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Renal failure in Wilms' tumor patients: a report from the National Wilms' Tumor Study Group
M L Ritchey1, D M Green, P R Thomas
1Department of Surgery, University of Texas-Houston Medical School, USA.
Insights
Children with bilateral Wilms' tumor (WT) face a high risk of renal failure (RF). Parenchymal-sparing procedures are recommended for bilateral WT, but not for unilateral WT with a healthy contralateral kidney.
Area of Science:
- Pediatric Oncology
- Nephrology
- Clinical Research
Background:
- Wilms' tumor (WT) is a common pediatric kidney cancer.
- Renal failure (RF) is a significant complication in WT survivors.
- Understanding RF etiology is crucial for long-term patient outcomes.
Purpose of the Study:
- To determine the incidence of RF in patients treated for WT.
- To identify the primary causes of RF in this population.
- To inform treatment recommendations regarding kidney preservation.
Main Methods:
- Retrospective analysis of the National Wilms' Tumor Study (NWTS) database.
- Identification of patients diagnosed with chronic renal failure.
- Categorization of RF etiology based on clinical data.
Main Results:
- 55 patients developed RF; 39 had bilateral WT, 15 unilateral.
- RF incidence in bilateral WT decreased across NWTS study groups (NWTS-1/2: 16.4%, NWTS-3: 9.9%, NWTS-4: 3.8%).
- Common RF causes included bilateral nephrectomy (24), Drash syndrome (12), and radiation nephritis (6).
Conclusions:
- Children with bilateral WT are at significant risk for RF and may benefit from parenchymal-sparing procedures.
- Unilateral WT with a normal contralateral kidney has a low RF incidence, not supporting nephron-sparing surgery in these cases.
- Etiologies of RF are multifactorial, including treatment-related complications and specific syndromes.
Abstract:
This report defines the incidence and determines the etiology of renal failure (RF) in patients undergoing treatment for Wilms' tumor (WT). The database of the National Wilms' Tumor Study (NWTS) was searched to identify all children reported to have developed chronic renal failure. There were 55 patients found to have RF. Of these, 39 patients had bilateral tumors, 15 with unilateral disease and one with a WT in a solitary kidney. The median interval from diagnosis to the onset of renal failure was 21 months. The incidence of RF in bilateral WT was 16.4% for NWTS-1 & -2, 9.9% for NWTS-3, and 3.8% for NWTS-4. The incidence of RF in unilateral WT remained stable. The most common etiologies of RF were: bilateral nephrectomy for persistent or recurrent tumor (24 pts), Drash syndrome (12 pts), progressive tumor in the remaining kidney (5 pts), radiation nephritis (6 pts), and other causes (5 pts). The etiology of renal failure was not reported in three children. Children with unilateral WT and a normal contralateral kidney have a very low incidence of RF, and this review does not support a recommendation for parenchymal sparing procedures in these patients. Children with bilateral WT are at risk for the development of RF, and parenchymal sparing procedures are warranted.