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Hepatotoksičnost dodataka prehrani je sverastući zdravstveni problem. Zbog manjka regulacije i standardizacije u proizvodnji, uz širokodostupnost pripravaka, zdravstveni radnici moraju biti na oprezu prilikom preporuke ovakvih proizvoda. Jetra je glavni organ metabolizma ksenobiotika te je kao takva sklona oštećenjima različitim mehanizmima stoga je ključno poznavati laboratorijske parametre i kliničke simptome oštećenja jetre kako bi se pacijente znalo pravovremeno upozoriti na mogućnost hepatotoksičnog djelovanja pripravka. Uz nekoliko analiziranih pripravaka koji su dostupni u Republici Hrvatskoj poput suplemenata koji sadrže ekstrakt crvene riže ili zelenog čaja, u radu je anketirano 105 studenata Farmaceutsko-biokemijskog fakulteta Sveučilišta u Zagrebu u vezi procjene njihovih znanja i stavova o hepatotoksičnosti dodataka prehrani i biljnih ekstrakata. Najveći broj studenata nije bio upoznat ili je nedovoljno upoznat s utjecajem biljnih pripravaka na jetru te smatra da se mora dodatno educirati i povećati oprez prilikom preporuke i/ili korištenja istih. Ono što i dalje ostaje problem je slaba dokazivost uzročno-posljedične veze između pripravaka i njihovih utjecaja na jetru zbog prisutnosti politerapije te ostalih rizičnih čimbenika u etiologiji oštećenja jetre. Iako ne postoje direktni i konačni zaključci o kompletnom utjecaju obrađenih pripravaka na jetru, potreban je dodatni oprez kako bi se rizik od štetnog utjecaja na jetru smanjio te odabrao pravi pripravak za pojedinog pacijenta kao temelj personalizirane medicine čemu moderna struka, uključujući i medicinu temeljena na dokazima, teže. Hepatotoxicity of dietary supplements is a growing health problem. Due to the lack of regulation and standardization in production, together with the wide availability of products, health professionals must be careful when recommending such supplements. Liver is the main organ of xenobiotic metabolism and as such is prone to damage by various mechanisms. Therefore, it is crucial to know the laboratory parameters and clinical symptoms of liver damage so that the patients could be warned in time about the possible hepatotoxic side effects. In addition to several analyzed supplements available in the Republic of Croatia, such as ones containing red rice extract or green tea extracts, a total of 105 students of the Faculty of Pharmacy and Biochemistry of the University of Zagreb were interviewed to assess their knowledge and attitudes regarding hepatotoxicity of dietary supplements and plant extracts. Most students were not familiar or were insufficiently familiar with the effect of herbal preparations on the liver and believe that additional education should be provided with increased caution when recommending and / or using these supplements. What remains a problem is the poor provability of a cause-and-effect relationship between preparations and their effects on the liver due to the presence of polytherapy and other risk factors in the etiology of liver damage. Although there are currently no direct and definitive conclusions about the complete impact of treated supplements on the liver, extra caution is needed to reduce the risk of adverse effects on the liver and choose the right product for the right patient as the end goal of evidence-based medicine.

