Paediatrics

Wilms Tumour

Wilms tumour (nephroblastoma) is an embryonal kidney cancer of childhood, usually presenting with a painless abdominal mass but sometimes haematuria or hypertension; urgent specialist referral and protocol-led treatment aim to cure while preserving renal function.

In a nutshell

Wilms tumour (nephroblastoma) is an embryonal kidney cancer, usually in children under 7. The classic presentation is a painless abdominal mass; visible haematuria or hypertension may occur. NICE recommends very urgent specialist assessment within 48 hours for a palpable abdominal mass, unexplained enlarged abdominal organ or unexplained visible haematuria. Ultrasound defines renal origin, then specialist MRI/CT, tissue and stage guide chemotherapy and surgery.

Classic presentation

A 3-year-old has a painless abdominal mass and raised blood pressure, with or without visible haematuria. Refer very urgently; do not manage as constipation without a clear benign explanation and reassessment.

Key points

Wilms tumour is a renal embryonal tumour, also called nephroblastoma.
Painless abdominal mass is the classic clue; haematuria and hypertension are important associated features.
A palpable abdominal mass, enlarged organ or visible haematuria needs very urgent assessment within 48 hours.
Ultrasound is usually first, followed by specialist MRI/CT and renal/chest staging.
Treatment is protocol-led chemotherapy and surgery, with radiotherapy for selected risk groups.
Bilateral disease and WAGR, aniridia, hemihypertrophy or Beckwith-Wiedemann features require genetics and renal-preservation planning.

First-line investigation

Blood pressure, urine assessment and abdominal ultrasound alongside very urgent specialist referral.

Management

Recognise and refer

Palpable abdominal mass, unexplained enlarged organ or visible haematuria requires very urgent specialist assessment within 48 hours; assess blood pressure and urine in parallel.^1,3

Define renal origin and extent

Use ultrasound first and specialist abdominal/chest MRI or CT to assess both kidneys, vessels, nodes and metastases.²

Treat by stage and risk

Specialist protocols usually combine chemotherapy and surgery, with selected radiotherapy and renal-sparing strategies for bilateral or high-risk disease.²

Protect renal and whole-person health

Monitor relapse, blood pressure, renal function, growth, fertility, cardiac effects and psychosocial health through long-term follow-up.²

Exam traps

A child can have Wilms tumour without haematuria or hypertension.
Do not wait for ultrasound before initiating the very urgent referral pathway.
Do not assume every paediatric renal mass should be biopsied before oncology review.
Bilateral disease changes the aim to preserve renal tissue where safe.
Long-term blood pressure and renal follow-up matter after cure.

Key sources

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.