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 99mTc 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.

Biomarkers Predictive of Metabolic Syndrome and Cardiovascular Disease in Childhood Cancer Survivors

“…In one study, patients exposed to radiotherapy but not to cardiotoxic chemotherapy had decreased left ventricle wall thickness and wall mass similar to those who received anthracyclines [ 25 ]. This mechanism was confirmed by a report that demonstrates the strong association between abdomen and liver radiation (>15 Gy) and portal hypertension in CCS of Wilms Tumor [ 26 ]. Patients exposed to abdomen radiation have the highest risk of developing type 2 diabetes and insulin intolerance as a result of adipose damage after radiation, which causes cytokine release and chronic low-grade inflammation.…”

Expanding the Use of Nephron-Sparing Surgery for Wilms Tumor

“…Another study examined long-term renal function after unilateral RN in nonsyndromic patients. 18 At 28 years of follow-up, GFR was similar to that of controls, except for those who received RT, and no patients developed ESRD. There was, however, a significant increased risk for hypertension in those with WT.…”

Hypertension in long-term childhood cancer survivors after treatment with potentially nephrotoxic therapy; DCCSS-LATER 2: Renal study

“…It better reflects actual BP, and nocturnal BP is the most significant predictor of CVD [19e21]. Studies in various cohorts of CCS using ABPM [15,22e26] reported insufficient nocturnal dipping [23,24,26] or deviant night-time diastolic BP (DBP) [15,22,25]. Unfortunately, these studies included small patient numbers.…”