scholarly journals P0845INCREASING TOTAL RENAL VOLUME AFTER NEPHRECTOMY FOR RENAL CELL CARCINOMA IS ASSOCIATED WITH RENAL FUNCTION EVOLUTION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
SAUL PAMPA-SAICO ◽  
M Soledad Pizarro-Sánchez ◽  
Simona Alexandru ◽  
Laura García Puente-Suárez ◽  
María López-Picasso ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Function ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Linear Regression Analysis ◽  
Multivariate Linear Regression Analysis ◽  
Renal Volume

Abstract Background and Aims Renal cell carcinoma is the most common form of kidney cancer. Reduction of renal mass after radical nephrectomy (RN) in these patients, results in compensatory hypertrophy of the contralateral kidney. The capacity of compensation will determine the renal function (RF) evolution. Measuring of total renal volume (TRV) of the remaining kidney pre and post RN can help assess the RF evolution. Aims To determine the correlation between TRV pre and post nephrectomy (a year of follow-up) with RF and the factors that modify. Method A retrospective cohort study was carried out in our institution, in 62 patients who had underwent RN from 2014 to 2018, due to renal cell carcinoma (confirmed by histopathology). The demographic data included age, gender, body mass index (BMI), associated comorbidities, smoking habits were collected. Serum creatinine, estimated glomerular filtration rate (eGFR) and proteinuria were collected in the preoperative period and in the follow-up. The TRV was calculated pre and post (a year of follow-up) RN, using ellipsoid formula equation (computed tomography scan or magnetic resonance imaging). Renal function evolution was assessed by eGFR using the modification of diet in Renal Disease formula. Multivariate linear regression analysis was used to determine the predictor of TRV at 1 year of follow-up. Results The median age at the time of RN was 71 years old (range, 43-86 years). Most of them were men, 69% (43/19). The estimated glomerular filtration rate (FGe) pre and post nephrectomy was 74 (41-102) and 52.1 ml/min/ m2 (22-89) respectively (P=0.013). The TRV pre and post-nephrectomy was 165.3 (102.3-259.7) and 188.3 ml (115.3-271.2) respectively (P=0.001). On multivariate linear regression analysis, controlling for age and sex; the pre-nephrectomy FGe (β = 0.42; P = 0.023) and the pre TRV (β = 1.23; P <0.0001) were positively correlated with the post-nephrectomy TRV, while the FGe at year of follow-up was correlated negatively (β = -1.11; P = 0.024) Conclusion The post nephrectomy TRV was positively correlated with TRV and FGe pre nephrectomy. While with the FGe at one year post nephrectomy was negatively correlated. The increasing TRV pre and post nephrectomy can help to predict renal function at a year of follow-up in this group of patients.

scholarly journals Parcial Nephrectomies - results of 12 years from an Oncology Institution

2016 ◽  
Vol 29 (2) ◽  
pp. 123
Author(s):  
Rui Freitas ◽  
Ricardo Cruz ◽  
Luís Antunes ◽  
Paulo Araújo ◽  
Pedro Silva ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Cell Carcinoma ◽  
Glomerular Filtration ◽  
Renal Cell ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Warm Ischemia ◽  
Ischemia Time

<p><strong>Introduction:</strong> The diagnosis of renal cell carcinoma has been increasing in recent years, especially due to incidental cases, and thus indication for nephron-preserving surgery has also risen.<br /><strong>Objectives:</strong> To review a series of partial nephrectomies from an oncology institution namely technique features, survival and change in renal function.<br /><strong>Material and Methods:</strong> A retrospective analysis of all patients with renal tumors that were submitted to partial nephrectomy at our institution between January 2000 and December 2012.<br /><strong>Results:</strong> A total 156 partial nephrectomies were performed, 85 in men and 71 in women, with mean overall age of 62 ± 15 years. Surgical approach was transperitoneal laparoscopic in 23 cases with the remainder 133 through lumbotomy. Mean ischemic time was &lt; 25 min in all patients and complication rate was 10.9 %, mostly corresponding grade 2 and 3 of the Clavien-Dindo scale. Mean tumor size was 2.9 ± 1.4 cm and the surgical margin was focally affected by tumor in 9.6% of cases. Histologically, 26.2% of cases corresponded to clear cell renal cell carcinoma, with oncocytomas being the most common benign neoplasm with 14.7% of the total. There were 4 cases of recurrence and one case death at follow-up. The mean change in estimated glomerular filtration rate was -5.3 mL/min per 1.73 m2 (p &lt; 0.001). There was no association between warm ischemia time, body mass index, age, ASA score, presence of complications with this decrease in glomerular filtration rate.<br /><strong>Discussion:</strong> Our positive surgical margins cases were slightly above what is described in literature, however we didn’t find any predictive factor for such finding and ultimately there was no evidence of tumor recurrence or influence in survival in all these cases. Even though there was a significant decrease in estimated glomerular filtration rate, warm ischemia time was very low and only five patients presented with de novo eGFR &lt; 60 mL/min per 1.73 m2, and two patients started hemodialysis. A high volume center seems to be critical for technique optimization and complication management.<br /><strong>Conclusion:</strong> Our series of partial nephrectomies presents oncological results and preservation of renal function similar to those published in literature. This is a safe technique with good results, justifying its growth.</p><p> </p>

