Urinary neutrophil gelatinase-associated lipocalin as early biomarker for renal disease in dogs with leishmaniosis.

Canine leishmaniosis (CanL), caused by Leishmania sp., presents a wide array of symptoms; renal dysfunction is frequently observed in these dogs and is associated with a poor prognosis and increased mortality. The traditional biomarkers namely urea and creatinine can detect renal damage but only in advanced stages of the disease. However, it has been shown that the symmetric dimethylarginine assay (SDMA) or the protein/creatinine ratio (UPC) and are early biomarkers of renal dysfunction. Their elevation occurs earlier than that of creatinine, but other novel biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) are currently under investigation. Our objective was to determine whether the urine NGAL-creatinine ratio (uNGAL/c) can provide very early diagnosis of kidney disease in CanL. In total, 68 dogs were included in the study: 15 healthy dogs and 53 dogs with CanL who were classified according to International Renal Interest Society (IRIS) classification: IRIS 1 (N= 34), IRIS 2 (N= 9) and IRIS 3/4 (N= 10). IRIS 1 was subdivided according to proteinuria in IRIS 1NP (13 dogs with UPC < 0.2), IRIS 1BL (8 dogs with UPC = 0.2-0.5) and IRIS 1 P (13 dogs with UPC > 0.5). Blood samples were collected for complete hematological and biochemistry analysis including plasma NGAL. Urinalysis included specific gravity, UPC, CysC and NGAL expressed as a ratio with creatinine. The mean concentrations of pCysC and SDMA in CanL, show a statistically significant increase from IRIS 1NP, not being statistically significant for pCysC in the IRIS 1BL group. The UPC show a statistically significant increase from IRIS 1NP. In all groups with CanL for uCysC/c and uNGAL/c was observed a statistically significant increase. The uNGAL/c in the group proteinuric animals, presents a positive correlation with all renal biomarkers studied. In the group of non-proteinuric animals, the uNGAL/c presents a positive correlation with SDMA and UPC. The uNGAL/c can be considered a reliable indicator of renal disease in dogs diagnosed with CanL who are non-azotemic and non-proteinuric.

Potential Biomarkers in Diagnosis of Renal Acanthamoebiasis.

Recent studies indicate that Acanthamoeba spp. may play a significant role in kidney dysfunction. The aim of the study was to examine the levels of kidney injury molecule 1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and monocyte chemotactic protein 1 (MCP-1), as well as an activity of matrix metalloproteinases 2 and 9 (MMP-2 and MMP-9, respectively) in the kidneys of immunocompetent and immunosuppressed mice infected with Acanthamoeba spp. The levels of KIM-1, NGAL, and MCP-1 were analyzed by enzyme-linked immunosorbent assay (ELISA), and the activity of MMPs was determined by gelatin zymography. The elevated KIM-1 level was found in the kidneys of immunocompetent mice at the beginning of Acanthamoeba spp. infection. In the immunosuppressed mice, the KIM-1 level was statistically different. The statistically decreased NGAL level was found in the kidneys of immunocompetent mice compared to the uninfected mice. In the immunocompromised mice, we found statistically significant differences in MCP-1 levels between the uninfected and infected groups. There was an increase in the expression of both MMP-2 and MMP-9 in the kidneys of immunocompetent and immunosuppressed mice infected with Acanthamoeba spp. compared to the uninfected mice. The results indicate that KIM-1, NGAL, MCP-1, MMP-2, MMP-9, and MMP-9/NGAL might be promising biomarkers of renal acanthamoebiasis.

Isolated renal hydatid disease: laparoscopic approach to an uncommon entity (case report).

Hydatidosis is a parasitic disease, endemic in various parts of the World. It frequently involves liver and lungs and, rarely, other organs as well. Isolated renal hydatidosis is a rare entity that accounts for less than 3% of all hydatid cases. Surgery remains the mainstay of treatment. We hereby report a case of isolated renal hydatid cyst involving left kidney that was managed by laparoscopic approach.

Medical treatment for an isolated renal multilocular hydatid cyst in an elderly: a case report.

