Incidence Of Hematuria Research Articles

Clinical characteristics and prognosis of steroid-resistant nephrotic syndrome in children: a multi-center retrospective study

BackgroundThis study investigated the factors influencing the prognosis of children with steroid-resistant nephrotic syndrome (SRNS) in patients from the Guangxi region.MethodsWe retrospectively analyzed clinical and pathological data of 279 patients with SRNS from six tertiary hospitals in Guangxi. Clinical data were compared between initial (I-SRNS) and secondary (S-SRNS) steroid resistance subgroups and Cox regression analysis was used to determine risk factors for chronic kidney disease (CKD) and CKD stage 5 (CKD5) in patients with SRNS.ResultsThe median age of onset was 54 months. Thirty-three patients had extra-kidney manifestations. Fifty-two, 24, 57, 33, and 41 patients had hypertension, acute kidney injury, vitamin D deficiency, high intraocular pressure, and dwarfism, respectively. One hundred eighty-two and 92 patients had I-SRNS and S-SRNS, respectively. There were significant differences in sex, ethnicity, family history, incidence of hematuria, clinical classification, efficacy of immune agents, and prognosis between groups (P < 0.05). Among the 279 cases of SRNS, 239 had normal kidney function, 37 developed CKD, and 16 had CKD5. An increase in serum creatinine level (HR = 1.003) was significantly associated with CKD in children with SRNS, and effective immunosuppressant therapy decreased the CKD risk (HR = 0.168). Patients with increased serum creatinine levels (HR = 1.003) and acute kidney injury (HR = 4.829) were more likely to progress to CKD5.ConclusionsChildren with S-SRNS showed a higher response to immunosuppressants than those with I-SRNS. Effective immunosuppressant therapy was found to protect against CKD, whereas increased acute kidney injury was an independent risk factor for CKD5.

Evaluating the safety of bipolar nephrostomy tract cauterization “BNTC” towards a safe tubeless percutaneous nephrolithotomy: a randomized controlled trial

To assess the safety and effectiveness of tubed versus tubeless percutaneous nephrolithotomy (PCNL) after tract inspection and bipolar cauterization of the significant bleeders. Patients who were scheduled for PCNL were screened for enrollment in this prospective randomized controlled trial. The patients were randomly assigned to one of two groups; Group 1 received tubeless PCNL with endoscopic inspection of the access tract using bipolar cauterization of the significant bleeders only, while Group 2 had a nephrostomy tube was inserted without tract inspection. We excluded patients with multiple tracts, stone clearance failure, and significant collecting system perforation. We recorded blood loss, hemoglobin drop after 6 h, postoperative analgesia requirements, hospital stay, and the need for angioembolization. A total of 110 patients completed the study. There were no significant differences between the two groups in in terms of demographic characteristics. Likewise, there was no significant difference in the mean decrease in hemoglobin after 6 h and the frequency of blood transfusion. However, the incidence of hematuria within the first 6 h (p = 0.008), postoperative pain scale (p = 0.0001), the rate of analgesia requirement (p = 0.0001) and prolonged hospital stay (p = 0.0001) were significantly higher in Group 2. Only 9 cases of tract screened patients (16% of group 1) required cauterization. Tubeless PCNL with tract inspection and cauterization of bleeders can provide a safer tubeless PCNL with less postoperative pain, analgesia requirement, and same-day discharge.

Efficacy and safety of onabotulinumtoxinA for the treatment of overactive bladder in men and women: A pooled analysis.

