From the Guidelines
Patients with a single kidney due to Wilms tumor removal should undergo routine imaging surveillance, with a recommended follow-up schedule that includes abdominal ultrasound and chest imaging at regular intervals, as well as regular renal function tests. The most recent and highest quality study, 1, published in 2022, suggests that surveillance after treatment for renal cell carcinoma allows for the monitoring of postoperative complications, renal function, local recurrence, and the development of metastases. According to this study, a risk-based approach to surveillance is recommended, taking into account factors such as patient age, pathological stage, relapse location, and comorbidities. Key aspects of the surveillance schedule include:
- Abdominal imaging to monitor for local recurrence and contralateral kidney recurrence
- Chest imaging to monitor for lung metastases
- Renal function tests, including blood pressure monitoring, urinalysis, and serum creatinine measurements, to monitor for potential late effects of treatment, such as renal dysfunction. While the study 1 does not specifically address Wilms tumor, its recommendations for renal cell carcinoma surveillance can be applied to patients with a single kidney due to Wilms tumor removal, as they are also at risk of developing contralateral Wilms tumor and potential late effects of treatment. Additionally, study 1 provides guidance on the follow-up schedule for clinically localized renal cell carcinoma, which can be used as a reference for patients with a single kidney due to Wilms tumor removal. However, it is essential to note that the most recent and highest quality study, 1, should be prioritized when making recommendations. In terms of specific intervals, the study 1 proposes a follow-up surveillance schedule that can be individualized based on the patient's risk factors, but does not provide specific details on the frequency of imaging. In contrast, study 1 recommends chest imaging every 12 to 24 months for 3 to 5 years for low-risk tumors, and abdominal imaging yearly for 3 to 5 years. However, these recommendations may not be directly applicable to patients with a single kidney due to Wilms tumor removal, and the most recent and highest quality study, 1, should be prioritized. Overall, routine imaging surveillance is crucial for patients with a single kidney due to Wilms tumor removal, and a risk-based approach should be taken to determine the optimal follow-up schedule.
From the Research
Routine Imaging for Patients with a Single Kidney after Wilms Tumor Removal
- Patients with a single kidney after Wilms tumor removal are at risk of developing renal dysfunction and hypertension, as evidenced by studies showing that 32% of survivors have renal dysfunction and 23% have arterial hypertension 2, 3.
- The risk of renal dysfunction and hypertension is higher in patients who received chemotherapy with radiation doses to the remaining kidney of more than 1200 cGy, and in children who were less than 24 months old at diagnosis 2.
- Regular monitoring of renal function and blood pressure is necessary for patients with a single kidney after Wilms tumor removal, as they are at increased risk of developing cardiovascular and kidney problems 4, 5.
- The use of ambulatory blood pressure monitoring (ABPM) may be beneficial in detecting masked hypertension in Wilms tumor survivors, and in monitoring the effectiveness of treatment 4.
- Nephron-sparing surgery may be a viable option for preserving renal function in patients with Wilms tumor, but further research is needed to determine its effectiveness 5.
- ACE inhibitors may be a good therapeutic option for treating hypertension in Wilms tumor patients, particularly those with elevated plasma renin levels 6.