• Logo
  • SBMUJournals

Pediatric Long-term follow up for renal disorders in ALL children by evaluating urine NGAL

Gholamreza Bahoush Mehdiabadi Grbahoush, Hasan Otukesh, Rozita Hosseini Shamsabadi, Mahdie Emami Arjomand




Introduction: Recent Developments in cancer treatment could provide a better survival rate for Acute Lymphoblastic Leukemia (ALL) patients. Survivors faced different long term complication after treatment, for instance cardiac, neurologic and kidney complications. Assessment of the late complications could be useful in the optimization of treatment protocols. The objective of this study was to evaluate the late kidney complications, renal function in ALL patients after therapy.

Material & Methods: In this study, we used 46 children. The treatment preformed based on ICBFM protocol. The mean age at the start of the treatment was 53±23 and the mean follow up time was 48±11 months. The tubular damage in these patients was evaluated by urinary NGAL level and the renal function was assessed by GFR.

Results: in this study 56.7% of the patients were male. The NGAL level shows abnormally high in 8.9% of patients and the mean urine NGAL was 63±113ng/mL. Also, the mean GFR at the time of the diagnosis and at the time of the start of the follow up were 102.8 ±25.6 mL/min/1.73 m2 and 93.6 ±29.1 mL/min/1.73 m2, respectively. The study indicated GFR were less than 60 mL/min/1.73 m2 in 13.3% of patients.

Conclusion: this study indicated the long term follow up of the ALL survivors for kidney disorders are an important manner. The urinary NGAL level shows that 8.9% of the patients are tubular damage by using this treatment protocol. The study concluded that ICBFM protocol is a safe protocol with little long term damage. 


Survivorship, Late complications, Renal diseases, ALL


Stiller C, Parkin D. Geographic and ethnic variations in the incidence of childhood cancer. British medical bulletin. 1996;52(4):682-703.

Greaves M. Infection, immune responses and the aetiology of childhood leukaemia. Nature Reviews Cancer. 2006;6(3):193.

Craft A, Pearson A. Three decades of chemotherapy for childhood cancer: from cure'at any cost'to cure'at least cost'. Cancer surveys. 1989;8(3):605-29.

Yetgin S, Olgar Ş, Aras T, Cetin M, Düzova A, Beylergil V, et al. Evaluation of kidney damage in patients with acute lymphoblastic leukemia in long‐term follow‐up: Value of renal scan. American journal of hematology. 2004;77(2):132-9.

Perazella MA. Crystal-induced acute renal failure. The American journal of medicine. 1999;106(4):459-65.

Kopecna L. Late effects of anticancer therapy on kidney function in children with acute lymphoblastic leukemia. Bratislavske lekarske listy. 2001;102(8):357-60.

Rossi R, Gödde A, Kleinebrand A, Riepenhausen M, Boos J, Ritter J, et al. Unilateral nephrectomy and cisplatin as risk factors of ifosfamide-induced nephrotoxicity: analysis of 120 patients. Journal of clinical oncology. 1994;12(1):159-65.

Ariceta G, Rodriguez‐Soriano J, Vallo A, Navajas A. Acute and chronic effects of cisplatin therapy on renal magnesium homeostasis. Medical and Pediatric Oncology: The Official Journal of SIOP—International Society of Pediatric Oncology (Societé Internationale d'Oncologie Pédiatrique. 1997;28(1):35-40.

Erdlenbruch B, Pekrun A, Roth C, Grunewald RW, Kern W, Lakomek M. Cisplatin nephrotoxicity in children after continuous 72-h and 3× 1-h infusions. Pediatric Nephrology. 2001;16(7):586-93.

Fassett RG, Venuthurupalli SK, Gobe GC, Coombes JS, Cooper MA, Hoy WE. Biomarkers in chronic kidney disease: a review. Kidney international. 2011;80(8):806-21.

Goetz DH, Willie ST, Armen RS, Bratt T, Borregaard N, Strong RK. Ligand preference inferred from the structure of neutrophil gelatinase associated lipocalin. Biochemistry. 2000;39(8):1935-41.

Bolignano D, Coppolino G, Romeo A, De Paola L, Buemi A, Lacquaniti A, et al. Neutrophil gelatinase-associated lipocalin (NGAL) reflects iron status in haemodialysis patients. Nephrology Dialysis Transplantation. 2009;24(11):3398-403.

Bolignano D, Lacquaniti A, Coppolino G, Donato V, Campo S, Fazio MR, et al. Neutrophil gelatinase-associated lipocalin (NGAL) and progression of chronic kidney disease. Clinical Journal of the American Society of Nephrology. 2009;4(2):337-44.