U rad su uključeni pacijenti s HER-2 pozitivnim karcinomom dojke dijagnosticirani u Kliničkom bolničkom centru Zagreb tijekom 2016.godine. Tijekom analiziranog razdoblja nađeno je 65 uzoraka HER-2 pozitivnih tumora u 58(14%) pacijenata. Radilo se o jednom 63-godišnjem muškarcu, ostalo su bile žene (starosti 27-84 godine; medijan 55 godina). Uzorci su uključivali 29 iglenih biopsija dojke, jednu iglenu biopsiju limfnog čvora, 15 kirurških materijala tkiva dojke sa ili bez limfnih čvorova te 14 uzoraka udaljenih metastaza. 51,2% tumora je bilo Luminal B HER-2, a 48.8% HER-2 imunofenotipa. Dodatni podaci bili su poznati za 46 pacijenata. U vrijeme dijagnoze, 18(40%) pacijenata je imalo lokaliziranu bolest, 15 (32%) uz pozitivne limfne čvorove, a 13(28%) je imalo udaljene metastaze. Luminal B HER-2+ tumori su bili češće gradusa 2 (90%), a čisti HER-2+ tumori gradusa 3(63%). Metastaze HER-2 pozitivnog karcinoma nađene su u limfnim čvorovima (16), jetri (11), kostima (8), mozgu (8), plućima (7), te rjeđe drugim lokacijama. Metastaze u mozak su češće nađene kod HER-2 pozitivnih karcinoma, a metastaze u kosti kod Luminal B HER-2+ tumora. 40 pacijenata je liječeno ciljanom anti-HER-2 terapijom (90% HER-2+ i 87% Luminal B HER-2+), a najčešće se koristio trastuzumab. U 14 pacijenata je trastuzumabu dodan pertuzumab, ili je kasnije zamijenjen drugim lijekovima (lapatinib, trastuzumab-emtansin i neratinib). Citotoksične lijekove je primalo 38 pacijenata, a najčešće su korišteni paclitaxel, docetaxel i kombinacija doxorubicina i ciklofosfamida. Dvanaest od 23 pacijenata s Luminal B HER-2+ tumorom je primalo i anti-hormsku terapiju, najčešće tamoxifen, letrozol ili anastrazol. U periodu praćenja do zaključno s kolovozom 2020, 21 pacijentica nakon provedene terapije nije pokazala znakove recidiva bolesti. Sedam pacijentica je i dalje na ciljanoj terapiji, a 8 je preminulo u terminalnoj fazi bolesti. Devet je pacijentica izgubljeno iz praćenja, većina u uznapredovaloj ili terminalnoj fazi bolesti. Najbolje preživljenje uočeno je u grupi lokaliziranog karcinoma u vrijeme dijagnoze, a najlošije u grupi primarno metastatskog tumora. Uspoređujući metastatska sijela, najlošije preživljenje je nađeno u pacijentica s moždanim metastazama. This study included patients with HER-2 positive breast cancer diagnostically evaluated in University Hospital Centre Zagreb during 2016. There were a total of 65 samples of HER-2 positive tumor from 58(14%) patients. One patient was a 63 year old male, and rest were females (age range 27-84; median 55 years) Samples included 29 breast core needle biopsies, one lymph node core biopsy, 15 surgical materials of breast tissue 14 distant metastases. Luminal B HER-2 positive cancer was diagnosed in 51.2% and HER-2 positive in 48.8% cases. Additional data regarding stage and histology were available for 46 patients. At the time of diagnosis 18(40%) patients had localized disease,15 (32%) had regional lymph node metastases, and 13(28%) patients had systemic disease. Luminal B HER-2 positive tumors were more commonly grade 2(90%) and pure HER-2 positive cancer grade 3(63%). Metastatic sites with HER-2 positive cancer included regional lymph nodes (16), liver (11), bones (8), brain (8), lung (7), and others. Brain metastases were more common in pure HER-2 positive cancers, while bone metastases were more common in Luminal B HER-2 positive tumors. 40 patients received specific targeted anti-HER-2 therapy (90% HER-2+ and 87% Luminal B HER-2+), and trastuzumab was the most commonly administrated drug. In 14 patients trastuzumab was used with pertuzumab or replaced with lapatinib, trastuzumab-emtansine or neratinib. 38 patients received cytotoxic drugs, most commonly paclitaxel, docetaxel or combination of doxorubicine and cyclophosphamide. Twelve patients with Luminal B HER-2 positive tumor also received anti-hormonal therapy, in most cases tamoxifen, letrozol or anastrazol. During follow-up period, 21 patients showed no signs of recurrent disease, 7 patients are still on targeted therapy, and 8 patients died from advanced disease. 9 patients were lost from follow-up, most in terminal stage of disease. The best survival were noted in group of patients with localized disease, and the poorest in group with primary systemic disease. Comparing to other metastatic sites, patients who developed brain metastases had the worst prognosis.

