Teresa Chuva - Academia.edu (original) (raw)

Papers by Teresa Chuva

World Journal of Oncology, Dec 1, 2022

Background: Acute kidney injury (AKI) after cytoreductive surgery followed by the infusion of hyp... more Background: Acute kidney injury (AKI) after cytoreductive surgery followed by the infusion of hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is associated with a higher rate of major complications, resulting in prolonged hospitalization and increased mortality. Our objective was to evaluate the incidence of AKI and further progression to chronic kidney disease (CKD) in patients submitted to this procedure and recognize the associated risk factors. Methods: This retrospective study collected demographic, tumorrelated, intraoperative, and postoperative data from 182 patients who underwent CRS/HIPEC from January 2016 to December 2019. Renal impairment was defined according to Kidney Disease Improving Global Outcomes criteria for AKI. We conducted univariate and multiple logistic regression analyses to assess the association between variables of interest and AKI. Results: Twenty-three patients (12.6%) developed AKI. In the AKI group, the risk for developing CKD was six times higher (odds ratio (OR) 6.48, confidence interval (CI) 1.601-26.255). Multivariate regression identified higher risk of developing AKI in patients who underwent HIPEC with cisplatin (OR 12.21, CI 1.26-109.70, P = 0.025), in each additional day spent in the intensive care unit (ICU) (OR 2.42, CI 1.07-5.45, P = 0.033), and an association for each unit increase in estimated glomerular filtration rate (eGFR) before HIPEC (OR 0.96, CI 0.94-0.98, P = 0.037) and AKI development. Conclusion: Patients who are at higher risk of AKI after CRS/HIPEC include those who performed cisplatin HIPEC regimen, had poorer preoperative renal function and had longer ICU stays. Early institution of preventive measures and frequent monitoring should be considered to minimize AKI risk and its associated morbidity, such as CKD progression.

Journal of onco-nephrology, Mar 6, 2023

Objective: To determine the cause of refractory hypercalcemia in a patient with metastatic renal ... more Objective: To determine the cause of refractory hypercalcemia in a patient with metastatic renal cell carcinoma. Methods: We describe the clinical, pathologic, and immunostain findings in a patient with metastatic renal cell carcinoma and hypercalcemia of malignancy refractory to intravenous bisphosphonates. Results: A 57-year-old man with a remote history of clear cell renal cell carcinoma was referred to our clinic for evaluation of resistant hypercalcemia 12 years after nephrectomy. The patient had simultaneous elevation of serum 1,25-dihydroxyvitamin D and parathyroid hormone-related peptide. Computed tomographic scan of the chest and abdomen demonstrated numerous ring-enhancing lesions in the liver, and histologic examination of a biopsy specimen revealed liver tissue infiltrated by a malignant neoplasm composed of cells with clear and eosinophilic cytoplasm, arranged in tubules and nests. Findings were morphologically consistent with renal cell carcinoma of clear cell type, and positive immunostaining with the epithelial markers EMA and CAM 5.2 were supportive of the morphologic impression of renal cell carcinoma. The tumor showed expression of 25-hydroxyvitamin D 1α-hydroxylase by immunostaining. After failing to respond to intravenous bisphosphonates, the hypercalcemia improved with prednisone treatment. Conclusions: In some patients with renal cell carcinoma, hypercalcemia of malignancy is associated with simultaneous elevation in serum 1,25-dihydroxyvitamin D and parathyroid hormone-related peptide. As our case exemplifies, it is imperative to identify such patients because hypercalcemia due to elevated 1,25-dihydroxyvitamin D levels may respond better to glucocorticoid treatment than to the conventional bisphosphonate therapy. (Endocr Pract. 2009;15:234-239) Abbreviations: 1,25(OH) 2 D = 1,25-dihydroxyvitamin D; HHM = humoral hypercalcemia of malignancy; PTH = parathyroid hormone; PTHrP = parathyroid hormonerelated peptide; RCC = renal cell carcinoma

Pediatric Nephrology, May 9, 2017

Background Immunodysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is a ra... more Background Immunodysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is a rare primary immunodeficiency syndrome characterized by the development of multiple autoimmune disorders in affected individuals. Different forms of renal injury have been reported in IPEX syndrome, and membranous nephropathy (MN) is among the most common glomerulopathies found. However, the exact pathogenesis of MN in this setting has not been elucidated, and it is not clear whether it is part of the clinical spectrum of the disease or secondary to medications, infections or other concomitant insults. Diagnosis/treatment We describe a child diagnosed with IPEX syndrome shortly after birth who presented with nephrotic syndrome at the age of 11 weeks. Renal biopsy revealed a MN with enhanced immunohistochemical staining for phospholipase A2 receptor (PLA2R). Conclusion This is the first report of a PLA2R-positive MN in a patient with IPEX syndrome. We suggest that, in this context, MN results from an autoimmune process against podocytic antigens, namely PLA2R.

