Renal functional reserve in long-term survivors of unilateral Wilms tumor

1991 ◽  
Vol 118 (5) ◽  
pp. 698-702 ◽  
Author(s):  
Donna M. Bhisitkul ◽  
Elaine R. Morgan ◽  
Michele A. Vozar ◽  
Craig B. Langman
Keyword(s):  
Wilms Tumor ◽  
Functional Reserve ◽  
Renal Functional Reserve ◽  
Long Term Survivors

Hypertension in long-term survivors of childhood renal cancers.

1989 ◽  
Vol 7 (7) ◽  
pp. 912-915 ◽  
Author(s):  
A F Kantor ◽  
F P Li ◽  
A J Janov ◽  
N J Tarbell ◽  
S E Sallan
Keyword(s):  
Wilms Tumor ◽  
Late Complication ◽  
Renal Surgery ◽  
Borderline Hypertension ◽  
Case Comparison ◽  
History Of ◽  
Family History Of Hypertension ◽  
Male Patients ◽  
Long Term Survivors

The prevalence of hypertension was investigated in 119 adults who have survived for up to 53 years following the diagnosis of renal cancer in childhood (Wilms' tumor, 116 patients; renal carcinoma, three patients). Twenty-four (20%) have developed definite or borderline hypertension, as compared with 18.1 cases expected based on US population rates (relative risk [RR], 1.3; 95% confidence interval [CI], 0.9 to 2.0; P = .20). This nonsignificant excess is due to the heightened prevalence of definite hypertension among one subgroup of male patients. The findings are not explained by cigarette smoking, obesity, age, and stage at diagnosis of Wilms' tumor, or family history of hypertension. A case-comparison analysis within the cohort showed no consistent hypertensive effect associated with radiation therapy dose, radiotherapy concurrent with dactinomycin chemotherapy, or extent of renal surgery. Hypertension is not a common late complication of Wilms' tumor in our patients.

Long-term survivors of leukemia treated in infancy: factors associated with neuropsychologic status.

1992 ◽  
Vol 10 (7) ◽  
pp. 1095-1102 ◽  
Author(s):  
R K Mulhern ◽  
E Kovnar ◽  
J Langston ◽  
M Carter ◽  
D Fairclough ◽  
...  
Keyword(s):  
Young Children ◽  
Wilms Tumor ◽  
Lymphoblastic Leukemia ◽  
Memory Performance ◽  
Auditory Memory ◽  
Very Young Children ◽  
Cns Relapse ◽  
Neuropsychologic Testing ◽  
Long Term Survivors

PURPOSE Because of concerns about late toxicities of treatment among infants diagnosed with acute lymphoblastic leukemia (ALL), and especially the effects of cranial radiation therapy (CRT), we compared the functional and neuropsychologic status of 26 long-term survivors of ALL who were diagnosed in the first 24 months of life versus 26 children who were treated previously for Wilms' tumor. PATIENTS AND METHODS Of the children with ALL, CNS prophylaxis included no CRT in six, 18 Gy CRT in five, 20 Gy CRT in seven, and 24 Gy CRT in five. Three additional children experienced CNS relapse and received total CRT doses of 24, 40, and 44 Gy. All children received neuropsychologic testing; children with ALL also participated in diagnostic imaging studies. RESULTS As a group, the children who were treated for ALL did not differ significantly from those who were treated for Wilms' tumor on objective measures of global functional status. However, children treated for ALL had a significantly lower mean intelligence quotient (IQ) (87 v 96), poorer performance on four of six measures of visual and auditory memory, lower achievement with regard to arithmetic skills, and a greater frequency of special educational intervention than those who were treated for Wilms' tumor. IQ and auditory memory performance in the ALL group was correlated inversely with time since the completion of therapy and total CRT dose. CONCLUSIONS These results reinforce the contemporary trend of prophylactic CRT omission in very young children except for those who are at risk for CNS relapse. For infants and very young children who require CRT, evidence is presented that supports the approach for the delay of CRT until the child is older.

