ABSTRACT
BACKGROUND: The treatment of choice in end-stage renal disease is transplantation. Hemodynamic disturbances can evoke graft loss, while early ultrasound identification of vascular problems improves outcome. The aim of this study was to identify differences in postoperative complications with and without systematic intraoperative Doppler ultrasound use. METHODS: The primary outcome was the postoperative rate of complications and the secondary aim was to find a predictive resistance index cut-off value, which would show where surgical reintervention was necessary. Over a 10-year period, 108 renal transplants were performed from living donors at our institution. In group 1 (n = 67), intraoperative duplex ultrasound and intraparenchymatous resistance index measurements assessed patients, while in group 2 (n = 41), no ultrasound was performed. RESULTS: There were no intergroup differences in the overall postoperative complication rate or in benefit to graft or patient survival with Doppler use. However, significantly more vascular complications (10% vs 0%, P = .02) and more acute rejections (37% vs 10%) occurred in group 2 than in group 1. Therefore, an intraoperative cut-off value of the resistance index 0.5 was proposed to justify immediate surgical revision. CONCLUSIONS: This is the first report demonstrating benefits of systematic intraoperative Doppler ultrasound on postoperative complications in renal transplantation from living donors. Our results support surgical revision with a resistance index <0.5.
Subject(s)
Kidney Transplantation/adverse effects , Postoperative Complications/diagnosis , Ultrasonography, Doppler/methods , Vascular Diseases/diagnosis , Vascular Resistance , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Kidney Failure, Chronic/surgery , Living Donors , Male , Middle Aged , Vascular Diseases/etiology , Young AdultABSTRACT
The occurrence of glucosuria in the absence of hyperglycemia is distinctive for renal glucosuria. SGLT2 mutations provoke familial renal glucosuria characterized by persistent glucosuria in the absence of any other renal tubular dysfunction. Renal glucosuria associated with others proximal tubular dysfunctions points to Fanconi syndrome. This generalized dysfunction of proximal tubule needs to be treated and may progress regarding its aetiology to chronic renal failure. The development and study of models of Fanconi syndrome has recently contributed to a better knowledge of the mechanisms implicated in the tubular transport of glucose and low-molecular-weight-proteins. This article reviews these recent developments.
Subject(s)
Fanconi Syndrome/physiopathology , Glycosuria, Renal/physiopathology , Sodium-Glucose Transporter 2/genetics , Adult , Biological Transport , Fanconi Syndrome/diagnosis , Female , Glucose/metabolism , Glycosuria, Renal/etiology , Glycosuria, Renal/genetics , Humans , Infant , Kidney Tubules, Proximal/metabolism , Male , MutationABSTRACT
We report a case of a 33 years old female with a history of paroxystic hemidystonia treated by acetazolamide, a carbonic anhydrase inhibitor (CAI), and who developed two years after the initiation of this treatment bilateral radio-opaque stones. Laboratory tests revealed a hyperchloremic acidosis, an elevated urinary pH, a hypercalciuria, a severe hypocitraturia and numerous granulations of amorphous carbonated calcium phosphates and brushite crystals on urinary microscopic examination, the whole suggests a diagnosis of acetazolamide-induced nephrolithiasis. We discuss in this article the lithogenetic process and the usual composition of the stones induced by CAI, and specific risk factors for developing drug-induced lithiasis which should be taken into consideration when prescribing long-term drug regimens.
Subject(s)
Acetazolamide/adverse effects , Calcium Phosphates/analysis , Carbonic Anhydrase Inhibitors/adverse effects , Kidney Calculi/chemistry , Kidney Calculi/chemically induced , Acetazolamide/administration & dosage , Adult , Carbonic Anhydrase Inhibitors/administration & dosage , Dystonia/drug therapy , Female , HumansABSTRACT
We report the case of a 35-year-old man with no cardiovascular morbidity, presenting with acute flank pain, microscopic haematuria and normal blood pressure. Initially diagnosed as a ureteral colic, the patient was recovered 6 weeks later with severe hypertensive crisis. Further investigations revealed a massive renal infarction secondary to medial fibromuscular dysplasia (FMD). Several aspects of this presentation are intriguing. Renal infarcts are usually seen in older patients having cardiac problems and/or major atheromatous plaques. In addition, FMD is mainly observed in young females and rarely progresses to renal artery occlusion. Furthermore, in this case, FMD remained silent until the acute renal infarction occurred, despite a significant kidney size reduction at the time of diagnosis. Finally, the observation of a delayed hypertensive response to a major renovascular insult provides incentives to discuss possible pathophysiological mechanisms involved in renovascular hypertension.
Subject(s)
Colic/etiology , Fibromuscular Dysplasia/complications , Kidney Diseases/etiology , Adult , Diagnosis, Differential , Fibromuscular Dysplasia/diagnosis , Flank Pain/etiology , Humans , Infarction/complications , Kidney/blood supply , Male , Urinary Calculi/diagnosisABSTRACT
The authors report an unusual case with bilateral coronary artery fistulas at the origin of the coronary cusps. The diagnostic technique and management are discussed.
Subject(s)
Arterio-Arterial Fistula , Coronary Vessel Anomalies , Pulmonary Artery/abnormalities , Arterio-Arterial Fistula/diagnostic imaging , Arterio-Arterial Fistula/physiopathology , Blood Flow Velocity , Coronary Angiography , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/physiopathology , Echocardiography, Transesophageal , Female , Humans , Middle Aged , Pulmonary Artery/diagnostic imagingABSTRACT
Percutaneous balloon mitral valvuloplasty (PBMV) described by Inoue et al, is a safe FDA (Food and Drug Administration) approved procedure in patients with severe mitral stenosis. One of the contraindications of the procedure is presence of a left atrial thrombus; however, it has been reported that intense warfarin therapy may led to dissolution of the thrombus. The authors report a patient who was referred for PBMV and was found to have a left atrial thrombus. After intense warfarin therapy, successful PBMV was undertaken without complications.