Renal function in patients with Wilms tumor.

Area of Science:

• Pediatric Oncology
• Nephrology
• Cancer Survivorship

Background:

• Wilms tumor (WT) survival rates are high, but long-term morbidity, particularly renal dysfunction, is a growing concern.
• Kidney damage in WT survivors stems from chemotherapy, radiation, and nephrectomy, leading to potential long-term renal issues.

Purpose of the Study:

• To review the literature on renal function in Wilms tumor patients.
• To present incidence, causes, and mitigation strategies for renal dysfunction in sporadic unilateral, syndromic unilateral, and bilateral WT.
• To critically evaluate nephron-sparing surgery for renal function preservation.

Main Methods:

• Literature review of existing studies on renal function in Wilms tumor patients.
• Analysis of renal dysfunction in three clinical scenarios: sporadic unilateral WT, syndromic unilateral WT, and bilateral WT.
• Critical assessment of nephron-sparing surgery's role in preserving renal function.

Main Results:

• Renal dysfunction is a common and feared long-term complication in Wilms tumor survivors.
• Strategies to mitigate renal dysfunction involve careful prospective monitoring, accurate diagnosis of predisposition syndromes, and molecular stratification.
• Nephron-sparing surgery shows potential for preserving renal function but requires further investigation.

Conclusions:

• Prospective, sensitive monitoring of renal function is essential for early diagnosis in pediatric cancer survivors.
• Accurate identification of syndromic cases prevents misclassification and inappropriate treatment.
• Molecular stratification and nephron-sparing surgery are key areas for future research to balance survival and renal function preservation.