Clinicopathological Features, Management and Outcome of Paediatric Solid Renal Tumours in Southeast Nigeria: The Need for Protocol and Multidisciplinary Collaboration

Abstract

Introduction: Renal malignancies are common in children and they constitute 6-7% of all childhood tumours and nephroblastoma is the most common solid renal tumour in children. Currently, standardised institutional protocols in management of renal tumours in children are the norm. Large scale collaborative studies have started emerging, yet not much has been documented on the clinical presentation, pathology and outcome of solid renal tumours particularly in Africa. Aim: To review the presentations, pathology and the management-outcome of solid renal tumour in the centre in the absence of a coordinated protocol and multi disciplinary collaboration. Materials and Methods: This was a nine and a half year longitudinal retrospective audit study of consecutive patients with solid renal tumours managed in a single tertiary centre: Nnamdi Azikiwe University Teaching Hospital, Nnewi, Southeast Nigeria. It took place from January 2009-June 2018. Relevant data on demography, clinical features, management and outcome were extracted from records. Results were analysed using Statistical Package for Social Sciences (SPSS) version 22. Categorical data were tested for independence using Chi-square test and significant p-value set at <0.05. Results: Twenty two paediatric cases (15 males and 7 females) were included in the study. The mean age at presentation was 50.10±45.18 months. The mean duration of symptoms was 5.5 months; 21 (95.5%) presented with abdominal masses while 6 (27.3%) had gross haematuria and 13 (59.1%) were emaciated. Tumours involved left kidney in 15 (68%). Histological reports were available in 9 cases with nephroblastoma being the most common 6 (27.3%). The most common stage was stage 3, 10 (45.5%) and most common procedure was nephroureterectomy, 11 (50%). Neo-adjuvant and adjuvant therapies were inconsistent. Conclusion: Late presentation, discordant treatment protocol, non completion of treatment and poor collaboration, were found to contribute largely to poor outcome of solid renal tumours in children in our setting. It is strongly believed that adoption of standard protocol and a multidisciplinary collaboration in management will improve records keeping and outcome.

Keywords

• nephroblastoma
• nephroureterectomy
• neo-adjuvant therapy
• renal malignancies