Growth impairment after ifosfamide-induced nephrotoxicity in children.
BACKGROUND
The goal of this study was to analyze long-term consequences of ifosfamide-induced nephrotoxicity on growth and renal function in children treated for cancer.


METHODS
In a retrospective study, departments for pediatric oncology and nephrology in Germany, Austria, and Switzerland were asked to report patients with serious long-term nephrotoxicity after ifosfamide-treatment. Data at first appearance of renal dysfunction and at the last renal examination were collected using a standardized questionnaire.


RESULTS
Fifty-nine patients with tubulopathy (35 severe, 24 moderate) following ifosfamide therapy were eligible for analysis of long-term outcome (median follow-up 4 years, range 1.1 to 12.9). Median height standard deviation score was significantly reduced at renal diagnosis, and at last renal examination (-1.7 and -2.1 respectively, P < 0.01 at each point in time). Patients with tubulopathy also had stunted growth in comparison with a control group of cancer patients without renal disease (mean difference at last examination: 7.3 cm (95% confidence interval: 2.5 to 12.1 cm). In patients with severe tubulopathy, glomerular filtration rate deteriorated significantly over time. End-stage renal disease was reported in one patient only, not solely caused by ifosfamide.


CONCLUSIONS
Depending on the extent of tubular dysfunction, patients with ifosfamide-induced nephrotoxicity experienced significant growth impairment and a slow decline in glomerular filtration rate.
Stöhr
Wolfgang
W
Department of Pediatric Oncology, LESS Centre, University Hospital for Children and Adolescents, Erlangen, Germany.
Patzer
Ludwig
L
Paulides
Marios
M
Kremers
Anja
A
Beck
Jörn-Dirk
JD
Langer
Thorsten
T
Rossi
Rainer
R
D000293:Adolescent; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects*; D001827:Body Height; D002648:Child; D002675:Child, Preschool; D005260:Female; D005919:Glomerular Filtration Rate; D006130:Growth Disorders / Q000209:etiology*; D006801:Humans; D007069:Ifosfamide / Q000009:adverse effects*; D007223:Infant; D007674:Kidney Diseases / Q000139:chemically induced* / Q000150:complications* / Q000503:physiopathology; D008297:Male; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
D018906:Antineoplastic Agents, Alkylating; D007069:Ifosfamide