title: Deferasirox-induced renal impairment in children: an increasing concern for pediatricians.
abstract: BACKGROUND
  Deferasirox (DFX) is an oral iron chelator with an established dose-dependent efficacy in transfusion-related iron overload. Whereas emerging long-term data confirm the safety of the drug, with transient moderate elevation of serum creatinine level, several authors have reported renal tubular dysfunction. The aim of this study was to evaluate tubular and glomerular function before and after the initiation of DFX therapy in a pediatric patient population.
  
  
  METHODS
  Ten children (4 girls, mean age 12.4 ± 3.9 years) enrolled in a routine blood transfusion program were treated with 24.8 ± 9.6 mg/kg per day of DFX, and renal function was assessed before and 17.2 ± 8.9 months after the initiation of DFX therapy.
  
  
  RESULTS
  Prior to treatment with DFX, all patients had a normal glomerular function rate (GFR) (125 ± 15 ml/min per 1.73 m(2)) and normal tubular function. Following the initiation of DFX therapy, the GFR decreased by approximately 20 % with one patient with a GFR of <80 mL/min per 1.73 m(2) and seven patients with a GFR of <100 mL/min per 1.73 m(2). Two patients experienced a generalized proximal tubular dysfunction whereas nine patients presented at least one sign of proximal tubular dysfunction.
  
  
  CONCLUSIONS
  Renal toxicity is a frequent adverse event of DFX treatment, presenting as both glomerular and proximal dysfunction. A routine renal assessment is therefore required to prevent chronic kidney disease that may result from prolonged tubular injury.
authors.affiliation: Centre de Référence des Maladies Rénales Rares, Service de Néphrologie et Rhumatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France. laurence.dubourg@chu-lyon.fr.|Exploration Fonctionnelle Rénale et Métabolique, Hospices Civils de Lyon, Lyon, France. laurence.dubourg@chu-lyon.fr.|Université Claude Bernard, Lyon I, France. laurence.dubourg@chu-lyon.fr.|FRE CNRS 3310, Université Claude Bernard, Lyon I, France. laurence.dubourg@chu-lyon.fr.|Exploration Fonctionnelle Rénale et Métabolique, Pavillon P-Hôpital Edouard Herriot, 5 place d'Arsonval, 69437, Lyon cedex 03, France. laurence.dubourg@chu-lyon.fr.
authors.forename: Laurence
authors.initials: L
authors.lastname: Dubourg
authors.affiliation: Centre de Référence des Maladies Rénales Rares, Service de Néphrologie et Rhumatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Laurain
authors.affiliation: Centre de Référence des Maladies Rénales Rares, Service de Néphrologie et Rhumatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Ranchin
authors.affiliation: Université Claude Bernard, Lyon I, France.|Institut d'Hématologie et d'Oncologie Pédiatrique et Centre de Références des Thalassémies, Hospices Civils de Lyon, Lyon, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Pondarré
authors.affiliation: Exploration Fonctionnelle Rénale et Métabolique, Hospices Civils de Lyon, Lyon, France.|Université Claude Bernard, Lyon I, France.
authors.forename: Aoumeur
authors.initials: A
authors.lastname: Hadj-Aïssa
authors.affiliation: FRE CNRS 3310, Université Claude Bernard, Lyon I, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Sigaudo-Roussel
authors.affiliation: Centre de Référence des Maladies Rénales Rares, Service de Néphrologie et Rhumatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.|Université Claude Bernard, Lyon I, France.|FRE CNRS 3310, Université Claude Bernard, Lyon I, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Cochat
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000367:Age Factors; D001565:Benzoates / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D000077588:Deferasirox; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007444:Inulin; D007502:Iron Chelating Agents / Q000008:administration & dosage / Q000009:adverse effects*; D019190:Iron Overload / Q000188:drug therapy / Q000209:etiology; D007674:Kidney Diseases / Q000139:chemically induced* / Q000503:physiopathology; D007678:Kidney Glomerulus / Q000187:drug effects* / Q000503:physiopathology; D007687:Kidney Tubules, Proximal / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D011446:Prospective Studies; D013997:Time Factors; D065227:Transfusion Reaction; D014230:Triazoles / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D001565:Benzoates; D007502:Iron Chelating Agents; D014230:Triazoles; D007444:Inulin; D000077588:Deferasirox