Chronic Renal Infection Research Articles

Treatment of respiratory pathology in Termas de Luso: renewal

The pathology of the respiratory tract has long been one of the main reasons for seeking thermal treatments in different types of water. Natural mineral water has antimicrobial properties, antioxidants (decreased mucus viscosity) and antiinflammatory properties (inhibition of IL-2 and INF-Gamma). In addition to the symptomatic improvement observed after thermal treatment, it is also frequent to improve the quality of life of these patients. Several studies have been carried out in this area. There are several pathologies to which thermal treatments are recommended, such as rhinitis, sinusitis, asthma, bronchitis, respiratory infections of repetition, among others. The therapeutic properties of Luso water have been recognized since the 18th century. It goes back to the year 1775 the first use of the bath for the treatment of skin diseases, by Dr. Antonio Augusto da Costa Simoes. In 1893, Gustave Eiffel devised a work that would become a reference at European level, the thermal pool. In 1850, the first physical-chemical analysis was carried out and the main characteristics of the Luso Thermal water were analyzed: hyossaline water, low mineralized, low sodium, silicate and chlorinated sodium. These waters are indicated for: Chronic renal and urinary tract infections; Hypertension; Reduced cholesterol levels; Metabolism and locomotor disorders; Rheumatism; Chronic Respiratory Affections; Dermatological pathology. The “Termas de Luso” recently invested in a renewed ORL and increased the number of treatment box’s. The quality is excellent and in this way it has managed to close an important gap and attract enough thermalists. In health, more and more seek innocuous treatments and with few side effects. Treatment with mineral water (in contact with the body, inhaled or ingested) brought this benefit, and the Termas de Luso, center all these alternatives. There is an improvement in the mean values of nasal symptoms after thermal treatment, which also contributes to the improvement of the quality of life of these patients. Further studies should be carried out in this area, and it is on the basis of this that the Termas de Luso invested in the improvement of thermal treatments. Within a short time the growth will be exponential and new agreements will be opened between several bordering institutions.

The importance of red cell distribution width on gastric cancer.

e15502 Background: Red cell distribution width (RDW) is an elevated marker in several cancers like breast, colon, prostate and pancreatic cancer at the time of diagnosis. Gastric cancer (GC) is the fifth most common cancer and also third leading cause of cancer deaths.We aimed to determine whether RDW values differ between gastric cancer and healthy subjects, as well as to evaluate association between RDW and other factors. Also, we examined other two important inflammatory markers in GC patients: neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) Methods: This retrospective study included 68 gastric cancer patients and 42 age and sex matched healthy controls. The exclusion criteria involved cardiac disease, chronic obstructive lung disease, thromboembolism, chronic renal failure, hepatic disorders, hypertension, acute and chronic infections, stroke, hematologic disease and other accompanying cancer. Blood samples were retrospectively obtained from computerized patient database. Results: Among 110 subjects; RDW, NLR and PLR were significantly higher in GC patients when compared to healthy subjects (RDW: 44,9 vs 41,4 p < 0.0001, NLR: 3,40 vs 1,90 p < 0.0001, PLR: 245,9 vs 131,1 p = 0.007). There was no statistically significant association between these markers (RDW, NLR and PLR) and stage, histopathological subgroups and metastasis stage at the time of diagnosis. Conclusions: Elevated RDW is a simple, cheap and readily available marker and may be useful in gastric cancer at the time of diagnosis. Also, NLR and PLR can accompany RDW in the assessment of gastric cancer. Key words: gastric, red cell distribution width, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, cancer

Metabolic pathway of 4-pyridone-3-carboxamide-1β-d-ribonucleoside and its effects on cellular energetics

