Back to 2026 Abstracts
Characterizing Nephrolithiasis in Childhood Cancer Survivors: A St. Jude Lifetime Cohort Study
Leon Chertin, MD1, Kohl Killeen, MD1, Melissa M. Hudson, MD2, Kirsten K. Ness, PT, PhD, FAPTA2, Angela Delaney, MD2, Sue C. Kaste, DO2, Alia Zaidi, MD2, Stephanie B. Dixon, MD, MPH2, Daniel Green, MD2, Dana W. Giel, MD1, Mary E. Killian, MD, EMBA1, Mohamed Soltan, MD1.
1University of Tennessee Health Science Center, Memphis, TN, USA, 2St. Jude Children's Research Hospital, Memphis, TN, USA.
Introduction: Childhood cancer survival has improved, producing a growing population of long-term survivors at risk for treatment-related late effects including nephrolithiasis a clinically significant but understudied complication with mechanisms including nephrotoxic chemotherapy-related tubular injury and corticosteroid-driven hypercalciuria. Population-level data on stone burden, risk factors, and kidney outcomes across the full spectrum of childhood cancer diagnoses are lacking.
Methods: We conducted a retrospective cohort study of 5,557 five-year childhood cancer survivors enrolled in the St. Jude Lifetime Cohort Study (SJLIFE) with complete cancer diagnosis and treatment data who underwent an onsite assessment including physical examination, laboratory testing, and dietary questionnaires. Nephrolithiasis was defined as urinary tract calculi Common Terminology Criteria for Adverse Events (CTCAE) grade ≥2 (symptomatic). Prevalences of stone by major cancer diagnosis groups were evaluated using modified Poisson regression among episodes occurring ≥5 years post-diagnosis (157 persons, 211 episodes), adjusting for age at cancer diagnosis and follow-up time. Blood nutrients, local climate, and BMI were further evaluated in multivariable models. Treatment exposure and nephrolithiasis onset occurring ≥5 years post-diagnosis was assessed using Cox regression, along with stone recurrence and temporal patterns.
Results: Of 5,557 survivors, median age at assessment 25.8 years (range 7.4-64.9) followed over 144,240 person-years from cancer diagnosis, 161 (2.9%) developed nephrolithiasis at an incidence rate of 1.12 per 1,000 person-years (95% CI: 0.95-1.30). Although 81.4% of cases occurred ≥10 years from diagnosis, most (59%) occurred in survivors under 30 years of age-an age group in which general population incidence is approximately 0.5-1.0 per 1,000 person-years. Compared with central nervous system (CNS) tumors, other major diagnosis groups had significantly higher nephrolithiasis risk: acute lymphoblastic leukemia (ALL) (RR 5.4), Hodgkin lymphoma (HL) (RR 5.9), non-Hodgkin lymphoma (NHL) (RR 6.2), Bone/Soft Tissue sarcoma (RR 4.5), and kidney tumors (RR 3.5). In the fully adjusted diagnosis model, lower eGFR, lower serum phosphorus, and higher sodium intake were associated with nephrolithiasis risk independent of cancer diagnosis. Bone/Soft Tissue sarcoma and kidney tumors were each associated with a greater than 10-fold increase in risk compared to CNS tumor survivors (RR 13.1, 95% CI: 1.5-115.1 and RR 14.3, 95% CI: 1.3-159.4). Corticosteroid exposure was the only independent predictor of nephrolithiasis occurring ≥5 years post-diagnosis (HR 1.4, 95% CI: 1.0-2.0; p=0.047); no other treatment variable was significant. Younger age at cancer diagnosis was associated with a higher risk of stone recurrence (HR 0.9 per year of age at diagnosis, 95% CI: 0.8-1.0; p=0.002), with no other significant associations. Chronic kidney disease (CKD) stage 3-5 developed after the first stone event in 9 survivors (5.6%) by eGFR <60 mL/min/1.73mē and 13 (8.1%) by CTCAE grade ≥2.
Conclusions: Nephrolithiasis is a progressive nephro-urologic late effect, accumulating predominantly beyond 10 years post-diagnosis and occurring at substantially younger ages than in the general population. Stone risk varies between major diagnosis groups. Corticosteroid exposure is independently associated with late-onset stone risk. These findings support further studies to determine whether high-risk survivor groups may benefit from nephrolithiasis surveillance.
Back to 2026 Abstracts
