Comprehensive renal function evaluation in patients treated for synchronous bilateral Wilms tumor

Abstract

Objectives The purpose of this study was to perform a comprehensive assessment of long-term renal function in patients treated at our institution for synchronous bilateral Wilms tumor (BWT) and to determine the optimal method for estimating glomerular filtration rate (eGFR). Methods Surgical approach, adjuvant therapy, and pathology reports were reviewed for patients with at least six months follow-up from definitive surgery. eGFRs, as assessed by the Schwartz and Chronic Kidney Disease in Children (CKiD) formulas, were compared to measured GFR (mGFR) determined by 99mTc-DTPA scanning. Urine studies, including microalbumin, β-microglobulin, and FENa were also reviewed. Results Forty-two patients were identified. Of 36 living patients, 28 (77.8%) had greater than 6 months follow-up, with a median overall follow-up of 5.2 years (range: 1.4-13.4). The median mGFR was 97mL/min/1.73m2, while the median eGFRSchwartz and eGFRCKiD were 103.3mL/min/1.73m2 and 79.7mL/min/1.73m2, respectively, (p=0.13 and p=0.75, compared to mGFR). Eleven (39.3%) patients had at least one abnormal urine study (microalbumin >30μg/g creatinine, n=3; β-2 microglobulin >133μg/g creatinine, n=9; FENa >1%, n=4). Conclusions In our series, few patients had an abnormally low GFR. Neither method for estimating GFR gave a significantly different result from measured GFR, suggesting that the Schwartz equation is adequate, although specific urine tests may be more sensitive for detecting subtle renal dysfunction.

Factors influencing risk‐based care of the childhood cancer survivor in the 21st century

“…For example, treating Wilms tumor in nonsyndromic children with unilateral radical nephrectomy, without nephrotoxic chemotherapy or ionizing radiation, appears to result in a low risk for significant long‐term contralateral renal dysfunction . In contrast, survivors with bilateral Wilms tumor or those with syndromic Wilms tumor (Wilms tumor + aniridia + genitourinary malformation + mental retardation [WAGR], and Denys‐Drash syndrome) are at a substantially higher risk for long‐term renal dysfunction . Thus, the recommendation for nephron‐sparing surgery for bilateral Wilms tumor balances dual goals of achieving local control and long‐term survival while decreasing the risk of renal dysfunction.…”

Evaluation of the nephron‐sparing surgery formula in Wilms tumors

“…Specific urine tests could possibly carry a higher sensitivity for detecting subtle renal dysfunction. 18 Other parameters of the NSS formula assessed the resection margins, either surgical or pathological. We did not find a correlation This study has the limitations of a retrospective and monocentric study over a long period, with several treatment protocols.…”

“…Renal dysfunction was defined as an eGFR < 90 mL/min/1.73 m 2 as recommended by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative clinical practice guidelines for chronic kidney disease in children and adolescents 16 . Despite the fact that other renal function studies, such as technetium‐99 m diethylenetriaminepenta acetic acid (99mTc‐DTPA) or iohexol clearance, have recently proven to be more efficient, 17 no difference has been shown between the measured GFR rate and the estimated one by the Schwartz formula for the evaluation of long‐term renal function among 28 patients with synchronous BWT with a median follow‐up of 5.2 years 18 . Interestingly, none of the long‐term renal function assessment studies already published showed a high rate of renal dysfunction, whatever the chemotherapy protocols used over time 19 .…”

“…Thus, we experienced very few patients with severe renal insufficiency to detect any correlation with the RRP parameter. Specific urine tests could possibly carry a higher sensitivity for detecting subtle renal dysfunction 18 …”

Bilateral Wilms Tumor: A Surgical Perspective

“…Five patients had ≥1+ proteinuria. 8.3% of patients had stage-2 chronic kidney disease as defined by an estimated glomerular filtration rate (eGFR) less than 90 mL/min/1.73 m 2 and ≥1+ proteinuria [ 32 , 44 ]. Thus, acceptable long-term renal outcomes are achievable with a bilateral nephron-sparing approach.…”