4-pirydone-3-carboxamide-1β-d-ribonucleoside (4PYR) is an endogenous nucleoside that could be converted to triphosphates, diphosphates, monophosphates and an analogue of NAD − 4PYRAD. Elevated level of these compounds have been reported in chronic renal failure, cancer and active HIV infection. However, little is known about the effect on cell functionality and the metabolic pathways. This study tested effects of 4PYR in different cell types on nucleotide, energy metabolism and clarified enzymes that are involved in conversions of 4PYR.We have found that human neuroblastoma cells, human malignant melanoma cells, human adipose-derived stem cells, human bone marrow-derived stem cells, human dermal microvascular endothelial cells and human embryonic kidney cells, were capable to convert 4PYR into its derivatives. This was associated with deterioration of cellular energetics. Incubation with 4PYR did not affect mitochondrial function, but decreased glycolytic rate (as measured by extracellular acidification) in endothelial cells. Silencing of adenosine kinase, cytosolic 5′-nucleotidase II and nicotinamide nucleotide adenylyltransferase 3, blocked metabolism of 4PYR. Incubation of endothelial cells with 4PYR decreased AMP deaminase activity by 40%.The main finding of this paper is that human cells (including cancer type) are capable of metabolizing 4PYR that lead to deterioration of energy metabolism, possibly as the consequence of inhibition of glycolysis. This study, it was also found that several enzymes of nucleotide metabolism could also contribute to the 4PYRconversions

Proton pump inhibitor - side effects and complications oflong-term proton pump inhibitor administration

Proton Pump Inhibitors are among the most common drugs taken. The indication is for treatment of heartburn, reflux disease, prophylaxis and treatment of peptic ulcers, in combination with NSAIDs and steroids as well as H. pylori-eradication. PPI's are widely used, even with non-specific symptoms. This certainly has to do with good tolerability and a previously considered low side effect profile. At the moment, there is growing evidence that the long-term intake of PPI's may not be as safe as assumed. In addition to interactions with some drugs, including platelet aggregation inhibitors, recent studies have shown an increased risk of myocardial infarction, interstitial nephritis, chronic renal injury, infections, vitamin deficiencies and electrolyte shifts as well developing dementia.

Isolation of a Seawater Tolerant Leptospira spp. from a Southern Right Whale (Eubalaena australis).

Leptospirosis is the most widespread zoonotic disease in the world. It is caused by pathogenic spirochetes of the genus Leptospira spp. and is maintained in nature through chronic renal infection of carrier animals. Rodents and other small mammals are the main reservoirs. Information on leptospirosis in marine mammals is scarce; however, cases of leptospirosis have been documented in pinniped populations from the Pacific coast of North America from southern California to British Columbia. We report the isolation of a Leptospira spp. strain, here named Manara, from a kidney sample obtained from a Southern Right Whale (Eubalaena australis) calf, which stranded dead in Playa Manara, Península Valdés, Argentina. This strain showed motility and morphology typical of the genus Leptospira spp. under dark-field microscopy; and grew in Ellinghausen-McCullough-Johnson-Harris (EMJH) medium and Fletcher medium after 90 days of incubation at 28°C. Considering the source of this bacterium, we tested its ability to grow in Fletcher medium diluted with seawater at different percentages (1%, 3%, 5%, 7% and 10% v/v). Bacterial growth was detected 48 h after inoculation of Fletcher medium supplemented with 5% sea water, demonstrating the halophilic nature of the strain Manara. Phylogenetic analysis of 16S rRNA gene sequences placed this novel strain within the radiation of the pathogenic species of the genus Leptospira spp., with sequence similarities within the range 97–100%, and closely related to L. interrogans. Two different PCR protocols targeting genus-specific pathogenic genes (G1-G2, B64I-B64II and LigB) gave positive results, which indicates that the strain Manara is likely pathogenic. Further studies are needed to confirm this possibility as well as determine its serogroup. These results could modify our understanding of the epidemiology of this zoonosis. Until now, the resistance and ability to grow in seawater for long periods of time had been proven for the strain Muggia of L. biflexa, a saprophytic species. To the best of our knowledge, this is the first isolation of a Leptospira sp. from cetaceans. Our phenotypic data indicate that strain Manara represents a novel species of the genus Leptospira, for which the name Leptospira brihuegai sp. nov. is proposed.

