Background Of Chronic Kidney Disease Research Articles

Approaches to therapy Amlodipine/Indapamide/Perindopril therapy of high arterial hypertension in ischemic heart disease patients with chronic kidney disease stage 1-3 after coronary stenting

Introduction: Acute coronary syndrome, chronic forms of ischemic heart disease (IHD) and postinfarction cardiosclerosis are the main causes of morbidity and mortality in the world, including Russia. In the XXI century, there is an increase in comorbid pathology, especially in the combination of IHD with arterial hypertension, diabetes, chronic obstructive pulmonary disease and chronic kidney disease. Patients with IHD and chronic kidney disease have a higher incidence of coronary events and complications. The frequency of coronary events and complications indicates the need to improve the diagnosis and treatment of this group of patients. diagnosis and treatment of this group of patients. The aim of the study was to analyze the dynamics of vascular stiffness, pulmonary hypertension (PH), diastolic heart dysfunction and endothelial dysfunction indices in patients with different variants of ischemic heart disease combined with chronic kidney disease (CKD) stage 1-3 using complex therapy of combined hypotensive drug Amlodipine/Indapamide/Perindopril three months after coronary stenting and to compare them with the group of patients on conservative therapy only. Materials and Methods: 85 patients with different forms of IHD, arterial hypertension (AH) on the background of CKD 1-3 stages, as well as data of 42 patients with IHD, AH without renal pathology were analyzed. The first group – IHD, postinfarction cardiosclerosis, CKD stage 1-3 (33 patients); the second group – acute coronary syndrome with ST-segment elevation, Myocardial infarction (MI) (30 patients); the third group – ACS without ST-segment elevation, Unstable angina (UA) (22 patients). Results: The highest indices of vascular stiffness (Pulse wave velocity (PWV), Augmentation index (AI), CAVI, Central Systolic Blood Pressure (SBPao), central arterial pulse pressure (PP)) were registered in combination of ACS with ST-segment elevation and CKD 1-3 stages. These indices are markers of IHD progression in these patients; they also have increased pulmonary hypertension and diastolic dysfunction of the heart, endothelial dysfunction with vasodilation insufficiency in 88% of cases, which even without hemodynamically significant coronary artery stenoses according to coronary CT angiography data leads to the development of ACS with ST-segment elevation and ACS without ST-segment elevation with MI. Amlodipine/Indapamide/Perindopril was prescribed to all patients due to high arterial hypertension on admission against the background of basic therapy of IHD and coronary stenting. Coronary CT angiography in patients with comorbid renal pathology does not lead to aggravation of chronic kidney disease after 3 months, on the contrary; in this group of patients the most pronounced decrease of arterial stiffness (AS), AI, SBPao, PP with elevation of glomerular filtration rate (GFR) and decrease of creatinine in blood occurs in comparison with the group of patients who did not undergo coronary stenting, they were only on conservative therapy. Conclusion: Prescription of three component drug Amlodipine/Indapamide/Perindopril on the background of baseline therapy especially in combination with surgical vascularization of the heart is justified.

Сравнительный фармакоэкономический анализ применения эпоэтина альфа и роксадустата в сочетании с препаратами железа у взрослых пациентов с анемией на фоне хронической болезни почек в условиях системы здравоохранения Российской Федерации

Сравнительный фармакоэкономический анализ применения эпоэтина альфа и роксадустата в сочетании с препаратами железа у взрослых пациентов с анемией на фоне хронической болезни почек в условиях системы здравоохранения Российской Федерации

ОСОБЕННОСТИ ДИАГНОСТИКИ И ВЕДЕНИЯ ПАЦИЕНТКИ С СИНДРОМОМ ФРЕДЕРИКА (КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ)