Nishida M, Kawakatsu H, Okumura Y, Hamaoka K. Serum and urinary neutrophil gelatinase‐associated lipocalin levels in children with chronic renal diseases. Pediatrics International. 2010;52(4):563-8.

Bolignano D, Coppolino G, Campo S, Aloisi C, Nicocia G, Frisina N, et al. Neutrophil gelatinase-associated lipocalin in patients with autosomal-dominant polycystic kidney disease. American journal of nephrology. 2007;27(4):373-8.

Brunner HI, Mueller M, Rutherford C, Passo MH, Witte D, Grom A, et al. Urinary neutrophil gelatinase–associated lipocalin as a biomarker of nephritis in childhood‐onset systemic lupus erythematosus. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 2006;54(8):2577-84.

Trollfors B, Norrby R. Estimation of glomerular filtration rate by serum creatinine and serum β2-microglobulin. Nephron. 1981;28(4):196-9.

Pui C-H, Boyett J, Rivera G, Hancock M, Sandlund J, Ribeiro R, et al. Long-term results of Total Therapy studies 11, 12 and 13A for childhood acute lymphoblastic leukemia at St Jude Children's Research Hospital. Leukemia. 2000;14(12):2286.

Reiter A, Schrappe M, Parwaresch R, Henze G, Müller-Weihrich S, Sauter S, et al. Non-Hodgkin's lymphomas of childhood and adolescence: results of a treatment stratified for biologic subtypes and stage--a report of the Berlin-Frankfurt-Münster Group. Journal of Clinical Oncology. 1995;13(2):359-72.

Schwartz GJ, Gauthier B. A simple estimate of glomerular filtration rate in adolescent boys. The Journal of pediatrics. 1985;106(3):522-6.

Harrison CJ, Haas O, Harbott J, Biondi A, Stanulla M, Trka J, et al. Detection of prognostically relevant genetic abnormalities in childhood B‐cell precursor acute lymphoblastic leukaemia: recommendations from the Biology and Diagnosis Committee of the International Berlin‐Frankfürt‐Münster study group. British journal of haematology. 2010;151(2):132-42.

Bonnesen TG, Winther JF, Asdahl PH, de Fine Licht S, Gudmundsdottir T, Holmqvist AS, et al. Long-term risk of renal and urinary tract diseases in childhood cancer survivors: A population-based cohort study. European Journal of Cancer. 2016;64:52-61.

Yetgin S, Olgar S, Aras T, Cetin M, Duzova A, Beylergil V, et al. Evaluation of kidney damage in patients with acute lymphoblastic leukemia in long-term follow-up: value of renal scan. American journal of hematology. 2004;77(2):132-9.

Hellerstein S, Alon U, Warady BA. Creatinine for estimation of glomerular filtration rate. Pediatric Nephrology. 1992;6(6):507-11.

Mishra J, Dent C, Tarabishi R, Mitsnefes MM, Ma Q, Kelly C, et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. The Lancet. 2005;365(9466):1231-8.

Nickolas TL, O'Rourke MJ, Yang J, Sise ME, Canetta PA, Barasch N, et al. Sensitivity and specificity of a single emergency department measurement of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury. Annals of internal medicine. 2008;148(11):810-9.

Ko GJ, Grigoryev DN, Linfert D, Jang HR, Watkins T, Cheadle C, et al. Transcriptional analysis of kidneys during repair from AKI reveals possible roles for NGAL and KIM-1 as biomarkers of AKI-to-CKD transition. American journal of physiology Renal physiology. 2010;298(6):F1472-83.

Wu Y, Su T, Yang L, Zhu S-N, Li X-M. Urinary neutrophil gelatinase-associated lipocalin: a potential biomarker for predicting rapid progression of drug-induced chronic tubulointerstitial nephritis. The American journal of the medical sciences. 2010;339(6):537-42.

Viau A, El Karoui K, Laouari D, Burtin M, Nguyen C, Mori K, et al. Lipocalin 2 is essential for chronic kidney disease progression in mice and humans. The Journal of clinical investigation. 2010;120(11):4065-76.

Rahimzadeh N, Otukesh H, Hoseini R, Sorkhi H, Otukesh M, Hoseini S, et al. Are serum and urine neutrophil gelatinase‐associated lipocalin predictive of renal graft function in short term? Pediatric transplantation. 2012;16(7):796-802.

DOI: https://doi.org/10.22037/jpn.v7i2.24506


  • There are currently no refbacks.