The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate a patient with renal complications following radiation and chemotherapy.
Subjective measures:
(1) symptoms
Objective measures:
(1) blood pressure
(2) hematuria
(3) edema
(4) specific gravity
Management measures:
(1) blood pressure and renal failure
(2) hematuria
Analytic studies:
(1) proteinuria
(2) creatinine clearance
(3) creatinine
(4) beta-2 microglobulin
If no toxicity is present, then the 0 points are assigned.
If a toxicity is present, then the grade indicates the number of points to assign.
|
Items |
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
|
symptoms |
NA |
NA |
fatigue, headache |
obtundation, oliguria, edema |
|
blood pressure |
NA |
mild |
moderate |
malignant |
|
hematuria |
microscopic |
intermittent macroscopic |
persistent macroscopic |
refractory |
|
edema |
transient |
pedal 2+ to 3+ |
pedal 4+, edema of lower legs |
anasarca; uremic coma |
|
specific gravity |
NA |
decreased |
NA |
NA |
|
management blood pressure and renal failure |
diet |
antihyper-tensive medication |
dialysis, unilateral nephrectomy |
permanent dialysis; renal transplant |
|
management of hematuria |
iron therapy |
occasional transfusion or single cauterization |
persistent transfusion or cauterization |
surgical intervention |
where:
• A mild increase blood pressure: systolic > normal but <= 20 mm Hg above normal; diastolic > normal but <= 10 mm Hg above normal.
• A moderate increase blood pressure: systolic > 20 mm Hg above normal but not malignant; diastolic > 10 mm Hg above normal but not malignant.
total score =
= SUM(points for all 7 items)
LENT score =
= (total score) / 7
|
Analytic Items |
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
|
proteinuria |
increased but < 3 g/L |
3 – 10 g/L |
> 10 g/L |
nephrotic syndrome |
|
creatinine clearance |
5-10% decrease |
10.1 – 30% decrease |
30.1 – 60% decrease |
> 60% decrease |
|
serum creatinine |
>= 1.25 and <= 2.5 times ULN |
> 2.5 and <= 5 times ULN |
> 5 and <= 10 times ULN |
> 10 times ULN |
|
serum beta-2 microglobulin |
NA |
NA |
> 2 and <=4 times normal |
> 4 times normal |
where:
• I am using 0.15 mg/L as the upper limit of proteinuria.
• I am not sure why a beta-2 microglobulin that is increased but <= 2 times the upper limit of normal is not graded.
Interpretation:
• maximum total score: 26
• minimum LENT score: 0
• maximum LENT score: 3.71
• maximum analytic score: 16
Specialty: Hematology Oncology, Nephrology
