Hidronefrosis como causa de poliglobulia secundaria / Hydronephrosis as a cause of secondary polyglobulia

La policitemia primaria es producida por una mutación adquirida o heredada en las células progenitoras de los glóbulos rojos, mientras que la poliglobulia secundaria está relacionada con un aumento de la eritropoyetina sérica como respuesta a la hipoxia tisular o a la producción autónoma tumoral. Hace más de medio siglo que se conoce que la hidronefrosis puede actuar como una rara causa de eritrocitosis debido al aumento de producción de eritropoyetina por un riñón que censa una disminución de oxígeno, mecanismo también observado en la estenosis de la arteria renal y en los quistes renales. Se describe a continuación el caso de un paciente de 38 años con poliglobulia atendido en el Hospital Italiano de San Justo (Argentina), que presenta como hallazgo una hidronefrosis unilateral severa y cuya resolución quirúrgica a través de una nefrectomía revierte el cuadro hematológico de base. (AU)

Primary polycythemia is produced by an acquired or inherited mutation in progenitor cells of red blood cells, while secondary polyglobulia is related to an increase in serum erythropoietin in response to tissue hypoxia or autonomous tumor production. Since the middle of the twentieth century, the hydronephrosis is known to be a rare etiology of secondary polycythemia, with increased erythropoietin production caused by diminished oxygen sensing by the kidney, also seen in renal artery stenosis and kidney cysts. We describe a case of a 38 year old patient with polycythemia studied in the "Hospital Italiano de San Justo" (Argentina) that presented an incidental severe unilateral hydronephrosis, and nephrectomy was carried out as a final resolution of the hematological disorder. (AU)

Ureteral stricture formation after ureteroscope treatment of impacted calculi: A prospective study

PURPOSE: Urinary calculi is a familiar disease. A well-known complication of endourological treatment for impacted ureteral stones is the formation of ureteral strictures, which has been reported to occur in 14.2% to 24% of cases. MATERIALS AND METHODS: This was a prospective study. Ureterotripsy treatment was used on patients with impacted ureteral stones. Then, after 3 months and 6 months, the condition of these patients was assessed by means of a kidney-ureter-bladder (KUB) ultrasound. If the KUB ultrasound indicated moderate to serious hydronephrosis, the patient was further assessed by means of a computed tomography intravenous urogram or retrograde pyelogram to confirm the occurrence of ureteral strictures. RESULTS: Of the 77 patients who participated in the study, 5 developed ureteral strictures. Thus, the stricture rate was 7.8%. An analysis of the intraoperative risk factors including perforation of the ureter, damage to the mucous membrane, and residual stone impacted within the ureter mucosa revealed that none of these factors contributed significantly to the formation of the ureteric strictures. The stone-related risk factors that were taken into consideration were stone size, stone impaction site, and duration of impaction. These stone factors also did not contribute significantly to the formation of the ureteral strictures. CONCLUSIONS: This prospective study failed to identify any predictable factors for ureteral stricture formation. It is proposed that all patients undergo a simple postoperative KUB ultrasound screening 3 months after undergoing endoscopic treatment for impacted ureteral stones.

Masked Hydronephrosis

No abstract available.

Dolicomegarterias ilíacas: presentación de un caso / Iliac mega-dolicho arteries: presentation of a case

Las anomalías del árbol vascular son comunes. Los aneurismas aislados de las arterias ilíacas son de observación bastante rara. Representan un porcentaje escaso de las distintas estadísticas y a menudo se resalta su aislamiento, precisamente para recordar su rareza. Reportamos un caso masculino, de 74 años de edad, que asistió a consulta por presentar síntomas urinarios. Se le realizó un ultrasonido de abdomen, observándose hidronefrosis renal bilateral moderada, además masas complejas una en cada fosa ilíaca. Se le indicó Tomografía Axial Computarizada de abdomen, donde se confirmó la hidronefrosis renal bilateral y aneurismas de ambas arterias ilíacas. Se completó el estudio con un Angiotac, y se demostró que ambas ilíacas estaban tortuosas y dilatadas (Dolicomegarterias).