Frontiers in Medicine, Mar 28, 2022

Monoclonal gammopathy (MG) causes various nephropathies, which may suffice for cytoreductive ther... more Monoclonal gammopathy (MG) causes various nephropathies, which may suffice for cytoreductive therapy even in the absence of diagnostic criteria for multiple myeloma or B-cell non-Hodgkin lymphoma. The aim of this study was to better understand the significance of light chain (LC) restriction or crystals (LC-R/C) in proximal tubules in the spectrum of LC-induced nephropathies. A consecutive cohort of 320 renal specimens with a history of B-cell dyscrasia was characterized. Special attention was paid to immunohistochemical LC restriction in proximal tubules, tubular crystals or constipation, and ultrastructural findings. Complementary cell culture experiments were performed to assess the role of LC concentrations in generating LC restriction. Light chain restriction or crystals in proximal tubules was found in a quarter of analyzed cases (81/316) and was associated with another LC-induced disease in 70.4% (57/81), especially LC cast-nephropathy (cast-NP) and interstitial myeloma infiltration. LC restriction without significant signs of acute tubular injury was observed in 11.1% (9/81). LC-R/C was not associated with inferior renal function compared to the remainder of cases, when cases with accompanying cast-NP were excluded. Besides crystals, cloudy lysosomes were significantly associated with LC-R/C on an ultrastructural level. In summary, LC-R/C is frequent and strongly associated with cast-NP, possibly indicating that a high load of clonal LC is responsible for this phenomenon, supported by the observation that LC restriction can artificially be generated in cell culture. This and the lack of significant tubular injury in a subgroup imply that in part LC-R/C is a tubular trafficking phenomenon rather than an independent disease process.

Journal of Onco-Nephrology

Background: Post-renal acute kidney injury (PR–AKI) is frequent in patients with cancer requiring... more Background: Post-renal acute kidney injury (PR–AKI) is frequent in patients with cancer requiring emergent intervention. With our study we aimed to describe the clinical features and prognostic factors for kidney and overall survival (OS) in cancer patients with PR–AKI. Methods: This is a single-center retrospective study that included 306 cancer patients with PR–AKI admitted from January 2011 to December 2021. Previous kidney function, AKI episode, and progression to end-stage kidney disease (ESKD) were compared. Kaplan Meier and Cox proportional regression methods were used for survival analyses. Results: The most frequent type of malignancy was the prostate (52, 17%) followed by the uterus (50, 16.3%). The mean baseline eGFR was 62 ml/min/1.73 m2. AKI stage 3 was present in 157 patients (51.3%) and renal replacement therapy (RRT) was performed in 19 patients (6%). At discharge, 197 patients (64.4%) had a quick recovery, and during follow-up 8 (2.6%) patients progressed to ESKD. T...

Nephrology Dialysis Transplantation

Background and Aims In the last decade, new therapeutic regimens have dramatically improved the p... more Background and Aims In the last decade, new therapeutic regimens have dramatically improved the prognosis of cancer patients and changed the paradigm of a previously highly lethal disease, increasing the number of cancer patients with chronic kidney disease (CKD) who progress to end-stage kidney disease (ESKD). However decision-making regarding dialysis initiation in patients with cancer and ESKD remains however controversial. The aim of our study was to characterize the clinical course and evaluate survival outcomes of cancer patients on chronic hemodialysis (HD). Method We conducted a retrospective study of chronic HD patients in a single oncology hospital unit between January 1991 and November 2022. Outpatients on HD for more than one month, who underwent dialysis after the diagnosis of cancer were included. Univariate and multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality were estimated using the Cox proportional hazards risk model. Resul...

Nephrology Dialysis Transplantation

Background and Aims Malignant hypercalcemia is the most common cause of hypercalcemia, occurring ... more Background and Aims Malignant hypercalcemia is the most common cause of hypercalcemia, occurring in 30% of cancer patients and rendering a poor prognosis. Most cases have a humoral cause, the majority mediated by parathyroid hormone related peptide (PTHrP), rarely by 1,25-dihydroxyvitamin D3 (1,25(OH)2D) and very rarely by parathyroid hormone (PTH) ectopic production; other cases are due to local osteolysis. In the literature, there are only 5 reported cases of hypercalcemia associated to gastrointestinal stromal tumour (GIST), only 2 of them due to 1,25(OH)2D overproduction. Method Case report. Results Sixty-two years-old male with small bowel GIST diagnosed in 2014, subjected to enterectomy and on tyrosine kinase inhibitor (TKI) since 2017. TKI was changed from imatinib to sunitinib 25mg since August 2020 to the present date due to disease progression with liver metastasis. In March 2022, a PET scan showed no bone or soft tissue metastasis and there was a finding of right ureteral...