Obrada pedijatrijskih pacijenata s oštećenjem bubrežne funkcije uključuje više neinvazivnih metoda kao što su klinički i ultrazvučni pregled te brojne laboratorijske analize krvi i urina. Pa ipak, s obzirom da se različite bolesti mogu slično klinički manifestirati, često je nužno napraviti i biopsiju bubrega. U radu su obrađene najčešće kliničke manifestacije i patološki laboratorijski nalazi djece kojima je od siječnja 2018. do prosinca 2019. u KBC Zagreb učinjena biopsija bubrega. Kliničke manifestacije bolesti uspoređene su s nalazima biopsije bubrega. Tijekom dvogodišnjeg razdoblja učinjene su 54 biopsije bubrega u 52 djeteta, 32 (61,5%) muška i 20 (38,5%) ženska; starosti od 13 mjeseci do 17 godina uz medijan 10 godina. Dvije najčešće indikacije za biopsiju bubrega bile su nefrotski sindrom i izolirana hematurija, a svaki su nađeni u 15 (27%) slučajeva. Klinička dijagnoza Henoch-Schönlein purpure nađena je u 5 slučajeva, dok su sindrom hematurije s proteinurijom, nefritički sindrom, kronična bubrežna insuficijencija i pogoršanje funkcije bubrežnog grafta bili indikacije svaki u 3 dodatna slučaja. Alportov sindrom bio je najčešća biopsijom postavljena dijagnoza a nađen je u 12 (22%) slučaja; slijedi Bolest minimalnih promjena, Henoch-Schönlein purpura i IgA nefropatia, nađene u 8, 5 i 4 slučaja. Od 12 pacijenata s Alportovim sindromom, 9 se manifestiralo hematurijom, a po jedan sindromom hematurije i proteinurije, nefrotskim sindromom te nefrotskim sindromom sa eritrociturijom. Iako nalaz Alportovog sindroma kao najčešće postavljene dijagnoze odudara od drugih studija, njegov nalaz u istraživanom razdoblju može se objasniti visokim stupnjem informiranosti i aktivnim traženjem osoba s karakterističnim obilježjima zbog potencijalnog uključivanja u znanstvenu studiju genetskih promjena vezanih za ovu nasljednu bolest. Pediatric patients with abnormal renal function are evaluated with several non-invasive methods including clinical examination, ultrasound, serum and urine analysis. However, since many different diseases may have a similar presentation, in many instances it's also necessary to perform renal biopsy. This study evaluated common clinical manifestations and abnormalities of serum and urine analysis in children who underwent renal biopsy at University Hospital Centre Zagreb during January 2018-December 2019. Clinical manifestations of renal diseases were correlated with results on renal biopsy. There were a total of 54 renal biopsies from 52 pediatric patients, 32 (61,5%) males and 20 (38,5%) females; age range from 13 months to 17 years; median 10 years. Two most common indications for renal biopsy were nephrotic syndrome and hematuria, each accounting for 15 (27%) of cases. Specific clinical diagnosis of Henoch-Schönlein purpura was found in 5 cases, while hematuria/proteinuria, nephritic syndrome, chronic renal insuficiency and dysfunction of kidney allograft were indication for biopsy each in additional 3 cases. The most common diagnosis on renal biopsy was Alport syndrome found in 12 (22%) cases, followed by Minimal Change Disease, Henoch-Schönlein purpura and IgA nephropathy accounting for additional 8, 5 and 4 cases. Among 12 patients with Alport syndrome, 9 had isolated hematuria, and the rest presented with hematuria/proteinuria; pure nephrotic syndrome and nephrotic syndrome with erythrocyturia. Having Alport syndrome as the leading biopsy proven diagnosis is very unusual. However, it can be explained by higher awareness and active search for individuals with typical phenotype, needed for inclusion into ongoing study of genetic changes related to this rare disease.

