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Kanbay M, Copur S, Yilmaz ZY, Tanriover C, Hasbal NB, Ortiz A, Perazella MA. A novel risk factor for malignancy: Albuminuria. Eur J Intern Med 2023; 118:22-31. [PMID: 37741791 DOI: 10.1016/j.ejim.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/03/2023] [Accepted: 09/10/2023] [Indexed: 09/25/2023]
Abstract
Cancer is the second leading cause of death among the adult population following cardiovascular diseases. Prevention and earlier diagnosis are among the cornerstones in the management of malignancies. Albuminuria is a diagnostic criterion for chronic kidney disease and has been associated with multiple conditions including cardiovascular diseases and systemic inflammation while the association between albuminuria and malignancy has been inadequately addressed. Large-scale observational studies with long follow-up periods demonstrate a statistically significant association between albuminuria and overall malignancy incidence, especially urothelial malignancy incidence. However, the underlying pathophysiology linking these two entities is not a straightforward causal relationship but most likely a multidirectional relationship including a causal link. In this narrative review, we evaluate the clinical studies investigating the association between albuminuria and malignancy along with potential underlying mechanisms linking them. We also summarize data on the impact of treatment modalities prescribed for albuminuria and/or proteinuria on the prevention or prognosis of malignancies.
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Affiliation(s)
- Mehmet Kanbay
- Department of Medicine, Section of Nephrology, Koc University School of Medicine, Istanbul, Turkey.
| | - Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Zeynep Y Yilmaz
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Cem Tanriover
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Nuri Baris Hasbal
- Department of Medicine, Section of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Alberto Ortiz
- Department of Medicine, Universidad Autonoma de Madrid and IIS-Fundacion Jimenez Diaz, Madrid, Spain
| | - Mark A Perazella
- Department of Internal Medicine Section of Nephrology, Yale University School of Medicine, CT, USA
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2
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Saly DL, Eswarappa MS, Street SE, Deshpande P. Renal Cell Cancer and Chronic Kidney Disease. Adv Chronic Kidney Dis 2021; 28:460-468.e1. [PMID: 35190112 DOI: 10.1053/j.ackd.2021.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/14/2021] [Accepted: 10/25/2021] [Indexed: 11/11/2022]
Abstract
The association between chronic kidney disease (CKD) and renal cell carcinoma (RCC) is bidirectional and multifactorial. Risk factors such as hypertension, diabetes mellitus, obesity, and smoking increase the risk of both CKD and RCC. CKD can lead to RCC via an underlying cystic disease or oxidative stress. RCC can cause CKD because of the tumor itself, surgical reduction of renal mass (either partial or radical nephrectomy), and perioperative acute kidney injury. Medical therapies such as immune checkpoint inhibitors and vascular endothelial growth factor inhibitors can lead to acute kidney injury and resultant CKD. Clinicians need to be aware of the complex, bidirectional interplay between both diseases.
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3
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Ellis RJ, Del Vecchio SJ, Gallagher KMJ, Aliano DN, Barber N, Bolton DM, Chew ETS, Coombes JS, Coory MD, Davis ID, Donaldson JF, Francis RS, Giles GG, Gobe GC, Hawley CM, Johnson DW, Laird A, Leung S, Malki M, Marco DJT, McNeill AS, Neale RE, Ng KL, Phipps S, Stewart GD, White VM, Wood ST, Jordan SJ. A Simple Clinical Tool for Stratifying Risk of Clinically Significant CKD after Nephrectomy: Development and Multinational Validation. J Am Soc Nephrol 2020; 31:1107-1117. [PMID: 32238473 DOI: 10.1681/asn.2019121328] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/17/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Clinically significant CKD following surgery for kidney cancer is associated with increased morbidity and mortality, but identifying patients at increased CKD risk remains difficult. Simple methods to stratify risk of clinically significant CKD after nephrectomy are needed. METHODS To develop a tool for stratifying patients' risk of CKD arising after surgery for kidney cancer, we tested models in a population-based cohort of 699 patients with kidney cancer in Queensland, Australia (2012-2013). We validated these models in a population-based cohort of 423 patients from Victoria, Australia, and in patient cohorts from single centers in Queensland, Scotland, and England. Eligible patients had two functioning kidneys and a preoperative eGFR ≥60 ml/min per 1.73 m2. The main outcome was incident eGFR <45 ml/min per 1.73 m2 at 12 months postnephrectomy. We used prespecified predictors-age ≥65 years old, diabetes mellitus, preoperative eGFR, and nephrectomy type (partial/radical)-to fit logistic regression models and grouped patients according to degree of risk of clinically significant CKD (negligible, low, moderate, or high risk). RESULTS Absolute risks of stage 3b or higher CKD were <2%, 3% to 14%, 21% to 26%, and 46% to 69% across the four strata of negligible, low, moderate, and high risk, respectively. The negative predictive value of the negligible risk category was 98.9% for clinically significant CKD. The c statistic for this score ranged from 0.84 to 0.88 across derivation and validation cohorts. CONCLUSIONS Our simple scoring system can reproducibly stratify postnephrectomy CKD risk on the basis of readily available parameters. This clinical tool's quantitative assessment of CKD risk may be weighed against other considerations when planning management of kidney tumors and help inform shared decision making between clinicians and patients.
