Cystatin C and Parenchymal Thickness/Kidney Length Ratio in Wilms Tumor Survivors

Background. This study presents a clinical, biochemical, and sonographic evaluation of single kidneys in Wilms tumor survivors. Procedure. The function of single kidneys in 26 Wilms tumor survivors (mean age, 11.17 years; mean follow-up, 7.09 years) was evaluated using cystatin C (CysC) levels and compared to serum creatinine concentration and glomerular filtration rate (eGFR), the latter of which was estimated by the Schwartz formula. The length of the kidney, the resistance index (RI) of the renal vessels, and the parenchymal thickness/kidney length ratio (PT/KL) were evaluated by sonographic examination. Results. Group A (n=15) consisted of children with normal CysC levels, and group B (n=11) consisted of children with CysC over 0.95 mg/L. No differences were observed between the groups in creatinine concentration, age, follow-up evaluation, age at the time of diagnosis, or kidney size. Children with elevated CysC had statistically lower eGFR (P=0.02) and PT/KL (P=0.0065). The correlation rate between CysC and PT/KL in all children was -0.38. Kidney hypertrophy was observed in 23 children and was correlated with CysC (group A, R=0.46; group B, R=0.4; P<0.05). RI was normal in all individuals. Conclusions. CysC levels may be elevated in people with normal GFR. Hypertrophy of a single kidney increases with deteriorating kidney function. PT/KL should be verified in future studies as a sonographic marker of kidney impairment. Pediatr Blood Cancer 2010;54:41-46. (C) 2009 Wiley-Liss. Inc.