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BACKGROUND: Renal function after left renal vein (LRV) ligation following en bloc resection of segmental inferior vena cava (IVC) and right kidney is understudied. We assessed the impact of LRV ligation on postoperative renal function following en bloc resection of segmental IVC and right kidney. METHODS: We retrospectively reviewed 28 patients who underwent LRV ligation during en bloc resection of segmental IVC and right kidney. Patient demographics, tumor characteristics, intraoperative factors, complications, length of hospital and intensive care unit (ICU) stay, and patient survival were collected. Pre- and postoperative renal function was retrospectively analyzed. RESULTS: Twenty patients underwent robot-assisted surgery and eight patients underwent open surgery. The median operative time was 162 min and estimated blood loss was 350 mL. Ten patients had normal renal function and 12 patients had an initial increase in creatinine but improved gradually. Six patients developed acute renal failure; five patients gradually recovered in 5-32 days after temporary hemodialysis. Renal replacement therapy significantly correlated with maximal anterior-posterior diameter of the LRV (p = 0.001). Complications were observed in 11 cases, four of which were Clavien-Dindo grades I-II. Thirteen patients were alive with no recurrence, nine patients were alive with metastasis, and six cases died during the follow-up period. CONCLUSIONS: LRV ligation following en bloc resection of segmental IVC and right kidney is feasible, with no significant long-term impact on renal function. The maximum anterior-posterior diameter of the LRV is a reliable method for predicting renal replacement therapy in the absence of collateral circulation.
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Neoplasias Renais , Veias Renais , Veia Cava Inferior , Humanos , Veia Cava Inferior/cirurgia , Veia Cava Inferior/patologia , Masculino , Feminino , Veias Renais/cirurgia , Estudos Retrospectivos , Pessoa de Meia-Idade , Ligadura , Neoplasias Renais/cirurgia , Neoplasias Renais/patologia , Idoso , Seguimentos , Adulto , Taxa de Sobrevida , Nefrectomia/métodos , Complicações Pós-Operatórias , Prognóstico , Rim/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Testes de Função Renal , Carcinoma de Células Renais/cirurgia , Carcinoma de Células Renais/patologiaRESUMO
Renin-secreting tumours are rare causes of secondary hypertension and hypokalaemia. They are usually surgically curable, hence proper diagnostic work-up and tumour localisation is essential. In this paper, we present three Swedish patients recently diagnosed with renin secreting tumours, two with reninomas and one with an extrarenal renin-producing tumour, to illustrate diagnostic challenges. We also discuss the biochemical work-up, the pros and cons of different imaging techniques (computer tomography [CT], magnetic resonance imaging and [18F]fluorodeoxyglucose-positron emission tomography-CT), as well as how renal vein sampling (RVC) may contribute to localisation of the tumour.
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Renina , Humanos , Renina/sangue , Renina/metabolismo , Feminino , Pessoa de Meia-Idade , Masculino , Adulto , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias Renais/diagnóstico , Neoplasias Renais/metabolismoRESUMO
BACKGROUND: Short harvested right renal veins (RV) are quite common in living donor kidney transplantation (KT). This technical difficulty might interfere implanting and increase warm ischemic time. Several techniques to overcome this problem have been applied, including iliac vein transposition, inverted transplant, synthetic graft, saphenous vein Application of accompanying gonadal vein (GV), which is easily approachable and less time-consuming, has been recently published. This study aims to evaluate its effectiveness and safety. METHODS: Retrospective study on KT using the gonadal vein to lengthen the short right renal vein at Viet Duc University Hospital from April 2019 to April 2022. The following data were gathered: baseline characteristics, vascular imaging in CT scan/after nephrectomy and after reconstruction (mm), reconstruction and surgical time, hospitalization days. The outcomes were determined by kidney function after transplantation (plasma creatinine, creatinine clearance) and related complications. RESULTS: Twenty-five cases with procured right kidney with short RV from the living donor which were reconstructed and lengthened by the accompanying GV were collected. The additional length of RV was 15.9 ± 2.4 mm. Average cold ischemic time, venoplasty time, warm ischemic time were 60.4 ± 8.2, 21.2 ± 5.3, and 38.1 ± 5.6 min, respectively. The average hospital stay was 15.3 ± 3.2 days. Average follow-up time was 31 ± 5.2 months, creatinine clearance was around 60 ml/min after 1 year, no vascular or urologic complications was observed. CONCLUSION: Accompanying GV from a living donor to lengthen short right RV in KT is a feasible, safe, and effective technique.
