Hypermagnesiuria and hypercalciuria in childhood leukemia: an effect of amikacin therapy.
OBJECTIVE
The purpose of this study is to assess the effects of amikacin on renal proximal tubular function, and on magnesium (Mg) and calcium (Ca) status in children treated for acute lymphoblastic leukemia (ALL).


METHODS
Eighteen children (11 male/7 female, ages 2-18 years) receiving antileukemic therapy (Dana Farber Cancer Institute protocols 87-001 or 91-001) and admitted for febrile neutropenia to The Children's Hospital at Chedoke-McMaster, Hamilton, Ontario were recruited into this descriptive prospective study. Each child was treated with amikacin (7.5 mg/kg/12 h x 10-14 days) for one or more courses.


RESULTS
No patient demonstrated elevations in amikacin trough levels. beta 2-Microglobulinuria, glucosuria, proteinuria, and hyperphosphaturia were absent. Children (50% presenting with hypomagnesemia (< 0.77 mmol/L) had a significant rise in mean urinary Mg:creatinine (0.46 +/- 0.27 versus 0.82 +/- 0.38 mmol, mean +/- SD, p < 0.05) in response to amikacin therapy and the mean Ca:creatinine ratio increased by 95% after 10-14 days of amikacin treatment. Serum Mg and Ca did not change notably after treatment, irrespective of initial Mg status.


CONCLUSIONS
Aminoglycoside therapy in children with ALL is not associated with overt nephrotoxicity. A transient renal leak of Mg and Ca does occur. Screening of ALL children for mild hypomagnesemia may help to identify those most at risk of disruption of renal conservation of Mg and possibly Ca.
Wu
B
B
Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
Atkinson
S A
SA
Halton
J M
JM
Barr
R D
RD
D000293:Adolescent; D000583:Amikacin / Q000009:adverse effects* / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002118:Calcium / Q000652:urine*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007687:Kidney Tubules, Proximal / Q000187:drug effects; D008274:Magnesium / Q000652:urine*; D008297:Male; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology / Q000652:urine; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000378:metabolism / Q000652:urine; D011446:Prospective Studies
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D000583:Amikacin; D008274:Magnesium; D002118:Calcium