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1.
Rev Med Liege ; 74(10): 521-526, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31609555

RESUMO

The role of medical imaging is of major impor¬tance in the follow-up of patients with kidney transplant.There as many and various renal transplant complications. The development of techniques in medical imaging, especially the progression of clinical and biological monitoring improve their detection. In this article, we will remind the diverses complications of renal transplant and their expression in the various imaging modalities, including Doppler ultrasound which remains the principal examination modality.


Assuntos
Nefropatias , Transplante de Rim , Angiografia , Humanos , Nefropatias/cirurgia , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias , Ultrassonografia
2.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 44(5): 501-506, 2019 May 28.
Artigo em Chinês | MEDLINE | ID: mdl-31303612

RESUMO

OBJECTIVE: To investigate the feasibility and clinical application of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) technique in non-invasive assessment for early chronic allograft nephropathy (CAN).
 Methods: A total of 23 renal allograft recipients were recruited from inpatients or outpatients according to the inclusion and exclusion criteria for this study. Recipients were divided into a CAN group (n=12, pathologically confirmed early CAN patients) and a control group (n=11, volunteers with long-term stable renal function). Abdominal MRI was performed on patients of renal allograft with a multi-b value DWI sequence. IVIM2b-new software was used for obtaining the IVIM-DWI quantitative parameter pseudo-color maps and the values of IVIM-DWI of renal parenchyma, including the pure diffusion coefficient (D), perfusion correlation diffusion coefficient (D*) and perfusion fraction (f). The IVIM quantitative parameters between the two groups were compared using independent sample t test. ROC analysis was performed when the differences in parameter were statistically significant and the area under curve (AUC) was calculated.
 Results: In IVIM bi-exponential analysis, The D value was significantly decreased in the CAN group compared with the control group (P<0.05), whereas there are no significantly difference in value of D* and f between the two groups (all P>0.05). The AUC of D value for distinguishing the early CAN from the control were 0.784 with sensitivity and specificity at 58.3% and 90.9%, respectively.
 Conclusion: The IVIM-DWI quantitative parameter D can non-invasively assess early CAN to some extent. IVIM-DWI technique is expected to be an effective, easy and non-invasive method to detect early CAN, and assist early diagnose as well as dynamically monitor CAN.


Assuntos
Nefropatias/cirurgia , Transplante de Rim , Aloenxertos , Imagem de Difusão por Ressonância Magnética , Humanos , Imagem por Ressonância Magnética , Movimento (Física)
3.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 44(5): 596-599, 2019 May 28.
Artigo em Chinês | MEDLINE | ID: mdl-31303625

RESUMO

The positive human leukocyte antigen (HLA) antibody present in kidney transplant recipients affects both surgery and rejection, and also affects the long-term survival of the transplanted kidney. During the third kidney transplant, bilateral axillary fossa and iliac vessel were destroyed. It was very difficult for selection or separation of surgical vessels because the adhesions and scar formation was easy to damage blood vessels and intestinal tubes. A case with strong positive HLA antibody undergoing the third kidney transplant in our hospital was successfully solved the problems, such as less transplant space and vascular scar adhesion. Rituximab, rabbit anti-human thymocyte immunoglobulin, and methylprednisolone treated-antibodies were used in the operation. The immune function test was used to develop individualized treatment after the operation. The postoperative creatinine and urine volume tended to be stable, and the 16-month follow-up renal function was good.


Assuntos
Nefropatias/cirurgia , Transplante de Rim , Anticorpos , Humanos , Rim , Nefrectomia , Rituximab
4.
Medicine (Baltimore) ; 98(24): e16077, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192970

