Predicting Future Renal Function Decline in Patients with Autosomal Dominant Polycystic Kidney Disease Using Mayo Clinic Classification.

INTRODUCTION: Mayo clinic classification (MCC) has been proposed in patients with autosomal dominant polycystic kidney disease (ADPKD) to identify who may experience a rapid decline of renal function. Our aim was to validate this predictive model in a population from southern Spain. METHODS: ADPKD patients with measurements of height-adjusted total kidney volume (HtTKV) and baseline estimated glomerular filtration rate (eGFR) >30 mL/min/1.73 m2 were selected. Last eGFR was estimated with Mayo Clinic (MC) equation and bias and accuracy were studied. We also analyzed predictive capacity of MCC classes using survival analysis and Cox regression models. RESULTS: We included 134 patients with a mean follow-up of 82 months. While baseline eGFR was not different between classes, last eGFR decreased significantly with them. eGFR variation rate was different according to the MCC class with a more rapid decline in 1C, 1D, and 1E classes. Final eGFR predicted was not significantly different from the real one, with an absolute bias of 0.6 ± 17.0 mL/min/1.73 m2. P10 accuracy was low ranging from 37.5 to 59.5% in classes 1C, 1D, and 1E. Using MC equation, the rate of eGFR decline was underestimated in 1C, 1D, and 1E classes. Cox regression analysis showed that MCC class is a predictor of renal survival after adjusting with baseline eGFR, age, sex, and HtTKV, with 1D and 1E classes having the worst prognosis. CONCLUSION: MCC classification is able to identify patients who will undergo a more rapid decline of renal function in a Spanish population. Prediction of future eGFR with MC equation is acceptable as a group, although it shows a loss of accuracy considering individual values. The rate of eGFR decline calculated using MC equation can underestimate the real rate presented by patients of 1C, 1D, and 1E classes.

Differential Diagnosis of Hepatic Mass with Central Scar: Focal Nodular Hyperplasia Mimicking Fibrolamellar Hepatocellular Carcinoma.

Fibrolamellar hepatocellular carcinoma is a primary hepatic tumor that usually appears in young adults. Radical surgery is considered curative for this kind of tumor, so early diagnosis becomes essential for the prognosis of the patients. The main characteristic of this entity is the central scar, which is the center of differential diagnosis. We report the case of a 30-year-old man who was diagnosed with fibrolamellar hepatocellular carcinoma by ultrasonography. Contrast-enhanced CT confirmed this diagnosis, and the patient underwent a [18F] fluorocholine PET/CT. Hypermetabolism and the morphology in the nuclear medicine exploration suggest neoplastic nature of the lesion. Radical surgery was performed, and histopathologic analysis was performed, which resulted in focal nodular hyperplasia. Hepatic masses with central scar could have a difficult differential diagnosis, and focal nodular hyperplasia could mimic fibrolamellar hepatocellular carcinoma imaging patterns. These morphofunctional characteristics have not been described in [18F] Fluorocholine PET/CT, so there is a need to find out the potential role PET/CT in the differential diagnosis of hepatic mass with central scar.

Atraumatic splenic rupture as a complication of acute exacerbation of chronic pancreatitis, an unusual disease.

We report the case of a patient with acute exacerbation of chronic pancreatitis and he suffered an atraumatic splenic rupture. Splenic rupture not associated with trauma is a rare entity that can occurs in normal spleen (spontaneous) or damaged spleen (pathological). This entity may be associated with local inflammatory processes, such as pancreatitis. Ultrasound is a non-invasive technique which is used in unstable patients. CT is useful for making a diagnosis of extension in patients with hemodynamic stability. Atraumatic splenic rupture as a complication of chronic pancreatitis is an unusual disease that requires a high index of suspicion which allows us an early diagnosis because it is a treatable entity that compromises the patient's life.

Nephron-sparing surgery for adenocarcinoma in a renal allograft.

The incidence of malignant tumors in recipients of renal allografts is higher than in the general population. Renal cell carcinoma (RCC) accounts for 4.6% of the tumors in transplanted patients; of them, only 10% are found in transplanted kidneys. Transplantectomy has always been the usual treatment. However, during the last years, nephron-sparing surgery of the allograft is more frequently done in well-selected cases, and therefore dialysis can be avoided. We report the case of a 37-year-old female patient with renal transplant, diagnosed with a 4.5 cm tumor in the lower pole of the renal allograft. The patient underwent partial nephrectomy successfully. Six years after surgery, there is no evidence of recurrence of the disease and the patient maintains an adequate renal function.

Retroperitoneoscopy to extract dropped gallstones after laparoscopic cholecystectomy.

Complications resulting from gallstones left in the peritoneal cavity are most often reported after laparoscopic treatment of cholelitiasis. Gallstones are frequently dropped in the posterior subhepatic space, which can lead to the development of abscesses that usually require laparotomy for extraction of the stones. We present a novel technique for treating collections associated with dropped gallstones, using retroperitoneoscopy with two 10-mm ports after ultrasound localization of the abscess. We carried out this procedure in two patients and successfully extracted the gallstones without postoperative complications or recurrences. We consider this approach to be technically feasible, safe, and effective. It avoids the usual inefficacy of simple percutaneous drainage of these collections and the complications associated with the drainage of intra-abdominal abscesses by laparotomy.

Application of modern imaging methods in diagnosis of gallbladder cancer.

The poor prognosis of gallbladder cancer (GBC) is related to its dissemination capacity and usually late diagnosis due to its non-specific clinical appearance. Recent improvements in hepatobiliary surgery have underlined the importance of an early specific diagnosis, which requires a multidisciplinary approach and, when possible, specialized equipment. The first step in an early diagnosis is to identify patients in the appropriate epidemiological setting (e.g., incidental finding, chronic cholecystitis) for the correct interpretation of test results. It is desirable to enhance the sensitivity of the initial ultrasound (US) examination by use of the appropriate technology in skilled specialist hands. When GBC is suggested by US findings, FDG-PET can be considered complementary to establish the benign/malignant nature of the lesion and to obtain a primary staging study. If GBC is confirmed, thin slice spiral CT can contribute valuable information on local spread. In this regard, recent hybrid PET-CT systems provide structural and functional information simultaneously and may offer early and accurate T, N, and M staging with an improved specificity.