ESPN 51th Annual Meeting

ESPN 2018


 
ACUTE KIDNEY INGURY (AKI) IN CHILDREN WITH ACUTE LEUKEMIA
TATIANA NASTAUSHEVA 1 EVGENIA GREVTSEVA 1 GALINA VOLOSOVETS 1 ELENA KULAKOVA 1

1- VORONEZH STATE MEDICAL UNIVERSITY, RUSSIA
 
Introduction:

Advances in diagnosis, treatment in children with acute leukemia (AL) have improved patient survival significantly. But several chemotherapeutic agents which are used for treatment of this disease can cause AKI. It is important to diagnose AKI early for prevention progress from mild to severe forms.

Material and methods:

We investigated prospectively 140 patients with diagnosis AL (121 with lymphoblastic leukemia, 19 with myeloid leukemia) from 10 days to 17.5 years old who were admitted at Voronezh Regional Children’s Hospital from January 2008 till January 2014. The group of patients included 78 boys and 62 girls. Children were investigated before chemotherapy, during intensive chemotherapy, during maintenance treatment and after chemotherapy in remission of AL. Different protocols of chemotherapy were used for patients. Stages of AKI were revealed according to pRIFLE classification. We used the Schwarts formulae for evaluation of GFR. We could not use such parameter as urine output because all patients received fluid i/v.

Results:

AKI was found in 71 (51.7%) children with AL. The 1-st stage (Risk) was diagnosed in 50 (35.7%), 2-nd stage (Injury) in 19 (13.6%), 3-d stage (Failure) was revealed in 2 (1.4%). Among 122 survival children with AL there were only mild forms of AKI: Risk and Injury – 42 (34.4%) and 12 (9.8%) patients correspondently. All 18 died patients (accept of 1) had AKI: 8 (6.6%) stage Risk, 7 (5.7%) stage Injury, 2 (1.6%) stage Failure. Before chemotherapy AKI was noticed in 17 patients from 75 (22.7%), during intensive chemotherapy it increased to 73.2% (in 60 from 82), during maintenance treatment AKI was found in 14.5% (in 9 from 62) and after chemotherapy in remission only 1 patient from 63 (1.6%) had AKI.

Conclusions:

AKI was registered quite often in children with AL (mostly mild forms) and associated with mortality. The children with AL should be monitored for AKI, especially during intensive chemotherapy.