Towards preservation of kidney function in children with cancer

Over the past decades, survival rates for children with cancer have improved markedly, shifting focus toward treatment-related complications and long-term health outcomes. Kidney injury—both acute kidney injury (AKI) and chronic kidney disease (CKD)—has emerged as a significant and potentially lasting complication in this population.
This thesis investigates the incidence, risk factors, and outcomes of kidney injury in children with cancer, with particular attention to critically ill patients and those with renal tumors such as Wilms tumor. The findings demonstrate that AKI is common during cancer treatment and is strongly associated with subsequent development of CKD, even after a single episode. Exposure to nephrotoxic medications, critical illness, and reduced nephron mass contribute substantially to this risk.
In critically ill patients requiring continuous kidney replacement therapy, mortality remains high. Importantly, fluid overload was identified as an early and clinically relevant predictor of poor outcome, preceding traditional markers such as serum creatinine. These findings highlight the importance of early recognition and timely intervention.
The thesis further shows that children with renal tumors represent a particularly vulnerable group due to combined oncological treatment and reduced kidney reserve. While radiotherapy appears to pose limited risk at lower doses, higher radiation exposure may contribute to long-term kidney damage.
Finally, this work underscores the limitations of conventional kidney function markers and highlights the potential of novel biomarkers, such as NGAL, for earlier detection of kidney injury.
Overall, this thesis advocates for a proactive, risk-based and multidisciplinary approach to nephrotoxicity in pediatric oncology, integrating prevention, early detection, and long-term follow-up. Such strategies are essential to preserve kidney function and improve quality of life for childhood cancer survivors.