Description of a clinical case. The article presents a clinical observation of a 77-year-old patient with newly diag-nosed Frederick’s syndrome, which is a combination of a permanent form of atrial fibrillation and complete atrioven-tricular block. An exacerbation of chronic pancreatitis was the reason for hospitalization of the patient. The patient had no complaints of bradycardia or syncope, but treatment of the underlying disease was difficult due to the development of acute kidney injury against the background of chronic kidney disease and uncompensated chronic heart failure. The cause of the development of Frederick’s syndrome was pronounced myocardium remodeling due to diseases that make up the classic complex of metabolic syndrome – coronary heart disease, arterial hypertension, type 2 dia-betes mellitus and obesity. Conclusion. The analysis of a few domestic and foreign literature sources showed that the development of Frederick’s syndrome is associated with a worsening prognosis and the development of various complications, which is usually underestimated by attending physicians. Taking into account the difficulties of diagnosis and management of patients with this pathology, it is necessary to be wary of the development of Frederick’s syndrome, especially in comorbid elderly and senile patients. Timely medical correction and referral of the patient for surgical treatment will improve the prognosis and reduce mortality in patients with atrial fibrillation.

DYNAMICS OF β2-MICROGLOBULIN CONTENT IN BLOOD AND URINE IN PATIENTS WITH KIDNEY DAMAGE WHO HAD CORONAVIRUS DISEASE

The purpose of the work – to study the content of beta-2-microglobulin in the bloodand urine of patients with kidney damage who suffered from coronavirus disease, and tointerpret the results.Material and methods. 95 patients with kidney damage who suffered from coronavirusdisease were examined. In all patients, the content of beta-2-microglobulin in blood andurine was examined by the immunoenzymatic method.The results. The most significant increase in the content of beta-2-microglobulin inboth blood and urine was noted in patients who contracted the coronavirus diseaseagainst the background of chronic kidney disease (CKD) of the III-IV stage, includingin patients undergoing hemodialysis. In patients with stage I-II CKD with pyelonephritisand glomerulonephritis, an increase in the level of beta-2-microglobulin only in theblood was observed. In CKD patients with type II diabetes, an increase in the content ofbeta-2-microglobulin in the blood and urine was noted even in the presence of CKD-II stage.Conclusions. The coronavirus disease has a negative effect on the course of chronickidney disease and accelerates its progression due to a significant acceleration of thedevelopment of renal (tubular) dysfunction. This is indicated by the increase in thecontent of beta-2-microglobulin in the blood and urine of patients who have suffered fromthe coronavirus disease. Patients with type II diabetes with kidney damage who haveexperienced coronavirus disease are a separate group at risk of rapid progression ofCKD. This method of monitoring the dynamics of beta-2-microglobulin content in bloodand urine can be used for early diagnosis of the progression of CKD in patients who havesuffered from the coronavirus disease.

STUDY OF THE QUALITY OF LIFE OF PATIENTS WITH HYPERPARATHYROIDISM ON THE BACKGROUND OF CHRONIC KIDNEY FAILURE

Introduction. The problem of secondary hyperparathyroidism (SHPT) and tertiary hyperparathyroidism (THPT) has drawn the attention of numerous researchers in many countries, including those where kidney transplantation is a routine procedure. The most acute aspects include determining the most effective methods of therapeutic treatment, diagnostic and prognostic criteria, indications for surgery, its scope, and methods of avoiding relapses.
 The aim. To study the quality of life of patients who underwent surgery for secondary and tertiary hyperparathyroidism on the background of chronic kidney disease.
 Materials and Methods. During the study, we conducted a survey of 60 patients with secondary and tertiary hyperparathyroidism who underwent surgery between 2020 and 2023. The surveys were conducted twice: before the surgical intervention and within a period of up to 9 months after it. Among those surveyed, there were 35 (58%) women and 25 (42%) men. The average age of the respondents was 51.31±9.16 years.
 Results and Discussion. Quality of life is one of the most important indicators of the effectiveness of treatment. We observed an improvement in the quality of life in all surveyed patients with Tertiary Hyperparathyroidism (THPT) after surgical treatment. From the physical component point of view, this effect is undoubtedly associated with a decrease in the level of PTH and ionized calcium in the blood. This is evidenced by the significant correlation between these indicators and the obtained values of physical functioning scales before and after the operation.
 Conclusions. A significant correlation was observed between the levels of parathyroid hormone, ionized calcium, and physical functioning scales before and after surgery.

