Long-term glomerular dysfunction after childhood cancer nephrectomy: what is the impact of nephrectomy and obesity?

I read with much interest the article from Kooijmans et al. describing long-term glomerular dysfunction in childhood cancer survivors. 1 Kooijmans E.C.M. van der Pal H.J.H. Pluijm S.M.F. et al. on behalf of the Dutch LATER study group. The Dutch Childhood Cancer Survivor Study (DCCSS)-LATER 2 kidney analysis examined long-term glomerular dysfunction in childhood cancer survivors. Kidney Int. 2022; 102: 1136-1146 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar As rightfully stated by the authors, a reduction in nephron mass will result in glomerular hyperfiltration, with glomerular injury over time. 2 McArdle Z. Schreuder M.F. Moritz K.M. et al. Physiology and pathophysiology of compensatory adaptations of a solitary functioning kidney. Front Physiol. 2020; 11: 725 Crossref PubMed Scopus (28) Google Scholar As the oldest group of patients mainly consists of patients with Wilms tumor who were treated with nephrectomy (with or without abdominal radiation), the conclusions on long-term consequences may be biased by the overrepresentation of older patients after nephrectomy. To me, it would be highly interesting and relevant to analyze the childhood cancer survivor cohort in 2 subgroups (i.e., with and without nephrectomy). This may provide additional information on the long-term consequences of kidney mass reduction in childhood, of which data are limited. 3 Sanna-Cherchi S. Ravani P. Corbani V. et al. Renal outcome in patients with congenital anomalies of the kidney and urinary tract. Kidney Int. 2009; 76: 528-533 Abstract Full Text Full Text PDF PubMed Scopus (276) Google Scholar In addition, this will show more clearly what the degree of glomerular dysfunction is in the childhood cancer survivors who have not experienced kidney mass reduction. The Dutch Childhood Cancer Survivor Study (DCCSS)-LATER 2 kidney analysis examined long-term glomerular dysfunction in childhood cancer survivorsKidney InternationalVol. 102Issue 5PreviewThis investigation aimed to evaluate glomerular dysfunction among childhood cancer survivors in comparison with matched controls from the general population. In the Dutch Childhood Cancer Survivor Study (DCCSS)-LATER 2 kidney analysis, a nationwide cross-sectional cohort study, 1024 survivors five or more years after diagnosis, aged 18 or more years at study, treated between 1963-2001 with nephrectomy, abdominal radiotherapy, total body irradiation, cisplatin, carboplatin, ifosfamide, high-dose cyclophosphamide or hematopoietic stem cell transplantation participated. Full-Text PDF Open AccessLetter to the EditorKidney InternationalVol. 103Issue 1PreviewWe thank Professor Schreuder1 for his interest in our study.2 He wondered if the decrease in estimated glomerular filtration rate (eGFR) in particular in the oldest childhood cancer survivors (CCSs) might be the result of nephrectomy, which was performed more often in this cohort. As suggested, we have performed a subgroup analysis comparing patients with and without nephrectomy. This revealed a significantly decreased mean eGFR in CCSs treated with nephrectomy compared with nonnephrectomized CCSs in all age groups (Figure 1), suggesting that glomerular injury is already present at a relatively young age in CCSs with kidney mass reduction. Full-Text PDF