scholarly journals Prenatally detected, unilateral, high-grade hydronephrosis: Can we predict the natural history?

2017 ◽  
Vol 12 (3) ◽  
pp. E137-41 ◽  
Author(s):  
Osama M. Sarhan ◽  
Ahmed El Helaly ◽  
Abdul Hakim Al Otay ◽  
Mustafa Al Ghanbar ◽  
Ziad Nakshabandi Nakshabandi
Keyword(s):  
Risk Factors ◽  
Renal Function ◽  
Prognostic Factors ◽  
Natural History ◽  
Surgical Intervention ◽  
Antenatal Diagnosis ◽  
Male Gender ◽  
High Grade ◽  
Fetal Hydronephrosis ◽  
Grade 3

Introduction: Fetal hydronephrosis (HN) occurs in around 5% of pregnancies and its prognosis depends mainly on the grade of the dilation.We attempted to determine the fate of isolated, unilateral, high-grade HN in children with antenatal diagnosis, emphasizing the risk factors for progression.Methods: We retrospectively evaluated 424 children (690 kidney units) with antenatal HN in the period between 2010 and 2014. We included only those patients with isolated high-grade HN (Society for Fetal Urology [SFU] Grade 3 or 4). Patients with bilateral HN or unilateral HN associated with dilated ureter or reflux and patients with missed followup were excluded. The prognosis of HN (whether improved, stabilized, or progressed) and the need for surgical intervention in this subset of patients was evaluated.Results: A total of 44 children (34 boys and 10 girls) were identified. Ultrasounds showed SFU Grade 3 HN in 24 (54%) and SFU Grade 4 HN in 20 (46%). After a mean followup of three years (range 1‒5), 10 children (23%) needed surgical intervention; four Grade 3 HN (16%) and six Grade 4 HN (30%). The majority of children with differential renal function (DRF) ≥40% (69.5%) were stable or improved. Five girls (50%) and five boys (17%) progressed and required surgical intervention. No patient with a renal pelvis anteroposterior diameter (APD) <1.5 cm needed surgical intervention.Conclusions: Infants with isolated, unilateral, high-grade HN might be managed conservatively. Male gender, DRF ≥40%, SFU Grade 3 HN, and APD <1.5 cm were favourable prognostic factors.

Rate of Decline of Residual Renal Function in Patients on Continuous Peritoneal Dialysis and Factors Affecting It

2000 ◽  
Vol 20 (4) ◽  
pp. 429-438 ◽  
Author(s):  
Manoj K. Singhal ◽  
Shaunmukhum Bhaskaran ◽  
Edward Vidgen ◽  
Joanne M. Bargman ◽  
Stephen I. Vas ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Renal Function ◽  
Multivariate Analysis ◽  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Outcome Measure ◽  
Residual Renal Function ◽  
Left Ventricular ◽  
Male Gender

