From the Research
The immediate cause of death (ICOD) is chronic kidney disease (CKD) type 5, the actual cause of death (ACOD) is obstructive uropathy, and the underlying cause of death (UCOD) is stage 3 cervical cancer. This sequence represents a logical progression of disease where cervical cancer led to obstruction of the urinary tract, which caused progressive kidney damage ultimately resulting in end-stage renal disease 1. The distinction between these causes is important for accurate death certification and epidemiological tracking. CKD type 5 indicates a glomerular filtration rate less than 15 mL/min, representing severe kidney failure requiring renal replacement therapy.
Key Points
- The survival rates of cervical cancer patients undergoing nephrostomy for obstructive uropathy are significantly affected by age, metastasis, and ECOG performance status 1.
- The presence of hydronephrosis negatively affects the overall survival of cervical cancer patients, with a reported 5-year OS hazards ratio ranging from 1.34 to 3.74 2.
- Percutaneous nephrostomy (PCN) is a simple and safe technique that can provide symptomatic improvement and significant fall in mean serum creatinine value in patients with advanced cervical cancer and obstructive uropathy 3.
Clinical Implications
The management of cervical cancer patients with obstructive uropathy requires a multidisciplinary approach, taking into account the patient's age, metastasis, and performance status. The decision to perform PCN should be made on a case-by-case basis, considering the potential benefits and risks of the procedure. Accurate death certification and epidemiological tracking are crucial in understanding the burden of cervical cancer and its complications, including obstructive uropathy and end-stage renal disease.
Evidence-Based Recommendation
The most recent and highest quality study 1 suggests that the survival outcome after percutaneous nephrostomy as palliative urinary diversion in obstructive uropathy due to advanced cervical cancer is affected by age, metastasis, and ECOG performance status. Therefore, these factors should be taken into account when making decisions about the management of these patients.