Kidney Nephroblastoma( Wilms' tumor) in children - Causes, symptoms and treatment. MF.

Wilms tumor or nephroblastoma is a malignant neoplasm originating from embryonic kidney tissues. The name of the tumor was in honor of the famous German surgeon Max Wilms, who first identified the disease in a child. As it turned out later, nephroblastoma can occur exclusively in children, mainly in the age of up to 5 years, since they have a large number of embryonic cells in the kidney tissues.

Causes of nephroblastoma

There are no precise reasons for the occurrence of Wilms tumor to date. Some scientists suggest that the predisposition to the disease can be transmitted hereditary, since most children with this pathology have congenital malformations. An active research work is being done to find out the causes of nephroblastoma and other embryonic tumors. The research process includes the best world experts in the field of medicine, genetics and embryology.

Symptoms of nephroblastoma in children

In most of its cases, Wilms' tumor has an asymptomatic course. In this situation, it is most often detected by parents in the form of a hilly, dense formation in the abdominal cavity of the child. As a rule, it is mobile and painless, although those clinical options, when the nephroblastoma sprouts into neighboring tissues, are accompanied by a rather pronounced pain symptomatology.

Another symptom that makes it possible to detect the presence of Wilms tumor is the macrogematuria( blood in the urine).Blood in the urine, as a rule, appears when the inner membranes of the glomerulus capsule are destroyed. In this case, the circulatory system of the kidney is connected to her pelvis, which is accompanied by bleeding into the cavity of the latter.

Nonspecific symptoms that can accompany nephroblastoma include increased body temperature, weight loss, gastrointestinal disorders, and increased blood pressure. These symptoms can occur due to the germination of the tumor with neighboring tissue or through impaired renal function.

If a child has at least one of the above symptoms and signs, it should be taken to a consultation with a urologist and an oncologist. These specialists, by common forces, will be able to diagnose correctly and prescribe adequate treatment.

Diagnosis of nephroblastoma

A general blood test for Wilms tumor is characterized by a progressive decrease in the number of red blood cells. Mechanisms of anemia in this pathology are three. First, malignant neoplasm, regardless of location, is accompanied by anemic syndrome. Secondly, due to impaired renal function, the secretion of erythropoietin decreases, which affects the production of red blood cells by the bone marrow. And the last link in the development of anemia in nephroblastoma is renal bleeding, which develops due to the above-mentioned reasons.

A general urine test for nephroblastoma is characterized by the presence, in large quantities, of the renal epithelium and red blood cells. In addition, during the decay of the tumor, the amount of protein in the urinalysis may increase, and during the attachment of the infectious process - bacteria and leukocytes.

Various methods of visualization are used to verify the diagnosis. The cheapest and one of the most reliable is ultrasound examination of the kidneys. On ultrasound, there is a circular formation of increased echogenicity, located in the retroperitoneal space.

Excretory urography in the early stages of the disease indicates deformity of the bowl-and-pelvic renal system. In the late stages of the disease, there is a complete absence of a contrast agent with a diseased kidney.

For differential diagnosis between a nephroblastoma and a kidney cyst, angiography of this organ can be used. It involves intravenous administration of a contrast medium followed by an X-ray examination. As a rule, with Wilms' tumor there is an increased blood supply to the neoplasm, while the cyst may not have any arterial vessels at all.

Wilms tumor on x-ray

Computed tomography is the best method of visualizing the kidneys. In carrying out this study, it is possible not only to detect the tumor, but also to accurately determine its size and location of localization.

The final stage in verification of the diagnosis of malignant neoplasm of the kidneys is aspiration puncture biopsy. Under the control of the ultrasound apparatus, a puncture of the skin and soft tissues in the lumbar region is carried out, followed by the capture of a small area of ​​the neoplasm tissue. Under the electron microscope, a histological study is performed, during which, as a rule, atypical cells of embryonic origin are identified.

Also, in order to identify distant metastases, it is necessary to conduct a chest X-ray and osteoscitigraphy. The first one makes it possible to determine the presence of distant metastases to the lungs, the second - to the bone.