Objective We analyzed residual renal function (RRF) in a large number of new peritoneal dialysis (PD) patients to prospectively define the time course of decline of RRF and to evaluate the risk factors assumed to be associated with faster decline. Study Design Single-center, prospective cohort study. Setting Home PD unit of a tertiary care University Hospital. Patients The study included 242 patients starting continuous PD between January 1994 and December 1997, with a minimum follow-up of 6 months and at least three measurements of RRF. Measurement All patients had data on demographic and laboratory variables, episodes of peritonitis and the use of aminoglycoside (AG) antibiotics, temporary hemodialysis, and number of radiocontrast studies. Adequacy of PD was measured from 24-hour urine and dialysate collection and peritoneal equilibration test using standard methodology. Further data on RRF was collected every 3 to 4 months until the patient became anuric (urine volume < 100 mL/day or creatinine clearance < 1.0 mL/min) or until the end of study in December 1998. Outcome Measure The slope of the decline of residual glomerular filtration rate (GFR) (an average of renal urea and creatinine clearance) was the main outcome measure. Risk factors associated with faster decline were evaluated by a comparative analysis between patients in the highest and the lowest quartiles of the slopes of GFR, and a multivariate analysis using a stepwise option within linear regression and general linear models. Results There was a gradual deterioration of residual GFR with time on PD, with 40% of patients developing anuria at a mean of 20 months after the initiation of PD. On multivariate analysis, use of a larger volume of dialysate ( p = 0.0001), higher rate of peritonitis ( p = 0.0005), higher use of AG ( p = 0.0006), presence of diabetes mellitus ( p = 0.005), larger body mass index (BMI) ( p = 0.01), and no use of antihypertensive medications ( p = 0.04) independently predicted the steep slope of residual GFR. Male gender, higher grades of left ventricular dysfunction, and higher 24-hour proteinuria were associated with faster decline on univariate analysis only. Conclusion Faster decline of residual GFR corresponds with male gender, large BMI, presence of diabetes mellitus, higher grades of congestive heart failure, and higher 24-hour proteinuria. Higher rate of peritonitis and use of AG for the treatment of peritonitis is also associated independently with faster decline of residual GFR. Whether the type of PD (CAPD vs CCPD/NIPD) is associated with faster decline of residual GFR remains speculative.

scholarly journals Retrospective Study of the Incidence and Risk Factors for Hematological Malignancies in Patients with Hepatitis B Virus Infection

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5403-5403 ◽  
Author(s):  
Erin Jou ◽  
Carmen KM Cheung ◽  
Ryan CY Ho ◽  
Diwakar Mohan ◽  
Uriel Felsen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Hepatitis B ◽  
Hematological Malignancies ◽  
Cell Lymphoma ◽  
Male Gender ◽  
High Grade ◽  
Positive Hbsag ◽  
Increased Risk

