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1.
Curr Opin Pediatr ; 33(2): 227-234, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33470672

RESUMO

PURPOSE OF REVIEW: Ureteropelvic junction obstruction (UPJO) is the most common cause of prenatally diagnosed hydronephrosis. Although associated with obstruction of the kidney, the natural history is variable, ranging from spontaneous resolution to progressive loss of function over the first few years of life. As a result, the optimal evaluation strategy and indications for treatment have not been well defined. The purpose of this article is to review recent literature focused on the prenatal and postnatal evaluation of infants with prenatally diagnosed hydronephrosis suspicious for UPJO. RECENT FINDINGS: Recent studies have focused on the effect of the urinary tract dilation (UTD) ultrasound classification system, as well as use of magnetic resonance imaging both prenatally and postnatally to stratify the risk of infants with prenatally diagnosed hydronephrosis to develop renal impairment or undergo surgery. Additionally, urinary biomarkers have been identified as a potential noninvasive alternative to diuretic renography in identifying infants with clinically significant UPJO. SUMMARY: Although continued work is needed to develop clear guidelines for evaluation and treatment and to better define long-term outcomes, these studies offer novel approaches to improve the care of these patients.


Assuntos
Hidronefrose , Obstrução Ureteral , Feminino , Humanos , Hidronefrose/diagnóstico , Hidronefrose/terapia , Lactente , Rim , Gravidez , Ultrassonografia , Obstrução Ureteral/diagnóstico , Obstrução Ureteral/terapia
3.
J Biomech ; 117: 110237, 2021 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-33486265

RESUMO

Malignant ureteral obstruction may lead to impaired renal function and requires drainage by a percutaneous nephrostomy tube or an internal ureteric stent. Usage of stiff tandem ureteral stents may decrease stent failure rates. In this paper we combined computational and in vitro models to examine the flow in a malignant ureteral obstruction (MUO) managed by 4 methods of drainage: single soft stent, single stiff stent, soft tandem ureteral stents, and stiff tandem ureteral stents. Pressure at the renal pelvis was the primary outcome of the computational and in vitro models. Different drainage modalities were compared using ANCOVA. Results of computational and in vitro models agreed completely. Drainage by stiff tandem ureteral stents provides lower renal pelvis pressure levels compared with single and soft stents (p < 0.001), especially for high levels of external pressure. Usage of stiff tandem ureteral stents may decrease stent-failure rates and postpone the need for percutaneous nephrostomy tube insertion.


Assuntos
Ureter , Obstrução Ureteral , Simulação por Computador , Drenagem , Humanos , Pelve Renal/cirurgia , Stents , Ureter/cirurgia , Obstrução Ureteral/terapia
4.
J Vasc Interv Radiol ; 31(11): 1795-1800, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32962854

RESUMO

This brief report presents 8 patients with silicone-covered metallic stent placement for ureteral strictures refractory to double-J stent placement, following kidney transplantation. Stent removal was successfully performed in 7 patients via antegrade (n = 4) or retrograde (n = 3) access 6 weeks to 6 months after stenting for elective removal (6-month interval, n = 3), urothelial hyperplasia (n = 2), or stent migration (n = 2), and their mean primary ureteral patency after stent removal was 15.4 months (range, 2-27 months). Hematuria (n = 2) and pain (n = 3) occurred, but resolved within 1 week. One stent was removed during reconstructive surgery. During follow-up of mean 22.6 months after stent removal, ureteral strictures recurred in 2 patients.


Assuntos
Cateterismo/instrumentação , Remoção de Dispositivo , Transplante de Rim/efeitos adversos , Stents Metálicos Autoexpansíveis , Silicones , Obstrução Ureteral/terapia , Adulto , Idoso , Cateterismo/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea , Desenho de Prótese , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/etiologia
5.
Urologe A ; 59(3): 261-265, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32030434