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Affiliation(s)
- Robert J Ellis
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia .,Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
| | - Sharon J Del Vecchio
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
| | - Kevin M J Gallagher
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Danielle N Aliano
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Logan Hospital, Logan, Queensland, Australia
| | - Neil Barber
- Urology Department, Frimley Park Hospital, Frimley, United Kingdom
| | - Damien M Bolton
- Austin Urology, Austin Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Jeff S Coombes
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Michael D Coory
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Ian D Davis
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Eastern Health, Melbourne, Victoria, Australia
| | - James F Donaldson
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Ross S Francis
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Graham G Giles
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Glenda C Gobe
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
| | - Carmel M Hawley
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
| | - David W Johnson
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
| | - Alexander Laird
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Steve Leung
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Manar Malki
- Urology Department, Frimley Park Hospital, Frimley, United Kingdom
| | - David J T Marco
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Palliative Care, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Alan S McNeill
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Rachel E Neale
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Queensland University of Technology, Brisbane, Queensland, Australia
| | - Keng L Ng
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Urology Department, Frimley Park Hospital, Frimley, United Kingdom
| | - Simon Phipps
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom.,Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Victoria M White
- Cancer Council Victoria, Melbourne, Victoria, Australia.,School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Simon T Wood
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Susan J Jordan
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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4
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Ellis RJ, Del Vecchio SJ, Ng KL, Dimeski G, Pascoe EM, Hawley CM, Johnson DW, Vesey DA, Coombes JS, Morais C, Francis RS, Wood ST, Gobe GC. Factors associated with acutely elevated serum creatinine following radical tumour nephrectomy: the Correlates of Kidney Dysfunction-Tumour Nephrectomy Database study. Transl Androl Urol 2017; 6:899-909. [PMID: 29184790 PMCID: PMC5673817 DOI: 10.21037/tau.2017.08.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/21/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND To identify factors associated with acutely elevated serum creatinine (SCr) within 7 days of radical tumour nephrectomy. METHODS The study population consisted of 130 consecutive patients managed for renal tumours. The primary outcome was acute kidney injury (AKI) (defined as SCr increase ≥50% above baseline), assessed using multivariable logistic regression analysis. The secondary outcome was SCr percentage increase, assessed using multivariable linear regression analysis. RESULTS Following nephrectomy, the mean percentage increase in SCr in the first week was 55%±29%, and 77 (59%) patients experienced AKI. Independent predictors of AKI post-nephrectomy were male gender [adjusted odds ratio (OR): 2.67; 95% confidence interval (95% CI): 1.01, 6.93], urine albumin-creatinine ratio (OR: 0.66; 95% CI: 0.47, 0.91), preoperative estimated glomerular filtration rate (eGFR) (OR: 1.03; 95% CI: 1.00, 1.05), laparoscopic nephrectomy (OR: 3.02; 95% CI: 1.00, 9.12), and non-clear cell renal cell carcinoma (RCC) (OR: 2.93; 95% CI: 1.04, 8.29). Independent predictors of a SCr increase were male gender (β: 12.0; 95% CI: 2.69, 21.3), urine albumin-creatinine ratio (β: -3.36; 95% CI: -6.55, -0.16), preoperative eGFR (β: 0.38; 95% CI: 0.10, 0.66), laparoscopic nephrectomy (β: 12.7; 95% CI: 1.05, 24.3) and obesity (β: 9.94, 95% CI: 0.61, 19.3). CONCLUSIONS Male gender, albuminuria, eGFR and laparoscopic nephrectomy independently associated with acutely elevated serum creatinine following radical tumour nephrectomy.