Abstract Background: Hepatitis B infection may be associated with an increased risk of non hodgkins lymphoma, especially diffuse large B cell lymphoma. Whether an intact immune system is required hepatitis B mediated lymphomagenesis and if factors such as other viral co infections and paraproteins may further compound this risk remains unclear. We retrospectively studied our large database of HBsAg positive patients for diagnoses of hematological malignancies or premalignant disorders (HM) and the risk factors for their development. Methods: Patients over the age of 18 with at least one positive HBsAg test between Jan 1st 2001 and Dec 31st 2011 were identified using the medical center database, clinical looking glass. Data were collected regarding demographics, HIV and hepatitis C status. Serum protein electrophoresis tests done after the HBsAg test were reviewed. Results of all biopsies performed for each patient, ICD9 and cancer registry diagnoses were reviewed for biopsy confirmed diagnoses of a HM. Liver biopsy results were reviewed for evidence of chronic hepatitis changes. Results: 3177 of 216,522 patients (1.5%) tested were HBsAg positive. Mean age of the HBsAg positive group was 43 years, 56% were male. 44% were black, 8% white and 7.4% were Asian. 33.6% of these patients had two positive HBsAg tests 6 months apart. 10.3% of patients underwent a liver biopsy and 9.4% of patients had biopsy changes consistent with chronic hepatitis. Of the 3177 patients, 4.9% (155 patients) had a biopsy of any lymphatic tissue or bone marrow performed. 2.2 % (71 patients) had a hematological malignancy or premalignant disorder diagnosed. 0.4% (12 patients) had an insufficient specimen for diagnosis and were excluded from further analysis. Of the 71 patients with a HM, 30 (42.3%) had a high grade B or T cell lymphoma; 12 (16.9%) had myeloma or smoldering myeloma; 11 (15.5%) had a low grade lymphoma; 6 (8.4%) had myelodysplasia, myeloproliferative disorder or acute leukemia and 11 (15.5%) had a premalignant disorder including multicentric castleman, MGUS or NK cell lymphocytosis. 47% of high grade lymphomas occurred in an extranodal location. Within the HBsAg positive population, HM positive patients (n=71) compared to HM negative controls (n=3094) were significantly older (52.5 vs 43 yrs, p<0.001) and more likely to be male (73.2% vs 55.5% p:0.003) HM positive patients were tested for other viral coinfections more often and were more likely to be seropositive for HIV (62.7% vs 31.4%, p<0.001) and Hepatitis C (20% vs 10.7%, p:0.014) . HM positive patients were also tested for paraprotein more frequently and had a significantly higher prevalence of paraproteinemia than their HM negative counterparts. (58.1% vs. 15.4%, p<0.0001) On multivariate analysis, male gender (OR: 2.4, 95% CI:1.1-4.9), paraprotein positivity (OR:16.3, 8.0-33.7) and HIV positivity (OR:2.6, 1.4-4.9) but not Hepatitis C positivity emerged as independent risk factors for development of HM. (Table 1) Of those patients with HBsAg positivity diagnosed with hematological malignancies, patients co-infected with HIV and hepatitis B had a significantly higher proportion of DLBCL cases as compared to those with hepatitis B alone (46.9% vs 10.5%, p:0.013). Conclusions: Concurrent HIV infection and paraproteinemia were associated with increased risk of HM in our HBsAg positive patients. Of those who develop HM, HIV and Hepatitis B co-infected patients have a higher proportion of DLBCL. These data suggest synergistic mechanisms of Hepatitis B and HIV in abnormal B cell proliferation. Being a retrospective study, inherent biases exist in terms of which patients get certain tests. Further work is required to confirm these findings and to elucidate the mechanisms of lymphomagenesis in this population. Abstract 5403. Table 1: Risk factors for the development of HM in HBsAg positive patients HM positive (n=71) HM negative (n=3094) p value Mean age in years (SE) 52.5 (12.9) 42.9 (13.6) <0.0001* Male gender (n,%) 52 (73.2%) 1716 (55.5%) 0.003* HIV serology or viral load tested (n,%) 51 (71.8%) 1787 (57.8%) 0.017* HIV positive of tested patients (n,%) 32/51 (62.7%) 561/1787 (31.4%) <0.0001* HCV serology done (n,%) 70 (98.6%) 2660 (86%) 0.001* HCV seropositive of those tested (n,%) 14 /70 (20%) 285 / 2660 (10.7%) 0.014* SPEP test done (n,%) 31 (43.6%) 311 (10.1%) 0.0001* SPEP positive of tested patients (n,%) 18/31 (58.1%) 48/311 (15.4%) <0.0001* Disclosures No relevant conflicts of interest to declare.

scholarly journals INNV-28. TEMOZOLOMIDE IN RENAL DYSFUNCTION

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii122-ii122
Author(s):  
Kayla Garzio ◽  
Kelly McElroy ◽  
Stuart Grossman ◽  
Matthias Holdhoff ◽  
Byram Ozer ◽  
...  
Keyword(s):  
Renal Function ◽  
Medical Records ◽  
Alkylating Agent ◽  
Primary Cns Lymphoma ◽  
Cns Lymphoma ◽  
High Grade ◽  
Secondary Endpoints ◽  
Grade 3 ◽  
Number Of Cycles ◽  
Experienced Grade

