RESUMEN
STUDY OBJECTIVE: To study the effectiveness of complex monitoring of the kidney function, based on biochemical and radionuclide methods in patients with metastatic renal cell carcinoma (mRCC). MATERIALS AND METHODS: 41 mRCC patients after nephrectomy received nivolumab (n = 23) and interferon-α (n = 18) from 2015 to 2017. At baseline and 2 months after, all patients underwent blood chemistry, urinalysis, Rehberg test, and ELISA to determine serum levels of IL-17A, TGF-ß, and erythropoietin. The monitoring of the renal function and urodynamics by complex renal scintigraphy (CRS) was used for all patients using a dual-detector gamma camera and simultaneous data recording in 2 projections. The interpretation of CRS data used the original SENS CRS technology. STUDY RESULTS: Statistically significant correlations were established between IL-17A, TGF-ß, and D (excretion rate of 99mTc-technephore from the parenchyma) and Rnfsc (a stable sign of nephrosclerosis), respectively. A significant correlation was established between the parameters of the complex functional monitoring with the prognosis for the risk of renal failure (RF) and efficacy of immunotherapy in mRCC. CONCLUSIONS: All mRCC patients after nephrectomy were recommended to undergo biochemical monitoring with inclusion of TGF-ß and IL-17A, as well as radionuclide monitoring (CRS) to determine the RF risk at an early stage.
RESUMEN
Physical status of 172 former cases of retroperitoneal tumors was investigated. As a result of treatment for cancer, former patients revealed changes in the urinary (62.5%), cardiovascular (25%) systems and gastrointestinal tract (71.5%). These indices, however, stayed within the morbidity rates in the total population.
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Estado de Salud , Calidad de Vida , Neoplasias Retroperitoneales/fisiopatología , Neoplasias Retroperitoneales/terapia , Adolescente , Adulto , Sistema Cardiovascular/fisiopatología , Niño , Preescolar , Sistema Digestivo/fisiopatología , Femenino , Humanos , Masculino , Neoplasias Retroperitoneales/secundario , Estudios Retrospectivos , Sistema Urinario/fisiopatologíaRESUMEN
Chemotherapy is an important method of antitumor therapy. Nephrotoxicity characteristic of many cytostatics, including platinum compounds, is a serious complication limiting the drug dose [4,5,7-9]. Platinum derivatives, in particular, cisplatin, are drugs of choice in the treatment of the majority of solid tumors. However, cisplatin induces a dose-dependent toxic damage to the kidneys [5,7,8,10].
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Antineoplásicos/efectos adversos , Cisplatino/efectos adversos , Enfermedades Renales/diagnóstico , Riñón/efectos de los fármacos , Riñón/fisiopatología , Neoplasias Ováricas/tratamiento farmacológico , Adulto , Anciano , Antineoplásicos/administración & dosificación , Cisplatino/administración & dosificación , Monitoreo de Drogas/métodos , Femenino , Humanos , Enfermedades Renales/inducido químicamente , Persona de Mediana Edad , Neoplasias Ováricas/fisiopatologíaRESUMEN
The paper deals with a diagnostic informational and analytical system (DIAS). The system is based on the current concept of a dynamic model of nephro-urological clearance macroregulation under retention factors at the pre-, intra-, and postrenal levels during drug load tests. DIAS includes a package of dynamic renoscintigraphic techniques, as well as original software support. A system for parameters of renal clearance regulation has been developed, which is effective at nephro-urological screening and monitoring at all treatment stages for cancer patients. A two-detector chamber which permits the mounting of a detector at an angle to the patient's body is the optimum diagnostic apparatus for a cancer clinic. The use of functional tests makes it possible to examine the regulatory reserves for each kidney, followed up by the choice of adequate corrective measures to prevent renal failure during treatment. In some cases, DIAS monitoring frequently shows a higher sensitivity to the signs of latent renal failure than does routine clinical and laboratory monitoring. The effective radiation dose taken by a patient during a study by the DIAS technology aimed at reducing radioopaque doses is 100-150 times higher than that at an X-ray study and is an order less than during routine urinary tests.
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Enfermedades Renales/diagnóstico por imagen , Riñón/diagnóstico por imagen , Monitoreo Fisiológico , Fenómenos Fisiológicos del Sistema Urinario , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/diagnóstico por imagen , Lesión Renal Aguda/fisiopatología , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Niño , Diagnóstico por Computador , Diagnóstico Diferencial , Femenino , Humanos , Riñón/metabolismo , Riñón/fisiología , Enfermedades Renales/diagnóstico , Enfermedades Renales/fisiopatología , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/diagnóstico por imagen , Fallo Renal Crónico/fisiopatología , Neoplasias Renales/diagnóstico , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Cintigrafía , Flujo Plasmático Renal , Rabdomiosarcoma/diagnóstico , Rabdomiosarcoma/diagnóstico por imagen , Rabdomiosarcoma/tratamiento farmacológico , Programas Informáticos , Urodinámica , Neoplasias Urogenitales/diagnóstico , Neoplasias Urogenitales/diagnóstico por imagen , Neoplasias Urogenitales/tratamiento farmacológico , Tumor de Wilms/diagnóstico , Tumor de Wilms/diagnóstico por imagen , Tumor de Wilms/tratamiento farmacológicoRESUMEN
The increasing doses of 2.4-3.5 g/m2 ifosfamide, i/v, dropwise, were administered for 40 min, on days 1-5 each week, for 3 weeks, in 4 courses. Simultaneously, MESNA was given in a dose two-thirds of that of ifosfamide. The maximum single tolerable dose of ifosfamide was 3.2 g/m2. The dose of 3.5 g/m2 proved neurotoxic causing encephalopathy. The other toxic effects were stage III-IV neutropenia (47%), nausea and vomiting (91%) and weakness (33%). No clinical evidence of renal failure was attributed to the high dosage of the drug in the course of assays of biochemical components of the blood, blood- and urine-beta-2-microglobulins, N-acetyl-D-hexoaminidase (NAG) level in urine, creatinine clearance and complex renoscintigraphy data. On days 3-5, ifosfamide treatment was followed by increase in NAG and beta-2-microglobulin levels in urine which pointed to the toxic effect exerted on the epithelium of renal tubules. The antitumor effect was apparent in 5 (29%) patients for 6 months, which testifies to the high effectiveness of ifosfamide treatment for soft-tissue sarcoma.
