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Cervical cancer: Renal complications and survival after percutaneous nephrostomy
Rev Assoc Med Bras 2016; 62(3):255-261 255
ORIGINAL ARTICLE
Cervical cancer: Renal complications and survival after
percutaneous nephrostomy
Alzira Carvalho Paula de Souza1, Alfredo Nunes Souza2, Rubens Kirsztajn2, Gianna Mastroianni Kirsztajn 3*
1MD, MSc, Department of Medicine of the Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
2MD, Department of Medicine of Unifesp, São Paulo, SP, Brazil
3MD, PhD, Department of Medicine of Unifesp, São Paulo, SP, Brazil
Summary
Study conducted at Hospital Ophir Loyola,
Belém, PA; and at Universidade
Federal de São Paulo (Unifesp), São
Paulo, SP, Brazil
Article received: 10/13/2014
Accepted for publication: 2/19/2015
*Correspondence:
Address: Rua Botucatu, 740, 2o andar
São Paulo, SP – Brazil
Postal code: 04023-900
Introduction: Obstructive nephropathy is a frequent complication in the course
of advanced cervical cancer (CC), and ultrasonography-guided percutaneous neph-
rostomy (PCN) is a well established technique for fast ureteral desobstruction.
Objective: To identify possible factors related to the survival and quality of life of
patients with advanced CC presenting acute urinary obstructive complications
that after desobstruction by PCN recovered urinary flux and renal function.
Method: This is an analytical, descriptive, cross-sectional study that included
45 patients with CC who underwent PCN and were divided into 2 groups: “death”
(DG) and “survival” (SG), in a public hospital that is reference for oncologic dis-
eases in Northern Brazil.
Results: The mean serum creatinine of the patients preceding PCN was >10 mg/
dL, and after PCN <2 mg/dL. The cutoffs of 8.7 g/dL for Hb (p=0.0241) and 27%
for Ht (p=0.0065) indicated the values that better discriminate the outcomes of
the groups. The presence of low blood pressure was statistically correlated
(p=0.0037) to the outcome “death”. Changes in glomerular filtration rate (al-
ready reduced in all cases) were not associated to the levels of Hb/Ht or to the
outcome “death” during the nephrological follow-up.
Conclusion: PCN was responsible for the recovery of renal function in 61.7% of
the patients, leading to interruption of renal replacement therapy (RRT) in all
of those patients. Hb levels >8.7g/dL and Ht >27% were associated to longer sur-
vival, and the presence of low blood pressure during follow-up was associated
with progression to death.
Keywords: ureteral obstruction, chronic kidney injury, percutaneous nephros-
tomy, anemia, creatinine, survival.
Introduction
Cervical cancer (CC) is one of the most common cancers
in women, especially in developing countries, constitut-
ing a real public health problem.¹
Prevention of CC is potentially effective, as there are
various forms of intervention and combating the mul-
tiple manifestations of the disease. However, despite the
effectiveness of control programs in many centers, CC
remains a disease with high prevalence, incidence and
mortality.²
Despite advancements in the treatment of urogeni-
tal neoplasms, surgical techniques, radiotherapy and che-
motherapy, we still observe the frequent progression to
obstructive urinary complications due to local expansion
or pelvic metastases,³ which characterizes CC as the main
pelvic tumor progressing with urinary obstruction.4
The development of obstructive acute renal failure
(ARF) in patients with a malignant neoplasm results in
an ethical dilemma, as renal clearance may often only be
accomplished through invasive palliative procedures such
as percutaneous nephrostomy (PCN), which in some cas-
es may compromise quality of life.5
Note that in advanced stages of neoplastic disease
treatment is always challenging, and thus interventions
should prioritize the patient’s quality of life, pain relief,
assurance of hygiene and psychological care.6,7