ABSTRACT
The compression of the renal parenchyma due to a subcapsular hematoma, also known as the "Page kidney," is a potentially serious but treatable complication of renal biopsy. Hypertension is very common and, in some cases, renal failure may be present. In kidney transplantation, it is a not well-described entity. Rapid intervention is essential to avoid irreversible damage of the graft and preserve its function. We report 2 cases of acute renal failure due to Page kidney in patients with renal transplant after a percutaneous biopsy with successful recovery after surgical treatment. In addition, we conducted a literature review in order to describe the clinical characteristics of this infrequent complication in patients with a history of renal transplant.
Subject(s)
Acute Kidney Injury/etiology , Biopsy/adverse effects , Hematoma/etiology , Kidney Transplantation/adverse effects , Postoperative Complications/etiology , Adult , Aged , Allografts/pathology , Humans , Kidney/pathology , MaleABSTRACT
Prostate Cancer is the second most frequent malignant neoplasm in males in the world. At the end of the disease, when the tumor becomes resistant to castration, we have a wide range of treatment possibilities aimed at the Androgenic Receptor, androgens synthesis, the skeleton, chemotherapy, and even new molecular targets that are still under investigation. Today, the best sequence of treatment for each patient has not been established yet. OBJECTIVE: The objective of this work is to review the current scene of treatment in castrate resistant prostate cancer, as well as the latest developments and strategies to choose the best sequence in each patient. MATERIAL AND METHODS: A literature review was performed through Medline Database (Pubmed) using as key words: "Castrate Resistant Prostate Cancer", "Sequencing", "Biomarkers", "Systemic Therapy". We also reviewed ASCO GU 2017 abstracts. RESULTS: Since Docetaxel was approved in 2004, which increased overall survival by about 2 months in patients with Metastatic Castration Resistant Prostate Cancer, in recent years a large number of therapies have been approved, demonstrating an increase in overall survival after several phase III clinical trials: Cabacitaxel, Abiraterone, Enzalutamide, Sipuleucel-T, Denosumab, Radium 223. And more recently, some investigations about new targeted therapies directed to the androgen receptor, with greater affinity than enzalutamide, or more accurate inhibitors of CYP 17 enzyme than abiraterone, as well as, agents as monoclonal antibodies (anti PD1), vaccines, poly adenosine diphosphate- ribose polymerase inhibitors, are coming to the light. In the future, these outcomes could tune up the treatment sequencing, through the study of predictive biomarkers that will indicate the right target of each therapy. CONCLUSIONS: In the near future, outcomes of different clinical trials that are studying new molecules, will allow us to apply the sequencing of different therapies based on biomarkers present in blood (circulating tumor cells) or in specimen biopsies, achieving an increase in overall survival and improving quality of life of patients in the advanced stage of the disease, however the best choice of sequence is unknown at this moment.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Prostatic Neoplasms, Castration-Resistant/drug therapy , Algorithms , Humans , MaleABSTRACT
El cáncer de próstata (CP) es la segunda neoplasia maligna más frecuente en el mundo dentro del sexo masculino. Para la fase final de la enfermedad, cuando el tumor se hace resistente a castración tenemos un amplio abanico de posibilidades de tratamiento dirigidos al Receptor Androgénico, a la síntesis de andrógenos, al esqueleto, quimioterapia, incluso nuevas dianas moleculares que están aún en estudio. Aún así hoy en día no se ha establecido la secuencia idónea de tratamiento para cada paciente. Objetivos: El objetivo de este trabajo es plantear el panorama actual de tratamiento en la fase de resistencia a la castración y las últimas novedades y estrategias para elegir la mejor secuencia en el paciente adecuado. Métodos: Se ha realizado una búsqueda a través de Medline Database (Pubmed) usando como palabras Clave: "Castrate Resistant Prostate Cancer", "Sequencing", "Biomarkers", "Systemic Therapy". Revisión de abstract de ASCO GU 2017. Resultados: Desde que se aprobara Docetaxel en 2004 que aumentaba la supervivencia global unos 2 meses en pacientes afectos Cáncer de Próstata Resistente a la Castración Metastásicos, en los últimos años se han aprobado un buen número de terapias demostrando aumento de la supervivencia global tras ensayos clínicos en fase III: Cabacitaxel, abiraterona, enzalutamida, sipuleucel T, denosumab, Radium 223. Y más recientemente están saliendo a la luz investigaciones de nuevas terapias dirigidas al receptor androgénico, con una mayor afinidad que enzalutamida, o inhibidores de la enzima CYP 17 más precisos que abiraterona, así como anticuerpos monoclonales (anti PD1), vacunas, inhibidores de la poli adenosina difosfato-ribosa polimerasa, que en un futuro podrían afinar la secuencia de tratamiento de cada paciente, siendo necesario el estudio de biomarcadores predictores que indiquen la diana de cada terapia. Conclusiones: En un futuro próximo con los resultados de los distintos ensayos clínicos que estudian las nuevas moléculas podremos aplicar la secuenciación de las distintas terapias en función de biomarcadores presentes en la sangre (células tumorales circulantes) o en las biopsias, consiguiendo aumentar la supervivencia y la calidad de vida de los pacientes en la fase avanzada de la enfermedad, pero por el momento la mejor elección de secuencia es desconocida
Prostate Cancer is the second most frequent malignant neoplasm in males in the world. At the end of the disease, when the tumor becomes resistant to castration, we have a wide range of treatment possibilities aimed at the Androgenic Receptor, androgens synthesis, the skeleton, chemotherapy, and even new molecular targets that are still under investigation. Today, the best sequence of treatment for each patient has not been established yet. Objective: The objective of this work is to review the current scene of treatment in castrate resistant prostate cancer, as well as the latest developments and strategies to choose the best sequence in each patient. Material and methods: A literature review was performed through Medline Database (Pubmed) using as key words: "Castrate Resistant Prostate Cancer", "Sequencing", "Biomarkers", "Systemic Therapy". We also reviewed ASCO GU 2017 abstracts. RESULTS: Since Docetaxel was approved in 2004, which increased overall survival by about 2 months in patients with Metastatic Castration Resistant Prostate Cancer, in recent years a large number of therapies have been approved, demonstrating an increase in overall survival after several phase III clinical trials: Cabacitaxel, Abiraterone, Enzalutamide, Sipuleucel-T, Denosumab, Radium 223. And more recently, some investigations about new targeted therapies directed to the androgen receptor, with greater affinity than enzalutamide, or more accurate inhibitors of CYP 17 enzyme than abiraterone, as well as, agents as monoclonal antibodies (anti PD1), vaccines, poly adenosine diphosphate-ribose polymerase inhibitors, are coming to the light. In the future, these outcomes could tune up the treatment sequencing, through the study of predictive biomarkers that will indicate the right target of each therapy. Conclusions: In the near future, outcomes of different clinical trials that are studying new molecules, will allow us to apply the sequencing of different therapies based on biomarkers present in blood (circulating tumor cells) or in specimen biopsies, achieving an increase in overall survival and improving quality of life of patients in the advanced stage of the disease, however the best choice of sequence is unknown at this moment
