Cateterismo urinário e as técnicas para prevenção de hematúria: revisão integrativa / Cateterismo urinario y las técnicas para prevención de hematuria: revisión integradora / Urinary catheterization and techniques for preventing hematuria: integrative review

Resumo Objetivo Analisar e sintetizar as evidências científicas disponíveis sobre o cateterismo urinário e as técnicas utilizadas para prevenir a hematúria no esvaziamento da bexiga, na retenção urinária aguda e crônica, em adultos e idosos. Métodos Revisão integrativa realizada nas bases de dados Pubmed, LILACS, Embase, Cochrane, Web of Science e Scopus; e busca manual nas listas de referências dos estudos incluídos. Um período ilimitado foi usado para revisar estudos em português, inglês, francês, alemão e espanhol. Aplicado estratégia PICOS na elaboração da pergunta de pesquisa e instrumento Joanna Briggs Institute (JBI) para avaliar qualidade metodológica dos estudos. Resultados Foram incluídos 11 estudos, com um total de 659 pacientes. A retenção urinária ocorreu principalmente em homens, tendo como principal causa a hiperplasia prostática benigna. As técnicas utilizadas para descompressão vesical, por cateterismo urinário, foram a descompressão rápida e a gradual, sendo as principais complicações, independente da técnica, hematúria e hipotensão. Os resultados mostraram que não houve diferença significativa entre as duas técnicas quanto ao desfecho prevenção da hematúria. Conclusão O esvaziamento gradual da bexiga não previne a hematúria em comparação com o esvaziamento rápido e completo. Mas os estudos, principalmente os relatos de casos, descrevem quadros clínicos que merecem atenção diante da ocorrência de hematúria após cateterismo urinário e as implicações no tratamento dos pacientes. Destaca a importância da enfermagem na identificação e prevenção do diagnóstico de Retenção Urinária, a fim de evitar intervenções posteriores e complicações clínicas, inclusive hematúria pós-cateterismo.

Resumen Objetivo Analizar y sintetizar las evidencias científicas disponibles sobre el cateterismo urinario y las técnicas utilizadas para prevenir la hematuria en el vaciado de la vejiga, en la retención urinaria aguda y crónica en adultos y personas mayores. Métodos Revisión integradora realizada en las bases de datos Pubmed, LILACS, Embase, Cochrane, Web of Science y Scopus y búsqueda manual en las listas de referencias de los estudios incluidos. Se utilizó un período ilimitado para revisar estudios en portugués, inglés, francés, alemán y español. Se aplicó la estrategia PICOS en la elaboración de la pregunta de investigación y el instrumento Joanna Briggs Institute (JIB) para evaluar la calidad metodológica de los estudios. Resultados Se incluyeron 11 estudios con un total de 659 pacientes. La retención urinaria ocurrió principalmente en hombres, principalmente a causa de la hiperplasia prostática benigna. Las técnicas utilizadas para la descompresión vesical por cateterismo urinario fueron la descompresión rápida y la gradual, y las principales complicaciones, independientemente de la técnica, fueron hematuria e hipotensión. Los resultados mostraron que no hubo diferencia significativa entre las dos técnicas respecto al resultado de prevención de la hematuria. Conclusión El vaciado gradual de la vejiga no previene la hematuria en comparación con el vaciado rápido y completo. Sin embargo, los estudios, principalmente los relatos de casos, describen cuadros clínicos que necesitan atención ante los episodios de hematuria después del cateterismo urinario y las consecuencias en el tratamiento de los pacientes. Se destaca la importancia de la enfermería en la identificación y prevención del diagnóstico de retención urinaria, a fin de evitar intervenciones posteriores y complicaciones clínicas, inclusive hematuria poscateterismo.

Abstract Objective Analyze and synthesize the available scientific evidence on urinary catheterization and techniques used to prevent hematuria in bladder emptying and acute and chronic urinary retention in adults and the elderly. Methods This integrative review was carried out in the PubMed, LILACS, Embase, Cochrane, Web of Science, and Scopus databases. Hand searching was used in the reference lists of included studies. An unlimited period was used to review the studies published in Portuguese, English, French, German, and Spanish. The PICOS strategy was applied to develop the research question and the Joanna Briggs Institute (JBI) instrument was used to assess the methodological quality of studies. Results Eleven studies were included, with a total of 659 patients. Urinary retention occurred mainly in men and the main cause was benign prostatic hyperplasia. Rapid and gradual decompressions were the techniques used for bladder decompression by urinary catheterization, and hematuria and hypotension were the main complications regardless of the technique. The results showed that there was no significant difference between the two techniques in terms of the outcome of hematuria prevention. Conclusion Gradual bladder emptying does not prevent hematuria compared to rapid and complete emptying. Case reports describe clinical conditions that deserve attention when hematuria occurs after urinary catheterization and the respective implications in the treatment of patients. We highlight the importance of nursing in identifying and preventing the diagnosis of Urinary Retention to avoid subsequent interventions and clinical complications, including post-catheterization hematuria.

Factores de riesgo asociados al cáncer vesical en pacientes adultos / Risk factors associated with bladder cancer in adult patients

Introducción: El cáncer vesical es una enfermedad que afecta, generalmente, a pacientes masculinos de la tercera edad. Este tumor tiene dos formas principales de manifestarse: como tumor superficial y de bajo grado, o como neoplasia invasora de alto grado. La mayoría de los pacientes afectados con esta enfermedad presentan como factor de riesgo, el consumo de tabaco. Objetivo: Contribuir al conocimiento de la comunidad científica en lo relativo a los factores de riesgo y al síntoma principal asociados al cáncer vesical en pacientes adultos de la tercera edad. Métodos: Se realizó una revisión sistemática sobre el tema en las bases de datos: SciELO, EBSCO, Scopus, PubMed, y en revistas de Urología. Los artículos fueron publicados en idioma español o inglés. Se realizó un análisis del contenido para lograr la actualización teórica del tema. Conclusiones: El cáncer vesical es una enfermedad multifocal que provoca la aparición de varias neoformaciones dentro del epitelio transicional, en toda su extensión. La presencia de hematuria asintomática en los pacientes adultos fue la causa más común de consulta con el urólogo. Dentro de los factores de riesgo, el principal fue el consumo de tabaco.

