Renal function in survivors of nonsyndromic Wilms tumor treated with unilateral radical nephrectomy

Abstract

Purpose Partial nephrectomy is being considered by some for children with unilateral Wilms tumor (UWT) to avoid the theoretical complication of renal insufficiency. We evaluated the prevalence of hypertension and impaired renal function in long-term survivors of non-syndromic UWT treated without nephrotoxic chemotherapy or ionizing radiation. Patients and Methods Eligibility included: age ≤15 years at diagnosis of non-syndromic UWT, treatment prior to 2002 and maintenance of remission following unilateral nephrectomy without abdominal irradiation or nephrotoxic chemotherapy. Renal function was assessed by urinalysis and estimated glomerular filtration rate (eGFR). Patients on anti-hypertensive medication or with blood pressure >140/90mmHg were defined as hypertensive. Results Seventy-five patients with median age at diagnosis of 3.2 (range: 0.2-12.1) years met eligibility criteria. The median length of follow-up was 19.6 (range: 10.0-32.8) years. All but one patient had stage 1/2 disease. Sixty-eight (90.7%) patients had favorable histology WT; seven had anaplastic histology. Sixteen (21.3%) patients had an eGFR <90 ml/min/1.73m2, two of whom also had proteinuria (12.5%). No patient had an eGFR<60 ml/min/1.73m2. Five (6.7%) patients had hypertension, three of whom were taking anti-hypertensive medications. No patient has developed end-stage renal disease. Conclusions Patients with UWT treated with unilateral radical nephrectomy without nephrotoxic chemotherapy or ionizing radiation are at low risk for significant long-term renal dysfunction. For this patient population, routine use of partial nephrectomy does not appear justified. However, monitoring and counseling are important for identifying the rare patient who develops subtle renal insufficiency and so might be at increased risk for adverse cardiovascular sequelae.

Sonographic Image of Solitary Kidney in Wilms Tumour Survivors

“…According to Stefanowicz et al, 56, 25% and 43, 75% of TWs were diagnosed as stage I and II of CKD, respectively [16]. However, according to Interiano et al, the current guidelines do not recognize solitary kidney as a structural abnormality [49]. However, further studies are needed to determine whether the absence of one kidney is a marker for CKD development [49].…”

“…However, according to Interiano et al, the current guidelines do not recognize solitary kidney as a structural abnormality [49]. However, further studies are needed to determine whether the absence of one kidney is a marker for CKD development [49]. In the Neu TWs study, 21/34 (62%) TWs (mean age 28.7 years, mean follow-up 24.8 years) had CKD stages I-III, based on cystatin-related eGFR [42].…”

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

“…Recently, Interiano et al (23) evaluated the prevalence of hypertension and impaired renal function in a group of 75 long-term survivors of non-syndromic UWT (median length of follow-up, 19.6 years; range: 10.0-32.8 years) who were treated without nephrotoxic chemotherapy or ionizing radiation. Renal function was assessed by urinalysis and eGFR.…”

“…Therefore, patients with a solitary kidney reveal an increased risk of albuminuria, hypertension and CKD.CKD can be diagnosed in all WTS subjected to nephrectomy. According to Interiano et al (23), the current guidelines do not recognize solitary kidney or unilateral nephrectomy as a structural abnormality, but further studies are needed to determine whether a lack of one kidney is a marker for CKD development. In our opinion, from the viewpoint of renal function and long-term survival among uninephrectomized WT patients, the above statement is neither certain nor obvious.…”

Long-term effects of Wilms tumour therapy on renal function

“…The paper by Interiano et al 2 is, therefore, a welcome addition to the evidence base that is trying to dissect the influence of the multiple mechanisms that might have a role in the pathogenesis of kidney impairment following treatment of unilateral Wilms tumour. This single institutional report describes the long-term renal function outcomes in young adulthood in 75 patients who were treated for stage I/II Wilms tumour at a median age of 3.2 years (median follow-up duration was 19.6 years).…”