Modern Pediatrics. Ukraine. (2026).2(154): 128-133. doi: 10.15574/SP.2026.2(154).128133
Makieieva N. I., Odynets P. I.
Kharkiv National Medical University, Ukraine

For citation: Makieieva NI, Odynets PI. (2026). Early diagnosis of kidney injury at different stages of programmed therapy in children with acute leukemia: a clinical case and literature review. Modern Pediatrics. Ukraine. 2(154): 128-133. doi: 10.15574/SP.2026.2(154).128133.
Article received: Nov 06, 2025. Accepted for publication: Mar 16, 2026.

Kidney injury is a common complication during the treatment of pediatric hematologic malignancies and is associated with less favorable therapeutic outcome. Impairment of renal function may remain asymptomatic for a prolonged period. There is an ongoing search for novel sensitive biomarkers capable of detecting the early stages of kidney injury.
Aim – to analyze a clinical case of acute kidney injury (AKI) in a child with acute lymphoblastic leukemia (ALL) using a comparative assessment of the glomerular filtration rate (GFR) calculated based on serum creatinine and cystatin C levels in order to identify early manifestations of renal dysfunction.
Clinical case. We present a clinical observation of a 7-year-old female patient with T-cell acute lymphoblastic leukemia, FAB type L2, with aberrant co-expression of CD33⁺ and MLL (KMT2A) gene deletion, and CNS-1 status. The disease course was characterized by unfavorable features, including the persistence of a significant residual tumor mass on the 15th and 33rd days of treatment, which corresponded to the high-risk group and required therapy intensification according to the HR-1 regimen at the end of Phase II of Protocol I. In the absence of clinical manifestations and conventional laboratory indicators of renal impairment, a comparative analysis of GFR values was performed using serum creatinine-based formulas (Schwartz, 1976; Bedside Schwartz, 2009) and the cystatin C-based formula (Zappitelli, 2006) at different stages of programmed chemotherapy. The results demonstrated that cystatin C showed higher sensitivity in detecting subclinical renal function impairment.
Conclusions. The analysis confirmed that cystatin C is a more sensitive biomarker for the early detection of nephrotoxicity and subclinical kidney dysfunction compared to creatinine-based estimations. The findings support the clinical usefulness of cystatin C as a marker for GFR calculation and the early diagnosis of acute kidney injury in children with acute leukemia at various stages of chemotherapy.
The study was conducted in accordance with the principles of the Declaration of Helsinki.
Written informed consent for the child’s participation in the study has been obtained from the parents.
The authors declare no conflict of interest.
Keywords: acute lymphoblastic leukemia, cystatin C, creatinine, glomerular filtration rate, acute kidney injury, children.

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