Successful pregnancy in renal transplant recipient with previous known polyomavirus nephropathy

Pregnancy after renal transplantation has become increasingly common. Studies in non-immunocompromised patients have shown that pregnant women have increased susceptibility to infection or reactivation of latent virus such as BK virus. To what extent a renal transplant recipient is at risk for reactivation of polyoma virus during pregnancy remains unknown. We hereby report successful pregnancy outcome in a renal transplant recipient with a known history of BK virus nephropathy treated with cidofovir i.v. To our knowledge, this is the first published experience with a successful pregnancy in renal transplant recipients with known history of polyomavirus-associated nephropathy.     

肾细胞癌伴发肾和腔静脉癌栓的诊治进展及相关的临床体会

肾细胞癌（RCC）是泌尿男生殖系统最常见的恶性肿瘤之一,其发病率居第2位。肾癌的生物学行为较为特殊,对化疗、放疗均不敏感,其转移途径中以血液循环最为常见。容易侵及肾静脉和下腔静脉形成瘤栓（亦称癌栓）是RCC的另一生物学特点,其伴发静脉癌栓的发病率国内外报道在4．O％～22．2％之间。RCC一旦伴发静脉癌栓,其临床分期属Ⅲ期b。随着MRI、CTA、彩超等技术的临床广泛应用,手术治疗癌栓的成功率得到大幅度提高。作者结合文献报道和临床诊治体会,对RCC诊断、治疗进行了总结,并对伴发静脉癌栓新的分类方法进行了探讨。     

Unilateral renal cell carcinoma with coexistent renal disease: a rare cause of end-stage renal disease.

BACKGROUND: Renal cell carcinoma (RCC) is a disorder encompassing a wide spectrum of pathological renal lesions. Coexistence of unilateral RCC and associated pathology in the contralateral kidney is an unusual and challenging therapeutic dilemma that can result in renal failure. So far, data on unilateral RCC with chronic renal failure necessitating renal replacement therapy have not been published. The aim of the present study was to evaluate the incidence of end-stage renal disease (ESRD) from unilateral RCC, and to assess the associated pathology and possible pathogenic factors. METHODS: In 1999, a survey of the 350 patients treated by chronic dialysis in Asturias, Spain, was carried out to identify and collect clinical information on patients with primary unilateral RCC whilst on their renal replacement programme. RESULTS: Seven patients were identified as having ESRD and unilateral RCC, giving an incidence of 2% of patients treated by dialysis. There was a wide spectrum of associated disease and clinical presentation. All patients underwent radical or partial nephrectomy and were free of recurrence 6--64 months after surgery. Six patients were alive and free of malignancy recurrence for 6--30 months after the onset of haemodialysis. CONCLUSION: ESRD is rare in association with unilateral RCC, but does contribute to significant morbidity. However, the data presented here are encouraging and suggest that cancer-free survival with renal replacement therapy can be achieved in such patients.     

Renal tumors in young adults

PURPOSE: The clinical and pathological features of solid or complex cystic renal masses in young adults have not been defined. We present our experience with patients 17 to 45 years old with such renal masses to define the incidence of malignant vs benign lesions, familial tendencies and clinical outcomes. MATERIALS AND METHODS: The medical records of all patients 17 to 45 years old who presented with a solid or suspicious complex cystic renal mass at 2 tertiary care hospitals between 1988 and 2002 were retrospectively reviewed. Pertinent clinical information was compiled, including age, gender, mode of presentation, renal function, year and type of surgery, pathological analysis and survival data. RESULTS: There were 114 evaluable patients who underwent a total of 119 nephrectomies. Mean patient age was 37.1 years and males comprised 56.1% of the population. Twelve patients had familial renal cell carcinoma (RCC), the von Hippel-Lindau syndrome. Mode of presentation for patients with sporadic disease was symptomatic (55.9%), incidental (35.3%) or unknown (8.8%). Radical nephrectomy, partial nephrectomy and nephroureterectomy were performed in 80 kidneys (67.2%), 37 (31.1%) and 2 (1.7%), respectively. Malignant lesions comprised 79.8% of all masses and 95.8% of these were renal cell carcinoma. Of the RCCs 75.8% were grade 1 or 2 and 89% were organ confined. Young women were much more likely than men to have a benign lesion (36.0% vs 9.5%, p <0.01) and the diversity of histologies was impressive (of the 24 total benign masses 9 were different tumor types). With an average followup of 38.3 months overall survival is 90.2%. Among patients with RCC 84.9% are alive and cancer-free, 11.6% are dead from disease and 3.5% are alive with recurrent disease. CONCLUSIONS: We report the largest known series of solid or suspicious complex renal masses in young adults. As expected, familial tumors are more common in this population. While RCC is the most common tumor, a wide variety of potential pathological outcomes are possible, particularly in women, who were much more likely to have a benign lesion. RCC in this patient population appears to have a favorable prognosis, despite symptomatic presentation in the majority of cases.     

