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1.
Anticancer Res ; 40(10): 5837-5844, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988913

RESUMO

BACKGROUND/AIM: Renal cell carcinoma (RCC) is one of the most common malignancies of the urinary tract. Venous migration, tumor thrombus and metastases are often seen in patients with RCC and are adverse prognostic factors. Intravascular tumor growth along the renal vein into the inferior vena cava occurs in up to 10% of all patients with RCC. Furthermore, extension of the tumor reaching the right atrium is detected in approximately 1% of all patients. Synchronous involvement of pulmonary arteries with tumor emboli is very rare and challenging. Management of metastatic RCC includes surgical resection of renal and metastatic lesions. We present 3 cases of patients with RCC tumor thrombus extending into the inferior vena cava (IVC) and with pulmonary emboli of the tumor thrombus into one of the branches of the main pulmonary artery. All the cases had simultaneous resection of the kidney tumor with the tumor thrombus and pulmonary lobectomy that included the tumor emboli with satisfactory outcome. CASE REPORT: We present a series of cases of RCC with tumor extension into the inferior vena cava (IVC) and with tumor emboli to the pulmonary arteries. Surgical procedure in all cases consisted of radical nephrectomy with IVC tumor thrombus resection, along with a thoracotomy with lung resection including the tumor emboli to one of the branches of the main pulmonary artery. Synchronous metastatic lesions were found on the liver in one case and contiguous extension of renal tumor to the pancreas in another. CONCLUSION: In patients with IVC thrombus with synchronous pulmonary artery tumor embolus, such as the cases presented in this series, a careful multidisciplinary management approach is preferable. Transplant technique used in our open approach minimizes complications, blood loss, and provides excellent visualization for abdominal vascular manipulation of IVC. This provides a potentially curable treatment option with acceptable survival rates.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Pulmonares/cirurgia , Artéria Pulmonar/cirurgia , Veia Cava Inferior/cirurgia , Adulto , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Feminino , Humanos , Rim/diagnóstico por imagem , Rim/patologia , Rim/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/secundário , Metástase Neoplásica , Células Neoplásicas Circulantes/metabolismo , Células Neoplásicas Circulantes/patologia , Nefrectomia/métodos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologia , Veias Renais/diagnóstico por imagem , Veias Renais/patologia , Veias Renais/cirurgia , Trombose/diagnóstico por imagem , Trombose/patologia , Trombose/cirurgia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/patologia , Trombose Venosa/cirurgia
2.
Radiol Clin North Am ; 58(5): 981-993, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32792128

RESUMO

Based on Surveillance, Epidemiology, and End Results studies, most renal cancers are low grade and slow growing. Long-term, single-center studies show excellent outcomes for T1a renal cell carcinoma (RCC), comparable to partial nephrectomy without affecting renal function and with much lower rates of complications. However, there are no multicenter randomized controlled trials of multiple ablative modalities or comparison with partial nephrectomy, and most studies are single-arm observational studies with short-term and intermediate follow-up. For treatment of stage T1a RCC, percutaneous TA is an effective alternative to surgery with preservation of renal function, low risk, and comparable overall and disease-specific survival.


Assuntos
Carcinoma de Células Renais/cirurgia , Ablação por Cateter/métodos , Neoplasias Renais/cirurgia , Diagnóstico por Imagem/métodos , Humanos , Rim/diagnóstico por imagem , Rim/cirurgia , Neoplasias Renais/diagnóstico por imagem , Resultado do Tratamento
3.
PLoS One ; 15(7): e0236396, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32702043

RESUMO

INTRODUCTION: Certain ABO blood types have been linked to cardiovascular disease, infection and cancers. The effect of recipient ABO blood group on patient and graft survival has not been studied in ABO-matched kidney transplantation. This study aims to determine the association between kidney transplant recipient ABO blood groups with patient and graft survival in Australian and New Zealand. METHODS: All Australian and New Zealand transplant recipients who received ABO-compatible primary kidney transplants between 1995-2016 were analysed using a de-identified dataset from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Primary analysis was undertaken of recipient ABO blood group O versus non-O blood groups. The primary outcome was patient survival post kidney transplantation and the secondary outcome was death censored graft survival. Recipient age at first transplant, gender, ethnicity, body mass index, smoking status, vascular disease, presence of diabetes mellitus, chronic lung disease, primary kidney disease, donor source, donor age and gender, and era of transplants were included in the multivariate model as confounders. RESULTS AND CONCLUSIONS: On analysis of 15,523 kidney transplant recipients, blood group O was not associated with patient survival (hazard ratio (HR) 0.96, 95% confidence interval (CI) 0.89-1.04) nor death censored graft survival (HR 0.97, 95% CI 0.89-1.05) compared to non-blood group O recipients. Competing risks analyses showed an increased risk of cancer-related mortality in blood group O recipients on univariate analyses (HR 1.18, 95% CI 1.01-1.37) however, this became insignificant on multivariate analyses. On secondary analyses, recipient blood group AB (4.11% participants) was associated with inferior death censored graft survival compared to those with blood group O (HR 1.24, 95% CI 1.02-1.50). Although recipient ABO blood groups were not associated with patient nor graft survival, differences in cause-specific mortality between individual blood groups cannot be excluded based on current analyses.