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Transplante de Rim , Doadores Vivos , Veias Renais , Humanos , Transplante de Rim/métodos , Estudos Retrospectivos , Masculino , Feminino , Adulto , Veias Renais/cirurgia , Pessoa de Meia-Idade , Resultado do Tratamento , Coleta de Tecidos e Órgãos/métodos , Veias , Nefrectomia/métodosRESUMO
CASE: A 33-year-old man with previously diagnosed lupus membranous nephropathy presented with painful swelling in both legs. Laboratory tests revealed acute kidney injury, and imaging studies by duplex ultrasound and computed tomography scan showed acute thrombosis of both renal veins, the infrahepatic inferior vena cava, and both iliofemoral venous segments. Initially, pharmacomechanical thrombolysis led to an insufficient morphological result. The therapeutic breakthrough was achieved by catheter-based mechanical thrombectomy of the infrarenal vena cava and both renal veins, which successfully cleared all affected venous segments from thrombus, paralleled by improvement of the patient's condition. However, after 1 week, the patient experienced recurrent thrombosis of the right renal vein with hemorrhagic infarction of the right kidney. After further optimization of immunomodulatory and antithrombotic therapy, a repeated catheter-based mechanical thrombectomy resulted in sustained clinical improvement and preservation of renal venous drainage and kidney function. CONCLUSION: Extensive acute thrombosis of both renal veins, the inferior vena cava, and both iliofemoral venous segments is a rare emergency potentially threatening kidney function. Immediate effective thrombus removal is essential to preserve kidney function and can be achieved by catheter-based mechanical thrombectomy embedded in a comprehensive immunomodulatory and antithrombotic therapeutic concept. CLINICAL IMPACT: This case demonstrated the efficacy of a catheter-based therapeutic approach in patients with extensive thrombosis of the venous system. A catheter-based approach must be embedded in a comprehensive medical therapeutic concept, which is essential to achieve a sustainable result.
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BACKGROUND: Nutcracker syndrome (NCS) describes a set of symptoms and signs resulting from compression of the left renal vein (LRV). There is a lack of knowledge about its natural course, diagnosis, and management, especially in children. Herein, we present our single-center experience with a large number of patients who have long-term follow-up results. METHODS: All patients with NCS diagnosed between January 2011 and March 2021 were included and their data were obtained retrospectively. RESULTS: A total of 123 NCS patients (85 females) were included. The median age at the time of diagnosis was 12 (IQR 10-14) years, and BMI percentiles were below 5% in 38% of the cases. At the time of diagnosis, two-thirds of the patients were asymptomatic. The most common laboratory finding was nephritic proteinuria (98%), followed by microscopic hematuria (16%). Signs of LRV compression were significantly more evident in upright position Doppler ultrasonography (DUS) examination. All patients have been followed conservatively; hematuria and/or proteinuria resolved in 43 of the 108 patients (40%) within 35.8 ± 25.8 months of follow-up. Control DUS was performed in 52 patients after a mean period of 39.1 ± 21.3 months. The median peak velocity and diameter ratios of the LRV in the upright position were found to be decreased significantly when compared to the initial assessment (p < 0.05). Normal DUS findings were noted in 13 patients at the final evaluation. CONCLUSIONS: In unexplained proteinuria and/or hematuria, NCS should be considered, especially in asthenic adolescents. Our results support conservative management in children as the first-line treatment approach.