肾癌并静脉癌栓的影像学诊断与手术方法选择

目的：探讨肾癌并静脉癌栓的影像学诊断与治疗及方法的选择。方法：回顾性分析我科收治的肾癌伴静脉癌栓患者21例的临床资料。结果：MRI精确地诊断出癌栓的范围；20例肾癌根治性切除加癌栓取出术的患者取得了满意的效果。结论：MRI可替代创伤性大、不良反应多的下腔静脉造影，用于确诊肾癌并静脉癌栓；应依据癌栓的类型选择手术方法。     

Incidentally discovered yellowish lesions in a renal graft from a deceased donor

The opening of Gerota's fascia, soon after harvesting the kidney, is a standard kidney donor procedure in Italy to exclude a renal cell carcinoma (RCC), a frequent finding in older donors. Herein we have reported our experience with the diagnosis and management of subcapsular yellow areas suggestive of RCC on the kidney surface during back-table procedures. From 2001 to 2006, 12/445 grafts showed a single yellowish subcapsular nodule during the back-table procedure which was excised for frozen section (FS) to rule out RCC. The affected donors were 7 males and 5 females of overall mean age of 60 years (range, 25-77 years). The mean nodule diameter was 0.75 cm (range, 0.3-1.2 cm), and all lesions were located in the upper renal pole. In 5 cases, a diagnosis of RCC could not be excluded by FS, and both kidneys were discarded. The final histology confirmed RCC in only 3 cases, and adrenal heterotopia (AH) in the other 2. In the remaining 7 cases, FS showed AH in 4, 1 angiomyolipoma, and 2 areas of infarction confirmed by histology. The adrenal foci consisted of clear cells and scattered cells with eosinophilic, granular cytoplasm and small round nuclei, some with small nucleoli. Immunostains for cytokeratins, CD10, and epithelial membrane antigen were negative, confirming the adrenal origin. AH is the most common pathological yellowish lesion in the upper kidney pole found incidentally during back-table preparation. A histological differential diagnosis with RCC at FS is difficult, relying on the distinction of normal corticoadrenal spongiocytes from Fuhrman grade 1 clear cancer cells. In Italy, for any renal mass suggestive of RCC, a graft discard is mandatory, even if several reports have described cases of renal transplantation performed after back-table excision of small unifocal tumors.     

Small bowel metastases from renal cell carcinoma: a rare cause of intestinal intussusception

Small bowel metastases from renal cell carcinoma (RCC) are very rare. Clinical presentation includes obstruction, bleeding, intussusception and rarely perforation. We report a case of a 48-year-old female presenting a jejunal intussusception due to intestinal metastasis from RCC. To our knowledge, there are only a few such cases reported in the literature (seven cases). However, if considered in the total summary of reported cases with small bowel metastases from RCC, intussusception is a probable cause.     

