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Bunel V, Tournay Y, Baudoux T, De Prez E, Marchand M, Mekinda Z, Maréchal R, Roumeguère T, Antoine MH, Nortier JL. Early detection of acute cisplatin nephrotoxicity: interest of urinary monitoring of proximal tubular biomarkers. Clin Kidney J 2017; 10:639-647. [PMID: 28979774 PMCID: PMC5622891 DOI: 10.1093/ckj/sfx007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/16/2017] [Indexed: 12/13/2022] Open
Abstract
Background Renal toxicity induced by cisplatin (CisPt) is a clinical issue in patients with or without chronic kidney disease (CKD). Proximal tubular injury can result in acute kidney injury (AKI), which may compromise the course of chemotherapy and the prognosis. The purpose of this study was to investigate the time course of urinary markers of acute tubulotoxicity and to assess the usefulness of such monitoring in a routine clinical setting. Methods This work is an open prospective pilot study carried out among 23 patients receiving a platinum-based chemotherapy. Individual comorbidities, plasma parameters of kidney function (urea, creatinine) and estimated glomerular filtration rate were registered. Urinary excretion of leucine aminopeptidase, neutrophil gelatinase-associated lipocalin, cystatin C, liver fatty acid-binding protein and interleukin-18 were monitored during successive chemotherapy cycles. Episodes of AKI were identified according to KDIGO (Kidney Disease Improving Global Outcomes) 2012 guidelines. Results A total of 28 patients were recruited; among them 23 agreed to be part of the study, of whom 18 received CisPt and 5 carbo- or oxaliplatin. Of the 18 CisPt patients, 12 had a preexisting CKD. Sixteen AKI episodes were observed in 13 patients receiving CisPt with a pejorative evolution in seven cases (partial recovery of the renal function); a transient but dramatic increase in urinary biomarkers was observed 3 h after chemotherapy initiation, whereas plasma creatinine rise appeared 72 h after the end of CisPt treatment. Identified precipitating factors included: dehydration due to lack of fluid intake or diuretic use, exposure to high CisPt doses, regular use of nonsteroidal anti-inflammatory drugs and/or iodinated contrast agents and sepsis. Conclusion Even if numerous precipitating factors could be avoided, the monitoring of urinary markers seemed helpful for the early detection of subclinical AKI induced during CisPt chemotherapy.
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Affiliation(s)
- Valérian Bunel
- Laboratory of Experimental Nephrology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Yasmina Tournay
- Department of Nephrology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Baudoux
- Laboratory of Experimental Nephrology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.,Department of Nephrology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Eric De Prez
- Laboratory of Experimental Nephrology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Marie Marchand
- Department of Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Zita Mekinda
- Department of Pneumology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Raphaël Maréchal
- Department of Gastroenterology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Roumeguère
- Department of Urology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marie-Hélène Antoine
- Laboratory of Experimental Nephrology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Joëlle L Nortier
- Laboratory of Experimental Nephrology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.,Department of Nephrology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Harris C, Meek D, Gilligan D, Williams L, Solli P, Rintoul RC. Assessment and Optimisation of Lung Cancer Patients for Treatment with Curative Intent. Clin Oncol (R Coll Radiol) 2016; 28:682-694. [PMID: 27546624 DOI: 10.1016/j.clon.2016.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 12/25/2022]
Abstract
Over the past decade the field of lung cancer management has seen many developments. Coupled with an ageing population and increasing rates of comorbid illness, the work-up for treatments with curative intent has become more complex and detailed. As well as improvements in imaging and staging techniques, developments in both surgery and radiotherapy may now allow patients who would previously have been considered unfit or not appropriate for treatment with curative intent to undergo radical therapies. This overview will highlight published studies relating to investigation and staging techniques, together with assessments of fitness, with the aim of helping clinicians to determine the most appropriate treatments for each patient. We also highlight areas where further research may be required.
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Affiliation(s)
- C Harris
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK
| | - D Meek
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK
| | - D Gilligan
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK
| | - L Williams
- Department of Cardiology, Papworth Hospital, Cambridge, UK
| | - P Solli
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - R C Rintoul
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK.
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Bunel V, Antoine MH, Nortier J, Duez P, Stévigny C. Nephroprotective effects of ferulic acid, Z-ligustilide and E-ligustilide isolated from Angelica sinensis against cisplatin toxicity in vitro. Toxicol In Vitro 2015; 29:458-67. [PMID: 25561245 DOI: 10.1016/j.tiv.2014.12.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/20/2014] [Accepted: 12/24/2014] [Indexed: 01/23/2023]
Abstract
Cisplatin (CisPt), a chemotherapeutic drug applied against solid tumors, is highly detrimental to the kidney. The risk of acute kidney injury implies adequate patient hydration to ensure sufficient diuresis; this strategy, now implemented in clinical practice, remains however incompletely satisfactory. New pharmacological approaches relying on the discovery of bioactive compounds need to be developed. Based on previous studies reporting renoprotective activities for extracts of Angelica sinensis (Oliv.) Diels roots, three of its major active compounds, ferulic acid, Z-ligustilide and E-ligustilide, were investigated for possible alleviation of CisPt-induced nephrotoxicity. Five phenomena involved in acute kidney injury and subsequent fibrosis were investigated: (i) modulation of cell survival via reduction of the apoptosis rate; (ii) reduction of oxidative stress; (iii) improvement of tubular regeneration capacities through proliferation and migration; (iv) limitation of extracellular matrix and collagen deposition; and (v) prevention of the dedifferentiation processes via the β-catenin pathway. Ferulic acid emerged as the most potent compound for alleviating cell death and collagen deposition, and for enhancing cell regeneration capacities. It also partially inhibited the β-catenin pathway, but was ineffective in lowering oxidative stress. Z- and E-ligustilides, however, were effective for limiting the oxidative stress, but only moderately affected other parameters. Ferulic acid appears to be a promising nephroprotective drug lead deserving further preclinical investigation.
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Affiliation(s)
- Valérian Bunel
- Laboratory of Experimental Nephrology, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium; Laboratory of Pharmacognosy, Bromatology and Human Nutrition, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Marie-Hélène Antoine
- Laboratory of Experimental Nephrology, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Joëlle Nortier
- Laboratory of Experimental Nephrology, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pierre Duez
- Laboratory of Pharmacognosy, Bromatology and Human Nutrition, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), Brussels, Belgium; Laboratory of Therapeutical Chemistry and Pharmacognosy, Université de Mons (UMONS), Mons, Belgium
| | - Caroline Stévigny
- Laboratory of Pharmacognosy, Bromatology and Human Nutrition, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), Brussels, Belgium
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