Hypertension in Wilms Tumor at Diagnosis: Proposed Treatment Recommendations Starting From a Bi-Institutional Retrospective Observational Study.
In a two-center retrospective cohort of 147 children with newly diagnosed Wilms tumor, hypertension occurred in 51%, was associated with several tumor-related features, and caused secondary complications in 8% of hypertensive patients, prompting multidisciplinary management recommendations.
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In a two-center retrospective cohort of 147 children with newly diagnosed Wilms tumor, hypertension occurred in 51%, was associated with several tumor-related features, and caused secondary complications in 8% of hypertensive patients, prompting multidisciplinary management recommendations.
Research significance
The study provides observational evidence that routine blood-pressure screening can identify a frequent and sometimes complicated comorbidity at Wilms tumor diagnosis; it is reasonable but not proven to infer that risk-adapted monitoring and standardized antihypertensive management could reduce acute hypertension-related complications.
Source abstract
BACKGROUND: Arterial hypertension (AH) is a common clinical finding at the time of Wilms tumor (WT) diagnosis, is often difficult to manage, and is potentially related to acute complications. METHODS: We retrospectively analyzed 147 patients with newly diagnosed WT treated between January 2010 and December 2023 at two high-volume Italian pediatric oncology centers. Demographic, clinical, treatment, and tumor characteristics were evaluated in relation to the presence of AH. RESULTS: At WT diagnosis, 75/147 (51%) of patients were hypertensive. Large tumor volume (continuous variable, p = 0.011), advanced tumor stage (p = 0.012), bilateral disease (p = 0.015), and renal vascular involvement (p = 0.004) were significantly associated with AH. Calcium channel blockers were the most frequently used antihypertensive agents, followed by angiotensin converting enzyme inhibitors. Six out of 75 (8%) of patients suffered from secondary complications related to AH. CONCLUSIONS: We confirmed the high prevalence of AH at WT diagnosis and identified tumor-related factors associated with an increased risk of developing AH. The key elements for the adequate management of these patients include the use of appropriate antihypertensive therapy and proper routine blood pressure screening for all patients with a new WT diagnosis. In the absence of standardized treatment guidelines, we propose recommendations developed through collaboration among pediatric oncologists, cardiologists, and nephrologists. TRIAL REGISTRATION: EudraCT number 2016-004180-39.