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Affiliation(s)
- Robert J. Ellis
- Kidney Disease Research Group, Diamantina Institute, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Sharon J. Del Vecchio
- Kidney Disease Research Group, Diamantina Institute, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Keng Lim Ng
- Kidney Disease Research Group, Diamantina Institute, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Goce Dimeski
- Kidney Disease Research Group, Diamantina Institute, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Chemical Pathology, Princess Alexandra Hospital, Brisbane, Australia
| | - Elaine M. Pascoe
- Translational Research Institute, Brisbane, Australia
- Australasian Kidney Trials Network, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Carmel M. Hawley
- Kidney Disease Research Group, Diamantina Institute, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- Australasian Kidney Trials Network, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - David W. Johnson
- Kidney Disease Research Group, Diamantina Institute, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- Australasian Kidney Trials Network, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - David A. Vesey
- Kidney Disease Research Group, Diamantina Institute, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Jeff S. Coombes
- UQ NHMRC Chronic Kidney Disease Centre for Research Excellence (CKD.QLD), Royal Brisbane and Women’s Hospital, Brisbane, Australia
- School of Human Movement and Nutrition Science, University of Queensland, Brisbane, Australia
| | - Christudas Morais
- Kidney Disease Research Group, Diamantina Institute, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Ross S. Francis
- Kidney Disease Research Group, Diamantina Institute, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- Australasian Kidney Trials Network, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Simon T. Wood
- Kidney Disease Research Group, Diamantina Institute, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Glenda C. Gobe
- Kidney Disease Research Group, Diamantina Institute, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- UQ NHMRC Chronic Kidney Disease Centre for Research Excellence (CKD.QLD), Royal Brisbane and Women’s Hospital, Brisbane, Australia
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Cheung CY, Ma MKM, Chak WL, Tang SCW. Cancer risk in patients with diabetic nephropathy: A retrospective cohort study in Hong Kong. Medicine (Baltimore) 2017; 96:e8077. [PMID: 28930846 PMCID: PMC5617713 DOI: 10.1097/md.0000000000008077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Diabetic nephropathy (DN) is a leading cause of end-stage kidney disease nowadays. Certain cancers are more common in patients with diabetes mellitus. However, there are no data concerning the cancer pattern in patients with DN. The aim of this study is to investigate the site-specific cancer risk and mortality in these patients.A retrospective cohort study of 5643 DN patients between 2000 and 2015 was conducted in 2 large hospitals in Hong Kong. Incidence and mortality of various cancers were compared with those of general population using standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) respectively.With 24,726 person-years follow-up, 250 cancers were diagnosed. Overall cancer incidence was similar between DN patients and the general population (SIR 1.05, 95% confidence interval [CI] 0.92-1.19). However, certain site-specific cancers are increased in DN patients: the highest risk was observed for laryngeal cancer (SIR 3.03, 95% CI 1.11-6.60), followed by cancers of liver (SIR 1.96, 95% CI 1.35-2.76) and colorectum (SIR 1.92, 95% CI 1.53-2.37), but the risk of prostate cancer was lower (SIR 0.48, 95% CI 0.21-0.95) in the males with DN. The SMR of all cancers was 1.17 (95% CI 1.01-1.37). For individual specific site, only colorectal cancer carried a significant higher mortality risk (SMR 2.45, 95% CI 1.82-3.23).Our data suggested that DN is associated with increased incidence of cancers of colorectum, liver, and larynx but decreased incidence of prostate cancer. Moreover, there is increased mortality of colorectal cancer in patients with DN.