Leptospirosis in animals and human contacts in Egypt: broad range surveillance.

Leptospirosis is a re-emerging zoonotic disease of humans and animals worldwide. The disease is caused by pathogenic species of the genus Leptospira. These organisms are maintained in nature via chronic renal infection of carrier animals, which excrete the organisms in their urine. Humans become infected through direct or indirect exposure to infected animals and their urine or through contact with contaminated water and soil. This study was conducted to investigate Leptospira infections as a re-emerging zoonosis that has been neglected in Egypt. Samples from 1,250 animals (270 rats, 168 dogs, 625 cows, 26 buffaloes, 99 sheep, 14 horses, 26 donkeys and 22 camels), 175 human contacts and 45 water sources were collected from different governorates in Egypt. The samples were collected from different body sites and prepared for culture, PCR and the microscopic agglutination test (MAT). The isolation rates of Leptospira serovars were 6.9%, 11.3% and 1.1% for rats, dogs and cows, respectively, whereas the PCR results revealed respective detection rates of 24%, 11.3% and 1.1% for rats, dogs and cows. Neither the other examined animal species nor humans yielded positive results via these two techniques. Only six Leptospira serovars (Icterohaemorrhagiae, Pomona, Canicola, Grippotyphosa, Celledoni and Pyrogenes) could be isolated from rats, dogs and cows. Moreover, the seroprevalence of leptospiral antibodies among the examined humans determined using MAT was 49.7%. The obtained results revealed that rats, dogs and cows were the most important animal reservoirs for leptospirosis in Egypt, and the high seroprevalence among human contacts highlights the public health implications of this neglected zoonosis.

Comment on “Metabolic Changes and Serum Ghrelin Level in Patients with Psoriasis”

Thanks are due to Dr. Ucak and colleagues for their valuable research evaluating the levels of serum ghrelin in patients with psoriasis [1]. However, we wish to make some comments on methodology of their study. Ghrelin is a hormone secreted mainly by stomach. Some types of antipsychotics, antidepressants, corticosteroids, bromocriptine, and anti-TNF-α therapy drugs were suggested to affect serum ghrelin levels [2, 3]. Also, dietary food supplements such as vitamin D and free fatty acids could affect these levels [4]. In this respect, the authors should define whether the participants use these kinds of drugs and dietary supplements or not. In addition, several studies revealed that certain diseases such as functional dyspepsia, celiac disease, cachexia, inflammatory bowel disease, asthma, ankylosing spondylitis, coronary artery disease, iron deficiency anemia, hepatocellular cancer, chronic liver disease, chronic renal disease, epilepsy, and Helicobacter pylori infection could affect serum ghrelin [5, 6]. The authors did not mention these contributing diseases in their paper. Ucak and colleagues stated that they questioned the patients' alcohol and cigarette smoking habits. As known, serum ghrelin levels are associated with alcohol intake and smoking [7, 8]. In this regard, a regression analysis could be applied for these variables to examine whether they affect serum ghrelin levels. Therefore, interpretation of results with its current form seems problematic. In conclusion, we believe that the study of Ucak et al. contributes important data to medical literature and could lead other researchers to design a study. However clarifying above concerns will provide clearer picture to the readers.

Characteristics of urinary retention in female inpatients managed with medical treatments.

