Marie A Neu1, Alexandra Russo1, Arthur Wingerter1, Francesca Alt1, Johanna Theruvath1, Khalifa El Malki1, Bettina Kron1, Matthias Dittrich1, Johannes Lotz2, Raimund Stein3, Rolf Beetz4, Joerg Faber5. 1. Department of Pediatric Hematology/Oncology/Hemostaseology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. 2. Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany. 3. Department of Pediatric and Adolescent Urology, University Medical Center Mannheim, Mannheim, Germany. 4. Department of Pediatric Nephrology, University Medical Center Mainz, Mainz, Germany. 5. Department of Pediatric Hematology/Oncology/Hemostaseology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. faber@uni-mainz.de.
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.
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.
Entities:
Keywords:
Late effects of cancer treatment; Long-term survival; Nephroblastoma; Renal function; Sequelae; Wilms tumor
Authors: Anders Grubb; Masaru Horio; Lars-Olof Hansson; Jonas Björk; Ulf Nyman; Mats Flodin; Anders Larsson; Arend Bökenkamp; Yoshinari Yasuda; Hester Blufpand; Veronica Lindström; Ingrid Zegers; Harald Althaus; Søren Blirup-Jensen; Yoshi Itoh; Per Sjöström; Gunnar Nordin; Anders Christensson; Horst Klima; Kathrin Sunde; Per Hjort-Christensen; David Armbruster; Carlo Ferrero Journal: Clin Chem Date: 2014-05-14 Impact factor: 8.327
Authors: Norman E Breslow; Allan J Collins; Michael L Ritchey; Yevgeny A Grigoriev; Susan M Peterson; Daniel M Green Journal: J Urol Date: 2005-11 Impact factor: 7.450
Authors: Rik Westland; Michiel F Schreuder; David F van der Lof; Annemieke Vermeulen; Inge M J Dekker-van der Meer; Arend Bökenkamp; Joanna A E van Wijk Journal: Pediatr Nephrol Date: 2014-06-09 Impact factor: 3.714
Authors: Rik Westland; Michiel F Schreuder; Arend Bökenkamp; Marieke D Spreeuwenberg; Joanna A E van Wijk Journal: Nephrol Dial Transplant Date: 2011-03-21 Impact factor: 5.992
Authors: Leon Holzscheiter; Claus Beck; Sandra Rutz; Ekaterina Manuilova; Ingrid Domke; Walter G Guder; Walter Hofmann Journal: Clin Chem Lab Med Date: 2014-04 Impact factor: 3.694
Authors: David I Chu; Abdulla M Ehlayel; Jill P Ginsberg; Kevin E Meyers; Maryjane Benton; Melissa Thomas; Claire Carlson; Thomas F Kolon; Gregory E Tasian; Jason H Greenberg; Susan L Furth; Michelle R Denburg Journal: J Pediatr Date: 2020-12-05 Impact factor: 4.406
Authors: Christiaan A J Oudmaijer; Winnie M C van den Boogaard; Daphne S J Komninos; Emma J Verwaaijen; Hanneke M van Santen; Marc R Lilien; Jan H J Hoeijmakers; Marc H W Wijnen; Marry M van den Heuvel-Eibrink; Wilbert P Vermeij Journal: Front Pediatr Date: 2022-01-27 Impact factor: 3.418
Authors: Anouk Steur; Paulien A M A Raymakers-Janssen; Martin C J Kneyber; Sandra Dijkstra; Job B M van Woensel; Dick A van Waardenburg; Cornelis P van de Ven; Alida F W van der Steeg; Marc Wijnen; Marc R Lilien; Ronald R de Krijger; Harm van Tinteren; Annemieke S Littooij; Geert O Janssens; Annemarie M L Peek; Godelieve A M Tytgat; Annelies M Mavinkurve-Groothuis; Martine van Grotel; Marry M van den Heuvel-Eibrink; Roelie M Wösten-van Asperen Journal: Cancers (Basel) Date: 2022-02-14 Impact factor: 6.639