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Affiliation(s)
- Chi Yuen Cheung
- Department of Medicine, Renal Unit, Queen Elizabeth Hospital, Hong Kong SAR
| | - Maggie Kam Man Ma
- Department of Medicine, Division of Nephrology, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
| | - Wai Leung Chak
- Department of Medicine, Renal Unit, Queen Elizabeth Hospital, Hong Kong SAR
| | - Sydney Chi Wai Tang
- Department of Medicine, Division of Nephrology, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
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6
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Dey S, Hamilton Z, Noyes SL, Tobert CM, Keeley J, Derweesh IH, Lane BR. Chronic Kidney Disease Is More Common in Locally Advanced Renal Cell Carcinoma. Urology 2017; 105:101-107. [PMID: 28365357 DOI: 10.1016/j.urology.2017.03.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/20/2017] [Accepted: 03/23/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To retrospectively evaluate clinical predictors of chronic kidney disease (CKD) in renal cell carcinoma (RCC) patients to identify associations between patient- and tumor-specific factors with poorer renal function. CKD and RCC are interrelated, with 26%-44% of RCC patients having concomitant CKD at diagnosis. PATIENTS AND METHODS Institutional registries from Spectrum Health and University of California, San Diego, were queried for preoperative glomerular filtration rate and proteinuria status before radical or partial nephrectomy. Preoperative clinical and tumor factors were recorded; proteinuria was classified as A1 (<30 mg), A2 (30-300 mg), and A3 (>300 mg). CKD was grouped by Kidney Disease Improving Global Outcomes classification (low, moderately increased, high, very high). RESULTS We evaluated 1569 patients undergoing surgery for renal cortical tumors. CKD status was low risk in 860 (55%), moderately increased in 381 (24%), high in 194 (12%), and very high in 134 (9%) patients. Increased radius, exophytic or endophytic properties, nearness of tumor to the collecting system or sinus in millimeters, anterior or posterior, location relative to polar lines score, tumor size, and clinical tumor stage were strongly associated with increased CKD risk at baseline. Clinical stage T3/T4 disease had more at-risk patients than stages T2 and T1 disease (39.5% vs 22% and 19%, P = .0001). Clinical tumor stage and gender were the only predictors of proteinuria, lower glomerular filtration rate, and higher CKD risk group in both univariate and multivariate analyses. CONCLUSION Forty-five percent of patients with RCC had moderate or higher CKD before treatment. A positive correlation between pretreatment CKD and locally advanced RCC (cT3/T4) was present. This likely relates to increased loss of functional parenchyma with increasing tumor size or stage, with important implications in patient management.
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Affiliation(s)
- Sumi Dey
- Spectrum Health, Grand Rapids, MI
| | | | | | | | | | | | - Brian R Lane
- Spectrum Health, Grand Rapids, MI; Michigan State University College of Human Medicine, Grand Rapids, MI.
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7
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Proteinuria in Patients Undergoing Renal Cancer Surgery: Impact on Overall Survival and Stability of Renal Function. Eur Urol Focus 2016; 2:616-622. [DOI: 10.1016/j.euf.2016.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/15/2016] [Indexed: 01/08/2023]
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8
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Hu SL, Chang A, Perazella MA, Okusa MD, Jaimes EA, Weiss RH. The Nephrologist's Tumor: Basic Biology and Management of Renal Cell Carcinoma. J Am Soc Nephrol 2016; 27:2227-37. [PMID: 26961346 PMCID: PMC4978061 DOI: 10.1681/asn.2015121335] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Kidney cancer, or renal cell carcinoma (RCC), is a disease of increasing incidence that is commonly seen in the general practice of nephrology. However, RCC is under-recognized by the nephrology community, such that its presence in curricula and research by this group is lacking. In the most common form of RCC, clear cell renal cell carcinoma (ccRCC), inactivation of the von Hippel-Lindau tumor suppressor is nearly universal; thus, the biology of ccRCC is characterized by activation of hypoxia-relevant pathways that lead to the associated paraneoplastic syndromes. Therefore, RCC is labeled the internist's tumor. In light of this characterization and multiple other metabolic abnormalities recently associated with ccRCC, it can now be viewed as a metabolic disease. In this review, we discuss the basic biology, pathology, and approaches for treatment of RCC. It is important to distinguish between kidney confinement and distant spread of RCC, because this difference affects diagnostic and therapeutic approaches and patient survival, and it is important to recognize the key interplay between RCC, RCC therapy, and CKD. Better understanding of all aspects of this disease will lead to optimal patient care and more recognition of an increasingly prevalent nephrologic disease, which we now appropriately label the nephrologist's tumor.
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Affiliation(s)
- Susie L Hu
- Division of Kidney Disease and Hypertension, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Anthony Chang
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Mark A Perazella
- Division of Nephrology, Yale University, New Haven, Connecticut; Medical Service Veterans Affairs Connecticut, West Haven, Connecticut
| | - Mark D Okusa
- Division of Nephrology and Center for Immunity, Inflammation and Regenerative Medicine, University of Virginia, Charlottesville, Virginia
| | - Edgar A Jaimes
- Renal Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Renal Division, Weill-Cornell Medical College, New York, New York
| | - Robert H Weiss
- Division of Nephrology and Cancer Center, University of California, Davis, California; and Medical Service, Veterans Affairs Northern California Health Care System, Sacramento, California
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9
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Izzedine H, Perazella MA. Onco-nephrology: an appraisal of the cancer and chronic kidney disease links. Nephrol Dial Transplant 2015; 30:1979-88. [PMID: 25648910 DOI: 10.1093/ndt/gfu387] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/20/2014] [Indexed: 01/20/2023] Open
Abstract
A bidirectional relationship has been observed for kidney disease and cancer. On the one hand, cancer is an important complication noted in kidney disease as well as a major cause of morbidity and mortality in this group. On the other hand, improved cancer treatment has prolonged survival, but also increased the development of acute and chronic kidney disease. The combination of cancer and kidney disease makes it challenging for clinicians to provide comprehensive and safe therapies for this group of patients. As such, clinicians caring for this group must develop expertise and become competent in the practice of a newly evolving subspecialty of nephrology known as 'onco-nephrology'. This brief narrative review will focus on the cancer risk in patients with underlying kidney disease, the therapies such as erythropoiesis-stimulating agents on cancer progression and other outcomes, and the appropriate dosing of anti-cancer agents in patients with underlying kidney disease.