This pooled analysis of randomized controlled studies investigated the safety and efficacy of onabotulinumtoxinA in male and female patients with overactive bladder (OAB). Data were pooled from four similarly designed trials in North America and Europe. Adults with idiopathic OAB for ≥6 months inadequately managed by at least one anticholinergic were randomized 1:1 or 2:1 to receive onabotulinumtoxinA 100 U or matched placebo in Cycle 1 and could request open-label retreatment with onabotulinumtoxinA 100 U at ≥12 weeks. Efficacy outcomes at Week 12 included the primary endpoint of mean urinary incontinence (UI) episodes per day and other variables, such as the proportion of patients with ≥50% reduction in daily UI episodes. Safety was assessed by monitoring treatment-emergent adverse events (TEAEs). Analyses by sex were descriptive. Males were further analyzed by benign prostatic hyperplasia (BPH) diagnosis status. In the pooled population (N = 1564), there were 194 males (12.4%) and 1370 females (87.6%). Mean number of baseline UI episodes per day was 4.9 in males and 5.5 in females. At Week 12, numerically greater mean reductions from baseline in number of daily UI episodes were observed with the onabotulinumtoxinA 100 U group (females: -3.0; males: -2.2) versus placebo (females: -1.1; males: -1.3). Achievement of ≥50% reduction in daily UI episodes was numerically greater with onabotulinumtoxinA 100 U (females: 64.8%; males: 61.2%) versus placebo (females: 30.6%; males: 44.8%), and numerically higher in males without BPH (onabotulinumtoxinA: 65.1%; placebo: 50.9%) versus with BPH (onabotulinumtoxinA: 54.3%; placebo: 36.6%). A total of 34.7% of males and 39.4% of females experienced at least one TEAE in the first 12 weeks during treatment Cycle 1. Urinary tract infection rate was 13.1% in females and 4.2% in males; incidence of hematuria was 6.8% in males and 1.1% in females. Incidence of urinary retention (defined as incomplete emptying, requiring catheterization) was 2.7% in females and 4.7% in males. OnabotulinumtoxinA 100 U was efficacious and well tolerated in men and women with OAB, including in males with and without BPH. No new safety findings were identified when data were analyzed by sex.

The Investigation of Kidney Involvement in 430 Hospitalized Patients with Omicron COVID-19 in Tianjin, China

Introduction: This study evaluated the incidence, clinical characteristics, and risk factors of kidney involvement in patients with the Omicron variant infection in the post-acute treatment phase in Tianjin, China. Methods: Data were collected from 430 patients with Omicron variant infection in Tianjin, China. Demographics, comorbidities, laboratory blood tests, urinalysis, vaccination status, and COVID-19 clinical classification were assessed. Patients were grouped based on kidney involvement, and associated risk factors of kidney involvement were also investigated. Results: Asymptomatic, mild, ordinary, and severe patients with Omicron COVID-19 variant comprised 1.5%, 49.1%, 48.9%, and 0.5% of the sample population, respectively, without critical illness or death. The incidences of hematuria, proteinuria, and concurrent hematuria and proteinuria were 14.7%, 14.2%, and 5.1%, respectively. Patients with and without kidney involvement differed in age, body mass index (BMI), comorbidity, creatinine levels, estimated glomerular filtration rate, and C-reactive protein (CRP) levels. Age, hypertension, higher CRP levels, and higher BMI were linked with kidney involvement. Conclusion: The majority of the patients suffered from mild or ordinary symptoms of Omicron COVID-19 infection. The primary kidney involvement was hematuria and proteinuria. Proteinuria was significantly associated with Omicron variant infection, and patients with hypertensive comorbidity, higher CRP, and higher creatinine levels were at increased risk of proteinuria after Omicron variant infection.

Feasibilities and outcomes of patients treated with simultaneous prostate biopsy and general urological surgeries.

The present single-center retrospective clinical real-world study aimed to assess the feasibility and outcomes of patients who underwent simultaneous prostate biopsy and general urological surgeries. The medical records of 49 patients who underwent prostate biopsy and general urological surgeries simultaneously from October 2016 to June 2019 were retrospectively reviewed. Patients' outcomes were evaluated 3 days, 1 month and 6 months after biopsy. Of the 49 biopsy cases, 41 were treated by transurethral prostatectomy, two by ureteroscopic lithotripsy, two by laparoscopic renal cyst decortication, two by cystostomy and two by ureteral stent extraction. The overall detection rate of clinically significant prostate cancer was 22.4%. The rate in patients with a prostate imaging reporting and data system (PI-RADS) score of 4-5 was 100%, while in cases with a PI-RADS score of <3 it was 7.1%. Postoperative complications within 3 days included hematuria in 39 (79.6%) cases, fever in three (6.1%) cases and hematochezia in two (4.1%) cases. There was no significant difference in the incidence of hematuria between the transrectal and transperineal approaches; however, the overall incidence of complications was significantly reduced after switching from a transrectal approach to a transperineal approach. No complications were observed after 1 or 6 months. In summary, combining simultaneous prostate biopsy to general urological surgeries is a safe and feasible approach. The transperineal approach has a lower incidence of complications. This method may benefit certain patients who are concurrently undergoing general urological surgeries and are under suspicion of prostate cancer in real-world clinical practice.

