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

• Verfasst von: Neu, Marie Astrid [VerfasserIn]
• Verfasst von: Stein, Raimund [VerfasserIn]
• Titel: Prospective analysis of long-term renal function in survivors of childhood Wilms tumor
• Verf.angabe: Marie A. Neu, Alexandra Russo, Arthur Wingerter, Francesca Alt, Johanna Theruvath, Khalifa El Malki, Bettina Kron, Matthias Dittrich, Johannes Lotz, Raimund Stein, Rolf Beetz, Joerg Faber
• E-Jahr: 2017
• Jahr: 28 April 2017
• Umfang: 11 S.
• Fussnoten: Gesehen am 16.08.2018
• Titel Quelle: Enthalten in: Pediatric nephrology
• Ort Quelle: Berlin : Springer, 1987
• Jahr Quelle: 2017
• Band/Heft Quelle: 32(2017), 10, Seite 1915-1925
• ISSN Quelle: 1432-198X
• DOI: doi:10.1007/s00467-017-3673-9
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1580122094

Abstract

BackgroundConsidering 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.MethodsThirty-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.ResultsAll 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.ConclusionEven 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.