Albuminuria predicts renal functional outcome after intervention in atheromatous renovascular disease.

BACKGROUND: Atheromatous renovascular disease is increasingly recognized as a cause of renal failure; however, the benefit of intervention on renal function outcome cannot be clearly anticipated. OBJECTIVE: To identify reliable predictor(s) of renal functional outcome after revascularization in patients with atheromatous renovascular disease. DESIGN: The effect of percutaneous transluminal renal angioplasty (n = 5) or surgery (n = 18) on glomerular filtration rate ([99mTc]-diethylene triaminopenta-acetic acid clearance) and renal haemodynamics was prospectively assessed in 23 patients with atheromatous renovascular disease (unilateral occlusion in five, unilateral stenosis in four, stenosis of a single kidney in five, unilateral occlusion associated with contralateral stenosis in six, bilateral stenosis in three). Renal function was altered in 18 patients. RESULTS: At early follow-up study (5 +/- 1 months) after intervention, glomerular filtration rate improved (i.e. increased by more than 15%) in six patients, deteriorated in five and remained unchanged in 12 patients. The change in glomerular filtration rate associated with intervention was inversely correlated with the pre-intervention level of urinary albumin excretion and positively with the change in effective renal plasma flow after intervention. Stepwise regression analysis showed that pre-intervention urinary albumin excretion was the only predictor of the glomerular filtration rate response to intervention. At late follow-up study (32 +/- 6 months, n = 13), glomerular filtration rate was stable compared with early follow-up determination in non-proteinuric patients whereas it had deteriorated further in proteinuric patients. CONCLUSION: In patients with atheromatous renovascular disease, albuminuria may be considered as a marker of pre-existing intra-renal vascular and glomerular damage and a reliable predictor of renal functional outcome after intervention.

[Diagnosis of ectopic ureteral openings in the seminal tract. Value of modern imaging]. / Diagnostic des abouchements ectopiques de l'uretère dans le tractus séminal. Intérêt de l'imagerie moderne.

We recently observed 3 cases of ectopic ureteric orifice in the seminal tract in patients between the ages of 16 and 42 years. The first case was discovered incidentally, but the other two presented with scrotal symptoms. Intravenous urography, ultrasonography and computed tomography contributed to the diagnosis, but magnetic resonance imaging was the most conclusive, avoiding the need for deferentography in one case. These 3 recent cases allow an evaluation of the respective value of these various imaging modalities.