Long-term renal function after treatment for unilateral, nonsyndromic Wilms tumor. A report from the St. Jude Lifetime Cohort Study

Abstract

Background: The impact of specific treatment modalities on long-term renal function and blood pressure among adult survivors of Wilms tumor (WT) has not been well documented.

Methods: Among 40 WT survivors and 35 noncancer controls, we estimated the glomerular filtration rate (eGFR) using the Chronic Kidney Disease-Epidemiology (CKD-EPI) equations with and without cystatin C, obtained 24-hour ambulatory blood pressure readings, and, among survivors only, measured ^99m Tc diethylenetriamine pentaacetic acid (DTPA) plasma clearance. Survivors were treated with unilateral nephrectomy and nonnephrotoxic chemotherapy. Twenty received whole abdomen radiation therapy (WART) [median -16.5 Gray (Gy)], and 20 received no radiation therapy. Pairwise comparisons between survivors treated with and without WART, and each group to controls were performed using two-sample t tests.

Results: Twenty-six (65%) WT survivors were female, and 33 (83%) were non-Hispanic white. GFR estimated with creatinine or creatinine + cystatin C was decreased among irradiated survivors compared with controls. No irradiated or unirradiated participant had an eGFR (creatinine + cystatin C) < 60 mL/min/1.73 m² . The prevalence of hypertension was significantly increased among unirradiated (25%) and irradiated survivors (35%) compared with controls (0%). Of the 24-hour ambulatory blood pressure monitoring parameters evaluated, only mean sleep period diastolic blood pressure load of those who received WART was significantly different from that of controls.

Conclusions: Chronic kidney disease was infrequent in long-term survivors of unilateral nonsyndromic WT, whether treated with WART or no radiation. The prevalence of hypertension was increased in both groups compared with controls, emphasizing the need for ongoing monitoring of renal and cardiovascular health.

Keywords: Wilms tumor; hypertension; nephrectomy; renal function; whole abdomen radiation therapy.

Figure 1 -

Flow diagram

Figure 2 –

Box plots of: A - serum creatinine and cystatin C by group; B - 24-hour urine protein by group; C - eGFR and ^99m Tc plasma clearance by group.

Figure 3 –

Scatterplots with regression line for correlation of: A - ^99mTc plasma clearance GFR versus CKD-EPI creatinine only eGFR in unirradiated survivors (solid line) and ^99mTc plasma clearance GFR versus CKD-EPI creatinine only eGFR in irradiated survivors (dashed line); B - ^99mTc plasma clearance GFR versus CKD-EPI creatinine + cystatin C eGFR in unirradiated survivors (solid line) and; C - ^99mTc plasma clearance GFR versus 24-hour urine measured creatinine clearance in unirradiated survivors (solid line) and ^99mTc plasma clearance GFR versus 24-hour urine measured creatinine clearance in irradiated survivors (dashed line).

Figure 4 –

Scatterplots with regression line for correlation of: A - CKD-EPI creatinine only eGFR versus 24-hour urine measured creatinine clearance in unirradiated survivors (solid line), irradiated survivors (short dashed line), and controls (alternating dashed line); B - CKD-EPI creatinine + cystatin C eGFR versus 24-hour urine measured creatinine clearance in unirradiated survivors (solid line), irradiated survivors (short dashed line), and controls (alternating dashed line).