Cervical cancer: Renal complications and survival after percutaneous nephrostomy

Abstract

Introduction:Obstructive nephropathy is a frequent complication in the course of advanced cervical cancer (CC), and ultrasonography-guided percutaneous nephrostomy (PCN) is a well established technique for fast ureteral desobstruction. Objective: To identify possible factors related to the survival and quality of life of patients with advanced CC presenting acute urinary obstructive complications that after desobstruction by PCN recovered urinary flux and renal function. Method: This is an analytical, descriptive, cross-sectional study that included 45 patients with CC who underwent PCN and were divided into 2 groups: "death" (DG) and "survival" (SG), in a public hospital that is reference for oncologic diseases in Northern Brazil. Results: The mean serum creatinine of the patients preceding PCN was >10 mg/ dL, and after PCN <2 mg/dL. The cutoffs of 8.7 g/dL for Hb (p=0.0241) and 27% for Ht (p=0.0065) indicated the values that better discriminate the outcomes of the groups. The presence of low blood pressure was statistically correlated (p=0.0037) to the outcome "death". Changes in glomerular filtration rate (already reduced in all cases) were not associated to the levels of Hb/Ht or to the outcome "death" during the nephrological follow-up. Conclusion: PCN was responsible for the recovery of renal function in 61.7% of the patients, leading to interruption of renal replacement therapy (RRT) in all of those patients. Hb levels >8.7g/dL and Ht >27% were associated to longer survival, and the presence of low blood pressure during follow-up was associated with progression to death.

Malignant ureteric obstruction decompression: how much gain for how much pain? A narrative review

“…In total, 4948 patients were included in this study (1,3,(8)(9)(10)(11)15,(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62) (3,9,10,23,24,28,32,38,44).…”

“…Patients with a malignancy of unknown primary or gastrointestinal origin were identified as having poorer outcomes (27,41) whereas gynaecological malignancies had a better outcome (37). Other variables included patients with upper ureteric obstruction (23), moderate-severe hydronephrosis (24), bilateral hydronephrosis (41), elevated creatinine (24,37), anaemia (55) and patients with an elevated CRP(29)…”

“…There are only nine papers including patients from the last ten years; in this time however there have been significant advances in oncological treatment options (9,10,15,29,35,41,(55)(56)(57)59). Therefore, outcomes may well be influenced by more conservative historic data.…”

The intersection of oncology, nephrology, and palliative care

“…32 Another study assessing the same population yielded a 25% hospital death rate post-PCN insertion. 34…”

Impact of cancers on the kidney function and structure; an ignored entity

“…A very common complication of advanced cervical cancer is obstructive nephropathy which one of the best techniques for resolving the obstruction could be ultrasonography-guided percutaneous neph rostomy (PCN) (35). In fact, PCN can recover renal function of more than 60% of cervical cancer patients, resulting in preventing renal replacement therapy in these patients (36). In addition, cervical cancer patients may develop hydronephrosis, as a cancer-related or cancer treatmentrelated complication, which is associated with higher morbidity and worse survival (35).…”