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Association of bone mineral density with incidental renal stone in long-term survivors of childhood acute lymphoblastic leukemia

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Abstract

Purpose

Our objective was to evaluate the association between low bone mineral density (BMD) and incidental renal stones among long-term survivors of childhood acute lymphoblastic leukemia (ALL).

Methods

Adult participants who were 10+ years from their childhood ALL diagnosis and members of the St. Jude Lifetime Cohort study were recruited between December 2007 and March 2011. During their risk-based medical evaluations, they underwent quantitative computed tomography (QCT) to evaluate BMD. Incidental renal stones were identified by radiologists' review of axial QCT source images. Demographic and dietary information were abstracted from health surveys and the Block Food Frequency questionnaire, respectively. The multivariable logistic regression model was used for analysis.

Results

At a median of 26.1 years from diagnosis, BMD Z scores were ≤−2 in 34 of 662 (5.2 %) and renal stones detected in 73 of 662 (11 %) participants. Adjusted for age, renal radiation, dietary vitamin D, gender, and body mass index, when compared to those with BMD Z scores ≥0, the risk of renal stones was increased among those with BMD Z scores ≤−2 (odds ratio [OR], 2.92; 95 % confidence interval [CI] 1.14–7.48). Risk of renal stones significantly increased for older age (45–54 vs.18–24 years; OR, 3.70; 95 % CI 1.11–12.35) whereas the risk was higher but nonsignificant for >141.5 IU (sample median) daily intake of vitamin D (OR, 1.64; 95 % CI 0.98–2.75).

Conclusions and implications for cancer survivors

Older ALL survivors with BMD Z scores ≤−2 are at risk for renal stones and should be counseled so that appropriate follow-up care can be provided for those among whom renal stones are detected.

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References

  1. Howlader N, Noone AM, Krapcho M, et al., eds. SEER cancer statistics review 1975–2008; based on November 2010 SEER data submission. 2011. http://www.seer.cancer.gov/csr/1975_2008. Accessed 6 Nov 2011

  2. Kaste SC. Skeletal toxicities of treatment in children with cancer. Pediatr Blood Cancer. 2008;50:469–73.

    Article  PubMed  Google Scholar 

  3. Wasilewski-Masker K, Kaste SC, Hudson MM, Esiashvili N, Mattano LA, Meacham LR. Bone mineral density deficits in survivors of childhood cancer: long-term follow-up guidelines and review of the literature. Pediatrics. 2008;121:e705–13.

    Article  PubMed  Google Scholar 

  4. Howard SC, Kaplan SD, Razzouk BI, et al. Urolithiasis in pediatric patients with acute lymphoblastic leukemia. Leukemia. 2003;17:541–6.

    Article  PubMed  CAS  Google Scholar 

  5. Jones DP, Spunt SL, Green D, Springate JE. Renal late effects in patients treated for cancer in childhood: a report from the Children's Oncology Group. Pediatr Blood Cancer. 2008;51:724–31.

    Article  PubMed  Google Scholar 

  6. Caudarella R, Vescini F, Buffa A, La Manna G, Stefoni S. Osteoporosis and urolithiasis. Urol Int. 2004;72:17–9.

    Article  PubMed  Google Scholar 

  7. Lauderdale DS, Thisted RA, Wen M, Favus MJ. Bone mineral density and fracture among prevalent kidney stone cases in the Third National Health and Nutrition Examination Survey. J Bone Miner Res. 2001;16:1893–8.

    Article  PubMed  CAS  Google Scholar 

  8. Tsuji H, Umekawa T, Kurita T, et al. Analysis of bone mineral density in urolithiasis patients. Int J Urol. 2005;12:335–9.

    Article  PubMed  Google Scholar 

  9. Letavernier E, Traxer O, Daudon M, et al. Determinants of osteopenia in male renal-stone-disease patients with idiopathic hypercalciuria. Clin J Am Soc Nephrol. 2011;6:1149–54.