Zero Contrast and Ultra-Low Contrast Percutaneous Coronary Intervention

Contrast-induced acute kidney injury (AKI) is a common complication following percutaneous coronary intervention (PCI) in patients with a background of chronic kidney disease (CKD). This complication can lead to short- and long-term dialysis requirements. There has been some interest in recent years in performing PCI in high-risk patients with minimal use of contrast to avoid this complication. We reviewed a case series of eight cases where ultra-low-contrast PCI was performed and a further case of zero-contrast PCI, which were primarily performed under the guidance of intravascular imaging. Pre- and post-renal functions were recorded, and clinical outcomes were measured based on the survival rate and the need for revascularisation in the culprit vessel. A step-by-step description of how to perform the procedure safely and effectively is provided. There were no procedural complications encountered in this cohort. The renal function remained stable 1 week after the procedure. The procedure was technically successful in all cases based on intravascular and angiographic measures. Patients were followed up for a minimum of 6 months and no adverse clinical events were recorded. A description of the procedural steps is provided based on current experience and review of the literature. Ultra-low-contrast PCI is feasible and safe in a carefully selected group of patients in centres with experience in the use of intravascular imaging.

The Conundrum of Thoracic Radiological Signs in Patients Having Chronic Kidney Disease (CKD) Who are on Haemodialysis

It is quite common in the practice of a pulmonologist to come across patients having pulmonary symptoms in the background of chronic kidney disease (CKD). This is also owing to the fact that advances in the medical field such as haemodialysis result in significant prolongation of survival in these terminally ill patients. However, this leads to emergence of a newer plethora of systemic manifestations which require further investigation and management.

A Case of Extensive Myocardial Calcification

Aortic valve and mitral annular calcification are commonly seen in elderly patients with chronic kidney disease and/ or altered calcium hemostasis. Extensive myocardial calcification is rare. We present a case of an elderly female who presented with sepsis and heart failure on a clinical background of chronic kidney disease and showed extensive myocardial calcification on multi-modality imaging, leading to severe impairment in systolic and diastolic function with restrictive physiology.
 Conclusion: Myocardial calcification is an under diagnosed entity that leads to considerable morbidity and mortality. Modern imaging methods allow a prompt diagnosis but a high index of suspicion has to be maintained for accurate detection of medical condition.

ОПЫТ ПРИМЕНЕНИЯ ДАСАБУВИРА / ОМБИТАСВИРА / ПАРИТАПРЕВИРА / РИТОНАВИРА У ПАЦИЕНТОВ, НАХОДЯЩИХСЯ НА ГЕМОДИАЛИЗЕ, С ВИРУСНОЙ ИНФЕКЦИЕЙ ГЕПАТИТА С

Abstract. Introduction. Hepatitis C virus is very common in patients on maintenance hemodialysis, resulting in high morbidity and mortality. Currently, new direct antiviral agents lead to a cure of Hepatitis C virus among most patients with a very good safety profile, which has allowed their use in the treatment of patients with Chronic Kidney Disease as well.Aim. To analyze the practical experience of using dasabuvir/ ombitasvir/ paritaprevir/ ritonavir in patients with chronic hepatitis C with history of chronic kidney disease. Material and methods. Treatment with dasabuvir/ ombitasvir/ paritaprevir/ ritonavir was carried out in 11 patients on hemodialysis with chronic hepatitis C. The virologic response was evaluated in 4 and 8 weeks at the end of the treatment, as well as sustained virologic response in 12 and 24 weeks after the start of treatment. Tolerability and safety of the drugs were also evaluated. Laboratory parameters and adverse reactions during treatment were analyzed.Results and discussion. Treatment using dasabuvir/ ombitasvir/ paritaprevir/ ritonavir was tolerated satisfactorily by all patients. There were no undesirable events. All patients completed the treatment cycle with a 100% rapid virologic response and 100% sustained virological response. No serious adverse reactions were registered. Upon follow-up, the hepatitis C virus was again detected in one patient, but of a different genotype.Conclusion. Treatment using dasabuvir/ ombitasvir/ paritaprevir/ ritonavir is effective for patients with chronic hepatitis C of the first genotype of the virus on the background of chronic kidney disease with program hemodialysis. Patients with chronic kidney disease are at high risk of infection and reinfection with parenteral viral hepatitis.