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Hematúria , Síndrome do Quebra-Nozes , Feminino , Adolescente , Humanos , Criança , Seguimentos , Hematúria/diagnóstico , Hematúria/etiologia , Estudos Retrospectivos , Ultrassonografia , Síndrome do Quebra-Nozes/diagnóstico , Síndrome do Quebra-Nozes/diagnóstico por imagem , Veias Renais/diagnóstico por imagem , Proteinúria/diagnóstico , Proteinúria/etiologia , Proteinúria/terapiaRESUMO
The recently discovered selective glomerular hypofiltration syndromes have increased interest in the actual elimination of molecules in the human kidney. In the present study, a novel human model was introduced to directly measure the single-pass renal elimination of molecules of increasing size. Plasma concentrations of urea, creatinine, C-peptide, insulin, pro-BNP, ß2-microglobulin, cystatin C, troponin-T, orosomucoid, albumin, and IgG were analysed in arterial and renal venous blood from 45 patients undergoing Transcatheter Aortic Valve Implantation (TAVI). The renal elimination ratio (RER) was calculated as the arteriovenous concentration difference divided by the arterial concentration. Estimated glomerular filtration rate (eGFR) was calculated by the CKD-EPI equations for both creatinine and cystatin C. Creatinine (0.11 kDa) showed the highest RER (21.0 ± 6.3%). With increasing molecular size, the RER gradually decreased, where the RER of cystatin C (13 kDa) was 14.4 ± 5.3% and troponin-T (36 kDa) was 11.3 ± 4.6%. The renal elimination threshold was found between 36 and 44 kDa as the RER of orosomucoid (44 kDa) was -0.2 ± 4.7%. The RER of creatinine and cystatin C showed a significant and moderate positive linear relationship with eGFR (r = 0.48 and 0.40). In conclusion, a novel human model was employed to demonstrate a decline in renal elimination with increasing molecular size. Moreover, RERs of creatinine and cystatin C were found to correlate with eGFR, suggesting the potential of this model to study selective glomerular hypofiltration syndromes.
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Creatinina , Cistatina C , Taxa de Filtração Glomerular , Rim , Humanos , Cistatina C/sangue , Masculino , Creatinina/sangue , Feminino , Idoso , Rim/metabolismo , Idoso de 80 Anos ou mais , Troponina T/sangue , Microglobulina beta-2/sangue , Ureia/sangue , Peptídeo Natriurético Encefálico/sangue , Peptídeo C/sangue , Insulina/sangue , Modelos Biológicos , Imunoglobulina G/sangueRESUMO
Albeit rare, renal vein abnormalities on autopsy and in cases of abdominal surgery complications have been reported and should be kept in mind when performing invasive procedures, such as renal biopsy. We detected a rare renal vein abnormality on colour Doppler ultrasound before renal biopsy, thereby, avoiding a haemorrhagic complication. A 10-year-old boy presented to our department for the first time because of incidental findings of haematuria and proteinuria. We suspected chronic glomerulonephritis and scheduled an ultrasound-guided percutaneous renal biopsy. A simple screening ultrasound at the initial visit revealed no renal or vascular abnormalities. The day before the renal biopsy, we confirmed the biopsy site by performing a colour Doppler ultrasound, which showed abnormal blood flow from the lower pole of the left kidney, which was the planned puncture site; therefore, we changed the biopsy site to the right and completed the examination. Subsequent computed tomography angiography depicted two renal veins; one was the usual left renal vein draining from the kidney hilum, and the second was an accessory vein draining from the inferior pole of the left kidney and entering the inferior vena cava through the dorsal side of the aorta. Although rare, abnormalities in the renal vessels on the inferior pole of the kidney, which is the usual site of renal biopsy, are essential to rule out preoperatively by colour Doppler ultrasound, because these can cause significant bleeding during renal biopsy if not recognized.
