Late effects on renal glomerular and tubular function in childhood cancer survivors

Background Late nephrotoxicity among childhood cancer survivors is poorly documented. Methods. We investigated 115 patients and 86 controls assessing serum cystatin C concentration (CysC), urinary N-acetyl-beta-D-glucosaminidase activity (NAG), and microalbuminuria. Protenuria was quantified and electrophoresis performed. Polymorphism of the angiotensin convertase enzyme (ACE) gene was determined by genomic PCR. Results. CysC was elevated in Wilms tumor (WT) patients. Gross proteinuria was observed in 30 patients including three patients with progressive proteinuria who improved on ACE-inhibitor treatment. Neither patients with proteinuria nor the entire study population differed from controls with respect to ACE polymorphism. Pathologically elevated urinary NAG was noted in 38% of leukemia/ lymphoma, 54% of solid tumor, 20% of WT survivors. A similar distribution of pathoiogical microalbuminuria was found. Conclusions. Mild-to-moderate subclinical glomerular and tubular damage can be identified in many childhood cancer survivors. However, most patients experience some spontaneous recovery from acute nephrotoxicity. (C) 2004 Wiley-Liss, Inc.