Renal involvement in children with malignancies

Renal complications in children with malignancies primarily arise from rena l parenchymal tumors, "tumor lysis syndrome," and malignant infiltration or obstruction of the urinary tract. Therapy-associated renal side effects ma y develop following surgical and cytostatic treatment or be induced by radi otherapy. Clinically, both acute renal failure, for example following cispl atin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients ar e, however, not well established, but terminal renal failure is a rare even t: pediatric malignancies account for only 0.9% of patients on renal replac ement therapy; the majority of these patients had been treated for a bilate ral nephroblastoma. Since potentially serious long-term renal sequelae may evolve following both single measures and additive nephrotoxic effects, lon g-term monitoring of growth, blood pressure, and renal function is mandator y for a great proportion of former pediatric oncology patients. Future rese arch should prospectively address frequencies of long-term renal impairment in these patients and should establish the prognosis of renal dysfunction. Only these data will ultimately allow risk-adopted use of potentially neph rotoxic treatment modalities and adequate counselling of patients.