Hidronefrose unilateral por urólito em pelve renal de felino - relato de caso / Unilateral hydrophageosis by urolium in feline's renal pelve - case report

Na hidronefrose ocorre dilatação da pelve renal devido à obstrução do fluxo urinário, causada principalmente por um aumento lento ou intermitente da pressão pélvica. Urolitíase é a presença de cálculos nas vias urinarias (urolitos). Cálculos são concreções formadas pela precipitação de sais de ácidos orgânicos e inorgânicos ou por outros elementos, tais como cistina, xantina, fosfato, carbonato, cilica ou uratos, em associação a uma matriz orgânica (proteica). Diante disto o presente trabalho teve como objetivo relatar um caso de hidronefrose unilateral por bloqueio da pelve renal em um paciente felino. O animal foi encaminhado ao centro veterinário Integrado de Campo Mourão PR para realização de exames complementares e foi possível observar hidronefrose no rim esquerdo e elevação nos níveis séricos de ureia, potássio, creatinina, cálcio e globulinas. O prognostico para este paciente era desfavorável devido ao estado clinico grave apresentado, sendo indicada a eutanásia. Após a eutanásia retirou-se o rim esquerdo do animal e observou-se um cálculo de consistência firme, arenosa e coloração amarelada obstruindo a conexão ureter e pelve. Na análise histopatológica a pelve renal apresentava-se com acentuado infiltrado inflamatório e fibrose moderada que se estendiam por todo parênquima renal, sendo o diagnóstico conclusivo de uma pielonefrite linfocítica difusa acentuada além de fibrose multifocal a coalescente.(AU)

In hydronephrosis, dilatation of the renal pelvis occurs due to obstruction of the urinary flow, mainly caused by a slow or intermittent increase in pelvic pressure. Urolithiasis is the presence of stones in the urinary tract (uroliths). Calculations are concretions formed by the precipitation of salts of organic and inorganic acids or by other elements, such as cystine, xanthine, phosphate, carbonate, cilica or urates, in association with an organic (protein) matrix. In view of this the present work aims to report a case of unilateral hydronephrosis by blocking the renal pelvis in a feline patient. The animal was referred to the Integrated Veterinary Center of Campo Mourão - PR to perform complementary tests and it was possible to observe hydronephrosis in the left kidney and increase in the serum levels of urea, potassium, creatinine, calcium and globulins. The prognosis for this patient was unfavorable due to the serious clinical condition presented, and euthanasia was indicated. After euthanasia, the left kidney was removed from the animal and observe a calculation of firm, sandy and yellowish consistency was found by obstructing the ureter and pelvis connection. In the histopathological analysis, the renal pelvis presented with marked inflammatory infiltrate and moderate fibrosis that extended throughout the renal parenchyma, being the conclusive diagnosis of a diffuse lymphocytic pyelonephritis, in addition to multifocal to coalescent fibrosis.(AU)

Hidronefrose unilateral por urólito em pelve renal de felino - relato de caso / Unilateral hydrophageosis by urolium in feline's renal pelve - case report

Na hidronefrose ocorre dilatação da pelve renal devido à obstrução do fluxo urinário, causada principalmente por um aumento lento ou intermitente da pressão pélvica. Urolitíase é a presença de cálculos nas vias urinarias (urolitos). Cálculos são concreções formadas pela precipitação de sais de ácidos orgânicos e inorgânicos ou por outros elementos, tais como cistina, xantina, fosfato, carbonato, cilica ou uratos, em associação a uma matriz orgânica (proteica). Diante disto o presente trabalho teve como objetivo relatar um caso de hidronefrose unilateral por bloqueio da pelve renal em um paciente felino. O animal foi encaminhado ao centro veterinário Integrado de Campo Mourão – PR para realização de exames complementares e foi possível observar hidronefrose no rim esquerdo e elevação nos níveis séricos de ureia, potássio, creatinina, cálcio e globulinas. O prognostico para este paciente era desfavorável devido ao estado clinico grave apresentado, sendo indicada a eutanásia. Após a eutanásia retirou-se o rim esquerdo do animal e observou-se um cálculo de consistência firme, arenosa e coloração amarelada obstruindo a conexão ureter e pelve. Na análise histopatológica a pelve renal apresentava-se com acentuado infiltrado inflamatório e fibrose moderada que se estendiam por todo parênquima renal, sendo o diagnóstico conclusivo de uma pielonefrite linfocítica difusa acentuada além de fibrose multifocal a coalescente.