Abstract BACKGROUND Temozolomide (TMZ) is a cytotoxic DNA alkylating agent. It is the only chemotherapy known to improve survival in patients with high grade astrocytomas. The active alkylating species, methylhydrazine, is not recovered in the urine and thus renal function is not expected to affect clearance of this agent. It has never been formally evaluated in adults with eGFR &lt; 36 mL/min/1.73 m2, and it is often recommended to administer with caution, dose reduce, or withhold therapy. However, lacking other effective therapies, we have elected to administer TMZ at full dose to these patients. This IRB approved retrospective study was conducted to evaluate the safety of this practice. METHODS The primary endpoint was to characterize the incidence and severity of thrombocytopenia in patients with renal impairment defined as eGFR &lt; 60 mL/min/1.73 m2 who received TMZ for the treatment of their high grade gliomas (HGG) or primary CNS lymphoma (PCNSL). Secondary endpoints included incidence and severity of neutropenia, lymphocytopenia, hepatotoxicity, and number of cycles administered. Medical records were reviewed for adult patients with HGG or PCNSL treated with TMZ from October 1, 2016-September 30, 2019. RESULTS Thirty-four patients met criteria for inclusion. Of the 7 patients with eGFR &lt; 36 mL/min/1.73m2, 33/34 cycles (97%) were completed successfully without grade 3–4 thrombocytopenia. No patients experienced grade 3–4 neutropenia, and grade 3–4 lymphocytopenia occurred in 5 cycles (15%). One patient required discontinuation of TMZ 7 days prior to completion of radiation due to thrombocytopenia. CONCLUSION The side effect profile from TMZ administered to patients with eGFR &lt; 36 mL/min/1.73 m2 appears to be similar to that of patients with normal renal function. This is not an unanticipated finding given what is known about the metabolism of the drug.

Fetal hydronephrosis: natural history and risk factors for postnatal surgery

2014 ◽  
Vol 42 (3) ◽  
Author(s):  
Cristina Plevani ◽  
Anna Locatelli ◽  
Giuseppe Paterlini ◽  
Alessandro Ghidini ◽  
Paolo Tagliabue ◽  
...  
Keyword(s):  
Risk Factors ◽  
Natural History ◽  
Fetal Hydronephrosis ◽  
Postnatal Surgery

Orbital Non Hodgkin’s Lymphoma (NHL): A Large Monocentric Study of Initial Characteristics, Natural History and Prognostic Factors.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1378-1378
Author(s):  
Meunier Jerome ◽  
Lumbroso Livia ◽  
Dendale Remy ◽  
Vincent-Salomon Anne ◽  
Asselain Bernard ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Natural History ◽  
Cell Lymphoma ◽  
Malignant Tumors ◽  
Univariate Analysis ◽  
Bone Marrow Involvement ◽  
B Cell Lymphoma ◽  
Low Grade ◽  
High Grade

Abstract Orbital NHL (ocular and/or adnexal involvement) represents less than 1% of all lymphomas but about half of malignant tumors of the eye and/or ocular adnexae. We therefore reviewed all patients treated at the Institut Curie between 1970 and 2003 for a NHL exhibiting initial orbital localization to define their initial characteristics, natural history and prognostic factors. Among 172 patients, 145 cases with completed datas were selected for the study. Pathological review according to the WHO classification showed 52 cases of MALT-type lymphoma (36%), 32 lymphoplasmocytic lymphomas (22%), 14 patients with lymphocytic lymphoma, 7 cases of follicular lymphoma, 13 unspecified low grade lymphomas [namely, 118 cases (82%) of low grade NHL], 22 patients with diffuse large B-cell lymphoma (15%), 2 cases of mantle cell lymphoma, 2 Burkitt’s lymphomas and one T-lymphoblastic lymphoma [namely, 27 cases (18%) of high-grade NHL]. Initial characteristics were: median age 66 years (range 3–96), sex ratio M/F 0.6, B symptoms 6%, PS≥2 in 4% of patients, stages III–IV 31.7%, bone marrow involvement 12%, elevated LDH in 18% and IPI 0-1/2/3/4-5 in 92/28/13 and 1 cases, respectively. Anatomic localizations were intra-orbital in 39 patients (27%), conjunctival in 38 (26%), eyelid in 9 cases, lachrymal in 8 and other in 8 cases. Treatment of selected patients consisted of abstention in 2 cases, surgical complete resection in 5 cases, mono or polychemotherapy alone (CT) in 4 cases, and radiotherapy alone in 98 cases (68%) or with CT in 36 cases (25%). With a median follow-up of 90 months (range 3–314), the 5-year relapse-free (RFS) and overall (OS) survivals were 64% and 79% for the low-grade NHL, and 43% and 50% for the high-grade NHL. Prognostic factors were determined for the 118 low-grade patients. In univariate analysis, age greater than 59 years, elevated IPI score and elevated LDH level were prognostic for lower RFS and OS. In multivariate analysis, age greater than 59 years was the only prognostic factor for both lower RFS and OS (Figure 1). In conclusion, with a median follow-up of 7.5 years, our large monocentric cohort of patients represents one of the most important series that defines the initial characteristics, natural history and prognostic factors of NHL with initial orbital localization. Figure Figure

