Neha S Kwatra1,2, Holly J Meany3, Sunil J Ghelani4, David Zahavi5, Nayan Pandya1, Massoud Majd6. 1. Division of Diagnostic Imaging and Radiology, Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC, 20010, USA. 2. Department of Radiology, Boston Children's Hospital, Boston, MA, USA. 3. Department of Hematology/Oncology, Children's National Medical Center, Washington, DC, USA. 4. Department of Cardiology, Boston Children's Hospital, Boston, MA, USA. 5. Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. 6. Division of Diagnostic Imaging and Radiology, Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC, 20010, USA. mmajd@childrensnational.org.
Abstract
BACKGROUND: Glomerular hyperfiltration has recently been reported in children with malignancies and has been attributed to increased solute from breakdown of tumor tissues. OBJECTIVE: To evaluate the prevalence of hyperfiltration in the pediatric oncology population and explore its pathophysiological mechanism. MATERIALS AND METHODS: Tc-99 m diethylenetriaminepentaacetic acid (DTPA) glomerular filtration rate (GFR) examinations (437 studies) and medical records of 177 patients <21 years of age diagnosed with a malignancy between January 2005 and October 2013 were retrospectively reviewed. Hyperfiltration was defined as a GFR ≥ 160 ml/min/1.73 m2. RESULTS: Seventy-seven (43.5%) patients had hyperfiltration in at least one GFR exam. A significantly higher percentage of patients with central nervous system (CNS) tumors (63.6%) had hyperfiltration when compared to other tumor types (27.3%, P < 0.001). No association was found between hyperfiltration and age, gender, race or bone marrow involvement. There was a significant trend toward decreasing hyperfiltration after the second cycle of chemotherapy (P = 0.006) and a significant increase in subjects with low GFR (<100 ml/min/1.73 m2) with increasing number of cycles of chemotherapy (P = 0.005). CONCLUSION: Glomerular hyperfiltration is common in children with malignancies at diagnosis and during initial cycles of chemotherapy. It is particularly prevalent in patients with central nervous tumors, which are frequently smaller in volume. Therefore, the pathophysiological mechanism of hyperfiltration cannot be explained solely on the basis of large tumor volume and subsequent cell breakdown. We hypothesize that host hypermetabolic state plays an important role in pathophysiology of hyperfiltration.
BACKGROUND: Glomerular hyperfiltration has recently been reported in children with malignancies and has been attributed to increased solute from breakdown of tumor tissues. OBJECTIVE: To evaluate the prevalence of hyperfiltration in the pediatric oncology population and explore its pathophysiological mechanism. MATERIALS AND METHODS:Tc-99 m diethylenetriaminepentaacetic acid (DTPA) glomerular filtration rate (GFR) examinations (437 studies) and medical records of 177 patients <21 years of age diagnosed with a malignancy between January 2005 and October 2013 were retrospectively reviewed. Hyperfiltration was defined as a GFR ≥ 160 ml/min/1.73 m2. RESULTS: Seventy-seven (43.5%) patients had hyperfiltration in at least one GFR exam. A significantly higher percentage of patients with central nervous system (CNS) tumors (63.6%) had hyperfiltration when compared to other tumor types (27.3%, P < 0.001). No association was found between hyperfiltration and age, gender, race or bone marrow involvement. There was a significant trend toward decreasing hyperfiltration after the second cycle of chemotherapy (P = 0.006) and a significant increase in subjects with low GFR (<100 ml/min/1.73 m2) with increasing number of cycles of chemotherapy (P = 0.005). CONCLUSION: Glomerular hyperfiltration is common in children with malignancies at diagnosis and during initial cycles of chemotherapy. It is particularly prevalent in patients with central nervous tumors, which are frequently smaller in volume. Therefore, the pathophysiological mechanism of hyperfiltration cannot be explained solely on the basis of large tumor volume and subsequent cell breakdown. We hypothesize that host hypermetabolic state plays an important role in pathophysiology of hyperfiltration.
Authors: John S Fleming; Maureen A Zivanovic; Glen M Blake; Maria Burniston; Philip S Cosgriff Journal: Nucl Med Commun Date: 2004-08 Impact factor: 1.690
Authors: Banu Aygun; Nicole A Mortier; Matthew P Smeltzer; Barry L Shulkin; Jane S Hankins; Russell E Ware Journal: Am J Hematol Date: 2012-12-17 Impact factor: 10.047
Authors: J R Brandt; Craig Wong; D R Jones; C Qualls; N McAfee; E Brewer; S L Watkins Journal: Pediatr Hematol Oncol Date: 2003-06 Impact factor: 1.969
Authors: Sila Kurugol; Onur Afacan; Richard S Lee; Catherine M Seager; Michael A Ferguson; Deborah R Stein; Reid C Nichols; Monet Dugan; Alto Stemmer; Simon K Warfield; Jeanne S Chow Journal: Pediatr Radiol Date: 2020-01-27
Authors: Evelyn Dhont; Tatjana Van Der Heggen; Annick De Jaeger; Johan Vande Walle; Peter De Paepe; Pieter A De Cock Journal: Pediatr Nephrol Date: 2018-10-29 Impact factor: 3.714
Authors: Pascal André; Léonore Diezi; Kim Dao; Pierre Alex Crisinel; Laura E Rothuizen; Haithem Chtioui; Laurent Arthur Decosterd; Manuel Diezi; Sandra Asner; Thierry Buclin Journal: Front Pediatr Date: 2022-01-05 Impact factor: 3.418
Authors: Stefanie W Benoit; Thelma Kathman; Jay Patel; Melinda Stegman; Cristina Cobb; Jonathan Hoehn; Prasad Devarajan; Edward J Nehus Journal: Kidney Int Rep Date: 2020-12-07