Cancer in Neonates: The Experience at The Children's Hospital of Philadelphia

PEDIATRICS ◽  
1982 ◽  
Vol 70 (3) ◽  
pp. 409-413
Author(s):  
Gordon B. Gale ◽  
Giulio J. D'Angio ◽  
Antonia Uri ◽  
Jane Chatten ◽  
C. Everett Koop
Keyword(s):  
Cancer Research ◽  
Radiation Therapy ◽  
Wilms Tumor ◽  
Surgical Excision ◽  
Careful Monitoring ◽  
Actuarial Survival ◽  
Parotid Carcinoma ◽  
Complete Surgical Excision ◽  
Long Term Survivors

Among 22 neonates treated at the Children's Cancer Research Center of Philadelphia, 11 had neuroblastoma, which in two cases was widely metastatic. There were three infants with teratoma, three with sarcoma, three with leukemia, one with Wilms' tumor, and one with parotid carcinoma. Nine of eleven patients (82%) are long-term survivors following complete surgical excision of tumor, whereas only one of eight (13%) has survived following incomplete surgical excision. All three neonates with leukemia died. The overall two-year actuarial survival is 45% (10/22). The problems associated with treating neonates with chemotherapy, radiation therapy, or both are especially difficult because of the immaturity of the organs and structures. Surgical excision alone has been the treatment of choice for solid tumors. Chemotherapy or radiation therapy, when indicated, require careful monitoring for both acute toxicities and potential long-term morbidities.

LONG-TERM FOLLOWUP OF RENAL FUNCTIONAL RESERVE CAPACITY AFTER UNILATERAL NEPHRECTOMY IN CHILDHOOD

1998 ◽  
Vol 160 (3 Part 1) ◽  
pp. 844-848 ◽  
Author(s):  
BIANCA M. REGAZZONI ◽  
NOEL GENTON ◽  
JACQUELINE PELET ◽  
ALFRED DRUKKER ◽  
JEAN-PIERRE GUIGNARD
Keyword(s):  
Unilateral Nephrectomy ◽  
Reserve Capacity ◽  
Functional Reserve ◽  
Renal Functional Reserve

Heritable Fraction of Unilateral Wilms Tumor

PEDIATRICS ◽  
1988 ◽  
Vol 81 (1) ◽  
pp. 147-149
Author(s):  
Frederick P. Li ◽  
Wick R. Williams ◽  
Kathreen Gimbrere ◽  
Francoise Flamant ◽  
Daniel M. Green ◽  
...  
Keyword(s):  
Genetic Counseling ◽  
Maximum Likelihood ◽  
Upper Bound ◽  
Maximum Likelihood Estimate ◽  
Confidence Limit ◽  
Wilms Tumor ◽  
Upper Confidence Limit ◽  
Familial Form ◽  
Long Term Survivors

Heritability of the unilateral-sporadic (non-familial) form of Wilms tumor was examined in the offspring of 96 long-term survivors of the neoplasm. No Wilms tumor has developed in any of the 179 offspring of these patients. The maximum likelihood estimate of a hereditary Wilms tumor in our patients is zero and the corresponding 95% upper confidence limit ranges between 0.06 and 0.11, depending on penetrance. Among their offspring, the 95% upper bound of the risk of Wilms tumor is 0.02. These figures can be applied in genetic counseling of other survivors of unilateral-sporadic Wilms tumor.

Reduced therapy for Wilms' tumor: analysis of treatment results from a single institution.