Introduction: bladder cancer is a disease that generally affects elderly male patients. This tumour has two main forms of manifestation: as a low-grade superficial tumor or as a high-grade invasive neoplasm. Most of the patients affected with this disease have tobacco consumption as a risk factor. Objective: to contribute to the knowledge of the scientific community in relation to the risk factors associated with bladder cancer in elderly patients. Methods: a systematic review on the subject was carried out in SciELO, EBSCO, Scopus and PubMed databases as well as in Urology journals. Articles published in Spanish or English languages were taken into account. A content analysis was conducted to achieve a theoretical update on this topic. Conclusions: bladder cancer is a multifocal disease that causes the appearance of several neoformations within the transitional epithelium and throughout its entire length. The presence of asymptomatic hematuria in adult patients was the most common reason for consultation with the urologist. The main risk factor was tobacco consumption.

Cistitis eosinofílica en mujer con enfermedad renal crónica

Se presenta caso de una mujer de 70 años, con antecedentes de enfermedad renal crónica sin requerimiento dialítico que ingresa con descompensación aguda y que mejora con sesiones de hemodiálisis. Al examen físico llama la atención hematuria franca por lo que se solicita ecografía de pelvis donde aprecia vejiga distendida con coágulo en su interior de 7,2 cm. La tomografía muestra aparente tumor de pared de vejiga. La uretrocistografía confirma una cistitis crónica eosinofílica. Es manejada con hidroxicina teniendo respuesta favorable cediendo episodios de hematuria. La cistitis eosinofílica es una condición médica rara que se presenta con síntomas urinarios tales como disuria y hematuria. Es más común en niños que en adultos. El método diagnóstico es a través de una biopsia de pared vesical por cistoscopía. El manejo está dirigido a aliviar los síntomas. El interés por el caso se debe a la rareza de esta patología.

We present the case of a 70-year-old woman with a history of chronic kidney disease without dialysis who was admitted with acute decompensation and improved with hemodialysis sessions. On physical examination, frank hematuria was noticeable, therefore a pelvic ultrasound was requested, where a distended bladder with a 7.2 cm clot inside was observed. The tomography showed an apparent bladder wall tumor. Cyst urethrography confirmed chronic eosinophilic cystitis. It was managed with hydroxyzine, having a favorable response, reducing episodes of hematuria. Eosinophilic cystitis is a rare medical condition that presents with urinary symptoms such as dysuria and hematuria. It is more common in children than in adults. The diagnostic method is through a bladder wall biopsy by cystoscopy. Management is aimed at relieving symptoms. The interest in the case is due to the rarity of this pathology.

Síndrome de Cascanueces en el embarazo: Reporte de caso

El Síndrome de cascanueces durante el embarazo es una condición infrecuente, con pocos casos reportados en la literatura. Se presenta como consecuencia de hipertensión venosa renal unilateral por la compresión mecánica de la vena renal izquierda secundaria a los cambios por el aumento de la presión intra abdominal por el útero grávido y aumento de diámetro aórtico; se manifiesta como hematuria asintomática persistente y puede estar asociado en menor frecuencia a dolor en flanco izquierdo. El diagnóstico se realiza ante la sospecha clínica, posterior a la exclusión de otras causas más frecuentes de hematuria durante la gestación y la resolución del cuadro clínico posterior al parto; estudios como la venografía lumbar están contraindicados en la gestación. Se describe el caso de una paciente de 26 años cursando con un embarazo de 23 semanas que presentó hematuria macroscópica ureteral izquierda asociado a dolor en flanco izquierdo con resolución espontánea en el puerperio confirmando el diagnóstico de síndrome de cascanueces. (provisto por Infomedic International)

Nutcracker syndrome during pregnancy is an uncommon condition, with few cases reported in the literature. It occurs as a consequence of unilateral renal venous hypertension due to mechanical compression of the left renal vein secondary to changes due to increased intra-abdominal pressure caused by the pregnant uterus and increased aortic diameter; it manifests as persistent asymptomatic hematuria and may be associated less frequently with left flank pain. The diagnosis is made upon clinical suspicion, after exclusion of other more frequent causes of hematuria during pregnancy and resolution of the clinical picture after delivery; studies such as lumbar venography are contraindicated in pregnancy. We describe the case of a 26-year-old patient with a 23-week pregnancy who presented macroscopic left ureteral hematuria associated with left flank pain with spontaneous resolution in the puerperium, confirming the diagnosis of nutcracker syndrome. (provided by Infomedic International)

Hematuria macroscópica como signo inicial del cáncer primario de uretra. Reporte de caso / Macroscopic hematuria as an initial sign of primary urethral cancer. Case report

Fundamento: El cáncer primario de uretra se define como el tumor cuya primera lesión se localiza en la uretra; es infrecuente, el mismo representa menos del 1 % de los tumores malignos y el 5 % de los tumores malignos del sistema urinario. La extensión de este proceso a la glándula prostática genera sintomatología urinaria obstructiva e irritativa y cuadros agudos como la hematuria macroscópica. Objetivo: Presentar el caso de un paciente con cáncer primario de uretra en su variedad urotelial con hematuria macroscópica como forma clínica de presentación. Presentación del caso: Caso clínico de un paciente masculino de 75 años de edad, con hematuria macroscópica como forma clínica de presentación de cáncer primario de uretra en su variedad urotelial, el cual se diagnosticó anatomopatológicamente durante el estudio de la hematuria. Conclusiones: El caso que se presenta permite alertar a la comunidad científica que en pacientes que presentan hematuria macroscópica, sin manifestaciones urológicas obstructivas ni irritativas, también debe tenerse en cuenta el diagnóstico de cáncer uretral primario, aunque sea un signo infrecuente como forma clínica de presentación de esa enfermedad.

