Bevacizumab-Associated Thrombotic Microangiopathy Treated with Eculizumab: A Case Report.

BACKGROUND Bevacizumab is an approved targeted therapy for metastatic cancer treatment. It can have adverse effects on multiple organs. Despite its low incidence, thrombotic microangiopathy (TMA) is the most severe complication. TMA has been associated with complement dysregulation, and treatment with eculizumab can be effective, despite the paucity of literature on eculizumab therapy for bevacizumab-associated TMA. To date, 10 cases have been reported, with less than half of them including a kidney biopsy. We present a new case of bevacizumab-associated TMA successfully treated with eculizumab, along with kidney biopsy records and an overview of mechanisms underlying TMA development in bevacizumab-treated patients. CASE REPORT A female patient diagnosed with metastatic breast cancer who was treated with bevacizumab in conjunction with chemotherapy was admitted to the hospital for acute kidney injury requiring hemodialysis, microangiopathic hemolytic anemia, and thrombocytopenia. TMA was diagnosed and was later confirmed by a kidney biopsy. Primary causes for TMA, such as ADAMTS13 deficiency and shiga toxin associated hemolytic-uremic syndrome, were ruled out, and the patient's condition was ultimately found to be triggered by exposure to bevacizumab. After discontinuing bevacizumab and receiving 4 weekly doses of eculizumab, kidney function and hematological parameters improved. CONCLUSIONS Bevacizumab-associated TMA can be reversed or attenuated in some patients with the use of eculizumab (inhibiting complement system overactivation), possibly reducing time to recovery, with fewer long-term sequelae. This additional case encourages future clinical trials to evaluate the safety and efficacy of eculizumab in cases of TMA associated with bevacizumab.

Acute kidney injury in cancer patients.

The increasing prevalence of neoplasias is associated with new clinical challenges, one of which is acute kidney injury (AKI). In addition to possibly constituting a clinical emergency, kidney failure significantly interferes with the choice and continuation of antineoplastic therapy, with prognostic implications in cancer patients. Some types of neoplasia are more susceptible to AKI, such as multiple myeloma and renal carcinoma. In cancer patients, AKI can be divided into pre-renal, renal (intrinsic), and post-renal. Conventional platinum-based chemotherapy and new targeted therapy agents against cancer are examples of drugs that cause an intrinsic renal lesion in this group of patients. This topic is of great importance to the daily practice of nephrologists and even constitutes a subspecialty in the field, the onco-nephrology.

Acute kidney injury in cancer patients

SUMMARY The increasing prevalence of neoplasias is associated with new clinical challenges, one of which is acute kidney injury (AKI). In addition to possibly constituting a clinical emergency, kidney failure significantly interferes with the choice and continuation of antineoplastic therapy, with prognostic implications in cancer patients. Some types of neoplasia are more susceptible to AKI, such as multiple myeloma and renal carcinoma. In cancer patients, AKI can be divided into pre-renal, renal (intrinsic), and post-renal. Conventional platinum-based chemotherapy and new targeted therapy agents against cancer are examples of drugs that cause an intrinsic renal lesion in this group of patients. This topic is of great importance to the daily practice of nephrologists and even constitutes a subspecialty in the field, the onco-nephrology.

RESUMO A crescente prevalência de neoplasias se associa a novos desafios clínicos, sendo a lesão renal aguda (LRA) um deles. Além de ser possível emergência clínica, a insuficiência renal interfere significativamente na escolha e continuação da terapia antineoplásica, tendo implicações prognósticas no paciente com câncer. Alguns tipos de neoplasias são mais suscetíveis a LRA, como o mieloma múltiplo e o carcinoma renal. Nos pacientes oncológicos, a LRA pode ser dividida em pré-renal, renal (intrínseca) e pós-renal. A quimioterapia convencional com platinas e os novos agentes de terapia-alvo contra o câncer são exemplos de drogas que causam lesão renal intrínseca nesse grupo de pacientes. Este tema é de grande importância atual para a prática diária do nefrologista, tornando-se inclusive subespecialidade na área, a onconefrologia.

Aplicação do instrumento de avaliação da qualidade de vida do estudante de medicina em escola pública de Brasília / Application of the questionnaire to evaluate the quality of life of medical student in health public school of Brasília, Brazil

Objetivo: Avaliar aspectos da qualidade de vida do estudante de medicina em escola de Brasília, correlacionando-os a possíveis fatores, subsidiando processo de gestão acadêmica. Métodos: Estudo descritivo e transversal. Foram analisados 345 estudantes do curso de Medicina de primeiro a sexto anos por meio de aplicação do instrumento de avaliação da qualidade de vida do estudante de medicina quanto aos domínios: Geral, Físico, de Gestão De Tempo, Ambiente de Ensino e Psicológico. Resultados: Método de ingresso no curso: 77,1% dos entrevistados provenientes de ampla concorrência, 19,7% oriundos de vagas por cotas sociais, 3,2% transferidos de outra instituição. Em relação aos domínios Geral, Físico, Ambiente de Ensino e Psicológico, o segundo ano apresentou a maior e o quarto ano a pior pontuação para qualidade de vida em relação a outros anos do curso (p<0,05). No domínio Gestão de Tempo, não houve diferença estatística entre os anos. Finalmente, no escore total, foi ratificado o segundo ano como o de melhor qualidade de vida na escola e o quarto ano como o de pior, seguido pelo sexto ano (p<0,05). Conclusão: A análise da qualidade de vida do estudante possibilita a abordagem e a intervenção precoce na formação educacional para minimizar a exposição e as consequências de fatores estressantes. Estes dados foram importantes para a reestruturação de uma política de desenvolvimento e apoio ao discente