Chronic Kidney Disease in Wilms Tumour Survivors – What Do We Know Today?

Abstract

Licence: This open access article is licensed under Creative Commons Attribution 4.0 International (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Users are allowed to share (copy and redistribute the material in any medium or format) and adapt (remix, transform, and build upon the material for any purpose, even commercially), as long as the authors and the publisher are explicitly identified and properly acknowledged as the original source. AbstractCurrently, the treatment of Wilms tumour (WT) is successful in approximately 90% of cases, and consists of chemotherapy, nephrectomy, and, in some cases, radiation therapy. All treatments have potential long-term influence on the function of solitary kidneys in WT survivors (WTS). Severe reduction in glomerular filtration rate occurs after nephrectomy. All patients who underwent surgical treatment for WT could be considered to have 132a risk of chronic kidney disease (CKD) because they lack a kidney. End-stage renal disease is rare (1.8% of National Wilms Tumour Study patients). Recent studies have revealed that patients with CKD have a greater risk of cardiovascular events and death. Most of the WTS have lower stages or no CKD. Regular biochemical studies and ultrasound examination at follow-up visits should be considered as indispensible elements of long-term care in uninephrectomized WTS. The evaluation of a single kidney function should be frequent, consisting of the assessment of estimated glomerular filtration rate (eGFR), assessment of albumin urine excretion, urine sediment analysis to detect abnormalities, ultrasound examination and measurements of blood pressure. According to Kidney Disease Improving Global Outcomes (KDIGO) recommendation and suggestions, GFR should be assessed using GFR-estimating equations that include serum creatinine and cystatin C concentrations. Cystatin C can be a more sensitive marker of kidney filtration function than creatinine, especially in diseases characterized by a mild decrease in glomerular filtration. This will facilitate the detection of early kidney impairment and assessment of the progression of CKD in WTS.

Effectiveness of Nephron Sparing Surgery and Radical Nephrectomy in the Management of Unilateral Wilms Tumor: A Meta-Analysis

“…The ability of this gold standard approach has been favored because of its ability to limit positive margins ( 52 ), spillage ( 43 ), residual tumor ( 13 ), and recurrence ( 53 ). Nevertheless, its ability to limit renal function as a result of substantial resection of unaffected renal tissue has raised questions concerning its efficiency ( 24 , 54 , 55 ). In addition, nephrotoxic effects of cancer therapies, genetic predisposition (WT1 mutation), and hyperfiltration injury have also been reported to contribute toward worsening renal function.…”

Sonographic Image of Solitary Kidney in Wilms Tumour Survivors

“…However, the typical chemo-and radiotherapy used in TW treatment does not generally cause severe renal injury [8,27]. According to SIOP rules, only high-risk patients or in stage IV are treated with nephrotoxic cytostatics, such as carboplatin and cyclophosphamide [3].…”

“…According to SIOP rules, only high-risk patients or in stage IV are treated with nephrotoxic cytostatics, such as carboplatin and cyclophosphamide [3]. Bilateral TWs are also at higher risk of CKD [8].…”

“…Signs of kidney damage may indicate the risk of deterioration of kidney function in the future [5]. Wilms tumour survivors (TWs) are at risk of deteriorating renal function and CKD because of the following: decreased number of nephrons after nephrectomy, nephrotoxic side effects of chemotherapeutic agents (carboplatin, cisplatin, ifosphamide, cyclophosphamide) or radiation therapy if the solitary kidney was in the field of radiation [7,8].…”

Fasting Intervention for Children With Unilateral Renal Tumors to Reduce Toxicity

“…Following short-term injury and toxicity experienced by children with cancer, adult survivors of childhood cancer are at risk for long-term nephrotoxicity, i.e., renal dysfunction and high blood pressure (47)(48)(49)(50)(51). In limited studies available, an increased risk of severe renal impairment was identified in unilateral WTsurvivors (50,52,53). In a follow-up study of unilateral WTsurvivors, 21% had stage II chronic kidney disease (CKD) (50).…”