The candidate for renal transplantation work up: medical, urological and oncological evaluation.

UNLABELLED: Renal transplantation prolongs life, reduces morbidity, improves quality of life, and enables social rehabilitation of patients with end stage renal disease (ESRD). Kidney transplantation is a surgical procedure with inherent risks due to anesthesia and the surgical procedure itself. In ESRD patients medical background and comorbidities are crucial at the time of considering a renal transplant candidate because they can determine the procedure success OBJECTIVES: To update and review, according to recent literature, the evaluation of renal transplant candidates. METHODS: We performed a retrospective review of medical literature published in Medline/Pubmed about the most important facts of medical, urological and oncological evaluation of ESRD patients candidates to renal transplant. RESULTS: Pretransplant medical evaluation aims to diagnose, treat, and optimize any preexisting disease, and how these can interfere with patient and graft survival. It is important to consider age, cardiovascular disease, presence of diabetes mellitus, coagulation disorders, obesity, gastrointestinal diseases, ESRD situation and associated complications, active infection and non compliance with treatment and follow up. Urological requirements for successful renal transplantation are the absence of urinary infections, a compliant and continent reservoir, and a reliable method of achieving complete bladder evacuation. Certain urological diseases may not be obvious in the anuric patient. Pretransplant urological evaluation aims to diagnose, treat, and optimize any preexisting urological disease that can jeopardize transplant evolution. Cancer is a frequent and recognized complication of organ transplantation. The need of continuous immunosuppressive therapy may lead to immunosuppression-related side effects and direct oncogenic effects. Pre-existing malignancies should be extensively evaluated before proceeding to transplantation. Appropriate screening for malignancies is recommended in ESRD patients during routine pretransplant evaluation. CONCLUSION: This review highlights the importance of performing a comprehensive medical, urological and oncological assessment before transplantation. We will go through these mayor aspects of the evaluation of ESRD patients, how these might affect renal transplantation, which complementary test should be performed, and what are the latest recommendations for those situations. Careful pre-operative work-up of every transplant candidate is mandatory to improve post-transplant organ and patient survival. The workup should be tailored according to patients ' specific conditions, by a multidisciplinary approach before proceeding to transplantation.

Polycystosis of the renal sinus or polycystic kidney disease Controversies, challenges and history of a shared discovery. / Poliquistosis del seno renal o hilioquistosis. Controversias, retos e historia de un descubrimiento compartido.

OBJECTIVE: To recall the history of the discovery of non-nephron cystic disease, detected simultaneously in 2 hospitals in Madrid, and the vicissitudes that the authors endured during the process of recognising this disease, while being ignored by the international scientific literature. MATERIAL AND METHOD: We analysed the authors' first publications and presentations, their correspondence relaying the difficulties in reporting the confusion with adult polycystic kidney disease (APKD) and the subsequent nosological identification of the process. We consulted with individuals who worked with the 2 authors to increase the accuracy and objectivity of the history report. RESULTS: We confirmed the authors' remarkable efforts in getting the process definitively recognised despite the notable difficulties. CONCLUSIONS: Rigorous clinical observation recognises processes ignored by the medical literature, and the correct application of the scientific method helps identify and reveal new nosological entities, confirming with this story's example that, in medicine, there are no exhausted issues.

El debate del Bosniak 3 o 4 y la vigente nosología quística / The current nosology on renal cysts: Bosniak III or IV?

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Poliquistosis del seno renal o hilioquistosis. Controversias, retos e historia de un descubrimiento compartido / Polycystosis of the renal sinus or polycystic kidney disease Controversies, challenges and history of a shared discovery

Objetivo: Recordar la historia del descubrimiento de la enfermedad quística no nefronal, detectada simultáneamente en 2 hospitales madrileños y las vicisitudes que sufrieron los autores para que el proceso, ignorado en la literatura mundial, fuese reconocido. Material y método: Se han analizado las primeras publicaciones y presentaciones de los autores, la correspondencia entre ellos con el relato de las dificultades habidas para denunciar la confusión con la enfermedad renal poliquística del adulto y la posterior identificación nosológica del proceso. Se han consultado colaboradores de ambos autores para mayor precisión y objetividad del relato histórico. Resultados: Se confirma el notable esfuerzo de los autores hasta conseguir el definitivo reconocimiento del proceso a pesar de señaladas dificultades. Conclusiones: La observación clínica rigurosa reconoce procesos ignorados por la literatura médica y la correcta aplicación del método científico permite identificar o desvelar nuevas entidades nosológicas, confirmando con la ejemplaridad de este relato que en Medicina no hay temas agotados

Objective: To recall the history of the discovery of non-nephron cystic disease, detected simultaneously in 2 hospitals in Madrid, and the vicissitudes that the authors endured during the process of recognising this disease, while being ignored by the international scientific literature. Material and method: We analysed the authors’ first publications and presentations, their correspondence relaying the difficulties in reporting the confusion with adult polycystic kidney disease (APKD) and the subsequent nosological identification of the process. We consulted with individuals who worked with the 2 authors to increase the accuracy and objectivity of the history report. Results. We confirmed the authors' remarkable efforts in getting the process definitively recognised despite the notable difficulties. Conclusions: Rigorous clinical observation recognises processes ignored by the medical literature, and the correct application of the scientific method helps identify and reveal new nosological entities, confirming with this story's example that, in medicine, there are no exhausted issues

