CLINICAL PRESENTATION AND TREATMENT 0UTCOME IN CHILDREN WITH NEPHROBLASTOMA IN KEP YA

Abstract

Objective: To review the clinical presentationand managemen1 ofchildren with nephroplastoma
and the factors influencing the outcome at Kenyatta National Referral and Teaching Hospital
(KNH).
Design: This was a retrospective case series study based on secondary data accumulated
between 1990 and 1996.
Setting: The relevant data were extracted from records oi all children aged 12 years and
below, admitted for cancer at KNH, Nairobi.
Results: Out of 803children with cancer, 71 (8.8% )had histol ~gically proven nephroblastoma.
At presentation, 1.5% were in stage 1, 13.2% stage 11.36.8 % stage III,41.2% stage IV and
7.4% stage V. Eighty five per cent presented with stage 111-\. disease. Ninety five per cent had
nepherectomy and received chemotherapy. Radiotherapy was given to 50.7% of the patients.
Nine patients died before commencement of chemotherapy, two of whom died in the
immediate post-operative period. The median duration bet ween admission and surgery was
41 days. Pre-operativechemotherapy was given to42% of the patients. Approximately 25.5%
of the p, tients received little or no induction chemothera~ y due to unavailability of drugs
while only 2.8% received the prescribed maintenance treatment with the remainder getting
erratic or no treatment. Overall, only 34.7% remained disease free two years from time of
diagnosis.
Conclusion: Late presentation, poor availability of cytotoxic drugs and frequent treatment
interruptions for various reasons have contributed to the I oor outcome of kephroblastoma
in Kenya.