Renal function assessment during follow-up after surgical treatment for renal cell carcinoma

2019 ◽  
Vol 18 (1) ◽  
pp. e1419-e1420
Author(s):  
P. Capogrosso ◽  
A. Larcher ◽  
F. Cianflone ◽  
F. Muttin ◽  
F. Trevisani ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Function ◽  
Surgical Treatment ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Function Assessment

Single-fraction radiosurgery for the treatment of renal cell carcinoma.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 590-590 ◽  
Author(s):  
Michael D. Staehler ◽  
Boris Schlenker ◽  
Alexander Karl ◽  
Annabel Spek ◽  
Alexander Muacevic
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Function ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Long Term Results ◽  
Tumor Control ◽  
High Dose ◽  
Short Term ◽  
Single Fraction

590 Background: We report on patients with renal cell carcinoma (RCC) who were treated with single fraction high-dose local stereotactic radiosurgery (SRS) using the robotic Cyberknife system to avoid nephrectomy and consecutive hemodialysis. Methods: Fifty-two patients with histologically confirmed RCC and median age of 63.6 years (43.6-86.5) with the indication for renal surgery and highest risk for consecutive hemodialysis were entered into a prospective case control study of single fraction SRS with 25Gy. Tumor response, renal function, survival, and adverse events were estimated every three months with a follow-up of at least six months. Results: R.E.N.A.L. score was low in 1, moderate in 30 and high in 21 patients. 28 patients had singular renal units. Median follow-up was 26.9 months (1.8 - 52.6). Local tumor control nine months after SRS was 98% (95% CI: 89-99%). 43 lesions showed a measurable tumor size reduction including six complete remissions and 33 partial remissions. Renal function remained stable with a median serum creatinine at baseline of 1.10 mg/dl (0.4 -2.0) and 1.11 mg/dl (0.8-2.2) at follow-up. In one patient grade I erythrodermia, in three patients grade I fatigue and in two patients grade I nausea occurred. In all patients nephrectomy was avoided. Conclusions: Single-fraction SRS as an outpatient procedure is a treatment modality with short-term safety and efficacy to avoid treatment-related loss of renal function and hemodialysis in selected patients with RCC. Short term follow up of oncological and functional results so far is excellent. Further studies are needed to determine the limits of SRS in this setting and long term results.

scholarly journals Renal Cancer is Not Radioresistant: Slowly but Continuing Shrinkage of the Tumor After Stereotactic Body Radiation Therapy

2019 ◽  
Vol 18 ◽  
pp. 153303381882232 ◽  
Author(s):  
Satoshi Funayama ◽  
Hiroshi Onishi ◽  
Kengo Kuriyama ◽  
Takafumi Komiyama ◽  
Kan Marino ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Function ◽  
Radiation Therapy ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Stereotactic Body Radiation Therapy ◽  
Solitary Kidney ◽  
Stereotactic Body Radiation ◽  
Local Progression

Purpose: To evaluate the safety and efficacy of stereotactic body radiation therapy for primary lesion of renal cell carcinoma with long-term and regular follow-up of tumor size and renal function. Methods: This prospective study included 13 patients treated with stereotactic body radiation therapy for primary lesion of stage I renal cell carcinoma between August 2007 and June 2016 in our institution. Diagnosis of renal cell carcinoma was made by 2 radiologists using computed tomography or magnetic resonance imaging. A dosage of 60 Gy in 10 fractions or 70 Gy in 10 fractions was prescribed. The higher dose was selected if dose constraints were satisfied. Tumor response on imaging examination, local progression-free rate, overall survival, and toxicity were assessed. Results: The mean follow-up period was 48.3 months (range: 11-108 months). The tumors showed very slow but continuous response during long-term follow-up. Three cases (23.1%) showed transient progression during the short follow-up. The mean duration until the day on which partial response was confirmed among the partial or complete response cases was 22.6 months (95% confidence interval, 15.3-30.0 months). Local progression-free rate was 92.3% for 3 years and overall survival rate 91.7% for 2 years and 71.3% for 3 years. Twelve cases (92.3%) had impaired renal function at baseline. Renal function decreased slowly and mildly in most of the cases, but 2 cases of solitary kidney showed grade 4 or 5 renal dysfunction. Conclusion: All renal tumors decreased in size slowly but continuously for years after stereotactic body radiation therapy. Renal cancer can be treated radically with stereotactic body radiation therapy as a radiosensitive tumor, but careful attention should be given in cases with solitary kidney.

