Prostate cancer is the most common cancer in men in United States and the fifth most common cancer in men in Korea. Although the majority of patients with metastatic prostate cancer initially respond to androgen deprivation therapy, almost all patients will eventually progress to develop castration-resistant prostate cancer (CRPC). Treatment options for CRPC remain limited. Prostate cancer was considered unresponsive to chemotherapy until the mid-1990s, when mitoxantrone combined with prednisone was shown to play a role in the palliative treatment of patients with CRPC. In 2004, two large randomized clinical trials demonstrated for the first time a small but significant survival advantage of docetaxel-based chemotherapy compared with mitoxantrone in patients with metastatic CRPC. Recently, cabazitaxel was shown to improve survival in patients with metastatic CRPC who progressed after docetaxel-based chemotherapy. Sipuleucel-T was also demonstrated to improve overall survival in patients with asymptomatic or minimally symptomatic metastatic CRPC. Along with mitoxantrone and docetaxel, cabazitaxel and sipuleucel-T are now approved for use in metastatic CRPC by the US Food and Drug Administration. There have been multiple early-phase clinical trials of various agents for the treatment of CRPC, and some are in phase III development. This review focuses on the key clinical trials of various treatment options of CRPC currently in use and under investigation.
Humans ; Imidazoles ; Immunotherapy ; Korea ; Male ; Mitoxantrone ; Molecular Targeted Therapy ; Nitro Compounds ; Palliative Care ; Prednisone ; Prostate ; Prostatic Neoplasms ; Taxoids ; Tissue Extracts ; United States ; United States Food and Drug Administration

Prostate cancer is the fourth most common cancer in men worldwide. Its incidence and mortality vary widely between countries and ethnicities. In Korea, the incidence of prostate cancer was much lower than that in most westernized countries, but recently, it appears to be rapidly increasing steadily. Prostate cancer has now become the fifth most common cancer in men in Korea since the year 2002. The recent dramatic increase in incidence may be attributed to the growth of elderly population, a westernized diet in daily life style, and introduction of prostate-specific antigen (PSA) screening. The prevalence of latent prostate cancers is similar around the world, but the incidence of clinically manifest cancers differs, with Asians having the lowest rates of clinical prostate cancers. Diet may play a role in converting latent prostate cancer into clinically manifest one. Fat consumption, especially polyunsaturated fat, shows a strong positive correlation with prostate cancer incidence and mortality. The mortality rates for prostate cancer have been decreasing in many developed countries, thanks to early detection and improved treatment, while the mortality rates have been increasing in Korea. Since a significantly higher proportion of Korean prostate cancers exhibit poor differentiation, early diagnosis and appropriate treatment may be important.
Aged ; Asian Continental Ancestry Group ; Developed Countries ; Diet ; Early Diagnosis ; Humans ; Incidence ; Korea ; Life Style ; Male ; Mass Screening ; Prevalence ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms

Traditional approaches to pathophysiology are advancing but still have many limitations that arise from real biologic systems and their associated physiological phenomena being too complicated. Microfluidics is a novel technology in the field of engineering, which provides new options that may overcome these hurdles. Microfluidics handles small volumes of fluids and may apply to various applications such as DNA analysis chips, other lab-on-a-chip analyses, micropropulsion, and microthermal technologies. Among them, organ-on-a-chip applications allow the fabrication of minimal functional units of a single organ or multiple organs. Relevant to the field of nephrology, renal tubular cells have been integrated with microfluidic devices for making kidneys-on-a-chip. Although still early in development, kidneys-on-a-chip are showing potential to provide a better understanding of the kidney to replace some traditional animal and human studies, particularly as more cell types are incorporated toward the development of a complete glomerulion-a-chip.
Animals ; DNA ; Humans ; Kidney* ; Lab-On-A-Chip Devices ; Microfluidics ; Nephrology ; Physiological Phenomena

Atherosclerotic renovascular hypertension is a form of secondary hypertension due to renal artery stenosis. After the introduction of medical therapy such as with statins and angiotensin blocking agents, it has been considered a very slowly progressive disease. In the 1990s, surgical methods were compared to radiological intervention and showed no additional benefits. Recent clinical data also demonstrate that in cases of relatively stable atherosclerotic renovascular disease, medical therapy is as effective as other interventions with regard to patient outcomes. In this paper the recent clinical outcomes are reviewed.
Angiotensins ; Atherosclerosis ; Humans ; Hypertension ; Hypertension, Renovascular ; Renal Artery Obstruction

No abstract available.
Humans ; Renal Dialysis

Objective, rapid, and accurate assessment of volume status is important in the early management of acute, critical illnesses, as inappropriate therapy may lead to interventions with fatal outcomes. Traditionally, the history and physical examinations have been used for this assessment, but have limitations. Radioisotopic measurement or invasive hemodynamic monitoring is impractical, complicated, and expensive. Recently developed technologies offer rapid, accurate estimation of volume status with the potential to improve clinical outcome. This review discusses the methods available for volume assessment, including ultrasound, bioimpedance, and the historical tools.
Critical Illness ; Fatal Outcome ; Hemodynamics ; Physical Examination ; Technology Assessment, Biomedical ; Water-Electrolyte Imbalance

