Dialysis Requirements After Wilms Tumor Surgical Removal
Most children with Wilms tumor do not require dialysis after surgical removal of the tumor, unless they have bilateral disease requiring extensive renal resection or complete nephrectomy of both kidneys.
Factors Determining Need for Dialysis
Unilateral vs. Bilateral Disease
- Unilateral Wilms tumor: Typically does not require dialysis after nephrectomy as the contralateral kidney maintains adequate renal function
- Bilateral Wilms tumor: Higher risk for requiring dialysis, especially when extensive resection is needed
Surgical Approach
Nephron-sparing surgery (NSS):
- Preferred approach for bilateral disease
- Significantly reduces need for dialysis
- In one study, only 3 of 17 patients with bilateral Wilms tumor who underwent NSS required dialysis at median follow-up of 72 months 1
Total nephrectomy:
- Required in some cases of bilateral disease when tumor burden cannot be reduced otherwise
- Will necessitate dialysis until transplantation can be performed
Outcomes Data
Renal Function After Surgery
- In patients with bilateral Wilms tumor treated with nephron-sparing surgery:
- 76.5% maintained adequate renal function without dialysis
- 5.9% developed renal insufficiency
- 17.6% developed renal failure requiring dialysis 1
Transplantation Considerations
- Current recommendation is to wait 1-2 years after completion of chemotherapy before renal transplantation 2
- Outcomes of children with Wilms tumor who proceed to renal transplantation are comparable to children with other diagnoses 2
- Important consideration: One study showed that patients with Wilms tumor who required dialysis but did not receive transplantation had poor outcomes, with most dying of their disease 2
Special Considerations
Genetic Predisposition Syndromes
- Children with certain genetic syndromes (e.g., Denys-Drash syndrome) may require nephrectomy due to high risk of Wilms tumor development, potentially leading to dialysis need 3
- Universal genetic testing and counseling should be offered to all children with bilateral Wilms tumors 3
Monitoring After Nephron-Sparing Surgery
- Regular monitoring of renal function is essential
- Watch for:
- Hypertension (seen in ~53% of patients after NSS for bilateral Wilms tumor) 1
- Proteinuria
- Progressive renal insufficiency
Dialysis Management If Required
- For patients requiring dialysis, indications for renal replacement therapy include:
- Persistent hyperkalemia
- Severe metabolic acidosis
- Volume overload unresponsive to diuretic therapy
- Overt uremic symptoms 3
Prevention of Dialysis Need
- Early detection and treatment of Wilms tumor
- Nephron-sparing surgical approaches whenever feasible
- Multidisciplinary management by experienced teams
- Careful surgical planning to preserve maximum renal tissue
Long-term Follow-up
- Children who undergo nephron-sparing surgery for bilateral Wilms tumor should have:
- Regular assessment of renal function
- Blood pressure monitoring
- Screening for proteinuria
- Tumor surveillance with abdominal ultrasounds every 3 months until at least 8 years of age 3
In conclusion, while dialysis is not typically required after removal of unilateral Wilms tumor, it may be necessary in cases of bilateral disease requiring extensive renal resection. The goal of treatment should be to preserve renal function while ensuring complete tumor removal, with nephron-sparing approaches preferred whenever oncologically safe.