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Risk Factors for End Stage Renal Disease in Non-WT1-Syndromic Wilms Tumor

Lange, Jane and Peterson, Susan M. and Takashima, Janice R. and Grigoriev, Yevgeny and Ritchey, Michael L. and Shamberger, Robert C. and Beckwith, Bruce and Perlman, Elizabeth and Green , Daniel M. and Breslow, Norman E. (2011) Risk Factors for End Stage Renal Disease in Non-WT1-Syndromic Wilms Tumor. The Journal of Urology , 186 (2). pp. 378-386. ISSN 0022-5347

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Article URL: http://www.sciencedirect.com/science/article/pii/S...

Abstract

PURPOSE: We assessed risk factors for end stage renal disease in patients with Wilms tumor without known WT1 related syndromes. We hypothesized that patients with characteristics suggestive of a WT1 etiology (early onset, stromal predominant histology, intralobar nephrogenic rests) would have a higher risk of end stage renal disease due to chronic renal failure. We predicted a high risk of end stage renal disease due to progressive bilateral Wilms tumor in patients with metachronous bilateral disease. MATERIALS AND METHODS: End stage renal disease was ascertained in 100 of 7,950 nonsyndromic patients enrolled in a National Wilms Tumor Study during 1969 to 2002. Risk factors were evaluated with cumulative incidence curves and proportional hazard regressions. RESULTS: The cumulative incidence of end stage renal disease due to chronic renal failure 20 years after Wilms tumor diagnosis was 0.7%. For end stage renal disease due to progressive bilateral Wilms tumor the incidence was 4.0% at 3 years after diagnosis in patients with synchronous bilateral Wilms tumor and 19.3% in those with metachronous bilateral Wilms tumor. For end stage renal disease due to chronic renal failure stromal predominant histology had a HR of 6.4 relative to mixed (95% CI 3.4, 11.9; p<0.001), intralobar rests had a HR of 5.9 relative to no rests (95% CI 2.0, 17.3; p=0.001), and Wilms tumor diagnosis at less than 24 months had a HR of 1.7 relative to 24 to 48 months and 2.8 relative to greater than 48 months (p=0.003 for trend). CONCLUSIONS: Metachronous bilateral Wilms tumor is associated with high rates of end stage renal disease due to surgery for progressive Wilms tumor. Characteristics associated with a WT1 etiology markedly increased the risk of end stage renal disease due to chronic renal failure despite the low risk in non-WT1 syndromic cases overall.

Item Type: Article
DOI: 10.1016/j.juro.2011.03.110
PubMed ID: 21683387
PMCID: PMC3133859
Keywords or MeSH Headings: Child, Preschool Genes, Wilms Tumor Humans Infant Kidney Failure, Chronic/epidemiology* Kidney Failure, Chronic/etiology* Kidney Neoplasms/complications* Kidney Neoplasms/genetics Risk Factors Wilms Tumor/complications* Wilms Tumor/genetics
Depositing User: Library Staff
Date Deposited: 15 Dec 2010 21:30
Last Modified: 14 Feb 2012 14:43
URI: http://authors.fhcrc.org/id/eprint/467

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