When is kidney removal surgery recommended for Wilms tumour?

Nephrectomy removes the affected kidney and nearby tissues that may contain tumour cells. The surgeon may also assess nearby lymph nodes. In some children, chemotherapy is given before surgery to shrink the tumour and make removal safer. The choice can change if both kidneys are involved, the tumour has grown into nearby structures, or it has spread to another part of the body. In those situations, the team may consider a kidney-sparing operation, staged treatment, or another combination of therapies.

Ask the paediatric oncology and surgical teams how imaging, blood tests, kidney function, and the tumour’s response to initial treatment affect the plan. Discuss how the remaining kidney will be monitored, what medicines the child may need, and how activity, eating, and school routines may change during recovery. Bring a complete list of medicines and tell the team about any fever, vomiting, reduced urine, or new pain.

Contact the treatment team promptly for fever, worsening abdominal swelling or pain, repeated vomiting, unusual sleepiness, difficulty passing urine, or much less urine than usual. After surgery, increasing wound redness, drainage, breathing difficulty, or pain that is not controlled needs urgent clinical advice.

Which kidney is affected, and is the tumour limited to that kidney? Is treatment before surgery advised? How will you protect and follow the remaining kidney? What signs after the operation should lead us to call the hospital?