A 2 Years Girls with Nephroblastoma: A Case Report

Introduction: Wilm's tumor, also known as nephroblastoma, is a common complication in children with renal cancer. It was responsible for 6% of all malignancies. It almost always affects children under the age of five. 90% of cases are diagnosed before the age of three, with the peak incidence occurring between the ages of two and five years. The case of a 2-year-old girl with Wilm's tumor is shown below. The majority of cases are unilateral, but 5% to 10% of the time both kidneys are affected. Case Presentation: A 2-year-old girl was taken to the hospital with a chief complaint of a lump in the abdomen, fever, vomiting and fatigue, nausea, swelling, pain in the abdomen, weakness. On physical examination the patient has experienced in weakness the upper and lower limb, pain experiencing in the abdomen and presenting lumps in the abdomen S1 and S2 are heard in the cardiological system, and air entry is bilaterally equal in the respiratory system. Pupils are reflected light, tone, and a palpable smooth abdominal mass is frequently discovered by chance. The infant was never admitted to a neonatal intensive care unit (NICU). There had been no previous evidence of neonatal sepsis or jaundice. For a year, the girl was breastfed. The right side of the abdomen was where the first symptoms appeared. Small at first, but quickly grew larger and more asymmetrical. Case Study Mendhe et al.; JPRI, 33(52A): 62-65, 2021; Article no.JPRI.75780 63


INTRODUCTION
Wilms tumor is the most common type of renal tumor in children, affecting about 650 children in the United States each year. Wilms' tumor, also known as nephroblastoma, is a kidney solid tumor caused by immature kidney cells. It is the most common type of cancer in children, as well as the most common cancer of the kidneys. Wilms tumors are usually unilateral, meaning they only affect one kidney. 5-10% of children with Wilms' tumors have multiple tumors in the same kidney, and about 5% of children with Wilms' tumors have bilateral Wilms' tumors, which affect both kidneys. Wilms' tumor is difficult to detect early because it can grow large without causing any symptoms. These kids may appear and behave normally. Swelling or a hard mass in the abdomen is the most common first clinical sign. It's usually firm and large enough to feel on both sides of the abdomen, and it's rarely painful [1].
A 2-year-old girl was admitted to the Acharya Vinoba Bhave Rural Hospital with a lump in her abdomen, fever, fatigue, nausea, swelling, abdominal pain, and upper and lower limb weakness. Wilms tumor was found in her. She did not improve after treatment, and her health was in jeopardy. The patient's family is in a difficult financial situation. Her entire family was disease-free, both communicable and noncommunicable. She and her family have a good rapport with their neighbors and other family members. She is suffering from a fever (1010 f). when he is accepted as directed by the physician, blood tests, computed tomography (CT) scans, liver function tests, kidney function tests, intravenous fluids, antiemetic drugs, and antipyretic drugs are administered [2].

PATIENT INFORMATION
A 2-year-old girl was admitted to the Acharya Vinoba Bhave Rural Hospital with a lump in her abdomen, fever, fatigue, nausea, swelling, abdominal pain, and upper and lower limb weakness. Wilms tumor was found in her. She did not improve after treatment, and her health was in jeopardy. The patient's family is in a difficult financial situation. Her entire family was disease-free, both communicable and noncommunicable. She and her family have a good rapport with their neighbors and other family members. She is suffering from a fever (1010 f). when he is accepted as directed by the physician, blood tests, computed tomography (CT) scans, liver function tests, kidney function tests, intravenous fluids, antiemetic drugs, and antipyretic drugs are administered.

PHYSICAL EXAMINATION
The child's skin appeared normal, wellnourished, and apyrexial during a physical examination. The blood pressure was 90/60 mmHg. The child weighed 12 kilograms. The patient had pins and limps in his abdomen, as well as upper and lower limb weakness. The heart and lung sounds were both normal. In the respiratory system, chest expansion and air entry were both normal, as was the gastrointestinal tract. the child was feeding well, no changes in bowel habits.

DIAGNOSTIC ASSESSMENT
A solid mass with cystic areas in the lower upper quadrant arising from the right kidney and measuring 11 cm by 8 cm was discovered on an abdominal scan, resembling a right Wilm's tumor. WBC-3.27, HB-8.7 (Low), MCV-58.6, PLT-255 Urinalysis results are normal.