RESUMO

RATIONALE: Secondary hyperparathyroidism (SHPT) is often complicated with chronic renal failure. Though the total parathyroidectomy (TPTX) with forearm autotransplantation (FAT) has been commonly used to treatment refractory renal SHPT, the recurrence of SHPT is not infrequent, resulting from hyperplastic autograft, remnant parathyroid tissues, and supernumerary parathyroid gland (SPG). PATIENT CONCERNS: A 67-year-old man undergoing TPTX+FAT 4 years previously for renal SHPT, who received regular hemodialysis with active vitamin D supplements of Rocaltrol treatment postoperatively, was admitted to our hospital with progressively elevated serum intact parathyroid hormone (iPTH) from 176 to 1266 pg/mL for 8 months and bilateral ankle joints pain for 1 month. Tc-sestamibi dual-phase imaging with single positron emission tomography (SPECT)/computed tomography (CT) revealed a nodule in suprasternal fossa, besides a nodule in autografted site, accompanied with intense radioactivity. DIAGNOSIS: Recurrent SHPT was easily diagnosed based on previous medical history, painful joints, increased serum iPTH level and positive findings of Tc-sestamibi imaging. Routine postoperative pathology showed that the nodules were consistent with an adenomatoid hyperplasic autograft and a supernumerary parathyroid adenoma in suprasternal fossa, respectively. INTERVENTIONS: Reoperation for removing nodules in suprasternal fossa and autografted site was performed 1 month later. Then regular hemodialysis 3 times a week with Rocaltrol was continued. OUTCOMES: During 12 months of follow-up, the joints pain improved obviously and the serum iPTH level ranged from 30.1 to 442 pg/mL. LESSONS: Although rare, recurrent renal SHPT may be caused by a coexistence of both hyperfunctional autograft and SPG after TPTX+FAT. The Tc-sestamibi parathyroid imaging with SPECT/CT is helpful to locate the culprits of recurrent renal SHPT before reoperation. To prevent recurrence of renal SHPT, the present initial surgical procedures should be further optimized in patient on permanent hemodialysis.


Assuntos
Adenoma/complicações , Autoenxertos , Hiperparatireoidismo Secundário/etiologia , Nefropatias/complicações , Neoplasias das Paratireoides/complicações , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adenoma/cirurgia , Idoso , Autoenxertos/patologia , Antebraço , Humanos , Hiperparatireoidismo Secundário/diagnóstico por imagem , Hiperparatireoidismo Secundário/patologia , Hiperparatireoidismo Secundário/cirurgia , Hiperplasia , Nefropatias/diagnóstico por imagem , Nefropatias/patologia , Nefropatias/cirurgia , Masculino , Neoplasias das Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Recidiva , Reoperação
6.
Turkiye Parazitol Derg ; 43(2): 89-91, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31204463

RESUMO

Hydatic cyst is a crucial and prevalent parasitic disease in the developing countries in the Mediterranean region. Its diagnosis is sometimes problematic because of non-specific complaints and unavailability of any positive results in a routine laboratory analysis. Isolated renal hydatid cysts are very rare. In this study, a primary left renal hydatid cyst which was found in a 12-year-old boy was presented. He was referred by another hospital to our department with a flank pain and cystic mass in left kidney. Indirect haemagglutination test (IHA) for Echinococcus was negative. Nephrectomy was performed with the diagnosis of renal cyst hydatic. Renal cyst hydatid may present with various clinical findings ranging from asymptomatic clinical course to total loss in renal function. It will be beneficial to consider a renal hydatid cyst in patients with blurred flank pain, even if IHA is negative.


Assuntos
Equinococose/diagnóstico , Nefropatias/parasitologia , Animais , Criança , Equinococose/diagnóstico por imagem , Equinococose/cirurgia , Echinococcus granulosus/isolamento & purificação , Testes de Hemaglutinação , Humanos , Nefropatias/diagnóstico , Nefropatias/diagnóstico por imagem , Nefropatias/cirurgia , Masculino , Nefrectomia , Tomografia Computadorizada por Raios X , Ultrassonografia
7.
Int Braz J Urol ; 45(5): 1076-1077, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31136107

RESUMO

INTRODUCTION: OHVIRA syndrome is a rare entity characterized by renal and Mullerian anomalies. The objective of the video is, through a clinical case, to discuss the importance of diagnosis, management and treatment, to avoid the complications that this syndrome entails, and to improve the long-term prognosis. MATERIALS AND METHODS: We report the case of a 10-year-old girl who consulted for abdominal pain, being diagnosed with OHVIRA syndrome. We describe the diagnosis and the surgical technique. In addition, we perform a systematic review in PubMed to report the published literature of this topic and we show the optimal management of this pathology.


