肾母细胞瘤

常见于高风险 Wilms 瘤，是化疗的一个不良反应。

可能需要广谱抗生素（用于中性粒细胞减少）和输注血小板和红细胞 (RBC)。[1]D'Angio GJ. The National Wilms Tumor Study: a 40 year perspective. Lifetime Data Anal. 2007;13:463-470.http://www.ncbi.nlm.nih.gov/pubmed/18027087?tool=bestpractice.com[66]Malogolowkin M, Cotton CA, Green DM, et al. Treatment of Wilms tumor relapsing after initial treatment with vincristine, actinomycin D, and doxorubicin. A report from the National Wilms Tumor Study Group. Pediatr Blood Cancer. 2008;50:236-241.http://www.ncbi.nlm.nih.gov/pubmed/17539021?tool=bestpractice.com

瘤内出血或腹内出血可能会导致正细胞正色素性贫血。

肉眼血尿和医源性失血可能会促进贫血，并导致缺铁。

还可能是由于化疗引起的骨髓抑制。

用浓缩 RBC 治疗。

长春新碱可引起肠蠕动减少和麻痹性肠梗阻；因此，在肾切除术后肠蠕动恢复前应停用长春新碱。

应提前开始使用粪便软化剂，以预防该并发症。

儿童便秘

很少与新诊断的 Wilms 瘤相关（发病率小于 10%）。[109]Coppes MJ, Zandvoort SW, Sparling CR, et al. Acquired von Willebrand disease in Wilms' tumor patients. J Clin Oncol. 1992;10:422-427.http://www.ncbi.nlm.nih.gov/pubmed/1311024?tool=bestpractice.com

通常在肿瘤治疗期间或治疗后会减轻。大部分患者无出血或有少量出血，不需要治疗。

有些患者可能需要血管加压素。

罕见情况下，如果出血严重且凝血功能检查显著异常，则应考虑 Von Willebrand 因子补充疗法。

维勒布兰德氏病

放射性肺炎很少会导致肺部疤痕和脊柱侧凸。[169]Greenberg M, Burnweit C, Filler R, et al. Preoperative chemotherapy for children with Wilms' tumor. J Pediatr Surg. 1991;26:949-953.http://www.ncbi.nlm.nih.gov/pubmed/1656009?tool=bestpractice.com[214]Mclnerney DP, Bullimore J. Reactivation of radiation pneumonitis by adriamycin. Br J Radiol. 1977;50:224-227.http://www.ncbi.nlm.nih.gov/pubmed/191139?tool=bestpractice.com

特发性肺纤维化

由于化疗和腹部照射。

可能导致肝窦梗阻综合征或静脉闭塞性疾病。[179]Kalapurakal JA, Nan B, Norkool P, et al. Treatment outcomes in adults with favorable histologic type Wilms tumor-an update from the National Wilms Tumor Study Group. Int J Radiat Oncol Biol Phys. 2004;60:1379-1384.http://www.ncbi.nlm.nih.gov/pubmed/15590168?tool=bestpractice.com[215]Pein F, Tournade MF, Zucker JM, et al. Etoposide and carboplatin: a highly effective combination in relapsed or refractory Wilms tumor: a phase II study by the French Society of Pediatric Oncology. J Clin Oncol. 1994;12:931-936.http://www.ncbi.nlm.nih.gov/pubmed/8164044?tool=bestpractice.com[216]Bisogno G, de Krake J, Weirich A, et al. Veno-occlusive disease of the liver in children treated for Wilms tumor. Med Pediatr Oncol. 1997;29:245-251.http://www.ncbi.nlm.nih.gov/pubmed/9251728?tool=bestpractice.com[217]Cesaro S, Spiller M, Sartori MT, et al. Veno-occlusive disease in pediatric patients affected by Wilms tumor. Pediatr Blood Cancer. 2011;57:258-261.http://www.ncbi.nlm.nih.gov/pubmed/21246705?tool=bestpractice.com

可能见于环磷酰胺或异环磷酰胺给药病例，但非常罕见。

可通过充分水化和使用美司钠进行预防。

DD-4A 化疗方案的风险较低。

但感染风险较高的患者（例如用 M 方案化疗的患者或复发的患者）应接受甲氧苄啶/磺胺甲噁唑预防，如果对该抗生素过敏，可雾化戊烷脒、氨苯砜或阿托伐醌。

金罗维氏肺囊虫肺炎

可能会出现蒽环霉素诱导的心肌病、心律失常或充血性心力衰竭，但发病率较低。[207]Termuhlen AM, Tersak JM, Liu Q, et al. Twenty-five year follow-up of childhood Wilms tumor: a report from the Childhood Cancer Survivor Study. Pediatr Blood Cancer. 2011;57:1210-1216.http://www.ncbi.nlm.nih.gov/pubmed/21384541?tool=bestpractice.com[213]Wright KD, Green DM, Daw NC. Late effects of treatment for Wilms tumor. Pediatr Hematol Oncol. 2009;26:407-413.http://www.ncbi.nlm.nih.gov/pubmed/19657990?tool=bestpractice.com

治疗期间及治疗完成后均应进行定期超声心动图检查。[129]Green DM, Grigoriev YA, Nan B, et al. Congestive heart failure after treatment for Wilms' tumor: a report from the National Wilms' Tumor Study group. J Clin Oncol. 2001;19:1926-1934.http://www.ncbi.nlm.nih.gov/pubmed/11283124?tool=bestpractice.com