偶发肾癌的临床探讨(附96例报告)

目的提高偶发肾癌的诊治水平。方法对９６例偶发肾癌进行回顾性总结并与２０２例非偶发肾癌进行对比分析。结果与非偶发肾癌相比,偶发肾癌均为Ｉ～Ｉ期肿瘤,病理分期低（Ｐ＜００１）;平均肿瘤体积小（４４ｃｍ,Ｐ＜００１）;术后５年生存率（８９．８％）高于非偶发组（４５６％）（Ｐ＜００１）。结论偶发肾癌病理分期低,肿瘤体积小,术后远期生存率高;偶发肾癌概念的提出,对肾癌的早期诊治及良好的预后有重要意义。     

Robot-Assisted Laparoscopic Partial Nephrectomy for Allograft Renal Cell Carcinoma: A Case Report

BackgroundNephron-sparing surgery is required for patients with kidney transplant with organ-confined renal cell carcinoma (RCC) in the allograft kidney to preserve renal function. Robot-assisted laparoscopic partial nephrectomy (RAPN) is expected to be the optimal surgical approach for these patients, as in the general population. However, RAPN for RCC arising in the allograft kidney is rarely reported. Here, we report 2 cases of patients who underwent RAPN for allograft RCC.Case presentationTwo patients were diagnosed with RCC in the renal allograft based on enhanced computed tomography findings. Case 1 was a 69-year-old man with a 32-mm mass in the middle portion of the right iliac fossa renal allograft, and case 2 was a 55-year-old man with a 24-mm mass in the lower pole of the right iliac fossa renal allograft. In each patient, RAPN was performed for the renal mass through a transperitoneal approach, with clamping of the renal artery. No major perioperative complications occurred in either patient, negative surgical margins were achieved, and no significant changes in kidney function were observed during either surgery. Pathologic findings showed clear cell RCC in case 1 and papillary RCC in case 2.ConclusionRAPN can be a feasible and effective treatment option for allograft RCC.     

Adjuvant therapy for high-risk renal cell carcinoma patients

For most cases of renal cell carcinoma (RCC), the standard of care is surgical resection as monotherapy or as part of a multimodal approach. In patients with early localized disease, radical nephrectomy is associated with a favorable prognosis, whereas patients with advanced disease are rarely cured. A significant number of patients undergoing surgery for localized RCC experience recurrence, suggesting that there are some individuals in whom surgical excision is necessary but insufficient. In these patients, the development of effective adjuvant strategies is imperative. In this article, we review the prognostic variables and comprehensive staging algorithms for identifying patients at high risk for disease recurrence. Additionally, we review data from completed adjuvant RCC trials and highlight relevant ongoing trials.     

Characterizing changes in kidney and renal pelvis cancer incidence from 1998 to 2006 in the United States

In this study, we characterize the changes in kidney and renal pelvis cancer (RCC) from 1998 to 2006 in the United States. The goal is to examine variations in stage and treatments. In addition, we explore changes in risk factors that have occurred over the same period. Data on over 20,000 patients diagnosed with RCC in National Cancer Data Base were used for the study. We investigated the changes in stage and treatment rates based on race, gender and age at diagnosis from 1998 to 2006. Changes in smoking, obesity and hypertension rates over the period were examined for comparison. The increase in RCC incidence rates from 1998 to 2006 was almost entirely a result of increases in stage I. Increases for blacks were proportionally higher than whites. Obesity and hypertension increased over the period but smoking declined. In terms of treatment, there was an increase in surgery cases primarily for stage I. There were no significant differences in trends based on gender, although rates in men were 65% greater than in women. The mean age at diagnosis was stable for stages I–IV. There are increased incidences of renal tumors, particularly stage I renal cancer among blacks and whites from 1998 to 2006. Patients were more likely to undergo surgical therapy for these tumors.     

Tratamiento conservador del carcinoma de células renales en el injerto renal

PurposeTo evaluate the new treatment strategies in renal cell carcinoma (RCC) that affects the graft in renal recipients.Acquisition of evidenceA literature review is made, analyzing all the published cases of conservative surgery in renal graft RCC.Synthesis of evidenceA total of 51 partial nephrectomies in renal graft patients have been described, with a graft survival rate of 88% and a recurrence rate of 6%. Most of the patients (75%) were asymptomatic at the time of diagnosis, and the mean lesion size was 2.8 cm. Enucleation was the most frequent technique employed. 77% of all immunosuppressor regimens included cyclosporine A. Six patients with graft RCC were subjected to radiofrequency ablation and two patients underwent percutaneous cryoablation, with a single case of relapse and a graft survival rate of 100%.ConclusionsNephron-sparing surgery is a good management option in renal graft RCC, affording good oncological control and graft survival. Modification of immunosuppression with the withdrawal of cyclosporine A and the introduction of mTOR inhibitors is an adequate measure in such patients.     