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Veias Renais , Ultrassonografia Doppler em Cores , Humanos , Masculino , Veias Renais/diagnóstico por imagem , Veias Renais/patologia , Criança , Rim/patologia , Rim/irrigação sanguínea , Rim/diagnóstico por imagem , Valor Preditivo dos Testes , Angiografia por Tomografia Computadorizada , Hemorragia/etiologia , Hemorragia/prevenção & controle , Cuidados Pré-Operatórios/métodos , Biópsia/efeitos adversos , Biópsia/métodosRESUMO
PURPOSE: In the modern era of robotic renal procedures and diagnostics, an even more detailed anatomical understanding than hitherto is necessary. Valves of the renal veins (RVV) have been underemphasized and have been disputed by some authors, and few textbooks describe them. The current anatomical study was performed to address such shortcomings in the literature. METHODS: One hundred renal veins were studied in fifty adult formalin-fixed cadavers. Renal veins were removed from the abdomen after sectioning them flush with their entrance to the renal hilum. The inferior vena cava was then incised longitudinally and opened, and RVV were examined grossly and histologically. A classification scheme was developed and applied to our findings. RESULTS: Nineteen RVVs were observed in the fifty cadavers (38%). Four (8%) valves were found on right sides and fifteen (30%) on left sides. The valves were seen as cord/band-like, folds, and single and double leaflets. Histologically, they were all extensions of the tunica intima. CONCLUSION: On the basis of our study, RVV are not uncommon. They were more common on left sides, and on both sides, they were found within approximately one centimeter of the junction of the inferior vena cava and renal vein. Although the function of such valves cannot be inferred from this anatomical study, the structures of the Single leaflet valve (TS2) and Double leaflet valve (TS3) valves suggest they could prevent venous reflux from the IVC into the kidney.
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Veias Renais , Veia Cava Inferior , Adulto , Humanos , Prevalência , Abdome , CadáverRESUMO
The renal vein is an exceptional location for leiomyosarcoma, an aggressive malignant tumor of smooth-muscle origin with a poor prognosis. We report the case of a 55-year-old female patient who consulted for left flank pain that had been present for 6 months. A CT scan revealed a 9.4cm left retroperitoneal mass in contact with the psoas muscle, left kidney, stomach, spleen, left colon and extending up to the pancreas, raising the suspicion of a tumour originating in the retroperitoneal tissues. A biopsy revealed a smooth-muscle cell tumour with a degree of malignancy difficult to define. The patient underwent a monobloc left compartmentectomy, which led to the diagnosis of leiomyosarcoma of the left renal vein. A review of the literature on these rare tumours in this location is presented.
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Neoplasias Renais , Leiomiossarcoma , Feminino , Humanos , Pessoa de Meia-Idade , Veias Renais/patologia , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/cirurgia , Leiomiossarcoma/patologia , Tomografia Computadorizada por Raios X , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Neoplasias Renais/patologiaRESUMO
We present two cases of multiple anatomical variations of the renal and gonadal vessels. The first case presented duplication of the renal vein and the presence of an accessory renal artery. However, the most interesting fact, in this case, was that the right gonadal vein emptied into the inferior right renal vein instead of ending in the inferior vena cava as would typically be the case. In the second case, we also found an accessory renal artery and the right gonadal vein emptied at the exact junction between the right renal vein and the inferior vena cava. Clinicians and surgeons should be familiar with anatomical variations to provide an accurate diagnosis during preoperative studies and to avoid surprises in abdominal surgical procedures.
Este estudo apresenta dois casos de variação anatômica múltipla de vasos renais e gonadais. O primeiro caso apresentou uma duplicação da veia renal e a presença de uma artéria renal acessória. Porém, o fato mais interessante nesse caso foi a veia gonadal direita desembocar na veia renal direita inferior em vez de terminar na veia cava inferior, como seria o normal. No segundo caso, além de também encontrarmos uma artéria renal acessória, a veia gonadal direita desembocava no exato ponto de junção entre a veia renal direita e a veia cava inferior. Clínicos e cirurgiões devem estar familiarizados com a presença de possíveis variações dos vasos renais e gonadais, sendo um conhecimento imprescindível para obter um diagnóstico mais preciso e para evitar surpresas em procedimentos cirúrgicos abdominais.
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Knowledge of the anatomical variations of the visceral branches of the abdominal aorta is important information for planning any surgeries in the region. We present here a rare constellation of variations of visceral vessels around the kidneys with a brief review of the recent literature. On the right side, an accessory renal artery was observed originating just distal to the main renal artery. The middle suprarenal artery was absent on the right side and there were two inferior suprarenal arteries originating from a branch of the main right renal artery. On the left side, the testicular artery had an arched course anterior to the left renal vein mimicking an unusual variety of nutcracker phenomenon. The right kidney was drained by two renal veins into the inferior vena cava. Knowledge of the coexistence of such complex anatomical variations might be helpful for clinicians during diagnostic and therapeutic procedures.