较罕见，但可能出现于广泛双侧疾病患者或 Denys-Drash 综合征患者。[83]Breslow NE, Collins AJ, Ritchey ML, et al. End stage renal disease in patients with Wilms tumor: results from the National Wilms Tumor Study Group and the United States Renal Data System. J Urol. 2005;174:1972-1975.http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16217371http://www.ncbi.nlm.nih.gov/pubmed/16217371?tool=bestpractice.com[154]Paya K, Horcher E, Lawrenz K, et al. Bilateral Wilms tumor - surgical aspects. Eur J Pediatr Surg. 2001;11:99-104.http://www.ncbi.nlm.nih.gov/pubmed/11371044?tool=bestpractice.com[213]Wright KD, Green DM, Daw NC. Late effects of treatment for Wilms tumor. Pediatr Hematol Oncol. 2009;26:407-413.http://www.ncbi.nlm.nih.gov/pubmed/19657990?tool=bestpractice.com在一项研究中，14% 的双侧 Wilms 瘤患者在手术和化疗后发生了终末期肾功能衰竭。[218]Sudour H, Audry G, Schleimacher G, et al. Bilateral wilms tumors (WT) treated with the SIOP 93 protocol in France: epidemiological survey and patient outcome. Pediatr Blood Cancer. 2012;59:57-61.http://www.ncbi.nlm.nih.gov/pubmed/22238153?tool=bestpractice.com

有些患者可能需要透析或肾移植。[84]Breslow NE, Takashima JR, Ritchey ML, et al. Renal failure in the Denys-Drash and Wilms tumor-aniridia syndromes. Cancer Res. 2000;60:4030-4032.http://cancerres.aacrjournals.org/cgi/content/full/60/15/4030http://www.ncbi.nlm.nih.gov/pubmed/10945603?tool=bestpractice.com[219]Grigoriev Y, Lange J, Peterson SM, et al. Treatments and outcomes for end-stage renal disease following Wilms tumor. Pediatr Nephrol. 2012;27:1325-1333.http://www.ncbi.nlm.nih.gov/pubmed/22430485?tool=bestpractice.com

急性肾衰竭

照射和化疗均与继发性恶性肿瘤增加相关。

非常罕见，15 年随访的累积发病率为 1.6%。[1]D'Angio GJ. The National Wilms Tumor Study: a 40 year perspective. Lifetime Data Anal. 2007;13:463-470.http://www.ncbi.nlm.nih.gov/pubmed/18027087?tool=bestpractice.com[207]Termuhlen AM, Tersak JM, Liu Q, et al. Twenty-five year follow-up of childhood Wilms tumor: a report from the Childhood Cancer Survivor Study. Pediatr Blood Cancer. 2011;57:1210-1216.http://www.ncbi.nlm.nih.gov/pubmed/21384541?tool=bestpractice.com[213]Wright KD, Green DM, Daw NC. Late effects of treatment for Wilms tumor. Pediatr Hematol Oncol. 2009;26:407-413.http://www.ncbi.nlm.nih.gov/pubmed/19657990?tool=bestpractice.com[214]Mclnerney DP, Bullimore J. Reactivation of radiation pneumonitis by adriamycin. Br J Radiol. 1977;50:224-227.http://www.ncbi.nlm.nih.gov/pubmed/191139?tool=bestpractice.com[220]Breslow NE, Lange JM, Friedman DL, et al. Secondary malignant neoplasms after Wilms tumor: an international collaborative study.Int J Cancer. 2010;127:657-666.http://onlinelibrary.wiley.com/doi/10.1002/ijc.25067/fullhttp://www.ncbi.nlm.nih.gov/pubmed/19950224?tool=bestpractice.com

环磷酰胺和全腹部照射增加不育的风险。[177]Taylor RE. Morbidity from abdominal radiotherapy in the First United Kingdom Children's Cancer Study Group Wilms Tumour Study. United Kingdom Children's Cancer Study Group. Clin Oncol (R Coll Radiol ). 1997;9:381-384.http://www.ncbi.nlm.nih.gov/pubmed/9448966?tool=bestpractice.com[213]Wright KD, Green DM, Daw NC. Late effects of treatment for Wilms tumor. Pediatr Hematol Oncol. 2009;26:407-413.http://www.ncbi.nlm.nih.gov/pubmed/19657990?tool=bestpractice.com[221]Sinisi AA, D'Apuzzo A, Pasquali D, et al. Antisperm antibodies in prepubertal boys treated with chemotherapy for malignant or non-malignant diseases and in boys with genital tract abnormalities. Int J Androl. 1997;20:23-28.http://www.ncbi.nlm.nih.gov/pubmed/9202987?tool=bestpractice.com[222]Nussbaum Blask AR, Nicholson HS, Markle BM, et al. Sonographic detection of uterine and ovarian abnormalities in female survivors of Wilms tumor treated with radiotherapy. AJR Am J Roentgenol. 1999;172:759-763.http://www.ncbi.nlm.nih.gov/pubmed/10063876?tool=bestpractice.com

发生于约 10% 进行手术的患者。[223]Gow KW, Barnhart DC, Hamilton TE, et al. Primary nephrectomy and intraoperative tumor spill: report from the Children's Oncology Group (COG) renal tumors committee. J Pediatr Surg. 2013;48:34-38.http://www.ncbi.nlm.nih.gov/pubmed/23331790?tool=bestpractice.com

右侧肿瘤和大肿瘤出现该并发症的风险较高。

与较高的复发率相关，需要更加强化的治疗。