Assuntos
Sistema ABO de Grupos Sanguíneos/genética , Incompatibilidade de Grupos Sanguíneos/epidemiologia , Sobrevivência de Enxerto/genética , Transplante de Rim/métodos , Rim/patologia , Adolescente , Adulto , Austrália/epidemiologia , Incompatibilidade de Grupos Sanguíneos/sangue , Tipagem e Reações Cruzadas Sanguíneas , Feminino , Rejeição de Enxerto/sangue , Rejeição de Enxerto/epidemiologia , Humanos , Estimativa de Kaplan-Meier , Rim/cirurgia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Transplantados , Adulto Jovem
5.
Urologe A ; 59(9): 1017-1025, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32533201

RESUMO

BACKGROUND: Percutaneous access to the renal pelvis still remains the most difficult step before nephrolitholapaxy (PCNL). New imaging techniques, such as 3D imaging and various navigation instruments such as electromagnetic, sonographic, CT-controlled and marker-based/iPAD try to simplify this step and reduce complications. OBJECTIVES: In this review, various new techniques for puncturing the renal collecting system are presented and their advantages and disadvantages are evaluated. MATERIALS AND METHODS: A systematic literature search was carried out in MEDLINE, whereby only puncture techniques that have already been evaluated in clinical studies were included. RESULTS: Five different navigation methods for puncturing the renal pelvis before PCNL were found. CONCLUSION: Intraoperative navigation can be useful when puncturing the collecting system. The combination of ultrasound and fluoroscopy currently remains the gold standard. However, there is still a need for further, primarily clinical, prospective studies to determine which new imaging technology and navigation systems will prevail and thus facilitate the access route to the kidney, especially in the case of special anatomical conditions.


Assuntos
Cálculos Renais/cirurgia , Rim/diagnóstico por imagem , Rim/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Nefrostomia Percutânea/métodos , Punções/métodos , Humanos , Cálculos Renais/diagnóstico por imagem
6.
Arch. esp. urol. (Ed. impr.) ; 73(4): 247-280, mayo 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192987

RESUMO

OBJETIVO: Caracterizar la condición clínica, el tipo de abordaje terapéutico y desenlaces de pacientes con trauma renal de alto grado (AAST: 4 y 5) atendidos en un hospital de tercer nivel. Cali, Colombia. MÉTODOS: Se realizó un estudio observacional descriptivo con pacientes mayores de 15 años atendidos entre el 1 de enero de 2015 y el 1 enero de 2019, con diagnóstico de traumatismo renal y traumatismo de vasos renales. Se recolectaron variables demográficas, clínicas y de severidad del trauma. Se realizó un análisis univariado con tablas de frecuencia, medidas de tendencia central, dependiendo de tipo de intervención, lesiones asociadas, uso de hemoderivados e índices de severidad. RESULTADOS: Se analizaron 71 historias clínicas, 82% de sexo masculino, el promedio de edad fue 25 años (rango: 15-55). Respecto al grado trauma renal, el 69%de los pacientes fueron grado IV y el 31% grado V. Las lesiones penetrantes se vieron en un 87% vs 13% delesiones por mecanismo contuso (no penetrante). El 54% de los pacientes fueron puntuados con un Índice de Severidadde Trauma >= 25 y el 51% de los pacientes presentó un Índice de Trauma Abdominal <= 24. Se observó manejo quirúrgico en 67% vs 32% para manejo no quirúrgico. El tiempo de estancia hospitalaria fue de 17 días en promedio y el 16,9% tuvo complicaciones. CONCLUSIONES: El traumatismo renal de alto grado es una condición clínica frecuente en pacientes masculinos entre la segunda y tercera década de vida, en nuestro medio la mayoría corresponden a traumas penetrantes. La mayoría de casos fueron manejados con algún procedimiento quirúrgico, sin embargo, con un importante porcentaje de manejo conservador con tasas de complicaciones menores del 30 %, que cambia el paradigma del tratamiento del trauma renal de alto grado


