Acute Kidney Injury in Chemotherapy for Children with Pediatric Malignancy

Abstract

Background: Acute kidney injury (AKI) is one of severe complications during the anti-cancer chemotherapy. The study by Lahoti et al. revealed that 36% of adult patients with acute myelogenous leukemia or high-risk myelodysplastic syndrome developed AKI on chemotherapy, and the 8-weeks mortality rates were about 15% of AKI patients in contrast to 3% of non-AKI patients. Therefore, it is very important to diagnose of AKI early and accurately.Purpose: The purpose of this study is to identify the predictive biomarker of AKI in children with pediatric cancer.Materials and Methods: In the present study, 16 children with cancer were enrolled. To evaluate AKI, we used RIFLE criteria modified by AKI Network group. The severity of AKI based on RIFLE criteria divided into 5 categories (Risk, Injury, Failure, Loss and End-stage). We measured five urinary biomarkers (total protein (TP), albumin (Alb), N-Acetyl-glucosaminidase (NAG), β2-microglobulin (BMG), and liver-type fatty acid-binding protein (L-FABP)) related AKI because these five biomarkers could measure commercially.Results: We obtained the Laboratory data of 16 children received total 58 courses of chemotherapy. In 31 (53.4%) of 58 courses, AKI developed. To reveal a predictive biomarker, we investigated as follows in total 31 times developed AKI; 1) the frequency that each biomarker increased, and 2) the day when each biomarker increased based on the day when AKI developed based on RIFLE criteria. In total, TP, Alb, NAG, BMG, and L-FABP increased 17 (55%), 16 (52%), 18 (58%), 20 (65%), and 24 (77%) in AKI of total 31 times, respectively. Also, the median day when TP, Alb, NAG, BMG, and L-FABP increased was 9.0 (range: 0-29), 8.5 (range: 0-29), 9.5 (range: 0-42), 6.0 (range: 0-35), and 13.0 (range: 0-42) days before the day when AKI developed, respectively. L-FABP was found to be a predictive marker of AKI showing the best area under the ROC curve value (AUC) during chemotherapy (AUC = 0.753, sensitivity = 77.4%, specificity = 63.3%).Conclusion: These results showed that L-FABP is a possible predict biomarker of AKI in chemotherapy for children with pediatric cancer. DisclosuresNo relevant conflicts of interest to declare.