[Kidney transplantation in children weighing 11 kg or less]. / Trasplante renal en el paciente con peso igual o menor a 11 kg.

AIMS OF THE STUDY: To evaluate the outcome of kidney transplantation in children with low weight. METHODS: Retrospective review of the medical records of patients weighing 11 kg or less that received kidney transplantation between 2001 and 2013 were retrospectively reviewed. RESULTS: Fifty-nine kidney transplantations were performed in pediatric patients in our center, 12 of them were performed in patients weighing 11 kg or less (20%). The mean age of the recipient at the time of transplantation was 2 years (1-3.5); the mean weight was 9.4 ± 1.1 kg (8.3-11). The etiology of kidney failure was malformative in 42% of patients, inherited in 33%, glomerular in 8% and oiler etiologies in 17% of the patients. Two patients did not receive replacement therapy before transplantation (16.7%), nine received peritoneal dialysis (75%) and one of them hemodialysis (8.3%). Eleven of the grafts were from cadaveric donor (91.7%) and one of them from a living donor (8.3%). The mean donor age was 10 years (0.5-29). There was one case of acute graft thrombosis (8.3%) and one case of eventration requiring reoperation; there were no other major complications. Mean follow-up was 59 months (4-130). Overall survival (OS) was 100% at 1 year and 91.7% at 5 years. There was one death in a patient with mitochondrial disease with a functioning graft. Graft survival (GS) was 92% at 1 year and 75% at 5 years. CONCLUSION: Kidney transplantation is the treatment of choice for end-stage kidney failure in the young child. It provides good results in terms of patient and graft survival.

[Cell energetic loading in experimental renal transplant with different periods of warm ischemia]. / Estudio de la carga energética celular en el trasplante renal experimental con diferentes periodos de isquemia caliente (0-30-45 y 90').

INTRODUCTION AND GOALS: Renal procurement after a period of heart st op demands a previous knowledge of ischemia-reperfusion injuries means. To study cell injury mechanisms an experimental study has been designed in pigs, with different rangres of warm ischemia (0-30-45 and 90 min). The main goal was to research on the basis of ischemic injury. MATERIAL AND METHODS: Biochemical parameters (creatinine, urine output), energetic loading (ATP, ADP, AMP and global energetic loading) and pathological studies as long as survival analysis by 5th day were completed. RESULTS: Animal survival and graft viability range from 100% at 5th day in control and 30 min warm ischemia groups to 60% in 90 min warm ischemia group. Creatinine levels rises at 1st, 3rd and 5th day, especially in those non-viable organs. ATP levels decrease after warm ischemia period, increases ADP and AMP levels after reperfusion in those viable organs. CONCLUSIONS: Prolonged periods of warm ischemia do not result necessarily in non-viable kidneys. Viable organs recover nucleotide levels early. Study of energetic cell loading levels is a good way to get on better in the knowledge of injury mechanisms after ischemia-reperfusion.

Antioxidant patterns (superoxide dismutase, glutathione reductase, and glutathione peroxidase) in kidneys from non-heart-beating-donors: experimental study.

INTRODUCTION: The evolution of renal antioxidant concentrations in the different phases of a non-heart-beating donor (NHBD) transplant after prolonged warm ischemia (40 and 90 minutes) and the effect of normothermic extracorporeal recirculation (37 degrees C) for 30 minutes were evaluated on antioxidant tissue concentrations in the kidney. METHODS: Forty pairs of pigs, were divided into groups of 10 as follows: group 0, control donor with beating heart; group 1, 40 minutes of warm ischemia without recirculation by cardiopulmonary bypass pump (groups 2 and 3); group 2, 40 minutes of warm ischemia and recirculation for 30 minutes at 37 degrees C; and group 3, 90 minutes of warm ischemia and recirculation for 30 minutes at 37 degrees C. The concentrations of superoxide dismutase (SOD), glutathione peroxidase, and glutathione reductase were determined at the tissue level by biopsy at baseline the end of warm ischemia, the end of recirculation, at the end of cold ischemia, and 1 hour after reperfusion. RESULTS: SOD was consumed at the end of the cold ischemia phase (P < .009) and increased during reperfusion (P < .02). Glutathione reductase was consumed during the cold ischemia phase (P < .04). In kidneys submitted to 40 minutes of warm ischemia, SOD was consumed during the cold ischemia phase (P < .04) and increased with reperfusion (P < .03). In kidneys undergoing 90 minutes of hot ischemia, SOD was consumed during cold ischemia (P < .04) and glutathione reductase during extracorporeal recirculation (P < .01). CONCLUSIONS: Recirculation increased the tissue level of SOD at the end of the cold ischemia period.