Nephrology Dialysis Transplantation

Background and Aims Onconephrology is a rapidly evolving nephrology subspecialty that focuses on ... more Background and Aims Onconephrology is a rapidly evolving nephrology subspecialty that focuses on the interaction between cancer and the kidney. Our aim was to describe the clinical activity of a Nephrology Department in a cancer care center, in a 2-year period. Method We retrospectively analyzed the patients observed by the Nephrology Department at our center between 2021 and 2022. Demographic, clinical and laboratory data were collected. The statistical analysis was performed with SPSS software. Results During the 2-year period, there were 26,015 admissions, 636 of which required a Nephrology observation. Sixty-two per cent were female; the mean age was 68 years (SD ±12.4) with a median Charlson Comorbidity Index of 7. Most cancers were from gastrointestinal (24.1%, n = 153) or urologic origins (22.3%, n = 142), 37% had metastatic disease. Hematologic malignancies accounted for 12.1% of patients (n = 77). Nearly 44.5% of patients (n = 283) had chronic kidney disease (CKD), 20.8% (n...

Endocrine Practice, 2009

Objective-To determine the cause of refractory hypercalcemia in a patient with metastatic renal c... more Objective-To determine the cause of refractory hypercalcemia in a patient with metastatic renal cell carcinoma. Methods-We describe the clinical, pathologic, and immunostain findings in a patient with metastatic renal cell carcinoma and hypercalcemia of malignancy refractory to intravenous bisphosphonates. Results-A 57-year-old man with a remote history of clear cell renal cell carcinoma was referred to our clinic for evaluation of resistant hypercalcemia 12 years after nephrectomy. The patient had simultaneous elevation of serum 1,25-dihydroxyvitamin D and parathyroid hormone-related peptide. Computed tomographic scan of the chest and abdomen demonstrated numerous ringenhancing lesions in the liver, and histologic examination of a biopsy specimen revealed liver tissue infiltrated by a malignant neoplasm composed of cells with clear and eosinophilic cytoplasm, arranged in tubules and nests. Findings were morphologically consistent with renal cell carcinoma of clear cell type, and positive immunostaining with the epithelial markers EMA and CAM 5.2 were supportive of the morphologic impression of renal cell carcinoma. The tumor showed expression of 25-hydroxyvitamin D 1α-hydroxylase by immunostaining. After failing to respond to intravenous bisphosphonates, the hypercalcemia improved with prednisone treatment. Conclusions-In some patients with renal cell carcinoma, hypercalcemia of malignancy is associated with simultaneous elevation in serum 1,25-dihydroxyvitamin D and parathyroid hormone-related peptide. As our case exemplifies, it is imperative to identify such patients

The Journal of Thoracic and Cardiovascular Surgery, 2020

Objectives: Cytoreductive surgery with hyperthermic intraoperative chemotherapy with cisplatin ha... more Objectives: Cytoreductive surgery with hyperthermic intraoperative chemotherapy with cisplatin has been used successfully to treat malignant pleural mesothelioma, a highly aggressive malignancy that is rapidly fatal in most cases. We hypothesized that the combination of ischemic injury with nephrotoxic injury from cisplatin would result in high rates of acute kidney injury. Methods: We conducted an observational study in 503 patients to study the risks and outcomes of acute kidney injury after surgical resection of malignant pleural mesothelioma. Eligible subjects underwent extrapleural pneumonectomy or pleurectomy/decortication with or without hyperthermic intraoperative chemotherapy. Acute kidney injury was defined as an increase in creatinine of 26.5 mmol/L or greater within 48 hours of surgery or a 50% or greater increase over 7 days.

portuguese journal of nephrology and hypertension, Dec 1, 2016

Nephrology Dialysis Transplantation

BACKGROUND AND AIMS Haemodialysis (HD) patients tend to be old, have weakened immune systems and ... more BACKGROUND AND AIMS Haemodialysis (HD) patients tend to be old, have weakened immune systems and suffer from multiple comorbidities, making them particularly prone to infections and death by the Coronavirus disease 2019 (COVID-19). Global vaccination against SARS-CoV2 has been underway, but long-term data in dialysis patients are still scant. We aimed to study the seroconversion with the Pfizer BNT162b2 vaccine in HD patients of 5 Dialysis Centres after the first 2 doses and monitor the immune responses and clinical data during the following 7 months. We also investigated the security of the vaccine. METHOD We included 404 patients on chronic HD. All patients received 2 shots of the Pfizer BNT162b2 vaccine, separated by 21 days. Serologic tests were run using Quant II IgG anti-Spike SARS-CoV-2 assay by Abbott. Blood was drawn 21 days after the first dose (D22), 21 days after the second dose (D43), 3 and 6 months after the first dose (M3 and M6, respectively). We asked the patients t...