RESUMO

A primary, congenital megaureter means a dilatation of the ureter with a ureteric diameter ≥7 mm due to a structural or functional obstruction of the ureterovesical junction and represents the second most likely cause of neonatal hydronephrosis. Conservative management is the primary treatment option for many patients due to a high spontaneous remission rate of up to 85%. Concerning diagnostic management, meticulous and repeat postnatal evaluation by ultrasound is mandatory to identify patients who are at risk of renal deterioration. Routine voiding cystourethrography or contrast-enhanced voiding urosonography is currently recommended for all patients to detect vesicoureterorenal reflux and other concomitant pathologies. The relevance of the additional information provided by this examination must be critically questioned considering the lack of clinical consequences. Moreover, the question arises as to whether these examinations should be prolonged until clinical symptoms occur. Nevertheless, a subvesical obstruction should still be ruled out for male patients with a bilateral megaureter. The same critical discussion is necessary for the routine use of diuretic renography in patients with primary megaureter. In principal, this examination is used to determine the global as well as the split renal function and in addition is considered to offer an evaluation of the extent of obstruction. Similarly, the question arises of whether this examination should be mandatory for every child with a primary megaureter or whether the decision should be based on the extent of the upper urinary tract dilatation. The trend of diagnostic management should go towards individualized and risk-adapted diagnostic measures.


Assuntos
Hidronefrose/diagnóstico por imagem , Ureter/anormalidades , Doenças Ureterais/diagnóstico por imagem , Obstrução Ureteral/congênito , Criança , Humanos , Hidronefrose/terapia , Masculino , Cintilografia , Ultrassonografia Pré-Natal , Ureter/diagnóstico por imagem , Doenças Ureterais/terapia , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/terapia , Micção , Urografia/métodos
6.
Curr Urol Rep ; 21(1): 3, 2020 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-31960193

RESUMO

PURPOSE OF REVIEW: In the setting of kidney transplantation, the ureter is a common source for complications. As a result, prevention of ureteral complications and their management is of crucial importance. In this context, the purpose of this review is to summarize recent literature on the ureter in the kidney transplant setting with a special focus on new findings. We conducted a PubMed and Medline search over the last 10 years to identify all new publications related to ureteroneoimplantations, stents and management of complications in the kidney transplant setting. RECENT FINDINGS: Performance of the "Lich-Gregoir" technique for ureteroneocystostomy seems to be favourable in regard to postoperative complications when compared with other methods described in the literature. Moreover, major urologic complications can be further reduced by ureteral stenting. A new approach for management of ureteral strictures in renal transplants is presented. We discussed the usage of a ureteral stent covered with a biostable polymer aiming to prevent tissue ingrowth into the lumen as a new option for management of ureteral stricture in the kidney transplant setting.


Assuntos
Transplante de Rim/métodos , Ureter/cirurgia , Obstrução Ureteral/terapia , Derivação Urinária/efeitos adversos , Derivação Urinária/métodos , Anastomose Cirúrgica/efeitos adversos , Constrição Patológica , Humanos , Stents , Obstrução Ureteral/etiologia
7.
Biomed Pharmacother ; 123: 109741, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31901549

RESUMO

Interleukin (IL)-17A is upregulated in several renal diseases and plays a crucial role in renal inflammation. However, it remains unclear how IL-17A contributes to renal fibrosis. Our result demonstrated that IL-17A expression was upregulated in the obstructed kidney of unilateral ureter obstruction (UUO) mice when compared to the contralateral control kidney. Inhibition of IL-17A functions by the intravenous administration of an anti-IL-17A receptor antibody (100 µg) 2 h prior to UUO and on post-UUO day 1 and 3 significantly reduced fibronectin expression in the UUO kidney. The addition of IL-17A (25-100 µg) to human renal proximal tubular cells or renal fibroblasts caused an increase in fibronectin production and extracellular signal-regulated kinase (ERK)1/2 activation, which were reduced upon pretreatment with the ERK inhibitor U0126. The level of phosphorylated (p)-ERK1/2 was increased in the UUO kidney, but reduced by the administration of the anti-IL-17A receptor antibody, verifying the importance of the ERK pathway in vivo. TGF-ß1 mRNA expression and protein were increased in the UUO kidney and in IL-17A-stimulated cultured cells. The administration of an anti-TGF-ß1 neutralizing antibody or TGF-ß1 receptor I inhibitor (SB431542) to cells abrogated the IL-17A-mediated increase of fibronectin production. IL-17A induced an increase in p-Smad2 and p-Smad3 expression at 7.5 min and 24 h and pretreatment with the anti-TGF-ß1 neutralizing antibody, and SB431542 reduced the IL-17A-stimulated increase of p-Smad2. Knockdown of Smad2 or Smad3 expression inhibited the IL-17A-enhanced production of fibronectin. These results suggest an essential role for the TGF-ß/Smad pathway in the IL-17A-mediated increase of fibronectin production. This study demonstrates that IL-17A contributes to the production of extracellular matrix, and targeting its associated signaling pathways could provide a therapeutic target for preventing renal fibrosis.


