The Application of 99mTc-DTPA Renal Dynamic Imaging to Measuring Renal Function of Children with Acute Lymphoblastic Leukemia after Induction Therapy

Abstract

Purpose. The study was aimed at assessing renal functions of children with acute lymphoblastic leukemia (ALL) after induction therapy by 99mTc-DTPA renal dynamic imaging Gates method (GFRGates) and investigating whether renal function after induction therapy will affect the occurrence of high-dose methotrexate- (HDMTX-) induced acute kidney injury (AKI). Methods. Children with newly diagnosed ALL were enrolled. Renal functions before the administration of HDMTX were assessed by estimated glomerular filtration rate (eGFR) and GFRGates, respectively, before the first cycle of HDMTX after induction therapy. The areas under the ROC curve were used to assess covariates’ ability to predict HDMTX-induced AKI. Results. 102 children with ALL were included in the study. A stepwise backward binary logistic regression showed that only standardized GFRGates was an independent risk factor for HDMTX-induced AKI ( $p=0.018$ , odds ratio 0.985, 95% CI 0.972-0.997). The area under the ROC of standardized GFRGates was 0.679 ( $p=0.012$ , 95% CI 0.554-0.804). Conclusion. Standardized GFRGates showed that the normal renal function of children is not enough to be used as a cutoff point to predict HDMTX-induced AKI in ALL children receiving HDMTX. More attention and supportive care should be given to the children with standardized GFRGates lower than the cutoff value to avoid the HDMTX-induced AKI.