Background: Primary urethral cancer is defined as a tumor whose first lesion is located in the urethra; is very uncommon, represents less than 1% of malignant tumors and 5% of malignant tumors of the urinary system. The extension of this process to the prostate gland creates obstructive and irritative urinary symptoms and acute conditions such as macroscopic hematuria. Objective: To present the case of a patient with primary urethral carcinoma in its urothelial variety with macroscopic hematuria as clinical presentation. Case presentation: Clinical case of a 75-year-old male patient, with macroscopic hematuria as a clinical presentation of primary cancer of the urethra in its urothelial variety, diagnosed anatomopathologically during the hematuria study. Conclusions: The case presented alerts the scientific community that the diagnosis of primary urethral cancer should be considered in patients with macroscopic hematuria in the absence of obstructive or irritative urologic manifestations, although it is a rare sign as clinical presentation of this disease.

Hemofilia A adquirida en el posparto: reporte de caso / Postpartum-acquired hemophilia A: case report

RESUMEN La hemofilia A adquirida es un trastorno hemorrágico poco frecuente a nivel mundial, y se caracteriza por la presencia de autoanticuerpos inhibidores dirigidos hacia un factor de la coagulación, en la mayoría de ocasiones el factor VIII. Las etiologías son variadas, entre las que se encuentra el posparto. Se presenta el caso de una paciente de 34 años con dolor lumbar, hematuria y hematoma en región glútea derecha, sin antecedentes previos de sangrado. Por extensión de las manifestaciones hemorrágicas es transferida al servicio de emergencia. Los exámenes auxiliares de perfil de coagulación, prueba de mezclas y medición de los títulos de inhibidores del factor VIII permitieron confirmar el diagnóstico. El caso resalta la importancia de considerar esta patología en una paciente puérpera con persistencia de sangrado por herida operatoria, hematoma extenso y sin historia de sangrado previo.

ABSTRACT Acquired hemophilia A is a rare bleeding disorder worldwide, characterized by the presence of inhibitory autoantibodies directed against a coagulation factor, most often factor VIII. There are several possible causes, and it can occur during the postpartum period. We present the case of a 34-year-old female patient with back pain, hematuria and a right gluteal hematoma, with no previous history of bleeding. She was transferred to the emergency department due to the extension of the hemorrhagic manifestations. Diagnosis was confirmed with the coagulation profile, mixing test and the assessment of factor VIII inhibitor tier. The case highlights the importance of considering this condition in a postpartum patient with persistent postoperative bleeding, extensive hematoma and no history of previous bleeding.

Síndrome de cascanueces: una causa infrecuente de hematuria / Nutcracker Syndrome: a Rare Cause of Hematuria

La hematuria en pediatría responde habitualmente a etiologías benignas. Una causa poco frecuente es el síndrome de cascanueces, que se define como la compresión de la vena renal izquierda entre la aorta y la arteria mesentérica superior, que deriva en una presión elevada en la vena renal izquierda con el desarrollo de venas colaterales y dilataciones varicosas. La prevalencia de este síndrome se desconoce. Cuando es sintomático ocasiona hematuria, proteinuria y dolor pélvico crónico. En la pubertad, el crecimiento rápido y el desarrollo de los cuerpos vertebrales pueden producir un estrechamiento del ángulo entre la aorta y la arteria mesentérica superior. Se describe el caso de una adolescente con diagnóstico de carcinoma mucoepitelial metastásico óseo múltiple que presenta hematuria anemizante. Se arribó al diagnóstico de síndrome de cascanueces y se discutieron las opciones de tratamiento. Finalmente, con el uso de realce del calzado para corrección de la escoliosis, se atenuó significativamente la hematuria. (AU)

In pediatrics, hematuria usually responds to benign etiologies. A rare cause is nutcracker syndrome, defined as compression of the left renal vein between the aorta and the superior mesenteric artery, resulting in elevated pressure in the left renal vein with the development of collateral veins and varicose dilatation. The prevalence of this syndrome is unknown. When symptomatic, it causes hematuria, proteinuria, and chronic pelvic pain. At puberty, the rapid growth and development of the vertebral bodies can produce a narrowing of the angle between the aorta and the superior mesenteric artery.We describe the case of a teenage girl diagnosed with multiple metastatic mucoepithelial carcinoma of bone who presented anemia-producing hematuria. The diagnosis of nutcracker syndrome was arrived at with consideration of the therapeutic options. Finally, with shoe enhancement for scoliosis correction, hematuria was significantly lessened. (AU)

La esquistosomiasis como factor de riesgo del cáncer de vejiga. Hospital Central de Nampula, Mozambique

Introducción: la esquistosomiasis es la infección por trematodos más importante a nivel global. El carcinoma de células escamosas constituye el 2 % de todos los tipos histológicos de cáncer vesical; sin embargo, la incidencia de esta variedad en países endémicos de esquistosomiasis es mayor. Objetivo: evaluar la relación entre la esquistosomiasis y el cáncer de vejiga en pacientes del Hospital Central de Nampula. Materiales y métodos: se realizó un estudio observacional, descriptivo y transversal en el período comprendido entre enero de 2014 y diciembre de 2020. Los pacientes se dividieron en grupos etarios, por intervalos de 10 años. Se tomaron muestras de biopsias de tumores de vejiga, clasificándose por tipo histológico, además de los hallazgos relacionados con infestación por esquistosomiasis y formas de presentación del cáncer de vejiga. El universo estuvo constituido por 184 pacientes, y la muestra se conformó por 135 casos. Resultados: se comprobó que el mayor número de pacientes con cáncer de vejiga es del sexo masculino; el tipo histológico más frecuente fue el carcinoma de células escamosas, representando un 84,3 % del total. La cistitis, la presencia de esquistosomas, y sus huevos estuvieron presentes en casi todas las biopsias realizadas. Sus formas de presentación más frecuente fueron la cistitis, la hematúrica y la dolorosa. Conclusiones: el cáncer de vejiga mostró una mayor incidencia en las edades comprendidas entre 30 y 69 años. El carcinoma de células escamosas fue el más frecuente, y su relación con la cistitis y la infección por esquistosomas estuvo presente en más del 90 % de las biopsias.