OBJECTIVE: To characterize the clinical condition, the type of therapeutic approach and outcome of patients with severe renal trauma (AAST: 4 and 5) treated in a tertiary hospital. Cali, Colombia. METHODS: A descriptive observational study was conducted with patients older than 15 years treated between January 1, 2015 and January 1, 2019, with a diagnosis of renal trauma and renal vessel trauma. Demographic, clinical and trauma severity variables were collected. A univariate analysis was carried out with frequency tables, measures of central tendency, depending on type of intervention, associated lesions, use of blood products and severity indices. RESULTS: 71 medical records were analyzed, 82% male, the average age was 25 years (range: 15-55). Regarding renal traumatic grade, 69% of the patients were grade IV and 31% grade V. Penetrating injuries were seen in 87% versus 13% of injuries due to blunt (non-penetrating) mechanism. 54% of the patients were scored with a trauma severity index >= 25 and 51% of the patients had an abdominal trauma index <= 24. Surgical management was managed in 67% vs. 32% for non-trauma management. surgical. The hospital stay was 17 days on average and 16.9% had complications. CONCLUSIONS: Severe renal trauma is a frequent clinical condition in male patients between the second and third decade of life, in our environment the majority corresponds to penetrating traumas. Most cases were managed with some surgical procedure, however, with a significant percentage of conservative management with complication rates of less than 30%, which changes the paradigm of treatment of high-grade renal trauma


Assuntos
Humanos , Masculino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Rim/lesões , Rim/cirurgia , Ferimentos e Lesões/epidemiologia , Colômbia , Índice de Gravidade de Doença , Tempo de Internação , Sistema Urinário/lesões
7.
Yonsei Med J ; 61(6): 515-523, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32469175

RESUMO

PURPOSE: This study aimed to evaluate the cost-effectiveness of treatment with retrograde intrarenal surgery (RIRS) versus repeated shock wave lithotripsy (SWL) in patients with renal calculi. MATERIALS AND METHODS: The non-retreatment rates (NRRs) and their respective real-world costs for RIRS and SWL were derived through retrospective analysis of health insurance claims data from 2015 to 2017. Decision tree modeling was performed to demonstrate the cost-effectiveness of RIRS. Furthermore, sensitivity analysis was performed to examine the robustness of the results. RESULTS: Analysis of the obtained data showed that NRRs of single SWL ranged from 46% to 56%, whereas NRRs of single RIRS ranged from 75% to 93%. Introducing RIRS early in the treatment sequence was observed to be favorable for the reduction of overall failure (overall NRR, 0.997) compared to the results of repeated SWL (overall NRR, 0.928). The implementation of decision tree modeling revealed that the cost per retreatment-avoided increased with the introduction of RIRS at an earlier time (first line, second line, third line, fourth line: 18640 USD, 10376 USD, 4294 USD, 3377 USD, respectively). Probabilistic modeling also indicated that the introduction of RIRS as the first line of treatment was least likely to be cost-effective, when compared to other options of introducing RIRS as the second, third, or fourth line of treatment. CONCLUSION: Performing RIRS as early as possible can be recommended for eligible patients to reduce the overall failure, even if it is not as cost-effective as performing RIRS later.


Assuntos
Análise Custo-Benefício , Cálculos Renais/economia , Cálculos Renais/cirurgia , Rim/cirurgia , Idoso , Técnicas de Apoio para a Decisão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Probabilidade , Estudos Retrospectivos
8.
Life Sci ; 253: 117705, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32334008

RESUMO

AIMS: Ischemia-reperfusion injury (IRI) is harmful to patients following kidney transplantation. Hypothermic machine perfusion (HMP) can be adopted to preserve grafts and reduce consequential injury. We hypothesized that aldehyde dehydrogenase 2 (ALDH2) partly mitigates kidney IRI via regulating excessive autophagy in HMP. MATERIALS AND METHODS: The rabbits were assigned to 5 groups: Normal, HMP, HMP + Alda-1, HMP + CYA and cold storage (CS). After the rabbit autologous kidney transplantation, renal pathology and function were evaluated by histological analysis, glomerular related proteins (desmin, nephrin), tubular injury factors (NGAL, Ki67), serum creatinine (Cr) and blood urea nitrogen (BUN). Oxidative stress molecular Malondialdehyde (MDA) and superoxide dismutase (SOD2) expression, as well as inflammatory cytokines (TNF-α, IL-6, IL-10) were assessed by immunohistochemistry. The expression of LC3, p62, ALDH2, p-Akt, mTOR, PTEN, p-PTEN, and 4-HNE were measured by immunohistochemistry, RT-PCR, Western blot analysis or ELISA. KEY FINDINGS: HMP was more effective than CS for kidney preservation, with p- ALDH2 expressed in greater quantities in HMP. The results of kidney pathology and function in HMP + Alda-1 were the best. The MDA & SOD2 and the Vyacheslav score were improved in HMP + CYA. ALDH2 reduced 4-HNE-induced oxidative stress, inflammatory infiltration, the expression of LC3, p62 and inhibited autophagy accompanied by activation of p-Akt and mTOR via p-PTEN/PTEN. SIGNIFICANCE: Akt-mTOR autophagy pathway is a novel target for ALDH2 to reduce renal IRI partly by inhibition of 4-HNE in HMP, then protecting the donated kidney received after cardiac death (DCD).


