Renal cell carcinoma with hepatic metastasis. The patient, a 58-year-old man, presented with difficulty urinating, fever, and other symptoms. He was diagnosed with renal cell carcinoma (RCC), the most common type of kidney cancer, which had metastasized to his liver. A medical workup found high cholesterol, creatinine, and other abnormalities. He underwent a nephrectomy where RCC was confirmed. A diet was prescribed to manage his condition, focusing on sodium and potassium restriction, adequate fluid intake, and maintaining a healthy weight. Regular medical follow-ups were recommended to monitor his progress and health status.

1. Renal Cell
Carcinoma
with Hepatic Metastasis

2. Introduction
Underlying Disease:
Renal Cell Carcinoma
- Most common type of cancer
- Carcinoma “Karkinos” meaning crab forming
cancer.
Secondary Disease:
-Hepatic Metastasis
-Pneumonia
-Severe Fatty Liver

3. Introduction
Etiology:
 Smoking
 Obesity
 Hypertension
Pathophysiology:
2 forms of RCC
 Hereditary
 Sporadic

5. Methodology
Patient Finding
Gathering of Data
Analysis and
Interpretation
Evaluation and
Implication
Recommendation

6. Subjective
Case: RCC with Hepatic Metastasis
Subject: Mr. Levi O. Fernandez
Age: 58 yrs. old
Civil Status: Married, with 3 sons
Occupation: Former Electrical
Engineer in Japan

7. Subjective
 Prior to his diagnosis, he experiences
difficulty in urinating, fever, malaise, night
sweats and hypertension.
 He loves eating salty foods, softdrinks and
sweets.
 The foods he doesn’t like are pork and
alcoholic beverages in relation to his
religion as an Adventist.

8. Objective
Table 1. Quantitative analysis of his 24-hour food recall
Meal No. of
exchanges
CHO (g) PRO (g) FATS (g) ENERGY (kcal)
Rice 10 230 20 - 1000
Meat
Low fat 1 - 8 1 41
Medium fat 1 - 8 6 86
Veg. A 2 3 - - 6
Coffee (free
food)
3 - - - -
TOTAL - 233 36 7 1133

9. Objective
 Nutrient Adequacy =
Actual Nutrient Intake/Recommended
Nutrient Intake *100
Protein = 36/60(100)
= 60%
Energy = 1133/2320(100)
= 49%

10. Objective
Food group Recommended servings Actual intake Variance
grains 6-11 6 0-5
vegetables 3-5 2 1-3
fruits 2-4 0 2-4
dairy 2-3 0 2-3
Meat/poultry/fish 2-3 2 0-1
Fats, oils and sweets Use sparingly 5 -
Table 2. Qualitative analysis of his 24-hour food recall

11. Assessment
 Anthropometric
Patient’s Height and Weight
Pt. Ht. = 5’7
= 67 inches
= 67 inches x 2.54 cm
= 170.18 cm or 1.70 m
Pt. Wt. = 73 kg

12. Assessment
Desirable Body Weight
DBW = 170.18- 100
= 70.18
= 70.18-7.018 (10% of 70.18)
=63.162 or 63 kg

13. Assessment
Body Mass Index
BMI = wt. (kg)/ ht. (m)²
= 73 kg/ 2.9
= 25.21

14. Assessment
Total Energy Allowance
TEA = Activity x DBW
= 35.0 (light) x 63 kg
= 2205 kcal

15. Assessment
 Biochemical
Clinical Chemistry Laboratory Findings/Result Reference Range Implication
- LDL Cholesterol 4.41 <4.07 HIGH
- Creatinine 135.2 umol/L 53.0-115.0 HIGH
- CHOLE-HDL Ratio 8.28 <4.40 HIGH
Table 3. Significant Laboratory Findings on Blood
Chemistry

16. HEMATOLOGY Laboratory Findings/Result Reference Range Implication
WBC COUNT 12.20 10^9/L 5.0-10.0 HIGH
Segmenters 0.83% 0.45-0.65 HIGH
Lymphocytes 0.17% 0.20-0.35 LOW
Table 4. Significant Laboratory Findings on Hematology

