Compensatory hypertrophy and progressive renal damage in children nephrectomized for Wilms' tumor

Tullio, Maria Teresa Di; Casale, Fiorina; Indolfi, Paolo; Polito, Cesare; Giuliano, Maria; Martini, Anna Lisa; Cimmaruta, Ersilia; Morgera, C.; Cioce, Fabrizio; Greco, N.

doi:10.1002/(sici)1096-911x(199605)26:5<325::aid-mpo4>3.0.co;2-k

Cited by 50 publications

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“…Increased excretion of albumin has been described in up to a third of patients surviving Wilms' tumour (Levitt et al, 1992;di Tullio et al, 1996) but was rare in our patients. Although the two patients with microalbuminuria may develop late glomerular problems, none are yet apparent 5 and 6 years after treatment.…”

Section: Clinicalcontrasting

confidence: 40%

“…Compensatory renal hypertrophy was found in all but two of our patients. These two patients did not have any other Levitt et al, 1992 Poor growth in 45% 53 Di Tullio et al, 1996 Poor growth in 3% 34 Bailey (this study) Hypertrophy 52 s.d. above 38 mean in 5% of patients signs of renal dysfunction.…”

Section: Clinicalmentioning

confidence: 54%

“…Reported effects after treatment for Wilms' tumour have included reduction in glomerular filtration rate (GFR) (Walker et al, 1982;Robitalle et al, 1985;Levitt et al, 1992), microalbuminuria (Levitt et al, 1992;di Tullio et al, 1996) (rarely resulting in hyperfiltration induced glomerulosclerosis and subsequent renal failure), failure of compensatory hypertrophy of the remaining kidney (Wikstad et al, 1986;Makipernaa et al, 1991;Levitt et al, 1992) and hypertension (Levitt et al, 1992).…”

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confidence: 99%

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Nephrotoxicity in survivors of Wilms' tumours in the North of England

et al. 2002

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One aspect of concern for survivors of Wilms' tumour has been the late outcome in terms of renal function. Previous studies have documented low glomerular filtration rate and high blood pressure in some patients. Furthermore, disorders in tubular function (especially urinary concentration defects) have been suggested but not confirmed in small studies. The aim of this study was to determine the prevalence and nature of subclinical and overt glomerular, proximal and distal renal tubular toxicity in a population based cohort of survivors of Wilms' tumour. Forty patients (24 female) with a median age of 4.3 years (3 months -11.8 years) at diagnosis were studied. Median follow-up was 8.8 (range 0.06 -27.5) years. Glomerular filtration rate was measured by 51 Cr-EDTA plasma clearance, proximal tubular function by electrolyte fractional excretions, urine excretion of low molecular weight proteins (retinol-binding protein) and renal tubular enzymes (alanine aminopeptidase; Nacetylglucosaminidase) and distal tubular function by the osmolality of the first two urines of the day on 3 consecutive days. Renal size (ultrasound) and blood pressure were also measured. Mean (range) glomerular filtration rate was 100 (61 -150) ml min 71 1.73 m 72 . Nine were below the reference range for healthy individuals with two kidneys. Most serum electrolyte concentrations (sodium, potassium, chloride, calcium, magnesium and phosphate) fell within the normal range for age, as did the fractional excretions. The values that fell outside the normal range were only marginally abnormal. Subclinical measures of tubular toxicity (retinal-binding protein, alanine aminopeptidase, N-acetylglucosaminidase) were abnormal in only four patients. Thirty-seven patients achieved maximal urine osmolalities 5800 mOsm kg 71 , but three failed to achieve this value even after DDAVP administration. Two patients had evidence of increased urinary albumin excretion. Compensatory renal hypertrophy was seen in all but two patients, but blood pressure was within normal limits in all patients. Current and past treatment for Wilms' tumour does not have any clinically important nephrotoxic effect in the majority of patients. This finding will enable paediatric oncologists to reassure patients and parents that treatment for Wilms' tumour rarely causes long-term renal impairment.

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Section: Clinicalcontrasting

confidence: 40%

Section: Clinicalmentioning

confidence: 54%

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confidence: 99%

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Nephrotoxicity in survivors of Wilms' tumours in the North of England

et al. 2002

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“…Mean value of renal length was 128 ± 14% of the reference value. Mean value of renal volume was from 155±35% to 213% (39,40). In one study, correlation between microalbuminuria and renal volume was observed (40).…”

Section: %mentioning

confidence: 99%

“…Mean value of renal volume was from 155±35% to 213% (39,40). In one study, correlation between microalbuminuria and renal volume was observed (40). The parenchymal thickness/kidney length ratio correlated with the deterioration of renal function (cystatin C serum concentration) (38).…”

Section: %mentioning

confidence: 99%

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

Stefanowicz

Kosiak

et al. 2016

Wilms Tumor

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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.

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