Percutaneous embolization of the failed renal allograft in patients with graft intolerance syndrome.

OBJECTIVE: To analyse the circumstances, results and complications of percutaneous embolization in failed renal grafts that are not tolerated, to avoid surgical graft removal in selected patients. PATIENTS AND METHODS: The study included 33 patients (mean age 42 years, SD 13.9) whose renal grafts failed between 1990 and 1999. The patients underwent percutaneous embolization of their renal transplant for graft intolerance syndrome. The allograft was left in situ after failure for a mean (SD) of 9.9 (6.5) months. The subsequent hospital stay, the appearance of complications and the final results were assessed. RESULTS: Post-embolization syndrome (fever for 2-5 days) appeared in 20 (61%) of the patients; the clinical intolerance resolved in 28 (85%). The embolization was unsuccessful in five of the 33 patients (15%) and they required graft removal. The mean (SD) hospital stay was 5 (2) days; there were no major complications from graft embolization. CONCLUSIONS: Graft embolization avoids kidney removal in many patients with failed and rejected transplants, with low rates of morbidity. Surgical graft nephrectomy was useful when graft intolerance syndrome persisted after embolization.

Embolización percutánea del injerto renal afuncionante como alternativa terapéutica a la trasplantectomía quirúrgica / Percutaneous embolisation of non-functioning renal graft as therapeutic alternative to surgical trasnsplactectomy

OBJETIVO: Analizar las indicaciones, resultados y complicaciones de la embolización del injerto renal afuncionante e intolerado con relación a la trasplantectomía quirúrgica. MATERIAL Y MÉTODOS: Se han estudiado 55 pacientes con injerto renal fracasado entre 1990 y 1998, en los cuales se les practicó, o bien transplantectomía subcapsular (23 pacientes) o embolización percutánea del injerto (32 pacientes).La edad media de ambos grupos fue de 40,9 ñ 3,14 y 42 ñ 2,45 años respectivamente. Tras el inicio de la diálisis se dejó el injerto in situ una media de 10,2 (ñ 11,2) y 9,9 (ñ 6,5) meses. Comparamos la estancia hospitalaria, aparición de complicaciones de la técnica utilizada y resultados de la misma. RESULTADOS: Aparece síndrome de post-embolización (fiebre de 2 a 5 días) en el 59 por ciento de los casos. No hemos observado complicaciones mayores derivadas de la embolización; mientras que en el 13 por ciento de las nefrectomías subcapsulares aparecieron complicaciones que requirieron reintervención. Existe menor estancia hospitalaria (p > 0,005) en el grupo de pacientes embolizados que en el grupo que siguió tratamiento quirúrgico. La clínica de intolerancia desaparece en el 84,4 por ciento de las embolizaciones. En 5 injertos embolizados (15,6 por ciento) los resultados no fueron satisfactorios, lo que nos obligó a la transplantectomía subcapsular diferida. CONCLUSIONES: A largo plazo, la embolización controla de forma satisfactoria la clínica de intolerancia y conlleva una menor morbilidad que la transplantectomía. La cirugía es útil cuando persiste la clínica de intolerancia tras una o más embolizaciones. Por su seguridad y efectividad, la embolización debe ser un tratamiento de elección en casos seleccionados (AU)

[Percutaneous embolization of non-functioning renal graft as therapeutic alternative to surgical transplantectomy]. / Embolización percutánea del injerto renal afuncionante como alternativa terapéutica a la trasplantectomía quirúrgica.

OBJECTIVE: To analyze the indications, results and complications of embolisation of a non-tolerated, non-functioning renal graft with regards to surgical transplantectomy. MATERIAL AND METHODS: Between 1990 and 1998, 55 patients with failed renal graft were studied. Patients had undergone either subcapsular transplantectomy (23 patients) or percutaneous embolisation of allograft (32 patients). Mean age in both groups was 40.9 +/- 3.14 and 42 +/- 2.45 years respectively. After start of dialysis, the graft was left in situ for an average of 10.2 (+/- 11.2) and 9.9 (+/- 6.5) months. Hospital stay, occurrence of complications from the technique used, and results were compared. RESULTS: Post-embolisation syndrome (high temperature for 2 to 5 days) was seen in 59% cases. No major complications secondary to embolization were seen, whereas 13% subcapsular nephrectomies had complications that required re-operation. Hospital stay was shorter (p > 0.005) in embolized patients than in those undergoing surgery. Sings and symptoms of intolerance disappears in 84.4% embolizations. Results were unsuccessful in 5 grafts (15.6%) undergoing embolisation, which resulted in deferred subcapsular transplantectomy. CONCLUSIONS: Long-term, embolization shows acceptable control over the signs and symptoms of intolerance and involves less morbidity than transplantectomy. Surgery is useful when intolerance persists after one or more embolizations. Because of its features of safety and effectiveness, embolisation should be a choice treatment in selected cases.