Immunotactoid glomerulopathy \u2013 an enigmatic case in the setting of nodal marginal zone lymphoma and systemic sclerosis sine scleroderma

BackgroundImmunotactoid Glomerulopathy (ITG) is an exceedingly rare type of glomerulopathy characterised by distinctive electron microscopic features. ITG has been linked to lymphoproliferative or autoimmune disorders. The clinical manifestations are diverse including nephrotic syndrome (NS), haematuria, acute kidney injury and end stage renal failure (ESRD). We present a case with a stage 3 Nodal Marginal Zone Lymphoma (NMZL) and systemic sclerosis sine scleroderma (SSSS), where the evolution of ITG was documented in 2 renal biopsies 19 months apart. To the best of our knowledge, no cases have been reported linking ITG to NMZL. Furthermore, there is only one non-peer reviewed report linking ITG to scleroderma. We discuss the implications of our findings and highlight the satisfactory management of the case.Case presentationA 79-year-old female with history of systemic sclerosis sine scleroderma and stage 3 NMZL presented with acute kidney injury and NS on a background of chronic kidney disease. Her first kidney biopsy showed a diffuse proliferative glomerulonephritis and her serum protein electrophoresis showed no abnormalities. She was managed satisfactorily with conservative measures. She returned 19 months later with features of fluid overload, increasing proteinuria and rising serum creatinine. A repeat serum protein electrophoresis showed excess free kappa light chains and ITG was detected in the repeat kidney biopsy. Her kidney function and proteinuria showed a good and sustained response to rituximab administered after the second biopsy.ConclusionITG is a rare type of glomerulopathy, associated with underlying haematological malignancies and autoimmune disorders that may result in ESRD.Rituximab is one of the effective agents used in the management of ITG with haematological malignancies.

Experience of using different dosages of the drug kalimate in order to correct hyperkalemia in chronic kidney disease

THE AIM: to evaluate the efficacy, safety, and tolerability of the preparation of calcium polystyrene sulfonate (Kalimate ® ), clinical observation was conducted in patients with chronic kidney disease who do not need dialysis, using different dosages of the drug with incomplete effectiveness of the hypokalemic diet as monotherapy for hyperkalemia. PATIENTS AND METHODS: the study included 70 patients suffering from chronic kidney disease who do not need renal replacement therapy, and with a plasma potassium level of 5.5 mmol/l or higher, after the use of hypokalemic diet therapy was ineffective. The patients were divided into 4 groups depending on the dose of calcium polystyrene sulfate. The 3 groups differed in the dose of the drug taken, the 4th group consisted of patients with reduced nutrition. Patients in all groups underwent control studies of serum potassium concentration before the start of the study, after 1 week, after 2 weeks, after 1 month, after 3, and after 6 months of treatment. RESULTS: The decrease in the level of potassium in the blood serum of group 1 patients for 6 months was 24.15 % (95 % CI 16.32-31.4 %), which in absolute value was 1.485± 0.513 mmol/l. Similar parameters for groups 2, 3 and 4 were, respectively: 22.59 % (95 %CI 15.57–31.12 %) and 1.38±0.487 mmol/L, 19.72 % (95 %CI 12.08–25.32 %) and 1.215±0.45 mmol/L, 25.24 % (95 % CI 17.86–30.24 %) and 1.58±0.502 mmol/l. CONCLUSION: the effectiveness of reducing serum potassium levels in patients with hyperkalemia on the background of chronic kidney disease who do not receive dialysis and follow only a hypokalemic diet, when using the drug polystyrene sulfate according to the instructions for 15-30 grams per day for at least 1 week with subsequent dose adjustment is an effective way of treating and correcting hyperkalemia.