[Living donor kidney transplantation: helical CT evaluation of candidates]. / Trasplante renal de donante vivo: evaluación de los candidatos mediante TC helicoidal.

OBJECTIVES: Computed tomography (CT) is a diagnostic tool that has won acceptance in the past years for the vascular evaluation of living renal donor (LRD) candidates. We show the findings observed in a series of 102 candidates consecutively evaluated in our centre and present the correlation with the surgical data obtained in those individuals finally operated. METHODS: From May 1995 to June 2005, 102 LRD candidates were evaluated with CT. Eighteen were also studied with digital subtraction angiography (DSA). Fifty-eight donors underwent nephrectomy. Prevalence of arterial and venous variants found on CT exams were analyzed, as well as the correlation with surgical and DSA data when they were obtained. RESULTS: Forty-four percent candidates showed multiple renal arteries at least in one kidney. Seventy-one percent of right kidneys and 76% of left kidneys had a single arterial pedicle. Early branching was observed in 7.8% and 15.7% in right and left kidneys respectively. Venous variants were present in 17.5% and the 13.7% in right and left sides respectively. Sensitivity, specificity and accuracy of CT to detect accessory arteries were 89%, 100% and 97% respectively when it was compared to DSA. Correlation with surgical data raised 93% for the presence of arterial variants. CONCLUSIONS: Vascular variants in renal pedicle showed a high prevalence. Helical CT can effectively achieve all the information required prior to surgery as a sole imaging procedure in LRD candidates.

Cystic pyeloureteritis: review of 34 cases. Radiologic aspects and differential diagnosis.

OBJECTIVES: To refine the clinical and radiologic description of an unusual benign disease, cystic pyeloureteritis (CPU), consisting of the appearance of suburothelial cysts that raise the mucosa layer of the urothelium. We also studied its relationship with various types of inflammation, including chronic infection, that may be the stimulus for the appearance of CPU. METHODS: We compiled 34 cases of CPU covering the period 1976 to 1994, analyzing the clinical manifestations, diagnostic procedures, differential diagnosis, and evolution. RESULTS: There are no specific symptoms associated with the presence of cysts. The average age of the patients was 59 years (range 30 to 77). Urinary tract infection was detected in 18 (53%). The pyeloureteritis was unilateral in 27 (79%) and bilateral in 7 (21%) of the patients. The location of the cysts was as follows: 1 pyelic (3%); 6 pyeloureteral (18%); and 27 (79%) ureteral. Resolution of the radiologic alterations depends on the resolution of the associated pathology: infections, lithiasis, and obstruction. CONCLUSIONS: We conclude that CPU is a benign pathology with indolent evolution and variable duration; it is not associated with sequelae. Diagnosis is made on the basis of radiologic findings, mainly intravenous urography; in view of the minor entity of the pathology, biopsy is not advisable if the radiologic findings are conclusive.

[Calcified kidney masses. Study of 23 cases]. / Masas renales calcificadas. Estudio de 23 casos.

We consider the presence of calcifications in a series of 107 renal masses by means of simple X-ray, echography and CAT, in which 23 cases (21.4%) were found. The most effective exploration for revealing them was CAT (in 13% of the cases, the only one). We found a relative higher frequency of calcification in the benign masses (31%) than in the neoplastic ones (17%). In the latter we found no differences in survival as compared with the non-calcified ones. No pattern of calcification proved characteristic of benignity or of neoplasia. The variety of malignant renal mass most often calcified was the papillary hypernephroma (57.1%).