Breast Non Hodgkin’s Lymphoma (NHL): A Large Monocentric Study of Initial Characteristics, Natural History, and Prognostic Factors.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2455-2455
Author(s):  
Philippe Arnaud ◽  
Bernard Asselain ◽  
Patricia Validire ◽  
Youlia Kirova ◽  
Corine Plancher ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Natural History ◽  
Univariate Analysis ◽  
Bone Marrow Involvement ◽  
Stage Iv ◽  
Complete Analysis ◽  
High Grade ◽  
Cns Involvement ◽  
Breast Radiotherapy ◽  
Historical Series

Abstract Breast NHL represents less than 1% of all lymphomas and 2% of lymphomatous extranodal sites. We therefore reviewed all patients treated at the Institut Curie between 1986 and 2004 for a NHL having initial breast localization to define their initial characteristics, natural history and prognostic factors. Forty-six cases were selected for the study. Pathological review according to the WHO classification showed 2 patients with lymphocytic lymphoma, 3 cases of grade I follicular NHL, 1 case of MALT lymphoma, 1 case of grade III follicular NHL, 1 Burkitt’s lymphoma, and 38 diffuse large cell lymphomas [namely, 40 cases (87%) of high-grade NHL]. A complete analysis was performed on the 40 high-grade NHL patients. Initial characteristics were: median age 62 years (range: 22–86), B symptoms 17%, PS < 2 in 92%, stages III-IV 57%, nodal involvement 57% (47% axillary sites), 2 or more extra-nodal sites 32% (15% of bone marrow involvement and 2.5% of central nervous system (CNS) involvement), elevated LDH in 37%, and IPI score of 0–1/2/3/4–5 in 45%/12%/12% and 15%, respectively. Treatment consisted of chemotherapy in all cases (chlorambucil 3, anthracycline-based regimen with (30) or without (7) intrathecal prophylaxis), breast radiotherapy in 29 cases (72%), and rituximab in 4 patients. At the end of initial therapy, 36 patients (90%) achieved CR. With a median follow-up of 96 months (range: 14–188), nineteen patients (47%) relapsed. Relapses were localized in 8 cases and diffuse in 11 cases; breast localizations were observed in 10 cases (53%), one of which included contralateral involvement, axillary in 5 cases, and CNS site involvement in 3 cases. Among relapsed patients, 8 cases achieved second CR (47 %). Among the 10 patients with breast relapses, 8 received localized radiotherapy during first-line therapy. The 2- and 5-year disease-free survivals (DFS) were 65% (95% CI: 51 to 81%) and 54 % (95% CI: 40 to 72%), respectively; the 2- and 5-year overall survivals (OS) were 74% (95% CI: 62 to 89%) and 61% (95% CI: 47 to 78%), respectively. In univariate analysis, stage IV, 2 or more extranodal sites, elevated LDH level, high IPI score, and CNS involvement were prognostic for lower DFS; moreover, age greater than 60 years, PS > 1, ESR > 30, IPI score > 2, and 2 or more extranodal sites influence adversely OS. In multivariate analysis, the presence of 2 or more extranodal sites (p = 0.0008; RR 5.48; 95% CI: 2.01–14.9) was the only one factor that had a pejorative impact on DFS (Figure 1.A). PS > 1 (p = 0.02; RR 3.63; 95% CI: 1.18–11.07) and 2 or more extranodal sites (p = 0.05; RR 2.64; 95% CI: 1.0–6.96) were associated with poor OS (Figure 1.B). Finally, high-grade selected patients were compared to a historical series of 111 patients with aggressive lymphomas treated at the Institut Curie between 1982 and 1997 with an anthracycline-based regimen. Ann Arbor stage adjusted OS was significantly lower for patients with initial breast involvement (p < 0.0383). In conclusion, initial breast localization has a pejorative impact on the outcome of NHL patients, with an impressive adverse influence of additional extranodal sites on both DFS and OS. These results suggest a specific management of NHL with breast involvement in prospective clinical trials.

