This investigation aimed to evaluate glomerular dysfunction among childhood cancer survivors in comparison with matched controls from the general population. In the Dutch Childhood Cancer Survivor Study (DCCSS)-LATER 2 kidney analysis, a nationwide cross-sectional cohort study, 1024 survivors five or more years after diagnosis, aged 18 or more years at study, treated between 1963-2001 with nephrectomy, abdominal radiotherapy, total body irradiation, cisplatin, carboplatin, ifosfamide, high-dose cyclophosphamide or hematopoietic stem cell transplantation participated. In addition, 500 age- and sex-matched controls from Lifelines, a prospective population-based cohort study in the Netherlands, participated. At a median age of 32.0 years (interquartile range 26.6-37.4), the glomerular filtration rate was under 60 ml/min/1.73m² in 3.7% of survivors and in none of the controls. Ten survivors had kidney failure. Chronic kidney disease according to age-thresholds (glomerular filtration rate respectively under 75 for age under 40, under 60 for ages 40-65, and under 40 for age over 65) was 6.6% in survivors vs. 0.2% in controls. Albuminuria (albumin-to-creatinine ratio over3 mg/mmol) was found in 16.2% of survivors and 1.2% of controls. Risk factors for chronic kidney disease, based on multivariable analyses, were nephrectomy (odds ratio 3.7 (95% Confidence interval 2.1-6.4)), abdominal radiotherapy (1.8 (1.1-2.9)), ifosfamide (2.9 (1.9-4.4)) and cisplatin over 500 mg/m² (7.2 (3.4-15.2)). For albuminuria, risk factors were total body irradiation (2.3 (1.2-4.4)), abdominal radiotherapy over 30 Gy (2.6 (1.4- 5.0)) and ifosfamide (1.6 (1.0-2.4)). Hypertension and follow-up 30 or more years increased the risk for glomerular dysfunction. Thus, lifetime monitoring of glomerular function in survivors exposed to these identified high risk factors is warranted.

这项调查旨在评估儿童癌症幸存者的肾小球功能障碍，并与来自一般人群的匹配对照进行比较。在荷兰儿童癌症幸存者研究 (DCCSS)-LATER 2 肾脏分析中，一项全国性的横断面队列研究，1024 名幸存者在诊断后五年或更长时间，研究时年龄在 18 岁或以上，在 1963 年至 2001 年间接受了肾切除术、腹部手术放疗、全身照射、顺铂、卡铂、异环磷酰胺、大剂量环磷酰胺或造血干细胞移植。此外，来自荷兰一项基于人群的前瞻性队列研究 Lifelines 的 500 名年龄和性别匹配的对照者也参与了研究。中位年龄 32.0 岁（四分位间距 26.6-37.4）时，肾小球滤过率低于 60 ml/min/1.73m²在 3.7% 的幸存者中，而在对照组中没有。十名幸存者肾衰竭。根据年龄阈值（肾小球滤过率分别为 75 岁以下为 40 岁以下、60 岁以下为 40-65 岁和 40 岁以上为 65 岁以上）的慢性肾病幸存者为 6.6%，而对照组为 0.2%。在 16.2% 的幸存者和 1.2% 的对照组中发现了白蛋白尿（白蛋白与肌酐的比率超过 3 mg/mmol）。基于多变量分析，慢性肾病的危险因素是肾切除术（比值比 3.7（95% 置信区间 2.1-6.4））、腹部放疗（1.8（1.1-2.9））、异环磷酰胺（2.9（1.9-4.4））和顺铂超过 500 mg/m ²(7.2 (3.4-15.2))。对于蛋白尿，危险因素是全身照射 (2.3 (1.2-4.4))、超过 30 Gy 的腹部放疗 (2.6 (1.4-5.0)) 和异环磷酰胺 (1.6 (1.0-2.4))。高血压和 30 年或更长时间的随访增加了肾小球功能障碍的风险。因此，有必要对暴露于这些已确定的高风险因素的幸存者进行终生肾小球功能监测。