Hypertension, high-dose corticosteroids, and renal infiltration in children with acute lymphoblastic leukemia

Abstract

Background Hypertension is a rarely recognized complicationof acute lymphoblastic leukemia (ALL). The incidence ofhypertension in ALL patients in Indonesia remains unknown,but the most common risk factors are corticosteroid use duringinduction-phase chemotherapy and renal leukemic infiltration.Objective To determine the incidence of hypertension in childrenwith ALL, and to assess for associations of high-dose corticosteroids,renal infiltration, and hyperleukocytosis to hypertension.Methods This was a cross-sectional study involving 100 childrenaged 2-18 years. Subjects were newly diagnosed ALL patients andthose underwent induction-phase chemotherapy in the PediatricWard or Outpatient Clinic at Cipto Mangunkusumo or DharmaisHospitals.Results Hypertension occurred in 6 (10%) of 60 newly diagnosedALL patients and 8 (20%) of 40 patients who had receivedhigh-dose corticosteroids, but the difference was not statisticallysignificant (OR=2.25; 95%CI 0.72 to 7.07; P=0.239). Hypertensionwas reported in 8 of 29 subjects who received dexamethasone,but in none of the subjects who received prednisone. However, thedifference in these subgroups was also not statistically significant.Renal enlargement was found in 1 of 14 hypertensive patients, butit was not associated with hypertension (OR=0.80; 95%CI 0.52to 1.24; P=0.417). Hyperleukocytosis was also not associated withhypertension (OR= 0.79; 95% CI 0.20 to 3.11; P=1.000).Conclusion The incidence of hypertension in ALL patients was14%. Hypertension is not associated with renal infiltration orhyperleukocytosis. Furthermore, hypertension is not associatedwith corticosteroid dose, though is found only in subjects whoreceive dexamethasone. [Paediatr Indones. 2014;54:372-6.].