Proteinurija predstavlja izlučivanje više od 150 mg proteina u 24 satnom urinu. Radi se o čestom simptomu mnogih primarnih bubrežnih bolesti, ali i mnogih sistemskih bolesti sa zahvaćanjem bubrega. Proteinurija se dalje opisuje kao blaga (manje od 1 g dnevno), umjerena (1-3,5 g dnevno) ili značajna (više od 3,5 g dnevno). Ovim radom je istražena učestalost i vrste proteinurije u odraslih pacijenata kojima je tijekom 2019. u KBC Zagreb učinjena biopsija bubrega. Rezultati su uspoređeni s histološkim promjenama nađenim biopsijom bubrega. U analiziranom razdoblju ukupno su u odraslih učinjene 152 biopsije bubrega; 87(57,24%) u muškaraca i 65(42,76%) u žena. Radilo se o 89(58,55%) biopsija nativnih i 63(41,44%) biopsije transplantiranih bubrega. Proteinurija je nađena u 126(83%) pacijenata, a vodeći simptom bila je u 45(29%) pacijenata. Razine proteinurije su bile više u pacijenata s biopsijom nativnih bubrega. Najčešće dijagnoze vezane za visoke vrijednosti proteinurije bile su fokalna segmentalna glomeruloskleroza, membranska nefropatija, bolest minimalnih promjena, dijabetička nefropatija i amiloidoza. Proteinurija u pacijenata s transplantiranim bubregom bila je nižih vrijednosti i povezana s kroničnim promjenama i kroničnim humoralnim odbacivanjem. S obzirom da se mnoge etiološki različite bolesti mogu klinički slično manifestirati i biti povezane sa proteinurijom, biopsija bubrega je od iznimne važnosti za postavljanje precizne dijagnoze i planiranje daljnjeg liječenja. Proteinuria is defined as an urinary protein excretion of more than 150 mg per day. It is a common sign of many kidney diseases, both primary, as well as systemic diseases. Based on the amount of excreted proteins, proteinuria is defined as mild (less than 1 gr per day), moderate (1-3,5 gr per day) or heavy (more than 3,5 gr per day) with typical signs of nephrotic syndrome. This study evaluated incidence and type of proteinuria in adult patients who underwent kidney biopsy in University Hospital Centre Zagreb during 2019. Results are correlated with histological changes found in kidney tissue. In period analysis, there were a total of 152 renal biopsies in adulta, including 87(57,24%) in males and 65(42,76%) in females. Biopsy of native kidney was performed in 89(58,55%) cases, and 63 (41,44%) were biopsies of transplanted kidneys (allograft biopsies). Proteinuria was found in 126(83%) patients and it was the leading symptom in 45(29%) cases. Levels of proteinuria were higher in patients with native kidney biopsy. The most common diagnoses wuith high levels of proteinuria were focal segmental glomerulosclerosis, membranous nephropathy, minimal change disease, diabetic nephropathy, and amyloidosis. Proteinuric patients with allograft biopsy tend to have lower levels of proteinuria, related to chronic changes, transplant glomerulopathy and chronic humoral rejection. Since many etiologicaly different diseases can have similar clinical manifestation and proteinuria, kidney biopsy is an essential tool to achieve precise diagnosis and assure adequate treatment.

U ovom je radu ispitivana vrijednost određivanja alfa-fetoproteina (AFP), humanog korionskog gonadotropina (hCG) i laktat dehidrogenaze (LD) u pacijenata kojima je tijekom 2017. u KBC Zagreb postavljena dijagnoza testikularnog tumora porijekla zametnih stanica (raka testisa). Nađeno je 65 novooboljelih (dob 11-70 godina; medijan 33,6), s ukupno 71 testikularnim tumorom. Najčešći histološki tipovi, seminom (S) i miješani tumor zametnih stanica (MGCT) nađeni su u 82% slučaja. Drugi tipovi tumora: čisti embrionalni karcinom (EC), čisti teratom i koriokarcinom (CC) bili su puno rjeđi. Sedam