Vascular tree anomalies are common. Iliac arteries isolated aneurisms are very unusual. They represent an scarce percent of the different statistics and their isolation is frequently highlighted, precisely to recollect their rareness.We report the case of a male, 74-years-old patient, assisting the consultation with urinary symptoms. An abdominal ultrasound was made, showing moderated bilateral renal hydronephrosis and also complex masses in each iliac fosse. An abdomen computed axial tomography was indicated, confirming the bilateral renal hydronephrosis and aneurisms in both iliac arteries. The study was completed with an Angiotac and it was demonstrated that both iliac arteries were tortuous and dilated ( Mega-dolicho arteries ).

Síndrome megabexiga microcólon hipoperistaltismo intestinal: sobrevida até a adolescência / Megacystis-microcolon-intestinal hypoperistalsis syndrome: survival to adolescence

A síndrome megabexiga microcólon hipoperistaltismo intestinal (SMMHI) é uma doença rara, de provável herança genética, com prognóstico reservado, já no primeiro ano de vida. Relata-se um caso de SMMHI em criança do sexo feminino, atualmente com 16 anos de idade, com o objetivo de ressaltar o prognóstico favorável, não esperado, com sobrevida até a adolescência, de uma síndrome rara. Chama-se a atenção para a possibilidade de estabelecer o diagnóstico no período perinatal e para a importância de realizar o estudo urodinâmico.

Transforming growth factor-β1 in congenital ureteropelvic junction obstruction: diagnosis and follow-up

OBJECTIVE: To assess the role of transforming growth factor-β1 (TGF-β1) in congenital ureteropelvic junction obstruction at diagnosis and during postoperative follow-up. MATERIAL AND METHODS: We conducted a case-control study including 19 patients with a mean age of 6.7 years and 19 matched controls. All patients presented negative voiding cystourethrography, obstructive diuretic renogram and underwent dismembered pyeloplasty. Urinary TGF-β1 and other markers were measured pre-, intra- and postoperatively. RESULTS: The mean bladder urine TGF-β1 concentration in obstructed patients prior to pyeloplasty was higher than in controls (92.5 pg/mL ± 16.8 vs. 35.8 pg/mL ± 16.2; p = 0.0001). The mean renal pelvic urine TGF-β1 concentration in the hydronephrotic kidney was higher than in the preoperative bladder urine sample (122.3 pg/mL ± 43.9 vs. 92.5 pg/mL ± 16.8; p = 0.036). Postoperative mean TGF-β1 concentration was significantly lower than preoperative TGF-β1 (48.7 pg/mL ± 13.1 vs. 92.5 pg/mL ± 16.8; p = 0.0001). CONCLUSION: TGF-β1 is a cytokine leading to renal fibrosis. The measurement of urinary TGF-β1 could become a useful tool for the diagnosis of obstructive hydronephrosis and the evaluation of the parenchyma function status, pre and postoperatively.

Crossed fused renal ectopia with staghorn calculus and gross hydronephrosis

Crossed fused renal ectopia is a rare renal anomaly. Formation of staghorn and struvite calculi within it has never been reported in local literature. A 25-year-old man with macrohematuria and right flank pain was admitted to the hospital. An intravenous pyelography revealed right sided crossed fused ectopic kidney showing a staghorn and struvite calculi in upper-moiety along with gross hydronephrosis. Patient was conservatively managed after exclusion of other congenital anomalies

Evaluation of renal transit time [RTT] in children with MR urography

To evaluate use of dynamic contrast material-enhanced.magnetic resonance [MR] urdgraphy for measurement, of renal transit time [RTT of a contrast agent through the kidney and collecting system so as to identify obstructive uropathy in children. One hundred twenty-six children suspected of having hydronephrosis were hydrated prior to undergoing both conventional and dynamic contrast-enhanced MR urography of the kidneys and urinary tract. A three-dimensional sequence was used to track passage of contrast agent through the kidneys. Time between the appearance of contrast material in the kidney and its appearance in the ureter at or below the level of the lower pole of the kidney was defined as RTT. Bland-Altman plots were used to quantify intra- and interobserver performance. In 30 children, a nuclear medicine renogram was also obtained, and the half-life of renal signal decay after furosemide administration was derived and compared with the MR imaging RTT by using receiver operating characteristic curves. On the basis of RTT, kidneys were classified as normal [RTT RTT 490 seconds]. Receiver operating characteristic analysis for comparison of results of MR imaging and diuretic renal scintigraphy showed.good agreement between the modalities, with a mean area under the curve of 0.90. When used in conjunction with morphologic images obtained in the same, examination, RTT generally allowed normal kidneys to be differentiated from obstructed and partially obstructed kidneys