Frequently Missed, Never Dismissed: Anticoagulant-Related Nephropathy<br/>—Case Presentation and Review of the Literature

We reported here a case of anticoagulant-related nephropathy (ARN) in an elderly patient with background history of chronic kidney disease (CKD-stage 4, with an estimated glomerular filtration rate (eGFR) of <24 ml/min). He presented with an acute kidney injury on background of chronic kidney disease (AKI/CKD) with eGFR of 9 ml/min and serum creatinine of 6.0 mg/dl.

Leptin and adiponectin in patients with chronic kidney disease and secondary hyperparathyroidism

Background. The results of studies evaluating the levels of adiponectin, leptin and their ratios in chronic kidney disease (CKD) are conflicting. It is assumed that hyperleptinemia and changes in adiponectin clearance are consequences of a decrease in the glomerular filtration rate, they exacerbate renal impairment and may affect the prognosis of survival due to cardiovascular events. It is known that secondary hyperaparathyroidism is the most frequent complication of CKD, which not only affects calcium-phosphorus metabolism and bone tissue, but also contributes to the development of pathological processes involving other hormonal and metabolic markers. Of greatest interest is the assessment of adipocytokine levels in the development of secondary hyperparathyroidism against the background of CKD as an independent factor of increasing cardiovascular risks. The purpose of the study was to assess adipocytokine levels (adiponectin, leptin) and their ratios in patients with different stages of chronic kidney disease and their relationship with manifestations of secondary hyperparathyroidism. Materials and methods. This cross-sectional study enrolled 160 people with CKD and 40 healthy individuals as a comparison group. Results. Leptin level reduction and an increase in the proportion of patients with hypoleptinemia with a decrease in the glomerular filtration rate were found, which may be an important factor determining nutritional status. Correlations were revealed between leptin level, body mass index (ρ = 0.411) and patients’ age (ρ = 0.189), as well as between leptin/adiponectin and adiponectin/leptin ratios (ρ = 0.395 and ρ = –0.395) and body mass index in patients with CKD persisting in subgroups by stage of renal failure. A relationship was found with sex for leptin and a decrease in its levels below normal values in both men and women. Conclusions. The proportion of patients with hyperadiponectinemia was significantly higher among those with end-stage CKD compared to patients with stages 1–2. There was no statistically significant relationship between adipocytokine and parathyroid hormone levels and the presence of secondary hyperparathyroidism in patients examined.

Multimodality imaging evaluation of pseudotumors in chronic renal dysfunction: exposing the masquerade!

Focal renal lesions in the background of chronic kidney disease (CKD) present a diagnostic challenge. Contrast administration is usually avoided in such a setting, undermining the usefulness of computed tomography and magnetic resonance imaging. Focal regenerating nodules may occur in the background of CKD and closely mimic renal neoplasms. The aim of the present article was to highlight the salient manifestations of such CKD pseudotumors on different imaging modalities and also to depict the differentiating features from malignancy. Radiologists must be aware of the imaging appearance of this uncommonly talked about entity so as to avoid inadvertent surgery or cause undue anxiety to the patient.

Случай герпесвирусной инфекции на фоне хронической болезни почек и трансплантации почки от родственного донора

В статье представлен клинический случай герпесвирусной инфекции, развившейся у мальчика 14 лет на фоне хронической болезни почек V степени с хронической почечной недостаточностью IV ст., состояние после трансплантации почки от родственного донора. Особенностью представленного клинического случая является необходимость оценки рисков и принятия решения по лечению пациента, так как почечная недостаточность является противопоказанием для назначения противовирусных препаратов (в частности, ацикловира).

Myocardial Hypertrophy and Fibrosis Are Associated with Cardiomyocyte Beta-Catenin and TRPC6/Calcineurin/NFAT Signaling in Spontaneously Hypertensive Rats with 5/6 Nephrectomy.

