Nephrotoxicity of Cancer Treatment in Children

Roderick Skinner

Disclosures

Pediatr Health. 2010;4(5):519-538. 

In This Article

Surgery

Residual renal tissue in children with single kidneys or those who undergo unilateral nephrectomy demonstrates compensatory structural and functional changes, characterized by renal hypertrophy[160] and relatively increased GFR (when corrected for renal surface area).[161] Unilateral or partial nephrectomy is often performed in Wilms' tumor and neuroblastoma, whilst synchronous or metachronous Wilms' tumor affecting both kidneys leads to a high risk of CRF and, ultimately, the need for renal replacement treatment. Contemporary surgical practice is to perform renal-sparing surgery in the hope of reducing this risk. Concerns have been expressed that such hyperfiltration of the remaining renal tissue may cause long-term damage manifest by proteinuria and microalbuminuria (reported in up to 35% of survivors of Wilms' tumor),[160,162] hypertension (described in 7% in a series of 1171 patients studied up to 5 years after treatment completion)[163] and, rarely, focal glomerulosclerosis leading to CRF.[22] Nevertheless, despite the use of additional chemotherapy in all patients and of abdominal or flank radiotherapy in 47.5%, functionally significant tubular dysfunction was not observed in one detailed study of 40 Wilms' tumor survivors.[160] Other than albuminuria and hypertension, clinically important nephrotoxicity appears uncommon in these survivors.[160]

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