Introduction: schistosomiasis is the most important trematode infection globally. Squamous cell carcinoma constitutes 2% of all the histological types of bladder cancer; however, the incidence of this variety of cancer in squistosomiasis-endemic countries is higher. Objective: to evaluate the relationship between squistosomiasis and bladder cancer in patients from the Central Hospital of Nampula. Materials and methods: a cross-sectional descriptive observational study was carried in the period between January 2014 and December 2020. Patients were divided into age-groups, by 10-year intervals. Biopsy samples of bladder tumors were taken, classified by histological type, in addition to findings related to squistosomiasis infestations and bladder cancer presentation forms. The universe consisted of 184 patients and the sample of 135 cases. Results: it was found that the largest number of patients with bladder cancer is male; squamous cell carcinoma is the most frequent histological type, representing 84.3% of the total. Cystitis, schistosome and their eggs were present in almost all the biopsies performed. Its most frequent presentation forms were hematuric and painful cystitis. Conclusions: bladder cancer showed higher incidence at the ages between 30 and 69 years. The squamous cell carcinoma was the most frequent, and its relationship with cystitis and schistosome infection was present in more than 90% of biopsies.

Discussion on the pathogenesis and treatment of renal hematuria based on the theory of "warming the injured and activating the relaxed" / 国际中医中药杂志

Based on the "warming the injured and activating the relaxed" theory, this article explored the pathogenesis and treatment of renal hematuria. The pathogenesis of renal hematuria mainly lies in the deficiency of spleen and kidney, blood stasis and qi obstruction, and the internal channeling of pathogenic wind. The author put forward that "warming the injured and activating the relaxed" as the general treatment principle of renal hematuria. In clinical practice, the main treatment methods should be to cultivate and supplement the spleen and kidney, promote blood circulation and expel wind, warm and supplement the spleen and kidney to restore the fixation of the qi of the viscera, promote blood circulation and remove blood stasis to remove the blood stasis outside the blood overflow vessels, and eliminate pathogenic wind to prevent and stop the disturbance of Jingguan. In accordance with the treatment of syndrome differentiation, it emphasized both nourishing and dispelling pathogenic factors, and according to the degree of deficiency of zang-fu organs and the retention of pathogenic factors, and listed the related therapeutic drugs, which provided a new idea and method for the clinical application of TCM in the treatment of renal hematuria.

Treatment of Renal Hematuria with Traditional Chinese Medicine： A Review / 中国实验方剂学杂志

Renal hematuria is caused by glomerular damage and basement membrane rupture due to coagulation dysfunction， ischemia and hypoxia， and immune function damage， resulting in red blood cells exuding through glomerular filtration membrane and excreting with urine. It is mainly manifested as microscopic and macroscopic hematuria. Among them， microscopic hematuria is characterized by microscopic urine sediment examination， there are three or more red blood cells per high-power microscopic field. Traditional Chinese medicine （TCM） believes that the pathogenesis of renal hematuria always belongs to ''asthenia in origin and sthenia in superficiality''， and ''asthenia in origin'' is caused by the deficiency of the three viscera of the lung， spleen， and kidney， while ''sthenia in superficiality'' is caused by the combination of dampness and blood stasis and the external disturbance of wind pathogens. The key pathogenesis features are ''deficiency， dampness， heat， blood stasis， and wind''. After consulting the TCM literature related to renal hematuria， the author found that the common syndrome types of renal hematuria in clinical practice were the deficiency of both Qi and Yin， the deficiency of both Yin and fire， the unsteadiness of kidney Qi， the deficiency of spleen and kidney Yang， the wind heat hurting the collateral， the dampness-heat blocking， and the blood stasis and internal resistance. The commonly used classical or temporal prescriptions included Shenqi Dihuangtang（参芪地黄汤）， Zhibai Dihuangtang（知柏地黄汤）， Wubi Shanyaowan（无比山药丸）， Jisheng Shenqiwan（济生肾气丸）， Sishenwan（四神丸）， Yinqiaosan（银翘散）， Bazhengsan（八正散）， Sanrentang（三仁汤）， Xuefu Zhuyutang（血府逐瘀汤）， Danggui Shaoyaosan（当归芍药散）， Xiaoji Yinzi（小蓟饮子）， Buzhong Yiqitang（补中益气汤）， et al. Self prepared prescriptions mainly include Tongluo Ningxue prescription （通络宁血方）， Qingre Zhixue prescription（ 清热止血方） and Wuteng Tongluo drink （五藤通络饮）. The traditional Chinese medicine is commonly used for the treatment of Xueniaoling granules（血尿灵冲剂）， Xueniaoan capsules（血尿安胶囊）， Ningmitai capsules（宁泌泰胶囊）， Huangkui capsules（黄葵胶囊） and Yishen nixuexiao granules（益肾溺血消颗粒）， which constantly enriched the treatment of renal hematuria. The combination of TCM and western medicine has obvious advantages. The treatment of renal hematuria in clinical practice often combines with modern medical methods， which has a good therapeutic effect on the improvement of symptoms and indicators of renal hematuria. At present， many doctors have made in-depth exploration on the etiology， pathogenesis， and clinical treatment of renal hematuria， but few scholars have made detailed induction and collation in recent years. Therefore， the author has collated the clinical data on the treatment of renal hematuria with TCM in the past ten years， and reviewed it from the aspects of etiology， pathogenesis， and clinical research， to provide useful references for clinical intervention and delay the progress of renal disease.

