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

Andry Juliansen; Murti Andriastuti; Sudung Pardede; Rini Sekartini

doi:10.14238/pi54.6.2014.372-6

Andry Juliansen Department of Child Health, University of Indonesia MedicalSchool, Jakarta
Murti Andriastuti Department of Child Health, University of Indonesia MedicalSchool, Jakarta
Sudung Pardede Department of Child Health, University of Indonesia MedicalSchool, Jakarta
Rini Sekartini Department of Child Health, University of Indonesia MedicalSchool, Jakarta

DOI: https://doi.org/10.14238/pi54.6.2014.372-6

Keywords: acute lymphoblastic leukemia, hypertension, corticosteroid, renal infiltration, hyperleukocytosis

Abstract

Background Hypertension is a rarely recognized complication of acute lymphoblastic leukemia (ALL). The incidence of hypertension in ALL patients in Indonesia remains unknown, but the most common risk factors are corticosteroid use during induction-phase chemotherapy and renal leukemic infiltration.

Objective To determine the incidence of hypertension in children with 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 children aged 2-18 years. Subjects were newly diagnosed ALL patients and those underwent induction-phase chemotherapy in the Pediatric Ward or Outpatient Clinic at Cipto Mangunkusumo or Dharmais Hospitals.

Results Hypertension occurred in 6 (10%) of 60 newly diagnosed ALL patients and 8 (20%) of 40 patients who had received high-dose corticosteroids, but the difference was not statistically significant (OR=2.25; 95%CI 0.72 to 7.07; P=0.239). Hypertension was reported in 8 of 29 subjects who received dexamethasone, but in none of the subjects who received prednisone. However, the difference in these subgroups was also not statistically significant. Renal enlargement was found in 1 of 14 hypertensive patients, but it was not associated with hypertension (OR=0.80; 95%CI 0.52 to 1.24; P=0.417). Hyperleukocytosis was also not associated with hypertension (OR= 0.79; 95% CI 0.20 to 3.11; P=1.000).

Conclusion The incidence of hypertension in ALL patients was 14%. Hypertension is not associated with renal infiltration or hyperleukocytosis. Furthermore, hypertension is not associated with corticosteroid dose, though is found only in subjects who receive dexamethasone. [Paediatr Indones. 2014;54:372-6.].

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