Complications
Normocytic normochromic anemia may occur due to intratumoral hemorrhage or intra-abdominal bleeding.
Gross hematuria and iatrogenic blood loss may contribute to the anemia and lead to iron deficiency.
May also result from chemotherapy-induced bone marrow suppression.
Managed with packed red blood cells.
Vincristine can cause decreased peristalsis and paralytic ileus; therefore, vincristine should be withheld until peristalsis is re-established after nephrectomy.
Stool softeners should be started early to prevent this complication.
Rarely associated with newly diagnosed Wilms tumor (<10% incidence).[50]
Usually remits during or following therapy for tumor. Majority of patients have no bleeding or minimal bleeding and do not require treatment.
Vasopressin may be required in some patients.
Rarely, if bleeding is severe and coagulation studies are very abnormal, replacement therapy with von Willebrand factor should be considered.
May occur very rarely with cyclophosphamide administration.
Prevented by adequate hydration and the use of mesna.
Risk is low on DD-4A chemotherapy regimen.
However, patients at higher risk of infection (e.g., patients on chemotherapy regimen M or relapsed patients) should receive trimethoprim/sulfamethoxazole prophylaxis, or if allergic to this antibiotic, aerosolized pentamidine, dapsone or atovaquone.
Rarely seen but may occur in patients with extensive bilateral disease or patients with Denys-Drash syndrome.[47][120][127] In one study, 14% of patients with bilateral Wilms tumor developed end-stage renal failure following surgery and chemotherapy.[128]
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Some patients may require dialysis or renal transplant.[117][129]
Occurs in approximately 10% of patients undergoing surgery.[134]
Right-sided and larger tumors are at higher risk of this complication.
Associated with higher recurrence rates and requires more intensive therapy.
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