Frontiers in Medicine, 2022

Monoclonal gammopathy (MG) causes various nephropathies, which may suffice for cytoreductive ther... more Monoclonal gammopathy (MG) causes various nephropathies, which may suffice for cytoreductive therapy even in the absence of diagnostic criteria for multiple myeloma or B-cell non-Hodgkin lymphoma. The aim of this study was to better understand the significance of light chain (LC) restriction or crystals (LC-R/C) in proximal tubules in the spectrum of LC-induced nephropathies. A consecutive cohort of 320 renal specimens with a history of B-cell dyscrasia was characterized. Special attention was paid to immunohistochemical LC restriction in proximal tubules, tubular crystals or constipation, and ultrastructural findings. Complementary cell culture experiments were performed to assess the role of LC concentrations in generating LC restriction. Light chain restriction or crystals in proximal tubules was found in a quarter of analyzed cases (81/316) and was associated with another LC-induced disease in 70.4% (57/81), especially LC cast-nephropathy (cast-NP) and interstitial myeloma infil...

portuguese journal of nephrology and hypertension, 2016

Background: Acute kidney injury secondary to cast nephropathy is a common complication of multipl... more Background: Acute kidney injury secondary to cast nephropathy is a common complication of multiple myeloma. Extracorporeal light chain elimination by high cut-off haemodialysis has been described as an adjuvant to effective chemotherapy to limit free light chain toxicity. The purpose of this study was to evaluate the impact of high cut-off haemodialysis and bortezomib-based chemotherapy on renal function recovery and overall survival in a cohort of patients with multiple myeloma and dialysis-dependent acute kidney injury. Methods: We did a historical cohort study of patients with multiple myeloma and dialysis-dependent acute kidney injury presenting to our Centre between the 1st January 1999 and 31st March 2013. Results: Forty-six patients were included, with a median age of 68 (56-73 Y) years old. Twenty-four per cent recovered renal function. Patients submitted to high cut-off haemodialysis had a significantly higher probability of renal function recovery (OR = 11.5; 95% IC: 1.0 t...

F1000Research, 2015

1 Department of Nephrology, Portuguese Oncology Institute of Porto, Portugal 2 Department of Medi... more 1 Department of Nephrology, Portuguese Oncology Institute of Porto, Portugal 2 Department of Medical Education and Biomedical Simulation, Faculty of Medicine of the University of Porto, Portugal 3 Department of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal 4 Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar – University of Porto (ICBAS-UP), Porto, Portugal ORIGINAL ARTICLE

Nephrology Dialysis Transplantation

Background and Aims Monoclonal gammopathy of renal significance (MGRS) refers to any plasma cell ... more Background and Aims Monoclonal gammopathy of renal significance (MGRS) refers to any plasma cell or B cell clonal lymphoproliferation that has at least one kidney lesion related to the monoclonal immunoglobulin productions plus, the underlying clone is not responsible for tumour complications. Plus, does not meet any haematological criteria for specific treatment. Although considered a non-malignant or smouldering hematologic condition, its effects on the kidney are not benign since it frequently evolves to end-stage renal disease. There has been some reluctance in treating these patients but increasing evidence has shown that renal outcomes are closely associated with the haematological response to chemotherapy. We aimed to evaluate the incidence of MGRS in the North of Portugal and to assess patients’ characteristics, treatment and follow-up. Method We have, retrospectively, collected information of all patients with a biopsy proven MGRS diagnosis, from four Portuguese centers. De...

Portuguese Journal of Nephrology & Hypertension

Hematological malignancies (HM) confer a high risk of acute kidney injury (AKI), which is associa... more Hematological malignancies (HM) confer a high risk of acute kidney injury (AKI), which is associated with elevated morbi-mortality. The aim of this study was to identify the prognostic factors for in-hospital mortality and one-year mortality in this population. We conducted a single center, retrospective, observational cohort study of 101 in-hospital patients with AKI and HM between January 2015 and December 2019. Multiple myeloma was present in 30.7% of the patients, followed by non-Hodgkin lymphoma (NHL) in 27.7%. Renal support therapy (RST) was needed in 60.4% of the cases. Independent predictors for in-hospital mortality were invasive mechanical ventilation (IMV) (OR 49.53; 95% CI:9.17 – 267.57; P<0.001) and infection during in-hospital stay (IDHS) (OR 5.09; 95% CI:1.18 – 21.89; P=0.029). Predictors for one-year mortality were NHL (HR 2.88; 95% CI:1.54 – 5.39; P=0.001), tumor progression (HR 2.36; 95% CI:1.29 – 4.32; P=0.006) and IMV (HR 6.38; 95% CI:3.50 – 11.64; P<0.001)...