Assuntos
Anormalidades Congênitas/cirurgia , Nefropatias/congênito , Rim/anormalidades , Laparoscopia/métodos , Nefroureterectomia/métodos , Vagina/anormalidades , Vagina/cirurgia , Anormalidades Múltiplas , Criança , Feminino , Humanos , Rim/cirurgia , Nefropatias/cirurgia , Reprodutibilidade dos Testes , Síndrome , Resultado do Tratamento , Útero/anormalidades , Útero/cirurgia
8.
Int J Sports Med ; 40(3): 209-217, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30703844

RESUMO

We aimed to analyze the effect of an exercise training program in autonomic modulation, and exercise tolerance of hemodialysis and kidney-transplanted patients. 4 groups of exercised and non-exercised patients undergoing hemodialysis and kidney-transplanted subjects had their biochemical tests, and heart rate variability evaluations analyzed. Also, sleep quality, anxiety and depression questionnaires were evaluated. Both exercised groups showed improvements in cardiovascular autonomic modulation, biochemical markers, and exercise tolerance after the exercise training program. The exercised kidney-transplanted patients group showed better improvements in cardiovascular autonomic modulation, biochemical markers, and exercise tolerance when compared to the exercised hemodialysis patients group. Both groups showed improvements in sleep quality, anxiety, and depression. The group of kidney-transplanted patients show better results in the cardiovascular autonomic modulation than subjects undergoing hemodialysis. However, the patients undergoing hemodialysis showed improvements in blood pressure, HDL, hemoglobin and phosphorus, changes not observed in the kidney-transplanted group. Exercise is beneficial for both hemodialysis and kidney-transplanted patients groups. However, exercise programs should be focused mainly in improving cardiovascular risk factors in the HD patients.


Assuntos
Terapia por Exercício , Nefropatias/terapia , Transplante de Rim , Diálise Renal , Adulto , Ansiedade/etiologia , Doenças Cardiovasculares/prevenção & controle , Estudos de Casos e Controles , Doença Crônica , Depressão/etiologia , Tolerância ao Exercício , Feminino , Taxa de Filtração Glomerular , Frequência Cardíaca , Humanos , Nefropatias/fisiopatologia , Nefropatias/psicologia , Nefropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Fatores de Risco , Sono , Teste de Caminhada
9.
Amino Acids ; 51(3): 529-547, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30604095

RESUMO

We developed and validated gas chromatography-mass spectrometry (GC-MS) methods for the simultaneous measurement of amino acids and their metabolites in 10-µL aliquots of human plasma and urine. De novo synthesized trideutero-methyl esters were used as internal standards. Plasma proteins were precipitated by acidified methanol and removed by centrifugation. Supernatants and native urine were evaporated to dryness. Amino acids were first esterified using 2 M HCl in methanol and then amidated using pentafluoropropionic anhydride for electron-capture negative-ion chemical ionization. Time programmes were used for the gas chromatograph oven and the selected-ion monitoring of specific anions. The GC-MS methods were applied in clinical studies on the HELLP syndrome and pediatric kidney transplantation (KTx) focusing on L-arginine-related pathways. We found lower sarcosine (N-methylglycine) and higher asymmetric dimethylarginine (ADMA) plasma concentrations in HELLP syndrome women (n = 7) compared to healthy pregnant women (n = 5) indicating altered methylation. In plasma of pediatric KTx patients, lower guanidinoacetate and homoarginine concentrations were found in plasma but not in urine samples of patients treated with standard mycophenolate mofetil-based immunosuppression (MMF; n = 22) in comparison to matched patients treated with MMF-free immunosuppression (n = 22). On average, the global arginine bioavailability ratio was by about 40% lower in the MMF group compared to the EVR group (P = 0.004). Mycophenolate, the major pharmacologically active metabolite of MMF, is likely to inhibit the arginine:glycine amidinotransferase (AGAT), and to enhance arginase activity in leukocytes and other types of cell of MMF-treated children.


