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Prospective analysis of long-term renal function in survivors of childhood Wilms tumor

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Abstract

Background

Considering the improved outcome, a better understanding of the late effects in Wilms tumor survivors (WT-S) is needed. This study was aimed at evaluating renal function and determining the prevalence of clinical and subclinical renal dysfunction in a cohort of WT-S using a multimodal diagnostic approach.

Methods

Thirty-seven WT-S were included in this prospective cross-sectional single center study. To evaluate renal function, glomerular filtration rate (GFR) and urinary protein excretion were assessed. Additionally, kidney sonomorphology and blood pressure were analyzed.

Results

All examined WT-S (mean age 28.7 years, mean follow-up 24.8 years) had been treated with a combination of surgery and chemotherapy; 59.5% had received adjuvant radiotherapy. Impaired glomerular renal function was detected in a considerable proportion of WT-S, with age-adjusted cystatin-based GFR estimation below age norm in 55.9%. A lower cystatin-based estimated GFR (eGFR) correlated with longer follow-up time and higher irradiation dose. In 5 patients (13.5%) albuminuria was identified. Analysis of sonomorphology detected compensatory contralateral renal hypertrophy in 83.3% of WT-S. Chronic kidney disease (CKD) ≥ stage II was present in 55.9% of WT-S. Blood pressure measurements revealed arterial hypertension in 15 (40.5%) WT-S (newly diagnosed n=10). In 24.3% both CKD ≥ stage II and arterial hypertension were determined.

Conclusion

Even though WT-S are believed to carry a low risk for end-stage renal disease, in this study, a remarkable number of WT-S presented with previously unidentified subclinical signs of renal function impairment and secondary morbidity. Therefore, it is important to continue regular follow-up, especially after transition into adulthood.

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Abbreviations

AM:

Antihypertensive medication

BSA:

Body surface area

CAPA:

Caucasian, Asian, Pediatric, and Adult

CKD:

Chronic kidney disease

CrCl:

Creatinine clearance

DEGUM:

Deutsche Gesellschaft für Ultraschall in der Medizin (German Society for Ultrasound in Medicine)

eGFR:

Estimated glomerular filtration rate

GFR:

Glomerular filtration rate

MDRD:

Modification of diet in renal disease

NGAL:

Neutrophil gelatinase-associated lipocalin

NKF KDOQI:

National Kidney Foundation Kidney Disease Outcomes Quality Initiative

NSS:

Nephron-sparing surgery

SFK:

Solitary functioning kidney

SIOP:

Société Internationale d’Oncologie Pédiatrique (International Society of Pediatric Oncology)

WT:

Wilms tumor

WT-S:

Wilms tumor survivor(s)

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Acknowledgements

We would like to express our gratitude to Prof. Peter Gutjahr, who has been focusing his clinical and research on late sequelae in childhood cancer survivors for several decades, inspiring and encouraging us to conduct this study.

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Author notes

  1. Marie A. Neu and Alexandra Russo contributed equally to this work

Authors and Affiliations

  1. Department of Pediatric Hematology/Oncology/Hemostaseology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany

    Marie A. Neu, Alexandra Russo, Arthur Wingerter, Francesca Alt, Johanna Theruvath, Khalifa El Malki, Bettina Kron, Matthias Dittrich & Joerg Faber

  2. Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany

    Johannes Lotz

  3. Department of Pediatric and Adolescent Urology, University Medical Center Mannheim, Mannheim, Germany

    Raimund Stein

  4. Department of Pediatric Nephrology, University Medical Center Mainz, Mainz, Germany

    Rolf Beetz

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  1. Marie A. Neu
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  2. Alexandra Russo
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Corresponding author

Correspondence to Joerg Faber.

Ethics declarations

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee (approved by ethics review committee of the Rhineland-Palatinate Chamber of Physicians and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Written informed consent was obtained from study participants or, in the case of minor participants, from the legal guardian.

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The authors declare that they have no conflicts of interest.

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Neu, M.A., Russo, A., Wingerter, A. et al. Prospective analysis of long-term renal function in survivors of childhood Wilms tumor. Pediatr Nephrol 32, 1915–1925 (2017). https://doi.org/10.1007/s00467-017-3673-9

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  • DOI: https://doi.org/10.1007/s00467-017-3673-9

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