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Continuous Renal Replacement Therapy, also known as CRRT, is a procedural treatment for acute kidney injury (AKI) that gradually removes uremic toxins and fluids while maintaining acid-base balance and stabilizing electrolytes. It is particularly useful for hemodynamically unstable patients. Unlike intermittent hemodialysis, which is faster, CRRT provides a gentler approach over 24 hours, closely mimicking the function of natural kidneys. However, CRRT is not ideal for patients with...
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Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
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A Core Outcome Set for Localized Renal Cell Cancer (L-RCC-COS).

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Cytoreductive nephrectomy in the current treatment algorithm.

Teele Kuusk1, Bernadett Szabados2, Wing Kin Liu3

  • 1Royal Free Hospital, Department of Urology, Renal Cancer Unit, London, UK.

Therapeutic Advances in Medical Oncology
|October 22, 2019
PubMed
Summary
This summary is machine-generated.

Recent trials CARMENA and SURTIME redefine metastatic renal cell carcinoma treatment. Cytoreductive nephrectomy (CN) is re-evaluated alongside targeted therapy and immune-checkpoint inhibitors for improved patient outcomes.

Keywords:
cytoreductive nephrectomyimmunotherapymetastatic renal cell carcinomarenal cell carcinomasunitinibsystemic therapytargeted therapytyrosine kinase inhibitors

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Area of Science:

  • Oncology
  • Nephrology
  • Clinical Trials

Background:

  • Metastatic renal cell carcinoma (mRCC) treatment has evolved with targeted therapies.
  • Cytoreductive nephrectomy (CN) has been a standard treatment component for mRCC.

Purpose of the Study:

  • To review the impact of the CARMENA and SURTIME trials on mRCC treatment paradigms.
  • To discuss current evidence and algorithms for mRCC management in the era of novel therapies.

Main Methods:

  • Comprehensive review of two prospective randomized trials: CARMENA and SURTIME.
  • Analysis of existing evidence regarding cytoreductive nephrectomy and targeted therapy in mRCC.

Main Results:

  • CARMENA trial questioned the necessity of CN in the targeted therapy era.
  • SURTIME trial explored deferred CN with sunitinib to identify therapy resistance.

Conclusions:

  • The findings necessitate a re-evaluation of the role of CN in mRCC.
  • Updated treatment algorithms integrating targeted therapy and immune-checkpoint inhibitors are crucial for primary mRCC.