scholarly journals Vhl Dependent Expression of REDD1 and PDK3 Proteins in Clear-Cell Renal Cell Carcinoma

2018 ◽  
Vol 37 (1) ◽  
pp. 31-38 ◽  
Author(s):  
Bojana B. Ilic ◽  
Jadranka A. Antic ◽  
Jovana Z. Bankovic ◽  
Ivana T. Milicevic ◽  
Gordana S. Rodic ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Clear Cell ◽  
Linear Regression Analysis ◽  
Multivariate Linear Regression Analysis ◽  
Cell Renal Cell Carcinoma ◽  
Vhl Gene ◽  
Control Tissue ◽  
Mutational Status

SummaryBackground: Sporadic clear-cell renal cell carcinoma (ccRCC) is associated with mutations in the VHL gene, upregulated mammalian target of rapamycin (mTOR) activity and glycolytic metabolism. Here, we analyze the effect of VHL mutational status on the expression level of mTOR, eIF4E-BP1, AMPK, REDD1, and PDK3 proteins. Methods: Total proteins were isolated from 21 tumorous samples with biallelic inactivation, 10 with monoallelic inactivation and 6 tumors with a wild-type VHL (wtVHL) gene obtained from patients who underwent total nephrectomy. The expressions of target proteins were assessed using Western blot. results: Expressions of mTOR, eIF4EBP1 and AMPK were VHL independent. Tumors with monoallelic inactivation of VHL underexpressed REDD1 in comparison to wtVHL tumors (P = 0.042), tumors with biallelic VHL inactivation (P < 0.005) and control tissue (P = 0.004). Additionally, REDD1 expression was higher in tumors with VHL biallelic inactivation than in control tissue (P = 0.008). Only in wt tumor samples PDK3 was overexpressed in comparison to tumors with biallelic inactivation of VHL gene (P = 0.012) and controls (P = 0.016). In wtVHL ccRCC, multivariate linear regression analysis revealed that 97.4% of variability in PDK3 expression can be explained by variations in AMPK amount. Conclusion: Expressions of mTOR, eIF4EBP1 and AMPK were VHL independent. We have shown for the first time VHL dependent expression of PDK3 and we provide additional evidence that VHL mutational status affects REDD1 expression in sporadic ccRCC.

scholarly journals Predicting the risk of postoperative acute kidney injury: development and assessment of a novel predictive nomogram

2021 ◽  
Vol 49 (8) ◽  
pp. 030006052110328
Author(s):  
Yukun Wu ◽  
Junxing Chen ◽  
Cheng Luo ◽  
Lingwu Chen ◽  
Bin Huang
Keyword(s):  
Renal Cell Carcinoma ◽  
Acute Kidney Injury ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Kidney Injury ◽  
Surgical Time ◽  
Blood Uric Acid ◽  
Postoperative Aki

Objective This study aimed to establish and internally verify the risk nomogram of postoperative acute kidney injury (AKI) in patients with renal cell carcinoma. Methods We retrospectively collected data from 559 patients with renal cell carcinoma from June 2016 to May 2019 and established a prediction model. Twenty-six clinical variables were examined by least absolute shrinkage and selection operator regression analysis, and variables related to postoperative AKI were determined. The prediction model was established by multiple logistic regression analysis. Decision curve analysis was conducted to evaluate the nomogram. Results Independent predictors of postoperative AKI were smoking, hypertension, surgical time, blood glucose, blood uric acid, alanine aminotransferase, estimated glomerular filtration rate, and radical nephrectomy. The C index of the nomogram was 0.825 (0.790–0.860) and 0.814 was still obtained in the internal validation. The nomogram had better clinical benefit when the intervention was decided at the threshold probabilities of >4% and <79% for patients and doctors, respectively. Conclusions This novel postoperative AKI nomogram incorporating smoking, hypertension, the surgical time, blood glucose, blood uric acid, alanine aminotransferase, the estimated glomerular filtration rate, and radical nephrectomy is convenient for facilitating the individual postoperative risk prediction of AKI in patients with renal cell carcinoma.

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