PATHOPHYSIOLOGY OF WILMS TUMOR

Predisposing factors:
Age: Wilms tumor (2-5 yrs old)
Congenital anomalies
Heredity

Precipitating factors:
Second hand smoking
obesity
exposed to abestos

Destruction of the structure of chromosome 11- loss of WT1

Unregulated & unsuppressed growth of cells and tissues

Cellular mutation in the kidney

Tumor production

Wilms Tumor

Tumor is confined to kidney only

(Stage 1)
With medical & surgical interventions;
Good prognosis, prevent metastasis

Without medical & surgical

interventions; tumor progression

Cortical infiltration & proliferation

With medical-surgical intervention:

good prognosis
Prevention of metastasis

Tumor extend to the kidney (stage 2)

Abdominal mass
Abdominal pain
Loss of appetite
Fever
constipation

Penetration of renal capsule &

invasion of renal sinus vessels

Without medical- surgical

intervention: tumor progression

Spread to lymph nodes from

abdominal cavity and adjacent vital
structures (stage 3)

Affects the renal cortex

Cortical infiltration &

proliferation
Affect the renal parenchyma

With medical-surgical
interventions:
Good prognosis
Prevention of
metastasis

Cancer enters blood stream

and affects other organs
(stage 4)

Affect the nephrons

Decreased
production of
Vit. D

Altered
RAA
mechanism

Decreased
absorption of
calcium in
the intestines

Hypertension

Decreased
erythropoietin
production
Decreased
number of
RBC
Anemia

Hypocalemia

Altered
waste
production
Decreased
urine
formation
Unitary
retention

Altered
acid
excretion
Increased
BUN &
creatinine
levels

Without medicalsurgical intervention:

Tumor progression

With medical-surgical
intervention:
Good prognosis
Prevention of metastasis

Without medical-surgical
interventions:
Tumor progression
Bilateral disease (stage 5)
Renal failure
Death