title: Renal function in survivors of nonsyndromic Wilms tumor treated with unilateral radical nephrectomy.
abstract: BACKGROUND
  Partial nephrectomy is considered by some for children with unilateral Wilms tumor (UWT) to avoid the theoretical complication of renal insufficiency. In the current study, the authors evaluated the prevalence of hypertension and impaired renal function in long-term survivors of nonsyndromic UWT who were treated without nephrotoxic chemotherapy or ionizing radiation.
  
  
  METHODS
  Eligibility included age ≤15 years at the time of diagnosis of nonsyndromic UWT, treatment receipt before 2002, and maintenance of disease remission after unilateral nephrectomy without receipt of abdominal irradiation or nephrotoxic chemotherapy. Renal function was assessed by urinalysis and estimated glomerular filtration rate (eGFR). Patients receiving antihypertensive medication or those with blood pressure readings of >140/90 mm Hg were considered to be hypertensive.
  
  
  RESULTS
  A total of 75 patients with a median age at diagnosis of 3.2 years (range, 0.2-12.1 years) met eligibility criteria. The median length of follow-up was 19.6 years (range, 10.0-32.8 years). All but 1 patient had stage I/II disease. Sixty-eight patients (90.7%) patients had WT with favorable histology and 7 patients had anaplastic histology. Sixteen patients (21.3%) had an eGFR <90 mL/minute/1.73m(2), 2 of whom also had proteinuria (12.5%). No patient had an eGFR <60 mL/minute/1.73m(2). Five patients (6.7%) had hypertension, 3 of whom were receiving antihypertensive medications. At the time of last follow-up, no patient had developed end-stage renal disease.
  
  
  CONCLUSIONS
  Patients with UWT who were treated with unilateral radical nephrectomy without nephrotoxic chemotherapy or ionizing radiation appear to be at low risk of developing significant long-term renal dysfunction. For this patient population, the routine use of partial nephrectomy does not appear justified. However, monitoring and counseling are important for identifying the rare patient who develops subtle renal insufficiency and therefore might be at an increased risk of adverse cardiovascular sequelae.
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee.|Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Rodrigo B
authors.initials: RB
authors.lastname: Interiano
authors.affiliation: Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Noel
authors.initials: N
authors.lastname: Delos Santos
authors.affiliation: Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Sujuan
authors.initials: S
authors.lastname: Huang
authors.affiliation: Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Deo Kumar
authors.initials: DK
authors.lastname: Srivastava
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Green
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee.|Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Davidoff
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology; D007223:Infant; D007668:Kidney / Q000503:physiopathology*; D007680:Kidney Neoplasms / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D009392:Nephrectomy / Q000379:methods; D015995:Prevalence; D011507:Proteinuria / Q000453:epidemiology / Q000209:etiology; D051437:Renal Insufficiency / Q000453:epidemiology / Q000209:etiology; D017741:Survivors / Q000706:statistics & numerical data; D009396:Wilms Tumor / Q000503:physiopathology* / Q000601:surgery*; D055815:Young Adult
keywords: Wilms tumor; long-term; nephrectomy; nonsyndromic; renal function
references.citation: Med Pediatr Oncol. 1996 Feb;26(2):75-80
references.pmid: 8531856
references.citation: J Urol. 2011 Aug;186(2):378-86
references.pmid: 21683387
references.citation: J Pediatr Surg. 2012 Jun;47(6):1234-8
references.pmid: 22703799
references.citation: NCHS Data Brief. 2013 Oct;(133):1-8
references.pmid: 24171916
references.citation: Cancer. 2008 May 1;112(9):2060-70
references.pmid: 18361398
references.citation: Pediatr Nephrol. 2015 May;30(5):821-8
references.pmid: 25403744
references.citation: Clin J Am Soc Nephrol. 2012 Sep;7(9):1416-27
references.pmid: 22822016
references.citation: J Urol. 2005 Mar;173(3):946-8; discussion 948
references.pmid: 15711346
references.citation: Am J Pediatr Hematol Oncol. 1991 Fall;13(3):342-4
references.pmid: 1665316
references.citation: Cancer Res. 2000 Aug 1;60(15):4030-2
references.pmid: 10945603
references.citation: Ann Intern Med. 2009 May 5;150(9):604-12
references.pmid: 19414839
references.citation: Cancer. 1995 Apr 15;75(8):2186-95
references.pmid: 7697611
references.citation: Pediatr Blood Cancer. 2014 Dec;61(12):2175-9
references.pmid: 25156758
references.citation: Eur J Pediatr Surg. 2007 Dec;17(6):382-6
references.pmid: 18072020
references.citation: Am J Kidney Dis. 2014 May;63(5):713-35
references.pmid: 24647050
references.citation: J Clin Oncol. 2009 Mar 10;27(8):1304-9
references.pmid: 19139431
references.citation: J Urol. 2014 Oct;192(4):1196-202
references.pmid: 24735935
references.citation: Pediatrics. 2009 Mar;123(3):906-15
references.pmid: 19255020
references.citation: Pediatr Nephrol. 2011 May;26(5):759-66
references.pmid: 21279390
references.citation: Pediatr Hematol Oncol. 1995 Mar-Apr;12 (2):143-52
references.pmid: 7626382
references.citation: Urology. 2014 Jun;83(6):1388-93
references.pmid: 24768019
references.citation: Pediatr Pathol. 1990;10(1-2):1-36
references.pmid: 2156243
references.citation: Ann Surg. 2010 Mar;251(3):555-8
references.pmid: 20142733
references.citation: Pediatr Nephrol. 2001 Jul;16(7):568-74
references.pmid: 11465806
references.citation: J Urol. 2013 May;189(5):1649-55
references.pmid: 23201493
references.citation: J Am Soc Nephrol. 2007 Nov;18(11):2953-9
references.pmid: 17942955
references.citation: Pediatr Blood Cancer. 2013 Dec;60(12):1929-35
references.pmid: 24039069
references.citation: J Cachexia Sarcopenia Muscle. 2013 Mar;4(1):19-29
references.pmid: 22777757
references.citation: Pediatrics. 2005 Oct;116(4):984-8
references.pmid: 16199712
references.citation: J Pediatr Surg. 1998 Feb;33(2):165-70
references.pmid: 9498380
references.citation: Pediatr Blood Cancer. 2012 Jun;58(6):898-904
references.pmid: 21744482
references.citation: N Engl J Med. 2004 Sep 23;351(13):1296-305
references.pmid: 15385656
references.citation: J Urol. 2012 Oct;188(4 Suppl):1506-10
references.pmid: 22910241
references.citation: Med Pediatr Oncol. 1993;21(3):172-81
references.pmid: 7680412
references.citation: JAMA. 2014 Feb 12;311(6):579-86
references.pmid: 24519297
references.citation: J Urol. 2005 Nov;174(5):1972-5
references.pmid: 16217371
references.citation: Ann Surg. 2011 May;253(5):1004-10
references.pmid: 21394016
references.citation: Pediatr Blood Cancer. 2011 May;56(5):825-36
references.pmid: 21370418
references.citation: Nat Rev Nephrol. 2014 Mar;10(3):135-45
references.pmid: 24419566
references.citation: J Am Soc Nephrol. 2002 Mar;13(3):745-53
references.pmid: 11856780
references.citation: BMC Nephrol. 2009 Oct 19;10:30
references.pmid: 19840369
references.citation: Nephrol Dial Transplant. 2014 May;29(5):944-7
references.pmid: 24516232