Patients with nonsyndromic unilateral Wilms’ tumor who underwent a unilateral radical nephrectomy without additional nephrotoxic chemotherapy or ionizing radiation demonstrated a low risk for developing long-term renal dysfunction, according to results from a St. Jude Children’s Research Hospital study.

A lack of data exists on the prevalence of renal dysfunction in adult survivors of Wilms’ tumors who underwent unilateral nephrectomy, according to study background.

Andrew M. Davidoff

Andrew M. Davidoff, MD,chair of the department of surgery and division chief of general pediatric surgery at St. Jude Children’s Research Hospital, and colleagues sought to assess the long-term renal function and associated cardiovascular sequelae of 75 adult survivors of nonsyndromic unilateral Wilms’ tumors who did not receive nephrotoxic chemotherapy or radiotherapy after radical nephrectomy and who were treated before 2002.

The median age at diagnosis was 3.2 years (range, 0.2-12.1) and the median length of follow-up was 19.6 years (range, 10-32.8). Seventy-four patients had stage I or stage II disease. Of the cohort, 90.7% had a favorable histology, whereas 9.3% had anaplastic histology.

Researchers measured renal function with urinalysis and estimated glomerular filtration rate.

Sixteen patients (21.3%) had an eGFR less than 90 mL/min/1.73 m² — the level considered as at risk for renal dysfunction — and two of these patients (12.5%) also had proteinuria. No patient had an eGFR less than 60 mL/min/1.73 m².

Five patients (6.7%) had hypertension — defined as blood pressure greater than 140 mm Hg/90 mm Hg — and three of these patients received antihypertension medications.

No patient had developed end-stage renal disease at the time of the last follow-up.

The researchers said longer follow-up is necessary to identify any further deterioration of renal function or other comorbidity risks because all of the patients in the study were aged 40 years or younger.  

“Although nephron-sparing surgery may have the theoretical benefit of avoiding long-term renal insufficiency, the results of the current study did not confirm a high prevalence of significant renal dysfunction in patients with nonsyndromic unilateral Wilms’ tumor who were treated with radical nephrectomy without abdominal irradiation or nephrotoxic chemotherapy,” Davidoff and colleagues concluded. “Thus, the data from the current study do not appear to support routine nephron-sparing surgery, with its associated risk of upstaging low-risk patients. Nevertheless, the current study does highlight the need for the long-term follow-up of children with unilateral Wilms’ tumor who have undergone radical nephrectomy to identify the rare patient with renal insufficiency who would benefit from early intervention.” – by Anthony SanFilippo

Disclosure: The researchers report no relevant financial disclosures.

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