Significance of urodynamic assessment of lower urinary tract in dialysis patients before renal transplantation.

INTRODUCTION: Some dialyzed patients suffer from lower urinary tract (LUT) anatomic and functional disturbances. Complete LUT assessment should be performed to decide whether they can be included on the waiting list, because such disorders, if not diagnosed and properly treated before transplant, may lead to graft loss. PATIENTS AND METHODS: Based on data in the medical records of 4170 dialysis patients, 535 were selected for further investigation: 265 patients after undergoing urethrocystography or urethrocystoscopy, were included on the waiting list for transplantation and 145 patients underwent nephroureterectomy owing to reflux, nephrolithiasis, polycystic renal disease, or hydronephrosis. Five patients with urethral or bladder neck stricture underwent urethral dilation or bladder neck incision. These patients were also ultimately listed for transplantation. Twenty-two patients, with serious LUT disease were qualified for kidney transplantation after extra-anatomic urine outflow. Ninety-eight patients underwent a urodynamic study (URD) to assess LUT disturbances. RESULTS: Of 535 studied patients, 460 (86%), including those who underwent surgical or pharmacologic treatment, were ultimately listed for kidney transplantation. Out of 98 patients who underwent a URD, 45 (46%) were included for kidney transplantation, and 47 for transplantation with atypical urinary outflow. Six patients were excluded from transplantation owing to refusal of investigations or serious contraindications. CONCLUSIONS: All potential kidney recipients should undergo proper evaluation of the LUT before being qualified for kidney transplantation. This study allows selection of patients who should undergo surgical and/or pharmacologic treatment before transplantation.

[Solitary kidney. Study of renal morphology and function in 95 children]. / Valoración de la morfología y función renal en una serie de 95 pacientes pediátricos con riñón unico.

UNLABELLED: The aim of the study was to evaluate renal growth and function of solitary kidney in paediatric patients. MATERIALS AND METHODS: A prospective study was performed in a fifteen years period between 1988 and 2003 in paediatric patients with a solitary kidney, in a Children's Hospital. All the following parameters were evaluated every year: age, sex, ethiology, elapsed time since the concept of solitary kidney was assessed (ET), blood pressure, renal function measured by GFR, urinary excretion of solutes, concentration ability and microalbuminuria (MA). DMSA was made at the beginning and every five years and renal ultrasonography was carried out every two years. Two groups were made depending of nephrourologic malformations in the remanent kidney and/or antecedents of pyelonephritis: Group I with antecedents of pyelonephritis and/or malformations; Group II, nor antecedents of pyelonephritis neither malformations. RESULTS: Ninety five patients were evaluated, 69% (n = 66) were males and 31% (n = 29) were females, with an age at diagnosis of 3.5 yr (ranged 0.1-17 yrs). ET was 9.2 yrs (range 1-20 yrs). The ethiology was: Nephrectomy of the contralateral kidney 39 patients (pts) (41%), renal agenesis (RA) 47 pts (49%) and nonfunctioning multicystic displastic kidney (MCDK) 9 pts (9.4%). Functional alterations were found in 18 pts (19%), such as MA in 12 pts (12.6%), decreased GRF in 5 pts (5.5%) and hypertension in 3 pts (3.2%). It was observed more significant functional alterations in the patients of the Group I (58%) versus Group II (9%) (p < 0.001). There was in Group II a significant correlation between kidney size and GFR (p < 0.01, r = 0.3), and between kidney size and ET (P < 0.05; r = 0.3). CONCLUSIONS: Any alteration in the renal function was observed in the 12.6% of the children. The most frequent affected parameter of renal damage was MA, followed by GFR reduction. Arterial hypertension was not a prominent finding. Alterations have been less frequently found in RA and MCDK of the Group II, so clinical reviews should be made with a lesser frequency.

[Percutaneous echo-guided drainage and sclerotherapy of symptomatic renal cysts: critical comparison with laparoscopic treatment]. / Drenaggio percutaneo ecoguidato e sclerotizzazione delle cisti renali sintomatiche: confronto critico con il trattamento laparoscopico.

Nowadays, the minimally invasive treatment of symptomatic renal cyst has been progressively gaining wide acceptance while classic open surgery has been almost abandoned. It is a still controversial which minimally invasive approach provides the major advantages and results. Fifty-two patients with symptomatic simple renal cyst underwent ultrasound guided percutaneous drainage and sclerotherapy (ethanol 95 degrees) and 20 patients underwent laparoscopic unroofing of simple renal cysts in our department. No major complication was recorded with both the techniques. Even if we reported a higher recurrence rate (82%) with sclerotherapy than that with laparoscopic treatment (5%) we consider the percutaneous drainage a valid approach because it is a safe, easy and at low cost procedure.