Tubular dysfunction after peritonectomy and chemohyperthermic treatment with cisplatin.
Peritoneal carcinomatosis has always been regarded as a contraindication in traditional cancer surgery treatment; however, good results have been reported by using new combined medical-surgical loco-regional techniques. Peritonectomy and chemohyperthermic perfusion with cisplatinum (CIIP) seem to play a central role in obtaining a better survival rate than with the traditional procedures, even though there is a cisplatinum nephrotoxic effect. The aim of this study was to investigate entity and type of renal injury after CIIP. Forty-two patients (12 males and 30 females) with recurrent or primary peritoneal carcinomatosis who underwent peritonectomy and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy with cisplatin were enrolled. A significant worsening in renal function was observed on the third post-operative day and this condition then persisted for three months. A reduction in estimated-Glomerular Filtration Rate (e-GFR) and an alteration in the albumin:creatinine ratio proved tubular injury. On the third post-operative day after cisplatinum administration, a high toxicity peak was found following platinum free fraction excretion. Proximal tubular injury was confirmed even at the three month analysis. A significant correlation between the total protein reduction rate and the decrease in renal function was established. In relation to that, the platinum free fraction could increase because of a binding protein shortage and the nephrotoxic effect could be enhanced due to platinum accumulation within the post-operative period. This finding suggests that the higher the protein reduction is, the lower the e-GFR determination is at three months.
La Manna
Gaetano
G
Nephrology, Dialysis and Renal Transplant Unit, University of Bologna, St. Orsola Hospital, Italy. gaetano.lamanna@unibo.it
Virzì
Salvatore
S
Deraco
Marcello
M
Capelli
Irene
I
Accorsi
Alma
A
Dalmastri
Vittorio
V
Comai
Giorgia
G
Bonomi
Serena
S
Grassi
Antonio
A
Selva
Saverio
S
Feliciangeli
Giorgio
G
Scolari
Maria
M
Stefoni
Sergio
S
D000419:Albuminuria / Q000175:diagnosis / Q000652:urine; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002277:Carcinoma / Q000628:therapy*; D010478:Chemotherapy, Cancer, Regional Perfusion; D002945:Cisplatin / Q000009:adverse effects*; D003131:Combined Modality Therapy; D003401:Creatine / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D006979:Hyperthermia, Induced; D007674:Kidney Diseases / Q000139:chemically induced* / Q000378:metabolism / Q000503:physiopathology; D007684:Kidney Tubules / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000188:drug therapy*; D010537:Peritoneum / Q000601:surgery*
D000970:Antineoplastic Agents; D003401:Creatine; D002945:Cisplatin