    Article  PubMed  Google Scholar 

  10. Davies JH, Evans BA, Jenney ME, Gregory JW. Skeletal morbidity in childhood acute lymphoblastic leukaemia. Clin Endocrinol (Oxf). 2005;63:1–9.

    Article  CAS  Google Scholar 

  11. Arjmandi-Rafsanjani K, Hooman N, Vosoug P. Renal function in late survivors of Iranian children with cancer: single centre experience. Indian J Cancer. 2008;45:154–7.

    Article  PubMed  CAS  Google Scholar 

  12. Kaste SC, Jones-Wallace D, Rose SR, et al. Bone mineral decrements in survivors of childhood acute lymphoblastic leukemia: frequency of occurrence and risk factors for their development. Leukemia. 2001;15:728–34.

    Article  PubMed  CAS  Google Scholar 

  13. Pui CH, Roy 3rd S, Noe HN. Urolithiasis in childhood acute leukemia and nonHodgkin's lymphoma. J Urol. 1986;136:1052–4.

    PubMed  CAS  Google Scholar 

  14. Johri N, Cooper B, Robertson W, Choong S, Rickards D, Unwin R. An update and practical guide to renal stone management. Nephron Clin Pract. 2010;116:c159–71.

    Article  PubMed  Google Scholar 

  15. Trinchieri A. Bone mineral content in calcium renal stone formers. Urol Res. 2005;33:247–53.

    Article  PubMed  CAS  Google Scholar 

  16. Coe FL, Parks JH, Asplin JR. The pathogenesis and treatment of kidney stones. N Engl J Med. 1992;327:1141–52.

    Article  PubMed  CAS  Google Scholar 

  17. Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol. 2010;12:e86–96.

    PubMed  Google Scholar 

  18. Lorenz EC, Lieske JC, Vrtiska TJ, et al. Clinical characteristics of potential kidney donors with asymptomatic kidney stones. Nephrol Dial Transplant. 2011;26:2695–700.

    Article  PubMed  Google Scholar 

  19. Glowacki LS, Beecroft ML, Cook RJ, Pahl D, Churchill DN. The natural history of asymptomatic urolithiasis. J Urol. 1992;147:319–21.

    PubMed  CAS  Google Scholar 

  20. Burgher A, Beman M, Holtzman JL, Monga M. Progression of nephrolithiasis: long-term outcomes with observation of asymptomatic calculi. J Endourol. 2004;18:534–9.

    Article  PubMed  Google Scholar 

  21. Kaste SC, Thomas NA, Rai SN, et al. Asymptomatic kidney stones in long-term survivors of childhood acute lymphoblastic leukemia. Leukemia. 2009;23:104–8.

    Article  PubMed  CAS  Google Scholar 

  22. Hudson MM, Ness KK, Nolan VG, et al. Prospective medical assessment of adults surviving childhood cancer: study design, cohort characteristics, and feasibility of the St. Jude Lifetime Cohort study. Pediatr Blood Cancer. 2011;56:825–36.

    Article  PubMed  Google Scholar 

  23. Kalender WA. Effective dose values in bone mineral measurements by photon absorptiometry and computed tomography. Osteoporos Int. 1992;2:82–7.

    Article  PubMed  CAS  Google Scholar 

  24. Cann CE. Low-dose CT, scanning for quantitative spinal mineral analysis. Radiology. 1981;140:813–5.

    PubMed  CAS  Google Scholar 

  25. Cann CE. Quantitative CT, for determination of bone mineral density: a review. Radiology. 1988;166:509–22.

    PubMed  CAS  Google Scholar 

  26. US Department of Health and Humans Services. Physical activity guidelines for Americans 2008. www.health.gov/paguidelines/pdf/paguide.pdf. Accessed 25 January 2012.

  27. Chen YY, Roseman JM, Devivo MJ, Huang CT. Geographic variation and environmental risk factors for the incidence of initial kidney stones in patients with spinal cord injury. J Urol. 2000;164:21–6.

    Article  PubMed  CAS  Google Scholar 

  28. Jeong IG, Kang T, Bang JK, et al. Association between metabolic syndrome and the presence of kidney stones in a screened population. Am J Kidney Dis. 2011;58:383–8.