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Affiliation(s)
- Hassan Izzedine
- Department of Nephrology, Monceau Park International Clinic, Paris, France
| | - Mark A Perazella
- Department of Nephrology, Yale University School of Medicine, New Haven, CT, USA
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10
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Kim MJ, Kang YU, Kim CS, Choi JS, Bae EH, Ma SK, Kweon SS, Kim SW. Proteinuria as a risk factor for mortality in patients with colorectal cancer. Yonsei Med J 2013; 54:1194-201. [PMID: 23918569 PMCID: PMC3743186 DOI: 10.3349/ymj.2013.54.5.1194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE We investigated the effects of proteinuria and renal insufficiency on all-cause mortality in patients with colorectal cancer, with special emphasis on cancer staging and cancer-related deaths. MATERIALS AND METHODS We retrospectively studied a cohort of patients with colorectal cancer. In protocol 1, patients were classified into four groups based on the operability of cancer and proteinuria: group 1, early-stage cancer patients (colorectal cancer stage ≤ 3) without proteinuria; group 2, early-stage cancer patients with proteinuria; group 3, advanced-stage cancer patients without proteinuria (colorectal cancer stage=4); and group 4, advanced- stage cancer patients with proteinuria. In protocol 2, patients were classified into four similar groups based on cancer staging and renal insufficiency (eGFR <60 mL/min/1.73 m(2)). Between January 1, 1998 and December 31, 2009, 3379 patients were enrolled in this cohort and followed until May 1, 2012 or until death. RESULTS The number of patients with proteinuria was 495 (14.6%). The prevalence of proteinuria was higher in advanced-stage cancer (n=151, 22.3%) than in early-stage cancer patients (n=344, 12.7%). After adjusting for age, gender and other clinical variables, the proteinuric, early-stage cancer group was shown to be associated with an adjusted hazard ratio of 1.67 and a 95% confidence interval of 1.38-2.01, compared with non-proteinuric early-stage cancer patients. However, renal insufficiency was not associated with colorectal cancer mortality. CONCLUSION Proteinuria is an important risk factor for cancer mortality, especially in relatively early colorectal cancer.
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Affiliation(s)
- Min Jee Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Un Kang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Joon Seok Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea
- Jeonnam Regional Cancer Center, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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11
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Jørgensen L, Heuch I, Jenssen T, Jacobsen BK. Association of albuminuria and cancer incidence. J Am Soc Nephrol 2008; 19:992-8. [PMID: 18256361 DOI: 10.1681/asn.2007060712] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Albuminuria, which is associated with noncardiovascular mortality, might be a result of altered vascular permeability caused by cytokines and other tumor cell products. The aim of this population-based, longitudinal study was to examine whether elevated albumin-to-creatinine ratio (ACR) is associated with cancer incidence. A total of 5425 participants without diabetes or previous cancer in the Tromsø Study were followed; 590 had a first diagnosis of cancer during 10.3 yr of follow-up. The ACR at baseline significantly correlated with the incidence of cancer, even after adjustment for age, gender, body mass index, physical activity, and smoking (P < 0.001). Participants with ACR in the highest quintile were 8.3- and 2.4-fold more likely to receive a diagnosis of bladder cancer and lung cancer, respectively, compared with those with ACR in the lowest quintile after similar adjustments. It is concluded that albuminuria is associated with cancer incidence in individuals without a history of diabetes, macroalbuminuria, or previous cancer and that it might confer risks of varying magnitude for different types of cancer.
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Affiliation(s)
- Lone Jørgensen
- Institute of Community Medicine, University of Tromsø, N-9037 Tromsø, Norway.
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