Nephrectomy

Survivors of childhood cancer who have undergone nephrectomy are at risk of hyperfiltration injury.

Compensatory hypertrophy of the remaining kidney typically occurs after nephrectomy, but over time, renal injury may manifest as reduced glomerular filtration, microalbuminuria and proteinuria, hypertension, and, rarely, focal glomerulosclerosis leading to chronic renal failure.[9,11]

Patients with nonsyndromic unilateral Wilms tumor treated with unilateral radical nephrectomy have a 35-year cumulative incidence of late kidney failure of 2.4%, an approximately 10-fold increased rate relative to siblings. No single chemotherapy–related or radiation therapy–related exposure was associated with late kidney failure in a CCSS study of late health outcomes in Wilms tumor survivors (n = 2,008).[12]

A meta-analysis examined data from 23 studies of patients with Wilms tumor (293 unilateral cases and 386 bilateral cases). The study demonstrated significantly increased odds of developing abnormal kidney function (OR, 4.29; 95% CI, 1.02–18.00) and having a lower estimated GFR (mean, -8.99) among patients treated with radical nephrectomy, compared with those treated with nephron-sparing surgery. Patients with bilateral Wilms tumor (mean follow-up, 7.7 years) treated with radical nephrectomy and contralateral nephron-sparing surgery had higher odds of developing abnormal kidney function (OR, 3.82; 95% CI, 1.76–8.33) and hypertension (OR, 5.81; 95% CI, 1.31–25.86), compared with those treated with bilateral nephron-sparing surgery.[13]