Abbreviations & Acronyms AKI = acute kidney injury AKIN = Acute Kidney Injury Network BMI = body mass index CI = confidence interval CVD = cardiovascular disease DM = diabetes mellitus eGFR = estimated glomerular filtration rate HT = hypertension IHD = ischemic heart disease KDIGO = Kidney Disease: Improving Global Outcomes NAC = neoadjuvant chemotherapy NSAID = non-steroidal antiinflammatory drugs OR = odds ratio POD = postoperative day RC = radical cystectomy RIFLE = Risk, Injury, Failure, Loss, End-Stage Renal Disease RRT = renal replacement therapy sCr = serum creatinine UD = urinary diversion UTI = urinary tract infection Objectives: To clarify the incidence, risk factors and clinical impact of acute kidney injury after radical cystectomy. Methods: A total of 210 patients who underwent radical cystectomy at Sapporo Medical University Hospital, Sapporo, Japan, from January 2006 through December 2012 were evaluated. The incidence of acute kidney injury was evaluated over the first 7 days postoperatively, during which time a ureteral catheter was inserted. Risk factors for postoperative acute kidney injury and its impacts on short-term clinical outcomes were evaluated. Results: Finally, 145 patients were eligible for this study. Postoperative acute kidney injury was observed in 48 patients (33.1%), with stages 1, 2, and 3 found in 33 (22.7%), 14 (9.6%) and 1 (0.7%), respectively. All patients with stage 1 and 2 acute kidney injury recovered by postoperative day 7, except for one with stage 1. Hypertension (P < 0.001), preoperative estimated glomerular filtration rate <60 mL/min/1.73 m 2 (P = 0.04) and neoadjuvant chemotherapy (P = 0.03) were independent risk factors for postoperative acute kidney injury. Furthermore, postoperative acute kidney injury was an independent risk factor for acute kidney injury after ureteral stent removal, but not of persistent elevated serum creatinine, prolonged hospital stay or the new onset of cardiovascular disorders during the hospital stay. Conclusions: The incidence of acute kidney injury after radical cystectomy is relatively high, although most cases are low grade and can be resolved. We should be aware of the risk for postoperative acute kidney injury, especially in patients who have comorbid hypertension, impaired renal function and received naoadjuvant chemotherapy.
Objectives To evaluate the effect of pretreatment C‐reactive protein/albumin ratio and modified Glasgow prognostic score on the prognosis in patients with metastatic renal cell carcinoma. Methods A retrospective study was carried out in 176 patients with metastatic renal cell carcinoma who received first‐line tyrosine kinase inhibitors. The effect of adding inflammatory prognostic scores to the International Metastatic Renal Cell Carcinoma Database Consortium model (International Metastatic Renal Cell Carcinoma Database Consortium‐C‐reactive protein/albumin ratio and International Metastatic Renal Cell Carcinoma Database Consortium‐Glasgow prognostic score models) on overall survival was evaluated using receiver operating characteristic curves. The prognostic value of inflammatory prognostic scores (C‐reactive protein/albumin ratio‐modified Glasgow prognostic score) was tested using the Kaplan–Meier method and Cox proportional regression models. Results Patients were stratified into two groups using the cut‐off value of 0.05: C‐reactive protein/albumin ratio‐low (<0.05) and C‐reactive protein/albumin ratio‐high (≥0.05). The area under the curve was significantly higher in the International Metastatic Renal Cell Carcinoma Database Consortium‐C‐reactive protein/albumin ratio model (0.720) than that of the International Metastatic Renal Cell Carcinoma Database Consortium model (0.689) and the International Metastatic Renal Cell Carcinoma Database Consortium‐modified Glasgow prognostic score model (0.703). Significant differences were observed in overall survival stratified by the number of risk factors in the International Metastatic Renal Cell Carcinoma Database Consortium‐C‐reactive protein/albumin ratio risk model between one or two and three or four factors (P < 0.001), and three or four and five or more factors (P = 0.001). For the patients in the International Metastatic Renal Cell Carcinoma Database Consortium intermediate‐risk group, overall survival was significantly different between the C‐reactive protein/albumin ratio‐low and ‐high groups (P = 0.001), whereas it was not significantly different between the patients with one and two International Metastatic Renal Cell Carcinoma Database Consortium risk factors (P = 0.106). Conclusion The C‐reactive protein/albumin ratio is a simple and independent predictor of overall survival in patients with metastatic renal cell carcinoma. The predictive activity was significantly improved in the International Metastatic Renal Cell Carcinoma Database Consortium‐C‐reactive protein/albumin ratio model compared with the International Metastatic Renal Cell Carcinoma Database Consortium/International Metastatic Renal Cell Carcinoma Database Consortium‐modified Glasgow prognostic score models.
Nocardia farcinica usually infects the respiratory tract and can sometimes cause central nervous system infections; however, it rarely infects the prostate. Here we report the first case of N. farcinica detected in the purulence specimen drained from a prostate abscess. A 70-year-old Japanese male receiving steroid and cyclosporine treatment came to our department with chief complaint of turbid urine. Computed tomography revealed a low-density lesion in his prostate. Antibiotic administration and prostatic drainage were effective. N. farcinica was detected in the cultures of urine and prostatic drainage purulence specimens. Nocardiosis should be included in the differential diagnosis in immunosuppressive patients with prostate abscess.
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