In hydronephrosis, dilatation of the renal pelvis occurs due to obstruction of the urinary flow, mainly caused by a slow or intermittent increase in pelvic pressure. Urolithiasis is the presence of stones in the urinary tract (uroliths). Calculations are concretions formed by the precipitation of salts of organic and inorganic acids or by other elements, such as cystine, xanthine, phosphate, carbonate, cilica or urates, in association with an organic (protein) matrix. In view of this the present work aims to report a case of unilateral hydronephrosis by blocking the renal pelvis in a feline patient. The animal was referred to the Integrated Veterinary Center of Campo Mourão - PR to perform complementary tests and it was possible to observe hydronephrosis in the left kidney and increase in the serum levels of urea, potassium, creatinine, calcium and globulins. The prognosis for this patient was unfavorable due to the serious clinical condition presented, and euthanasia was indicated. After euthanasia, the left kidney was removed from the animal and observe a calculation of firm, sandy and yellowish consistency was found by obstructing the ureter and pelvis connection. In the histopathological analysis, the renal pelvis presented with marked inflammatory infiltrate and moderate fibrosis that extended throughout the renal parenchyma, being the conclusive diagnosis of a diffuse lymphocytic pyelonephritis, in addition to multifocal to coalescent fibrosis.

Isolated low grade prenatally detected unilateral hydronephrosis: do we need long term follow-up?

ABSTRACT Purpose: To assess the need for postnatal evaluation and the medium term outcome in patients with isolated unilateral low grade prenatally detected hydronephrosis. Materials and Methods: We prospectively selected 424 patients (690 kidney units) with a prenatal diagnosis of urinary tract dilatation between 2010 and 2013. We included only those patients with isolated unilateral low-grade hydronephrosis who underwent at least 2 postnatal ultrasound examinations. The Society for Fetal Urology (SFU) grading system was utilized for assessment of the hydronephrosis. We excluded patients with bilateral dilation or other urological abnormalities. The fate of hydronephrosis including resolution, stability or worsening was documented. Results: A total of 66 infants (44 boys and 22 girls) with antenatally diagnosed unilateral urinary tract dilation (23 right and 43 left) were identified. Ultrasounds showed SFU grade 1 hydronephrosis in 32 patients (48%) and SFU grade 2 hydronephrosis in 34 (52%). After a mean follow-up period of 32 months (range 12 to 60), 37 patients (56%) had complete resolution of hydronephrosis while the remaining 29 were stable (44%). None of our patients developed UTIs during follow-up and none required surgical intervention. Conclusions: Prenatally detected, isolated unilateral low-grade hydronephrosis usually have a favorable prognosis. All cases in our cohort showed either stability or resolution of hydronephrosis without any harmful consequences. Based on our findings on medium-term in this category of patients, long-term follow-up is not warranted.

Isolated low grade prenatally detected unilateral hydronephrosis: do we need long term follow-up?

PURPOSE: To assess the need for postnatal evaluation and the medium term outcome in patients with isolated unilateral low grade prenatally detected hydronephrosis. MATERIALS AND METHODS: We prospectively selected 424 patients (690 kidney units) with a prenatal diagnosis of urinary tract dilatation between 2010 and 2013. We included only those patients with isolated unilateral low-grade hydronephrosis who underwent at least 2 postnatal ultrasound examinations. The Society for Fetal Urology (SFU) grading system was utilized for assessment of the hydronephrosis. We excluded patients with bilateral dilation or other urological abnormalities. The fate of hydronephrosis including resolution, stability or worsening was documented. RESULTS: A total of 66 infants (44 boys and 22 girls) with antenatally diagnosed unilateral urinary tract dilation (23 right and 43 left) were identified. Ultrasounds showed SFU grade 1 hydronephrosis in 32 patients (48%) and SFU grade 2 hydronephrosis in 34 (52%). After a mean follow-up period of 32 months (range 12 to 60), 37 patients (56%) had complete resolution of hydronephrosis while the remaining 29 were stable (44%). None of our patients developed UTIs during follow-up and none required surgical intervention. CONCLUSIONS: Prenatally detected, isolated unilateral low-grade hydronephrosis usually have a favorable prognosis. All cases in our cohort showed either stability or resolution of hydronephrosis without any harmful consequences. Based on our findings on medium-term in this category of patients, long-term follow-up is not warranted.