Assuntos
MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Fibrose/metabolismo , Interleucina-17/metabolismo , Interleucina-17/farmacologia , Rim/metabolismo , Proteínas Smad/metabolismo , Animais , Benzamidas/farmacologia , Butadienos/farmacologia , Linhagem Celular , Citocinas/metabolismo , Dioxóis/farmacologia , Feminino , Fibroblastos , Fibronectinas/metabolismo , Fibrose/patologia , Humanos , Rim/patologia , Camundongos , Camundongos Endogâmicos BALB C , Modelos Animais , Nitrilas/farmacologia , Transdução de Sinais , Fator de Crescimento Transformador beta1/metabolismo , Obstrução Ureteral/patologia , Obstrução Ureteral/terapia
9.
Urolithiasis ; 48(1): 47-56, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30259058

RESUMO

Ureteric stents have become an indispensable tool in the armamentarium of every urologist. However, they carry their own morbidity resulting mostly from infectious or abacterial fouling and biofilm formation, and/or urothelial hyperplastic reaction. All of these may interact and lead to clinical complications. Many different stent designs and coatings have been proposed. In this study, we focused on the effect of paclitaxel-coated stents on hyperplastic proliferation of ureteral tissue, using as example anastomotic strictures after ureteroureterostomy in a rat model. Human urothelial cells (SV-HUC-1) were used to determine paclitaxel dosages in vitro. Polyurethane stents were coated with a paclitaxel containing biodegradable polymer and studied in a ureteroureterostomy rat model. 48 male 9-week-old Sprague-Dawley rats underwent either sham surgery (n = 16) or ureteroureterostomy with sutured anastomosis, and consecutive stenting with either a paclitaxel-coated or an uncoated stent (16 per group), respectively. The animals received daily intraperitoneal injections of 5-bromo-2-deoxyuridine (20 mg/ml, 100 mg/kg body weight) during the first eight postoperative days, and were sacrificed on day 28. Healing of the ureteral anastomosis and proliferation of urothelial cells was examined histologically and immunohistochemically. In vitro, a concentration of 10 ng/mm2 paclitaxel can be considered as non-toxic, while still exerting an anti-proliferative effect on urothelial cells. Histologically, typical wound healing processes were seen at the site of the ureteral anastomosis in vivo. Proliferation of urothelial cells was significantly lower in animals with paclitaxel-coated stents compared to those with uncoated stents (LI 41.27 vs. 51.58, p < 0.001). Our results indicate that stenting of ureteral anastomoses with paclitaxel-coated stents can reduce hyperplastic proliferation of ureteral tissue. Paclitaxel-coated stents thus might be able to prevent not only scar-induced postoperative stenosis after reconstructive surgery, but also hyperplastic urothelial reaction in non-anastomotic stent patients as part of their inflammatory response to the foreign material.


Assuntos
Stents Farmacológicos , Paclitaxel/administração & dosagem , Ureter/efeitos dos fármacos , Obstrução Ureteral/terapia , Urotélio/efeitos dos fármacos , Animais , Linhagem Celular , Proliferação de Células/efeitos dos fármacos , Modelos Animais de Doenças , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/patologia , Humanos , Hiperplasia/prevenção & controle , Masculino , Ratos , Ureter/patologia , Ureter/cirurgia , Urotélio/citologia , Urotélio/patologia
10.
J Vasc Interv Radiol ; 31(1): 155-161, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31420261

RESUMO

Although a snare is the commonly used device for antegrade double J (DJ) stent removal, there are some cases in which DJ stent removal using only a snare is particularly difficult. In the present study, an unfavorable positioning of the proximal DJ stent tip and tip embeddedness were significantly associated with a simple snare technique failure; thus, present the modified snare technique to overcome the simple snare technique failure. By applying these 2 techniques together, we can increase the overall technical success rate up to 97% (196/202). The modified snare technique is safe and effective in cases of simple snare technique failure.