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Antineoplásicos Alquilantes/administración & dosificación , Antineoplásicos Alquilantes/efectos adversos , Ifosfamida/administración & dosificación , Ifosfamida/efectos adversos , Sarcoma/tratamiento farmacológico , Adulto , Esquema de Medicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
The results of combined radiodiagnosis of the urinary system in patients with renal tumors before and after nephrectomy were analyzed. Investigations included excretory urography and renography with the processing of the results of measurements by a common algorithm and on the basis of 3 mathematical models of RP body transport. The results were correlated with the findings of biochemical blood and urine tests and pathoanatomical investigation of the removed kidney. Ample potentialities of renography for the detection of latent renal insufficiency in the preoperative period and for accurate and exhaustive assessment of function of the urinary system were shown.
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Neoplasias Renales/fisiopatología , Renografía por Radioisótopo , Sistema Urinario/fisiopatología , Urografía , Humanos , Ácido Yodohipúrico , Neoplasias Renales/diagnóstico por imagen , Sistema Urinario/diagnóstico por imagenRESUMEN
Various mathematical models describing the process of transport of nephrotropic radiopharmaceutic drugs in the body of patients are used at present on a wide scale in processing the results of radionuclide studies of the urinary system functional status. The authors propose to give an objective quantitative assessment on the basis of a complex consisting of 3 mathematical models.
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Modelos Biológicos , Sistema Urinario/diagnóstico por imagen , Enfermedades Urológicas/diagnóstico por imagen , Humanos , Ácido Yodohipúrico , Matemática , Compuestos Organometálicos , Ácido Pentético , Renografía por Radioisótopo/métodos , Tecnecio , Pentetato de Tecnecio Tc 99mRESUMEN
Some criteria for assessment of the adequacy of various radionuclide methods of determination of the separate renal clearance were proposed. Some methods were analyzed according to these criteria: one of them was proposed by S. U. Schlegel et al. and used in the paper by M. E. Karaev and R. N. Samedov, and the other one was proposed by V. Kh. Frenkel' and V. B. Shushkovskii. Both methods were shown to be insufficiently substantiated from physiological and mathematical view-points. A method of assessment of the separate renal clearance in the form of a circulation model was proposed. It was based on the minimal possible number of simplifying allowances and made it possible to define the state of secretory-excretory (or filtration) function and the state of hemodynamics of each kidney as a result of single administration of a transit nephrotropic radiopharmaceutical.
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Riñón/fisiopatología , Renografía por Radioisótopo/métodos , Circulación Renal , Humanos , Ácido Yodohipúrico , Compuestos Organometálicos , Ácido Pentético , Tecnecio , Pentetato de Tecnecio Tc 99mRESUMEN
The task was to develop a simple and effective method of radionuclide determination of separate clearance of the kidneys (SCK), i.e. separate assessment of secretory-excretory function of each kidney. The other earlier known methods of SCK determination were either methodologically incorrect or very difficult. A method of SCK determination intended both for gamma-chambers and standard radiographic units based on common renographic methods, was proposed. An algorithm for processing of measurement results was based on the generalization of the mathematical apparatus of circulation models usually employed for a study of the central and organ hemodynamics, and on its development for transitory nephrotropic radiopharmaceuticals (RP). An investigation of 21 healthy persons and 51 patients with renal tumors using 131I-hippuran showed that the proposed method possessed sufficient sensitivity for its clinical use. Advantages and shortcomings of the method were analysed. All the allowances were justifiable.
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Renografía por Radioisótopo/métodos , Humanos , Ácido Yodohipúrico , Riñón/fisiopatología , Neoplasias Renales/fisiopatologíaRESUMEN
Different schemes of prospidin administration to 54 patients were evaluated. Stage IV paresthesia or renal derangements are limitations of prospidin treatment due to its toxicity. Rheovasographic studies established that disorders in vascular tension are responsible for paresthesia development. The best results were obtained with the administration of 300-400 mg every other day for 2-3 weeks. Schemes of combined administration of prospidin and cyclophosphamide and bleomycin were worked out (58 cases). Therapeutic effect was recorded in the treatment of melanoma, carcinoma of the lip, tongue, nasopharynx, salivary gland and skin. Prospidin, cyclophosphamide and radiation therapy were successfully used in the management of small cell carcinoma of the lung.