PurposeWe aimed to analyze the characteristics of urinary retention (UR) in female inpatients managed with medical treatments.Materials and MethodsWe retrospectively analyzed the medical records of female inpatients referred to the department of urology for UR at our institution from January 2009, to December 2014. UR was defined as a difficulty in self-voiding despite a sufficient urine volume or >300-mL postvoid residual. The data included patients' age, body mass index (BMI), ambulatory status, medical and surgical history, classes of taking drugs, and urinary tract infection.ResultsA total of 182 women were included as retention group, mean age of 72.64±12.94 years and BMI of 22.94±3.10 kg/m2. In the chi-square analysis, cardiovascular disorders (p=0.000), diabetes mellitus (p=0.008), metastatic malignancy (p=0.008), chronic renal disorders (p=0.028) were found significantly. In the multiple logistic regression analysis, cardiovascular disorders (p=0.002; odds ratio [OR], 0.491), metastatic malignancy (p=0.013; OR, 2.616) were found to increase the risk of UR. The most common surgical history was anti-incontinence surgery (7.2%). In term of medication use, the most prescribed agents were nonsteroidal anti-inflammatory drugs (NSAIDs) (53.8%). The patients taking multiple drugs with antimuscarinic effects except of NSAIDs, narcotics and diuretics were 48 (26.4%). Urinary tract infection was identified in 43 patients (23.6%).ConclusionsUR in females managed with medical treatments could be occurred occasionally. We think that thorough attentions are needed for UR to patients with cardiovascular disorders including diabetes mellitus, metastatic malignancy, chronic renal disorders urinary tract infection, and more careful interests when managing with drugs with antimuscarinic effects.

Ureteritis cystica associated with xanthogranulom atouspyelonephritis

Ureteritis cystica (UC) and xanthogranulomatous pyelonephritis (XP) are rare, benign conditions that uncommonly appear together. The first one has not well established etiology yet and can affect ureter, renal pelvis and bladder. The second one is a chronic renal infection resulting in severe kidney deterioration and destruction. Both of these entities are usually unilateral. They both cause wide spectrum of symtoms so the diagnose can be difficult to establish. We report the case of a 68 year old male with a history of intermittent macroscopic hematuria, left flank pain, recurrent urinary tract infection and calculosis of left kidney. We describe the imaging and endoscopic investigations leading to the diagnosis of ureteritis cystica as well as the treatment options.

Live imaging of bioluminescent leptospira interrogans in mice reveals renal colonization as a stealth escape from the blood defenses and antibiotics.

Leptospira (L.) interrogans are bacteria responsible for a worldwide reemerging zoonosis. Some animals asymptomatically carry L. interrogans in their kidneys and excrete bacteria in their urine, which contaminates the environment. Humans are infected through skin contact with leptospires and develop mild to severe leptospirosis. Previous attempts to construct fluorescent or bioluminescent leptospires, which would permit in vivo visualization and investigation of host defense mechanisms during infection, have been unsuccessful. Using a firefly luciferase cassette and random transposition tools, we constructed bioluminescent chromosomal transformants in saprophytic and pathogenic leptospires. The kinetics of leptospiral dissemination in mice, after intraperitoneal inoculation with a pathogenic transformant, was tracked by bioluminescence using live imaging. For infective doses of 106 to 107 bacteria, we observed dissemination and exponential growth of leptospires in the blood, followed by apparent clearance of bacteria. However, with 2×108 bacteria, the septicemia led to the death of mice within 3 days post-infection. In surviving mice, one week after infection, pathogenic leptospires reemerged only in the kidneys, where they multiplied and reached a steady state, leading to a sustained chronic renal infection. These experiments reveal that a fraction of the leptospiral population escapes the potent blood defense, and colonizes a defined number of niches in the kidneys, proportional to the infective dose. Antibiotic treatments failed to eradicate leptospires that colonized the kidneys, although they were effective against L. interrogans if administered before or early after infection. To conclude, mice infected with bioluminescent L. interrogans proved to be a novel model to study both acute and chronic leptospirosis, and revealed that, in the kidneys, leptospires are protected from antibiotics. These bioluminescent leptospires represent a powerful new tool to challenge mice treated with drugs or vaccines, and test the survival, dissemination, and transmission of leptospires between environment and hosts.

