Residual renal tissue in children with single kidneys or those who undergo unilateral nephrectomy demonstrates compensatory structural and functional changes, characterized by renal hypertrophy and relatively increased GFR (when corrected for renal surface area). 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) and, rarely, focal glomerulosclerosis leading to CRF. 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. Other than albuminuria and hypertension, clinically important nephrotoxicity appears uncommon in these survivors.
Pediatr Health. 2010;4(5):519-538. © 2010 Future Medicine Ltd.
Cite this: Nephrotoxicity of Cancer Treatment in Children - Medscape - Oct 01, 2010.