Vesicoureteral reflux in neonates with hydronephrosis; role of imaging tools

Neonatal Hydronephrosis is a common abnormality diagnosed ante- or postnatally. The aim of this study was to determine the prevalence and severity of vesicoureteral reflux [VUR] in neonates with antenatal or postnatal hydronephrosis and the value of ultrasonography as a noninvasive tool for VUR prediction. In a prospective study, 202 infants with neonatal hydronephrosis were studied. Two successive renal ultrasound examinations were performed at 1 and 4-6 weeks after birth in neonates with antenatal hydronephrosis or immediately after presentation. Voiding cystourethrography [VCUG] was performed in all infants. The incidence of VUR was 29.7%, of which 17.8% had severe [grade IV-V] reflux. 27% of 133 neonates with unilateral and 34.8% of 69 cases with bilateral hydronephrosis had VUR. Although a significant association was observed between severity of hydronephrosis and VUR, 5.9% of normal appearing and 7.8% of grade 1 hydronephrotic neonates had high-grade reflux. VUR was observed significantly in hydronephrotic neonates. A normal or mildly hydronephrotic urinary tract on ultrasound scan cannot exclude presence of severe VUR. We recommend performing VCUG in all hydronephrotic newborns

Uro - resonancia en niños / Uro - resonance in children

Ultrasound and nuclear medicine appear to be the modalities of choice when dealing with the imaging study of the urinary system in infants. In children, a CT sean does not have the impact it has had on adults, since pediatric patients present with different pathologies and also because of the peculiar physiological conditions of childhood. The Uro-resonance has emerged as a powerful and useful diagnostic tool, bringing together in a single study anatomical images and functional information as well without the use of ionizing radiation. We review the technical aspeets, anatomical and physiological concepts of the study, while providing examples of current applications in the infant.

El estudio por imágenes del sistema urinario del niño ha estado a cargo del ultrasonido y la medicina nuclear. En el niño, la tomografía computada no tiene el impacto que ha tenido en adultos, por tratarse de patologías diferentes y por las condiciones fisiológicas propias de la edad pediátrica. La Uro-resonancia se proyecta como una herramienta útil, reuniendo en un solo estudio imágenes anatómicas e información funcional, en ausencia de radiación ionizante. Se revisan aspectos de la técnica, conceptos anatómicos y fisiológicos del estudio, adicionando ejemplos de aplicaciones en el niño.

Pioureterohidronefrosis / Pioureterohydronephrosis

Se presenta un caso clínico y los hallazgos imagenológicos de una pioureterohidronefrosis en una paciente de 4 años de edad, sin antecedentes patológicos, con historia de 5 días de evolución con dolor abdominal, fiebre de 38,2ºC, dolor en hipocondrio y flanco izquierdo con ocupación del fondo de saco lateral izquierdo al tacto rectal.

A case of a 4 year old girl with no pathologic background, with pyoureterohydronephrosis is presented. The history was 5 days of abdominal pain and fever (38,2 Cº), and an occupation of the left recess in the rectal digital examination.Imagenologic studies demonstrate pyoureterohydronephrosis.

unusual complication of uterine prolapse. Bilateral severe hydronephrosis

Obstructive uropathy with bilateral hydronephrosis may be seen in uterine procidentia cases. Early recognition and treatment can prevent irreversible renal damage. Although this association has been known for a long time, it is clinically under evaluated most of the time. Here, we present a neglected case of total uterine procidentia in a 64-year-old woman who was detected also to have renal dysfunction. After surgical correction of procidentia, renal function tests returned to normal