Genotypes of pathogenic Leptospira spp isolated from rodents in Argentina

Leptospirosis is the most widespread zoonosis in the world and significant efforts have been made to determine and classify pathogenic Leptospira strains. This zoonosis is maintained in nature through chronic renal infections of carrier animals, with rodents and other small mammals serving as the most important reservoirs. Additionally, domestic animals, such as livestock and dogs, are significant sources of human infection. In this study, a multiple-locus variable-number tandem repeat analysis (MLVA) was applied to genotype 22 pathogenic Leptospira strains isolated from urban and periurban rodent populations from different regions of Argentina. Three MLVA profiles were identified in strains belonging to the species Leptospira interrogans (serovars Icterohaemorrhagiae and Canicola); one profile was observed in serovar Icterohaemorrhagiae and two MLVA profiles were observed in isolates of serovars Canicola and Portlandvere. All strains belonging to Leptospira borgpetersenii serovar Castellonis exhibited the same MLVA profile. Four different genotypes were isolated from urban populations of rodents, including both mice and rats and two different genotypes were isolated from periurban populations.

Multimodality imaging of renal inflammatory lesions.

Spectrum of acute renal infections includes acute pyelonephritis, renal and perirenal abscesses, pyonephrosis, emphysematous pyelonephritis and emphysematous cystitis. The chronic renal infections that we routinely encounter encompass chronic pyelonephritis, xanthogranulomatous pyelonephritis, and eosinophilic cystitis. Patients with diabetes, malignancy and leukaemia are frequently immunocompromised and more prone to fungal infections viz. angioinvasive aspergillus, candida and mucor. Tuberculosis and parasitic infestation of the kidney is common in tropical countries. Imaging is not routinely indicated in uncomplicated renal infections as clinical findings and laboratory data are generally sufficient for making a diagnosis. However, imaging plays a crucial role under specific situations like immunocompromised patients, treatment non-responders, equivocal clinical diagnosis, congenital anomaly evaluation, transplant imaging and for evaluating extent of disease. We aim to review in this article the varied imaging spectrum of renal inflammatory lesions.

Complement Protective Epitopes and CD55–Microtubule Complexes Facilitate the Invasion and Intracellular Persistence of Uropathogenic Escherichia coli

Escherichia coli-bearing Dr-adhesins (Dr+ E. coli) cause chronic pyelonephritis in pregnant women and animal models. This chronic renal infection correlates with the capacity of bacteria to invade epithelial cells expressing CD55. The mechanism of infection remains unknown. CD55 amino acids in the vicinity of binding pocket-Ser155 for Dr-adhesin were mutated to alanine and subjected to temporal gentamicin-invasion/gentamicin-survival assay in Chinese hamster ovary cells. CD55/microtubule (MT) responses were studied using confocal/electron microscopy, and 3-dimensional structure analysis. Mutant analysis revealed that complement-protective CD55-Ser165 and CD55-Phe154 epitopes control E. coli invasion by coregulating CD55-MT complex expression. Single-point CD55 mutations changed E. coli to either a minimally invasive (Ser165Ala) or a hypervirulent pathogen (Phe154Ala). Thus, single amino acid modifications with no impact on CD55 structure and bacterial attachment can have a profound impact on E. coli virulence. While CD55-Ser165Ala decreased E. coli invasion and led to dormant intracellular persistence, intracellular E. coli in CD55-Phe154Ala developed elongated forms (multiplying within vacuoles), upregulated CD55-MT complexes, acquired CD55 coat, and escaped phagolysosomal fusion. E. coli target complement-protective CD55 epitopes for invasion and exploit CD55-MT complexes to escape phagolysosomal fusion, leading to a nondestructive parasitism that allows bacteria to persist intracellularly.

Renal Mass with Caval Thrombous as Atypical Presentation of Xantogranulomatous Pyelonephritis. a Case Report and Literature Review

Xantogranulomatous pyelonephritis is a rare, severe, chronic renal infection typically resulting in diffuse renal destruction. Enlarged kidney is typical radiological finding. In this work we describe an extremely rare case in which a clinically classified cT3b Tumor (level II IVC thrombus) was detected; at specimen analysis to be xantogranulomatous pyelonephritis with IVC extension. U.V., female, 86 years old, we diagnosed with right renal mass, with extension to IVC. By pathological analysis, it was found that renal mass and the thrombus was not due to RCC, but by xantogranulomatous pyelonephritis. Xantogranulomatous pyelonephritis with IVC thrombus is exceptional and has been described in 4 cases. Such a diagnosis could have anesthesiologic importance, in particular related to antimicrobial treatment. Xantogranulomatous pyelonephritis has its own classification, based on extension and organ involvement, but this case fall out of current classification. This possibility could be suspected and updating of disease's classification could be suggested.

