Impact of nephrectomy on long-term renal function in non-syndromic children treated for unifocal Wilms tumor

Kern, Adam; Inouye, Brian M.; Ko, Joan; Gorin, Michael A.; Allaf, Mohamad E.; Goldstein, Seth D.; DiCarlo, Heather; Shah, Bhavik; Wang, Ming Hsien

doi:10.1016/j.jpurol.2014.06.017

Cited by 16 publications

(12 citation statements)

References 19 publications

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“…Kern et al reported on 55 patients with unifocal WT treated over 16 years who had estimated GFR calculated using the Schwartz formula. After a median follow-up of 6 years, 15% (8 patients) had a decreased age-adjusted GFR with 4% (2) progressing to chronic renal insufficiency [15]. Green published a comprehensive compilation of case series that assessed renal dysfunction beyond ESRD in unilateral WT survivors using variable methods including estimated and calculated GFR as well as microalbuminuria.…”

Section: Measures Of Renal Dysfunctionmentioning

confidence: 99%

Renal function in patients with Wilms tumor

Romao

Lorenzo

2016

Urologic Oncology: Seminars and Original Investigations

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Section: Measures Of Renal Dysfunctionmentioning

confidence: 99%

Renal function in patients with Wilms tumor

Romao

Lorenzo

2016

Urologic Oncology: Seminars and Original Investigations

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“…Cost et al (37) for instance, reported a reduction in renal function in children operated with radical nephrectomy after a mean follow-up of 2.1 years. Likewise, Kern et al (41) and Cozzi et al (39) reported a reduction in glomerular filtration rate after radical nephrectomy. The authors mentioned an inverse relationship between a longer follow-up and renal function postsurgery.…”

Section: Discussionmentioning

confidence: 87%

“…Thereafter, upon excluding the duplicates and applying the inclusion criteria, a total of 20 studies were retained. Thirteen of the included studies were retrospective cohort studies (12,15,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43), whereas seven of the included studies were prospective cohort studies (44)(45)(46)(47)(48)(49)(50). Qualitative and quantitative data were then extracted from all the studies and summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

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

2020

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Background: Unilateral Wilms tumor is the most common renal malignancy in the pediatric population. Although the onset of surgical intervention like radical nephrectomy has substantially reduced the mortality rate, recent evidence has raised concerns regarding several postoperative complications associated with this procedure. Nephron sparing surgery has been reported to avoid such postoperative complications and have high technical success rate. However, no attempt to date has been made to synthesize the evidence comparing the efficacy of radical nephrectomy and nephron sparing surgery for managing unilateral Wilms tumor. Methods and Results: To metastatistically compare the efficiency of radical nephrectomy with nephron sparing surgery for managing unilateral Wilms tumor, a systematic identification of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines on four academic databases: MEDLINE, Scopus, EMBASE, and CENTRAL. A meta-analysis comparing renal function (estimated glomerular filtration rate), survival rate, and rate of relapse was performed to compare the efficacy of radical nephrectomy and nephron sparing surgery. Out of 1,283 records, 20 articles including 5,246 children (mean age, 4.3 ± 3.0 years) were included in this review. Radical nephrectomy was performed on 11 of the included studies, whereas nephron sparing surgery was performed on five studies. Two studies compared the efficacy of both interventions. The meta-analysis reveals the beneficial effects of nephron sparing surgery (Hedge's g, 0.76) as compared to radical nephrectomy (−0.16) for the estimated glomerular filtration rate for children with unilateral Wilms tumor. Moreover, higher survivability (0.59) and lesser occurrence of relapse were (−1.0) also reported for cases operated with nephron sparing surgery. Conclusion: The current meta-analysis recommends the use of nephron sparing surgery for unilateral Wilms tumor. The procedure accounts for higher survivability and postoperative renal function and lesser incidence of relapse as compared to radical nephrectomy.

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“…Patients with WT are mostly very young children, and the prevalence of severe renal dysfunction owing to multifactorial causes is likely to increase with longer follow-up and survival. Kern et al (35) assessed the renal function in a group of 55 patients with nonsyndromic UWT and reported that increasing time between surgery and the last known GFR follow-up was associated with decreased GFR. They concluded that longer follow-up may reveal that a clinically significant decline in the renal function occurs in the years following nephrectomy.…”

Section: Chronic Kidney Disease In Wtsmentioning

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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Impact of nephrectomy on long-term renal function in non-syndromic children treated for unifocal Wilms tumor

Cited by 16 publications

References 19 publications

Renal function in patients with Wilms tumor

Renal function in patients with Wilms tumor

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

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

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