Wilms Tümörü Hastalarında Uzun Dönemli Böbrek Fonksiyonları

Abstract

BACKGROUND: Wilms tumor is the most common renal malignancy of childhood. Following the development in chemotherapy, the survival rates have increased up to 90%. Due to the improvement in prognosis and increase in survival rates the long term renal consequences of Wilms tumor are of greater concern. METHOD: We investigated the long term effects of the treatment on survivors of non-syndromic unilateral Wilms tumor. A total of 45 unilaterally nephrectomized survivors of Wilms tumor from our center were enrolled in the study. After the second year following the cessation of treatment; glomerular filtration rate (GFR), urinary protein excretion, urinary ß2 microglobulin levels and blood pressure were assessed as well as general health status and quality of life. Results were analyzed for correlation with clinical variables, chemotherapy and radiotherapy as possible risk factors. RESULTS: At a median follow-up time of 8.7 years , none of the patients included in the study developed end-stage renal disease. During the follow-up, patients had any of the renal problems; hypertension, proteinuria or tubulopathy. Proteinuria was detected None of the patients had increased ß2 microglobulin levels. Compensatory hypertrophy was observed under ultrasound in 72%. Median maximum bipolar length (MBL) was significantly higher in patients diagnosed after the age of 36 months. 10 (23%) and 3 (7%) of the 45 patients were hypertensive at the time of diagnosis and study respectively. Similarly, median GFR values were significantly lower at the time of diagnosis. Although at the time of the study all patients had normal GFR values; with longer follow-up intervals, especially after 10 years, a significant declining trend in GFR was observedCONCLUSIONS: Although the risk of developing end stage renal disease is remarkably low in non-syndromic unilateral Wilms tumor, a group of less serious but progressive renal dysfunction is of concern. Detailed analysis of renal functions should be performed during the long-term follow-up.