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In order to distinguish the voices of the two authors the remarks of Miss Iris Hill (age 7) are presented as quotations. We would like to begin by acknowledging the indigenous peoples of this land: the members of the Haudenosaunee Confederacy beginning with the Seneca (Keepers of the Western Door), the Cayuga (Little Brothers), the Onondaga (Keepers of the Fire and center of the Haudenosaunee government), the Oneida (Little Brothers), the Mohawk (Keepers of the Eastern Door), and the last members to join the Confederacy, the Tuscarora. We also acknowledge the indigenous peoples of Long Island, the Unckuchug and Shinnecock. My name is Hilary Weaver, also known as Ganowasheh. I am Lakota by birth and Haudenosaunee, Seneca Beaver Clan, by adoption. I am very happy to be here with my daughter, Iris Hill. "Hello, my name is Iris Hill. I am also known as Awehnheyo. I am Lakota and a member of the Seneca Beaver Clan." Indigenous identity is very much rooted in multigenerational relationships. Most of the indigenous groups of what is now known as North America have a concept of the Seven Generations. For some of us this means that we can reflect on the seven generations of ancestors that preceded us and know that they were planning for us and that their thoughtful planning has led to our continued existence. Likewise, we have a responsibility and a sacred trust to be planning for the next seven generations to come: those yet unborn. We must be conscious of the social and environmental choices that are made now so that there will be a future for ongoing generations of Native Americans. Some Native Americans picture the concept of Seven Generations as the preceding three generations, the following three generations, with the current generation nestled in the middle. The core meaning of the concept is the same regardless of how the Seven Generations are counted. Our identity is intimately linked to those who have come before and those who will follow. Multigenerational relationships are central to what it means to be Native American. CONNECTIONS ACROSS THE DIFFERENT GENERATIONS In order to illustrate some of the multigenerational relationships in our family, I'll begin with a description of my grandfather. Since he was born in the late 19th century, his story provides a good illustration of life at a time of great changes for Native Americans. Iris will then share her perspectives on her two grandparents who were still living at the time of her birth. William A. Clark, Lakota (1891-1973) My grandfather was born in 1891, less than a year after the massacre at Wounded Knee. This massacre is often cited as the last major confrontation between the U.S. military and Native American nations. This was a very difficult time to be Lakota. My grandfather was born into a time of poverty and racism that ultimately shaped both his body and his life. As the oldest of nine children at a time when food was scarce, he often went hungry. The government rations promised by the treaties were meager. As a result, he suffered from severe malnutrition that led to problems with rickets and bowed legs: physical markers of poverty and racism that would shape his body for a lifetime. Like many Native Americans, he sought one of the few remaining vehicles for being a warrior: he joined the U.S. military. As a combatant in World War I, he fought in Germany, and it was there on the battlefield that he was shot in the arm. His injury was not initially a major one but ultimately had severe consequences. Although these events happened long before my time, even as a child, I remember clearly feeling the perspective of family members that my grandfather had been left with his injuries to rot on the battlefield for 3 days because he was not White. When he finally did receive medical care, it was too late to save his arm. After the amputation, he received a prosthetic arm that he rarely wore. The arm was white. …

Renal failure is a known complication of acute leukemias both at diagnosis and following cytostatic treatment. No recent studies give data on the incidence and risk factors of renal complications and their prognostic impact.Two hundred and twenty consecutive adult patients with newly diagnosed acute leukemia treated at a major university medical center were evaluated for renal complications before, during, and after treatment; 166 patients were treated by chemotherapy only and 54 patients were treated with chemotherapy and later transplanted with allogeneic or autologous bone marrow. Renal complications were subdivided into 3 entities: acute renal failure, major and minor complications, based on clinical and laboratory parameters. Renal failure occurring as a consequence of terminal multi-organ failure was excluded from the present study.Approximately 30% of patients in the chemotherapy group had a renal complication either before or after chemotherapy. Patients undergoing transplantation had a 50% risk of renal complications. Risk factors for complications were male sex, age, previous kidney disease, white cell count, and refractory leukemia (chemotherapy group) and allogeneic versus autologous transplant (transplant group). In the chemotherapy group, early but not delayed renal complications had a poor prognostic impact. In the transplant group renal complications had no impact on prognosis. In all patient groups, acute renal failure was prognostically unfavorable.We conclude from our study that renal complications are frequent in acute leukemias and that the treatment and prevention of renal complications is important for the management of acute leukemias.