Background: Arterial hypertension (AH) is associated with heart and chronic kidney disease (CKD). However, the precise mechanisms of myocardial remodeling (MR) in the settings of CKD remain elusive. We hypothesized that TRPC6, calcineurin/NFAT, and Wnt/β-catenin signaling pathways are involved in the development of MR in the background of CKD and AH. Methods: Early CKD was induced by performing a 5/6 nephrectomy (5/6NE) in spontaneously hypertensive rats (SHR-NE). Sham-operated (SO) SHR (SHR-SO) and Wistar Kyoto (WKY-SO) rats served as controls. Systolic blood pressure (SBP), heart rate, myocardial mass index (MMI), serum creatinine, cardiomyocyte diameter (dCM), myocardial fibrosis (MF), serum and kidney α-Klotho levels, myocardial expression of calcineurin (CaN), TRPC6, and β-catenin were measured two months after 5/6NE or SO. Results: NE-induced kidney dysfunction corresponded to mild-to-moderate human CKD and was associated with an increase in FGF23 and a decrease in renal α-Klotho. The levels of SBP, MMI, dCM, and MF were higher in SHRs compared to WKY-SO as well as in SHR-NE vs. SHR-SO. The MR was associated with increased cardiomyocyte expression of CaN/NFAT and β-catenin along with its intracellular re-distribution. TRPC6 protein levels were substantially elevated in both SHR groups with higher Trpc6 mRNA expression in SHR-NE. Conclusions: The Wnt/β-catenin and TRPC6/CaN/NFAT hypertrophic signaling pathways seem to be involved in myocardial remodeling in the settings of AH and CKD and might be mediated by FGF23 and α-Klotho axis.

FEATURES OF ANTIBACTERIAL THERAPY OF CHRONIC BACTERIAL PTOSTATITIS ON THE BACKGROUND OF ATYPICAL UROINFECTION

This study was made of 87 patients with a chronic bacterial prostatitis complicated by atypical uroinfection. The endocellular pathogens were identified among 38 patients on the background of chronic kidney disease in the acute phase and among 49 patients in the lag phase. There were identified 97 cultures in total. The associative microflora has been submitted by mainly two-componential association and was observed in 19 % cases.&#x0D; The 6 types of bacteria, by general number 127 of cultures, were allocated in microbiological research of a secret prostate before the beginning of treatment. In 17 monitorings there were associations of culture, in other cases as monocultures. Patients received in tablet form of roxithromycini in a daily dose of 300 mg, azithromycini in a daily dose of 1000 mg and josamycini in a daily dose 1500 mg during 10-14 day. The maximal clinical and bacteriological efficiency of treatment was marked in case of application josamycini.

Salvage Tibiotalocalcaneal Arthrodesis Augmented With Fibular Columns and Iliac Crest Autograft: A Technical Note.

Failure of ankle arthrodesis or total ankle replacement (TAR) results in a challenging clinical situation and may take the form of symptomatic nonunion following arthrodesis and aseptic or infective loosening following TAR. Revision in these scenarios is technically demanding, and if associated with subtalar degeneration, conversion to tibiotalocalcaneal (TTC) arthrodesis may be required, with use of bone grafting to maintain length and reduce disability. Fibular strut grafting in the form of pillars or columns, potentially supplemented by tricortical and iliac graft, may be used in association with intramedullary TTC nailing or lateral plating and has demonstrated encouraging fusion rates. In this technical note, we review the history of this technique and report indications and surgical approach. Furthermore, of 6 cases (mean age 69.8 years) treated at our institution and followed at 13 months (range, 8 to 20 months), 5 (83%) were clinically and radiologically united, and patients were satisfied with the outcome of surgery. One patient with a background of chronic kidney disease remained dissatisfied with no union achieved, persistent pain, and awaiting a below-the-knee amputation. No other complications were observed. TTC fusion augmented with fibular columns and iliac crest autograft is an option to treat combined ankle and subtalar joint pathologies with significant talar bone loss.Levels of Evidence: Level V (technical note).