[Xanthogranulomatous pyelonephritis. Our experience in the last 10 years]. / Pielonefritis xantogranulomatosa. Nuestra experiencia en los últimos 10 años.

A retrospective study of 34 xanthogranulomatous pyelonephritis (XGP) cases operated on in our Service was performed. An analysis is made of the clinical signs, laboratory data, imaging diagnostic techniques and the value of cytology in the assessment of this entity. A very characteristic clinical and biological picture, although somewhat nonspecific of XGP, was encountered. The high sensitivity of simple abdominal X-ray films and I.V.U., as well as the high specificity of cytologic studies in the diagnosis of the disease, was shown.

[Growing teratoma syndrome in metastatic germinal non-seminomatous testicular tumors]. / Síndrome del crecimiento teratomatoso en los tumores germinales no seminomatosos metástasicos de testículo.

Presence of retroperitoneal or mediastinal mature teratomas secondary to metastatic testicle germinal tumours which have not responded to multiple chemotherapy constitute the so called Growing Teratoma. They can either represent the metastasis of a mature teratoma site in the original testicle tumour or the evolution from a non-differentiated lesion during therapy. The first two cases of Growing Teratoma Syndrome published in the national literature are presented here. Both cases had a retroperitoneal growth of the mature teratoma following successful achievement of normalization of serum tumoral markers through chemotherapy with CDDP, Bleomycin, and VP-16 in one case (Hospital Clínico) and with BOMP/EPI (Belomycin, Metrothexate, Vincristine, Cisplatin/Vo-16, Cisplatin, Iphosphamide) in the second one (Hospital del Mar) of a non-seminomatose testicle tumour. After a follow-up of 14 and 9 months respectively the good prognosis of these mature teratomas was verified in both cases, so as in the rest of the literature. We coincide with regard to performing a retroperitoneal lymphadenectomy with exeresis of tumoral masses as the most adequate attitude, both to prevent growth of the mature teratoma and to allow us to discard the presence of residual immature lesions.

[Malignant hemangiopericytoma: a rare primary retroperitoneal tumor]. / Hemangiopericitoma maligno: un raro tumor retroperitoneal primario.

A case of malignant retroperitoneal hemangiopericytoma is described. The infrequency of the retroperitoneal mesenchymatous origin, specific anatomopathological criteria of malignity, constant hypervascularization as well as clinico-radiological, surgical and prognostic characteristics found in the literature are highlighted.

[Congenital obstructive disease of the ureter]. / Enfermedad obstructiva congénita del uréter.

Congenital diseases of the ureter form a broad sub-section of urology, where nomenclature is not clear and much less their etiopathogeny. In attempt to clear this up, we present the morphological study of ureteral development throughout the whole embryonic period, in both human and rat embryos, by means of the use of optical and electronic microscopy. After the description of ureteral obstruction phenomena (at the ureterovesical union and in the ureter itself), we discuss their physiopathological implications in embryonic development and we put forward a common etiopathogenic theory for obstructive diseases of the ureter with a congenital origin.

[Cholesteatoma of the kidney pelvis in horseshoe kidney]. / Colesteatoma de la pelvis renal en un riñon en herradura.

This paper presents one case of cholesteatoma of the left renal pelvis of a horseshoe kidney. This is quite an unusual process presenting an uncertain etiology and originated from a escamour metaplasia of the urothelium. Diagnosis can be made by X-rays and unlike leukoplasia it is not considered to be a pre-malignant condition. Probable etiologies, diagnosis and treatment are commented.

[Bladder lavage cytology in the diagnosis and follow-up of superficial bladder cancer]. / La citología del lavado vesical en el diagnóstico y seguimiento del cáncer vesical superficial.

