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Nursing QUESTION #9274
Question 1
A 4-year-old child is admitted with painless, gross hematuria. Ultrasound shows a large unilateral intrarenal mass. The child appears otherwise well. The MOST likely diagnosis in this age group is:
  • Neuroblastoma
  • Wilms' Tumor (Nephroblastoma)✔️
  • Polycystic kidney disease
  • Renal cell carcinoma
Correct Answer Explanation

Wilms' Tumor (Nephroblastoma) — most common renal malignancy in children (peak age 3–4 years).

Classic presentation:

  • Asymptomatic abdominal mass (discovered by parent/during bath)
  • Painless gross hematuria
  • Hypertension (renin secretion)
  • Child appears well (unlike neuroblastoma — ill-appearing)

Important physical examination note: DO NOT palpate the abdominal mass repeatedly — risk of tumor capsule rupture and metastatic seeding.

Associations:

  • WAGR syndrome: Wilms' + Aniridia + Genitourinary anomalies + mental Retardation (WT1 gene mutation)
  • Beckwith-Wiedemann syndrome
  • Hemihypertrophy

Staging and Treatment:

StageDescriptionSurvival
IConfined to kidney, completely resected~95%
II–IIIRegional extension~85–90%
IVHematogenous mets (lung, liver)~75%

Treatment: Nephrectomy + chemotherapy (actinomycin D, vincristine) ± radiotherapy. Wilms' has excellent prognosis — one of most curable solid tumors.