Outcome of Post-resection Intravesical BCG and Mitomycin C Therapy on Non-muscle Invasive High- Grade Transitional Cell Carcinoma of Urinary Bladder

Objective: This study aimed to compare the outcome of postoperative intravesical BCG and Mitomycin C therapy on non-muscle invasive high grade superficial bladder tumor. Methods: This prospective quasi experimental study was carried out among the patients with non-muscle invasive high grade transitional cell carcinoma (TCC) of urinary bladder, who underwent complete transurethral resection of bladder tumor of primary tumor attended at the urology department of DMCH, during March 2017 to August 2019. After pre-operative evaluation and counselling, 70 patients with histologically documented high grade superficial bladder tumor were included and divided in two groups. We instilled intravesical BCG in one group and Mitomycin C (MMC) therapy in other group. The patients were followed up at 3rd ,6th , 9th , 12th and 18th month. Results: The mean age of BCG group was 55.8 years while 60.2years in MMC group with majority between 45 to 65 years (&gt;80%). Sex distribution in both groups were almost equal (p=0.062). There were equal number of TaG3 and T1G3 disease in each group (p=0.809). Local adverse reactions were significant in BCG group (p= 0.016), among them UTI, between two groups, was statistically significant (p=0.039). Incidence of hematuria (p=0.324), voiding frequency (p=0.163) and local rash (P=0.642) had no statistically significant difference. The incidence of post-instillation systemic adverse reactions between two groups were statistically significant (p=0.034). Fever (p=0.028) was significant among them. Intavesical BCG was significantly more effective than MMC in terms of disease recurrence (p=0.047) and progression (p=0.008). Conclusions: We analysed the efficacy and safety of intravesical BCG and MMC in two groups, showing that BCG was more effective in terms of disease recurrence and progression but local and systemic side effects were higher in BCG group. Bangladesh J. Urol. 2021; 24(1): 62-71

A Comparative Study of Percutaneous Nephrolithotripsy and Extracoeporeal Shockwave Lithotripsy For The Treatment of Lower Pole Kidney Stone of Size 10-20 mm

Introduction: A renal stone is commonly found at the Lower-pole of the kidney. Studies have reported various opinions about efficacy and safety of Percutaneous Nephrolithotripsy and Extracoeporeal Shockwave Lithotripsy for the treatment of lower pole stone of size 10-20 mm. &#x0D; Aims: The present study aimed to compare between Percutaneous Nephrolithotripsy and Extracoeporeal Shockwave Lithotripsy for safe and effective treatment of lower pole stone of size 10-20 mm.&#x0D; Methods: It is a prospective study conducted from December 2019 to November 2020 in the Urology Department of Nepalgunj Medical College. Total 66 patients under inclusion criteria were divided into two groups. Group I (32 patients) was allocated for patients who were treated under Percutaneous Nephrolithotripsy while Group II (34 patients) was allocated for patients who were treated with Extracoeporeal Shockwave Lithotripsy. Two groups were compared for stone free rate, retreatment rate, auxiliary treatment (%), operation time, hospital stay, haematuria, blood transfusion, obstruction and fever.&#x0D; Results: The stone free rate was significantly higher in Group I when compared to Group II. While the rate of retreatment and auxiliary treatment were significantly lower in Group I than Group II. However, mean hospital stay, mean operation time and the rate of haematuria was significantly higher in Group I when compared to group II. There were no statistically significant differences between Group I and Group II for post-operative complications such as, blood transfusion, obstruction and fever.&#x0D; Conclusion: Stone free rate was significantly higher in Group I while retreatment rate and auxiliary treatment rate were significantly higher in Group II. Therefore, Percutaneous Nephrolithotripsy is more effective for the treatment of the lower pole stone of size 10-20mm when compared to Extracoeporeal Shockwave Lithotripsy. However, duration of hospital stay and operation time were longer and incidence of haematuria was higher in Percutaneous Nephrolithotripsy than Extracoeporeal Shockwave Lithotripsy.

