This case suggests that TIO has a dismal prognosis in prostate cancer patients. The clinical oncology community must be aware about such disturbance that can be present in those patients with weakness, bone pain, and hypophosphatemia.

Cancer patients are living longer. The sequelae of cancer treatment and the role of comorbid conditions present before the diagnosis, such as CKD, have been increasingly recognized. The interface between CKD and cancer is multifaceted. CKD is frequently observed in patients with cancer, and cancer treatment contributes to CKD development and progression. In addition, CKD has been recognized as an important risk factor for cancer development and reduced specific cancer survival. In this context, an accurate evaluation of the glomerular filtration rate (GFR) during oncologic treatment is pivotal and is used to define surgery strategies, program prophylactic management of contrasted examinations, make decisions on cisplatin eligibility, and adjust drug prescriptions, particularly chemotherapy agents. Although the most commonly used equations to estimate GFR based on serum creatinine levels in clinical practice (Cockcroft-Gault, Modification of Diet in Renal Disease Study, and CKD Epidemiology Collaboration equations) have not been validated in patients with cancer in large prospective studies, there is increasingly evidence supporting the use of CKD Epidemiology Collaboration equation to assess the GFR in patients with cancer, including for the use of chemotherapy prescriptions. Many patients with cancer may have changes in nutrition status and clearance measurements such as exogenous filtration markers might be extremely useful when clinical decisions differ depending on the GFR level. Future perspectives include the advent of new serum GFR biomarkers such as cystatin C, beta-trace protein, and beta-2 microglobulin as well as the GFR assessment by measuring total kidney parenchymal volume through image examinations.

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BackgroundData on renal replacement therapy (RRT) in cancer patients with acute kidney injury (AKI) in the intensive care unit (ICU) is scarce. The aim of this study was to assess the safety and the adequacy of intermittent hemodialysis (IHD) in critically ill cancer patients with AKI.Methods and FindingsIn this observational prospective cohort study, 149 ICU cancer patients with AKI were treated with 448 single-pass batch IHD procedures and evaluated from June 2010 to June 2012. Primary outcomes were IHD complications (hypotension and clotting) and adequacy. A multiple logistic regression was performed in order to identify factors associated with IHD complications (hypotension and clotting). Patients were 62.2 ± 14.3 years old, 86.6% had a solid cancer, sepsis was the main AKI cause (51%) and in-hospital mortality was 59.7%. RRT session time was 240 (180–300) min, blood/dialysate flow was 250 (200–300) mL/min and UF was 1000 (0–2000) ml. Hypotension occurred in 25% of the sessions. Independent risk factors (RF) for hypotension were dialysate conductivity (each ms/cm, OR 0.81, CI 0.69–0.95), initial mean arterial pressure (each 10 mmHg, OR 0.49, CI 0.40–0.61) and SOFA score (OR 1.16, CI 1.03–1.30). Clotting and malfunctioning catheters (MC) occurred in 23.8% and 29.2% of the procedures, respectively. Independent RF for clotting were heparin use (OR 0.57, CI 0.33–0.99), MC (OR 3.59, CI 2.24–5.77) and RRT system pressure increase over 25% (OR 2.15, CI 1.61–4.17). Post RRT blood tests were urea 71 (49–104) mg/dL, creatinine 2.71 (2.10–3.8) mg/dL, bicarbonate 24.1 (22.5–25.5) mEq/L and K 3.8 (3.5–4.1) mEq/L.ConclusionIHD for critically ill patients with cancer and AKI offered acceptable hemodynamic stability and provided adequate metabolic control.

Ao Dr. Luis Yu pela oportunidade oferecida e pela confiança em me delegar tarefa tão árdua. Ao Dr. Fernando Liaño pelo carinho, atenção e sugestões que enriqueceram esse estudo. Ao Dr. Isaac de Castro pela paciência e ajuda na análise estatística. Ao Grupo de estatística do Hospital Ramón Y Cajal pela participação e colaboração nesse estudo. Ao Dr. Rui Toledo pela dedicação a esta Instituição. Ao Dr. Emerson Quintino pelas idéias e sugestões. A Sandra Coelho, Ana Flávia e Dr Rui pela contribuição na minha formação. como nefrologista. A Norma e Clésio pelo exemplo durante a graduação. Dedico a vocês esse estudo. Aos meus pais a quem devo tudo o que sou. Vocês são o meu porto-seguro. Às minhas irmãs que são as amigas que eu teria escolhido. A você, Quelzinha pela ternura e carinho. A você Leia, pela cumplicidade e apoio incondicionais. Sem você eu não teria finalizado essa tarefa. À Iza (In memoriam) pelo amor desde o início. Aos meus padrinhos Regina e Jorge por serem a minha segunda família. A Toinho pelo companheirismo, amizade e confiança. A Paula e Gabriela pela amizade e cumplicidade em todos esses anos. A Bárbara pelo carinho, amizade e partilha. A Cris pelo amparo, amizade e por ter me ensinado a buscar o tempo da delicadeza. A Amanda por ter sido a primeira paulistana a me acolher na terra da garoa. Prego!. Às amigas da pós-graduação, Andréia, Flávia e Etienne, pelos momentos compartilhados. A Flavinha, pelo carinho e companhia. A Manus, pela companhia em São Paulo. Aos pacientes, motivação última do meu empenho. A Deus por tudo. v "Se queremos progredir, não devemos repetir a história, mas fazer uma história nova" Gandhi vi Esta tese está de acordo com as seguintes normas, em vigor no momento desta publicação:

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