MEDICAL MANAGEMENT
The patient is well-oriented to place and person upon admission. However, the patient has not responded. Then he's put on a ventilator and a Ryle tube is inserted. All reflexes should be checked, and the patient should be carefully assessed by the staff nurses. In addition, the patient was given holistic care. Wilm's tumor treatment is determined by histological findings, clinical staging, and metastasis.
Wilm's tumors in stages I and II with favorable histology are usually treated with nephrectomy and 18 weeks of chemotherapy: Nephrectomy, abdominal radiotherapy, and chemotherapy for 24 weeks are used to treat stage III, IV, and V tumors.
Massive chemotherapy requires preoperative radiotherapy and chemotherapy.

NURSING MANAGEMENT
Vital signs were monitored and recorded. Her health is deteriorating. Renal function, weight, intake output, and KFT values were all monitored. I looked for signs that something was working. provided a comfortable position and a cold body compressor to keep the body temperature stable. Examined the oral cavity for signs of pain, ulcers, lesions, gingivitis, mucositis, and stomatitis, as well as their impact on the ability to eat and drink. Examine all reflexes. As reported by patient family members to nursing staff, excellent nursing care was provided. Respiratory function is improved, physical mobility is improved, and anxiety and suffering are reduced. By intervening, you can improve parental care and reduce the risk of complications.

DISCUSSION
On May 24, 2021, a 2-year-old girl was admitted to Acharya Vinoba Bhave Rural Hospital with the primary complaint of A 2-year-old girl was admitted to the hospital with a lump in her abdomen, fever, fatigue, nausea, swelling, abdominal pain, and weakness. Wilms tumors are typically discovered when they begin to cause symptoms such as swelling in the abdomen (belly), but by this time, they have often grown to a size that is difficult to detect. They can be detected earlier in some children using tests such as an abdominal ultrasound. If a child exhibits signs or symptoms that suggest he or she may have a kidney tumor, the doctor will want to obtain a thorough medical history to learn more about the symptoms and how long they have been present. It's also important to know if there's a family history of cancer or birth defects. The abdomen (belly) and an increase in blood pressure, which is another possible sign of a kidney tumor, will most likely be the focus. It's also possible that blood and urine samples will be taken for testing [5].
Wilms' tumors are most commonly recognized when swelling begins in the abdomen, but they have often grown quite large by this time. If the child has an abdominal ultrasound and a CT scan, it can be discovered earlier.
To determine all symptoms that may be related and how long they have existed, a complete medical history should be obtained. When a doctor suspects a tumor in a child, ultrasound and imaging tests (xrays, magnetic fields, or radioactive substances) are used to rule out the possibility. The tests will aid doctors in determining the tumors location, type, and size. The tests also help to determine how far the tumor has spread in the kidney and other parts of the body. The tests are also used in treatment therapy. It could also predict the prognosis of the tumor after treatment. Hematological tests, for example, should be investigated. A child with moderate and microcytic anemia may be seen. Blood infusions may be required in the case of moderate anemia before, during, or after surgery, depending on the circumstances. In children, hypertension was uncommon [6].
High blood pressure in the child could be another sign of a kidney tumor. It is necessary to keep an eye on the child while he or she is in the hospital. Testing may also include the collection of blood and urine samples [7].
Wilms' tumors can run in families, but this is uncommon. When a child is diagnosed with Wilms tumors, parents can be tested [2][3][4]. Wilms' tumor screening is critical for children because it is linked to survival. Finding kidney tumors early on, when they are small and have not spread to other organs, can save a person's life for up to two years. As a result, screening for Wilms tumor is critical for children with syndromes, birth defects, or a family history of the disease. Physical exams by a specialist are a very simple and inexpensive way to go; ultrasound regularly is also recommended [8].

CONCLUSION
The most common type of kidney cancer in children is Wilms' tumor. Wilms' tumor is a rare type of kidney cancer that affects mostly children. It's also known as nephroblastoma, and it's the most common kidney cancer in children. Wilms' tumor is usually treated with surgery, chemotherapy, and, in some cases, radiation therapy. Treatment options may differ depending on the stage of cancer. Wilm's tumor can also be passed down through generations.

CONSENT
As per international standard or university standard, patients' written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
We conducted our research after obtaining proper IEC approval.