Nitric oxide and asymmetric dimethyl arginine (ADMA) levels in an experimental hydronephrotic kidney caused by unilateral partial ureteral obstruction.

AIM: Our aim is to measure asymmetric dimethyl arginine and nitric oxide levels in rats with induced unilateral acute ureteral obstruction to research the effects on the kidney. MATERIAL AND METHODS: The study included 21 adolescent (average age 6 weeks) Sprague-Dawley male rats weighing between 240-290g divided at random into 3 groups. Group-1: Control group (n=6): underwent no procedures. Group-2: Sham group (n=6): underwent the same procedures as the experimental group without ureter and psoas muscle dissection. Group-3: Group with induced partial unilateral ureteral obstruction (n=9). All rats were sacrificed after 12 weeks. Superoxide dismutase enzyme activity and nitrite and nitrate salt levels were measured in renal tissue. Plasma nitrite-nitrate and ADMA levels were examined. RESULTS: In the experimental group histopathological changes observed included renal pelvis dilatation, flattened papillae, sclerotic glomerulus and fibrosis. In the experimental group tissue SOD and blood ADMA levels were higher than the control and sham groups (p<0.05) while tissue NO and plasma NO values were lower than in the sham and control groups (p<0.05). CONCLUSION: Oxidative stress and disruption of NO synthesis play an important role in renal function and histopathological changes after obstructive renal disease. To prevent renal complications developing after obstructive nephropathy we believe that a new strategy may be research on reducing ADMA.

Nitric oxide and asymmetric dimethyl arginine (ADMA) levels in an experimental hydronephrotic kidney caused by unilateral partial ureteral obstruction

ABSTRACT Aim Our aim is to measure asymmetric dimethyl arginine and nitric oxide levels in rats with induced unilateral acute ureteral obstruction to research the effects on the kidney. Material and Methods The study included 21 adolescent (average age 6 weeks) Sprague-Dawley male rats weighing between 240-290g divided at random into 3 groups. Group-1: Control group (n=6): underwent no procedures. Group-2: Sham group (n=6): underwent the same procedures as the experimental group without ureter and psoas muscle dissection. Group-3: Group with induced partial unilateral ureteral obstruction (n=9). All rats were sacrificed after 12 weeks. Superoxide dismutase enzyme activity and nitrite and nitrate salt levels were measured in renal tissue. Plasma nitrite-nitrate and ADMA levels were examined. Results In the experimental group histopathological changes observed included renal pelvis dilatation, flattened papillae, sclerotic glomerulus and fibrosis. In the experimental group tissue SOD and blood ADMA levels were higher than the control and sham groups (p<0.05) while tissue NO and plasma NO values were lower than in the sham and control groups (p<0.05). Conclusion Oxidative stress and disruption of NO synthesis play an important role in renal function and histopathological changes after obstructive renal disease. To prevent renal complications developing after obstructive nephropathy we believe that a new strategy may be research on reducing ADMA.

Comparison of Cajal-like cells in pelvis and proximal ureter of kidney with and without hydronephrosis

Objectives: To evaluate effects of Cajal-like cells on human renal pelvis and proximal ureter on peristalsis. Materials and Methods: 63 patients submitted to nephrectomy due to atrophic non-functional kidney associated with hydroureteronephrosis were included as study group and 30 cases with nephrectomy due to other reasons were included as control group. Samples from renal pelvis and proximal ureters were obtained and sections of 5μ form paraffin blocks of these samples were prepared; layers of lamina propria and muscularis mucosa were examined by immune-histochemistry using CD117 in order to determine count and distribution of Cajal-like cells. Results: During immune-histochemical examinations of sections, obtained from renal pelvis and proximal ureter of hydronephrotic kidneys by CD117, Cajal-like cells number determined in lamina propria and muscularis propria was statistically significantly lower compared to control group (p<0.001). Distribution of Cajal-like cells in renal pelvis and proximal tubulus was similar under examination by light microscope, and also both groups were not different from each other regarding staining intensity of Cajal-like cells by c-kit. Conclusion: Significantly reduced number of Cajal-like cells in study group compared to control group, shows that these cells may have a key role in regulation of peristalsis at level of renal pelvis and proximal ureter in urinary system.