Clinical application of a novel urinary cytology detection system for bladder cancer / 现代泌尿外科杂志

【Objective】 To investigate the diagnostic efficacy of a novel bladder cancer detection system utilizing a urine cell processing kit for urine sample preservation and detection. 【Methods】 Patients with primary persistent gross hematuria and high recurrence risk of bladder cancer after transurethral resection of bladder tumor were prospectively enrolled between Dec.2021 and Mar.2022. Urine specimens were either added to (experimental group) or not added to (control group) the urine cell processing kit and were fixed on Day 0, Day 3 and Day 7. The sensitivity and specificity of the two groups were compared after the cells were fixed, produced, stained and read with body fluid cytology total staining technique. 【Results】 The sensitivity and specificity of the experimental group on Day 0 were 82.50% (33/40) and 87.50% (14/16), respectively; those of the control group were 79.49% (31/39) and 82.35% (14/17), respectively. On Day 3, the sensitivity and specificity of the experimental group were 76.32% (29/38)and 81.25% (13/16), respectively; those of the control group were 52.78% (19/36) and 78.57% (11/14), respectively. On Day 7, the sensitivity and specificity of the experimental group were 71.43% (25/35) and 72.22% (13/18), respectively; those of the control group were 35.71% (10/28) and 60.00% (9/15), respectively. The sensitivity of the experimental group on Day 3 and Day 7 was significantly higher than that of the control group (P<0.05). 【Conclusion】 This bladder cancer urine cytology detection system provides clear diagnostic advantages and can be used as an auxiliary examination before cystoscopy for patients with hematuria and those at high risk of bladder cancer recurrence. It can also be used as a bladder cancer screening tool for pre-screening a large sample of people in order to achieve early diagnosis and treatment of bladder cancer.

Urinary sediment findings and clinicopathologic features of IgA nephropathy patients with acute kidney injury / 中华肾脏病杂志

Objective:To investigate the urinary sediment findings and the clinicopathologic features of IgA nephropathy (IgAN) patients with acute kidney injury (AKI).Methods:It was a retrospective study. The patients with renal biopsy-proven primary IgAN in Peking University First Hospital from January 31, 2013 to July 31, 2015 were selected. According to whether AKI occurred at renal biopsy or not, the patients were divided into AKI group and non-AKI group. Morning urine samples were obtained on the day of renal biopsy. Urine sediments, including various cells and casts, were examined. The clinical data, urinary sediments, and renal pathological changes were compared between the two groups. Logistic regression analysis was performed to identify the association between clinical pathological changes, urinary sediment indicators and AKI, or clinical pathological changes and urinary sediment indicators.Results:There were 502 IgAN patients enrolled in this study, with age of (36.1±12.1) years old and 261 males (52.0%). The incidence of AKI was 11.4% (57/502) among the enrolled patients at the time of renal biopsy. Common causes of AKI included gross hematuria-induced AKI (10 cases), acute tubulointerstitial nephritis (10 cases), crescentic IgAN (9 cases), malignant hypertensive renal damage (6 cases), and multiple etioloqy or unknown etiology (22 cases). Compared with non-AKI group, AKI group had higher proportions of males and malignant hypertension, higher levels of proteinuria and urinary erythrocyte counts, and higher frequencies of gross hematuria, leukocyturia, renal tubular epithelial cells, and granular casts (all P<0.05). AKI group also had higher proportions of severe tubular atrophy/interstitial fibrosis (T2) and cellular/cellular fibrous crescent formation (C2) than non-AKI group (both P<0.05). Logistic regression analysis results showed that, there were statistically significant differences in the correlation between AKI and gender, 24 h urinary protein, urinary erythrocyte counts, granular casts and renal tubular atrophy/interstitial fibrosis (T) scores (all P<0.05). Hematuria, leukocyturia, red blood cell casts, white blood cell casts, granular casts, and fatty casts were correlated with endothelial hypercellularity (E) and cellular/cellular fibrous crescent formation (C) scores, respectively (all P<0.05). Hematuria was correlated with mesangial hypercellularity (M) scores ( OR=2.613, 95% CI 1.520-4.493, P=0.001). Hematuria ( OR=1.723, 95% CI 1.017-2.919, P=0.043) and fatty casts ( OR=2.646, 95% CI 1.122-6.238, P=0.026) were correlated with segmental sclerosis or adhesion (S) scores. Leukocyturia ( OR=1.645, 95% CI 1.154-2.347, P=0.006) and fatty casts ( OR=2.344, 95% CI 1.202-4.572, P=0.012) were correlated with T scores. Epithelial cell cast was correlated with C scores ( OR=1.857, 95% CI 1.174-2.939, P=0.008). Conclusions:AKI is a common complication among IgAN patients with diverse etiology and more severe clinicopathological features. Urinary sediment findings can reflect renal pathological changes to some extent, and therefore assist in the clinical diagnosis and treatment of IgAN patients with AKI.

Fenotipos inesperados en el síndrome de Alport: la necesidad del estudio genético / Unexpected phenotypes in Alport syndrome: the need for genetic testing

El diagnóstico del síndrome de Alport supone un reto en la edadpediátrica, debido a la ausencia de fenotipos clínicos esperados de la enfermedad, su clásica caracterización de entidad rara y la práctica muy restringida de biopsias renales con análisis rutinario de la muestra por microscopía electrónica durante la infancia. Se presentan las características clínicas y genéticas de 6 pacientes pediátricos (4 mujeres) diagnosticados de síndromede Alport en dos centros hospitalarios entre 2018 y 2021. Todos los pacientes presentaron un debut clínico claramente diferente y ninguno presentó complicaciones auditivas nioftalmológicas. La mitad carecía de antecedentes familiares de enfermedad renal crónica. Ninguna biopsia renal realizada confirmó el diagnóstico. Todos los pacientes fueron confirmadosgenéticamente y fueron el caso índice del estudio familiar. Esta serie ilustra la presencia de fenotipos clínicos inesperados en el síndrome de Alport y refleja la necesidad de incorporar el estudio genético para su diagnóstico.