Salvage Tibiotalocalcaneal Arthrodesis Augmented with Fibular Columns and Iliac Crest Autograft: A Technical Note

Category:Ankle; Ankle ArthritisIntroduction/Purpose:End-stage ankle arthritis may be managed with ankle arthrodesis or total ankle replacement (TAR). Failure of these procedures results in a challenging clinical situation. Revision in these scenarios is technically demanding, and if associated with subtalar degeneration, conversion to tibiotalocalcaneal (TTC) arthrodesis may be required. Bone grafting may be necessary to maintain length and reduce disability, and fibular strut grafting in form of ‘pillars’ or ‘columns’ may be used in association with intramedullary TTC nailing. In our experience, fibular column autograft may be supplemented with tricortical and cancellous iliac crest graft and stabilised with cannulated screws and either an intramedullary nail or a lateral plate. In this technical note, we review the history of this technique and report indications, surgical approach, results and complications.Methods:A distal J-shaped lateral approach is performed over the posterior edge of the distal fibula. An oblique fibular cut is made with a saw at 8- 12 cm from the fibular tip. Careful removal of the implant, previous cement spacer or metalwork is performed then articular surfaces are prepared. After assessment of the articular gap, the autograft is prepared by removing the tip of the fibula from the fibular block, then sectioning it in to either three or four columns which are positioned into the gap and stabilised either in a press-fit fashion or using 1.6mm K-wires. Six patients (4M, 2F; mean age: 69.8 years (range, 51 to 83)) were treated between December 2018 and March 2019 (5 failed TAR and 1 was symptomatic tibiotalar non-union) at our institution. Fixation was achieved in 5 cases with a locked intramedullary nail and in 1 case with a lateral locking plate.Results:At a mean follow up of 10 months (range, 6 to 11 months), 4 patients had clinically and radiologically united and were satisfied with the outcome of surgery. Two patients remained dissatisfied having not united: one patient with a background of chronic kidney disease had raised inflammatory blood markers at 10 months and is undergoing investigation to exclude infection whilst one other patient with no obvious risk factors for non-union has started low intensity pulsed ultrasound treatment at 6 months. No other complications were observed.Conclusion:Tibiotalocalcaneal fusion augmented with fibular columns and iliac crest autograft is an option to treat combined ankle and the subtalar joint pathologies with significant talar bone loss. However larger studies with longer follow-up are required to define the rates of success and failure with future research directed to better understand which factors may predict the outcome.

Multimodal imaging in sclerochoroidal calcification: a case report and literature review

BackgroundSclerochoroidal calcification (SCC), a rare condition found in elderly people, is idiopathic or occasionally secondary to disorders affecting calcium metabolism. Findings of multimodal imaging including choroidal circulation are, however, largely unknown. We present a patient of SCC with systemic background, who underwent multimodal imaging evaluations.Case presentationA 70-year-old Japanese man was referred to our clinic because of bilateral fundus lesions. He had a history of chronic kidney disease (CKD) and secondary hyperparathyroidism. Fundus photography showed a cluster of choroidal folds in the superotemporal extra-macular region OS. Swept-source optical coherence tomography demonstrated ellipsoid zone disruption OD, retinal pigment epithelium undulation OS, dilated Haller layer veins OU, and central choroidal thickening OU and thinning of the overlying choroid due to scleral elevation OS. Fluorescein angiography detected macular hyperfluorescence OD. Indocyanine green angiography demonstrated choroidal vascular hyperpermeability together with numerous scattered hypofluorescent lesions OU. Fundus autofluorescence showed multiple hypoautofluorescent spots surrounded by hyperautofluorescent areas OD. Laser speckle flowgraphy exhibited choroidal blood flow reduction represented by a cold color pattern OU. B-mode echography displayed hyperechoic solid lesions with acoustic shadowing and orbital computed tomography revealed high density areas in the sclera, both of which were consistent with calcification. The patient was diagnosed with SCC, and these imaging findings remained unchanged 7 months after the diagnosis.ConclusionsWe reported a case of SCC with the background of CKD. Our detailed multimodal observations indicated choroidal hypoperfusion possibly caused by mechanical compression due to calcium deposition in the sclera.