World Journal of Oncology, Dec 1, 2022

Background: Acute kidney injury (AKI) after cytoreductive surgery followed by the infusion of hyp... more Background: Acute kidney injury (AKI) after cytoreductive surgery followed by the infusion of hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is associated with a higher rate of major complications, resulting in prolonged hospitalization and increased mortality. Our objective was to evaluate the incidence of AKI and further progression to chronic kidney disease (CKD) in patients submitted to this procedure and recognize the associated risk factors. Methods: This retrospective study collected demographic, tumorrelated, intraoperative, and postoperative data from 182 patients who underwent CRS/HIPEC from January 2016 to December 2019. Renal impairment was defined according to Kidney Disease Improving Global Outcomes criteria for AKI. We conducted univariate and multiple logistic regression analyses to assess the association between variables of interest and AKI. Results: Twenty-three patients (12.6%) developed AKI. In the AKI group, the risk for developing CKD was six times higher (odds ratio (OR) 6.48, confidence interval (CI) 1.601-26.255). Multivariate regression identified higher risk of developing AKI in patients who underwent HIPEC with cisplatin (OR 12.21, CI 1.26-109.70, P = 0.025), in each additional day spent in the intensive care unit (ICU) (OR 2.42, CI 1.07-5.45, P = 0.033), and an association for each unit increase in estimated glomerular filtration rate (eGFR) before HIPEC (OR 0.96, CI 0.94-0.98, P = 0.037) and AKI development. Conclusion: Patients who are at higher risk of AKI after CRS/HIPEC include those who performed cisplatin HIPEC regimen, had poorer preoperative renal function and had longer ICU stays. Early institution of preventive measures and frequent monitoring should be considered to minimize AKI risk and its associated morbidity, such as CKD progression.

Journal of onco-nephrology, Mar 6, 2023

Objective: To determine the cause of refractory hypercalcemia in a patient with metastatic renal ... more Objective: To determine the cause of refractory hypercalcemia in a patient with metastatic renal cell carcinoma. Methods: We describe the clinical, pathologic, and immunostain findings in a patient with metastatic renal cell carcinoma and hypercalcemia of malignancy refractory to intravenous bisphosphonates. Results: A 57-year-old man with a remote history of clear cell renal cell carcinoma was referred to our clinic for evaluation of resistant hypercalcemia 12 years after nephrectomy. The patient had simultaneous elevation of serum 1,25-dihydroxyvitamin D and parathyroid hormone-related peptide. Computed tomographic scan of the chest and abdomen demonstrated numerous ring-enhancing lesions in the liver, and histologic examination of a biopsy specimen revealed liver tissue infiltrated by a malignant neoplasm composed of cells with clear and eosinophilic cytoplasm, arranged in tubules and nests. Findings were morphologically consistent with renal cell carcinoma of clear cell type, and positive immunostaining with the epithelial markers EMA and CAM 5.2 were supportive of the morphologic impression of renal cell carcinoma. The tumor showed expression of 25-hydroxyvitamin D 1α-hydroxylase by immunostaining. After failing to respond to intravenous bisphosphonates, the hypercalcemia improved with prednisone treatment. Conclusions: In some patients with renal cell carcinoma, hypercalcemia of malignancy is associated with simultaneous elevation in serum 1,25-dihydroxyvitamin D and parathyroid hormone-related peptide. As our case exemplifies, it is imperative to identify such patients because hypercalcemia due to elevated 1,25-dihydroxyvitamin D levels may respond better to glucocorticoid treatment than to the conventional bisphosphonate therapy. (Endocr Pract. 2009;15:234-239) Abbreviations: 1,25(OH) 2 D = 1,25-dihydroxyvitamin D; HHM = humoral hypercalcemia of malignancy; PTH = parathyroid hormone; PTHrP = parathyroid hormonerelated peptide; RCC = renal cell carcinoma

Pediatric Nephrology, May 9, 2017

Background Immunodysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is a ra... more Background Immunodysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is a rare primary immunodeficiency syndrome characterized by the development of multiple autoimmune disorders in affected individuals. Different forms of renal injury have been reported in IPEX syndrome, and membranous nephropathy (MN) is among the most common glomerulopathies found. However, the exact pathogenesis of MN in this setting has not been elucidated, and it is not clear whether it is part of the clinical spectrum of the disease or secondary to medications, infections or other concomitant insults. Diagnosis/treatment We describe a child diagnosed with IPEX syndrome shortly after birth who presented with nephrotic syndrome at the age of 11 weeks. Renal biopsy revealed a MN with enhanced immunohistochemical staining for phospholipase A2 receptor (PLA2R). Conclusion This is the first report of a PLA2R-positive MN in a patient with IPEX syndrome. We suggest that, in this context, MN results from an autoimmune process against podocytic antigens, namely PLA2R.

