Long-term follow-up of blood pressure and glomerular filtration rate in patients with a solitary functioning kidney: a comparison between Wilms tumor survivors and nephrectomy for other reasons.
BACKGROUND
Children with unilateral Wilms tumor (WT) treated with chemotherapy and/or radiotherapy and nephrectomy have excellent survival rates. A solitary functioning kidney (SFK) is associated with progressive renal injury. This study aims to investigate the additional effect of Wilms tumor treatment on renal function compared with children with an SFK for non-oncological reasons.


METHODS
A single-center retrospective cohort study on the renal injury markers of 79 survivors of unilateral WT was performed and compared with a matched group of children with an SFK for non-oncological reasons. Mean age at follow-up was 12.4 (SD 5.9) years.


RESULTS
During follow-up, mean estimated glomerular filtration rate (eGFR) and blood pressure z-scores remained stable at an acceptable level. However, in the group of 31 WT patients with a follow-up of 15 years, 23% showed signs of renal injury. This proportion was smaller than the 54% in a group of SFK patients based on non-oncological causes (p = 0.004).


CONCLUSIONS
A significant proportion of WT survivors develop renal injury during follow-up. Our data may be an underestimation of the true frequency of progressive renal injury, due to a lack of information on proteinuria. As with patients with a non-oncological SFK, long-term follow-up is essential to monitor WT survivors.
Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.
Annelies M C
AM
Mavinkurve-Groothuis
Department of Pediatric Hematology and Oncology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands.|Radboudumc Amalia Children's Hospital Department of Pediatric Nephrology 804, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
Frank
F
van de Kracht
Department of Pediatric Nephrology, VU University Medical Center, Amsterdam, The Netherlands.
Rik
R
Westland
Department of Pediatric Nephrology, VU University Medical Center, Amsterdam, The Netherlands.
Joanna A E
JA
van Wijk
Department of Pediatric Hematology and Oncology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands.
Jacqueline J
JJ
Loonen
Radboudumc Amalia Children's Hospital Department of Pediatric Nephrology 804, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. michiel.schreuder@radboudumc.nl.
Michiel F
MF
Schreuder
D000293:Adolescent; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D007223:Infant; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D009392:Nephrectomy / Q000009:adverse effects*; D011507:Proteinuria / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D009396:Wilms Tumor / Q000175:diagnosis / Q000601:surgery*
Blood pressure; Glomerular hyperfiltration; Proteinuria; Solitary functioning kidney; Wilms tumor