O conhecimento das variações anatômicas dos ramos viscerais da aorta abdominal é uma informação importante para o planejamento de qualquer cirurgia nessa região. Neste relato, apresentamos um raro conjunto de variações de vasos viscerais ao redor dos rins, bem como uma breve revisão da literatura recente. No lado direito, foi observada uma artéria renal acessória originando-se distal à artéria renal principal. Não havia artéria suprarrenal média no lado direito, e havia duas artérias suprarrenais inferiores originando-se de um ramo da artéria renal direita. No lado esquerdo, a artéria testicular apresentava um curso arqueado anterior à veia renal esquerda, simulando uma variedade incomum do fenômeno do quebra-nozes. O rim direito era drenado por duas veias renais para a veia cava inferior. O conhecimento da coexistência de tais variações anatômicas complexas pode ser útil para os clínicos durante os procedimentos diagnósticos e terapêuticos.
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BACKGROUND: Renal vein stenosis is uncommon following transplantation. We report acute renal vein stenosis post-transplant treated with an endovascular stent and complicated by urinary obstruction from clot formation. METHODS: Retrospective case report. RESULTS: A 16-year-old female 3 years post-transplant suffered anuria post-stenting with renal ultrasound demonstrating obstructive clot in the collecting system, a previously unreported complication. Subsequent nephroureteral JJ stent placement resulted in high-volume urine output. CONCLUSION: This article underscores the high index of suspicion required for renal vein stenosis following transplantation and the need to monitor urine output closely following stent placement.
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BACKGROUND: Neonatal renal vein thrombosis (NRVT) is a rare condition with little data available. METHODS: We retrospectively analyzed newborns diagnosed with NRVT admitted to 3 pediatric nephrology units in Paris from 2005 to 2020. RESULTS: Twenty-seven patients were analyzed (male = 59%). The median age at diagnosis was 2.5 days (1 - 4.5). Diagnosis was suspected based on at least one of the three cardinal signs of renal vein thrombosis in 93%: flank mass (67%), hematuria (67%) and thrombocytopenia (70%). In all patients, diagnosis was confirmed by ultrasound. All patients had at least one known perinatal risk factor. A prothrombotic risk factor was found in 13 patients (48%). NRVT was unilateral in 70%, involving the left renal vein in 58%. Among 25 treated patients, 19 (76%) received low molecular weight heparin (LMWH) as initial therapy, 2 (8%) received unfractionated heparin and 4 (16%) received fibrinolysis. Median duration of treatment was 8 weeks (4 - 12). Bleeding occurred significantly more often with fibrinolysis than with LMWH/supportive therapy (3 of 4: 75% vs 0 of 4: 0%, p = 0.05). Clot resolution in patients treated with fibrinolysis did not differ significantly from those treated with LMWH/supportive therapy. After a median follow-up of 5.7 years (3 years - 9.9 years), pathological kidney features were observed in 73% of the patients (19 of 26), kidney atrophy in 18 (69%), hypertension in 2 (8%), chronic kidney disease (CKD) in 1 (4%) and proteinuria in 2 (8%). CONCLUSIONS: NRVT remains a challenging condition, which still requires further study because of its associated morbidity. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Nefropatias , Trombose , Trombose Venosa , Criança , Recém-Nascido , Humanos , Masculino , Heparina/efeitos adversos , Heparina de Baixo Peso Molecular/uso terapêutico , Heparina de Baixo Peso Molecular/efeitos adversos , Veias Renais/diagnóstico por imagem , Seguimentos , Estudos Retrospectivos , Trombose Venosa/diagnóstico , Trombose Venosa/tratamento farmacológico , Anticoagulantes , Trombose/etiologia , Nefropatias/complicações , Rim/diagnóstico por imagemRESUMO