Microscopic schistocyte determination according to International Council for Standardization in Hematology recommendations in various diseases

Recently, a consensus report for microscopic schistocyte determination was prepared by International Council for Standardization in Hematology (ICSH). ICSH focused on diagnosis of thrombocytopenic purpura (TTP)/hemolytic uremic syndrome (HUS). We aimed to reanalyze schistocytes according to ICSH recommendations, to study diseases other than TTP/HUS related to the schistocytes, and to compare the percentage of schistocytes among the various diseases. We retrieved all reported cases of peripheral blood (PB) smear in a single institution during 6 years. Schistocytes on 282 PB smears showing previous peripheral schistocytes and hemoglobin ≤10 g/dL were recounted according to ICSH recommendations. The schistocytes were frequently observed in patients with microangiopathic hemolytic anemia (MAHA), metastatic carcinoma, sepsis, chronic renal failure, preterm infant, and infection. Only two among 34 patients categorized as MAHA were diagnosed as TTP/HUS. Schistocytes were observed with other morphological changes in 169 of 170 cases with schistocyte ≤1% and in 102 of 112 with schistocyte >1%. The median schistocyte percentages of patients with hematologic malignancy, megaloblastic anemia, acute renal failure, and preterm infant were 1.20%, 1.30%, 1.35%, and 1.70%, respectively. Schistocytes were observed above 1% in many diseases other than TTP /HUS. Therefore, it is important to understand that schistocytes could be seen in various diseases, and in these cases, schistocytes were usually detected together with other red blood cell morphologic changes. These data support ICSH recommendation that a schistocyte count should be considered clinically meaningful if schistocytes represent the main morphological abnormality in the PB smear.

Prosthetic graft infections involving the femoral artery

Prosthetic graft infection is a major complication of peripheral vascular surgery. We investigated the experience of a single institution over 10 years with bypass grafts involving the femoral artery to determine the incidence and risk factors for prosthetic graft infection. A retrospective cohort single-institution review of prosthetic bypass grafts involving the femoral artery from 2001 to 2010 evaluated patient demographics, body mass index, comorbidities, indications, location of bypass, type of prosthetic material, case urgency, and previous ipsilateral bypass or percutaneous interventions and evaluated the incidence of graft infections, amputations, and mortality. There were 496 prosthetic grafts identified with a graft infection rate of 3.8% (n = 19) at a mean follow-up of 27 months. Multivariable analysis showed that redo bypass (hazard ratio [HR], 5.8; 95% confidence interval [CI], 2.2-15.0), active infection at the time of bypass (HR, 5.2; 95% CI, 1.9-14.2), female gender (HR, 4.5; 95% CI, 1.6-12.7), and diabetes mellitus (HR, 4.6; 95% CI, 1.5-14.3) were significant predictors of graft infection. Graft infection was predictive of major lower extremity amputation (HR, 9.8; 95% CI, 3.5-27.1), as was preoperative tissue loss (HR, 4.7; 95% CI, 1.8-11.9). Graft infection did not predict long-term mortality; however, chronic renal insufficiency (HR, 2.3; 95% CI, 1.6-3.4), tissue loss (HR, 1.4; 95% CI, 1.0-1.9), and active infection (HR, 2.3; 95% CI, 1.6-3.4) did. Infected grafts were removed 79% of the time. Staphylococcus epidermidis (37%) and methicillin-sensitive Staphylococcus aureus (26%) were the most common pathogens isolated. Redo bypass, female gender, diabetes, and active infection at the time of bypass are associated with a higher risk for prosthetic graft infection and major extremity amputation but do not confer an increased risk of mortality. Autologous vein for lower extremity bypass and endovascular interventions should be considered when feasible in high-risk patients.