Acute or chronic dysfunction of the heart or kidneys can cause dysfunction of other organs.This interaction between the heart and kidneys is characterized as cardiorenal syndrome (CRS). Recently, a preponderance of data indicated that venous congestion plays an important role in the combination of renal and cardiac diseases. This review aims to focus on the pathophysiology of venous congestion that leads to renal impairment in heart failure and the use of diuretics or ultrafiltration as decongestive therapy in CRS. We found that although clinical studies have confirmed that decongestive therapy has a definite role in decreasing volume overload and the consequent symptom improvement in patients with CRS, the impact of diuretics or ultrafiltration on the improvement of kidney function or mortality remains uncertain. A precise assessment of volume status is required to determine the adequacy of decongestion. Objective measures of renal venous congestion may be a future metric to assess the adequacy of the diuretic response in patients and guide therapeutic decision making.

Pressure natriuresis refers to the concept that increased renal perfusion pressure leads to a decrease in tubular reabsorption of sodium and an increased sodium excretion. The set point of blood pressure is the point at which pressure natriuresis and extracellular fluid volume are in equilibrium. The term "abnormal pressure natriuresis" usually refers to the expected abnormal effect of a certain level of blood pressure on sodium excretion. Factors that cause abnormal pressure natriuresis are known. Sympathetic nerve system, genetic factors, and dietary factors may affect an increase in renal perfusion pressure. An increase in renal perfusion pressure increases renal interstitial hydrostatic pressure (RIHP). Increased RIHP affects tubular reabsorption through alterations in tight junctional permeability to sodium in proximal tubules, redistribution of apical sodium transporters, and/or release of renal autacoids. Renal autocoids such as nitric oxide, prostaglandin E2, kinins, and angiotensin II may also regulate pressure natriuresis by acting directly on renal tubule sodium transport. In addition, inflammation and reactive oxygen species may mediate pressure natriuresis. Recently, the use of new drugs associated with pressure natriuretic mechanisms, such as angiotensin receptor neprilysin inhibitor and sodium glucose co-transporter 2 inhibitors, has been consistently demonstrated to reduce mortality and hypertension-related complications. Therefore, the understanding of pressure natriuresis is gaining attention as an antihypertensive strategy. In this review, we provide a basic overview of pressure natriuresis to the target audience of nephrologists.

Acute or chronic dysfunction of the heart or kidneys can cause dysfunction of other organs.This interaction between the heart and kidneys is characterized as cardiorenal syndrome (CRS). Recently, a preponderance of data indicated that venous congestion plays an important role in the combination of renal and cardiac diseases. This review aims to focus on the pathophysiology of venous congestion that leads to renal impairment in heart failure and the use of diuretics or ultrafiltration as decongestive therapy in CRS. We found that although clinical studies have confirmed that decongestive therapy has a definite role in decreasing volume overload and the consequent symptom improvement in patients with CRS, the impact of diuretics or ultrafiltration on the improvement of kidney function or mortality remains uncertain. A precise assessment of volume status is required to determine the adequacy of decongestion. Objective measures of renal venous congestion may be a future metric to assess the adequacy of the diuretic response in patients and guide therapeutic decision making.

PURPOSE: This study was performed to investigate the significance of preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and postoperative ESR and CRP nadir as predictive factors for prognosis in patients with non-metastatic renal cell carcinoma (RCC). MATERIALS AND METHODS: In 66 patients with non-metastatic RCC for whom ESR and CRP could be measured before radical nephrectomy and during follow-up, the preoperative ESR, preoperative CRP, postoperative ESR nadir and postoperative CRP nadir were compared with the clinicopathological variables. RESULTS: Patients with elevated preoperative ESR or CRP levels were more likely to have tumors with adverse features, including larger tumor size, higher T stage, higher nuclear grade and more frequent metastasis at follow-up, as compared to those patients with lower preoperative ESR or CRP levels, respectively. Patients with an elevated postoperative CRP nadir developed metastasis more frequently at follow-up as compared to those patients with a lower level of postoperative CRP nadir. The univariate analyses identified tumor size, T stage, preoperative ESR, preoperative CRP and postoperative CRP nadir as significant prognostic factors for recurrence-free survival. CONCLUSIONS: Elevated preoperative ESR, preoperative CRP and postoperative CRP nadir are associated with a worse prognosis and a higher recurrence rate in patients with non-metastatic RCC, suggesting that ESR and CRP are valuable prognostic indicators in RCC.
Blood Sedimentation* ; C-Reactive Protein* ; Carcinoma, Renal Cell* ; Erythrocytes* ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Nephrectomy ; Prognosis* ; Recurrence