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. 2017 Jan;52(1):98-103.
doi: 10.1016/j.jpedsurg.2016.10.027. Epub 2016 Oct 27.

Comprehensive renal function evaluation in patients treated for synchronous bilateral Wilms tumor

Rodrigo B Interiano  1 , M Beth McCarville  2 , Noel Delos Santos  3 , Shenghua Mao  4 , Jianrong Wu  4 , Jeffrey S Dome  5 , Kathleen Kieran  6 , Mark A Williams  7 , Rachel C Brennan  8 , Matthew J Krasin  9 , Daniel M Green  10 , Andrew M Davidoff  11
Affiliations

Comprehensive renal function evaluation in patients treated for synchronous bilateral Wilms tumor

Rodrigo B Interiano et al. J Pediatr Surg. 2017 Jan.

Abstract

Objectives: The purpose of this study was to perform a comprehensive assessment of long-term renal function in patients treated at our institution for synchronous bilateral Wilms tumor (BWT) and to determine the optimal method for estimating glomerular filtration rate (eGFR).

Methods: Surgical approach, adjuvant therapy, and pathology reports were reviewed for patients with at least six months follow-up from definitive surgery. eGFRs, as assessed by the Schwartz and Chronic Kidney Disease in Children (CKiD) formulas, were compared to measured GFR (mGFR) determined by 99mTc-DTPA scanning. Urine studies, including microalbumin, β-microglobulin, and FENa were also reviewed.

Results: Forty-two patients were identified. Of 36 living patients, 28 (77.8%) had greater than 6months follow-up, with a median overall follow-up of 5.2years (range: 1.4-13.4). The median mGFR was 97mL/min/1.73m2, while the median eGFRSchwartz and eGFRCKiD were 103.3mL/min/1.73m2 and 79.7mL/min/1.73m2, respectively, (p=0.13 and p=0.75, compared to mGFR). Eleven (39.3%) patients had at least one abnormal urine study (microalbumin >30μg/g creatinine, n=3; β-2 microglobulin >133μg/g creatinine, n=9; FENa>1%, n=4).

Conclusions: In our series, few patients had an abnormally low GFR. Neither method for estimating GFR gave a significantly different result from measured GFR, suggesting that the Schwartz equation is adequate, although specific urine tests may be more sensitive for detecting subtle renal dysfunction.

Level of evidence: Level IV - retrospective case series with no comparison group.

Keywords: Bilateral Wilms tumor; Nephron-sparing surgery; Renal function.

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Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials (CONSORT) diagram depicting the cohort of patients included in the present study.
Figure 2
Figure 2
Diagram plotting total renal parenchymal volume for all patients with immediate post-operative ultrasound imaging and imaging at last follow-up. The age of the patients was plotted versus the total kidney volume, with the trend lines adapted from nomograms of total kidney volume adopted from Leung et al. [23].
See this image and copyright information in PMC

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