Prospective Comparison of Contrast-Enhanced Ultrasound and Magnetic Resonance Imaging to Computer Tomography for the Evaluation of Complex Cystic Renal Lesions.

OBJECTIVE: To prospectively evaluate the diagnostic accuracy of contrast enhanced ultrasound (CEUS) and MRI compared to computed tomography (CT) as the current gold standard for the characterization of cystic renal lesions using the Bosniak classification. METHODS: Between July 2014 and October 2017 we prospectively enrolled patients with cystic renal lesions. Based on the Bosniak classification of complex renal lesions (≥BII-F) we evaluated the accuracy of observed agreement by Cohen's Kappa coefficient and calculated sensitivity, specificity, positive and negative predictive values (PPV/NPV) between the three imaging modalities CT, MRI and CEUS. RESULTS: We evaluated 65 cystic renal lesions in 48 patients (median age 63 years, range 36-91 years; 18 females, 30 males). According to CT 29 (47%) of the cystic renal lesions were classified as complex. The agreement between CEUS and CT in the classification of complex cystic lesions was fair (agreement 50.8%, Kappa 0.31), and was excellent between MRI and CT (agreement 93.9%, Kappa 0.88). Compared to CT, CEUS and MRI had a sensitivity of 100% and 96.6%, a specificity of 33.3% and 91.7%, a PPV of 54.7% and 90.3%, and a NPV of 100% and 97.1% with an accuracy of 63.1% and 93.8% respectively. CONCLUSION: CEUS has an excellent sensitivity and NPV and represents a promising non-invasive screening tool for renal cystic lesions. The classification of complex renal cysts based on MRI and CT scans correlated closely.

[Incremental hemodialysis «â€ less is more†¼ also when starting hemodialysis†?] / Hémodialyse incrémentale ­ «â€ less is more†¼ lors de l'initiation de la dialyse†?

When initiating hemodialysis, incremental hemodialysis takes into account the residual kidney function (RKF) and adds a dialysis regimen to achieve a satisfactory clearance and ultrafiltration. This approach allows less frequent or shorter dialysis sessions than the standard of 3 sessions per week regimen. It is associated with multiple benefits for the patient. However, RKF has to be monitored regularly to enable the dialysis regimen to be adapted accordingly in order to avoid under-dialysis.

Lors de l'initiation d'un traitement d'hémodialyse chronique, l'hémodialyse incrémentale prend en compte la fonction rénale résiduelle (FRR) du patient et complète celle-ci par une dose de dialyse pour atteindre un niveau d'épuration et d'ultrafiltration satisfaisant. Cela permet d'effectuer des séances d'hémodialyse qui sont plus courtes et moins intenses ou moins fréquentes que la prescription standard de 3 dialyses par semaine. Cette méthode est associée à de multiples bénéfices pour le patient. Néanmoins, la FRR doit être monitorée régulièrement afin d'adapter la dose de dialyse et d'éviter une sous-dialyse.