Assuntos
Hipotermia Induzida/métodos , Transplante de Rim/métodos , Proteínas Proto-Oncogênicas c-akt/metabolismo , Traumatismo por Reperfusão/prevenção & controle , Serina-Treonina Quinases TOR/metabolismo , Aldeído-Desidrogenase Mitocondrial/metabolismo , Aldeídos/metabolismo , Animais , Autofagia/fisiologia , Creatinina/sangue , Citocinas/metabolismo , Rim/irrigação sanguínea , Rim/patologia , Rim/cirurgia , Masculino , Estresse Oxidativo/fisiologia , Coelhos
9.
Am J Physiol Renal Physiol ; 318(5): F1167-F1176, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32223312

RESUMO

Cellular senescence, a permanent arrest of cell proliferation, is characterized by a senescence-associated secretory phenotype (SASP), which reinforces senescence and exerts noxious effects on adjacent cells. Recent studies have suggested that transplanting small numbers of senescent cells suffices to provoke tissue inflammation. We hypothesized that senescent cells can directly augment renal injury. Primary scattered tubular-like cells (STCs) acquired from pig kidneys were irradiated by 10 Gy of cesium radiation, and 3 wk later cells were characterized for levels of senescence and SASP markers. Control or senescent STCs were then prelabeled and injected (5 × 105 cells) into the aorta of C57BL/6J mice. Four weeks later, renal oxygenation was studied in vivo using 16.4-T magnetic resonance imaging and function by plasma creatinine level. Renal markers of SASP, fibrosis, and microvascular density were evaluated ex vivo. Per flow cytometry, irradiation induced senescence in 80-99% of STCs, which showed increased gene expression of senescence and SASP markers, senescence-associated ß-galactosidase staining, and cytokine levels (especially IL-6) secreted in conditioned medium. Four weeks after injection, cells were detected engrafted in the mouse kidneys with no evidence for rejection. Plasma creatinine and renal tissue hypoxia increased in senescent compared with control cells. Senescent kidneys were more fibrotic, with fewer CD31+ endothelial cells, and showed upregulation of IL-6 gene expression. Therefore, exogenously delivered senescent renal STCs directly injure healthy mouse kidneys. Additional studies are needed to determine the role of endogenous cellular senescence in the pathogenesis of kidney injury and evaluate the utility of senolytic therapy.


Assuntos
Proliferação de Células , Senescência Celular , Túbulos Renais/transplante , Rim/cirurgia , Animais , Proliferação de Células/efeitos da radiação , Células Cultivadas , Senescência Celular/efeitos da radiação , Feminino , Fibrose , Mediadores da Inflamação/metabolismo , Rim/metabolismo , Rim/patologia , Túbulos Renais/metabolismo , Túbulos Renais/patologia , Túbulos Renais/efeitos da radiação , Masculino , Camundongos Endogâmicos C57BL , Fenótipo , Sus scrofa , Transplante Heterólogo
10.
PLoS One ; 15(4): e0227546, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32343697

RESUMO

We developed a preoperative assessment system to predict surgical workload in hand-assisted laparoscopic donor nephrectomy (HALDNx) using the normal-based linear discriminant rule (NLDR). A total of 128 cases of left HALDNx performed by a single operator were used as training data. Surgical workload was measured by operative time. The optimized model had 9 explanatory variables: age, total protein, total cholesterol, number of renal arteries (numberRA), 4 variables of perinephric fat (PNF), and thickness of subcutaneous fat. This model was validated using cross-validation and the .632 estimator to estimate discrimination rates with future test data. PNF and numberRA were the predominant factors affecting workload followed by the computed tomography value of PNF, body weight, and male sex. The estimated accuracy of the prediction system was 94.6%. The complication rate was 9.38% and did not correlate with surgical workload. We also made our program available online for constructing assessment functions from other cohort data. In conclusion, the surgical workload of HALDNx could be predicted with PNF and numberRA as the dominant risk factors.