Assuntos
Remoção de Dispositivo/métodos , Stents , Ureter , Obstrução Ureteral/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ureter/diagnóstico por imagem , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/etiologia , Adulto Jovem
11.
Support Care Cancer ; 28(2): 725-730, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31129761

RESUMO

PURPOSE: Hydronephrosis due to ureteric obstruction (UO) is stage-defining at cervical cancer presentation but may occur after primary staging. We aimed to determine the incidence and review the presentation and management of UO in women with cervical cancer attending our center. Particular attention was paid to the evolving role of interventional radiology (IR) in management. METHODS: Women with a new diagnosis of cervical cancer between January 2012 and December 2016 formed the cohort that was retrospectively reviewed from the oncology database and patient records. RESULTS: There were 310 women diagnosed with cervical cancer; 240 were stages I/II and 70 were stages III/IV. Primary treatments were chemoradiotherapy (n = 168; 54.2%), surgery (n = 121; 39.0%), and palliative care alone (n = 21; 6.8%). UO occurred in 74 (23.9%); present at primary staging in 53 (71.6%) and arising after staging in 21 (28.4%). Primary interventions for hydronephrosis were IR (n = 50; 67.6%), cystoscopic stenting (n = 19; 25.7%), bowel urinary conduit construction (n = 2; 2.7%), and none (n = 3; 4.1%). For those who attended IR, the mean number of IR procedures was 2.2, range 1-7. Maximum serum creatinine was 303 µmol/L for women with UO at primary staging compared with 252 µmol/L for UO after staging (P = 0.267). Thirty-eight women experienced substantial morbidity related to UO. Stage-adjusted mortality risk was 2.3 times higher for UO cases compared with those without UO. CONCLUSIONS: UO is associated with substantial morbidity and survival disadvantage in cervical cancer and may present after primary cancer staging. We recommend renal biochemistry during routine follow-up. A majority of cervical cancer-associated UO cases are managed with IR in our center.


Assuntos
Obstrução Ureteral , Neoplasias do Colo do Útero/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia , Estudos de Coortes , Creatinina/sangue , Feminino , Humanos , Hidronefrose/patologia , Incidência , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Obstrução Ureteral/diagnóstico , Obstrução Ureteral/patologia , Obstrução Ureteral/terapia , Neoplasias do Colo do Útero/terapia , Adulto Jovem
12.
BMC Urol ; 19(1): 137, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31881875

RESUMO

BACKGROUND: To study the outcomes and experiences of using metallic stents in treating patients with malignant ureteral obstruction (MUO), we examined the effects of metallic ureteral stenting using the Cook Resonance® stent in the treatment of MUO. METHODS: All patients who had a Resonance metallic stent inserted between April 2015 and March 2018 at one of multiple facilities were prospectively observed with a 1-year follow-up. The primary outcome was the patency rate of the metallic ureteral stent. The secondary outcomes included the complications (e.g., infection and fever). RESULTS: Although stent insertion was attempted in 50 patients, the stent could not be inserted as a ureteral stent in three patients due to severe ureteral stricture, and one ureteral cancer patient was excluded from the analysis. The remaining 46 patients' median age was 67 years (range 28-85 years) (16 males, 30 females). Twenty-four patients died during the study; their median survival time was 226 days. The median follow-up period for the censored patients was 355 days (range 16-372 days), and just seven patients were still alive without Resonance failure > 1 year later. The women's IPSS scores tended to be lower than those of the men. Regarding the OABSS score, although the women's total score tended to be low, the difference between the men's and women's scores was nonsignificant. The bacteria detected from urine culture after stent insertion were more gram-positive than gram-negative. CONCLUSION: Metallic ureteric stenting using the Resonance stent is safe and effective for treating MUO. Subjective symptoms were relatively less in the female patients.