Assuntos
Amidinas/metabolismo , Aminoácidos/sangue , Aminoácidos/urina , Arginase/metabolismo , Cromatografia Gasosa-Espectrometria de Massas/métodos , Síndrome HELLP/metabolismo , Nefropatias/metabolismo , Transplante de Rim/métodos , Adolescente , Adulto , Arginina/metabolismo , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Imunossupressores/farmacologia , Nefropatias/tratamento farmacológico , Nefropatias/cirurgia , Metilação , Projetos Piloto , Gravidez
10.
Int Urol Nephrol ; 51(3): 409-415, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30637594

RESUMO

OBJECTIVES: To evaluate the feasibility and clinical efficacy of a novel intraabdominal retractor device in laparoendoscopic single-site nephrectomy(LESS-N). METHODS: Between February 2012 and February 2017, 98 patients underwent LESS-N in our institution, including 38 patients with benign renal disease and 60 patients with malignant renal disease. 39 were performed conventional LESS-N(C-LESS-N) and 59 were performed intraabdominal retractor-assisted LESS-N(IAR-LESS-N). Demographic data, and perioperative and postoperative data were collected and analyzed retrospectively. RESULTS: All the procedures were completed successfully. In C-LESS-N group, four patients were added one 5-mm additional trocar and two patients were converted to open surgery. In IAR-LESS-N group, no patients required additional trocars or conversion to open surgery. The mean operative time was lower in IAR-LESS-N group than that in C-LESS-N group (94.2 min vs 127.4 min, P < 0.05). The mean renal vascular management time declined from 25.4 min in C-LESS-N group to 18.4 min in IAR-LESS-N group (P < 0.05). The mean estimated blood loss was 128.6 ml in C-LESS-N group and 102.3 ml in IAR-LESS-N group (P < 0.05). Two patients in C-LESS-N group required blood transfusion, while none of the patients in IAR-LESS-N group did. No severe postoperative complications occurred in both groups. Study limitations included retrospective study, short follow-up, and accumulated surgical experience and skills. CONCLUSIONS: Intraabdominal retractors allow performance of LESS-N with improved working space, quicker renal hilar management, and shortened total operative time. It is expected that the application of intraabdominal retractors, along with the new robotic platform might revive LESS and translate into a renewed future interest of LESS.


Assuntos
Endoscopia/instrumentação , Nefropatias/cirurgia , Laparoscopia/instrumentação , Nefrectomia/instrumentação , Adulto , Idoso , Perda Sanguínea Cirúrgica , Transfusão de Sangue , Endoscopia/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Duração da Cirurgia , Estudos Retrospectivos
11.
Clin Imaging ; 53: 97-104, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30317137

RESUMO

OBJECTIVES: To evaluate the effects of diuretic stimulation on Diffusion Weighted Imaging (DWI) and Diffusion Tensor Imaging (DTI) techniques in transplanted kidneys. METHODS: 33 transplanted kidney recipients underwent DWI and DTI sequences before and after furosemide. Cortical and medullary Apparent Diffusion Coefficient (ADC) and Fractional Anisotropy (FA) values were calculated in transplanted kidneys. Patients were divided into two groups according to their estimated glomerular rate filtration (Group A ≥ 60 ml/min and Group B < 60 ml/min). Wilcoxon matched pairs signed rank test was applied to compare pre- and post-furosemide values. ADC and FA values were compared between the 2 groups using a Mann-Whitney U test. Receiver Operating Curves (ROC) analysis was performed to predict normal renal function. RESULTS: Wilcoxon test revealed a statistically significant difference for all pre- and post- ADC and FA values in group B. For group A, a significant difference was found comparing pre- and post-medullary ADC and FA values (p = 0.0151 and p = 0.0054). In the comparison between group A and group B, cortical and medullary mean ADC values were significantly different before and after furosemide. With regard to medullary FA values, a significant difference was found between groups before and after diuretic stimulation (p respectively of 0.004 and 0.042). Comparing cortical FA mean values, no statistical difference was observed between groups before and after furosemide. The highest Area Under Curve values were reported for cortical ADC (0.878) and medullary ADC (0.863) before diuretic bolus. CONCLUSIONS: In transplanted kidneys, furosemide did not improve the differentiation between normal and reduced function.


