January 2019

Renal transplantation: management of renal tumor in the graft and in the native kidney

García Marchiñena P, Romeo A, Martínez P, et al.
Rev.Arg.de Urol.·Vol.79(4)2014

Abstract

OBJECTIVES:

To describe the characteristics, forms of presentation and therapeutic management in transplanted patients treated for renal tumor in our hospital.

MATERIALS AND METHODS:

We conducted a retrospective analysis of 10 patients who underwent renal transplantation and developed a renal tumor between January 2010 and June 2014. The collection of data was carried through history electronic medical records of our hospital (Intranet).

RESULTS:

During the study period, 796 patients were treated for a kidney tumor in our hospital; 10 of these cases occurred in renal transplant patients. 90% were men. Average age was 40 years. Average time kidney transplantation/tumor was 14 years. 80% of the tumors were incidental. 90% had localized disease. Half of the patients (n=5) included in this series had one or more tumors in the native kidneys, while the other 50% had a tumor in the graft. All patients (n=5) with native kidney tumor underwent laparoscopic radical nephrectomy. Graft tumor: renal explant (n=1), partial nephrectomy conventional route (n=3) and active surveillance (n=1). 46% (n=6) of the tumors corresponded to clear cell renal carcinoma variety. The other 7 (54%) tumors corresponded to papillary variety. The average follow-up of patients was 14.7 months. Surgical patients (n=9) underwent 88.8% (n=8) developed favorably.

CONCLUSIONS:

Renal tumors in transplant patients are characterized by incidental diagnosis and a higher proportion of papillary types. The treatments for these patients are similar to the general population.

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Interdisciplinary Management of Renal Cell Carcinoma Associated to Von Hippel-Lindau Disease

Daruich M, García Marchiñena P, Jurado A, Gueglio G
Rev. Arg. de Urol. · Vol. 81 (3) 2016

Abstract

OBJECTIVES:

We aimed to describe the clinical characteristics of patients with Von Hippel-Lindau disease, evaluated by the “Von Hippel-Lindau disease interdisciplinary management group” of a Latin American hospital, noting the management and behavior of renal cell carcinoma associated with this syndrome.

MATERIALS AND METHODS:

A retrospective observational descriptive study was conducted. We included all patients with clinical diagnosis of this disease evaluated during the period from August 2014 to August 2015.

RESULTS:

Eleven patients were included. Mean age of first manifestation was 30 (17-56) years. The initial clinical manifestations were hypertension (54.5% [n=4]), neurological symptoms (18.1% [n=2]), eye symptoms (18.1% [n=2]) and others (27.2% [n=3]). A family history was detected in 81.8% (n=9) of cases. The 54.5% (n=6) of the patients developed renal cell carcinoma with an average of 2.5 (1-5) surgeries per patient. The 81.8% (n=9) of these procedures were open procedures. The mean resected tumors per procedure was 3 (1-8). One patient began hemodialysis and another patient developed metastasis. Mean follow- up was 7.5 (1-26) years.

CONCLUSIONS:

The interdisciplinary management of renal cell carcinoma associated with Von Hippel-Lindau disease could prevent and differ the sequelae associated, not only to the loss of kidney function, but also in other organs involved in the disease, improving the quality of life of these patients.

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Current patterns of presentation and treatment of renal masses: a clinical research office of the endourological society prospective study

Laguna MP, Algaba F, Cadeddu J, et al.
J Endourol. 2014 Jul;28(7):861-70.
DOI: 10.1089/end.2013.0724

Abstract

PURPOSE:

To assess epidemiologic characteristics, clinical and pathologic patterns of presentation, and treatment strategies in a contemporary population with renal masses (RMs).

METHODS:

The Clinical Research Office of the Endourological Society collected prospective epidemiologic, clinical, and pathologic data on consecutive patients with RMs who were treated during a 1-year period in 98 centers worldwide. Preoperative assessment and treatment were performed according to local clinical practice guidelines.

RESULTS:

From January 2010 to February 2012, 4288 patients (4355 cases, 4815 tumors) were treated for a RM. The mean age of the cohort was 61.5 years, and the ratio male:female 1.8:1. Caucasians represented 75% of the population, and the median body mass index was 27. The cohort exhibited a high rate of comorbidity (65.6%), including a 48.5% rate of hypertension; one-third of patients had a combination of two or more comorbidities. One-third of patients (36%) had risk factors for renal-cell carcinoma (RCC), of which smoking and obesity were the most common. Diagnosis was incidental in 67% of cases, and 22.2% of cases had chronic kidney disease stage ≥III at presentation. Median radiologic size was 44 mm (range 2-300 mm) and 68% were cT1. Radical nephrectomy and nephron-sparing surgery (NSS) including ablation were performed in 52% and 46% of cases, respectively, while 3.6% of cases were actively surveyed. Median pathologic size was 43 mm (range 2-300 mm) and 63% of the RCCs were pT1.

CONCLUSIONS:

Current patterns of presentation of RMs are consistent with the decreasing trends in age and clinical or pathologic size and increasing incidental diagnosis. Patients exhibit a considerable basal comorbidity and presence of risk factors for RCC. Half of the cases are treated by a nephron-sparing modality with an increase in the penetration of NSS techniques in the contemporary urologic practice.

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Circulating Fibroblast Growth Factor 21 (Fgf21) as Diagnostic and Prognostic Biomarker in Renal Cancer

Knott ME, Minatta JN, Roulet L, et al.
J Mol Biomark Diagn. 2016 Jun;1(Suppl 2).
DOI: 10.4172/2155-9929.S2-015

Abstract

BACKGROUND:

The finding of new biomarkers is needed to have a better sub-classification of primary renal tumors (RCC) as well as more reliable predictors of outcome and therapy response. In this study, we evaluated the role of circulating FGF21, an endocrine factor, as a diagnostic and prognostic biomarker for ccRCC.

MATERIALS AND METHODS:

Serum samples from healthy controls (HC), clear cell and chromophobe RCC cancer patients were obtained from the serum biobank “Biobanco Público de Muestras Séricas Oncológicas” (BPMSO) of the “Instituto de Oncología “Ángel H. Roffo”. Serum FGF21 and leptin were measured by ELISA while other metabolic markers were measured following routinely clinical procedures.

RESULTS:

One of our major findings was that FGF21 levels were significantly increased in ccRCC patients compared with HC. Moreover, we showed an association between the increased serum FGF21 levels and the shorter disease free survival in a cohort of 98 ccRCC patients, after adjustment for other predictors of outcome.

CONCLUSIONS:

Our results suggest that higher FGF21 serum level is an independent prognostic biomarker, associated with worse free-disease survival.

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