Fractura urotelial en la hidrodistension vesical por cistopatía interscial (IC) y síndrome de vejiga dolorosa (PBS) / Bladder urothelial fracture in interstitial cystitis hydrodistention (IC) and painful bladder syndrome (PBS)

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Estudio del candidato a trasplante renal: Evaluación médica, urológica y oncológica / The candidate for renal transplantation work up: medical, urological and oncological evaluation

El trasplante renal aumenta la supervivencia, reduce la morbilidad y mejora la calidad de vida del enfermo en insuficiencia renal crónica terminal (IRCT). Es un procedimiento quirúrgico con inherentes riesgos relacionados con la anestesia y la propia cirugía.Los antecedentes y enfermedades comórbidas del paciente con IRCT son muy importantes a la hora de considerarlo candidato a trasplante.OBJETIVOS: Revisar y actualizar, según la literatura reciente, la evaluación del paciente candidato a trasplante renal.MÉTODOS: Realizamos una revisión retrospectiva de la literatura publicada en Medline/Pubmed sobre los aspectos más importantes a tener en cuenta en la evaluación del candidato a trasplante renal en lo que se refiere a la situación médica, del aparato genitourinario y a posibles neoplasias concomitantes. RESULTADOS: La evaluación médica pretrasplante pretende poner de manifiesto los antecedentes clínicos del paciente así como estos pueden condicionar la evolución del enfermo e injerto una vez trasplantado. Se debe considerar la edad, la enfermedad cardiovascular, la existencia de diabetes mellitus, potenciales alteraciones de la coagulación, la obesidad, la presencia de patología en el tracto gastrointestinal, situación y complicaciones asociadas a su IRCT, una infección activa, la falta de compliance con el tratamiento y seguimiento(AU)

El aparato urinario deseable para cualquier candidato a trasplante debe ser estéril, de buena capacidad, compliance y con un mecanismo seguro de conseguir un correcto vaciado vesical. Algunas anomalías urológicas pueden pasar desapercibidas en el paciente anúrico. La evaluación prestrasplante del aparato urológico, pretende diagnosticar, tratar y optimizar cualquier patología urológica presente, así como detectar alteraciones anatómicas que pongan en riesgo el éxito de la cirugía.La patología neoplásica es una frecuente y reconocida complicación asociada al trasplante de órganos. El tratamiento inmunosupresor puede condicionar efectos secundarios directos así como un potencial efecto oncogénico. Los tumores prexistentes deben evaluarse concienzudamente antes de realizar el trasplante, así como la existencia de una neoplasia oculta.CONCLUSIÓN: En esta revisión destacamos la importancia de realizar una exhaustiva evaluación médica, urológica y oncológica antes del trasplante renal. Repasaremos los principales aspectos de la evaluación de los enfermos en IRCT, que pruebas diagnósticas se deben aplicar y cuáles son las últimas recomendaciones al respecto.Es imprescindible una evaluación cuidadosa de cada candidato a entrar en lista de espera para trasplante para mejorar la supervivencia de injerto y receptor. El estudio debe ser individualizado según la condición particular de cada paciente, a través de un abordaje multidisciplinar antes de proceder con el trasplante(AU)

Renal transplantation prolongs life, reduces morbidity, improves quality of life, and enables social rehabilitation of patients with end stage renal disease (ESRD). Kidney transplantation is a surgical procedure with inherent risks due to anesthesia and the surgical procedure itself.In ESRD patients medical background and comorbidities are crucial at the time of considering a renal transplant candidate because they can determine the procedure success.OBJECTIVES: To update and review, according to recent literature, the evaluation of renal transplant candidates.METHODS: We performed a retrospective review of medical literature published in Medline/Pubmed about the most important facts of medical, urological and oncological evaluation of ESRD patients candidates to renal transplant(AU)

RESULTS: Pretransplant medical evaluation aims to diagnose, treat, and optimize any preexisting disease, and how these can interfere with patient and graft survival. It is important to consider age, cardiovascular disease, presence of diabetes mellitus, coagulation disorders, obesity, gastrointestinal diseases, ESRD situation and associated complications, active infection and non compliance with treatment and follow up.Urological requirements for successful renal transplantation are the absence of urinary infections, a compliant and continent reservoir, and a reliable method of achieving complete bladder evacuation. Certain urological diseases may not be obvious in the anuric patient. Pretransplant urological evaluation aims to diagnose, treat, and optimize any preexisting urological disease that can jeopardize transplant evolution.Cancer is a frequent and recognized complication of organ transplantation. The need of continuous immunosuppressive therapy may lead to immunosuppression-related side effects and direct oncogenic effects. Pre-existing malignancies should be extensively evaluated before proceeding to transplantation. Appropriate screening for malignancies is recommended in ESRD patients during routine pretransplant evaluation.CONCLUSION: This review highlights the importance of performing a comprehensive medical, urological and oncological assessment before transplantation. We will go through these mayor aspects of the evaluation of ESRD patients, how these might affect renal transplantation, which complementary test should be performed, and what are the latest recommendations for those situations.Careful pre-operative work-up of every transplant candidate is mandatory to improve post-transplant organ and patient survival. The workup should be tailored according to patients` specific conditions, by a multidisciplinary approach before proceeding to transplantation(AU)