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    r> Conclusions A large percentage of children with cancer experience AKI during the course of treatment, and AKI is associated with impaired long-term renal function. (J Pediatr 2019;208:243-50).
    Patients with cancer may experience various adverse events during the course of their disease, including acute kidney injury (AKI). Cancer is a known risk factor of AKI.1-5 AKI occurs in such patients because of tumor lysis syndrome (TLS), the use of nephrotoxic agents (eg, chemotherapeutics, antimicrobials, and Z-VAD-FMK media), direct infiltration
    of the genitourinary system by cancer cells, or multiorgan failure following sepsis or other morbidities.1,5,6 When AKI occurs during cancer treatment, certain treatment agents may require dose adjustments or complete elimination from the treatment strategy, which may adversely affect the outcome of cancer treatment. In critically ill patients, AKI itself may be associated with increased length of hospital stay and odds of mortality Z-VAD-FMK and may have a negative impact on prognosis.7-9 Moreover, AKI is a known risk factor of chronic kidney disease (CKD), further affecting the long-term quality of life of cancer survivors.10 AKI has been investigated in patients with cancer in various studies. In a population-based cohort study that included
    patients of all ages, the incidence of AKI in the first year of cancer diagnosis was 25.8% among 37 267 patients with cancer, and their 1-year cumulative risk was 17.5%.11,12 In another recent study, 12% of 3558 adults admitted to a cancer center developed AKI.9 However, the incidence of AKI has not been well established in the pediatric population of patients with cancer. In the few available studies, the incidence of AKI ranged between 11% and 84%, but these studies were limited to patients with hematologic malignancies.13-16 Cancer among children differs from that among adults in aspects such as biology, host, and epidemiology. Children rarely
    have epithelial tumors in solid organs, such as the lung, colon, and breast, but
    usually have embryonal tumors in the hematopoietic system and the central ner-
    vous system.17 Concomitant medical conditions, such as diabetes, hypertension, From the 1 Department of Pediatrics, Seoul National
    and CKD, are rare in children, and children seldom smoke or drink. The epide-
    University College of Medicine, Seoul, Korea; 2Seoul
    miology of diseases in children is, thus, expected to be different from that in National University Cancer Research Institute, Seoul,
    Korea; 3Department of Internal Medicine, Seoul National
    adults. In addition, the impact of AKI on the development of CKD can be University Hospital, Seoul, Korea; 4Statistics and Data
    Center, Samsung Medical Center, Seoul, Korea; 5Kidney
    Research Institute, Seoul National University College of
    Medicine, Seoul, Korea; and 6Department of Biomedical
    Engineering, Seoul National University College of
    AKI Acute kidney injury HSCT Hematopoietic stem cell
    Medicine, Seoul, Korea
    *Contributed equally.
    ALL Acute lymphoblastic leukemia
    Supported by the Interdisciplinary Research program
    AML Acute myeloid leukemia KDIGO Kidney Disease: Improving Global
    from College of Engineering and College of Medicine,
    CKD Chronic kidney disease
    Seoul National University, Seoul, Korea
    Cr Creatinine NBL Neuroblastoma
    CT Computed tomography RRT Renal replacement therapy
    eGFR Estimated glomerular filtration rate TLS Tumor lysis syndrome
    THE JOURNAL OF PEDIATRICS Volume 208 May 2019
    expected to be different in children because of the differences in underlying medical conditions. In general, AKI has been shown to be more common in children than in adults, as indicated in a systematic review of 312 studies reporting a higher incidence of AKI in children in hospital settings compared with adults (33.7% vs 21.6%).18 The incidence of AKI in hospitalized children has recently been reported to be 34%-40%, with two-thirds of them being stages 2 or 3.18-21 Nonetheless, more focused and comprehensive data on AKI among children with cancer are limited. We, thus, aimed to evaluate the characteristics of AKI in children with cancer, including its incidence, change during the course of cancer treatment, and risk factors. We further analyzed the influence of AKI on long-term renal outcomes, including CKD and proteinuria, in this patient group.