Frontiers in Medicine, Mar 28, 2022

Monoclonal gammopathy (MG) causes various nephropathies, which may suffice for cytoreductive ther... more Monoclonal gammopathy (MG) causes various nephropathies, which may suffice for cytoreductive therapy even in the absence of diagnostic criteria for multiple myeloma or B-cell non-Hodgkin lymphoma. The aim of this study was to better understand the significance of light chain (LC) restriction or crystals (LC-R/C) in proximal tubules in the spectrum of LC-induced nephropathies. A consecutive cohort of 320 renal specimens with a history of B-cell dyscrasia was characterized. Special attention was paid to immunohistochemical LC restriction in proximal tubules, tubular crystals or constipation, and ultrastructural findings. Complementary cell culture experiments were performed to assess the role of LC concentrations in generating LC restriction. Light chain restriction or crystals in proximal tubules was found in a quarter of analyzed cases (81/316) and was associated with another LC-induced disease in 70.4% (57/81), especially LC cast-nephropathy (cast-NP) and interstitial myeloma infiltration. LC restriction without significant signs of acute tubular injury was observed in 11.1% (9/81). LC-R/C was not associated with inferior renal function compared to the remainder of cases, when cases with accompanying cast-NP were excluded. Besides crystals, cloudy lysosomes were significantly associated with LC-R/C on an ultrastructural level. In summary, LC-R/C is frequent and strongly associated with cast-NP, possibly indicating that a high load of clonal LC is responsible for this phenomenon, supported by the observation that LC restriction can artificially be generated in cell culture. This and the lack of significant tubular injury in a subgroup imply that in part LC-R/C is a tubular trafficking phenomenon rather than an independent disease process.

Journal of Onco-Nephrology

Background: Post-renal acute kidney injury (PR–AKI) is frequent in patients with cancer requiring... more Background: Post-renal acute kidney injury (PR–AKI) is frequent in patients with cancer requiring emergent intervention. With our study we aimed to describe the clinical features and prognostic factors for kidney and overall survival (OS) in cancer patients with PR–AKI. Methods: This is a single-center retrospective study that included 306 cancer patients with PR–AKI admitted from January 2011 to December 2021. Previous kidney function, AKI episode, and progression to end-stage kidney disease (ESKD) were compared. Kaplan Meier and Cox proportional regression methods were used for survival analyses. Results: The most frequent type of malignancy was the prostate (52, 17%) followed by the uterus (50, 16.3%). The mean baseline eGFR was 62 ml/min/1.73 m2. AKI stage 3 was present in 157 patients (51.3%) and renal replacement therapy (RRT) was performed in 19 patients (6%). At discharge, 197 patients (64.4%) had a quick recovery, and during follow-up 8 (2.6%) patients progressed to ESKD. T...

Nephrology Dialysis Transplantation

Background and Aims In the last decade, new therapeutic regimens have dramatically improved the p... more Background and Aims In the last decade, new therapeutic regimens have dramatically improved the prognosis of cancer patients and changed the paradigm of a previously highly lethal disease, increasing the number of cancer patients with chronic kidney disease (CKD) who progress to end-stage kidney disease (ESKD). However decision-making regarding dialysis initiation in patients with cancer and ESKD remains however controversial. The aim of our study was to characterize the clinical course and evaluate survival outcomes of cancer patients on chronic hemodialysis (HD). Method We conducted a retrospective study of chronic HD patients in a single oncology hospital unit between January 1991 and November 2022. Outpatients on HD for more than one month, who underwent dialysis after the diagnosis of cancer were included. Univariate and multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality were estimated using the Cox proportional hazards risk model. Resul...

Nephrology Dialysis Transplantation

Background and Aims Malignant hypercalcemia is the most common cause of hypercalcemia, occurring ... more Background and Aims Malignant hypercalcemia is the most common cause of hypercalcemia, occurring in 30% of cancer patients and rendering a poor prognosis. Most cases have a humoral cause, the majority mediated by parathyroid hormone related peptide (PTHrP), rarely by 1,25-dihydroxyvitamin D3 (1,25(OH)2D) and very rarely by parathyroid hormone (PTH) ectopic production; other cases are due to local osteolysis. In the literature, there are only 5 reported cases of hypercalcemia associated to gastrointestinal stromal tumour (GIST), only 2 of them due to 1,25(OH)2D overproduction. Method Case report. Results Sixty-two years-old male with small bowel GIST diagnosed in 2014, subjected to enterectomy and on tyrosine kinase inhibitor (TKI) since 2017. TKI was changed from imatinib to sunitinib 25mg since August 2020 to the present date due to disease progression with liver metastasis. In March 2022, a PET scan showed no bone or soft tissue metastasis and there was a finding of right ureteral...