[Renal angiomyolipoma located intrasinusally. An anomalous location which poses diagnostic problems]. / Angiomiolipoma renal de localización intrasinusal. Una localización anómala que plantea problemas diagnósticos.

Presentation of one case of intrasinusale located renal angiomyolipoma. Given the location, the ECO as well as the IVU, arteriography and CAT presented diagnostic doubts. We believe this unusual presentation should be added to those circumstances where uncertainty of tumor diagnosis due to size, behaviour or clinical signs and symptoms, elicits a more aggressive attitude.

[Malignant neoplasms and kidney transplantation]. / Neoplasias malignas y transplante renal.

In 661 renal transplantations, 2 potentially migrated tumours (0.38%), 5 preexisting neoplasias (0.76%), and 31 "de novo" tumours were seen in 29 patients (4.4&). Although of very low incidence, the likelihood of tumour migration from elderly donors, given the circumstances surrounding removal, offers a high risk. None of the preexisting neoplasias relapsed following transplant. The highest prevalence was seen in skin (40%), lung (13%), kidney (13%) and bladder (6.6%) "de novo" tumours. Incidence of lymphoma was low. Dominant etiological factors of the recipient were older age, effective and tolerated immunosuppression, viral infections, environmental agents and antigenic stimulation of the graft. Skin lesions have responded well to local treatment, without need to discontinue immunosuppression, a measure that is mandatory in other malignant tumours. Also, the conclusions of a round table during the 25th National Meeting of Urotransplantation of the Spanish Association of Urology held in 1994 on "Oncology and Renal Transplantation" are presented.

[The nutcracker phenomenon: an infrequent cause of hematuria]. / Fenómeno nutcracker o cascanueces: una infrecuente causa de hematuria.

The nutcracker phenomenon consists in the compression of the left renal vein by the aortomesenteric clamp. This is an infrequent cause of haematuria. The present paper presents one case of nutcracker phenomenon showing haematuria after mild accidental lumbar bruising, with arteriographic diagnosis. CAT assessment showed a mark in the lumbar ureter as well as peripyelic and periureteral varices.

Embolization of non-tolerated non-functioning kidney graft: alternative to surgical removal.

The results of treatment by percutaneous transcatheter embolization in eight cases of non-tolerated non-functioning kidney graft are presented. The symptoms resulting from non-tolerance of the renal graft were fever, pain and haematuria. Embolization was well tolerated in all eight cases and the only adverse effect was post-embolization self-limited fever in five cases. The symptoms of non-tolerance of the graft disappeared immediately in all cases, with minimal morbidity and no mortality. In only one patient was it necessary to perform second embolization procedure to achieve permanent control of symptoms. We conclude that percutaneous embolization of non-tolerated non-functioning kidney graft is an effective procedure with significantly less morbidity than with surgical graft nephrectomy.

Effect of different preservation solutions on adenine nucleotide content and metabolism in human kidney transplantation.

Differences in purine metabolism produced by three preservation solutions were studied by determining the adenine nucleotide (ATP, ADP, AMP, and IMP) and nucleoside (adenosine, inosine, and hypoxanthine) levels in human kidney cortical biopsies. Forty kidney allografts were studied using University of Wisconsin (UW) solution (n = 20), Euro-Collins (EC) solution (n = 12), and modified EC solution with mannitol (M; n = 8). No significant differences were found between the three solutions studied with regard to ATP, ADP, or AMP changes. The mean ATP level (nmol/mg prot +/- SEM) at the end of preservation in the UW group was 2.7 +/- 0.3 nmol/mg, in the EC group 3.8 +/- 0.7 nmol/mg, and in the M group 2.3 +/- 0.4 nmol/mg. ATP 30 min after reperfusion in the UW, EC, and M groups was 5.7 +/- 0.8 nmol/mg, 6.4 +/- 1.0 nmol/mg, and 4.6 +/- 0.5 nmol/mg, respectively. However, an important difference appeared in the catabolic products determined. Kidneys perfused with UW solution had a significantly higher level of adenosine (2.6 +/- 0.6 nmol/mg), inosine (11.8 +/- 2.2 nmol/mg), and hypoxanthine (18.1 +/- 2.1 nmol/mg) at the end of cold storage than those perfused with EC (0.4 +/- 0.1 nmol/mg, 2.0 +/- 0.8 nmol/mg, and 7.1 +/- 1.4 nmol/mg) and M solutions (0.2 +/- 0.05 nmol/mg, 0.5 +/- 0.1 nmol/mg, and 5.2 +/- 0.6 nmol/mg; P < 0.05). These levels returned to initial values 30 min postreperfusion and there were no differences with the EC or M solution groups at that time.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ureteral obstruction secondary to endometriosis. Report of a case]. / Obstrucción ureteral secundaria a endometriosis. A propósito de un caso.