Comparison of Cajal-like cells in pelvis and proximal ureter of kidney with and without hydronephrosis.

OBJECTIVES: To evaluate effects of Cajal-like cells on human renal pelvis and proximal ureter on peristalsis. MATERIALS AND METHODS: 63 patients submitted to nephrectomy due to atrophic non-functional kidney associated with hydroureteronephrosis were included as study group and 30 cases with nephrectomy due to other reasons were included as control group. Samples from renal pelvis and proximal ureters were obtained and sections of 5µ form paraffin blocks of these samples were prepared; layers of lamina propria and muscularis mucosa were examined by immune-histochemistry using CD117 in order to determine count and distribution of Cajal-like cells. RESULTS: During immune-histochemical examinations of sections, obtained from renal pelvis and proximal ureter of hydronephrotic kidneys by CD117, Cajal-like cells number determined in lamina propria and muscularis propria was statistically significantly lower compared to control group (p<0.001). Distribution of Cajal-like cells in renal pelvis and proximal tubulus was similar under examination by light microscope, and also both groups were not different from each other regarding staining intensity of Cajal-like cells by c-kit. CONCLUSION: Significantly reduced number of Cajal-like cells in study group compared to control group, shows that these cells may have a key role in regulation of peristalsis at level of renal pelvis and proximal ureter in urinary system.

PAX2 polymorphisms and congenital abnormalities of the kidney and urinary tract in a Brazilian pediatric population: evidence for a role in vesicoureteral reflux.

BACKGROUND AND OBJECTIVES: Congenital anomalies of the kidney and urinary tract (CAKUT) are common genetic malformations. Since the PAX2 gene has a role in kidney organogenesis, this study investigated the association of PAX2 gene polymorphisms with CAKUT in general and with specific phenotypes of CAKUT in a Brazilian pediatric population. METHODS: This study included 241 individuals with antenatal hydronephrosis and 259 healthy controls. For genotyping and allelic discrimination we used the probes to rs2077642, rs4244341, rs6421335, rs11190698, and rs11190693. RESULTS: No statistical differences in allele and genotype frequencies were observed for the single nucleotide polymorphism (SNP) rs11190693. At the SNPs rs4244341 and rs11190698, the frequencies of the ancestral alleles were significantly higher among CAKUT patients (rs4244341 allele G: 0.86 vs. 0.78; rs11190698 allele A: 0.85 vs. 0.79). At the SNP rs4244341, the genotype GG was increased in CAKUT group (0.72 vs. 0.61, P = 0.013), while the TT was higher in controls (0.01 vs. 0.05, P = 0.001). At the SNP rs11190698, the genotype CC was increased in controls (0.02 vs. 0.06, P = 0.01). The most frequent CAKUT phenotypes were vesicoureteral reflux (VUR), multicystic dysplastic kidney (MCDK), and ureteropelvic junction obstruction (UPJO). In patients with VUR, the frequencies of the monozygotic ancestral alleles decreased at the SNP rs11190693 (AA 0.13 vs. 0.26, P = 0.04) and increased at the SNP rs4244341 (GG 0.77 vs. 0.61, P = 0.03). No statistical differences were detected between controls and patients with UPJO and with MCDK for all SNPs. CONCLUSION: The PAX2 gene seems to be involved with the pathogenesis of VUR in our sample.

