Renal Dysfunction
The overall prevalence of a history of AKI in our cohort was high, with
15 subjects (33%, 95% CI: 20-49%) developing AKI at least once. The
majority of AKI occurred at time of diagnosis (10/15, 66.7%). Of the 15
subjects with AKI, 13 (86.7%) had KDIGO stage 1 AKI, 1 (6.7%) had
KDIGO stage 2 AKI, and 1 (6.7%) had KDIGO stage 3 AKI. In the 28
high-risk ALL patients, 13 had AKI (46%), while in the 17 standard-risk
ALL patients, only 2 had AKI (11.8%). Those treated with high-risk ALL
therapy were more likely to have AKI than those treated with
standard-risk ALL therapy (P = 0.017). In univariate analysis,
predictors for AKI included increasing age at time of diagnosis (median
age with AKI 9.5yr vs median age with no AKI 4.3yr, P = 0.006) and
high-risk ALL (P = 0.026). Interestingly, number of nephrotoxic agents,
number hospitalizations, and need for vasopressors were not found to be
significant risk factors for AKI.
No patients in this short period of follow-up demonstrated CKD. However,
13 of 45 patients (28.9%, 95% CI: 16.4-44.3%) had hyperfiltration,
which represents a supraphysiologic elevation in GFR. Last recorded GFR
for patients are shown in figure 1. The mean last GFR was
146.1ml/min/1.73m2 (range 74-228
ml/min/1.73m2). The median month that last GFR was
calculated was 30 months (range 15-60 months) post diagnosis. In the 28
high-risk ALL patients, 9 had hyperfiltration (32.1%). In the 17
standard-risk ALL patients, 4 had hyperfiltration (23.5%). In light of
the small sample size, no variable was identified as a risk factor for
developing hyperfiltration.
Urinalysis was completed in 41 patients, as 4 were unable to provide a
sample. Eleven of 41 patients (24%) had abnormal urinalysis. One
patient (2%) had proteinuria alone, 6 patients (15%) had albuminuria
alone, and 3 patients (7%) had combined proteinuria and albuminuria.
Univariate analysis in the proteinuria group was not performed due to
small sample size. Univariate analysis in the microalbuminuria group did
not result in identification of any significant risk factors.