Hidronefrosis prenatal en doble sistema excretor / Hidronefrosis prenatal in double system excretor

Con la introducción del ultrasonido materno-fetal en el seguimiento sistemático del embarazo normal se detectan anomalías congénitas en el 1 por ciento de los fetos, el 20 por ciento de las cuales corresponden al tracto urinario. Se realizó el estudio de recién nacidos y lactantes con hidronefrosis prenatal, cuyos ultrasonidos materno-fetales demostraron la presencia de un doble sistema excretor. Para este propósito todos los recién nacidos y lactantes con hidronefrosis detectada prenatalmente, y doble sistema excretor diagnosticado antes o después del nacimiento, fueron seguidos mediante ultrasonografía renal evolutiva, uretrocistografía miccional, gammagrafía estática o dinámica y, en algunos casos, mediante urograma excretor. Hallamos doble sistema excretor en 7 de los 182 pacientes (3,8 por ciento) con anormalidades del tracto urinario diagnosticadas antes del nacimiento. El diagnóstico fue prenatal solo en uno de los fetos (31 semanas de embarazo). La dilatación hidronefrótica fue ligera en dos fetos y grave en cinco. La hidronefrosis obedeció a diferentes causas. Se realizó nefrectomía polar superior en los casos de ectopia ureteral y de uréter superior obstruido, reimplantación en un ureterocele, y en otro se comprobó la ruptura espontánea mediante endoscopia. Los restantes pacientes se trataron sintomáticamente. La hidronefrosis detectada antes del nacimiento mediante ultrasonografía materno-fetal puede estar asociada a un doble sistema excretor. La dilatación hidronefrótica asociada a un doble sistema puede deberse a diferentes causas, y es necesario estudiar cuidadosa y sistemáticamente a estos niños y tratarlos adecuadamente, porque cada uno puede necesitar una conducta diferente.

With the introduction of the maternofetal ultrasound in the systematic follow-up of normal pregnancy, congenital anomalies are detected in 1 percent of the fetuses, 20 percent of which correspond to the urinary tract. The newborns and infants with prenatal hydronephrosis were studied. The maternofetal ultrasound showed a double excretory system. To this end, all the newborns and infants with prenatally detected hydronephrosis and double excretory system diagnosed before or after birth were followed up by evolutive renal ultrasonography, micturition urethrocystography, static or dynamic scintigraphy and, in some cases, by excretory urogram. Double excretory system was found in 7 of the 182 patients (3.8 percent) with abnormalities of the urinary tract diagnosed before birth. Diagnosis was prenatal in just one of the fetuses (31 weeks of pregnancy). Hydronephrotic dilatation was mild in two fetuses and severe in five. Hydronephrosis had different causes. Upper polar nephrectomy was performed in those cases of ureteral ectopy and obstructed upper ureter, reimplantation in one ureterocele, whereas in another it was confirmed the spontaneous rupture by endoscopy. The rest of the patients were symptomatically treated. The hydronephrosis detected before birth by maternofetal ultrasonography may be associated with a double excretory system. Hydronephrotic dilatation associated with a double excretory system may have different causes, and it is necessary to study carefully and systematically these children and to treat them adequately, since each of them may need a different conduct.

Acurácia do estudo dos jatos ureterais à ultra-sonografia com Doppler colorido no diagnóstico das hidronefroses / Diagnostic accuracy of color Doppler ultrasonographic study of the ureteric jets in evaluation of hydronephrosis

O objetivo do estudo foi avaliar a aplicabilidade do estudo dos jatos ureterais como método diagnóstico na identificação das hidronefroses obstrutivas e não obstrutivas na população pediátrica.Foram estudadas 48 crianças com Hidronefrose Unilateral.Freqüência Relativa dos Jatos (FRJ) foi definida como o número de jatos ureterais no lado afetado dividido pela soma dos jatos ureterais observados bilateralmente.Observou-se que FRJ < 0,25 é o melhor valor que distingue as hidronefroses e o faz corretamente em 91,2 por cento dos casos, com uma Sensibilidade de 86,4 por cento e Especificidade de of 96.15 por cento. FRJ < 25 por cento mostrou ser indicador de obstrução nas hidronefroses unilaterais da infância e pode ser utilizado na diferenciação das hidronefroses obstrutivas e não obstrutivas na população pediátrica.

