Aspects of renal function in patients with colorectal cancer in a gastroenterology clinic of a county hospital in Western Romania.

Colorectal cancer represents the third cause of cancer. Since its detection in due time is important resolution, appropriate monitoring is mandatory. The present study deals with the relationship between colorectal cancer and renal function, as well as other associated risk factors. Chronic kidney disease (CKD) represents a risk factor of cancer, both in non-dialysed patients and especially in dialysed patients and in patients with renal transplant. It can get aggravated with cancer in general and particularly with colorectal cancer, partly related to the toxins that cannot be appropriately eliminated because of renal functional disturbances. At the same time, immunosuppressive therapy used for treating glomerular or secondary nephropathies represents an important risk factor of cancer. Some patients with colorectal cancer were found to present also impaired renal function, a fact whose significance is still little known. The object of the present paper is an analysis of the case records of a clinic of gastroenterology on the relationship between colorectal cancer and renal functional impairment. We found in the patients with colorectal cancer under study a glomerular filtration rate (GFR calculated with the EPI formula) of < 60 ml/min/1.73m2 in 31/180 patients, respectively 17.22% of the cases, a value that is similar to that in specialised literature. We also analysed associated risk factors that could be related to renal function impairment in these patients: age, gender, anaemia, diabetes mellitus and hypertension. These could represent, together with the colorectal cancer of the investigated patients, risk factors affecting on the one hand renal function, and on the other hand, potentially increasing the risk of cancer. Correction of these risk factors would have beneficial effects on patients. The relationship between renal functional impairment, respectively CKD, and colorectal cancer is to be regarded from the point of view of complex reciprocity: the impairment of the renal function is a factor of risk of colorectal cancer and colorectal cancer can influence renal function of these patients. This report of reciprocity based on important pathogenic mechanisms also interrelates with factors of risk consecutive to both renal function impairment and colorectal cancer.

Biomarkers in assessing tubular lesions of the solitary kidney. The solitary kidney in special conditions.

The paper highlights the importance of tubular lesions of the solitary kidney (SK), identified and monitored by means of urinary biomarkers, mainly N-acetyl-beta-D-glucosaminidase (NAG), albumin, alpha 1-, and beta 2-microglobulin. It is considered that the assessment of a SK should be performed with four and not three parameters as it was usually done until recently: renal function, proteinuria and blood pressure (BP), to which biomarkers should be added. The solitary kidney can result after nephrectomy for kidney transplantation. In some countries living kidney donors represent the only option for performing kidney transplantation. The SK in living donors has generally a good evolution, although sometimes renal injury manifested by proteinuria, arterial hypertension (AH), or diminution of renal function does occur. Therefore, living donors require attentive monitoring. The SK is considered to have a good evolution (even in donors), in spite of alterations of the above-mentioned clinical and biological parameters. The very infrequent cases who evolve progressively towards renal failure are not predictable, which requires monitoring of all persons with a SK. The SK represents a special situation in case of association with a disease affecting the kidney, such as urinary tract infection (UTI), diabetes mellitus, or systemic lupus erythematosus (SLE). Pregnancy occurring in a person with a SK also needs attentive follow-up. Pregnancy associated diseases, such as preeclampsia occurring in patients with a SK, impose appropriate therapeutic behaviour. The SK remains a particular entity in nephrology which needs to be carefully monitored.

Diabetic nephropathy and multiorgan protection. Part I.

Diabetic nephropathy, one of the most important complications of diabetes mellitus, requires during its evolution protective measures defined as renoprotective. Since the complications of diabetes mellitus are not limited to diabetic nephropathy and as this is frequently associated with heart complications that require protective measures defined as cardioprotective, neurologic measures that require neuroprotection of the retina, of the large vessels etc., much more complex protective measures are necessary. The metabolic complications that are usually at the basis of the other complications at the level of the cell also impose measures of protection. Such an approach can have important practical consequences. It is a well-known fact that most patients with chronic kidney disease--CKD--do not reach final stages as in the meantime they decease because of cardiovascular diseases. Consequently, cardioprotective measures have to be associated with renoprotective ones, as well as protective measures that address other organs, in close connection with protective measures at metabolic level. The protective measures must also address to microcirculation, diabetic nephropathy being a disease that primarily affects microcirculation. Diabetes mellitus also frequently affects the large vessels, the circulatory system being usually affected in its complexity. The paper represents a synthesis of multiorganprotective measures in diabetic nephropathy, in diabetes mellitus, respectively, the concept of multiorgan protection finding in this disease an ideal domain of expression. The first part gives the main multiorgan measures: monitoring of blood pressure and, mainly, protection by means of the renine aldosterone (RAAS) system, multiorgan by intensive monitoring of glycaemia and by treatment of proteinuria. The second part presents the other protective measures used in diabetic nephropathy.

Elements of renal injury in patients with varicose ulcer. Preliminary study.

The kidney may be affected in the processes of microbial, viral, parasitic infections. Knowledge of renal disease during chronic infection, with a different location than the throat, is of particular importance for the practicing physician for the detection and prevention of impaired renal function. Chronic kidney disease recovered in the early stages can prevent the progression of renal function decline. We studied a total of 85 patients with varicose ulcers with a mean age of 66.78 +/- 12.09 years, hospitalized in the Clinic of Dermatology and a control group consisting of 110 apparently healthy individuals. Urinary abnormalities have been detected in 26 (30%) of patients studied. GFR < 60 ml/min have been detected in 14 (17%) of patients studied. CRF stage II have been detected in 36 (42%) of patients studied. We detected recurrent varicose ulcer in 2 (2%) of patients studied. In two (2%) of patients during hospitalization we found a decrease in GFR by 15 and 12 ml/min, accompanied by an increase in serum creatinine from 0.7 mg % to 1 mg % in one patient and in another patient from 1.5 mg % to 2 mg %. Urinary abnormalities detected in patients with both acute and recurrent erysipelas warn about renal impairment and the need for monitoring of the renal patients with varicose ulcers.

The effect of the association of calcium channel inhibitors with antagonists of H2 histamine receptors on the gastric secretion in duodenal ulcer patients.

The effect of the association of verapamil (isoptin), a calcium channel inhibitor, with a cimetidine-like inhibitor of histamine receptors, on stimulated basal gastric secretion was studied in a group of 8 patients with duodenal ulcer. It was observed that by associating verapamil the effect of cimetidine was enhanced in most of the patients. The association of cimetidine with verapamil or other calcium channel inhibitors should be used especially in coronary patients with concomitant duodenal ulcer.