

The researchers tested study members’ kidney function. These tests evaluated glomerular function and glomerular flow rate, which looks at the volume of fluid the kidneys filter.

The study found that certain chemotherapy medications — including ifosfamide, cisplatin, carboplatin, high-dose methotrexate and high-dose cyclophosphamide — as well as radiation aimed at the kidney region and nephrectomy (surgical removal of part or all of the kidney) increased the risks of later kidney damage.

At a median follow-up of 21 years, childhood cancer survivors who were treated with the potentially toxic chemotherapies had significantly lower glomerular flow rate and higher risks of glomerular dysfunction for up to 35 years after a cancer diagnosis, compared with survivors who did not receive these agents or have kidney surgery.

Ifosfamide, cisplatin and nephrectomy were associated with worse glomerular function.

Survivors who had been treated with high doses of cisplatin had the highest rate of kidney dysfunction.

The researchers learned that glomerular function decline began soon after cancer treatment, did not recover and continued to worsen over time, putting some survivors at risk for kidney failure.

This study was published September 24 in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

This study was supported by the Tom Voute Fund, Amsterdam, the Netherlands. No potential conflicts of interest were disclosed.

Review Date: 
September 24, 2013
Last Updated:
September 25, 2013