The Role of Laparoscopic Nephrectomy in Pediatric Xanthogranulomatous Pyelonephritis: A Case Report

Xanthogranulomatous pyelonephritis (XGP) is a rare chronic renal infection characterized by the destruction of renal parenchyma. Traditional treatment involves open radical nephrectomy, which is challenging due to the inflammatory process associated with XGP. More recently, laparoscopic nephrectomy has been employed successfully in adult XGP. We present a case of a six-year-old female child with XGP who was successfully treated by laparoscopic nephrectomy with minor complications. Our case demonstrates the safety and feasibility of laparoscopic nephrectomy for childhood XGP, indicating that it should be considered a management option in such cases.

Xanthogranulomatous pyelonephritis: Rare presentation of a rare disease

Xanthogranulomatous pyelonephritis is a rare chronic renal infection of unknown pathogenesis characterized by replacement of renal parenchyma by lipid filled macrophages frequently associated with an enlarged, non-functioning kidney and an obstructing calculus. We report a case of a 45 year old non diabetic female who presented with gradually enlarging renal mass with extensive retroperitoneal involvement and a non-functioning kidney with no evidence of obstructing stone or fat density and simulating malignancy. She was diagnosed as stage III Xanthogranulomatous pyelonephritis and managed with radical nephrectomy with favourable outcome.

Commentary to ‘Native nephrectomy in pediatric transplantation – Less is more!’

The authors have provided contemporary data that strongly support retaining native kidneys in the majority of children with end-stage renal disease in anticipation of transplantation. Even ‘bad’ kidneys may allow the young patient a more liberal fluid intake. Moreover, such kidneys can provide enough native erythropoietin (EPO) to negate the need for exogenous, expensive EPO or, rarely, blood transfusions for anemia; metabolically, vitamin D/calcium homeostasis may be maintained as well by such kidneys. Retaining at least one ‘urine producing’ renal unit, when possible, also will allow ongoing cycling of the bladder; clearly an advantage for allograft ureteral reimplantation at the time of the transplant. Additionally, even if nephrectomy(ies) must be performed, retaining the distal native ureter allows the option of uretero-ureterostomy either initially at transplant engraftment in the case of a complex bladder scenario, or in those cases where urological complications occur after ureteroneocystotomy and a bail-out option is required. It is evident that in most cases with native refluxing ureters, and in those where there is hypertension, medical management, not surgery, is a successful option. This is opposed to the not-so-distant past philosophy, when nephrectomy was performed in preparation for transplantation in such scenarios, as a routine prophylactic measure. Again, this paper reveals that delayed nephrectomy after transplantation will be indicated in only 2%–5% of cases in moderate term follow up, if the conservative approach is embraced. This limits native nephrectomy to a very select population pre-transplant, predominantly the patient with severe proteinuria where nutrition and fluid replacement are impacted, those with malignancies or malignant predisposition, and those with uncontrollable hypertension. Even in patients for whom ureterocystoplasty is contemplated (1 case in this current paper), one might argue for simultaneous nephrectomy and bladder reconstruction at the same sitting as the transplant [[1]Kim Jr., C.O. Gosalbez R. Burke 3rd, G.W. Simultaneous ureterocystoplasty and living related renal transplantation.Clin Transplant. 1996; 10: 333-336PubMed Google Scholar]. Native nephrectomy in pediatric transplantation – Less is more!Journal of Pediatric UrologyVol. 9Issue 1PreviewIndications for pre-transplantation native nephrectomy (PTNN) include chronic renal parenchymal infection, proteinuria, intractable hypertension, polycystic kidneys and malignancy. Our aim was to establish the frequency and reasons for PTNN in children undergoing renal transplant at our center. Full-Text PDF

Cutaneous Melioidosis in Adolescent Returning from Guadeloupe

Cutaneous Melioidosis in Adolescent Returning from Guadeloupe