Emrullah Arslan1, Seha Saygili2, Tülin Tiraje Celkan3, Sebuh Kurugoglu4, Mehmet Elicevik5, Abdulhamit Enes Camcioglu6, Dildar Konukoglu7, Hilmi Apak3, Salim Caliskan2, Lale Sever2, Nur Canpolat8. 1. Department of Pediatrics, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey. 2. Department of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey. 3. Department of Pediatric Hematology Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey. 4. Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey. 5. Department of Pediatric Surgery, Division of Pediatric Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey. 6. Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey. 7. Department of Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey. 8. Department of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey. nur.canpolat@iuc.edu.tr.
Abstract
BACKGROUND: There is evidence of increased risk of hypertension, albuminuria, and development of chronic kidney disease (CKD) in long-term follow-up of survivors of Wilms tumor (WT). However, most studies were conducted in heterogeneous groups, including patients with solitary kidney. In addition, little is known about tubular dysfunction. This study aimed to investigate kidney sequelae, including CKD development, hypertension, and glomerular and tubular damage in WT survivors. METHODS: This cross-sectional, single-center study included 61 patients treated for WT. Surrogates for kidney sequelae were defined as presence of at least one of the following: decrease in GFR for CKD, hypertension detected by ambulatory blood pressure monitoring, albuminuria (albumin-to-creatinine ratio [ACR] > 30 mg/g), or increase in at least one tubular biomarker (beta-2-microglobulin, neutrophil gelatinase-associated lipocalin, kidney injury marker-1, and liver fatty acid-binding protein) in 24-h urine. RESULTS: Median age of patients was 11.7 years, with median follow-up of 8.8 years. Thirty-eight patients (62%) had at least one surrogate for kidney sequelae. Twenty-four patients (39%) had CKD, 14 patients (23%) had albuminuria, 12 patients (21%) had hypertension, and 11 patients (18%) had tubular damage. Urine ACR was significantly higher in patients with advanced tumor stage and patients with nephrotoxic therapy than their counterparts (p < 0.05), but neither eGFR nor tubular biomarkers showed any association with tumor- or treatment-related factors. CONCLUSIONS: A considerable number of patients with WT have kidney sequelae, especially early-stage CKD with a high prevalence. Albuminuria emerges as a marker associated with tumor stages and nephrotoxic treatment. A higher resolution version of the Graphical abstract is available as Supplementary information.
BACKGROUND: There is evidence of increased risk of hypertension, albuminuria, and development of chronic kidney disease (CKD) in long-term follow-up of survivors of Wilms tumor (WT). However, most studies were conducted in heterogeneous groups, including patients with solitary kidney. In addition, little is known about tubular dysfunction. This study aimed to investigate kidney sequelae, including CKD development, hypertension, and glomerular and tubular damage in WT survivors. METHODS: This cross-sectional, single-center study included 61 patients treated for WT. Surrogates for kidney sequelae were defined as presence of at least one of the following: decrease in GFR for CKD, hypertension detected by ambulatory blood pressure monitoring, albuminuria (albumin-to-creatinine ratio [ACR] > 30 mg/g), or increase in at least one tubular biomarker (beta-2-microglobulin, neutrophil gelatinase-associated lipocalin, kidney injury marker-1, and liver fatty acid-binding protein) in 24-h urine. RESULTS: Median age of patients was 11.7 years, with median follow-up of 8.8 years. Thirty-eight patients (62%) had at least one surrogate for kidney sequelae. Twenty-four patients (39%) had CKD, 14 patients (23%) had albuminuria, 12 patients (21%) had hypertension, and 11 patients (18%) had tubular damage. Urine ACR was significantly higher in patients with advanced tumor stage and patients with nephrotoxic therapy than their counterparts (p < 0.05), but neither eGFR nor tubular biomarkers showed any association with tumor- or treatment-related factors. CONCLUSIONS: A considerable number of patients with WT have kidney sequelae, especially early-stage CKD with a high prevalence. Albuminuria emerges as a marker associated with tumor stages and nephrotoxic treatment. A higher resolution version of the Graphical abstract is available as Supplementary information.
Authors: Rodrigo B Interiano; Noel Delos Santos; Sujuan Huang; Deo Kumar Srivastava; Leslie L Robison; Melissa M Hudson; Daniel M Green; Andrew M Davidoff Journal: Cancer Date: 2015-04-01 Impact factor: 6.860
Authors: Jane Lange; Susan M Peterson; Janice R Takashima; Yevgeny Grigoriev; Michael L Ritchey; Robert C Shamberger; J Bruce Beckwith; Elizabeth Perlman; Daniel M Green; Norman E Breslow Journal: J Urol Date: 2011-06-17 Impact factor: 7.450
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: Gregory T Armstrong; Yan Chen; Yutaka Yasui; Wendy Leisenring; Todd M Gibson; Ann C Mertens; Marilyn Stovall; Kevin C Oeffinger; Smita Bhatia; Kevin R Krull; Paul C Nathan; Joseph P Neglia; Daniel M Green; Melissa M Hudson; Leslie L Robison Journal: N Engl J Med Date: 2016-01-13 Impact factor: 91.245
Authors: S Bailey; A Roberts; C Brock; L Price; A W Craft; R Kilkarni; R E J Lee; A W Skillen; R Skinner Journal: Br J Cancer Date: 2002-11-04 Impact factor: 7.640