1. ¹Department of Radiological Sciences, Division of Diagnostic Imaging, University of Tennessee at Memphis, Memphis, TN, USA
2. ²Department of Oncology, University of Tennessee at Memphis, Memphis, TN, USA
3. ³Department of Radiology, University of Tennessee at Memphis, Memphis, TN, USA
4. ⁴Department of Biostatistics, St. Jude Children's Research Hospital, University of Tennessee at Memphis, Memphis, TN, USA
5. ⁵Department of Pediatrics, University of Tennessee at Memphis, Memphis, TN, USA

Correspondence: Dr SC Kaste, Division of Diagnostic Imaging, Department of Radiological Sciences, St. Jude Children's Research Hospital, 332 N. Lauderdale, Memphis, TN 38105-2794, USA. E-mail: sue.kaste@stjude.org

Received 10 April 2008; Revised 30 July 2008; Accepted 13 August 2008; Published online 2 October 2008.

Abstract

We hypothesized an association between renal calculi and bone mineral density (BMD) deficits, shown in adults, exists in survivors of childhood acute lymphoblastic leukemia (ALL). Thus, we analyzed the associations between quantitative computed tomography (QCT)-determined renal calcifications and clinical parameters (gender, race, age at diagnosis and age at the time of QCT), BMD, treatment exposures and Tanner stage. We investigated the associations between stone formation and nutritional intake, serum and urinary calcium and creatinine levels, and urinary calcium/creatinine ratio. Exact ²-test was used to compare categorical patient characteristics, and the Wilcoxon–Mann–Whitney test to compare continuous measurements. Of 424 participants, 218 (51.4%) were males; 371 (87.5%) were nonblack. Most (n=270; 63.7%) were 3.5 years at ALL diagnosis. Mean (s.d.) and median (range) BMD Z-scores of the entire cohort were -0.4 (1.2) and -0.5 (-3.9 to 5.1), respectively. Nineteen participants (10 males; 10 Caucasians) had kidney stones (observed prevalence of 4.5%; 19/424) with a significant negative association between stone formation and body habitus (body mass index, P=0.003). Stone formation was associated with treatment protocol (P=0.009) and treatment group (0.007). Thus, kidney stones in childhood ALL survivors could herald the future deterioration of renal function and development of hypertension. Long-term follow-up imaging may be warranted in these patients to monitor for progressive morbidity.