BACKGROUND: Pheochromocytoma is a neuroendocrine tumor, and its treatment is dependent on surgical resection. Due to the wide availability of cross-sectional imaging, pheochromocytomas are commonly seen as small tumors less than 10 cm in size and are mostly treated with minimally invasive surgery. Their concomitant presence with horseshoe kidney or other anatomical and vascular anomalies is rare. Herein, we present a surgically complex giant pheochromocytoma case who underwent an open left radical adrenalectomy. CASE PRESENTATION: A 41-year-old Hispanic female presented with a 12 × 8 cm left hypervascular adrenal mass, pelvic horseshoe kidney, and severely dilated large left retro-aortic renal vein which branched into a left adrenal vein, congested left ovarian vein, and left uterine plexus. She was managed with insulin and metformin for uncontrolled diabetes with an A1c level of 9% and doxazosin for persistent hypertension. Clinical diagnosis of pheochromocytoma was confirmed with elevated urine and serum metanephrine and normetanephrine. The pre-operative ACTH was within normal range with a normal dexamethasone suppression test and 24-hour urine free cortisol. The adrenalectomy of the highly aggressive adrenal mass was performed via open approach to obtain adequate surgical exposure. Due to the large size of the tumor and its significant involvement with multiple adjacent structures, coordination with multiple surgical teams and close hemodynamic monitoring by anesthesiology was required for successful patient outcomes including preservation of blood supply to the pelvic horseshoe kidney. The histopathological diagnosis was pheochromocytoma with negative surgical margins. The patient was followed at 1, 4, 12, and 24 weeks postoperatively. She had a normal postoperative eGFR and was able to discontinue antihypertensive and antidiabetic medications at four weeks. She had transient adrenal insufficiency, which resolved at five months. The horseshoe kidney was intact except for a minimal area of hypo-enhancement in the left superior renal moiety due to infarction, which was significantly improved at six months. CONCLUSION: Our patient had a giant pheochromocytoma with anatomical variations complicating an already surgically challenging procedure. Nonetheless, with multiple provider collaboration, detailed pre-operative surgical planning, and meticulous perioperative monitoring, radical resection of the giant pheochromocytoma was safe and feasible with successful postoperative outcomes.
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Neoplasias das Glândulas Suprarrenais , Rim Fundido , Feocromocitoma , Humanos , Feminino , Adulto , Feocromocitoma/complicações , Feocromocitoma/cirurgia , Feocromocitoma/diagnóstico , Rim Fundido/complicações , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/cirurgia , Neoplasias das Glândulas Suprarrenais/diagnóstico , Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodosRESUMO
BACKGROUND: Nutcracker syndrome (NCS) caused by left renal vein (LRV) entrapment, is one of the most common causes of orthostatic proteinuria. In stereotype, orthostatic proteinuria is often accompanied by left renal vein obstruction and is found in young and underweight individuals. Here, we report a rare case with orthostatic proteinuria in an old obese female caused by a rare type of congenital inferior vena cava (IVC) interruption. CASE PRESENTATION: A 65-year-old obese woman, who suffered from fluctuated proteinuria, had been misdiagnosed as chronic glomerulitis for 30 years. Instead of having any sign of NCS, she had a unique type of IVC interruption. Most venous blood from infrarenal IVC and right kidney drained into her LRV, and then through the expanded communicating vessel, drained into the left ascending lumbar vein which extended as hemiazygos vein. To the best of our knowledge, this is one of the first cases reported of orthostatic proteinuria attributed to the subsequent hemodynamic irregularity caused by IVC interruption without nutcracker phenomenon. CONCLUSION: Adult-onset orthostatic proteinuria is relatively rare, hard to be recognized and could be misdiagnosed as chronic glomerulonephritis. The case provided a novel differential diagnostic condition for those who suffered from fluctuated proteinuria of unknown causes.
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Veias Renais , Veia Cava Inferior , Humanos , Adulto , Feminino , Idoso , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/anormalidades , Veias Renais/anormalidades , Rim , Proteinúria/etiologiaRESUMO
Left renal vein stenting is a preferable therapeutic option for patients with nutcracker syndrome (NS). As a potential complication of stent implantation, stent migration from the original placement to the right ventricle is relatively rare but can seriously threaten the patient's life. Endovascular stent retrieval is the most beneficial procedure for coping with this fatal complication. In this report, we aimed to describe an effective but relatively feasible endovascular approach using the combination of a goose neck snare and a large bore sheath for the retrieval of a stent dislodged in the right ventricle.
