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Assessment of renal function during high‐dose methotrexate treatment in children with acute lymphoblastic leukemia
Author(s) -
Ylinen Elisa,
Jahnukainen Kirsi,
SaarinenPihkala Ulla M.,
Jahnukainen Timo
Publication year - 2014
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.25137
Subject(s) - medicine , cystatin c , creatinine , renal function , nephrotoxicity , methotrexate , urology , gastroenterology , acute kidney injury , urinalysis , urine , toxicity
Background High‐dose methotrexate (HD‐MTX) is potentially nephrotoxic. The feasibility of novel biomarkers to indicate renal injury due to HD‐MTX infusion was studied in children with acute lymphoblastic leukemia (ALL). Procedure Markers for glomerular and tubular injury were evaluated prospectively after HD‐MTX infusion in 20 children with ALL. Plasma creatinine, cystatin C, and neutrophil gelatinase‐associated lipocalin (NGAL) were measured 24–48 hr before MTX‐infusion and 24, 36, 48, and 72 hr after starting the HD‐MTX treatment, and thereafter daily until the MTX concentration was below 0.1 µmol/L. Urine NGAL, β 2 ‐microglobulin, and creatinine concentrations as well as dipstick and urinalysis were performed at the same time points. Results In children with ALL, HD‐MTX treatment at 5 g/m 2 over 24 hr was well tolerated and none of the patients developed significant glomerular or tubular dysfunction. The mean plasma cystatin C level increased significantly ( P < 0.001) from 0.83 mg/L at baseline to 0.94 mg/L at 36 hr after starting the HD‐MTX treatment. The cystatin C concentration remained within reference range in all but two patients (10%). There was no significant change in plasma creatinine level during or after HD‐MTX treatment, the values being normal in all patients. Plasma and urea NGAL did not increase during or after the HD‐MTX treatment. Conclusions Our results suggest that plasma cystatin C concentration alone is a sensitive marker to monitor renal function during and after HD‐MTX infusion in pediatric ALL patients. Plasma or urine NGAL do not provide any further advantage in the follow‐up of these patients. Pediatr Blood Cancer 2014;61:2199–2202. © 2014 Wiley Periodicals, Inc.