Assuntos
Diuréticos/farmacologia , Furosemida/farmacologia , Nefropatias/diagnóstico , Transplante de Rim , Rim/efeitos dos fármacos , Adulto , Idoso , Anisotropia , Área Sob a Curva , Imagem de Difusão por Ressonância Magnética/métodos , Imagem de Tensor de Difusão/métodos , Feminino , Humanos , Rim/fisiologia , Rim/fisiopatologia , Nefropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Curva ROC , Estatísticas não Paramétricas
12.
Am J Clin Pathol ; 151(2): 205-208, 2019 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-30265272

RESUMO

Objectives: Renal biopsy is the gold standard for the diagnosis of both native and allograft renal diseases. We studied the impact of tissue procurement at bedside (TPB) omission on the adequacy of renal biopsies. Methods: We compared 120 renal biopsies collected during 2015 using TPB with 111 renal biopsies collected during 2016 when TPB was discontinued. Adequacy criteria were applied as follows: by light microscopy, 10 glomeruli and two arteries for allograft biopsies and seven glomeruli for native biopsies. At least one glomerulus was considered adequate for immunofluorescence and electron microscopy in both groups. Results: The rate of inadequacies in allograft biopsies increased significantly, from 12.50% to 21.61% (P < .05), when TPB was discontinued. Conclusions: Elimination of TPB service had a negative impact on allograft specimen adequacy. Repeat biopsies add cost and delay patient care. Institutions should take this into consideration when considering omission of TPB.


Assuntos
Biópsia com Agulha de Grande Calibre/normas , Nefropatias/diagnóstico , Guias de Prática Clínica como Assunto , Obtenção de Tecidos e Órgãos/normas , Aloenxertos/normas , Aloenxertos/cirurgia , Imunofluorescência , Humanos , Rim/cirurgia , Nefropatias/cirurgia , Glomérulos Renais/cirurgia , Transplante de Rim , Microscopia Eletrônica , Nefrectomia , Estudos Retrospectivos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos
13.
Transpl Int ; 32(2): 173-183, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30179275

RESUMO

Poor reproducibility in scoring antibody-mediated rejection (ABMR) using the Banff criteria might limit the use of histology in clinical trials. We evaluated the reproducibility of Banff scoring of 67 biopsies by six renal pathologists at three institutions. Agreement by any two pathologists was poor: 44.8-65.7% for glomerulitis, 44.8-67.2% for peritubular capillaritis, and 53.7-80.6% for chronic glomerulopathy (cg). All pathologists agreed on cg0 (n = 20) and cg3 (n = 9) cases, however, many disagreed on scores of cg1 or cg2. The range for the incidence of composite diagnoses by individual pathologists was: 16.4-22.4% for no ABMR; 17.9-47.8% for active ABMR; and 35.8-59.7% for chronic, active antibody-mediated rejection (cABMR). A "majority rules" approach was then tested in which the scores of three pathologists were used to reach an agreement. This increased consensus both for individual scores (ex. 67.2-77.6% for cg) and for composite diagnoses (ex. 74.6-86.6% cABMR). Modeling using these results showed that differences in individual scoring could affect the outcome assessment in a mock study of cABMR. We conclude that the Banff schema has high variability and a majority rules approach could be used to adjudicate differences between pathologists and reduce variability in scoring in clinical trials.


Assuntos
Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/imunologia , Nefropatias/cirurgia , Transplante de Rim , Túbulos Renais/imunologia , Adulto , Biópsia , Ensaios Clínicos como Assunto , Feminino , Glomerulonefrite/diagnóstico , Humanos , Isoanticorpos , Rim/patologia , Nefropatias/imunologia , Túbulos Renais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Projetos de Pesquisa , Estudos Retrospectivos , Índice de Gravidade de Doença , Transplante Homólogo
15.
Angiology ; 70(1): 12-19, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29682989