Classical mictional cytology (MC) has a series of widely recognized limitations for the diagnosis and follow-up of surface vesical carcinoma (SVC). A prospective study was conducted in 171 patients with suspected signs and symptoms or a background of SVC using cystoscopy, MC and vesical lavage cytology (LC). Overall sensitivity was 98.8%, 45.4% and 66.6% respectively. LC showed a significant difference (p < 0.05) when compared to MC in suspected disease with no SVC background, and follow-up with endovesical prophylaxis.

[Erectile dysfunction and its severity are related to the number of cardiovascular risk factors]. / La disfunción eréctil y su severidad están en relación con el número de factores de riesgo cardiovascular.

AIM: Erectile dysfunction (ED) is a very common condition in the general population. ED is closely related to Hypertension (HT), Diabetes Mellitus (DM), Dyslipidemia (DLP) and Metabolic Syndrome (MS). This study has aimed to clarify whether the presence and severity of ED are related to the presence and number of cardiovascular risk factors (CVRF). MATERIAL AND METHODS: We retrospectively analyzed the characteristics of 242 males referred to our center for a prostate biopsy from September 2007 to December 2009. The following variables were collected prospectively: age, height, weight, body mass index (BMI), AHT, DM, DLP and obesity (BMI<30 kg/m(2)). The Erection Hardness Score Questionnaire was used to assess erectile function. We analyzed the relation between the presence and severity of ED and the presence of HT, DM, DLP and obesity. We analyzed the clinical variables based on the presence or absence of ED and in relationship to its severity. RESULTS: The presence of ED was related to HT (OR: 1.805 [1.128-2.887]; p=0.013), DM (OR 3.585 [1.613-7.966]; p=0.001) and Dyslipidemia (OR: 1.928 [1.062-3.500]; p=0.029). Erectile function was not related to Obesity (OR: 0.929 [0.522-1.632]; p=0.795). Patients with ED were more likely to have more CVRF (p=0.009) and the severity of ED was related to the presence of HT (p<0.001), DM (p<0.001), DLP (p=0.001) and the number of CVRF (p<0.001). CONCLUSIONS: The presence and severity of ED correlate with the presence of HT, DM, Dyslipidemia and the number of DVRF.

[Large series of 114 cases with long-term follow-up of upper urinary tract urothelial tumors]. / Carcinoma urotelial de tracto urinario superior: 114 casos con largo seguimiento.

PURPOSE: Upper urinary tract urothelial carcinoma (UUTUC) represents 5% of all urothelial tumors and has uncertain prognostic. Exist few series which describes clinical-pathological parameters of tumor progression. The aim of this study is to evaluate clinical and pathological parameters and determine their value as prognostic factors of tumor progression and cancer-specific survival. MATERIAL AND METHODS: Retrospective analysis of 114 cases of radical nephroureterectomy or partial ureterectomy collected between 1991-2004. Variables analyzed were age, sex, pathological tumor stage, histological tumor grade, CIS, tumor localization, multiplicity, bladder cancer history, pathological nodes and adjuvant chemotherapy. Spearman test was used for correlations. The probabilities of progression free survival and cancer-specific survival were calculated using Kaplan-Meier curves. In the multivariate analysis forward stepwise Cox regression was performed. RESULTS: Pathological stage was: 15 pTa, 25 pT1, 26 pT2, 32 pT3 and 16 pT4. There were 10 G1 (9%), 52 G2 (45.5%) and 52 G3 (45.5%). Fifteen patients presented pathological nodes at the moment of diagnosis. Fourteen percent of 114 patients received adjuvant treatment (Platin-based regimen). Mean follow-up: 74.8 months; 30.7% of the patients developed tumor progression. Death from the disease: 24.6%. Five-years overall and cancer-specific survival: 59.3% and 72.9%, respectively. Five-year progression-free survival: 68%. Mean time of tumor progression: 12.2 months and 23.3 months for cancer-specific death. In the multivariate analysis the independent predictive variables of death and tumor progression were histological grade and pathological stage. CONCLUSIONS: We demonstrated that histological grade and pathological stage constitute independent prognostic factors of tumor progression and cancer-specific survival in UUTUC.

