[Late effect of treatment of nephroblastoma in patients treated in 1980-2001 in a single centre]

The aim of the study was to describe the late effects in a cohort of patients in long-term remission (> 5 years from end of treatment) diagnosed and treated for nephroblastoma at the single paediatric centre during 1980- 2001.

151 patients were examined for renal function, lipid profile, sonography, echocardiography, exercise capacity and postural status. Age at diagnosis was 3.7 +/- 2.7 years, median 3.1, range 0.01-17.2 years. The cohort included 55% of women. Age in the study 19.4 +/- 5.8, median 19.6 years, range 7.8-36 years. Anthracyclines (ATC) were administered to 25.9% of the cohort. Abdominal radiotherapy (RTA) was required in 34.2%.

Creatinine clearance was on average 1.56 +/- 0.56 ml/s/1.73m2, (median 1.49 ml/s/1.73m2). Proteinuria was 0.18 +/- 0.30 g/24 h/m2, median 0.13 mg/24 h/m2. Three patients had proteinuria above 1 g/24 h with a normal glomerular filtration rate and s-albumin. Hypertension was treated in 8.6% of patients (6% by pharmacotherapy). Increased diastolic blood pressure (DBP) and systolic blood pressure (SBP) was found in adolescents: DBP > 90 Torr was found in 10.2% of patients and SBP > 135 Torr in 8.3%, all of them above the age of 15 years. ECHO did not reveal any pathology even in patients treated by ATC. Plasma cholesterol, LDL, HDL, triglycerides were outside the recommended range in two or more parameters in 28.9% of the cohort. Lipoprotein Lp(a) > 500 mg.l(-1) (more than 200% higher than the upper limit) was found in 15.2%. Low peak oxygen consumption (VO2peak) was found in 40% of the cohort. Scoliosis (Sc) was anamnestically found in 46%. Prevalence of Sc according to the age of treatment has a similar trend as the reduced use of the RTA. Pulmonary function test showed a moderate increase in the functional residual capacity (the average Z-score of 1.35). VO2 peak correlates positively with the inspiratory capacity (p < 0.05).

Based on the found pathologies and known risks, a schedule of late effect prevention and monitoring of patients in long-term NFB remission was established. It should include clinical examination, kidney function and blood pressure monitoring, sonographic and echocardiography examination, long-term physiotherapeutic care and prevention of cardiovascular diseases.