RESUMO

An accessory renal artery (ARA) represents an anatomic variation which can challenge endovascular aortic aneurysm repair (EVAR). The aim of this review was to summarize the current knowledge on postoperative outcomes following ARA coverage during EVAR. We performed a systematic literature review. The MEDLINE database was searched on September 2017, and 8 relevant studies were included. The frequency of ARA in patients undergoing EVAR varied between 9.5% and 16.2%, and the frequency of ARA coverage varied between 5.2% and 9.4%. Four reports did not observe any significant changes on postoperative renal function, whereas 1 study reported an early transient increase in creatinine after ARA coverage. The occurrence of renal infarct varied from 20% to 84%. Five studies did not observe endoleaks related to ARA coverage, whereas one reported the occurrence of type II endoleaks in 3 of 18 patients who had ARA coverage. No significant change in blood pressure, mortality, and mean length of hospital stay was observed. The ARA coverage can potentially have renal and vascular consequences, but none of them were critical. Further studies may be useful to identify preoperative criteria that may help to choose the most appropriate surgical approach before ARA coverage.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Endoleak/cirurgia , Procedimentos Endovasculares , Artéria Renal/cirurgia , Resultado do Tratamento , Idoso , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Feminino , Humanos , Nefropatias/fisiopatologia , Nefropatias/cirurgia , Masculino , Pessoa de Meia-Idade
16.
Nephrology (Carlton) ; 24(4): 450-455, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29532554

RESUMO

AIM: Epstein syndrome is a hereditary disease characterized by macrothrombocytopaenia and progressive nephritis. The abnormality of the MYH9 gene has a strong relationship to the severity of the disease. Severe Epstein syndrome progresses to end-stage renal disease rapidly after adolescence. There is no established therapy. We sought to clarify appropriate management of Epstein syndrome nephropathy. METHODS: Epstein syndrome patients who underwent renal transplantation at our institution between March 2009 and March 2017 were enrolled. Epstein syndrome was diagnosed based on clinical features and genetic testing. Patient medical records were reviewed retrospectively. RESULTS: Four male patients with Epstein syndrome, all with severe MYH9 gene mutations (p.R702C in three and p.S96L in one), were enrolled. Despite treatment with renin-angiotensin system blockers, nephropathy was refractory and progressed rapidly, and the patients required dialysis or renal transplantation after adolescence. Early preparation for treatment based on early and accurate diagnosis of Epstein syndrome enabled two patients to undergo pre-emptive renal transplantation. For these patients, we kept the platelet count above 100 × 109 /L until day 7 after renal transplantation with platelet transfusions for macrothrombocytopaenia, and no postoperative bleeding episodes occurred. CONCLUSION: Epstein syndrome nephropathy due to a severe MYH9 gene mutation can be refractory and progress rapidly; therefore, early and accurate diagnosis is important for safer therapeutic options including pre-emptive renal transplantation. By keeping the platelet count above 100 × 109 /L during the perioperative period, renal transplantation can be a safe treatment option for severe Epstein syndrome nephropathy.


Assuntos
Perda Auditiva Neurossensorial/complicações , Nefropatias/cirurgia , Transplante de Rim/métodos , Doadores Vivos , Trombocitopenia/congênito , Adulto , Criança , Progressão da Doença , Predisposição Genética para Doença , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/genética , Humanos , Nefropatias/diagnóstico , Nefropatias/etiologia , Masculino , Proteínas Motores Moleculares/genética , Mutação , Cadeias Pesadas de Miosina/genética , Fenótipo , Estudos Retrospectivos , Trombocitopenia/complicações , Trombocitopenia/diagnóstico , Trombocitopenia/genética , Resultado do Tratamento
17.
Urology ; 125: 40-45, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30594662

