Résumé
Abstract: Background: Cancer is currently among the three leading causes of death after solid organ transplantation and its incidence is increasing. Non-melanoma skin cancer - squamous cell carcinoma and basal cell carcinoma - is the most common malignancy found in kidney transplant recipients (KTRs). The incidence of non-melanoma skin cancer in KTRs has not been extensively studied in Portugal. Objectives: To determine the incidence of non-melanoma skin cancer in KTRs from the largest Portuguese kidney transplant unit; and to study risk factors for non-melanoma skin cancer. Methods: Retrospective analysis of clinical records of KTRs referred for the first time for a dermatology consultation between 2004 and 2013. A case-control study was performed on KTRs with and without non-melanoma skin cancer. Results: We included 288 KTRs with a median age at transplantation of 47 years, a male gender predominance (66%) and a median transplant duration of 3.67 years. One fourth (n=71) of KTRs developed 131 non-melanoma skin cancers, including 69 (53%) squamous cell carcinomas and 62 (47%) basal cell carcinomas (ratio squamous cell carcinoma: basal cell carcinoma 1.11), with a mean of 1.85 neoplasms per patient. Forty percent of invasive squamous cell carcinomas involved at least two clinical or histological high-risk features. The following factors were associated with a higher risk of non-melanoma skin cancer: an older age at transplantation and at the first consultation, a longer transplant duration and the presence of actinic keratosis. KTRs treated with azathioprine were 2.85 times more likely to develop non-melanoma skin cancer (p=0.01). Conclusion: Non-melanoma skin cancer was a common reason for dermatology consultation in Portuguese KTRs. It is imperative for KTRs to have access to specialized dermatology consultation for early referral and treatment of skin malignancies.
Sujets)
Humains , Mâle , Femelle , Enfant , Adolescent , Adulte , Adulte d'âge moyen , Sujet âgé , Jeune adulte , Tumeurs cutanées/épidémiologie , Carcinome basocellulaire/épidémiologie , Carcinome épidermoïde/épidémiologie , Transplantation rénale/effets indésirables , Receveurs de transplantation , Portugal/épidémiologie , Tumeurs cutanées/étiologie , Carcinome basocellulaire/étiologie , Carcinome épidermoïde/étiologie , Incidence , Études rétrospectives , Facteurs de risque , Facteurs âges , Estimation de Kaplan-Meier , Jeune adulte , Immunosuppresseurs/effets indésirablesSujets)
Humains , Mâle , Femelle , Adulte , Acide urique/urine , Calcium , Calculs rénaux/urine , Citrates , Maladies inflammatoires intestinales/urine , Hyperoxalurie , Magnésium/urineRésumé
O refluxo vesicoureteral primário é uma condição freqüentemente ameaçadora ao parênquima renal. Esta doença severa pode levar a uma displasia e cicatrização renal. Quando revelada por infecção aguda do trato urinário, o dano renal em muitos casos quase sempre ocorre, sendo a intervenção clínica ou cirúrgica tardia. Objetivamos, através do enfoque deste assunto, alertar para o diagnóstico precoce, screening de populações de alto risco e prevenção de infecções, juntamente com melhor manejo de disfunção vesical, no intuito de reduzir a incidência de dano renal devido a refluxo vesicoureteral primário