Nephrology Dialysis Transplantation

Background and Aims Onconephrology is a rapidly evolving nephrology subspecialty that focuses on ... more Background and Aims Onconephrology is a rapidly evolving nephrology subspecialty that focuses on the interaction between cancer and the kidney. Our aim was to describe the clinical activity of a Nephrology Department in a cancer care center, in a 2-year period. Method We retrospectively analyzed the patients observed by the Nephrology Department at our center between 2021 and 2022. Demographic, clinical and laboratory data were collected. The statistical analysis was performed with SPSS software. Results During the 2-year period, there were 26,015 admissions, 636 of which required a Nephrology observation. Sixty-two per cent were female; the mean age was 68 years (SD ±12.4) with a median Charlson Comorbidity Index of 7. Most cancers were from gastrointestinal (24.1%, n = 153) or urologic origins (22.3%, n = 142), 37% had metastatic disease. Hematologic malignancies accounted for 12.1% of patients (n = 77). Nearly 44.5% of patients (n = 283) had chronic kidney disease (CKD), 20.8% (n...

Endocrine Practice, 2009

Objective-To determine the cause of refractory hypercalcemia in a patient with metastatic renal c... more Objective-To determine the cause of refractory hypercalcemia in a patient with metastatic renal cell carcinoma. Methods-We describe the clinical, pathologic, and immunostain findings in a patient with metastatic renal cell carcinoma and hypercalcemia of malignancy refractory to intravenous bisphosphonates. Results-A 57-year-old man with a remote history of clear cell renal cell carcinoma was referred to our clinic for evaluation of resistant hypercalcemia 12 years after nephrectomy. The patient had simultaneous elevation of serum 1,25-dihydroxyvitamin D and parathyroid hormone-related peptide. Computed tomographic scan of the chest and abdomen demonstrated numerous ringenhancing lesions in the liver, and histologic examination of a biopsy specimen revealed liver tissue infiltrated by a malignant neoplasm composed of cells with clear and eosinophilic cytoplasm, arranged in tubules and nests. Findings were morphologically consistent with renal cell carcinoma of clear cell type, and positive immunostaining with the epithelial markers EMA and CAM 5.2 were supportive of the morphologic impression of renal cell carcinoma. The tumor showed expression of 25-hydroxyvitamin D 1α-hydroxylase by immunostaining. After failing to respond to intravenous bisphosphonates, the hypercalcemia improved with prednisone treatment. Conclusions-In some patients with renal cell carcinoma, hypercalcemia of malignancy is associated with simultaneous elevation in serum 1,25-dihydroxyvitamin D and parathyroid hormone-related peptide. As our case exemplifies, it is imperative to identify such patients

The Journal of Thoracic and Cardiovascular Surgery, 2020

Objectives: Cytoreductive surgery with hyperthermic intraoperative chemotherapy with cisplatin ha... more Objectives: Cytoreductive surgery with hyperthermic intraoperative chemotherapy with cisplatin has been used successfully to treat malignant pleural mesothelioma, a highly aggressive malignancy that is rapidly fatal in most cases. We hypothesized that the combination of ischemic injury with nephrotoxic injury from cisplatin would result in high rates of acute kidney injury. Methods: We conducted an observational study in 503 patients to study the risks and outcomes of acute kidney injury after surgical resection of malignant pleural mesothelioma. Eligible subjects underwent extrapleural pneumonectomy or pleurectomy/decortication with or without hyperthermic intraoperative chemotherapy. Acute kidney injury was defined as an increase in creatinine of 26.5 mmol/L or greater within 48 hours of surgery or a 50% or greater increase over 7 days.

portuguese journal of nephrology and hypertension, Dec 1, 2016

Nephrology Dialysis Transplantation

BACKGROUND AND AIMS Haemodialysis (HD) patients tend to be old, have weakened immune systems and ... more BACKGROUND AND AIMS Haemodialysis (HD) patients tend to be old, have weakened immune systems and suffer from multiple comorbidities, making them particularly prone to infections and death by the Coronavirus disease 2019 (COVID-19). Global vaccination against SARS-CoV2 has been underway, but long-term data in dialysis patients are still scant. We aimed to study the seroconversion with the Pfizer BNT162b2 vaccine in HD patients of 5 Dialysis Centres after the first 2 doses and monitor the immune responses and clinical data during the following 7 months. We also investigated the security of the vaccine. METHOD We included 404 patients on chronic HD. All patients received 2 shots of the Pfizer BNT162b2 vaccine, separated by 21 days. Serologic tests were run using Quant II IgG anti-Spike SARS-CoV-2 assay by Abbott. Blood was drawn 21 days after the first dose (D22), 21 days after the second dose (D43), 3 and 6 months after the first dose (M3 and M6, respectively). We asked the patients t...

