RESUMEN
We report a case of exceptionally large kidneys in autosomal dominant polycystic kidney disease (ADPKD) in India. A 43-year-old male with a family history of ADPKD presented with abdominal pain, intermittent fever, and a sense of bilateral fullness in both flanks. On examination, he had bilaterally enlarged kidneys extending towards iliac fossae. The serum metabolic panel revealed elevated serum creatinine and blood urea nitrogen. Ultrasound abdomen and pelvis showed enlarged kidneys with parenchyma replaced by multiple varying-sized cysts and few cysts in both the kidneys leading to hemorrhagic transformation. CT abdomen showed bulky bilateral kidneys with multiple non-communicating cysts, with few cysts showing the hemorrhagic and calcific transformation. The right kidney measured 30.3 x 15 cm, weighing 9 lb, was resected. The left kidney measured 37.0 x 14.0 cm and was resected three months later. The specimen weighed 19.8 lb. Histopathological examination showed a gross specimen with a bossellated surface composed of sub-capsular multiple cysts of varying sizes. Both the enlarged kidneys were resected due to cyst hemorrhage and infection. The patient is currently on hemodialysis until he receives a renal graft.
RESUMEN
PURPOSE: Occult renal disease (ORD) is a clinical condition in which glomerular filtration rate (GFR) is less than 60 ml/min/1.73 m2, while serum creatinine is ≤ 1.3 mg/dl. The aim of the study was to compare the incidence of postoperative stage I acute kidney injury (AKI) according to Acute Kidney Injury Network (AKIN) classification in patients with ORD undergoing either off-pump or on-pump coronary artery bypass grafting. METHODS: A single center prospective randomized study was conducted from March 2011 through January 2014. A total of 120 coronary artery disease (CAD) patients with ORD undergoing coronary artery bypass grafting (CABG) were randomized to either off-pump (group1, n = 62) or on-pump (group2, n = 58) CABG in 1:1 ratio by computer-generated random number table. The GFR and serum creatinine levels were measured preoperatively and postoperatively on day 1 and day 5. The primary outcome (postoperative AKI (stage I)) and secondary outcomes (AKI (stage III) requiring renal replacement therapy (RRT) death, myocardial infarction (MI), cerebrovascular accident, atrial fibrillation (AF), and re-exploration for bleeding) at 30 days were analyzed between the groups. RESULTS: There is no significant difference in baseline characteristics of patients between off-pump and on-pump group. The incidence of postoperative AKI (stage I) was similar between on-pump (20.69%) and off-pump (16.13%) groups (p = 0.51). There was no significant difference in mortality (p = 0.33), postoperative MI (p = 0.34), cerebrovascular accident (p = 1.00), re-exploration (p = 0.96), and AF (p = 0.50). The number of patients of stage III AKI requiring RRT was higher in the off-pump group (3 patients, 4.8%) and none in the on-pump group (p = 0.08). CONCLUSIONS: This study demonstrated that on-pump CABG is associated with significantly lower GFR and significantly higher serum creatinine on postoperative day 1 which return to baseline by postoperative day 5. In patients with ORD undergoing CABG, the incidence of postoperative AKI and major adverse cardiac and cerebrovascular events were similar between off-pump or on-pump CABG patients.
RESUMEN
BACKGROUND: This study assessed whether preoperative renal insufficiency predisposes patients undergoing off-pump coronary artery revascularization to postoperative dialysis. METHODS: From August 2004 through June 2009, 2,275 patients undergoing off-pump coronary artery bypass were categorized into five groups (stages) by glomerular filtration rate (GFR). Of these, 1,855 patients had renal insufficiency: stage 2: 1,406; stage 3: 428; stage 4: 21, and 414 had normal renal function, stage 1. Excluded were 6 patients with end-stage renal disease (stage 5). Preoperative variables and postoperative outcomes were compared among groups. RESULTS: Preoperative patient characteristics were similar; however, patients with normal renal function were younger (p = 0.001). Serum creatinine rose significantly above baseline on the first postoperative day in the renal insufficiency groups (p = 0.001). The GFR groups had similar inotrope use, reexploration rate, duration of postoperative mechanical ventilation, postoperative stroke, wound infection, and mortality rate. Stage 4 patients had a higher incidence of postoperative myocardial infarction (p = 0.002). Stage 3 and 4 patients had an increased need for postoperative dialysis vs stage 1 patients (p = 0.002). CONCLUSIONS: Nonparametric contingency analysis showed patients with low preoperative GFR (stage 3 and 4, p < 0.0001) and a history of smoking (p = 0.04) were at increased risk for postoperative dialysis. Patients who required postoperative inotropic support tended toward requiring postoperative dialysis (p = 0.06). Low preoperative ejection fraction (p = 0.83), class III or IV angina (p = 0.069), and postoperative blood transfusions were not associated with the need for postoperative dialysis in patients undergoing off-pump revascularization.
