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Wilm's tumour (nephroblastoma) (Clinical presentation (Abdominal…
Wilm's tumour
(nephroblastoma)
Epidemiology
Commonest renal tumour
of childhood
Most <5y, rare >10y
Pathophysiology
Defect
Sporadic or familial mutation, or
Beckwith Wiederman syndrome
Mechanism
Undifferentiated mesodermal tumour
Metastasis usually to the lungs
Clinical
presentation
Abdominal mass
Haematuria
Abdo pain
Anorexia
Diagnosis
Examination
Abdo exam
Pallor, abdominal mass
Investigations
Bloods
FBC (anaemia), U+E (renal dysfunction), LFTs
Imaging
USS KUB: renal mass
CT KUB: renal mass, staging
Bedside
Obs (may have HTN)
Heighth/weight (may have weight loss)
Urine
Dipstick (haematuria)
ACR, MCS
History
DH
Current meds, allergies
FH
Cancera, renal disease
SH
Living arrangements, school/nursery
PMH
Growth and development
Vaccinations
Known medical conditions
PC/HPC
Abdominal mass, pain, loss of appetite,
haematuria, fatigue
Management
Medical
Chemotherapy
Indication: all patients
E.g. vincristine and actinomycin
Radiotherapy
Indication: alongside chemo if advanced
Surgery
Nephrectomy
Indication: resectable disease
Conservative
Information, advice, support
MDT (nephrologist, surgeon, specialist nurse,
psychologist, counselling)
Complications
Renal failure
Metastatic spread
Prognosis
80% patients cured
Definition
Malignant neoplasm of
embryonic renal tissue