Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Feinberg School of Medicine at Northwestern University, Chicago, IL.
Division of Nephrology, Children's Hospital of New Orleans, New Orleans, LA.
J Pediatr. 2021 Mar;230:215-220.e1. doi: 10.1016/j.jpeds.2020.12.005. Epub 2020 Dec 5.
To assess the prevalence of therapy-related kidney outcomes in survivors of Wilms tumor (WT).
This prospective cohort study included survivors of WT who were ≥5 years old and ≥1 year from completing therapy, excluding those with preexisting hypertension, prior dialysis, or kidney transplant. Participants completed 24-hour ambulatory blood pressure monitoring (ABPM). Abnormal blood pressure (BP) was defined as ≥90th percentile. Masked hypertension was defined as having normal office BP and abnormal ABPM findings. Urine was analyzed for kidney injury molecule-1, interleukin-18, epidermal growth factor, albumin, and creatinine. The estimated glomerular filtration rate (eGFR) was calculated using the bedside chronic kidney disease in children equation. Recent kidney ultrasound examinations and echocardiograms were reviewed for contralateral kidney size and left ventricular hypertrophy, respectively. Clinical follow-up data were collected for approximately 2 years after study enrollment.
Thirty-two participants (median age, 13.6 years [IQR, 10.5-16.3 years]; 75% stage 3 or higher WT) were evaluated at a median of 8.7 years (IQR, 6.5-10.8 years) after therapy; 29 participants underwent unilateral radical nephrectomy, 2 bilateral partial nephrectomy, and 1 radical and contralateral partial nephrectomy. In this cohort, 72% received kidney radiotherapy and 75% received doxorubicin. Recent median eGFR was 95.6 mL/min/1.73 m (IQR, 84.6-114.0; 11 [34%] had an eGFR of <90 mL/min/1.73 m). Abnormal ABPM results were found in 22 of 29 participants (76%), masked hypertension in 10 of 29 (34%), and microalbuminuria in 2 of 32 (6%). Of the 32 participants, 22 (69%) had abnormal epidermal growth factor; few had abnormal kidney injury molecule-1 or interleukin-18. Seven participants with previous unilateral nephrectomy lacked compensatory contralateral kidney hypertrophy. None had left ventricular hypertrophy.
In survivors of WT, adverse kidney outcomes were common and should be closely monitored.
评估肾母细胞瘤（WT）幸存者治疗相关的肾脏结局的发生率。
本前瞻性队列研究纳入了年龄≥5 岁且距完成治疗≥1 年的 WT 幸存者，排除了有高血压、透析或肾移植病史的患者。参与者完成了 24 小时动态血压监测（ABPM）。异常血压定义为≥第 90 百分位数。隐匿性高血压定义为办公室血压正常而 ABPM 异常。对尿液进行肾损伤分子-1、白细胞介素-18、表皮生长因子、白蛋白和肌酐分析。使用床边慢性肾脏病儿童公式计算估计肾小球滤过率（eGFR）。回顾最近的肾脏超声和超声心动图检查，以分别评估对侧肾脏大小和左心室肥厚。在研究入组后约 2 年收集临床随访数据。
在治疗后中位数为 8.7 年（IQR，6.5-10.8 年），对 32 名参与者（中位年龄 13.6 岁[IQR，10.5-16.3 岁]；75%为 3 期或更高级别 WT）进行了评估；29 名参与者接受了单侧根治性肾切除术，2 名接受了双侧部分肾切除术，1 名接受了根治性和对侧部分肾切除术。该队列中，72%的患者接受了肾放疗，75%的患者接受了阿霉素治疗。最近的中位 eGFR 为 95.6 mL/min/1.73 m（IQR，84.6-114.0；11 名[34%]患者的 eGFR＜90 mL/min/1.73 m）。29 名参与者中有 22 名（76%）的 ABPM 结果异常，10 名（34%）为隐匿性高血压，32 名中有 2 名（6%）为微量白蛋白尿。32 名参与者中有 22 名（69%）的表皮生长因子异常；很少有患者的肾损伤分子-1 或白细胞介素-18 异常。22 名有单侧肾切除术史的患者中，对侧肾脏缺乏代偿性肥大。没有人有左心室肥厚。
WT 幸存者中，不良肾脏结局较为常见，应密切监测。