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Procedimentos Endovasculares , Migração de Corpo Estranho , Humanos , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Stents/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Veias RenaisRESUMO
Extrasplanchnic venous thrombosis is a rare complication of chronic pancreatitis. Thrombosis of inferior vena cava and renal vein, in particular, is extremely rare. We present our recent experience of managing two patients of chronic pancreatitis who presented with renal vein thrombosis. We also highlight the treatment dilemmas facing a clinician managing patients with this atypical and rare vascular complication.
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PURPOSE: To report a rare case of acute renal vein thrombosis (RVT) that was treated with endovascular thrombectomy and lysis, and discuss potential etiology and indications for catheter-directed management. CASE REPORT: A 21-year-old female athlete presented with sudden pain in her left flank and vomiting. A 3-phase computed tomography (CT) angiogram identified total occlusion of the left renal vein with no excretion from the swollen tender left kidney. Catheter-directed thrombolysis and thrombectomy were initiated 24 hours after onset of symptoms. Complete resolution of the RVT with normalized renal function was achieved. Post-operative Doppler ultrasound scan confirmed normal renal resistance and flow in the renal vein. The patient was discharged on Apixaban and remains well at 6 months. Combined hormonal contraception via an intra-vaginal ring and raised Factor VIII activity were the only identified risk factors. CONCLUSION: Acute complete RVT with impaired kidney function is rare. Combined hormonal contraception and increased Factor VIII activity were potential risk factors. Endovascular thrombectomy and lysis restored renal perfusion and function, and can be used effectively in the management of fit patients with acutely compromised kidney function from total renal vein obstruction.
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BACKGROUND: Fusobacterium nucleatum (F. nucleatum) is a resident anaerobic bacterium, which in rare cases may invade blood from the head and neck or the digestive tract to cause bacteremia and induce venous thrombosis. F. nucleatum is closely related to abdominal tumors, but it has not been reported in relation to renal tumors. We report herein a possible case. CASE PRESENTATION: This patient had kidney cancer with thrombosis in the right renal vein but had no sign of infection. After radical nephrectomy, thrombi formed in his left renal vein, and when removed, severe sepsis occurred. He did not respond to treatment with antibiotics and died, but the blood culture done confirmed that he had F. nucleatum bacteremia. CONCLUSION: F. nucleatum may also be associated with kidney cancer, and could cause post-operative renal vein thrombosis, and sepsis or septic shock after thrombectomy.
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Infecções por Fusobacterium , Sepse , Composição de Bases , Infecções por Fusobacterium/diagnóstico , Infecções por Fusobacterium/tratamento farmacológico , Fusobacterium nucleatum , Humanos , Masculino , Nefrectomia , Filogenia , RNA Ribossômico 16S , Sepse/complicações , Análise de Sequência de DNARESUMO
BACKGROUND: Multiple myeloma (MM) is a malignant neoplasm associated with kidney involvement in nearly half of the patients. Cast nephropathy, monoclonal immunoglobulin deposition disease (MIDD), and light chain (AL) amyloidosis are the most common monoclonal immunoglobulin-mediated causes of renal injury. Cardiac involvement is also present in MM, characterized by restrictive cardiomyopathy generated by light chain deposit or amyloid. Thromboembolic complications such as deep vein thrombosis or pulmonary embolism are also described. CASE PRESENTATION: We present an unusual multidisciplinary case of a woman with a newly diagnosed MM associated with severe proteinuria and high natriuretic peptide. A renal and fat pad biopsy with Congo red staining were performed but amyloid deposition was not discovered. While immunofluorescence on fresh frozen unfixed tissue was not contributory, the immunofluorescence on fixed tissue and electron microscopy revealed the correct diagnosis. During subsequent investigations, two intracardiac right-sided masses and massive pulmonary embolism were also detected. CONCLUSIONS: This case highlights that multiple organ involvement in patients with MM may result from a combination of paraprotein-dependent and -independent factors. Moreover, renal diseases induced by monoclonal gammopathies are a group of complex and heterogeneous disorders. Their subtle presentation and their potential multiorgan involvement require the expertise of a multidisciplinary team able to provide the most appropriate diagnostic and therapeutic assessment.