Assuntos
Laparoscopia Assistida com a Mão/efeitos adversos , Modelos Estatísticos , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Idoso , Índice de Massa Corporal , Análise Discriminante , Feminino , Laparoscopia Assistida com a Mão/estatística & dados numéricos , Humanos , Rim/irrigação sanguínea , Rim/diagnóstico por imagem , Rim/cirurgia , Curva de Aprendizado , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Nefrectomia/estatística & dados numéricos , Duração da Cirurgia , Segurança do Paciente , Seleção de Pacientes , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Período Pré-Operatório , Artéria Renal/diagnóstico por imagem , Artéria Renal/cirurgia , Medição de Risco/métodos , Fatores de Risco , Coleta de Tecidos e Órgãos/métodos , Coleta de Tecidos e Órgãos/estatística & dados numéricos , Tomografia Computadorizada por Raios X , Carga de Trabalho/estatística & dados numéricos , Adulto Jovem
11.
Am J Physiol Renal Physiol ; 318(5): F1229-F1236, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32249610

RESUMO

Metformin, an AMP-activated protein kinase (AMPK) activator, has been shown in previous studies to reduce kidney fibrosis in different models of experimental chronic kidney disease (CKD). However, in all of these studies, the administration of metformin was initiated before the establishment of renal disease, which is a condition that does not typically occur in clinical settings. The aim of the present study was to investigate whether the administration of metformin could arrest the progression of established renal disease in a well-recognized model of CKD, the subtotal kidney nephrectomy (Nx) model. Adult male Munich-Wistar rats underwent either Nx or sham operations. After the surgery (30 days), Nx rats that had systolic blood pressures of >170 mmHg and albuminuria levels of >40 mg/24 h were randomized to a no-treatment condition or to a treatment condition with metformin (300 mg·kg-1·day-1) for a period of either 60 or 120 days. After 60 days of treatment, we did not observe any differences in kidney disease parameters between Nx metformin-treated and untreated rats. However, after 120 days, Nx rats that had been treated with metformin displayed significant reductions in albuminuria levels and in markers of renal fibrosis. These effects were independent of any other effects on blood pressure or glycemia. In addition, treatment with metformin was also able to activate kidney AMPK and therefore improve mitochondrial biogenesis. It was concluded that metformin can arrest the progression of established kidney disease in the Nx model, likely via the activation of AMPK.


Assuntos
Proteínas Quinases Ativadas por AMP/metabolismo , Ativadores de Enzimas/farmacologia , Rim/efeitos dos fármacos , Metformina/farmacologia , Nefrectomia , Insuficiência Renal Crônica/prevenção & controle , Albuminúria/etiologia , Albuminúria/metabolismo , Albuminúria/prevenção & controle , Animais , Modelos Animais de Doenças , Progressão da Doença , Ativação Enzimática , Fibrose , Hipertensão/etiologia , Hipertensão/metabolismo , Hipertensão/prevenção & controle , Rim/enzimologia , Rim/patologia , Rim/cirurgia , Masculino , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/metabolismo , Mitocôndrias/patologia , Biogênese de Organelas , Ratos Wistar , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/metabolismo , Insuficiência Renal Crônica/patologia , Fatores de Tempo
12.
Qual Life Res ; 29(9): 2355-2374, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32285345

RESUMO

PURPOSE: Living donor kidney transplant (LDKT) imparts the best graft and patient survival for most end-stage kidney disease (ESKD) patients. Yet, there remains variation in post-LDKT health-related quality of life (HRQOL). Improved understanding of post-LDKT HRQOL can help identify patients for interventions to maximize the benefit of LDKT. METHODS: For 477 LDKT recipients transplanted between 11/2007 and 08/2016, we assessed physical, mental, social, and kidney-targeted HRQOL pre-LDKT, as well as 3 and 12 months post-operatively using the SF-36, Kidney Disease Quality of Life-Short Form (KDQOL-SF), and the Functional Assessment of Cancer Therapy-Kidney Symptom Index 19 item version (FKSI-19). We then examined trajectories of each HRQOL domain using latent growth curve models (LGCMs). We also examined associations between decline in HRQOL from 3 months to 12 months post-LDKT and death censored graft failure (DCGF) using Cox regression. RESULTS: Large magnitude effects (d > 0.80) were observed from pre- to post-LDKT change on the SF-36 Vitality scale (d = 0.81) and the KDQOL-SF Burden of Kidney Disease (d = 1.05). Older age and smaller pre- to post-LDKT decreases in serum creatinine were associated with smaller improvements on many HRQOL scales across all domains in LGCMs. Higher DCGF rates were associated with worse physical [e.g., SF-36 PCSoblique hazard ratio (HR) 1.18; 95% CI 1.01-1.38], mental (KDQOL-SF Cognitive Function HR 1.27; 95% CI 1.00-1.62), and kidney-targeted (FKSI-19 HR: 1.18; 95% CI 1.00-1.38) HRQOL domains. CONCLUSION: Clinical HRQOL monitoring may help identify patients who are most likely to have failing grafts and who would benefit from post-LDKT intervention.