scholarly journals Bevacizumab in high-grade glioma patients following intraparenchymal hemorrhage

2016 ◽  
Vol 4 (1) ◽  
pp. 24-28 ◽  
Author(s):  
Xuling Lin ◽  
Mariza Daras ◽  
Elena Pentsova ◽  
Craig P. Nolan ◽  
Igor T. Gavrilovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Therapeutic Option ◽  
Treatment Options ◽  
High Grade Glioma ◽  
Recurrent Glioblastoma ◽  
Anaplastic Oligodendroglioma ◽  
High Grade ◽  
Intraparenchymal Hemorrhage ◽  
Grade 3 ◽  
Poor Functional Status

AbstractBackgroundIntraparenchymal hemorrhage (IPH) is a relative contraindication to bevacizumab therapy, an anti-vascular endothelial growth factor (VEGF) monoclonal antibody approved for the treatment of recurrent glioblastoma. However, in patients with symptomatic enhancing tumors and poor functional status, bevacizumab may be the only beneficial therapeutic option.MethodsWe retrospectively reviewed all patients with high-grade glioma who were treated between January 1, 2005 and December 31, 2014 with bevacizumab despite prior IPH.ResultsEighteen patients met our study criteria. There were 12 women and 6 men with a median age of 56 years. Tumor types were glioblastoma (n = 15), anaplastic astrocytoma (n = 2), and anaplastic oligodendroglioma (n = 1). Seventeen patients had prior spontaneous intratumoral bleed (13 grade 1–2; 4 grade 3–4); the 1 remaining patient had a grade 3 bleed due to cerebral venous thrombosis. Among them, identifiable risk factors for hemorrhage were anti-VEGF therapy, anticoagulation use, thrombocytopenia, and hypertension; seven had no identifiable risk factors. The median duration from IPH to (re-)initiation of bevacizumab was 113 days (range 13–1367). Brain imaging performed prior to bevacizumab treatment showed persistent or evolving hemorrhage in 8 patients and complete resolution in 10 patients. With a median follow-up duration of 137 days after bevacizumab re-initiation, only 1 (6%) of the 18 patients re-bled; this patient had an anaplastic oligodendroglioma and developed a grade 2 intratumoral bleed after 3 doses of bevacizumab.ConclusionsThe incidence of re-bleed is rare. Bevacizumab use was safe in patients with recurrent high-grade glioma following IPH for whom no other meaningful treatment options existed.

Improving Selection Criteria for Early Cystectomy in High-Grade T1 Bladder Cancer: A Meta-Analysis of 15,215 Patients

2015 ◽  
Vol 33 (6) ◽  
pp. 643-650 ◽  
Author(s):  
William Martin-Doyle ◽  
Jeffrey J. Leow ◽  
Anna Orsola ◽  
Steven L. Chang ◽  
Joaquim Bellmunt
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
Prognostic Factors ◽  
Lamina Propria ◽  
Selection Criteria ◽  
Meta Analysis ◽  
Depth Of Invasion ◽  
Cochrane Central Register ◽  
High Grade ◽  
Cancer Specific Survival