The diagnosis of Alport syndrome is a challenge in the pediatric age, due to the absence of expected clinical phenotypes of the disease, its classic characterization of a rare disease and the very restricted practice of renal biopsies with routine analysis of the sample by electron microscopy during infancy. The clinical and genetic characteristics of 6 pediatric patients (4 women) diagnosed with Alport syndrome in two hospital centers between 2018 and 2021 are reported. All patients presented a clearly different clinical debut and none presented auditory or ophthalmological complications. Half had no family history of chronic kidney disease. No kidney biopsy performed confirmed the diagnosis. All patients were genetically confirmed and were the index case in the family study. This series illustrates the presence of unexpected clinical phenotypes in Alport syndrome and reflects the need for the incorporation of the genetic study for its diagnosis.

Prevalencia de compromiso renal en pacientes pediátricos internados con enfermedad por coronavirus 2019: estudio multicéntrico / Prevalence of renal involvement among pediatric patients hospitalized due to coronavirus disease 2019: A multicenter study

Introducción. El compromiso renal (CR) en niñosinternados con enfermedad por coronavirus2019 (COVID-19, por su sigla en inglés) varía entre el 1,2 % y el 44 %. Dado que existe limitada información local, el objetivo primario de este estudio fue estimar la prevalencia de CR en nuestro medio. Población y métodos. Estudio transversalrealizado en 13 centros de Argentina entre marzo y diciembre de 2020. Se incluyeron pacientes internados con COVID-19, de 1 mes a 18 años y que tuvieran al menos una determinación de creatinina sérica y/o de orina completa.Se excluyeron aquellos con enfermedad renal conocida. Se consideró CR la presencia de lesión renal aguda (LRA), proteinuria, hematuria, leucocituria y/o hipertensión arterial (HTA). Resultados. De 528 historias clínicas elegibles, seincluyeron las de 423 pacientes (el 55,0 % de sexo masculino, mediana de edad 5,3 años). El cuadro clínico fue asintomático en el 31 %, leve en el 39,7 %, moderado en el 23,9 %, grave en el 1,2 %, crítico en el 0,7 %, y el 3,5 % presentó síndrome inflamatorio multisistémico pediátrico (SIMP). Dos pacientes (0,47 %) fallecieron. La prevalencia de CR fue del 10,8 % (intervalo de confianza 95% 8,2-14,2), expresada por leucocituria (16,9 %), proteinuria (16,0 %), hematuria (13,2 %), HTA (3,7 %) y LRA (2,3 %). Ninguno requirió diálisis. Presentar CR se asoció (p <0,0001) con formas graves de enfermedad. Conclusión. La prevalencia de CR en pacientes pediátricos internados con COVID-19 en 13 centros de nuestro país fue del 10,8 % y predominó en las formas clínicas graves.

Introduction. Renal involvement among pediatric patients with coronavirus disease 2019 (COVID-19) ranges between 1.2% and 44%. Given the limited information available locally, the primary objective of this study was to estimate the prevalence of renal involvement in our setting. Population and methods. Cross-sectional study conducted in 13 Argentine sites between March and December 2020. Patients aged 1 month to 18 years hospitalized due to COVID-19 and with at least one measurement of serum creatinine and/or a urinalysis were included. Those with a known kidney disease were excluded. Renal involvement was defined as the presence of acute kidney injury (AKI), proteinuria, hematuria, leukocyturia and/or arterial hypertension (HTN). Results. Among 528 eligible medical records, 423 patients were included (55.0% were males; median age: 5.3 years). The clinical presentation was asymptomatic in 31%; mild, in 39.7%; moderate, in 23.9%; severe, in 1.2%; critical, in 0.7%; and 3.5% had multisystem inflammatory syndrome in children (MIS-C). Two patients (0.47%) died. The prevalence of renal involvement was 10.8% (95% confidence interval: 8.2­14.2); it was described as leukocyturia (16.9%), proteinuria (16.0%), hematuria (13.2%), HTN (3.7%), and AKI (2.3%). No patient required dialysis. Renal involvement was associated with severe forms of disease (p < 0.0001). Conclusion. The prevalence of renal involvement among pediatric patients hospitalized due to COVID-19 in 13 Argentine sites was 10.8%; severe forms of disease prevailed.

Síndrome de Alport: Rol de la semiología y la genética

El síndrome de Alport es una enfermedad renal progresiva por alteración de la membrana basal glomerular secundaria a mutación en los genes COL4A4, COL4A5 y COL4A6 del colágeno tipo IV, con 3 patrones hereditarios: ligado al cromosoma X, autosómico dominante y autosómico recesivo. No existe tratamiento específico para el síndrome de Alport, el objetivo del tratamiento es evitar la progresión rápida a enfermedad renal crónica y mejorar la calidad de vida del paciente. Se reporta el caso de una femenina de 5 años que acudió al cuarto de urgencias con historia de dolor abdominal y edema en miembros inferiores con hematuria microscópica, resto de exámenes de laboratorio y gabinete con hallazgos sugestivos de apendicitis aguda. Se realizó diagnóstico de apendicitis aguda y síndrome nefrítico, sin embargo, debido a la persistencia de hematuria con proteinuria e historia familiar de hematuria, se sospecha de síndrome de Alport.  Inició tratamiento con inhibidores de la enzima convertidora de angiotensina y se realizó biopsia renal reportada sin alteraciones a la microscopía de luz sin reporte de microscopía electrónica. Cursó con proteinuria en rango nefrótico, inicia tratamiento con corticoides e inhibidores de calcineurina sin respuesta. Se obtiene reporte de panel genético confirmatorio de Alport y se suspende inmunosupresión. (provisto por Infomedic International)