Assuntos
Nível de Saúde , Transplante de Rim/psicologia , Qualidade de Vida/psicologia , Transplantados/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Rim/cirurgia , Falência Renal Crônica/terapia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Psicometria , Adulto Jovem
13.
Ann Biol Clin (Paris) ; 78(2): 191-194, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32319948

RESUMO

Howell-Jolly bodies are intraerythrocytic inclusions corresponding to a small portion of chromatin. Red blood cells that contain these nuclear remnants are removed from the circulation by the spleen. In most cases, presence of Howell-Jolly bodies on a blood smear is the result of functional asplenia and splenectomy. Observation. We report incidental finding of numerous Howell-Jolly bodies in a patient followed by the nephrology department. This microscopic observation of blood smear led to a diagnostic imaging and to the evidence of a reduced spleen, possibly favoured by a history of Goodpasture syndrome in this renal transplant patient without splenectomy. Vaccination and antibioprophylaxy were proposed to prevent infectious risk linked to this splenic hypoplasia. Conclusion. Seeking of Howell-Jolly bodies could be made in every condition associated with a risk of splenic hypoplasia to prevent infectious risk.


Assuntos
Doença Antimembrana Basal Glomerular/sangue , Inclusões Eritrocíticas/patologia , Doenças da Imunodeficiência Primária/sangue , Baço/anormalidades , Adulto , Doença Antimembrana Basal Glomerular/diagnóstico , Doença Antimembrana Basal Glomerular/cirurgia , Feminino , Testes Hematológicos , Humanos , Achados Incidentais , Rim/patologia , Rim/cirurgia , Doenças da Imunodeficiência Primária/diagnóstico , Doenças da Imunodeficiência Primária/cirurgia , Baço/cirurgia , Esplenectomia
14.
Lancet ; 395(10234): 1444-1451, 2020 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-32234534

RESUMO

BACKGROUND: Catheter-based renal denervation has significantly reduced blood pressure in previous studies. Following a positive pilot trial, the SPYRAL HTN-OFF MED (SPYRAL Pivotal) trial was designed to assess the efficacy of renal denervation in the absence of antihypertensive medications. METHODS: In this international, prospective, single-blinded, sham-controlled trial, done at 44 study sites in Australia, Austria, Canada, Germany, Greece, Ireland, Japan, the UK, and the USA, hypertensive patients with office systolic blood pressure of 150 mm Hg to less than 180 mm Hg were randomly assigned 1:1 to either a renal denervation or sham procedure. The primary efficacy endpoint was baseline-adjusted change in 24-h systolic blood pressure and the secondary efficacy endpoint was baseline-adjusted change in office systolic blood pressure from baseline to 3 months after the procedure. We used a Bayesian design with an informative prior, so the primary analysis combines evidence from the pilot and Pivotal trials. The primary efficacy and safety analyses were done in the intention-to-treat population. This trial is registered at ClinicalTrials.gov, NCT02439749. FINDINGS: From June 25, 2015, to Oct 15, 2019, 331 patients were randomly assigned to either renal denervation (n=166) or a sham procedure (n=165). The primary and secondary efficacy endpoints were met, with posterior probability of superiority more than 0·999 for both. The treatment difference between the two groups for 24-h systolic blood pressure was -3·9 mm Hg (Bayesian 95% credible interval -6·2 to -1·6) and for office systolic blood pressure the difference was -6·5 mm Hg (-9·6 to -3·5). No major device-related or procedural-related safety events occurred up to 3 months. INTERPRETATION: SPYRAL Pivotal showed the superiority of catheter-based renal denervation compared with a sham procedure to safely lower blood pressure in the absence of antihypertensive medications. FUNDING: Medtronic.