Adriamycin-induced fetal hydronephrosis

INTRODUCTION: At the end of pregnancy, the amniotic fluid (AF) depends basically on renal function, corresponding to fetal urine. Changes in AF, especially oligohydramnios, are reported in association with fetal hydronephrosis (FH). The experimental model using adriamycin in pregnant female rats has a teratogenic effect and has been classically employed to study esophageal atresia. Nevertheless, adriamycin promotes FH with high frequency as well. In the present study, using this animal model, we tried to identify the incidence and microscopic changes of FH, as well as its correlation with AF weight. MATERIALS AND METHODS: Eight Spreague-Dawley pregnant female rats received adriamycin 2.2 mg/kg on the 8th and 9th gestational days (considering term gestation = 22 days). Those fetuses that received adriamycin (Adriamycin Group) were compared with fetuses from 2 female rats (Control Group), which received 0.9 percent saline solution. On the 21.5 gestational day, the fetuses were collected by cesarean incision, sacrificed, and examined for macro and microscopic changes in kidneys and ureters. Fetuses with bilateral hydronephrosis formed the Hydronephrosis Group. AF weight was determined as well. RESULTS: Hydronephrosis occurred in 70 (95 percent) of the 74 fetuses in the adriamycin group against none of the 21 fetuses from the control group. The amniotic fluid weight was increased in the adriamycin group in relation to the control group (p < 0.001). The histomorphometric study revealed dilation of the renal pelvis and reduction of renal parenchyma in the hydronephrosis group in relation to the control group. Severe cortical atrophy, cortical tubular atrophy and medullar atrophy were observed in the hydronephrosis group. CONCLUSIONS: Slight renal lesions were in agreement with changes in AF weight, since they suggest that there was production of urine with the maintenance of AF.

Adriamycin-induced fetal hydronephrosis.

INTRODUCTION: At the end of pregnancy, the amniotic fluid (AF) depends basically on renal function, corresponding to fetal urine. Changes in AF, especially oligohydramnios, are reported in association with fetal hydronephrosis (FH). The experimental model using adriamycin in pregnant female rats has a teratogenic effect and has been classically employed to study esophageal atresia. Nevertheless, adriamycin promotes FH with high frequency as well. In the present study, using this animal model, we tried to identify the incidence and microscopic changes of FH, as well as its correlation with AF weight. MATERIALS AND METHODS: Eight Spreague-Dawley pregnant female rats received adriamycin 2.2 mg/kg on the 8th and 9th gestational days (considering term gestation = 22 days). Those fetuses that received adriamycin (Adriamycin Group) were compared with fetuses from 2 female rats (Control Group), which received 0.9% saline solution. On the 21.5 gestational day, the fetuses were collected by cesarean incision, sacrificed, and examined for macro and microscopic changes in kidneys and ureters. Fetuses with bilateral hydronephrosis formed the Hydronephrosis Group. AF weight was determined as well. RESULTS: Hydronephrosis occurred in 70 (95%) of the 74 fetuses in the adriamycin group against none of the 21 fetuses from the control group. The amniotic fluid weight was increased in the adriamycin group in relation to the control group (p < 0.001). The histomorphometric study revealed dilation of the renal pelvis and reduction of renal parenchyma in the hydronephrosis group in relation to the control group. Severe cortical atrophy, cortical tubular atrophy and medullar atrophy were observed in the hydronephrosis group. CONCLUSIONS: Slight renal lesions were in agreement with changes in AF weight, since they suggest that there was production of urine with the maintenance of AF.

Prognostic factors in prenatally-detected posterior urethral valves: a multivariate analysis.

To identify prognostic factors associated with chronic renal insufficiency in children with posterior urethral valves (PUV), 22 children with PUV were submitted to a systematic protocol and prospectively followed. Prognostic factors associated with fetal echography and clinical and laboratory findings were studied on admission. Median follow-up was 76 months. The analysis was conducted in two steps: in univariate analysis, variables associated with adverse outcome were identified by the Kaplan-Meier method. The variables that were significantly associated with adverse outcome were then included in a multivariate analysis using the Cox model. Eleven patients (50%) developed chronic renal failure (CRF) during follow-up. After adjustment by the multivariate model, four factors were identified as independent predictors of adverse outcome: oligohydramnios (relative risk [RR] = 10.6, 95% CI = 2.7 - 77, P = 0.02), ventilatory support (RR = 6, 95% CI = 2 - 24, P = 0.01), urea higher than 40 mg/dl (RR = 3.7, 95% CI = 0.92 - 15.0, P = 0.06), and bilateral vesicoureteral reflux (VUR) (RR = 6.1, 95% CI = 1.25 - 30, P = 0.02). On the other hand, the presence of unilateral VUR was a protective factor against the development of CRF or death during follow-up (RR = 0.92, 95% CI = 0.87 - 0.98, P = 0.05).