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A Cochrane review of 61 studies found reported rates of kidney damage after childhood cancer treatment ranging from nought to 84 per cent, which is a statement about the literature rather than about kidneys. On systematic clinical testing of one large cohort, kidney dysfunction was present in 5 per cent, among the least common of the organ problems measured.
Four treatments damage the kidney in childhood: cisplatin, carboplatin, ifosfamide, radiotherapy that includes the kidney region, and removal of a kidney, usually for a Wilms tumour. The damage takes three forms, and they are often confused: a fall in glomerular filtration rate, protein in the urine, and tubulopathy, in which the tubules leak magnesium, phosphate, potassium and bicarbonate. Ifosfamide is the characteristic cause of the third, and a child with persistent low phosphate after treatment may need lifelong replacement to protect their bones.
The Cochrane review is the honest summary of what is known. Its 2019 update included 61 studies; the 52 evaluating prevalence covered 13,327 participants of interest, of whom at least 4,499 underwent renal function testing. The prevalence of adverse renal effects ranged from 0 to 84 per cent. The reviewers' own explanation is the finding: "This variation may be due to diversity of included malignancies, received treatments, reported outcome measures, follow-up duration and the methodological quality of available evidence." In other words the field has not agreed what to measure, so the studies cannot be compared and no single prevalence figure is defensible. That is a gap rather than a number, and it is stated here rather than filled.
What a prospectively tested cohort found. In the St Jude Lifetime Cohort's systematic exposure-based assessment of 1,713 survivors, kidney dysfunction was present in 5.0 per cent (95 per cent confidence interval 4.0 to 6.3), among the least common of the organ-system abnormalities measured, far below pulmonary, auditory, endocrine, cardiac and neurocognitive problems. Kidney damage is real and worth monitoring, and it is not the thing most likely to be wrong.
What follows. The International Guideline Harmonization Group has published harmonised nephrotoxicity surveillance recommendations, and the Children's Oncology Group guidelines set out testing by exposure: blood pressure, urinalysis for protein, creatinine and electrolytes including magnesium and phosphate. A survivor with one kidney should know that this does not usually limit life or activity, but that blood pressure control and avoiding unnecessary nephrotoxic drugs matter more for them than for others. Blood pressure is the common thread with the cardiac record alongside this one.
What comes back, and when: acute kidney injury during treatment usually recovers. Glomerular filtration reduced by cisplatin tends to be stable rather than progressive in most survivors, and ifosfamide tubulopathy may improve over the first years after treatment but frequently persists and needs replacement. A single remaining kidney hypertrophies and compensates. What cannot be undone is nephron loss, so the sensible aim is to protect what is left: blood pressure, hydration, care with anti-inflammatory drugs and contrast, and a nephrology opinion before pregnancy or further nephrotoxic treatment.
Cisplatin accumulates in proximal tubular cells through organic cation transporters and causes apoptosis and magnesium wasting; ifosfamide's chloroacetaldehyde metabolite damages the same segment and produces a Fanconi-type tubulopathy with phosphate, bicarbonate and potassium loss. Radiation injures the glomerular endothelium and the interstitium, producing fibrosis over years. Because the kidney cannot make new nephrons, loss from any of these is permanent and the remaining nephrons hyperfiltrate, which is why blood pressure control matters more in a survivor than the original insult does.
Query for this technology: (TITLE:"Kidneys after cisplatin, ifosfamide, radiotherapy and nephrectomy in childhood" OR ABSTRACT:"Kidneys after cisplatin, ifosfamide, radiotherapy and nephrectomy in childhood") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Kidneys after cisplatin, ifosfamide, radiotherapy and nephrectomy in childhood, not a curated reading list.
Shares International Guideline Harmonization Group for late effects of childhood cancer, St Jude Lifetime Cohort Study (SJLIFE), The Children's Oncology Group Long-Term Follow-Up Guidelines, How much illness childhood cancer survivors carry, and at what age and the tags rejuvenation, survivorship, paediatric, late-effects.
Shares International Guideline Harmonization Group for late effects of childhood cancer, St Jude Lifetime Cohort Study (SJLIFE), The Children's Oncology Group Long-Term Follow-Up Guidelines, How much illness childhood cancer survivors carry, and at what age and the tags rejuvenation, survivorship, paediatric, late-effects.
Shares International Guideline Harmonization Group for late effects of childhood cancer, St Jude Lifetime Cohort Study (SJLIFE), The Children's Oncology Group Long-Term Follow-Up Guidelines, How much illness childhood cancer survivors carry, and at what age and the tags rejuvenation, survivorship, paediatric, late-effects.
Shares International Guideline Harmonization Group for late effects of childhood cancer, St Jude Lifetime Cohort Study (SJLIFE), The Children's Oncology Group Long-Term Follow-Up Guidelines, How much illness childhood cancer survivors carry, and at what age and the tags rejuvenation, survivorship, paediatric, late-effects.
Shares International Guideline Harmonization Group for late effects of childhood cancer, The Children's Oncology Group Long-Term Follow-Up Guidelines, Wilms tumour (nephroblastoma), Ewing sarcoma and the tags rejuvenation, survivorship, paediatric, late-effects.
Shares International Guideline Harmonization Group for late effects of childhood cancer, St Jude Lifetime Cohort Study (SJLIFE), The Children's Oncology Group Long-Term Follow-Up Guidelines, How much illness childhood cancer survivors carry, and at what age and the tags rejuvenation, survivorship, paediatric, late-effects.
Shares International Guideline Harmonization Group for late effects of childhood cancer, The Children's Oncology Group Long-Term Follow-Up Guidelines, How much illness childhood cancer survivors carry, and at what age, Germ cell tumours of childhood and adolescence (extracranial and CNS) and the tags rejuvenation, survivorship, paediatric, late-effects.
Shares International Guideline Harmonization Group for late effects of childhood cancer, St Jude Lifetime Cohort Study (SJLIFE), The Children's Oncology Group Long-Term Follow-Up Guidelines, How much illness childhood cancer survivors carry, and at what age and the tags rejuvenation, survivorship, paediatric, late-effects.