Assuntos
Hipertensão/cirurgia , Rim/inervação , Rim/cirurgia , Adulto , Anti-Hipertensivos/normas , Austrália/epidemiologia , Áustria/epidemiologia , Teorema de Bayes , Pressão Sanguínea/fisiologia , Canadá/epidemiologia , Feminino , Alemanha/epidemiologia , Grécia/epidemiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/etnologia , Irlanda/epidemiologia , Japão/epidemiologia , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Placebos/efeitos adversos , Estudos Prospectivos , Simpatectomia/métodos , Resultado do Tratamento , Reino Unido/epidemiologia , Estados Unidos/epidemiologia
15.
Transplant Proc ; 52(3): 722-730, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32143866

RESUMO

CONTEXT: Studies on the surgical outcome in living kidney donors mainly report perioperative complications with short follow-up. OBJECTIVE: The objectives of this study are to evaluate the long-term surgical outcome in living kidney donors and to identify donors with an increased risk for a complicated postoperative course. BASIC PROCEDURES: A prospectively collected database of 496 living kidney donors at the Department of General, Visceral, and Transplantation Surgery of the Ruprecht Karls University Heidelberg was retrospectively analyzed in a retrospective, observational single-center study. RESULTS: The median follow-up time was 37 months. The perioperative severe complication (Clavien-Dindo IIIb) rate was 2.8%, the early postoperative (PO) severe complication rate (1-3 months post operation) was 0.7%, and the late PO severe complication rate (> 3 months post operation) was 8.4%. In multivariate analyses, male sex was associated with higher overall perioperative complication rate (odds ratio [OR], 1.930; P = .005) as well as higher rate of late PO complications (OR, 2.243; P = .014). An increased body mass index was associated with a higher late and severe (Clavien-Dindo ≥ IIIb) PO complication rate (OR, 1.107; P = .009 and OR, 1.105; P = .008, respectively). CONCLUSIONS AND RELEVANCE: Long-term surgery-associated severe complications occur in 8.4% of kidney donors. Older age is associated with an increased operative time, greater intraoperative blood loss, and longer PO hospital stay. Male donors and donors with an increased body mass index have a higher risk for a complicated PO course after kidney donation. Within a shared decision-making process before living kidney donation, special awareness should be brought to these facts.


Assuntos
Transplante de Rim/métodos , Doadores Vivos , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Idoso , Índice de Massa Corporal , Feminino , Humanos , Rim/cirurgia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
17.
Can Assoc Radiol J ; 71(3): 352-361, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32166970

RESUMO

This review aims to examine the challenges facing radiologists interpreting trauma computed tomography (CT) images in this era of a changing approach to management of solid organ trauma. After reviewing the pearls and pitfalls of CT imaging protocols for detection of traumatic solid organ injuries, we describe the key changes in the 2018 American Association for the Surgery of Trauma Organ Injury Scales for liver, spleen, and kidney and their implications for management strategies. We then focus on the important imaging findings in observed in patients who undergo nonoperative management and patients who are imaged post damage control surgery.


Assuntos
Rim/lesões , Fígado/diagnóstico por imagem , Fígado/lesões , Baço/diagnóstico por imagem , Baço/lesões , Tomografia Computadorizada por Raios X/métodos , Humanos , Rim/diagnóstico por imagem , Rim/cirurgia , Fígado/cirurgia , Baço/cirurgia , Índices de Gravidade do Trauma
18.
Medicine (Baltimore) ; 99(10): e19403, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150088

RESUMO

BACKGROUND: Shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and minimally invasive PCNL are currently therapeutic options for lower-pole renal stones (LPS). However, the optimal treatment for LPS remains unclear. A comprehensive evaluation of the efficacy and safety of each intervention is needed to inform clinical decision-making. This study aimed at assessing the efficacy and safety of different interventions for LPS. METHODS: PubMed, Embase, ScienceDirect, ClinicalKey, Cochrane Library, ProQuest, Web of Science, and ClinicalTrials.gov were searched from inception to December 6th 2018. Only randomized controlled trials (RCTs) including the patients treated for LPS were included. The frequentist models of network meta-analysis were used to compare the effect sizes. The primary outcome was stone free rate, and the secondary outcomes were overall complication rate, major complication rate, retreatment rate, and auxiliary procedure rate. RESULTS: This study included 13 RCTs comprising 1832 participants undergoing 6 different interventions, including RIRS, PCNL, Mini-PCNL, Micro-PCNL, SWL, and conservative observation. PCNL had the best stone free rate (odds ratio [OR] = 3.45, 95% confidence interval [CI] = 1.30-9.12), followed by Mini-PCNL (OR = 2.90, 95% CI = 1.13-7.46). Meta-regression did not find any association of the treatment effect with age, sex, and stone size. Although PCNL tended to exhibit a higher complication rate, the difference of complication rate among various interventions did not achieve a statistical significance. SWL was the less effective and associated with higher retreatment rate compared with PCNL, Mini-PNCL, and RIRS. CONCLUSIONS: PCNL was associated with the best stone free rate for LPS regardless of age, sex, and stone size. Each treatment achieved a similar complication rate compared with the others. Future large-scale RCTs are warranted to identify the most beneficial management for renal stones at a more complicated location.


