Comprehensive renal function evaluation in patients treated for synchronous bilateral Wilms tumor

Area of Science:

• Pediatric Nephrology
• Pediatric Oncology
• Renal Function Assessment

Background:

• Synchronous bilateral Wilms tumor (BWT) is a rare pediatric malignancy.
• Long-term renal function is a critical concern for survivors due to potential treatment-related nephrotoxicity.
• Accurate estimation of glomerular filtration rate (eGFR) is essential for monitoring kidney health.

Purpose of the Study:

• To comprehensively assess long-term renal function in BWT patients.
• To determine the optimal method for estimating glomerular filtration rate (eGFR) in this population.
• To evaluate the sensitivity of specific urine biomarkers in detecting renal dysfunction.

Main Methods:

• Retrospective case series of 42 patients with BWT.
• Review of surgical approach, adjuvant therapy, and pathology reports.
• Comparison of estimated GFR (eGFR) using Schwartz and CKiD formulas against measured GFR (mGFR) via 99mTc-DTPA scan.
• Analysis of urine studies including microalbumin, β-microglobulin, and fractional excretion of sodium (FE_Na).

Main Results:

• A median follow-up of 5.2 years was achieved for 28 of 36 living patients.
• Median mGFR was 97 mL/min/1.73m², with no significant difference compared to eGFR_Schwartz (103.3) or eGFR_CKiD (79.7).
• Eleven patients (39.3%) exhibited abnormal urine studies, indicating potential subclinical renal impairment.

Conclusions:

• Most BWT patients in this series maintained normal GFR.
• The Schwartz equation is a suitable method for estimating GFR in BWT survivors.
• Specific urine tests may offer greater sensitivity for detecting early-stage renal dysfunction than GFR estimation alone.