Purpose High-grade T1 (HGT1) bladder cancer is the highest risk subtype of non–muscle-invasive bladder cancer, with highly variable prognosis, poorly understood risk factors, and considerable debate about the role of early cystectomy. We aimed to address these questions through a meta-analysis of outcomes and prognostic factors. Methods PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and American Society of Clinical Oncology abstracts were searched for cohort studies in HGT1. We pooled data on recurrence, progression, and cancer-specific survival from 73 studies. Results Five-year rates of recurrence, progression, and cancer-specific survival were 42% (95% CI, 39% to 45%), 21% (95% CI, 18% to 23%), and 87% (95% CI, 85% to 89%), respectively (56 studies, n = 15,215). In the prognostic factor meta-analysis (33 studies, n = 8,880), the highest impact risk factor was depth of invasion (T1b/c) into lamina propria (progression: hazard ratio [HR], 3.34; P < .001; cancer-specific survival: HR, 2.02; P = .001). Several other previously proposed factors also predicted progression and cancer-specific survival (lymphovascular invasion, associated carcinoma in situ, nonuse of bacillus Calmette-Guérin, tumor size > 3 cm, and older age; HRs for progression between 1.32 and 2.88, P ≤ .002; HRs for cancer-specific survival between 1.28 and 2.08, P ≤ .02). Conclusion In this large analysis of outcomes and prognostic factors in HGT1 bladder cancer, deep lamina propria invasion had the largest negative impact, and other previously proposed prognostic factors were also confirmed. These factors should be used for prognostication and patient stratification in future clinical trials, and depth of invasion should be considered for inclusion in TNM staging criteria. This meta-analysis can also help define selection criteria for early cystectomy in HGT1 bladder cancer, particularly for patients with deep lamina propria invasion combined with other risk factors.

scholarly journals Risk factors for acute kidney injury in postoperative cardiac surgery

2021 ◽  
Vol 10 (2) ◽  
pp. e34710212480
Author(s):  
Mario Augusto Cray da Costa ◽  
Stella Kuchller ◽  
Vanessa Carolina Botta ◽  
Adriana de Fátima Menegat Schuinski ◽  
Ana Carolina Mello Fontoura de Souza
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Body Mass ◽  
Kidney Injury ◽  
Male Gender ◽  
Baseline Serum ◽  
Significant Difference

Objective: To evaluate the perioperative risk factors associated with postoperative AKI in patients undergoing cardiac surgery. Methodology: Between January 2011 and December 2017, we analyzed prospectively 544 patients, who were divided into two groups: patients with acute kidney injury associated with cardiac surgery (AKI-ACS) defined as an increase of 0.3 mg/dL or 1.5 times the baseline serum creatinine value and control group formed by patients without AKI-ACS. We compared patients and surgical variables using the chi-square test, Fisher's exact test, and mann-Whitney test and logistic regression. Results: AKI-ACS occurred in 29.8% of the patients. In the univariate analysis, the following variables presented a statistically significant difference: male gender (p=0.0087), age (p<0.0001), body mass (p=0.035), BMI (p=0.001), thoracic aortic surgery (p=0.029), use of extracorporeal circulation (p=0.012), CPB time (p=0.0001), aortic clamping time (p=0.0029), use of vasoactive drugs in post-operative  period (p=0.017), preoperative kidney function (p<0.0001), presence of diabetes mellitus (p=0.008) and NYHA functional class (p=0.041). In the multivariate analysis, the following variables presented a statistical difference: male gender (OR 2.11), higher BMI (OR 2.11), worse preoperative renal function, demonstrated by creatinine clearance (OR 0.13), longer cardiopulmonary bypass (OR 1.008). Conclusion: The independent predictors for LRA-ACC were male gender, higher body mass index, worse preoperative renal function, and more complex surgeries associated with longer cardiopulmonary bypass.

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