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Kidney Week

Abstract: PO2321

Managing Pediatric Renal Cell Carcinoma in Jehovah’s Witness Patient

Session Information

Category: Trainee Case Report

  • 1700 Pediatric Nephrology

Authors

  • Zhang, Yifeng, Baystate Medical Center, Springfield, Massachusetts, United States
  • Luty, Joanna, Baystate Medical Center, Springfield, Massachusetts, United States
Introduction

Pediatric Renal Cell Carcinoma (pRCC) is rare in children and adolescents and only account for about 5% of all pediatric renal neoplasms. The driver mutation of the majority of these tumors is due to cytogenetic translations involving the MiT family of transcription factors. Surgical resection of the mass is the main treatment and depending on the advancement of the cancer, can result in a complete nephrectomy. Due to complexity of surgery and the risk of blood loss, treatment can be complicated by a patient’s religion that decline blood product transfusions, such as Jehovah’s Witness. This case describes an already rare cancer requiring a unique medical management due to a family’s religious belief.

Case Description

A previously healthy 14-year-old male presented complaining of left flank pain. Patient was afebrile, tachycardic to the 120s, and initially hypertensisve to 133/81 that self resolved. Due to persistent pain with unknown etiology imaging was obtained and MRI showed 8 cm solid mass in the left kidney with a dilated and thrombosed left renal vein. The mass could not be differentiated between Wilms Tumor or pRCC, thus a complete nephrectomy was decided to be the best course of treatment. Due to family’s religious background of Jehovah’s Witness a multi-disciplinary approach was considered to reduce the need for blood transfusions. Patient received daily erythropoietin injections and iron supplementation about three weeks prior to nephrectomy to stimulate production of red blood cells and was continued post-operatively. Additionally, on the day of his procedure, interventional radiology (IR) first embolized the left renal artery leading to tumor followed immediately by a left radical nephrectomy. Patient tolerated the procedure well with minimal blood loss and only had mild anemia. He required no post-surgical transfusion. There was mild increase in creatinine levels with acute kidney injury status-post nephrectomy that has since improved. Pathology report came back and confirmed clear cell renal cell carcinoma. Cytogenetic screen showed a translocation of the transcription factor E3 (TFE3) gene. Patient did well post-operatively with no signs of cancer on recent imaging and did not require any chemotherapeutics.

Discussion


This case adds to the field of pediatric renal cell carcinoma and highlights a treatment approach that incoroporates religious backgrounds into medical management.