Management of renal angiomyolipoma in complex clinical situations.

Renal angiomyolipoma (AML) is associated with complex clinical situations such as tumour in a solitary kidney, bilateral, large or multicentric tumours or those associated with tuberous sclerosis (TS) or pregnancy. Management in these situations may be challenging. Fifteen patients (20 kidneys) were admitted with symptomatic AML over last 10 years. Eleven patients had one or the other complicating factor. Ten patients had a tumour of >10 cm, 4 had TS, 5 had multiple and bilateral tumours, 1 patient was pregnant and 1 had a solitary functioning kidney. With the newer imaging modalities correct diagnosis was possible in 12 cases and renal cell carcinoma (RCC) was suspected in 3 cases. Selective angioembolization (SAE) was done in 3 patients, which successfully controlled bleeding in all. Nephron-sparing surgery (NSS) was performed in 5 patients. Total nephrectomy was done in 4 cases, in 3 due to suspicion of RCC and in 1 due to extensive involvement of the kidney. Three patients with multiple and bilateral tumours were chosen for conservative treatment and none developed recurrence of bleeding on strict follow-up. In a pregnant patient, bleeding was successfully controlled with angioembolization. However, 1 patient with a solitary functioning kidney with large-sized tumour (20 x 18 cm) underwent NSS. In conclusion, the basis of management of AML is preservation of renal tissue, which can be effectively achieved with SAE or NSS. In a solitary functioning kidney, NSS or SAE is the ideal treatment, if feasible. The patients in the TS group are usually more complicated and require life-long follow-up after initial management with NSS or SAE. Pregnant AML patients can be safely managed with SAE. Conservative treatment without any intervention and regular follow-up may be more helpful in some patients with multiple, bilateral extensive tumours.     

Retroperitoneoscopic radical nephrectomy for renal-cell carcinoma during twin pregnancy

Renal-cell carcinoma (RCC) is rarely reported during pregnancy. Both the open and the laparoscopic approach to nephrectomy have been used effectively and safely in pregnant patients with RCC. We report a unique case of a 52-year-old woman found to have RCC during twin gestation who was treated with retroperitoneoscopic radical nephrectomy, one of the first such cases managed by this approach.     

妊娠期肾积水的诊治（附87例报告）

目的：探索妊娠期合并肾积水的原因和治疗方法。方法：87例妊娠合并肾积水患者中69例（79％）采用内科保守治疗,11例（12％）采用膀胱镜下输尿管置管,8例（9％）输尿管镜术＋弹道碎石的方法治疗。结果：87例中肾绞痛症状均得到缓解,肾盂积水不同程度减少,86例治疗后顺利完成妊娠,1例因恐惧药物和手术影响胎儿自行终止妊娠后完成输尿管镜碎石。结论：轻度和中度妊娠期肾积水合并肾绞痛、尿路感染者经保守治疗大部分可以获得缓解。妊娠合并肾绞痛反复发作或重度肾积水的患者采用经膀胱镜输尿管置双J管引流术效果良好;输尿管结石妊娠患者输尿管镜弹道碎石效果可靠,生理干扰少,损伤小,对胎儿是比较安全的。     