The aim of this study was to evaluate the Ureteral Jets(UJ) in the bladder as a diagnostic tool to distinguish obstructive from non-obstructive dilatations of the upper tract in pediatric population.We evaluated 48 patients who presented with unilateral hydronephrosis suspicious of pyeloureteral junction obstruction. Relative Jet Frequency (RJF) was defined as the UJ frequency of hydronephrotic side divided by total UJ frequency. RJF< 0.25 was the best threshold and it correctly discriminates obstruction in 91.2 per cent of the childrens with a sensitivity of 86.4 per cent and specificity of 96.15. In this study RJF < 25 per cent was found to be a good indicator of obstruction in children with unilateral hydronephrosis. CDUS evaluation of UJ can be used to differentiate obstructed from non-obstructed hydronephrosis in the pediatric population.

Hydronephrose geante à propos de trois observations au CHU Hubert Maga de Cotonou

Introduction : Les hydronephroses geantes sont rares mais non exceptionnelles. Le but de cette etude est de rapporter la frequence de l'affection dans le service d'Urologie et de decrire la tactique operatoire de trois etiologies. Observations No 1 : Mme Nadine H.; 26 ans; admise le 2/ 06 /06 pour douleurs et masse du flanc gauche. Le debut de sa maladie remonte a 8 ans marque par des crises de colique nephretique gauche et de pyelonephrite gauche. Ses antecedents sont sans particularite. L'examen physique ote un bon etat general; dans le service. Elle atteint les deux sexes. Le sex-ratio est de 3 hommes pour 1 femme. L'age moyen est de 21 ans. Le cote dominant est gauche chez la femme et droit chez l'homme. La masse d'un flanc; la douleur; l'hyperthermie et l'hematurie sont les principaux motifs de consultation. L'examen clinique decouvre la masse qui donne le contacte lombaire et le ballottement renal. L'echographie et l'urographie intraveineuse sont la cle du diagnostic. La tactique operatoire est representee par la pyeloplastie et la nephrectomie quand le rein est detruit. Conclusion : L'hydronephrose geante est rare. Le retard a la consultation est un facteur de mauvais pronostic fonctionnel. La masse d'un flanc; la douleur; l'hematurie; la fievre et l'urinome retroperitoneal en sont evocateurs. Dans les meilleurs cas; la pyeloplastie est une solution sinon la nephroureterectomie. Une masse du flanc gauche donnant un contacte lombaire et un ballottement renal. L'echographie et l'urographie intraveineuse revelent une hydronephrose geante. Une pyeloplastie est faite. Les suites sont simples. No 2 : Mme Catherine G.; 55 ans; obese; hypertendue et diabetique; est admise le 27/10/06 pour des douleurs febriles du flanc gauche; evoluant depuis 5 ans sur un fond d'hyperthermie. L'examen physique note un bon etat general; une masse ovoide du flanc gauche; donnant un contact lombaire et un ballottement renal. L'echographie renale et l'urographie intraveineuse revelent une hydronephrose geante lithiasique. Une nephrectomie gauche est pratiquee. Les suites sont simples. No3 : Mlle Tatiana A.; 19 ans; admise le /10 / 05 pour masse abdominale gauche; douleurs et hyperthermie a 39oC. Dans ses antecedents; existe une laparotomie blanche pour une suspicion de kyste de l'ovaire gauche depuis deux jours. L'examen clinique revele une alteration de l'etat general; une temperature a 39oC; une plaie fraiche de laparotomie. La fosse lombaire gauche est comblee; donnant un contacte lombaire et un ballottement renal. Le membre pelvien gauche est en psoitis et une hydrocele du canal de Nuck gauche. L'echographie et l'urographie intraveineuse montrent une hydronephrose geante ectopique. Une nephrectomie gauche est realisee. Une operation de Hartmann est faite pour lesion iatrogene du colon sigmoide avec un retablissement de continuite trois mois plus tard. Les suites sont simples. Discussion : L'hydronephrose geante est une pathologie rare mais non exceptionnelle. Sa frequence est de 0;05 dans le service. Elle atteint les deux sexes. Le sex-ratio est de 3 hommes pour 1 femme. L'age moyen est de 21 ans. Le cote dominant est gauche chez la femme et droit chez l'homme. La masse d'un flanc; la douleur; l'hyper- thermie et l'hematurie sont les principaux motifs de consultation. L'examen clinique decouvre la masse qui donne le contacte lombaire et le ballottement renal. L'echographie et l'urographie intraveineuse sont la cle du diagnostic. La tactique operatoire est representee par la pyeloplastie et la nephrectomie quand le rein est detruit. Conclusion : L'hydronephrose geante est rare. Le retard a la consultation est un facteur de mauvais pronostic fonctionnel. La masse d'un flanc; la douleur; l'hematurie; la fievre et l'urino- me retroperitoneal en sont evocateurs. Dans les meilleurs cas; la pyeloplastie est une solution sinon la nephroureterectomie