Assuntos
Stents , Obstrução Ureteral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/urina , Creatinina/sangue , Feminino , Seguimentos , Neoplasias Gastrointestinais/complicações , Neoplasias dos Genitais Femininos/complicações , Humanos , Imageamento por Ressonância Magnética , Masculino , Metais , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Falha de Prótese , Implantação de Prótese/métodos , Fatores Sexuais , Stents/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Obstrução Ureteral/etiologia , Obstrução Ureteral/mortalidade
13.
J Laparoendosc Adv Surg Tech A ; 29(12): 1565-1570, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31660792

RESUMO

Aim: Percutaneous nephrostomy (PN), the indispensable interventional procedure in situations such as obstructive uropathy and pyonephrosis, requires serious experience. As a result, many urologists and radiologists avoid this procedure. However, this can leave both doctor and patient in a difficult situation when it is necessary. In this study, we aimed at presenting a nephrostomy insertion technique by using a transrectal ultrasonography probe that we use in our clinic and we believe that this has made the PN procedure easier, along with our results. Patients and Methods: Data from patients with PN inserted by using this method at our clinic from January 2013 to December 2018 were retrospectively scanned. The nephrostomy indications, complications, and success rates for patients were assessed. All procedures were performed under local anesthesia without the help of a radiologist. Results: A total of 84 patients, 55 male and 29 female, had 146 nephrostomy catheters inserted. Nephrostomy was performed in 52 patients due to obstruction linked to malignancy and in 32 patients due to reasons other than malignancy. The procedure was successfully concluded in all patients independent of degree of hydronephrosis. Conclusion: With our technique, PN was found to be performed easily with low complication rates.


Assuntos
Nefrostomia Percutânea/métodos , Ultrassonografia/métodos , Obstrução Ureteral/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Obstrução Ureteral/etiologia
14.
Clin Exp Nephrol ; 23(12): 1345-1356, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31482255

RESUMO

BACKGROUND: Previous studies showed that microRNA-29b (miR-29b) inhibits renal fibrosis. Therefore, miR-29b replacement therapy represents a promising approach for treating renal fibrosis. However, an efficient method of kidney-targeted miRNA delivery has yet to be established. Recombinant adeno-associated virus (rAAV) vectors have great potential for clinical application. For kidney-targeted gene delivery, the most suitable AAV serotype has yet to be established. Here, we identified the most suitable AAV serotype for kidney-targeted gene delivery and determined that AAV-mediated miR-29b delivery can suppress renal fibrosis in vivo. METHOD: To determine which AAV serotype is suitable for kidney cells, GFP-positive cells were identified by flow cytometry after the infection of rAAV serotype 1-9 vectors containing the EGFP gene. Next, we injected rAAV vectors into the renal pelvis to determine transduction efficiency in vivo. GFP expression was measured seven days after injecting rAAV serotype 1-9 vectors carrying the EGFP gene. Finally, we investigated whether rAAV6-mediated miR-29b delivery can suppress renal fibrosis in UUO mouse model. RESULTS: We found that rAAV6 vector is the most suitable for targeting kidney cells regardless of animal species in vitro and rAAV6 is the most suitable vector for kidney-targeted in vivo gene delivery in mice. Intra-renal pelvic injection of rAAV vectors can transduce genes into kidney TECs. Furthermore, rAAV6-mediated miR-29b delivery attenuated renal fibrosis in UUO model by suppressing Snail1 expression. CONCLUSION: Our study has revealed that rAAV6 is the most suitable serotype for kidney-targeted gene delivery and rAAV6-mediated miR-29b delivery into kidney TECs can suppress established renal fibrosis.