pacijenata je u trenutku dijagnoze imalo uznapredovalu metastatsku bolest. Vrijednosti LD, hCG i AFP bile su dostupne za 60 pacijenata od kojih su 24 (40%) imala povišene vrijednosti barem jednog od analiziranih biljega. Povišene vrijednosti LD nađene su u 5 pacijenata sa seminomom i dva pacijenta s MGCT (sa seminomskom komponentom). Blago do umjereno povišenje hCG je nađeno u 6 seminoma i 8 MGCT. Vrlo visoke vrijednosti hCG imao je jedan pacijent s metastatskim koriokarcinomom. Povišenje AFP je nađeno kod jednog pacijenta sa seminomom i 13 pacijenata s MGCT. Svih 11 pacijenata koji su preoperativno imali povišene tumorske biljege, tijekom kemoterapije je pokazalo normalizaciju vrijednosti. Ponovno povišenje tumorskih biljega je nađeno u njih trojice i bilo je povezano s progresijom bolesti. Pacijenti s dijagnozom EC i teratoma imali su normalne ili blago povišene vrijednosti tumorskih biljega. Iako nisu strogo specifični ili osjetljivi, određivanje serumskih tumorskih biljega AFP, hCG i LD se pokazalo korisno u velikoj skupini pacijenata s testikularnim tumorom zametnih stanica. Uz navedeno, u ovisnosti od vrijednosti navedenih biljega, pacijente se može podijeliti na skupine niskog, umjerenog i visokog rizika za progresiju bolesti, što je vrlo važno za odluku o daljnjem liječenju i načinu praćenja pacijenata oboljelih od raka testisa. This study evaluated use of alfa-fetoprotein (AFP), human chorionic gonadotropin (hCG) and lactate dehydrogenase (LD) in patients with testicular tumor diagnosed in University Hospital Centre Zagreb during 2017. There were 65 newly diagnosed patients (age range 11-70; median 33,6 years), with a total of 71 testicular germ cell tumor. Based on histology, Seminoma (S) and Mixed germ cell tumor (MGCT) were two most common types accounting 82% of all cases. Other types of germ cell tumors: pure Embryonal carcinoma (EC), pure Teratoma (T) and pure Choriocarcinoma (CC) were less common. Seven patients presented with advanced, metastatic disease. Data regarding AFP, hCG and LD were available for 60 patients; 24 of them (40%) had elevated levels of at least one analysed tumor marker. Elevated levels of lactate dehydrogenase were seen in five seminoma and two MGCT cases). Mild to moderate elevation of serum hCG was noted in 6 cases of seminoma and 8 cases of MGCT. Very high levels had one patient with choriocarcinoma. Elevation of AFP had one patient with seminoma, and 13patients with MGCT. All eleven patients with positive preoperative tumor markers, during chemotherapy showed normalization of values, while new increase in 3 patients during follow-up was related to disease progression. Patients with EC and teratoma had normal or mildly elevated levels of serum tumor markers. Although not very specific nor sensitive, evaluation of serum AFP, hCG and LD proved to be useful in significant subset of patients with diagnosis of testicular germ cell tumor. Based on serum tumor markers, patients could be divided into group with low, intermediate or high risk for disease progression, which is important for further therapy and follow-up.

Ovim su radom analizirani podaci pacijenata kojima su u razdoblju od siječnja do prosinca 2016. u KBC Zagreb učinjene transrektalne biopsije prostate. U analizu su uključeni osnovni klinički i laboratorijski podaci. U analiziranom razdoblju učinjeno je 356 biopsija prostate, od kojih 348 standardnih sa uzetih 12 uzoraka te 8 proširenih biopsija s 18 uzoraka. U 255 ispitanika radilo se prvoj, a u 101 o ponovljenoj biopsiji. Pacijenti su bili starosti od 48 do 88 godina (medijan 67 godina). Većina biopsija je učinjena u starosnoj skupini od 61-70 godina (186; 52,24%) uz