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Abstract
Now that most patients with Wilms' tumour are cured, it is practicable to study the long-term morbidity of their treatment and use this information to reduce treatment sequelae in the future. In this study we evaluate the size and function of the remaining kidney in 53 survivors of Wilms' tumour with a mean off treatment follow-up of 13 years. There was evidence of renal dysfunction in 17 (32%), including ten (19%) with a low GFR (< 80 ml/min/1.73 m2SA), six (11%) with hypertension and five (9%) with increased urinary albumin excretion. Measurements of renal size showed 'good' renal compensatory hypertrophy in only 55% of patients. 'Good' refers to renal size of more than 2 s.d. above the mean renal length for children with two kidneys. There were no correlations between GFR, renal size, blood pressure, microalbuminuria or type of treatment. However, children less than 24 months at diagnosis and children receiving chemotherapy with radiation doses to remaining kidney of more than 1200 cGy had a worse renal prognosis. Patients whose Wilms' tumour is diagnosed in infancy should have careful long-term follow-up of renal function and size. Older patients may safely be followed up less often, unless their remaining kidney was received > 1200 cGy.
Highlights
One patient had E. coli urinary tract infection on the study day; and her data were included in this analysis
Electrolytes, urea and creatinine were normal in all patients
The mean glomerular filtration rate (GFR) estimated from the plasma clearance of 5'Cr EDTA was 89.9 ± 13.7 ml/min/1.73 m2 surface area (SA) (Figure 1)
Summary
The aim of our study was to measure renal growth and function in long-term survivors of unilateral Wilms' tumour and to identify risk factors for renal damage
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