Assuntos
Técnicas de Transferência de Genes , Terapia Genética/métodos , Vetores Genéticos , Nefropatias/prevenção & controle , Túbulos Renais Proximais/metabolismo , MicroRNAs/genética , Parvovirinae/genética , Obstrução Ureteral/terapia , Animais , Linhagem Celular , Modelos Animais de Doenças , Fibrose , Humanos , Nefropatias/diagnóstico , Nefropatias/metabolismo , Nefropatias/patologia , Túbulos Renais Proximais/efeitos dos fármacos , Túbulos Renais Proximais/patologia , Masculino , Camundongos Endogâmicos C57BL , MicroRNAs/metabolismo , Parvovirinae/metabolismo , Ratos , Fator de Crescimento Transformador beta1/toxicidade , Obstrução Ureteral/genética , Obstrução Ureteral/metabolismo , Obstrução Ureteral/patologia
15.
Vet Clin North Am Exot Anim Pract ; 22(3): 521-538, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31395329

RESUMO

Medical devices are defined as implantable if they are intended to remain in the body after the procedure. In veterinary medicine, use of such devices is marginal but may find some indications. Use in exotic pet medicine is even more challenging due to size restriction and the limited data available. This review focuses on the esophageal and tracheal stent in the case of stricture, ureteral stent and subcutaneous ureteral bypass in the case of ureteral obstruction, permanent urinary diversion in the case of bladder atony, and pacemaker in the case of severe arrythmias. Comparative aspects are developed.


Assuntos
Obstrução das Vias Respiratórias/veterinária , Animais Exóticos , Materiais Biocompatíveis/classificação , Estenose Esofágica/veterinária , Marca-Passo Artificial/veterinária , Obstrução Ureteral/veterinária , Obstrução das Vias Respiratórias/terapia , Animais , Gatos , Cistotomia/instrumentação , Cistotomia/veterinária , Cães , Estenose Esofágica/terapia , Feminino , Furões , Humanos , Masculino , Coelhos , Stents , Obstrução Ureteral/terapia , Derivação Urinária
16.
J Vet Intern Med ; 33(5): 2124-2132, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31386229

RESUMO

BACKGROUND: Subcutaneous ureteral bypass (SUB) device placement is an increasingly popular treatment option for decompression of ureteral obstruction in cats. Mineralization occlusion of the device occurs in a minority of cases but is the most common complication. OBJECTIVE: To evaluate a 2% tetrasodium ethylenediaminetetraacetic acid (tEDTA) solution for treatment of mineralization occlusion in cats with SUBs. ANIMALS: Six client-owned cats (8 obstructed devices). METHODS: Case series. Each cat was found to have device occlusion based on a combination of ultrasound examination, SUB irrigation, and failure to identify another cause of device obstruction. Each SUB was drained, irrigated using sterile saline, and infused with 1-2 mL of 2% tEDTA solution. Success was defined as normalization of flow during subsequent ultrasound visualization while irrigating. The volume and frequency of tEDTA instillations, time to achieve device patency, follow-up biochemical and ultrasound findings, and future reobstruction events were recorded. RESULTS: Resolution of mineralization was documented in all 8 SUBs. Reobstruction events occurred in 2 cats, all of which resolved after additional tEDTA infusions, but 1 cat ultimately required device exchange at 356 days from the first tEDTA infusion. In 1 cat, a single infusion was prematurely discontinued because of persistent pelvic dilatation after 1.25 mL of tEDTA had been instilled. No complications were observed. CONCLUSIONS AND CLINICAL IMPORTANCE: Tetrasodium EDTA infusions can be safely considered as a treatment option for mineralized SUB devices in cats. This solution was easily infused, well tolerated, and avoided the need for SUB device exchange in the majority of cats in which it was used.


Assuntos
Doenças do Gato/terapia , Ácido Edético/administração & dosagem , Stents/veterinária , Procedimentos Cirúrgicos Urológicos/veterinária , Animais , Quelantes de Cálcio/administração & dosagem , Doenças do Gato/diagnóstico por imagem , Gatos , Feminino , Masculino , Ultrassonografia/veterinária , Obstrução Ureteral/terapia , Obstrução Ureteral/veterinária , Procedimentos Cirúrgicos Urológicos/instrumentação
17.
J Chin Med Assoc ; 82(10): 767-771, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31356568

