Skip to main content

Advertisement

SpringerLink
Log in

Glomerular hyperfiltration in children with cancer: prevalence and a hypothesis

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hjorth L, Wiebe T, Karpman D (2011) Hyperfiltration evaluated by glomerular filtration rate at diagnosis in children with cancer. Pediatr Blood Cancer 56:762–766

    Article  PubMed  Google Scholar 

  2. Fleming JS, Zivanovic MA, Blake GM et al (2004) Guidelines for the measurement of glomerular filtration rate using plasma sampling. Nucl Med Commun 25:759–769

    Article  PubMed  Google Scholar 

  3. Piepsz A, Pintelon H, Ham HR (1994) Estimation of normal chromium-51 ethylene diamine tetra-acetic acid clearance in children. Eur J Nucl Med 21:12–16

    Article  CAS  PubMed  Google Scholar 

  4. Brandt JR, Wong C, Jones DR et al (2003) Glomerular filtration rate in children with solid tumors: normative values and a new method for estimation. Pediatr Hematol Oncol 20:309–318

    Article  CAS  PubMed  Google Scholar 

  5. Blake GM, Gardiner N, Gnanasegaran G et al (2005) Reference ranges for 51Cr-EDTA measurements of glomerular filtration rate in children. Nucl Med Commun 26:983–987

    Article  PubMed  Google Scholar 

  6. Piepsz A, Tondeur M, Ham H (2006) Revisiting normal (51)Cr-ethylenediaminetetraacetic acid clearance values in children. Eur J Nucl Med Mol Imaging 33:1477–1482

    Article  CAS  PubMed  Google Scholar 

  7. Bhatt MK, Bartlett ML, Mallitt K-A et al (2011) Correlation of various published radionuclide glomerular filtration rate estimation techniques and proposed paediatric normative data. Nucl Med Commun 32:1088–1094

    Article  PubMed  Google Scholar 

  8. Thomas DM, Coles GA, Williams JD (1994) What does the renal reserve mean? Kidney Int 45:411–416

    Article  CAS  PubMed  Google Scholar 

  9. Aygun B, Mortier NA, Smeltzer MP et al (2013) Hydroxyurea treatment decreases glomerular hyperfiltration in children with sickle cell anemia. Am J Hematol 88:116–119

    Article  CAS  PubMed  Google Scholar 

  10. Helal I, Fick-Brosnahan GM, Reed-Gitomer B et al (2012) Glomerular hyperfiltration: definitions, mechanisms and clinical implications. Nat Rev Nephrol 8:293–300

    Article  CAS  PubMed  Google Scholar 

  11. Douglas RG, Shaw JH (1990) Metabolic effects of cancer. Br J Surg 77:246–254

    Article  CAS  PubMed  Google Scholar 

  12. Jeevanandam M, Horowitz GD, Lowry SF et al (1984) Cancer cachexia and protein metabolism. Lancet 1:1423–1426

    Article  CAS  PubMed  Google Scholar 

  13. Donohoe CL, Ryan AM, Reynolds JV (2011) Cancer cachexia: mechanisms and clinical implications. Gastroenterol Res Pract 2011:601434

    Article  PubMed  PubMed Central  Google Scholar 

  14. Fearon KCH, Glass DJ, Guttridge DC (2012) Cancer cachexia: mediators, signaling, and metabolic pathways. Cell Metab 16:153–166

    Article  CAS  PubMed  Google Scholar 

  15. Li Z, Zhang H (2016) Reprogramming of glucose, fatty acid and amino acid metabolism for cancer progression. Cell Mol Life Sci 73:377–392

    Article  CAS  PubMed  Google Scholar 

  16. Stallings VA, Vaisman N, Chan HS et al (1989) Energy metabolism in children with newly diagnosed acute lymphoblastic leukemia. Pediatr Res 26:154–157

    Article  CAS  PubMed  Google Scholar 

  17. den Broeder E, Oeseburg B, Lippens RJ et al (2001) Basal metabolic rate in children with a solid tumour. Eur J Clin Nutr 55:673–681

    Article  Google Scholar 

  18. Picton SV (1998) Aspects of altered metabolism in children with cancer. Int J Cancer Suppl 11:62–64

    Article  CAS  PubMed  Google Scholar 

  19. Green GJ, Weitzman SS, Pencharz PB (2008) Resting energy expenditure in children newly diagnosed with stage IV neuroblastoma. Pediatr Res 63:332–336

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Diagnostic Imaging and Radiology, Children’s National Medical Center, 111 Michigan Ave. NW, Washington, DC, 20010, USA

    Neha S. Kwatra, Nayan Pandya & Massoud Majd

  2. Department of Radiology, Boston Children’s Hospital, Boston, MA, USA

    Neha S. Kwatra

  3. Department of Hematology/Oncology, Children’s National Medical Center, Washington, DC, USA

    Holly J. Meany

  4. Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA

    Sunil J. Ghelani

  5. Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    David Zahavi

Authors
  1. Neha S. Kwatra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Holly J. Meany
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sunil J. Ghelani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Zahavi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nayan Pandya
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Massoud Majd
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Massoud Majd.

Ethics declarations

Conflicts of interest

None

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kwatra, N.S., Meany, H.J., Ghelani, S.J. et al. Glomerular hyperfiltration in children with cancer: prevalence and a hypothesis. Pediatr Radiol 47, 221–226 (2017). https://doi.org/10.1007/s00247-016-3733-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-016-3733-5

Keywords

Search

Navigation