Alport syndrome is a progressive kidney disease, due to alterations of the glomerular basement membrane secondary to mutations in the COL4A4, COL4A5 and COL 4A6 genes of type IV collagen with three hereditary patterns: X-linked, autosomal dominant and autosomal recessive. There is no specific treatment for Alport Syndrome. The main goal of the therapeutic options is to prevent rapid progression to chronic kidney disease and improve the patient's quality of life. The report of a 5-year-old female, who attended the emergency room with abdominal pain, edema in the lower limbs and microscopic hematuria, the rest of the laboratory and clinical studies with findings suggestive of acute appendicitis. A diagnosis of acute appendicitis and nephritic syndrome was made, however, due to the persistence of hematuria and family history, Alport syndrome was suspected. Treatment with angiotensin-converting enzyme inhibitors was started and renal biopsy was performed, reported minimal change and without electron microscopy report. The patient quickly progressed to nephrotic range proteinuria and started corticosteroids and calcineurin inhibitors without response.  A confirmatory genetic panel was performed, Alport syndrome was diagnosed, and immunosuppression was suspended. (provided by Infomedic International)

Cistitis hemorrágica por adenovirus en trasplante renal: revisión epidemiológica y resultados clínicos

Contexto la infección de vías urinarias (IVU), causada por adenovirus (ADV) posterior al trasplante renal, tiene el potencial de causar disfunción o pérdida del injerto. La presentación clínica es variable y el tratamiento difiere según la disponibilidad de medicamentos en el medio y la experiencia clínica. Objetivo el estudio describe las características clínicas, de laboratorio y la respuesta al tratamiento de una serie de casos de pacientes trasplantados renales con IVU por ADV en un hospital de Cali, Colombia. Metodología estudio retrospectivo que incluye a todos los pacientes adultos trasplantados con diagnóstico de IVU por ADV entre enero del 2015 hasta enero del 2021. El diagnóstico se realizó basado en la clínica, el resultado positivo de la prueba de reacción de cadena de polimerasa (PCR) y la carga viral del ADV. Resultados de 256 pacientes trasplantados, ocho presentaron diagnóstico de cistitis hemorrágica o nefritis intersticial secundaria a infección por ADV. Se presentó de forma temprana (≤ 3 meses) en el 62 % de los casos, quienes debutaron con macrohematuria asociada a piuria estéril y linfopenia. Por otra parte, se presentó alteración en la función renal en el 87,5 % de los casos y la reducción de la inmunosupresión fue el pilar fundamental en el manejo clínico. Conclusiones el reconocimiento de la infección por ADV en pacientes trasplantados renales ha ido en aumento. La sospecha clínica es clave para el diagnóstico (macrohematuria, síntomas urinarios irritativos y falla renal) y la reducción de la dosis de inmunosupresión para restaurar la función inmune puede ser suficiente en la resolución de la infección y la reversión de la disfunción renal.

Introduction Urinary tract infection (UTI) caused by adenovirus (ADV) after kidney transplantation has the potential to cause graft dysfunction or loss. The clinical presentation is variable, from an asymptomatic course to a multisystemic compromise. Treatment varies based on the availability of different medications and clinical experience. Objective The study describe the clinical, laboratory characteristics and results of a series of cases of kidney transplant patients with hemorrhagic cystitis secondary to ADV infection in a hospital in Cali, Colombia. Methods Retrospective study based on the records of patients with a diagnosis of UTI caused by ADV between January 2015 to January 2021 were included. The diagnosis was made by clinical suspicion and polymerase chain reaction (PCR) - Adenovirus DNA viral load. Results Of 256 transplant patients, eight patients had a diagnosis of hemorrhagic cystitis or interstitial nephritis secondary to ADV infection. It presented early (≤ 3 months) in 62%, who presented with macrohematuria, associated with sterile pyuria and lymphopenia. Alterations in renal function were presented in 87.5%. The reduction of immunosuppression was the fundamental pillar in the management. Conclusions The recognition of ADV infection in kidney transplant patients has been increasing. Clinical suspicion is the key for the diagnosis, with a predominance of macrohematuria, irritative urinary symptoms and kidney graft dysfunction. Reducing the dose of immunosuppression by restoring immune function may be sufficient in resolving the infection and reversing renal dysfunction.

Oral Manifestations of Chronic Renal Disease

Chronic Renal Disease is a Global Health Problem which has multiple clinical features which are problematic to the patient, reduces their life expectancy and changes their way of living. It is mainly comprised of hematuria, proteinuria and progressive loss of kidney function. If it reaches end-stage that means there is 90% loss of the kidney function. At times, it also gives rise to oral manifestations which are misdiagnosed and as a result go untreated. This review article deals with the oral manifestations of Chronic Renal Disease so that proper awareness of this problem can be met among Dentists as well.

Cantharis dissolves calculus in the ureter of a kitten: case repor

Urolithiasis is a disease thatcan occur alone or together, obstruct the urinary flow, and even progress to the animal's death. Objective:The present study is to report the dissolution of calculus in the ureter in a kitten. Methodology: a feline, SRD, male, started at 3 months old with the signs of vomiting, constipation,and hematuria, presenting leukocytosis and increased serum urea. Two abdominal ultrasounds were performed 30 days apart and the third at 3 months. Results:Inthe first ultrasound there was hydronephrosis in the right kidney and dilation of the ureter and microlithiasis in the urinary bladder. The animalhad already been treated with antibiotic therapy and did not improve. Given these characteristics, Cantharis Vesicatoria30cH was administered, there was no more hematuria and when the drug was discontinued, the symptom returned. After 30 days of startinghomeopathic treatment, we repeated the ultrasound which showed 2 kidney stones, and a urinary bladder with cystitis associated with sandy lithiasis. BerberisVulgaris30cH was then administered for 15 days, after which both drugs were discontinued and theanimal remained asymptomatic. After 3 months the ultrasound was repeated which showed 2 kidney stones, Causticum6cH was inserted for 14 days to dissolvekidney stones, thus preventing the return of the initial symptoms. Conclusion:the treatment was beneficial for the patient, who was asymptomatic after the use of Causticum.Considering the natural history of the disease in cats and the high chance of recurrence of the disease, the recommendation was to monitor the organs through an annual ultrasound examination, in addition to encouraging water intake.