Assuntos
Cálculos Renais/cirurgia , Rim/cirurgia , Litotripsia , Nefrolitotomia Percutânea , Humanos , Litotripsia/efeitos adversos , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Metanálise em Rede , Complicações Pós-Operatórias , Reoperação
19.
Curr Urol Rep ; 21(1): 5, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32006250

RESUMO

PURPOSE OF THE REVIEW: To update the most relevant literature regarding complex vascular cases in kidney transplant setting involving the graft, especially during the harvesting procedure and back-table preparation from the subsequent implant. RECENT FINDINGS: Challenging situations affecting the kidney graft such as multiple vessels, renal artery aneurysms, kidney anatomical anomalies, or major injuries do not contraindicate the transplant, but require an exhaustive graft viability assessment and several bench surgery techniques. Graft vessel conditioning in the back-table might include simple anastomosis between them, enlarging with venous patch or reconstruction with donor or synthetic grafts. Compared with conventional transplant, literature reports longer warm ischemia time (40 vs 32 min) and slightly increased rates of delayed graft function (10.3% vs 8.2%) and vascular complications (10.8% vs 8.1%), but similar graft and patient survival. Kidney graft vascular complex cases require exhaustive assessment, meticulous harvesting, good surgical technique in the bench table, and proper surgery in the recipient. Despite its complexity, vascular complex kidney transplant offers comparable outcomes in the long term to conventional population when technically well performed, with slightly increased rates of vascular complications and delayed graft function.


Assuntos
Doenças Cardiovasculares/cirurgia , Transplante de Rim/métodos , Rim/cirurgia , Coleta de Tecidos e Órgãos/métodos , Transplantes/irrigação sanguínea , Aneurisma/cirurgia , Função Retardada do Enxerto , Sobrevivência de Enxerto , Humanos , Rim/anormalidades , Rim/irrigação sanguínea , Nefropatias/cirurgia , Falência Renal Crônica/cirurgia , Artéria Renal/cirurgia , Transplantes/anormalidades , Transplantes/cirurgia , Doenças Vasculares/cirurgia , Malformações Vasculares/cirurgia , Lesões do Sistema Vascular/cirurgia , Isquemia Quente
20.
Curr Urol Rep ; 21(1): 7, 2020 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-32020365

RESUMO

PURPOSE OF REVIEW: To update the most relevant literature regarding complex cases during kidney transplant setting that recipient presents by himself, especially during implantation surgery due to vascular diseases and/or urinary tract anomalies. RECENT FINDINGS: Increasing age of donors and recipients is leading to an increased complexity of kidney transplant implantation surgery. In addition, the high peripheral vascular disease prevalence worldwide increases difficulty of surgery and decreases long-term outcomes as well. Moreover, it also increases transplant morbidity and mortality, both overall and cardiovascular, and finally clearly decreases graft survival. However, dialysis alternative has even worse outcomes in terms of mortality, with a proportional risk of death 2.66 higher compared with transplanted patients. Aorto-iliac prosthesis and 3rd and 4th transplants in occupied iliac fossae do also represent a challenging situation with a clearly increased morbidity and mortality. In some of those particular conditions, orthotopic kidney transplant technique is an alternative with good functional and survival outcomes, but not exempt of complications. Kidney transplant in vascular complex recipients has worse outcomes compared with conventional non-risky population. It remains a challenging surgical and medical procedure with higher morbidity and mortality, and decreased graft survival. However, dialysis mortality is still even greater and a transplant attempt might be justified. Orthotopic kidney transplant technique might play a role in selected patients with aorto-iliac unworkable segments or even in patients with special urinary tract conditions.


Assuntos
Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Anormalidades Urogenitais/cirurgia , Doenças Vasculares/cirurgia , Malformações Vasculares/cirurgia , Lesões do Sistema Vascular/cirurgia , Anastomose Cirúrgica/efeitos adversos , Humanos , Doença Iatrogênica , Complicações Intraoperatórias/terapia , Rim/irrigação sanguínea , Rim/cirurgia , Falência Renal Crônica/complicações , Transplante de Rim/efeitos adversos , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/cirurgia , Reoperação , Transplantes/irrigação sanguínea , Transplantes/cirurgia , Resultado do Tratamento , Doenças Vasculares/complicações , Malformações Vasculares/complicações
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