RESUMO

OBJECTIVE: To evaluate the factors predicting the risk for failed angiographic management (AM), we retrospectively studied cases of digital subtraction angiography (DSA) and superselective angiography (SSA) to control severe/delayed bleeding following renal interventions, which may otherwise be life threatening and often require nephrectomy. METHODS: We have retrospectively evaluated the data of 154 patients who underwent DSA and or SSA during January 2006 to June 2016. Twenty-one patients (Group A) with failed AM were compared to patients with success AM (n = 133, Group B). RESULTS: Out of 21 patients in whom AM failed, 20 should be managed with subsequent sessions of DSA/SSA and only 1 had to undergo nephrectomy. On univariate analysis, low hemoglobin (P = .025), multiple tracts (n > 1) during percutaneous nephrolithotomy (P = .01), multiple bleeding site (>1 = 0.01 and >2 = 0.001) and patients, who needed inotropes (P = .008) were found to predict risk for failure. On multivariate analysis, multiple bleeding site >2 (P = .003, odds ratio 5.23, 95% confidence interval = 1.3-22.5) and patients on inotropes (P = .02, odds ratio 2.56, 95% confidence interval = 2.15-4.75) were found to independently predict the failure. CONCLUSION: Patients with multiple bleeding lesions and who are on inotropic (leading to intrarenal vasoconstriction) are at high risk for failure of AM. Most of them can be successfully managed by subsequent session AM.


Assuntos
Angiografia Digital , Angiografia/métodos , Embolização Terapêutica , Nefropatias/cirurgia , Hemorragia Pós-Operatória/diagnóstico por imagem , Hemorragia Pós-Operatória/terapia , Adulto , Protocolos Clínicos , Embolização Terapêutica/métodos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento
18.
JAMA Surg ; 154(3): 225-231, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30516801

RESUMO

Importance: Although the intent of nephron-sparing surgery is to eradicate malignant tumors found on preoperative imaging, benign masses often cannot be differentiated from malignant tumors. However, in the past there have been discrepancies in the reported percentages of benign masses removed by partial nephrectomy (PNx). Objective: To investigate the annual trend of prevalence of benign pathologic findings after PNx and to investigate what potential factors are associated with this prevalence. Design, Setting, and Participants: A total of 18 060 patients who underwent PNx between 2007 and 2014 were selected from Truven Health MarketScan Research Databases. We selected those patients who underwent PNx as an inpatient from 2007 and set the surgery date as the index date. Overall, a total of 21 445 patients with International Classification of Diseases, Ninth Revision, Clinical Modification code of 55.4 were identified from 2007 to 2015. Main Outcomes and Measures: The annual trend of benign pathologic findings was described as an actual number and as a proportion. Univariate and multiple analyses were performed to investigate factors predictive of a benign final pathologic diagnosis, including type of preoperative imaging modality or performance of a renal mass biopsy. Results: Among the 18 060 patients, mean (SD) age was 57 (12) years, and there were 10637 (58.9%) men and 7423 (41.1%) women. The overall prevalence of benign pathologic findings was 30.9% and the annual trends demonstrated a prevalence of over 30% for nearly every year of the study period. On univariate analysis, the performance of magnetic resonance imaging (MRI) and renal mass biopsy was associated with benign pathologic findings (P = .02 and P < .001, respectively). On multivariable analysis, female sex (odds ratio [OR], 0.62; 95% CI, 0.58-0.66; P < .001), older age (>65 years) (OR, 0.99; 95% CI, 0.99-0.99; P < .001), and computed tomography (CT) only preoperative imaging (OR, 1.16; 95% CI, 1.05-1.28; P = .004) were associated with benign pathologic findings after PNx. Conclusions and Relevance: We found that the overall prevalence of benign pathologic findings after PNx was higher than the literature suggests, with consistent year-over-year rates exceeding 30%. Female sex, older age (>65 years), and CT only preoperative imaging were predictive of a benign tumor. Further elucidation concerning covariates associated with a benign diagnosis should be the focus of future investigations to identify a cohort of patients who could potentially avoid unnecessary surgical intervention.


Assuntos
Nefropatias/diagnóstico por imagem , Nefropatias/patologia , Tomografia Computadorizada por Raios X , Idoso , Feminino , Humanos , Nefropatias/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Prevalência , Estados Unidos/epidemiologia
19.
Bol. pediatr ; 59(247): 19-31, 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183164

