Glomerular filtration rate and prevalence of chronic kidney disease in Wilms’ tumour survivors

Abstract

Glomerular filtration rate (GFR) was evaluated in 32 Wilms’ tumour survivors (WTs) in a cross-sectional study using 99 Tc-diethylene triamine pentaacetic acid (99 Tc-DTPA) clearance, the Schwartz formula, the new Schwartz equation for chronic kidney disease (CKD), cystatin C serum concentration and the Filler formula. Kidney damage was established by beta-2-microglobulin (B-2-M) and albumin urine excretion, urine sediment and ultrasound examination. Blood pressure was measured. No differences were found between the mean GFR in 99 Tc-DTPA and the new Schwartz equation for CKD (91.8 ± 11.3 vs. 94.3 ± 10.2 ml/min/1.73 m2 [p = 0.55] respectively). No differences were observed between estimated glomerular filtration rate (eGFR) using the Schwartz formula and the Filler formula either (122.3 ± 19.9 vs. 129.8 ± 23.9 ml/min/1.73 m2 [p = 0.28] respectively). Increased urine albumin and B-2-M excretion, which are signs of kidney damage, were found in 7 (22%) and 3 (9.4%) WTs respectively. Ultrasound signs of kidney damage were found in 14 patients (43%). Five patients (15.6%) had more than one sign of kidney damage. Eighteen individuals (56.25%) had CKD stage I (10 with signs of kidney damage; 8 without). Fourteen individuals (43.75%) had CKD stage II (6 with signs of kidney damage; 8 without). The new Schwartz equation for CKD better estimated GFR in comparison to the Schwartz formula and the Filler formula. Furthermore, the WT survivors had signs of kidney damage despite the fact that GFR was not decreased below 90 ml/min/1.73 m2 with 99 Tc- DTPA.

Risk factors for chronic kidney disease after chemotherapy for testicular cancer

“…24 More recently, several investigators reported the usefulness of eGFR in oncological patients. 18,19,25,26 In the present study, we also showed that the eGFR evaluation is a simple and useful screening tool to monitor the outpatients at risk of developing CKD.…”

“…However, there are few studies addressing this issue in cancer survivors after chemotherapy. 18,19 To our knowledge, there is no report describing the prevalence of CKD defined by eGFR in testicular cancer survivors.…”

Chronic Kidney Disease in Wilms Tumour Survivors – What Do We Know Today?

“…The most common causes of ESRD were progressive BWT (55); DDS (27); WAGR syndrome (10); radiation nephritis (12); focal segmental glomerulosclerosis (18); CKD, aetiology unknown (16) and hypertension (7). Fifty-five patients whose ERSD resulted from progressive BWT experienced high early mortality from WT that limited their opportunity for transplant (47% at 5 years) and survival (44% at 10 years) compared with population controls.…”

“…Signs of kidney damage may indicate the risk of deterioration of kidney function in the future. Long-term monitoring of renal function in WTS will facilitate the identification of those with treatmentrelated impairment of function.WTS are at risk of deterioration of renal function and CKD because of the following: decreased number of nephrons -after nephrectomy, nephrotoxic side effects of chemotherapy (carboplatin, cisplatin, ifosfamide, cyclophosphamide) or radiation therapy -if solitary kidney was in the field of radiation (3,4,26,27). According to Daw et al (3), the most severe reduction in GFR, measured by 99Tc-DTPA (technetium-99m-diethylenetriamine pentaacetic acid) clearance, occurs after nephrectomy.…”

“…Arterial hypertension, based on the mean values of systolic and diastolic blood pressures from three independent measurements, over the 95th centile was observed in 6.25% individuals (27).…”