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Correlation between alterations in GFR and coagulation parameters in urine of patients with stage IIB-IIIB uterine cervix cancer treated by radiochemotherapy

Paweł Derlatka1, Mariusz Bidziński1, Ryszard Krynicki1, Małgorzata Benke2, Ewa Stachurska3, Joanna Jońska1

Affiliacja i adres do korespondencji
GIN ONKOL 2007, 5 (2), p. 87-101
Streszczenie

Introduction: Radio- and chemotherapy increase the risk of disorders in the hemostasis system. Pathologic activation of coagulation and fibrinolysis may lead to formation of clots in microcirculation of many organs and subsequently to their dysfunction. Presence of serum coagulation proteins in urine may indicate renal dysfunction. Aim of paper: 1) Evaluation of correlation between hemostatic parameters in urine of patients with stage IIB-IIIB cervical cancer and results of dynamic scintigraphy. 2) Assessment of influence of prophylactic administration of low-molecular-weight heparins (LMWH) on renal function in this patient population. Material and method: The study was randomized. Treatment protocol included radiotherapy (46-65 Gy administered by the box technique) and cisplatin (40 mg/m2 q7d) in patients with normal serum creatinine level. Renal function was assessed by dynamic scintigraphy and glomerular filtration rate (GFR) was determined. Parameters of serum hemostatic system assessed included: D-dimers, PAP, PAI-1, tPA, F1+2 and TAT. Patients were subdivided into 2 groups: a study group – with reduced GFR and a control – with normal GFR. Half of the patients in the study group received 2850 I.U. aXa or 0.3 mL nadroparin during and 6 weeks after chemotherapy (randomization list). Results: Reduction of GFR in the control group (median -9.7%) and in the study group without nadroparin (median -9.9%) were noticed. In the study group receiving nadroparin, an increase of GFR (median 22.3%) was seen. Significant differences were noticed between alterations of GFR in the control and study groups receiving nadroparin and between study groups with and without nadroparin (p=0.0001). Assessment of parameters of hemostatic system in urine revealed activation of fibrinolysis in patients receiving nadroparin and its further inhibition in the group without nadroparin. Conclusions: 1) Alterations in GFR values correlate with changes in hemostasis parameters assessed in urine. An increase of GFR is associated with alterations consistent with inhibition of coagulation and activation of fibrinolysis. Inhibition of fibrinolysis and continuous activation of coagulation results in reduction of GFR values. 2) Prophylactic administration of LMWH enhance activation of fibrinolysis, resulting in an improvement of GFR values in this patient population.

Słowa kluczowe
cervical cancer, radiochemotherapy, renal failure, hemostatic parameters in urine, glomerular filtration rate (GFR)