RESUMO

La urología pediátrica comprende una extensa serie de patologías de complejidad variable, que afectan al sistema urogenital, y que suponen aproximadamente el 50% de las intervenciones quirúrgicas en cirugía pediátrica. describiremos aquellas de mayor impacto y repercusión clínica desde el punto de vista quirúrgico, destacando las denominadas CaKUt o anomalías congénitas del riñón y del tracto urinario. estas últimas tienen su origen en la alteración de alguno de los procesos que conforman el desarrollo renal: a) Malformación del parénquima renal: hipoplasia, displasia, agenesia renal y riñón multiquístico (drMQ). b) anomalías relacionadas con la migración de los riñones: ectopia renal y anomalías de fusión. c) anomalías en el desarrollo del sistema colector: estenosis pieloureteral (epU), duplicidades ureterales, megauréter primario, uréter ectópico, ureterocele y válvulas de uretra posterior (VUp). El objetivo de este artículo es determinar en qué casos es necesaria la cirugía para resolver un problema urológico en el niño y cuándo es el mejor momento para realizar la intervención


Pediatric Urology comprises an extensive series of pathologies of variable complexity, which affect the urogenital system, and account for approximately 50% of surgical interventions in pediatric surgery. We will describe those ones of greater impact and clinical repercussion from the surgical point of view, highlighting the so-called CaKUt or congenital anomalies of the kidney and urinary tract. the latter have their origin in the alteration of some of the processes during the renal development: a) Malformation of the renal parenchyma: hypoplasia, dysplasia, renal agenesis and multicystic kidney (MCdK). b) abnormalities related to the migration of the kidneys: renal ectopia and fusion anomalies. c) abnormalities in the development of the collecting system: pyelo-ureteral stenosis, ureteral duplicities, primary megaureter, ectopic ureter, ureterocele and posterior uretral valves. R The objective of this article is to inform about the cases in which surgery is necessary to solve a urological problem in the child, and the best time to perform the intervention


Assuntos
Humanos , Criança , Nefropatias/classificação , Doenças Urológicas/classificação , Nefropatias/congênito , Doenças Urológicas/congênito , Índice de Gravidade de Doença , Estreitamento Uretral/diagnóstico , Estreitamento Uretral/cirurgia , Refluxo Vesicoureteral/diagnóstico , Refluxo Vesicoureteral/cirurgia , Nefropatias/diagnóstico , Nefropatias/cirurgia , Doenças Urológicas/diagnóstico , Doenças Urológicas/cirurgia , Hidronefrose/diagnóstico , Hidronefrose/cirurgia , Ureter/anormalidades , Cistos/diagnóstico , Cistos/cirurgia
20.
Transplant Proc ; 50(10): 3128-3134, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30577178

RESUMO

BACKGROUND: Nonlinear optical microscopic (NLOM) imaging technique shows its high resolution imaging features in histocytology. The purpose of this study was to investigate NLOM imaging technique as a useful tool for a donor kidney quality assessment. MATERIALS AND METHODS: Eighty-three pretransplant kidney biopsies from adult donors were analyzed retrospectively. Each specimen was paraffin-embedded and sectioned into 2 consecutive 5-µm thick sections. One section was stained with Masson trichrome, and the other was left unstained for NLOM imaging using second harmonic generation combined with two-photon excited fluorescence (SHG/TPEF). The pretransplant kidney quality was assessed by an experienced pathologist using the Remuzzi scoring system, which characterizes renal tissue morphology into 4 aspects: tubular atrophy, interstitial fibrosis, glomerulosclerosis, and vascular injury. The K coefficient was used to measure the consistency of the Remuzzi scores between conventional Masson trichrome stained images and SHG/TPEF images. RESULTS: NLOM imaging technology can capture high-resolution tissue images from unstained renal tissue, is easy to operate, and shortens time-consuming histological processing procedures. No significant differences (P > .05) were found between the Remuzzi scores of the SHG/TPEF images and the Masson trichrome stained images. The high κ coefficients (0.804-0.895) showed a good consistency between these 2 techniques. CONCLUSION: The NLOM technique is suitable for renal tissue imaging and could potentially be used for routine pretransplant kidney evaluation in clinical settings.


Assuntos
Seleção do Doador , Nefropatias/diagnóstico por imagem , Nefropatias/patologia , Transplante de Rim , Microscopia Óptica não Linear , Adolescente , Adulto , Biópsia , Feminino , Humanos , Nefropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Coloração e Rotulagem , Adulto Jovem
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