Un cas de syndrome de la jonction pyelo-ureterale sur rein unique

Les auteurs rapportent une observation exceptionnelle de syndrome de la jonction pyelo-ureterale congenital sur rein unique. Il s'agit d'un cas decouvert chez un jeune homme de 21 ans apres une lombalgie chronique unilaterale droite evoluant depuis trois ans. La fonction renale etait toujours conservee. Le diagnostic a ete confirme par les examens d'imagerie. Une pyeloplastie a ciel ouvert a donne un excellent resultat

Ureter retrocava: relato de caso / Retrocaval ureter: a case report

Relata-se o caso de um paciente com ureter retrocava, diagnosticado inicialmente em exame de urografia excretora e confirmado com tomografia computadorizada do abdome. A tomografia computadorizada torna-se necessária não apenas para confirmar a posição do ureter em relação à veiacava inferior, como também para excluir outras doenças que cursam com hidronefrose, pois hidronefrose é o principal achado do ureter retrocava sintomático.

The authors report a case of a patient with retrocaval ureter found out in an excretory urography and confirmed with abdominal computerized tomography. The computerized tomography is necessary to confirm the position of the ureter and to exclude other diseaseswhich are associated with hydronefrosis, the main imaging finding,when there is a symptomatic retrocaval ureter.

Eggshell calcification of kidney in ureteropelvic junction obstruction

Eggshell calcification of kidney in case of ureteropelvic junction obstruction (UPJO) is an uncommon finding with only a few cases reported in literature. We report a thirty-year-old symptomatic man with curvilinear calcification in hydronephrotic right kidney. Thorough investigations to rule out genitourinary tuberculosis and hydatid disease of kidney were performed prior to the definitive management by laparoscopic approach.

Dietl's crisis: an under-recognized clinical entity in the pediatric population

OBJECTIVE: To characterize and determine whether patients with recurrent abdominal symptoms and associated ureteropelvic junction obstruction (UPJO) (Dietl's crisis) are effectively treated by pyeloplasty and to determine criteria for evaluating UPJO in childhood abdominal pain. MATERIALS AND METHODS: A retrospective chart review from 1998 to 2001 was performed to identify patients with Dietl's crisis and associated UPJO. Chart review included presenting symptoms, location of lesion, condition of the affected renal unit, referral method, and surgery success. RESULTS: Eight patients (7 male and 1 female) were identified with Dietl's crisis. All eight were initially misdiagnosed and spent at least a year with significant pain symptoms before being properly diagnosed. Only one patient had associated urologic complaints. Renal scan split functions of the affected renal unit ranged from 34 percent to 51 percent. One nephrectomy and seven pyeloplasties were performed and resolution of all patients' abdominal symptoms, including pain, resolved. CONCLUSIONS: Children with Dietl's crisis often suffer a delay in diagnosis; the clinical entity appears to be under-diagnosed. Renal parenchyma is typically preserved, and there is a paucity of associated urologic complaints. Once properly diagnosed, patients are well served by a pyeloplasty. Children with periumbilical pain and vomiting, particularly males, would benefit from ultrasound imaging.