Conocimiento sobre la valoración de hematíes dismórficos en sedimento urinario en profesionales de laboratorio clínico de Lima metropolitana / Knowledge about the assessment of dysmorphic red blood cells in urinary sediment in clinical laboratory professionals in metropolitan Lima

Introducción: A pesar de la existencia de directrices internacionales para la correcta valoración de la hematuria dismórfica, es frecuente que su categorización presente mucha variabilidad, inclusive entre los profesionales del mismo laboratorio. Objetivo: Determinar el nivel de conocimiento de profesionales tecnólogos médicos para la valoración de hematíes dismórficos en sedimento urinario. Material y Métodos: Estudio transversal observacional. Se aplicó un instrumento de medición para evaluar el conocimiento sobre la fase preanalítica y analítica de la valoración de hematíes dismórficos en sedimento urinario a 113 profesionales con más de tres años de experiencia en el área de uroanálisis y que laboran en centros hospitalarios estatales y privados. Resultados. La media del puntaje obtenido fue de 5,4±1,9 de 10 puntos posibles; El 85,0% de los encuestados presento un conocimiento medio e insuficiente y solo el 15,0% un conocimiento avanzado; Se observo asociación entre los niveles de conocimiento y años de experiencia (p=0,006), no se evidenció asociación significativa con la variable sexo (p=0,791) y sedes hospitalarias (p=0,888). Discusión: Se evidenció un bajo conocimiento en los dominios preanalíticos y analíticos para la valoración de hematíes dismórficos, además de una asociación significativa entre el nivel de conocimiento y los años de experiencia del profesional.

Background: Despite the existence of international guidelines for the correct assessment of dysmorphic hematuria, its categorization frequently presents a lot of variability, even among professionals in the same laboratory. Objective: To determine the level of knowledge of professional medical technologists for the assessment of dysmorphic red blood cells in urinary sediment. Material and Methods: Observational cross-sectional study. Ameasurement instrument was applied to assess knowledge about the preanalytical and analytical phase of the assessment of dysmorphic red blood cells in urinary sediment to 113 professionals with more than three years of experience in the area of urinalysis and who work in state and private hospitals. Results.The mean score obtained was 5.4±1.9 out of 10 possible points; 85.0% of the respondents presented medium and insufficient knowledge and only 15.0% advanced knowledge; An association was observed between levels of knowledge and years of experience (p=0.006), no significant association was found with the variable gender (p=0.791) and hospital locations (p=0.888). Discussion: Low knowledge was evidenced in the preanalytical and analytical domains for the assessment of dysmorphic red blood cells, in addition to a significant association between the level of knowledge and the years of experience of the professional.

Embolización de la arteria renal: serie de casos y revisión de la literatura / Renal artery embolization: case series and literature review

Resumen Introducción: La embolización de arteria renal (EAR) es un procedimiento percutáneo que ocluye la arteria renal, con la consecuente isquemia del territorio vascular. Sus indicaciones más comunes son la hematuria y el manejo paliativo en cáncer renal metastásico. A pesar del desarrollo técnico y de la experiencia progresiva, los estudios incluyen un número reducido de pacientes y en nuestro país se revisan casos aislados. Objetivo: Describir la experiencia en el Servicio de Salud Valparaíso San Antonio y revisar la literatura existente. Materiales y Método: Realizamos un estudio descriptivo de los pacientes sometidos a EAR por anemia severa secundaria a hematuria, durante los años 2012 a 2020. Posteriormente, realizamos una revisión de la literatura en PubMed, hasta abril de 2020. Resultados: Incluimos 9 pacientes, 6 (66,7%) hombres y 3 (33,3%) mujeres. La mediana de edad fue de 69 años (RIC = 18). La principal causa de la hematuria fue cáncer renal avanzado (7 pacientes). No hubo complicaciones, y se logró éxito clínico en todos los pacientes. Nuestra búsqueda de literatura arrojó 571 referencias y 24 cumplieron con nuestros criterios de elegibilidad. La edad de los pacientes y las causas subyacentes de hematuria fueron variadas. La menor tasa de éxito clínico fue de 65%, sin embargo, 15 estudios (62,5%) reportaron un éxito igual o mayor al 90%. Seis estudios reportaron más de un 10% de pacientes con alguna complicación. Conclusión: Nuestros resultados y la evidencia revisada muestran que la EAR parece ser segura y eficaz en el manejo de anemia severa secundaria a hematuria.

Introduction: Renal artery embolization (RAE) is a percutaneous procedure that occludes the renal artery, with consequent ischemia of the vascular territory. The most common indications include hematuria and palliation for metastatic renal cancer. Despite technical development and progressive experience, studies include a small number of patients and few cases have been published in our country. Aim: To share our experience at Valparaíso-San Antonio Health Service and to review the existing literature. Materials and Method: We performed a retrospective descriptive review of medical records of patients with severe anemia due to hematuria managed with RAE, between 2012 and 2020. Subsequently, we conducted a literature search in PubMed, from inception until April 2020. Results: We included 9 patients. There were 6 (66.7%) males and 3 (33.3%) females with a median age of 69 years (IQR = 18). Main cause of hematuria was advanced kidney cancer (7 patients). There were no complications and clinical success was achieved in all patients. Our literature search yielded 571 references, 24 met our eligibility criteria. The age of patients and the underlying causes of hematuria were varied. The lowest clinical success rate was 65%, however, 15 studies (62.5%) reported a success equal to or greater than 90%. Six studies reported more than 10% of patients with complications. Conclusión: Our results and the studies reviewed show that RAE appears to be safe and effective in the management of patients with severe anemia due to hematuria.