The urinary tract is rarely affected by endometriosis, urinary bladder being the most common location. This paper presents one case of advanced extrinsic endometriosis which initially presented as obstructive pyelonephritis. The diagnostic methodology, including uro-tomographic imaging, is evaluated. Although good results have been reported with hormone-therapy, we support the surgical approach sanctioned by the patho-anatomical findings.

[Ambulatory treatment without anesthesia of urinary lithiasis by extracorporeal shock-wave lithotripsy: 7,000 cases]. / Tratamiento ambulatorio sin anestesia de la litiasis urinaria mediante litotricia extracórporea por ondas de choque: 7.000 casos.

Exposition of results and complications in 7,162 consecutive sessions with Shockwave Extracorporeal Lithotripsy (SWEL) applied to 3,950 lithiasis located at all levels of the urinary tract. These procedures have been performed without sedation or anaesthesia. Diuresis was not forced during or after treatment with serotherapy, mannitol, or diuretics. Treatment was conducted in an outpatients clinic in all cases. The treatment/lithiasis ratio in this initial series was 1.7. Following therapy, 7.09% of patients treated attended the emergency unit due to colic pain/fever. 3.60% of patients treated required hospitalization due to major complications: subcapsular-retroperitoneal haematoma, 9 cases; ureteral obstruction, 120 cases; septicemia, 22 cases; renal function annulment, 11 cases and death, 2 cases.

[Acquired cystic renal disease associated with renal carcinoma: report of 3 cases]. / Asociación entre enfermedad quística renal adquirida y carcinoma renal: presentación de tres casos.

Presentation of three cases of haemodialysis patients with acquired cystic renal disease (ACRD) who, over the course of their illness, developed clear cells renal carcinoma. The paper emphasizes the common association of these two entities and the need to consider ACRD cases as patients at high risk of developing renal neoplasia.

[BCG in superficial carcinoma of the bladder. Authors' experience]. / BCG en el carcinoma vesical superficial. Nuestra experiencia.

Contribution of 95 patients with surface vesical tumour managed with UTR and endovesical BCG. The response was absence of recurrence in 68.4% cases in Ta stage, 63% in T1 and 66.7% in 'in situ' carcinoma. Therapy tolerability was good, with few side-effects. We conclude that BCG endovesical instillation as co-adjunctive therapy to UTR in surface vesical tumours has been shown to be effective for the period under study.

[Mannitol solution (M-400) vs. mannitol solution combined with allopurinol in the prevention of post-transfusion acute renal failure]. / Solución de manitol (M-400) versus solución de manitol y alopurinol en la prevención del fracaso renal agudo post-TR.

Evaluation on the incidence of Acute Renal Failure (ARF) from a total of 41 corpse renal graft receptors, 20 of which received perfusion with mannitol solution at 400 mOsm/kg (Group 1) and 21 the same mannitol solution plus allopurinol (Group 2). No significant differences were present between both groups when they were analyzed for ARF incidence (15% vs 23.8%); overall incidence was 19.5%. 24-hour initial diuresis was shown to be an excellent predictor for long-term graft functionality. We can conclude that the addition of mannitol to the perfusion solution contributes decisively to reduce post-transplantation ARF, while addition of allopurinol does not have further beneficial effects.

[Urinary sepsis as manifestation of a renal angiomyolipoma]. / Sepsis urinaria como manifestación de un angiomiolipoma renal.

Renal angiolipomas are the most frequent benign renal tumours. Since ultrasound techniques have been in use to study algetic lumbar syndromes, their symptomatic appearance has decreased. Most authors agree that CAT has a 100% specificity. The paper contributes one case of renal angiomyolipoma isolated in a 39-year old woman, its primary interest being the clinical presentation, within an extensive septic milieu of urinary origin, the intra-operative diagnosis, considering the previous false-negative echography and dubious tomographic diagnoses, and the findings of regional node invasion, all exceptional states in the reviewed literature.