PSA vrijednost 4-10 ng/ml (233; 65,44%). Ukupno gledajući, benigne promjene u bioptatima prostate (N=356) nađene su u 144 (40,45 %) pacijenata, nalaz suspektan na tumor je nađen u 37 (10,40 %) pacijenata, a jasni nalaz adenokarcinoma prostate je nađen u 175 (49,16 %) pacijenata. Pacijenti s dokazanim adenokarcinomom su u prosjeku bili 3 godine stariji od pacijenata s benignim ili suspektnim nalazom. Dok je većina pacijenata s benignim ili suspektnim nalazom imala vrijednosti PSA 4-10 ng/ml (75,69% i 75,68%), istu vrijednost je imalo samo polovina pacijenata (54%) s dokazanim adenokarcinomom, a značajan broj (41,7%) je imao vrijednosti PSA veće od 10 ng/ml. Pacijenti s klinički potvrđenom lokaliziranom bolešću imali su niže vrijednost PSA, manje od 4 pozitivnih cilindara prostate te histološki nalaz nižih gradusnih grupa, dok su pacijenti s uznapredovalim karcinomom imali vrijednosti PSA više od 10 ng/ml, često više od 8 pozitivnih cilindara i dokazan adenokarcinom viših gradusnih grupa (Gradus Grupa I vs Gradus Grupa IV). Kasniji podaci su bili dostupni za 305 pacijenata. U razdoblju praćenja do 36 mjeseci, 107 (35,08%) pacijenata nije pokazivalo znakove maligne bolesti, a u 27 (8,85%) je novo dijagnosticiran adenokarcinom prostate. U skupini pacijenata s ranije postavljenom dijagnozom adenokarcinoma (N=150), 21 (147%) je i dalje u statusu aktivnog nadzora, a kod 3 (2%) je započeto aktivno liječenje. Stabilno stanje bez znakova recidiva nađeno je u 112 (74,67%) ranije aktivno liječenih pacijenata, a progresija u metastatsku bolest u 14 (9,33%) pacijenata. This study included patients who underwent prostate core needle biopsy at University Hospital Centre Zagreb between January and December 2016. Main clinical and pathological features were analyzed. During analyzed period a total of 356 prostate core needle biopsies were performed, including 348 standard biopsies with 12 cores and 8 extended with 18 cores. In 255 cases prostate biopsy was performed for the first time, and 101 patient had previous prostate biopsy. Patients age ranged between 48 and 88 years (median 67 years). Most of biopsies were performed in group of patients aged 61-70 years (186; 52,24%) and with PSA levels 4-10 ng/ml (233; 65,44%). Overall, histological analysis in 144 (40,45 %) patients showed benign features, suspicious findings had 37 (10,40 %) patients and 175 (49,16 %) had definitive diagnosis of adenocarcinoma. Patients with proved adenocarcinoma on prostate biopsy were 3 years older than patients with benign or suspicious findings. While majority of patient with benign and suspicious findings had PSA levels 4-10 ng/ml (75,69% and 75,68% respectively), same levels had only half of patients (54%) with biopsy proven adenocarcinoma and significant amount (41,7%) of patients with adenocarcinoma had higher levels of PSA. Patients with clinically proven localized disease tend to have lower levels of PSA, less than 4 cores positive on biopsy and lower Grade Groups, while patients with advanced disease tend to have PSA levels higher than 10 ng/ml, more than 8 cores positive showing adenocarcinoma of higher grades (Grade Group I vs Grade Group IV). Follow-up data were available for 305 patients. In follow-up period (up to 36 months) 107 (35,08%) patients showed no signs of malignant disease, and 27 (8,85%) had newly diagnosed prostatic cancer. Of patients with previous diagnosis of prostate cancer (N=150), 21(14%) were still in active surveillance, 3 (2%) underwent active treatment. Stable state with no signs of progression were found in 112 (74,67%) previously treated patients, and progression to metastatic disease in 14 (9,33%) patients.