Frontiers in Medicine, 2022

Monoclonal gammopathy (MG) causes various nephropathies, which may suffice for cytoreductive ther... more Monoclonal gammopathy (MG) causes various nephropathies, which may suffice for cytoreductive therapy even in the absence of diagnostic criteria for multiple myeloma or B-cell non-Hodgkin lymphoma. The aim of this study was to better understand the significance of light chain (LC) restriction or crystals (LC-R/C) in proximal tubules in the spectrum of LC-induced nephropathies. A consecutive cohort of 320 renal specimens with a history of B-cell dyscrasia was characterized. Special attention was paid to immunohistochemical LC restriction in proximal tubules, tubular crystals or constipation, and ultrastructural findings. Complementary cell culture experiments were performed to assess the role of LC concentrations in generating LC restriction. Light chain restriction or crystals in proximal tubules was found in a quarter of analyzed cases (81/316) and was associated with another LC-induced disease in 70.4% (57/81), especially LC cast-nephropathy (cast-NP) and interstitial myeloma infil...

portuguese journal of nephrology and hypertension, 2016

Background: Acute kidney injury secondary to cast nephropathy is a common complication of multipl... more Background: Acute kidney injury secondary to cast nephropathy is a common complication of multiple myeloma. Extracorporeal light chain elimination by high cut-off haemodialysis has been described as an adjuvant to effective chemotherapy to limit free light chain toxicity. The purpose of this study was to evaluate the impact of high cut-off haemodialysis and bortezomib-based chemotherapy on renal function recovery and overall survival in a cohort of patients with multiple myeloma and dialysis-dependent acute kidney injury. Methods: We did a historical cohort study of patients with multiple myeloma and dialysis-dependent acute kidney injury presenting to our Centre between the 1st January 1999 and 31st March 2013. Results: Forty-six patients were included, with a median age of 68 (56-73 Y) years old. Twenty-four per cent recovered renal function. Patients submitted to high cut-off haemodialysis had a significantly higher probability of renal function recovery (OR = 11.5; 95% IC: 1.0 t...

F1000Research, 2015

1 Department of Nephrology, Portuguese Oncology Institute of Porto, Portugal 2 Department of Medi... more 1 Department of Nephrology, Portuguese Oncology Institute of Porto, Portugal 2 Department of Medical Education and Biomedical Simulation, Faculty of Medicine of the University of Porto, Portugal 3 Department of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal 4 Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar – University of Porto (ICBAS-UP), Porto, Portugal ORIGINAL ARTICLE

Nephrology Dialysis Transplantation

Background and Aims Monoclonal gammopathy of renal significance (MGRS) refers to any plasma cell ... more Background and Aims Monoclonal gammopathy of renal significance (MGRS) refers to any plasma cell or B cell clonal lymphoproliferation that has at least one kidney lesion related to the monoclonal immunoglobulin productions plus, the underlying clone is not responsible for tumour complications. Plus, does not meet any haematological criteria for specific treatment. Although considered a non-malignant or smouldering hematologic condition, its effects on the kidney are not benign since it frequently evolves to end-stage renal disease. There has been some reluctance in treating these patients but increasing evidence has shown that renal outcomes are closely associated with the haematological response to chemotherapy. We aimed to evaluate the incidence of MGRS in the North of Portugal and to assess patients’ characteristics, treatment and follow-up. Method We have, retrospectively, collected information of all patients with a biopsy proven MGRS diagnosis, from four Portuguese centers. De...

Portuguese Journal of Nephrology & Hypertension

Hematological malignancies (HM) confer a high risk of acute kidney injury (AKI), which is associa... more Hematological malignancies (HM) confer a high risk of acute kidney injury (AKI), which is associated with elevated morbi-mortality. The aim of this study was to identify the prognostic factors for in-hospital mortality and one-year mortality in this population. We conducted a single center, retrospective, observational cohort study of 101 in-hospital patients with AKI and HM between January 2015 and December 2019. Multiple myeloma was present in 30.7% of the patients, followed by non-Hodgkin lymphoma (NHL) in 27.7%. Renal support therapy (RST) was needed in 60.4% of the cases. Independent predictors for in-hospital mortality were invasive mechanical ventilation (IMV) (OR 49.53; 95% CI:9.17 – 267.57; P<0.001) and infection during in-hospital stay (IDHS) (OR 5.09; 95% CI:1.18 – 21.89; P=0.029). Predictors for one-year mortality were NHL (HR 2.88; 95% CI:1.54 – 5.39; P=0.001), tumor progression (HR 2.36; 95% CI:1.29 – 4.32; P=0.006) and IMV (HR 6.38; 95% CI:3.50 – 11.64; P<0.001)...