Audit of an initial 100 cases of laparoscopic live donor nephrectomy.

BACKGROUND: The objective of this study was to analyze variables related to the surgical technique and postoperative evolution of kidney donors. MATERIALS AND METHODS: This retrospective analysis describes 100 laparoscopic nephrectomies from living donors performed in our hospital between February 2002 and July 2007. The variables were age, family relationship, surgical time, warm ischemia time, hospital stay, oral feeding resumption, morphine use, return to work, and complications. RESULTS: The average age of the donors was 49.5 years and their male:female ratio was 1:2. The left kidney was extracted from 82% of patients. The warm ischemia time was 2.5 minutes (range = 1.09-5.10). There was only one case of multiple vessels. The surgical time was 149.5 minutes (range = 80-255). The mean hospital stay was 4.8 days (range = 1-18). Food intake was resumed after 24 hours, with morphine needed for 0.9 days. The time to return to work was 39 days (range = 7-120). The complications included kidney rupture (n = 1), liver tear (n = 1), hematoma (n = 6), including four requiring blood transfusions; fever and leukocytosis (n = 5) and one collection. No patients died as a result of the surgery. CONCLUSIONS: Living-donor laparoscopic nephrectomy constitutes the gold standard among surgical options.

Third and fourth kidney transplant: still a reasonable option.

INTRODUCTION: At present, a second kidney transplant is considered an established therapeutic option for patients who have lost a previous graft. Second transplants show similar graft survival as first transplants. A debate exists about the benefit of submitting the patient to a third or fourth renal transplant, or to maintain dialysis. OBJECTIVE: We sought to analyze graft and patient survivals as well as associated variables and surgical complications of third and fourth transplantations. MATERIAL AND METHODS: From July 1985 to December 2008, we performed 74 third and 8 fourth transplantations among 2763 cases. We prospectively collected the variables of age, gender, graft origin, hyperimmunization, time on dialysis, location, bench surgery, acute rejection episodes, graft survival, and operative complications. RESULTS: Third and fourth trasplantations were performed in 49 men and 33 women, with an overall mean age of 40.26 years who were on dialysis for an average of 126.89 months before transplantation. Mean graft survivals of their first and second grafts were 35.6 and 50.1 months, respectively. Acute or chronic rejection was reason for renal failure in 71% and 75% of cases, respectively. Patient survivals at 1 and 5 years were 92.7% and 90.6%, for third and both 85.7% for the fourth transplantation. The third and fourth transplantations showed 1- and 5-year graft survivals of 88% and 76.4% and 71.4% and 42.9%, respectively. Sixty-eight cases underwent cadaveric donor and 14 living donor (mean age, 42.1 years) transplantations. Nine patients were hyperimmunized. In 60 cases, we used the left kidney. Orthotopic kidney transplantation was performed in 15 cases; heterotopic transplant to the right iliac fossa in 40 and in the left iliac fossa in 17 cases. Arterial bench surgery was necessary in 6 cases and venous in 3. We performed 3 hepatorenal and 1 cardiorenal transplantation. The complications included 29 cases (35.4%) of postoperative acute tubular necrosis, 14 of acute rejection episodes (17.1%); 12 of perirenal hematoma (14.6%); 1 urinary fistula (1.2%); 4 lymphocele (4.9%); 2 ureteral stenosis (2.4%); variables arterial kink requiring surgery (1.2%), and 1 venous thrombosis with graft loss (1.2%). The 4 patients who died in the perioperative period succumbed to intravascular disseminated coagulation (n = 1) cardiac failure (n = 2), and septic shock (n = 1). Induction antibody therapy, hyperimmunized status, or operative complications were not independent prognostic factors for patient or graft survival. CONCLUSIONS: Third or fourth renal transplantations constitute a valid therapeutic option with reasonable short- and long-term patient and graft survivals. Although orthotopic kidney transplantation was used in selected patients, we preferred an iliac fossa approach for most.