Reinert Shannon, Benoit Stefanie W, Nagarajan Rajaram
Department of Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Pediatr Nephrol. 2025 May;40(5):1603-1611. doi: 10.1007/s00467-024-06624-x. Epub 2025 Jan 9.
Several studies have investigated long-term kidney outcomes in survivors of Wilms tumor (WT). However, many have small sample sizes, and there is a wide variation in reported outcomes. The aim of this study is to investigate the long-term kidney outcomes in survivors of WT (S-WT), including those patients considered to be at high risk for poor kidney outcomes, and using updated estimated glomerular filtration rate (eGFR) equations.
This was a retrospective chart review of 64 patients treated for WT at a single pediatric center. Patients were off treatment for 5 years or more at the time of analysis and were evaluated for decreased kidney function, hypertension, proteinuria, and compensatory hypertrophy of the contralateral kidney.
At a median follow-up time of 11.3 years off treatment (range 5-22.6) and average age of 16.7 years (range 6.5-30), 35 patients had a decreased eGFR (< 90 mL/min/1.73 m), and 2 patients had progressed to chronic kidney disease stage 5. Compensatory hypertrophy was observed in 67% of cases. 41% of patients had elevated clinic blood pressures, with 2 patients on an anti-hypertensive medication. Three of 9 patients had evidence of hypertension on ambulatory blood pressure monitoring. Eight of 37 patients (22%) had proteinuria.
Kidney dysfunction is common in S-WT at a young age. This population should be carefully monitored for the development of decreased eGFR, hypertension, and proteinuria as part of their routine survivorship care. This is particularly true for modifiable risk factors of chronic kidney disease progression, such as hypertension and proteinuria.
多项研究调查了肾母细胞瘤（WT）幸存者的长期肾脏预后。然而，许多研究样本量较小，且报告的预后存在很大差异。本研究的目的是调查WT幸存者（S-WT）的长期肾脏预后，包括那些被认为肾脏预后不良风险较高的患者，并使用更新的估计肾小球滤过率（eGFR）方程。
这是一项对在单一儿科中心接受WT治疗的64例患者进行的回顾性病历审查。在分析时，患者已停止治疗5年或更长时间，并对肾功能下降、高血压、蛋白尿和对侧肾脏代偿性肥大进行了评估。
在中位随访时间为停止治疗11.3年（范围5 - 22.6年）且平均年龄为16.7岁（范围6.5 - 30岁）时，35例患者的eGFR下降（<90 mL/min/1.73 m²），2例患者已进展至慢性肾脏病5期。67%的病例观察到代偿性肥大。41%的患者临床血压升高，2例患者正在服用抗高血压药物。9例患者中有3例在动态血压监测中有高血压证据。37例患者中有8例（22%）有蛋白尿。
年轻时S-WT中肾功能障碍很常见。作为其常规生存护理的一部分，应对该人群密切监测eGFR下降、高血压和蛋白尿的发生情况。对于慢性肾脏病进展的可改变风险因素，如高血压和蛋白尿，尤其如此。
