Real time ultrasound guided pediatric percutaneous renal biopsy: the traditional method versus angled tangential approach.

AIM: The aim of the present study was to compare the success and complication rates of pediatric renal biopsy procedures between the angled tangential approach and the traditional approach. METHODS: From 2004 to 2009 we prospectively enrolled pediatric patients who had undergone real time ultrasound guided renal biopsy with angled tangential approach. For comparison, we retrospectively reviewed pediatric patients who had undergone traditional renal biopsy between 2002 and 2004. Adequacy of renal tissue histopathological samples and the complication rates were compared between groups. RESULTS: One hundred twenty-eight patients underwent traditional renal biopsy (Group A) while 166 patients underwent biopsy performed with angled tangential approach (Group B).The rate of inadequate material was higher in Group A compared to Group B (6.3% vs. 0.6%, p = 0.006). In four cases (three in Group A and one in Group B) renal biopsies revealed normal renal tissue. While a major complication (hemoperitoneum requiring transfusion) occurred in one case in Group A, no major complications were seen in Group B. CONCLUSION: Compared with the traditional technique, the angled tangential approach resulted in a higher adequate material rate and lower complication rate.These findings indicate that angled tangential approach could be considered for pediatric percutaneous renal biopsies.

Nephrotic syndrome after oral bisphosphonate (alendronate) administration in a patient with osteoporosis.

Alendronate is a widely used bisphosphonate in the treatment of osteoporosis. Although it has been proven to be a very useful drug, it has some side effects as well. In this paper, we describe a case of nephrotic syndrome due to alendronate administration. A 36-year-old man was admitted to the nephrology outpatient clinic with widespread edema 4 months after initiation of alendronate. He had a 13-kg weight gain within a 2-week period. He had no clinical or laboratory problems apart from osteoporosis, which was the indication for initiation of the drug. Physical examination at admission was unremarkable, but for nephrotic edema. Laboratory studies revealed nephrotic range proteinuria (13.5 g/day), normal renal function, hypoalbuminemia (1.7 g/dl), and also hypercholesterolemia (400 mg/dl). A kidney biopsy was performed. Light microscopic evaluation revealed a slight increase in mesangial cells and matrix; however, no abnormalities in the tubules or interstitium were noted. Alendronate was withdrawn and diuretic therapy was initiated. Patient's weight gradually decreased from 84 to 67 kg within a 1-week period. No other drugs for the treatment of nephrotic syndrome were administered. During the clinical course, serum creatinine remained stable, and proteinuria gradually decreased and disappeared 40 days after stopping alendronate. It was noted that alendronate administration can give rise to nephrotic syndrome, while discontinuation of this drug may improve the pathology without any specific treatment.

Solitary colonic metastasis of renal cell carcinoma.

We report a rare case of a solitary metastasis of a renal cell carcinoma which manifested as a primary colonic tumour. A 60-year-old male patient who had undergone a right radical nephrectomy 5 years previously for renal cell carcinoma, presented with a history of dyspepsia and pain in the right upper abdomen. A mass on the hepatic flexure was detected by computed tomography and colonoscopy and right hemicolectomy was performed. Postoperative histological examination revealed that the tumour was a metastatic renal cell carcinoma of the clear cell type.