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Long‐term renal prognosis and risk for hypertension after myeloablative therapies in survivors of childhood high‐risk neuroblastoma: A nationwide study
Author(s) -
Suominen Anu,
Jahnukainen Timo,
Ojala Tiina H.,
Sarkola Taisto,
Turanlahti Maila,
SaarinenPihkala Ulla M.,
Jahnukainen Kirsi
Publication year - 2020
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.28209
Subject(s) - medicine , renal function , cystatin c , creatinine , blood pressure , ambulatory blood pressure , albuminuria , cohort , urology , endocrinology , cardiology , gastroenterology
Background Patients with high‐risk neuroblastoma (HR NBL) treated with myeloablative regimens are reported to be at risk for cardiovascular morbidity, and this risk may be increased by impaired renal function. Procedure Long‐term renal function was assessed in a national cohort of 18 (age 22.4 ± 4.9 years) HR NBL survivors by plasma creatinine (P‐Cr), urea, and cystatin C (P‐Cys C) concentrations, urine albumin/creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR). Ambulatory blood pressure was monitored, and common carotid intima‐media thickness (CIMT) and left ventricular mass index (LVMI) were evaluated. Results No significant difference in P‐Cr, P‐Cys C, or eGFR was found between the NBL survivors and the age‐ and sex‐matched 20 controls. P ‐Cys C–based eGFR (eGFRcysc) was significantly lower than the P‐Cr–based eGFRcr (97 ± 17 mL/min/1.73 m 2 vs 111 ± 19 mL/min/1.73 m 2 , P < 0.001) among the NBL survivors. The eGFRcysc was below normal in 28%, and ACR was above normal in 22% of the NBL survivors. Abnormal blood pressure was found in 56% of the survivors, and an additional 17% were normotensive at daytime but had significant nocturnal hypertension. Both ACR and P‐Cys C were associated with nighttime diastolic hypertension. Conclusions Long‐term survivors of childhood HR NBL showed signs of only mild renal dysfunction associated with diastolic hypertension. Elevated ACR and P‐Cys C were the most sensitive indicators of glomerular renal dysfunction and hypertension in this patient cohort.