Bilateral renal cancer in children: A difficult, challenging and changing management problem

Bilateral disease occurs in 6% of patients with Wilms' tumour. Bilateral re nal involvement is present in 25%-50% of children with B-cell non-Hodgkin's lymphoma. Paediatric oncologists therefore encounter bilateral renal disea se relatively frequently. A patient with bilateral Wilms' tumour is presented, in whom at least 16 sy nchronous rumours in the kidneys were treated successfully by primary chemo therapy and 'nephron-sparing' surgery, without renal radiotherapy. We belie ve the successful treatment without radiotherapy will allow greater potenti al for normal growth in the future. The case history of a patient with renal failure due to the infiltration of both kidneys by lymphoma and who was treated successfully by chemotherapy, is also presented. One kidney has completely returned to normal function a nd growth; the other has completely failed and almost disappeared, demonstr ating complete reversibility of the damage up to some critical point, beyon d which, failure and atrophy result. These two case histories demonstrate extreme examples of clinical dilemmas involving bilateral renal tumours and allow discussion of modern management aimed at preserving renal function.