**Author details**

Akihiro Tojo

**Medical therapy Mechanism Renal diseases References**

increase in sCr

ARF

Belldegrun [77]

INF-α: Quesada [80]

Roncone [86]

IFN-γ: Nair [81], Tashiro [82]

Shalmi [78] Guleria [79]

Proteinuria, TMA Rini [83], Summers [84],

MCNS, iATN Chen [89] AIN Winn [91]

AGN Rolleman [92]

FSGS, TMA Costero [93]

IgAN Jonkers [94] AIN Izzedine [95]

FSGS Izzedine [97]

MCNS: minimal change nephrotic syndrome, IN: interstitial nephritis, ARF: acute renal failure, TMA: thrombotic micro‐

Recent advances in the molecular understanding of renal cell carcinoma have shed light on the mechanism of paraneoplastic glomerulopathy. Clear cell renal cell carcinoma with a VHL gene mutation stimulates HIF-1α transcription, and produces various cytokines and growth factors including VEGF, PDGF, TGF−α/β, IL-6, CAIX and EPO. Renal cell carcinoma has a feature of cytokine disease or immunogenic disease, and enhanced cytokines and growth factors stimulate lymphocytes and plasma cells, and the latter works as a causative factor for various forms of paraneoplastic glomerulopathies. The precise mechanism of glo‐ merulonephritis has not been completely elucidated, and further investigation of renal cell carcinoma related glomerulopathies will open a new perspective in the understanding of

**Table 5.** Interleukin, interferon and molecular-target drugs related nephropathy in the renal cell carcinoma

TMA, MCNS Overkleeft [90]

Interleukin-2 immunomodulatory cytokine Proteinuria, transient

Interferon α, γ immunomodulatory cytokine proteinuria, MCNS, IN,

Bevacizumab Humanized VEGF-neutralizing antibody

122 Renal Tumor

Sunitinib VEGF receptor and multiple

Sorafenib VEGF receptor and multiple

Temsirolimus Inhibitor of the mammalian

**7. Summary**

glomerular diseases.

tyrosine kinase inhibitor

tyrosine kinase inhibitor

target of rapamycin

angiopathy, iATN: ischemic acute tubular necrosis, AGN:acute glomerulonephritis.

Address all correspondence to: akitojo-tky@umin.ac.jp

Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan

## **References**


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**Section 3**

**Management of Metastatic/Advanced Renal**

**Tumor**


**Management of Metastatic/Advanced Renal Tumor**

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**Chapter 8**

**Surgical and Oncological Results of Treatment of**

Urooncological diseases account about 40% of all oncological pathologies in men and more than 10% in women. Renal cell carcinoma (RCC) accounts for about 4% of all adult malig‐ nancies and is the most lethal urological cancer. 60 920 new cases of RCC have been diag‐ nosed in the US in 2011 and 13 120 died of cancer [1]. The patient death rate from RCC has decreased in the last 15 years due to the improvements in early diagnosis and surgical treat‐ ment of the disease [1]. However, it is estimated that 1/3 of the patients with localized cancer will develop distant metastasis after radical treatment [2]. Therefore, early identification of metastatic disease, timely and proper treatment is the main goal in the management of RCC. The most common sites of metastases of RCC are: lymph nodes, lungs, liver, bones and brain [3]. It is known that the disease can metastasize to almost every organ. Adrenal meta‐ stasis of RCC is relatively rare. It can be: synchronous or metachronous; ipsilateral, contrala‐ teral or bilateral; solitary or part of a massive metastatic spread. Malignant involvement of the ipsilateral adrenal gland has been detected in up to 10% of the radical nephrectomy specimens [4-8]. Contralateral adrenal metastasis however, is uncommon. In the autopsy study of more than 400 patients who had undergone nephrectomy for RCC, the solitary con‐

The predisposing factors for the disease spread and the optimal treatment of this rare com‐ plication are not fully understood. It is well-known that some patients with isolated meta‐ stasis may benefit from surgical treatment. However, the optimal diagnosis and treatment of the contralateral adrenal metastasis from RCC is not yet well defined. The available infor‐

> © 2013 Chkhotua et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2013 Chkhotua et al.; licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

tralateral adrenal metastasis has been detected in only 2.5% of cases [9].

**Metastases of Renal Cell Carcinoma to the**

**Contralateral Adrenal Gland**

Archil Chkhotua, Laurent Managadze and

Additional information is available at the end of the chapter

Ambrosi Pertia

**1. Introduction**

http://dx.doi.org/10.5772/53745
