Wilms' tumor


  • Affects children <15yr, 2/3 of cases diagnosed before age 5[1]
  • Arises from persistent embryonal renal cells
  • Most common renal malignancy in children[2]
  • 10-15% will have mets at presentation (lungs)
  • 10% of cases are associated with malformation syndromes such as WAGR, Denys-trash, Beckwith-Wiedemann[3]

Clinical Features

  • Abdominal swelling/mass, can have abdominal pain
    • Avoid vigorous palpation to prevent capsular rupture; causes tumor spillage (will then need more intensive therapy)
  • Subcapsular hemorrhage presents as abdominal enlargement, anemia, HTN, and possibly fever
  • Patient often appears well
  • Less frequent features include abdominal pain, hematuria, fever, anorexia, nausea/vomiting, hypertension[4]

Differential Diagnosis


  • Ultrasound, CT or MRI
  • Chest imaging to look for lung mets, usually CT
  • CBC, chemistry including serum calcium and creatinine, LFTs, coags


  • Consult oncology/surgery
  • Surgery/biopsy, chemo, and/or radiation based on staging


  • Admission for further workup and management