BACKGROUND: Almost all cases of renal hydatid cysts need surgical intervention for treatment. We report a case of isolated renal hydatid cyst treated successfully only with medical therapy. CASE PRESENTATION: This case is a 79-year-old veterinarian presented with right flank pain, hydatiduria and positive echinococcus granulosus serology. A 70*50 mm cyst with daughter cysts in mid-portion of right kidney on presentation was changed into a 60*40 mm cyst without daughter cysts at last follow-up. Due to patient's refusal of surgery, our patient received medical treatment including praziquantel and albendazole. After completion of first round of treatment, recurrence occurred and the same treatment was repeated. At last, the cyst became inactive and calcified with negative serology and no clinical symptoms under medical treatment. CONCLUSION: The treatment of choice in renal hydatid cyst is surgery; although there are some reports about the efficacy of medical treatments for hydatid cysts but lower rates of recurrence and higher efficacy put surgery in a superior position compared to medical approaches. Our case showed relative success of medical treatment, despite the presence of a large multilocular renal involvement. Thus, medical therapy without surgery can be considered in very particular cases with isolated renal hydatid cysts.

Renal echinococcosis; the parasite, host immune response, diagnosis and management.

Renal echinococcosis is a rare parasite-caused disease of humans and animals; it makes up about 4% of confirmed cases of cystic echinococcosis. It is a zoonotic disease that occurs in the intermediate hosts harboring the larval stage, the hydatid cyst, of Echinococcus spp. The renal involvement is often asymptomatic or with unspecific signs. Its diagnosis is mostly based on imaging technique. Immunodiagnostic tests are not applicable. Furthermore, because the disease is not common, our knowledge about its different aspects is scarce. In this review, the parasite, host immune response, diagnosis, and management of renal echinococcosis are described.

Hydatid Cyst Treatment and Management in Retroperitoneal Organs; Is Percutaneous Drainage an Option?

PURPOSE: To evaluate patients who cyst hydatid (CH) in their retroperitoneal space and organs in order to determine a standard treatment option for CH. MATERIALS AND METHODS: The files of 56 patients who were treated for CH in our clinic were evaluated retrospectively. All patients underwent either percutaneous drainage (PD) or surgery. Patients were divided into two groups as PD (Group one) and surgery groups (Group two). Preoperative and postoperative results were compared statistically. RESULTS: 31 of 56 patients were male. Mean age of the patient was 39.7 (10-85). 16 patients had been treated with PD and 40 with different surgical interventions such as total cystectomy, partial cystectomy, partial nephrectomy, total nephrectomy, surrenalectomy, and laparoscopic partial surrenalectomy. Patients' followed up was 18 months (6-38m). Relapse was seen in 1 patient who underwent PD. On comparing the results, hospitalization period was prolonged in the surgical group with enlarged cyst presence. CONCLUSION: CH presence in the retroperitoneal area is rare. PD, a minimally invasive method, has the potential to be the standard treatment option as it can be performed safely in selected patients. However, currently surgical treatment is considered as the first treatment option after CH diagnosis.

Isolated Renal Hydatid Cyst Masquerading as Cystic Renal Tumor.

Hydatid disease or echinococcosis is a zoonotic disease caused by cestode Echinococcus granulosus. In humans, isolated renal involvement or primary renal hydatid cyst of the kidney is rare and accounts for about 1%-5% of all the cases of hydatid cyst. Isolated renal hydatid cyst can mimic cystic renal tumor both clinically and radiologically. We present a rare case of isolated hydatid cyst in a 38-year-old male who was diagnosed as a case of cystic renal tumor on radiology.

Case Report: Isolated Renal Hydatid Cyst in a Boy

Hydatic cyst is a crucial and prevalent parasitic disease in the developing countries in the Mediterranean region. Its diagnosis is sometimes problematic because of non-specific complaints and unavailability of any positive results in a routine laboratory analysis. Isolated renal hydatid cysts are very rare. In this study, a primary left renal hydatid cyst which was found in a 12-year-old boy was presented. He was referred by another hospital to our department with a flank pain and cystic mass in left kidney. Indirect haemagglutination test (IHA) for Echinococcus was negative. Nephrectomy was performed with the diagnosis of renal cyst hydatic. Renal cyst hydatid may present with various clinical findings ranging from asymptomatic clinical course to total loss in renal function. It will be beneficial to consider a renal hydatid cyst in patients with blurred flank pain, even if IHA is negative.