nucleostemin基因在肾癌中的表达及其意义

目的 观察nucleostemin基因在肾癌组织和正常肾组织中的表达,探讨其在肾癌发生中的意义.方法 收集肾癌组织标本62例,透明细胞型50例,颗粒细胞型12例.同时取10例癌旁非癌肾组织和10例非瘤正常肾组织作对照组.应用逆转录-聚合酶链反应(RT-PCR)方法,以GAPDH为内参照,检测上述组织nucleostemin基因mRNA的表达,统计学分析实验结果.结果 肾癌组织中,nucleostemin基因47例显示阳性表达,阳性率为75.81%.正常肾组织未见有nucleostemin基因阳性表达.nucleostemin基因在肾癌组织中的阳性表达显著高于正常肾组织(P<0.01).nucleostemin基因在透明细胞癌中阳性表达率为74.00%;颗粒细胞癌阳性表达率为83.33%,两者比较差异无统计学意义(P>0.05).结论 nucleostemin基因在肾癌组织中呈高表达,而在正常肾组织中无表达;nucleostemin基因的表达可能与病理类型无关.提示nucleostemin基因的表达与肾癌的发生密切相关.     

肾嫌色细胞癌(附15例报告)

目的　提高肾嫌色细胞癌的诊治水平和对此类型肾癌的认识。　方法　回顾性分析15例肾嫌色细胞癌的临床资料。男 10例 ,女 5例。年龄 4 7～ 74岁 ,平均 5 7岁。均行根治性肾切除术。　结果　术后病理证实为肾嫌色细胞癌。病理分期 :pT1N0 M0 6例 ,pT2 N0 M0 5例 ,pT3bN0 M0 2例 ,pT1N2 M0 1例 ,pT2 N2 M0 1例。病理分级 :G2 10例 ,G3 5例。 11例获随访 ,随访 2～ 31个月 ,平均19个月 ,1例死于心脏病 ,1例局部复发 ,9例无瘤生存。　结论　肾嫌色细胞癌是一种具有特殊形态的少见肾癌类型。肾根治性切除术是治疗肾嫌色细胞癌的首选方法。与同期、同级的其他类型肾癌相比 ,肾嫌色细胞癌预后较好。     

p16蛋白及PCNA在肾癌中的表达及意义

目的探讨肾癌中p16蛋白与PCNA的表达与肾癌组织学类型、临床分期、病理分级及预后的关系。方法采用免疫组织化学SP法检测41例肾癌及18例癌旁正常肾组织中p16蛋白及PC－NA的表达。结果p16蛋白在肾癌及癌旁正常肾组织中的阳性表达率间具有显著性差异（P＜0.05）,p16蛋白表达在肾透明细胞癌及颗粒细胞癌间无显著性差异,随肾癌分级、分期升高而明显降低,p16阳性表达组术后5年生存率明显高于阴性表达组;肾癌及癌旁肾组织中PCNA的阳性表达率增高,与预后有关,与肾癌的组织类型及分期无关。结论p16基因及蛋白的检测可作为肾癌的辅助诊断及预后判断的参考指标;PCNA可作为肿瘤恶性程度的判断及预后的参考指标。     

长期血透患者获得性囊性肾病合并肾癌8例报告并文献复习

目的:学习长期血透患者获得性囊性肾病合并肾癌的筛查和诊治方法。方法:回顾性分析我院维持性血透获得性囊性肾病合并肾癌患者8例,均为B超和CT诊断为双肾多发性囊肿合并肾实质性占位,并行后腹腔镜下根治性肾切除术,术后维持规律性血透,并严密随访。结果:长期血透患者226例,获得性囊性肾病105例(46.5%),获得性囊性肾病合并肾癌8例(3.5%),在获得性囊性肾病中发生率为7.6%(8/105),其中男5例,女3例,年龄(58.6±16.4)岁,血透(12.2±6.9)年。8例患者(9次)行后腹腔镜下根治性肾切除术,手术均成功,出血(45.2±20.3)ml,手术时间(72.5±20.3)min,无严重手术并发症,术后病理3例为透明细胞癌和6例为乳头状癌。住院天数为(7.5±2.4)d。随访12～63个月,无瘤存活5例。结论:肾癌在获得性囊性肾病患者中发病率高,随着血透患者寿命的延长,血透3年后需重视和建立肾癌筛查机制,腹腔镜下根治性肾切除术安全有效、恢复快,并注重患者心脑血管疾病及糖尿病等并发症的积极治疗,有助于进一步延长血透患者寿命。