RESUMO

BACKGROUND: Postoperative urology patients may require the insertion of a ureteral stent. However, the delayed removal or change of the ureteral stent may lead to serious consequences for some patients. This study primarily aimed to examine the risk factors and complications associated with forgotten double-J stents (DJSs). METHODS: In this retrospective study, postoperative patients who underwent DJS insertion were recruited. Based on the brand of DJS, the maximal stent life (MSL) was classified into 3-month, 6-month, and 12-month groups, and a forgotten DJS was defined as the one that had yet to be removed 2 weeks past its MSL. A total of 479 patients were analyzed. The reasons for the use of DJSs use and the time and method of their insertion were recorded, and the risk factors and possible complications associated with forgotten DJSs were analyzed. RESULTS: The primary reason for DJS insertion was urolithiasis (69.7%), and insertions performed using ureterorenoscopy were the most common (413/479, 86.2%). Eighteen patients (3.8%) had forgotten DJSs, with an average overdue period of 63.17 days (18-189 days). Multivariate analysis revealed that patients older than 60 years (odds ratio [OR] = 3.626, 95% confidence interval [CI] = 1.070-12.289; p = 0.039) and DJSs exchanged using fibrocystoscopy (OR = 5.437, 95% CI = 1.060-28.256; p = 0.042) were significantly associated with forgotten DJSs. Out of the 18 patients with forgotten DJS, three (16.67%) experienced symptomatic complications, with one developing acute pyelonephritis, and the remaining two experiencing stone encrustation. CONCLUSION: Patients older than 60 years were 3.6 times more likely to have forgotten DJSs than patients aged 60 and below, and DJSs exchanged using fibrocystoscopy were 5.4 times more likely to be forgotten than those inserted using ureterorenoscopy. Greater attention with regards to tracking and recalling DJSs should be paid in high-risk patients to prevent forgotten DJSs and associated complications.


Assuntos
Remoção de Dispositivo , Corpos Estranhos/complicações , Stents/efeitos adversos , Obstrução Ureteral/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Erros Médicos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
18.
J R Coll Physicians Edinb ; 49(2): 125-127, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31188341

RESUMO

Retroperitoneal fibrosis is a rare cause of renal dysfunction, typically presenting with obstructive uropathy (sometimes with extra-renal manifestations). Given its insidious and subtle presentation, reaching the diagnosis can be challenging. We report the case of a 65-year-old female presenting with a 6-month history of unexplained constitutional symptoms, weight loss and mild renal impairment. Abdominal imaging revealed bilateral ureteric obstruction due to retroperitoneal fibrosis and so she underwent urgent ureteric stent insertion. Subsequent treatment with oral corticosteroids led to resolution of her symptoms and regression of the retroperitoneal mass.


Assuntos
Insuficiência Renal Crônica/etiologia , Fibrose Retroperitoneal/complicações , Fibrose Retroperitoneal/diagnóstico por imagem , Obstrução Ureteral/etiologia , Idoso , Anti-Inflamatórios/uso terapêutico , Feminino , Humanos , Prednisolona/uso terapêutico , Doenças Raras/diagnóstico , Doenças Raras/terapia , Fibrose Retroperitoneal/tratamento farmacológico , Stents , Obstrução Ureteral/terapia
19.
PLoS One ; 14(4): e0215232, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30978213