Biomarkers and renal arterial resistive index in dogs naturally infected with Leishmania infantum.

Canine visceral leishmaniasis frequently causes glomerulonephritis and tubulointerstitial nephritis, nephropathies for which diagnosis has been limited by the low sensitivity of traditional tests. The aim of this study was to evaluate serum cystatin C and urinary gamma-glutamyltransferase (uGGT) levels and the urinary GGT/urinary creatinine ratio (uGGT/uCR) and to measure the renal arterial resistive index (RARI) in dogs with leishmaniasis with varying degrees of renal injury based on the urine protein: creatinine ratio (UP/C) and serum creatinine (SCr) level. We tested 59 untreated adult dogs of both sexes and undefined breeds naturally infected with Leishmania infantum. The dogs were grouped into four groups based on UP/C and SCr level: group 1 (n = 15), dogs with SCr levels < 1.4 mg/dL and UP/C < 0.5; group 2 (n = 13), dogs with SCr levels < 1.4 mg/dL and UP/C of 0.5-1.0; group 3 (n = 16), dogs with SCr levels < 1.4 and UP/C > 1.0; and group 4 (n = 15), dogs with SCr levels > 1.4. A fifth group of healthy dogs (n = 10) was the control. uGGT concentrations and uGGT/uCR were higher in dogs with proteinuria and SCr < 1.4 mg/dL, whereas the serum cystatin C concentrations and RARI were higher only in dogs with SCr levels > 1.4. In conclusion, uGGT and uGGT/uCR may be useful tools for early detection and assessment of renal lesions associated with leishmaniasis; however, cystatin C is useful for monitoring the progression of kidney disease when measured sequentially.

Microfilaria in kidney biopsy: A report of two cases.

Filariasis is traditionally diagnosed on finding microfilaria in peripheral blood smear and in cases of occult filariasis by immunological tests. Clinically, it presents with a wide range of symptoms and signs. We present two cases of filariasis presenting with renal symptoms warranting kidney biopsy. Histopathology of both revealed microfilaria in the glomerular capillary loop. First case was a 23-year-old male who presented with complaints of passage of milky urine. Second case was a 36-year-old female patient who presented with complaints of gross hematuria. Urine examination revealed nephrotic range proteinuria in both patients. Subsequently they underwent guided kidney biopsy for the evaluation of nephrotic range protienuria. Histopathology of both revealed microfilaria in the glomerular capillary loop. However, neither of the two cases showed proliferative changes in the glomeruli. To conclude, diagnosis of filariasis on kidney biopsy by identifying microfilaria is very rare. High index of suspicion is required to diagnose filariasis due to its wide range of clinical presentation and laboratory findings.

Laparoscopic Treatment of the Isolated Renal Hydatid Cyst: Long-Term Outcomes from a Single Institution.

OBJECTIVE: To determine the effectiveness of treatment via laparoscopic approach and to present the long-term outcomes in patients with isolated renal hydatid cyst. MATERIALS AND METHODS: We reviewed the data of 11 patients who underwent laparoscopic treatment for isolated renal hydatid cyst between March 2004 and January 2017. Demographic characteristics and clinical, laboratory, and radiological findings of cases were examined. Mann-Whitney U and t-test were used in statistical analysis. RESULTS: The mean age of the patients was 36.7 years (25-51). The common complaint of the patients was lumbar pain and 9 patients had a palpable mass. It was identified that serologic evaluation of Echinococcus granulosus was positive in 5 patients. The mean cyst size was determined as 72 mm (40-150). The mean operation time was 128 minutes (120-150) while the length of hospital stay was 4 days (3-13). Perioperative major complication was not observed in any of the patients. The levels of hematocrit and creatinine were measured, 37.8 (26-43) and 0.93 (0.5-1.3), respectively, in the postoperative period, while these levels were 39 (26-45) and 0.90 (0.5-1.3) in the preoperative period and there was no statistically significant difference (P > .05). The mean follow-up time was 84 months (40-166). No relapses were observed in any patients. CONCLUSIONS: The treatment of renal hydatid cyst disease with laparoscopic approach is a safe and effective method. There was no recurrence in any of the patients in the long-term period. Further studies including a large series of patients are needed.

