RENAL-FAILURE IN WILMS-TUMOR PATIENTS - A REPORT FROM THE NATIONAL WILMS-TUMOR STUDY-GROUP

This report defines the incidence and determines the etiology of renal failure (RF) in patients undergoing treatment for Wilms' tumor (WT). The database of the National Wilms' Tumor Study (NWTS) was searched to identify all children reported to have developed chronic renal failur e. There were 55 patients found to have RF. Of these, 39 patients had bilateral tumors, 15 with unilateral disease and one with a WT in a so litary kidney. The median interval from diagnosis to the onset of rena l failure was 21 months. The incidence of RF in bilateral WT was 16.4% for NWTS-1 & -2, 9.9% for NWTS-3, and 3.8% for NWTS-4. The incidence of RF in unilateral WT remained stable. The most common etiologies of RF were: bilateral nephrectomy for persistent or recurrent tumor (24 p ts), Drash syndrome (12 pts), progressive tumor in the remaining kidne y (5 pts), radiation nephritis (6 pts), and other causes (5 pts). The etiology of renal failure was not reported in three children. Children with unilateral WT and a normal contralateral kidney have a very low incidence of RF, and this review does not support a recommendation for parenchymal sparing procedures in these patients. Children with bilat eral WT are at risk for the development of RF, and parenchymal sparing procedures are warranted. (C) 1996 Wiley-Liss, Inc.