Cisplatin dose rate as a risk factor for nephrotoxicity in children.
Cisplatin dose rate as a risk factor for nephrotoxicity in children.
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DOI：
10.1038/bjc.1998.276
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发表时间：
1998-05
影响因子：
8.8
通讯作者：
Craft, A W
中科院分区：
文献类型：
--
作者：
Skinner, R;Pearson, A D;English, M W;Price, L;Wyllie, R A;Coulthard, M G;Craft, A W
本研究的目的是评价儿童顺铂肾毒性的发生率、危险因素和严重程度随时间的变化。共有35名儿童在完成顺铂化疗后接受了肾小球滤过率（GFR）和肾小管功能的测量。无儿童接受异环磷酰胺治疗。临床相关的“肾毒性评分”来自GFR和血清镁。在顺铂治疗后1年和2年分别对16名和15名儿童进行了随访研究。观察到肾毒性的患者间差异相当大。3例患者因肾毒性而调整治疗。31例患者中有18例GFR较低。近端肾单位毒性引起低镁血症10例，低钙血症5例。30名儿童中有22名出现尿N-乙酰氨基葡萄糖苷酶排泄升高，表明存在亚临床肾小管毒性。接受顺铂剂量率为40 mg m（-2）d（-1）的儿童肾毒性较接受更高剂量率的儿童轻（P < 0.005），但与接受的总剂量无关。随访显示GFR部分恢复（P < 0.05）。肾小球和近端肾单位毒性在接受顺铂治疗的儿童中很常见，并且在较高剂量率下更严重。尽管GFR部分恢复，但肾毒性的长期结局仍未知，有必要仔细监测慢性毒性。
The purpose of the study was to evaluate the incidence, risk factors and changes in severity with time of cisplatin nephrotoxicity in children. A total of 35 children underwent measurement of glomerular filtration rate (GFR) and tubular function after completion of cisplatin chemotherapy. No child received ifosfamide. A clinically relevant 'nephrotoxicity score' was derived from GFR and serum magnesium. Follow-up studies were performed in 16 children at 1 year and in 15 at 2 years after cisplatin. Considerable interpatient variability in nephrotoxicity was observed. Treatment was modified in three patients because of nephrotoxicity. GFR was low in 18 out of 31 patients. Proximal nephron toxicity caused hypomagnesaemia in ten patients and hypocalcaemia in five patients. Elevated urinary N-acetylglucosaminidase excretion was seen in 22 out of 30 children, indicating subclinical tubular toxicity. Nephrotoxicity was less severe in children who received cisplatin courses at a dose rate of 40 mg m(-2) day(-1) than in those who received higher dose rates (P < 0.005), but there was no correlation with total dose received. Follow-up studies revealed partial recovery of GFR (P < 0.05). Glomerular and proximal nephron toxicity are common in children treated with cisplatin, and more severe at higher dose rates. Despite partial recovery of GFR, the long-term outcome of nephrotoxicity remains unknown and careful monitoring of chronic toxicity is necessary.