Isolated Renal Hydatid Cyst Misdiagnosed and Operated as a Cystic Renal Tumor.

OBJECTIVE: The aim of this work is the presentation of a case of isolated renal hydatid cyst with novel findings and an unusual surgical scenario. CLINICAL PRESENTATION AND INTERVENTION: A 54-year-old female patient presented with left loin pain and a palpable left renal mass. Imaging described a well-demarcated left renal cystic lesion with a double-layer wall. Radical nephrectomy was performed due to the possibility of malignancy. On retrograde revision, the double-layer wall represented the detached germinative membrane of a hydatid cyst that was confirmed by histopathology. CONCLUSION: Isolated renal hydatid cyst could be misinterpreted as a renal tumor. It should be considered in the differential diagnosis of renal cystic lesions.

Balamuthia mandrillaris Granulomatous Amebic Encephalitis With Renal Dissemination in a Previously Healthy Child: Case Report and Review of the Pediatric Literature.

Balamuthia mandrillaris is a recently described ameba known to cause a subacute to chronic central nervous system infection called granulomatous amebic encephalitis. Evidence suggests that apparently immunocompetent persons are at risk for disease and show a similar nonspecific presentation to that of immunodeficient persons. However, evidence of hematogenous dissemination, which has been found in immunodeficient patients, has been lacking in immunocompetent patients. Here, we describe a previously healthy patient with B mandrillaris-associated granulomatous amebic encephalitis in whom both central nervous system and renal disease were found during autopsy, which suggests hematogenous dissemination. We also provide a comprehensive review of the pediatric literature on this disease and its clinical presentation in children.

Huge Renal Hydatid Cyst-an Unusual Presentation: A Case Report.

Isolated renal hydatid cyst is a rare entity accounting for only 2-4% of cases. A 60-year-old male presented to our clinic complaining of pain in right flank. He had a history of eating raw sheep liver. Imaging revealed an expansive cystic mass measuring approximately300×180 mm in the right side of abdomen. The patient was treated by open surgery in combination with perioperative chemotherapy with albendazol. In this case, we reported an unusual presentation of hydatid cyst disease. Physicians should be aware of its clinical presentations and complications.

Characterization of BAFF and APRIL subfamily receptors in rainbow trout (Oncorhynchus mykiss). Potential role of the BAFF / APRIL axis in the pathogenesis of proliferative kidney disease.

Proliferative kidney disease (PKD) is a parasitic infection of salmonid fish characterized by hyper-secretion of immunoglobulins in response to the presence of the myxozoan parasite, Tetracapsuloides bryosalmonae. In this context, we hypothesized that the BAFF/APRIL axis, known to play a major role in B cell differentiation and survival in mammals, could be affected by the parasite and consequently be involved in the apparent shift in normal B cell activity. To regulate B cell activity, BAFF and APRIL bind to transmembrane activator and calcium modulator and cyclophilin ligand interactor (TACI) and B cell maturation antigen (BCMA), whereas BAFF also binds to BAFF receptor (BAFF-R). In teleost fish, although some BAFF and APRIL sequences have been reported, their receptors have not been identified. Thus, as a first step in the current work, we have identified homologues to mammalian TACI, BCMA and BAFF-R in rainbow trout (Oncorhynchus mykiss), that constitute the first report of BAFF and APRIL receptor sequences in fish. Subsequently we studied the transcriptional modulation of BAFF, APRIL, and the fish-specific related cytokine, BALM and their putative receptors in fish naturally exposed to T. bryosalmonae. Finally, to gain further insights on the functional role that these cytokines play during the course of PKD, we have studied their effect on the survival of kidney IgM+ B cells and on immunoglobulin transcription. Our results support the premise that the BAFF / APRIL axis could play an important role during PKD, which may open the possibility of new therapeutic treatments against the disease.