    Article  PubMed  Google Scholar 

  29. Expert Panel on Detection E, Adults ToHBCi. Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285:2486–97.

    Article  Google Scholar 

  30. Boucher B, Cotterchio M, Kreiger N, Nadalin V, Block T, Block G. Validity and reliability of the Block98 food-frequency questionnaire in a sample of Canadian women. Public Health Nutr. 2006;9:84–93.

    Article  PubMed  Google Scholar 

  31. Borghi L, Schianchi T, Meschi T, et al. Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. N Engl J Med. 2002;346:77–84.

    Article  PubMed  CAS  Google Scholar 

  32. Taylor EN, Stampfer MJ, Curhan GC. Dietary factors and the risk of incident kidney stones in men: new insights after 14 years of follow-up. J Am Soc Nephrol. 2004;15:3225–32.

    Article  PubMed  Google Scholar 

  33. Pearl J. Causal diagrams for empirical research. Biometrika. 1995;82:669–88.

    Article  Google Scholar 

  34. Arrabal-Polo MA, Arrabal-Martin M, de Haro-Munoz T, et al. Mineral density and bone remodelling markers in patients with calcium lithiasis. BJU Int. 2011;108:1903–8.

    Article  PubMed  CAS  Google Scholar 

  35. Looker AC, Wahner HW, Dunn WL, et al. Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int. 1998;8:468–89.

    Article  PubMed  CAS  Google Scholar 

  36. Jolivet J, Cowan KH, Curt GA, Clendeninn NJ, Chabner BA. The pharmacology and clinical use of methotrexate. N Engl J Med. 1983;309:1094–104.

    Article  PubMed  CAS  Google Scholar 

  37. Abelson HT, Fosburg MT, Beardsley GP, Goorin AM, Gorka C, Link M, et al. Methotrexate-induced renal impairment: clinical studies and rescue from systemic toxicity with high-dose leucovorin and thymidine. J Clin Oncol. 1983;1:208–16.

    PubMed  CAS  Google Scholar 

  38. Türk C, Knoll T, Petrik A, Sarica K, Straub M, Seitz C. Guidelines on urolithiasis. Arnhem: European Association of Urology (EAU); 2011.

    Google Scholar 

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Acknowledgments

This study was funded by the National Cancer Institute (grant no. CA 21765) and by the American Lebanese Syrian Associated Charities (ALSAC).

Conflict of interest

The authors made no disclosures.

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Authors and Affiliations

  1. Department of Epidemiology and Cancer Control MSN 735, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-2794, USA

    Prasad L. Gawade, Kirsten K. Ness & Zhenghong Li

  2. Department of Radiological Sciences, St Jude Children’s Research Hospital, Memphis, TN, 38105, USA

    Shelly Sharma, Matthew J. Krasin & Sue C. Kaste

  3. Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, TN, 38105, USA

    Deo Kumar Srivastava

  4. Department of Oncology, St Jude Children’s Research Hospital, Memphis, TN, 38105, USA

    Sheri L. Spunt, Melissa M. Hudson & Sue C. Kaste

  5. Department of Hematology, St Jude Children’s Research Hospital, Memphis, TN, 38105, USA

    Kerri Nottage

  6. Department of Radiology, College of Medicine, University of Tennessee Health Science Center, 910 Madison, Suite 1002, Memphis, TN, 38163, USA

    Sue C. Kaste

Authors
  1. Prasad L. Gawade
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  2. Kirsten K. Ness
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  9. Melissa M. Hudson
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  10. Sue C. Kaste
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Correspondence to Prasad L. Gawade.

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Gawade, P.L., Ness, K.K., Sharma, S. et al. Association of bone mineral density with incidental renal stone in long-term survivors of childhood acute lymphoblastic leukemia. J Cancer Surviv 6, 388–397 (2012). https://doi.org/10.1007/s11764-012-0241-y

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  • DOI: https://doi.org/10.1007/s11764-012-0241-y

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