nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2017-3-61-68nefr-265Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSОСТРОЕ ПОВРЕЖДЕНИЕ ПОЧЕК У ДЕТЕЙ С ЛЕЙКОЗАМИACUTE KIDNEY INJURY IN CHILDREN WITH LEUKEMIAГревцеваЕ. А.GrevtsevaE. A.

онкогематологическое отделение химиотерапии Воронежской областной детской клинической больницы №1, врач-гематолог,

394087, Воронеж, ул. Ломоносова, д. 114

Hematological department, hematologist,

94087, Voronezh, street of Lomonosov, d. 114

grievtsieva85@mail.ruНастаушеваТ. Л.NastaushevaT. L.

д.м.н., кафедра госпитальной и поликлинической педиатрии, профессор,

394036, Воронеж, ул. Студенческая, д. 10

Prof., MD, PhD, DMedSci., Department of hospital and polyclinic Pediatrics,

394036, Voronezh, Studencheskaya str., 10

nastat53@mail.ruВолосовецГ. Г.VolosovetsG. G.

асс., к.м.н.,  кафедра госпитальной и поликлинической педиатрии, 

394036, Воронеж, ул. Студенческая, д. 10

Ass., CandidateMedSci, Department of hospital and polyclinic Pediatrics,

394036, Voronezh, Studencheskaya str., 10

volga-6@mail.ruЮдинаН. Б.YudinaN. B.

онкогематологическое отделение химиотерапии, зав. отделением, врач-онколог,

394087, Воронеж, ул. Ломоносова, д. 114

Hematological department, head. office, oncologist,

394087, Voronezh, street of Lomonosov, d. 114

n.yudina@list.ruВоронежский государственный медицинский университет им. Н.Н. Бурденко; Воронежская областная детская клиническая больница №1РоссияVoronezh State Medical University named after N.N. Burdenko; Regional children's clinical hospital № 1Russian FederationВоронежский государственный медицинский университет им. Н.Н. БурденкоРоссияVoronezh State Medical University named after N.N. BurdenkoRussian FederationВоронежская областная детская клиническая больница №1РоссияRegional children's clinical hospital № 1Russian Federation2017250420172136168Copyright © Гревцева Е.А., Настаушева Т.Л., Волосовец Г.Г., Юдина Н.Б., 20172017Гревцева Е.А., Настаушева Т.Л., Волосовец Г.Г., Юдина Н.Б.Grevtseva E.A., Nastausheva T.L., Volosovets G.G., Yudina N.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/265ЦЕЛЬ

ЦЕЛЬ. Оценка частоты и течения острого повреждения почек (ОПП) у детей на различных этапах терапии лейкозов.

ПАЦИЕНТЫ И МЕТОДЫ

ПАЦИЕНТЫ И МЕТОДЫ. В исследование было включено 143 ребенка с различными вариантами лейкоза, получавшими лечение на базе онкогематологического отделения химиотерапии Воронежской областной детской клинической больницы №1 за период с 01.2008г. по 01.2014г. Наблюдение проводилось на 4-х этапах: до назначения полихимиотерапии (ПХТ), на этапе интенсивной ПХТ, в период поддерживающей ПХТ и на этапе после окончания лечения в периоде стойкой ремиссии. ОПП диагностировали с учетом уровня скорости клубочковой фильтрации (СКФ) и креатинина сыворотки крови, превышающих нормальные значения как минимум в 1,5 раза (на 25%).

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. ОПП диагностировано у 109 детей (76,2%) из 143 обследованных, причем стадия риска ОПП (Risk) выявлена у 44 детей (30,8%), стадия повреждения (Injury) – у 46 детей (32,2%), стадия недостаточности (Failure) – у 19 детей (13,3%). ОПП отмечалось на всех этапах терапии, но максимально часто (у 77 из 89 детей, 86,5%) – на этапе интенсивного лечения. У 16 из 30 детей (53,3%), наблюдавшихся на всех этапах терапии, ОПП различных стадий регистрировалось неоднократно, максимально до 4 раз. За период наблюдения летальный исход наблюдался у 20 пациентов, в основном в периоде интенсивной ПХТ, у всех было ОПП средней и тяжелой степени тяжести: 8 – стадия Injury, 12 – стадия Failure.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. ОПП достаточно часто регистрируется у детей с лейкозами, максимально часто на этапе интенсивной ПХТ. Развитие ОПП ухудшает прогноз лейкоза у детей в отношении выживаемости. У одного и того же пациента возможно неоднократное развитие ОПП на разных этапах лечения. 

THE AIM

THE AIM. Evaluation of frequency and course of acute kidney injury (AKI) in children with leukemia at the different stages of therapy.

PATIENTS AND METHODS

PATIENTS AND METHODS. In our study we included 143 children with different variants of leukemia receiving polychemiotherapy (PCHT) at oncohematolological unit of VRCH №1 for the period from 01.2008 to 01.2014 year. The observation was conducted at 4 stages: before polychemiotherapy (PCHT), during intensive PCHT, during maintaining PCHT, after the end of the treatment during stable remission. AKI was diagnosed with regard to the level of glomerular filtration rate (GFR) and serum creatinine which were decreased and increased respectively minimum in 1.5 times (25%).

RESULTS

RESULTS: We diagnosed AKI in 109 children (76,2 %) from 143 observed patients, Risk stage was found in 44 children (30,8 %), the stage of Injury – in 46 children (32,2 %), the stage of Failure – in 19 children (13,3%). AKI was noted at all phases of chemotherapy, maximum at the stage of intensive PCHT (in 77 from 89 children, 86,5 %). In 16 from 30 children (53,3 %) observed during all phases of treatment AKI registered several times (maximum 4 times). During the period of observation the fatal outcome was registrated in 20 children (more often in the period of intensive PCHT); all of them had moderate and severe stages of AKI: 8 patients – stage Injury, 12 – stage Failure.

CONCLUSION

CONCLUSION. AKI was registrated quite often in children with leukemia, the most frequent at the stage of intensive PCHT. Development of AKI aggravates prognosis of leukemia in children in relation to survival. The patient with leukemia can develop AKI several times during different stages of PCHT and after the end of treatment. 

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The authors declare that there are no conflicts of interest present.