Occurrence of dioctophymosis in canines within a riparian zone of the Río de La Plata watercourse, in Ensenada, Buenos Aires Province, Argentina.

Dioctophymosis is a parasitic disease occasioned by the so-called "giant kidney worm", Dioctophyme renale, a nematode with an indirect life cycle. This parasite's definitive host is the mink, Mustela vison, though numerous wild and domestic mammals as well as man can serve as final hosts. The worms also can be in ectopic locations in the body. We surveyed 692 canines by ecography, urine sampling, surgery, necropsy, and clinical examination and diagnosed 244 cases of dioctophymosis (35.3%). Of the cases of dioctophymosis identified, 30.7% were obtained by ecography, 45.9% by urinalysis, and 17.6% by both those techniques -in addition to positive findings through surgery (2.5%), necropsy (2.5%), and the spontaneous elimination of the parasites (0.8%). Cases of dioctophymosis were observed in animals as young as 4months of age up to 15years. The frequency of D. renale diagnosis throughout the sampling period varied significantly. There was a statistically significant association between risk factors (swimming in the river, eating frogs, fish or eels, drinking ditch water) and the prevalence of infection. It was discussed the period missing after infection in canines.

[Fistulized renal hydatic cyst in a patient on chronic hemodialysis]. / Kyste hydatique rénal fistulisé dans les voies urinaires chez un hémodialysé chronique.

Hydatidosis is a parasitic infection caused by the larval stage of Echinococcus granulosus. Renal hydatic cyst is unusual. It may fistulize into the urinary excretory system, requiring specific management. The aim of our study was to highlight the diagnostic and therapeutic specificity of this pathology in patients on chronic hemodialysis among whom diuresis is not always preserved, in order to focus attention on hydaturia and to give an indication to diagnosis. We report the case of a 47-year old patient with a 4-year history of hemodialysis due to glomerular nephropathy detected at the final stage. Moreover, the patient had a 6-month histoiry of impaired general condition associated with right lower back pain, without fever. Abdominal CT scan showed right kidney measuring 13.4cm, with important ureteropyelocaliceal dilation, pushing the renal parenchyma associated with renal pelvis measuring 4.3cm, without detectable lithiasic obstacle. However, it showed membranous cyst at the level of the lower right renal polar parenchyma, measuring approximately 76.5 x 54 mm, contacting the renal pelvis, also containing a few membranes. The patient underwent thorough interview revealing the presence of hydaturia in the few drops of residual diuresis. Given that the patient had end stage chronic renal failure and that he was under renal replacement therapy, therapeutic approach was based on total nephrectomy.

Uncommon localizations of hydatid cyst. Review of the literature.

INTRODUCTION: Hydatid disease is an endemic anthropozoonosis with usual localization in liver and lungs. Rarely it localizes in uncommon sites as spleen, skeleton, kidney, brain, cardiac muscle, peritoneum, sub cutis. Complications of uncommon localizations are the same that for usual ones. MATERIAL AND METHODS: Review of the literature on rare and atypical localization of hydatid cysts in soft tissues. Key-words used on Pub-Med [(echinococ OR hydatid) AND (soft tissue OR subcutaneous OR cutaneous)] without time limit. There were found 282 articles; 242 were excluded because of muscular or bone localizations. 40 were coherent. RESULTS: Different variables are taken into account: age, sex, geographic area, anatomic localization of the cyst, dimension, symptoms, signs, mobility, blood exams and specific serological tests, imaging techniques for diagnosis, existing of septa in the structure, treatment, anaesthesia, spillage, neo-adjuvant and adjuvant treatment, follow-up period, recurrent lesions. CONCLUSION: It would be useful create an homogeneous and standardized collection of data of these rare and potentially life-threatening conditions in order to create guide-line of diagnostic and therapeutic process and create (or adopt) unique classification of the lesions.