In recent years, a dynamic development of oncology has been observed, resulting from the increasingly frequent occurrence of neoplasms and therefore, increasing population of patients. The most effective form of therapy for cancer patients is complex multidisciplinary specialized disease management, including nephro-oncology care. Different forms of renal function impairment are frequently diagnosed in cancer patients. They are caused by different co-morbidities existing before starting the oncologic treatment as well as the direct undesirable effects of this therapy which may cause temporary or irreversible damage of the urinary system—especially kidneys. According to different therapeutic programs, in such cases the degree of renal damage is often crucial for the possibility of further anti-cancer treatment. Medical personnel responsible for delivering care to oncology patients should be properly educated on current methods of prevention and treatment of renal complications resulting from anti-cancer therapy. The development of oncologic medicines design, including especially immuno-oncological agents, obliges us to learn new patomechanisms determining potential adverse effects, including renal complications. This publication is focused on the most important undesirable nephrotoxic effects of the frequently used anti-cancer drugs.
Introduction
The gold standard of vascular access for chronic hemodialysis patients is the arteriovenous fistula (AVF). If an AVF cannot be created, the hemodialysis catheter can be inserted into the internal jugular, femoral or subclavian vein. After exhausting the abovementioned standard accesses, translumbar access to the inferior vena cava (IVC) is considered a quick, last-chance and rescue method.
Aim
Retrospective analysis of early complications (EC) of translumbar IVC catheterization using one type of catheter by one medical team.
Material and methods
From January 2010 to October 2019, a total of 34 translumbar IVC catheters were implanted in 27 patients.
Results
A major EC was found in 1 (2.9%) procedure. Minor EC occurred in 23.5 attempts. None of these complications required an intervention.
Conclusions
In patients with exhausted possibilities of obtaining standard vascular access for HD, translumbar IVC cannulation proved to be a safe and effective method.
The term monoclonal gammopathy of renal significance MGRS means a group of renal diseases resulting from the presence of the monoclonal protein produced by plasmatic cells or other clones of B cells. The patients with MGRS do not fulfill the diagnostics criteria both of multiple myeloma and other neoplasm originating from B cells. The involvement of different renal structures in the course of MGRS results the dysfunction of kidneys. The monoclonal protein may injure the glomerular structures (including vascular) as well as tubular structures (interstitial in more wide sense). The early diagnosis of MGRS is difficult and the late detection of the disease is connected with high risk of irreversible renal damage. Therefore, the multidisciplinary cooperation – including general practitioners, nephrologists, hematologists and nephro-pathologists – is particularly important for the diagnostics and treatment of MGRS cases. This new hemato-nephrological meta-disease entity is connected with relatively high morbidity and mortality as well as relapses in transplanted kidney. The decision of the treatment initiation against the toxic clone in MGRS cases results mainly from the nephrological reasons. The article presents current diagnostic and therapeutic possibilities that may be used in MGRS patients. The main purpose of this article was to present the current state of knowledge regarding the diagnostics and treatment of MGRS.
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