Treatment of nephroblastoma in children

As the main method of treatment of Wilms tumor, surgical intervention is used, the volume of which depends on the size of the tumor and its distribution. If in the early stages you can do with just a simple removal of the tumor, then late resection of the kidney is applied with excision of the regional lymph nodes. Operative intervention should be applied as soon as possible after the detection of neoplasm. If a similar pathology is present in the newborn, then it should be operated on during the first 14 days of his life.

In addition to surgery, chemotherapy and teletherapy can be used. The aim of these treatments is to prevent the recurrence of the disease or to reduce the size of the tumor before surgery.

It should be noted that Wilms' tumor is one of the few diseases that can be treated very effectively. According to different statistical studies, the number of cured children with Wilms tumor reaches 90 percent.

Treatment with folk remedies

As a rule, for malignant neoplasms, patients are not forbidden to use traditional methods of treatment, as traditional medicine can not reliably guarantee a positive outcome of treatment. With Wilms' tumor, a slightly different situation. Since in 70-90 percent of cases it is possible to cure it, folk methods of treatment can only delay a good moment for the beginning of operative and conservative treatment.

Nutritional and lifestyle characteristics of

Unfortunately, patients with Wilms' tumor should adhere to recommendations for life, according to the 7 diet table for Pevzner. They need to limit the amount of fatty, salty, sour and fried foods in the diet. This is necessary in order to reduce the diuretic load on a single healthy kidney.

Rehabilitation after

As a rule, in a few weeks after surgical intervention patients are assigned courses of physiotherapeutic treatment, during which they undergo different procedures on UVM and darsonvalization devices. Not bad results are observed after the sanatorium treatment in Saki and Morshin, where special schemes of hospitalotherapy, mineral and mud treatment were developed for patients with kidney pathology.

Complications of Wilms tumor

The first complication that develops after the development of Wilms' tumor is arterial hypertension. The mechanism of its development is no different from the mechanism of development of other nephrogenic hypertension. Increased production of renin, which is a very strong vasospalic agent, leads to a narrowing of the lumen of blood vessels and an increase in blood pressure.

Another dangerous complication of nephroblastoma is renal bleeding, which develops as a result of impairment of the membrane in the glomerulus capsule. In this case, hemorrhage occurs in the cavity of the renal pelvis, which is accompanied by a large amount of blood and blood clots in the urine. A sharp loss of a large amount of blood can result in a drop in blood pressure and collapse, which is manifested by loss of consciousness. Long-term complications of renal bleeding should be considered anemia, which has a posthemorrhagic character.

The so-called classic complications of malignant neoplasm should be considered regional and distant metastases that occur in the third and fourth stages of the oncological process. Most often, Wilms' tumor is metastasized to the lungs, which is manifested by pain behind the sternum, shortness of breath, and discharge of bloody sputum.

In addition, the complications of the Wilms tumor can be considered as the attachment of a secondary infectious process and the formation of kidney stones. As a rule, kidney stone disease with nephroblastoma is much more difficult than with a conventionally healthy kidney.

Prevention of Wilms tumor

Because in many cases nephroblastoma is a congenital oncological disease, its prevention should be performed even before the birth of the child. It consists in the prenatal prevention of infections that can disrupt the normal development of the fetus, the refusal of alcoholic beverages and smoking during pregnancy, as well as in healthy dietary nutrition when carrying a child.

In addition, it is necessary to minimize traumatic injuries and the harmful effects of environmental factors during pregnancy. All medications that are used during pregnancy should be checked by a doctor for the absence of teratogenic effect.

Postnatal prophylaxis of nephroblastoma consists in treatment and prevention of inflammatory diseases of the kidneys and leveling out the impact of harmful environmental factors.

Forecast for nephroblastoma

As already mentioned, Wilms tumor is one of the most favorable in terms of treatment of malignant tumors, both kidneys and other organs. Approximately 8 out of ten children who have completed the full course of treatment for this disease have not been remembered for a lifetime. Of course, if treatment was started in the third or fourth stage, when there are already distant metastases, the survival rate will be much lower.

Rev.doctor urologist Astashin Е.Е.