1988 ◽  
Vol 6 (10) ◽  
pp. 1630-1635 ◽  
Author(s):  
J A Wilimas ◽  
E C Douglass ◽  
S Lewis ◽  
D Fairclough ◽  
G Fullen ◽  
...  
Keyword(s):  
Wilms Tumor ◽  
Survival Rates ◽  
Stage Iv ◽  
Single Institution ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Favorable Histology ◽  
Long Term Survivors ◽  
Extent Of Disease

From 1968 to 1986, 192 patients from 0 to 17 years of age were enrolled in three consecutive protocol-controlled studies of Wilms' tumor at St Jude Children's Research Hospital. Tumors were completely excised at the time of diagnosis whenever possible, and patients were subsequently treated with chemotherapy and radiotherapy according to the initial extent of disease. All patients received dactinomycin and vincristine, with doxorubicin added to the regimens in studies 2 and 3. Chemotherapy was extended to 18 months in study 2 (n = 53), but was limited to 12 months for most patients in study 3 (n = 107). In the third study, radiation was eliminated altogether for patients with stage I or II tumors and was reduced to 12 Gy for those with more advanced disease. Intensification of chemotherapy in study 2 improved the 5-year relapse-free survival rate over that in study 1 (82% v 52%), but the accompanying increase in toxicity was considered unacceptable. Comparison of 2-year relapse-free survival rates in studies 2 and 3 indicated that the reduction of therapy in the latter trial did not jeopardize disease control: 88% v 86% for patients with stage II or III disease, favorable histology; 75% v 57% for the same stages, unfavorable histology; and 57% v 61% for stage IV patients. At least 80% of all patients enrolled in study 3 will be long-term survivors. We conclude that rescheduling of effective antitumor drugs and eliminating or reducing radiotherapy are feasible alternatives in the treatment of Wilms' tumor with favorable histologic features.

scholarly journals Renal functional reserve capacity before and after living kidney donation

2018 ◽  
Vol 315 (6) ◽  
pp. F1550-F1554 ◽  
Author(s):  
Marco van Londen ◽  
Nicolien Kasper ◽  
Niek R. Hessels ◽  
A. Lianne Messchendorp ◽  
Stephan J. L. Bakker ◽  
...  
Keyword(s):  
Kidney Function ◽  
Kidney Donation ◽  
Reserve Capacity ◽  
Living Kidney Donation ◽  
Functional Reserve ◽  
Dopamine Infusion ◽  
Renal Functional Reserve ◽  
Donor Screening

Compensatory gomerular filtration rate (GFR) increase after kidney donation results in a GFR above 50% of the predonation value. The renal functional reserve (RFR) assessed by the renal response to dopamine infusion (RFRdopa) is considered to reflect functional reserve capacity and is thought to be a tool for living donor screening. However, it is unknown if the RFRdopa predicts long-term kidney function. Between 1984 and 2017, we prospectively measured GFR (125I-iothalamate) and RFR by dopamine infusion in 937 living kidney donors. We performed linear regression analysis of predonation RFRdopa and postdonation GFR. In donors with 5-yr follow-up after donation we assessed the association with long-term GFR. Mean donor age was 52  yr (SD 11); 52% were female. Mean predonation GFR was 114  ml/min (SD 22), GFRdopa was 124 ml/min (SD 24), resulting in an RFR of 9 ml/min (SD 10). Three months postdonation, GFR was 72 ml/min (SD 15) and GFRdopa was 75 ml/min (SD 15), indicating that donors still had RFRdopa [3 ml/min (SD 6), P < 0.001]. Predonation RFRdopa was not associated with predonation GFR [standardized (st.) β −0.009, P = 0.77] but was positively associated with GFR 3 mo after donation (st. β 0.12, P < 0.001). In the subgroup of donors with 5-yr follow-up data ( n = 383), RFRdopa was not associated with GFR at 5 yr postdonation (st. β 0.05, P = 0.35). In conclusion, RFRdopa is a predictor of short-term GFR after living kidney donation but not of long-term kidney function. Therefore, measurement of the RFRdopa is not a useful tool for donor screening. Studies investigating long-term renal adaptation are warranted to study the effects of living kidney donation and improve donor screening.

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