RESUMO

BACKGROUND: The costimulatory CD40-CD40L pathway plays a role in kidney inflammation. We have previously reported that renal CD40 upregulation precedes cellular interstitial infiltrate and fibrosis in the unilateral ureteral obstruction (UUO) model. Here we sought to evaluate whether the administration of siRNA-CD40 has a therapeutic effect in a reversible unilateral ureteral obstruction (D-UUO) mice model. METHODS: Eight week-old C57BL6J male mice were divided into four groups: Vehicle (Phosphate-buffered saline) (n = 8); siRNA SC (non-specific siRNA) (n = 6); siRNA-CD40 (n = 8) and WT (wild type) (n = 6) mice. UUO was performed with a microvascular clamp. At day 3 after surgery, the ureteral clamp was removed and nephrectomy of the contralateral kidney was performed. Immediately, PBS, siRNA SC (50µg) or siRNA-CD40 (50µg) was administrated via the tail vein. Mice were killed 48h hours after the siRNA or saline administration. Wild type (WT) mice were used as controls. Blood samples were collected for measuring creatinine and blood urea nitrogen (BUN). Histology and kidney mRNA expression were performed. RESULTS: The administration of siRNA-CD40 reduced significantly the severity of acute renal failure associated with UUO. Pathologic analysis showed reduction of tubular dilation, interstitial fibrosis, F4/80 macrophage and CD3 (T cell) infiltration in animals treated with siRNA-CD40. Furthermore, kidney mRNA gene expression analysis showed significantly lower levels of macrophage markers (F4/80 and Mannose receptor), fibrosis matrix proteins (Fibronectin, MMP-9, Collagen IV and α-SMA), pro-inflammatory cytokines (iNOS and MCP-1) and the pro-fibrotic molecule TGF-ß1 in siRNA-CD40. CONCLUSIONS: The administration of siRNA-CD40 therapy reduces the severity of the acute kidney injury induced by obstructive uropathy and promotes kidney repair. This strategy seems suitable to be tested in humans.


Assuntos
Injúria Renal Aguda/etiologia , Injúria Renal Aguda/prevenção & controle , Antígenos CD40/antagonistas & inibidores , Antígenos CD40/genética , Obstrução Ureteral/complicações , Obstrução Ureteral/terapia , Injúria Renal Aguda/patologia , Animais , Modelos Animais de Doenças , Fibrose , Expressão Gênica , Inativação Gênica , Humanos , Mediadores da Inflamação/antagonistas & inibidores , Rim/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , RNA Interferente Pequeno/genética
20.
Stem Cell Res Ther ; 10(1): 104, 2019 03 21.
Artigo em Inglês | MEDLINE | ID: mdl-30898157

RESUMO

BACKGROUND: Putative endothelial progenitor cells (pEPCs) have been confirmed to participate in alleviation of renal fibrosis in several ischaemic diseases. However, their mechanistic effect on renal fibrosis, which is characterized by vascular regression and further rarefaction-related pathology, remains unknown. METHODS: To explore the effect and molecular mechanisms by which pEPCs act on unilateral ureteral obstruction (UUO)-induced renal fibrosis, we isolated pEPCs from murine bone marrow. In vivo, pEPCs (2 × 105 cells/day) and pEPC-MVs (microvesicles) were injected into UUO mice via the tail vein. In vitro, pEPCs were co-cultured with renal-derived pericytes. Pericyte-myofibroblast transition was evaluated using the myofibroblast marker α-smooth muscle actin (α-SMA) and pericyte marker platelet-derived growth factor receptor ß (PDGFR-ß). RESULTS: Exogenous supply of bone marrow-derived pEPCs attenuated renal fibrosis by decreasing pericyte-myofibroblast transition without significant vascular repair in the UUO model. Our results indicated that pEPCs regulated pericytes and their transition into myofibroblasts via pEPC-MVs. Co-culture of pericytes with pEPCs in vitro suggested that pEPCs inhibit transforming growth factor-ß (TGF-ß)-induced pericyte-myofibroblast transition via a paracrine pathway. CONCLUSION: pEPCs effectively attenuated UUO-induced renal fibrosis by inhibiting pericyte-myofibroblast transition via a paracrine pathway, without promoting vascular repair.


Assuntos
Células da Medula Óssea , Células Progenitoras Endoteliais , Miofibroblastos , Comunicação Parácrina , Pericitos , Obstrução Ureteral , Animais , Células da Medula Óssea/metabolismo , Células da Medula Óssea/patologia , Células Progenitoras Endoteliais/metabolismo , Células Progenitoras Endoteliais/patologia , Células Progenitoras Endoteliais/transplante , Fibrose , Nefropatias/etiologia , Nefropatias/metabolismo , Nefropatias/patologia , Nefropatias/terapia , Masculino , Camundongos , Camundongos Transgênicos , Miofibroblastos/metabolismo , Miofibroblastos/patologia , Pericitos/metabolismo , Pericitos/patologia , Obstrução Ureteral/complicações , Obstrução Ureteral/metabolismo , Obstrução Ureteral/patologia , Obstrução Ureteral/terapia
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