Karcinom bubrega je zloćudni tumor porijekla epitela bubrežnih kanalića, a najčešći histološki tip je tzv. svijetlostanični karcinom bubrega. Kirurško liječenje je metoda izbora za rane stadije karcinoma bubrega, dok je u slučaju metastatske bolesti neophodno i sistemno liječenje. U ovome radu prikazane su kliničke i patološke karakteristike bolesnika s metastatskim karcinomom bubrega liječenim antiangiogenim terapeutikom-sunitinibom u KBC Zagreb u vremenskom razdoblju od 6 godina (1. 7. 2010 - 30. 6. 2016.) Za 85 bolesnika liječenih sunitinibom bili su dostupni relevantni klinički i patološki podaci. Radilo se o 62 muškaraca i 23 žene (omjer 2,7:1), dobi od 33 do 80 godina (medijan 59 godina). Svijetlostanični karcinom bubrega je dijagnosticiran u 96,5% slučajeva, a ostatak čine neklasificirani karcinomi sa sarkomatoidnom slikom. Veličina primarnih tumora kretala se od 4 do 13 cm; prosječno 7,9 cm. Primarno metastatski karcinom bubrega je dijagnosticiran u 47 (55,3%) analiziranih bolesnika, dok su u ostalih metastaze nađene u razdoblju od 1 do čak 19 godina od dijagnoze primarnog karcinoma bubrega. Najčešća metastatska sijela bila su pluća (77,6%), kosti (56,4%) i jetra (22,3%). U analiziranoj skupini, liječenje sunitinibom je trajalo od nekoliko mjeseci do 8 godina, a u 62 (73%) bolesnika je sunitinib naknadno zamijenjen drugim lijekom, najčešće sorafenibom (18 bolesnika), nivolumabom (15 bolesnika) te everolimusom (13 bolesnika). U razdoblju praćenja 55 (64,7%) bolesnika je preminulo; 19 (22,4%) je živo s metastatskom bolešću, a 11 (12,9%) je izgubljeno iz praćenja. Petogodišnje preživljenje od dijagnoze karcinoma bubrega izračunato za 72 bolesnika iznosilo je 38,9%. Preživljenje bolesnika s primarno metastatskim karcinomom bubrega je bilo znatno lošije, s 32 (68,08%) bolesnika preminula u prve dvije godine od postavljanja dijagnoze. Od 19 i danas živih bolesnika ispitivane skupine, 9 je na terapiji sunitinibom (trajanje terapije od 3-8 godina); 6 bolesnika prima nivolumab, 3 aksitinib i 1 bolesnik prima pazopanib. Sunitinib je pokazao najveću učinkovitost u slučajevima oligometastatske bolesti te u slučajevima plućnih metastaza. Sunitinib i ostali terapeutici nisu pokazali značajnu učinkovitost kod pacijenata s prisutnim višestrukim metastatskim sijelima u sklopu brzo napredujuće bolesti te u slučaju moždanih metastaza. Renal cell carcinoma (RCC) is malignant tumor originating from epithelial lining of renal tubules. The most common type is clear cell renal cell carcinoma. Surgical approach is treatment of choice for early stage of RCC, while systemic therapy is needed for more advanced cases. This study included patients with advanced RCC treated with sunitinib at University Hospital Centre Zagreb between July 2010 and June 2016. Main clinical and pathological features were analyzed. Of 91 patients, relevant clinical and pathological data were available for 85 patients; 62 males and 23 females (ratio 2,7:1), with age range 33-80 years (median 59 years). Clear cell RCC was diagnosed in 96,5% and sarcomatoid unclassified RCC in rest of the cases. Size of primary tumors varied from 4 to 13 cm (average 7,9 cm). Primary metastatic RCC was diagnosed in 47 (55,3%) cases, in other metastases occurred in period from less than 1 year to up to 19 years after primary RCC. The most common metastatic sites were lungs (77,6%), bones (56,4%) and liver (22,3%). Sunitinib as a treatment for advanced RCC was used in wide period range, from few months to up to 8 years. During treatment and follow-up of 62 patients, sunitinib has been replaced with other therapeutics, most commonly with sorafenib (18 patients), nivolumab (15 patients) or everolimus (13 patients). In follow-up period 55 (64,7%) of patients included in this study died; 19 (22,4%) are alive with metastatic disease and 11 (12,9%) were lost from follow-up. Overall 5-year survival available for 72 analyzed patients was 38,9%. Patients with primary metastatic RCC had worse prognosis; 32 (68,08%) died in the first 2 years after diagnosis. Of 19 still alive patients, 9 are treated with sunitinib (duration of therapy 3-8 years); 6 with nivolumab, 3 with axitinib and one with pazopanib. Sunitinib showed the best efficacy in cases of oligometastatic disease and lung metastases. Sunitinib and other mentioned therapeutics were less efficient in cases with high tumor volume, multiple metastatic sites, highly advanced metastatic disease and brain metastases.