17. Urinalysis Laboratory Findings/Result Reference Range Implication
Physical examination
- Color Brown red Yellow
- Transparency cloudy Clear
- Reaction Acidic ACIDIC
Chemical Examination
- Nitrite Positive NEGATIVE BACTERIURIA
Table 5. Significant Laboratory Findings on Urinalysis

18. Sonography:

19. Radiological Test:

20. Final Histophatologic Diagnosis
Kidney, Radical nephrectomy (left):
RENAL CELL CARCINOMA, CLEAR CELL TYPE, FUHRMAN GRADE 2, 8.4
CM IN WIDEST TUMOR DIMENSION.
RENAL CAPSULAR INVASION AND LYMPHOVASCULAR SPACE INVASION
ARE PRESENT.

21. Plan
 Diet Rx: 2520kcal; C445; P38; F79
2000 mg Na
1600 mg K (41 mEq)
500 mg P (39 mEq)
1200 Ca(60 mEq)
1500 ml fluid
HBV - 2/3 (25.2)
LBV - 1/3 (12.6)

22. Food group # of
exchanges
Pro Na K Ca P Fluid Cho Fat
Milk
A.powder
½ 4 80 200 180 125 0.3 6 5
Meat ¾ 26 - - - - - - -
Lean Meat
(V-A)
1 - 30 200 15 70 31.0 - 1
Fish
(V-A)
1 ½ - 45 300 22.5 105 46.5 - 1.5
Egg (V-C) ¾ - 82.5 71.25 37.5 86 33.75 - 4.5
Total - 30 237.5 771.25 255 386 111.55 6 12

23. Food group # of
exchanges
Pro Na K Ca P Fluid Cho Fat
Veg. B1 2 0.6 16 220 60 20 60 3 -
Rice 6 12 - - - - - 118 -
A 4 - 8 240 60 140 300 - -
B 1 - 230 60 20 35 10 - -
Total - 12.6 254 1520 140 195 370 121 -
Total 3 & 4 - 42.6 492 1292 395 581 482 127 12

24. Food group # of
exchanges
Pro Na K Ca P Fluid Cho Fat
Fruits 3 0 - - - - - - -
A 2 0.8 6 240 20 20 95 20 -
B 1 0.2 2 60 5 5 42 10 -
Sugar 63.6 - - - - - - 384 -
Total - 1.0 8 300 25 25 137 414 -
445 (prescribed)
127 (milk and vegetable and rice)
318 /5 = 63.6 or 64

25. Food group # of
exchanges
Pro Na K Ca P Fluid Cho Fat
Fat - - - - - - - - -
A 8 0.5 320 16.0 8.0 8.0 8.0 - 4.0
B ½ - 9 22.0 4.0 10.0 9.0 - 2.5
Free foods 4 - - - - - - - 20
Total 3,4,5 and
6
44.1 829 1630 432 624 636 541 74.5
Fat milk 5
Meat 12
17 – 79 = 62 / 5 = 12.4 or 12

26. Fluid rx = 1500 ml
Inherent 636 ml
864 ml (additional oral fluid)
Na rx = 2000 mg/day
Inherent 829 mg
1171 mg/day (additional oral)
1200 – 432 = 768 = 1 tablet

27. Intervention
Medical
 Omeprazole, to maintain healing of erosive esophagitis
 Vit. B complex, to treatment To Prevent Vitamin Deficiency Medications
Inherited Disease Marked by Excretion of Sulfur in Urine Medications
 Paracetamol, Taken as required for relief of mild-to-moderate pain or fever.
 Clonidine, treat high blood pressure
 Tramadol, treat moderate to severe pain
 Tranexamic acid, used to control unwanted bleeding
 Ceftriaxone, given before certain types of surgery to prevent infections that may
develop after the operation
 Centrum silver , For Multivitamins and minerals deficiency
 Neobloc, H TN & chronic angina pectoris.

28. Intervention
Diet
 Maintain A Healthy Body Weight
 Eating more vegetables and fruit
 Potassium and sodium restriction
 fluid
 Low calorie diet

29. Evaluation
 To check if the patient will follow the
dietary plan, there should be a regular
visit and report about the progress of his
condition. Regular checkup in his
physician is also recommended to have
an update about his health status.

30. The End.