MO158CLINICOPATHOLOGICAL FEATURES OF COEXISTENT LIGHT CHAIN CASE NEPHROPATHY AND LIGHT CHAIN DEPOSITION DISEASE IN PATIENTS WITH NEWLY DIAGNOSED MULTIPLE MYELOMA

Abstract Background and Aims Several patients with multiple myeloma suffered from more than one type of kidney disease simultaneously, of which the most common pattern is coexistent light chain cast nephropathy and light chain deposition disease (LCCN+LCDD). We investigated clinicopathological characteristics of LCCN+LCDD in comparison with pure LCCN and pure LCDD. Method Forty-seven percent of the renal biopsies revealed a monoclonal κ light chain restriction, ranging from 31% in the pure LCCN group to 90% in the pure LCDD group. Of note, more than half of the patients with LCCN+LCDD showed λ light chain isotype, which was significantly different from patients with pure LCDD (56% vs. 10%, p = 0.033). Compared with patients with pure LCDD, patients with LCCN+LCDD usually presented atypical features of LCDD with less nodular glomerulosclerosis (p = 0.003) and less diffuse deposit distribution (p = 0.027). Compared to patients with pure LCDD, patients with LCCN+LCDD had lower hemoglobin (126.5 g/L vs. 82.0 g/L, p = 0.008), higher incidence of AKI (20% vs. 89%, p = 0.003), lower percentage of urinary albumin excretion (%UAE) (68.9% vs. 5.1%, p = 0.003). There was no significant clinical difference between patients with LCCN+LCDD and patients with pure LCCN. Compared to patients with pure LCDD, patients with pure LCCN had lower hemoglobin (126.5 g/L vs. 87.0 g/L, p = 0.001), higher incidence of AKI (20% vs. 85%, p &amp;lt; 0.001), higher incidence of hemodialysis at diagnosis (10% vs. 65%, p = 0.003), higher serum creatinine (165.8 μmol/L vs. 627.0 μmol/L, p = 0.02) and lower incidence of hematuria (6/10 vs. 4/26, p = 0.035). Results Forty-seven percent of the renal biopsies revealed a monoclonal κ light chain restriction, ranging from 31% in the pure LCCN group to 90% in the pure LCDD group. Of note, more than half of the patients with LCCN+LCDD showed λ light chain isotype, which was significantly different from patients with pure LCDD (56% vs. 10%, p = 0.033). Compared with patients with pure LCDD, patients with LCCN+LCDD usually presented atypical features of LCDD with less nodular glomerulosclerosis (p = 0.003) and less diffuse deposit distribution (p = 0.027). Compared to patients with pure LCDD, patients with LCCN+LCDD had lower hemoglobin (126.5 g/L vs. 82.0 g/L, p = 0.008), higher incidence of AKI (20% vs. 89%, p = 0.003), lower percentage of urinary albumin excretion (%UAE) (68.9% vs. 5.1%, p = 0.003). There was no significant clinical difference between patients with LCCN+LCDD and patients with pure LCCN. Compared to patients with pure LCDD, patients with pure LCCN had lower hemoglobin (126.5 g/L vs. 87.0 g/L, p = 0.001), higher incidence of AKI (20% vs. 85%, p &amp;lt; 0.001), higher incidence of hemodialysis at diagnosis (10% vs. 65%, p = 0.003), higher serum creatinine (165.8 μmol/L vs. 627.0 μmol/L, p = 0.02) and lower incidence of hematuria (6/10 vs. 4/26, p = 0.035). Conclusion Pathologically, patients with LCCN+LCDD were more likely to have λ light chain isotype and presented atypical features of LCDD including less nodular glomerulosclerosis and less deposit distribution than patients with pure LCDD. In clinical characteristics, patients with LCCN+LCDD and patients with pure LCCN shared similar features. For patients with LCCD, especially those with λ restriction, nephrologists should carefully evaluate the kidney specimens to exclude the possibility of combined LCCN.

“Functional outcome in pediatric grade IV renal injuries following blunt abdominal trauma salvaged with minimally invasive interventions”

Non-operative management of higher-grade renal injuries has gradually become accepted in pediatric circles following multiple studies over the past decade which showed good renal salvage rates. However, some children do fail this conservative approach and need interventions which are mostly minimally invasive. There is still paucity of studies on the functional outcomes in this unique subgroup of patients. In this study, we review our management and functional outcome of children with grade IV renal injury due to blunt trauma of abdomen managed with minimally invasive interventions (MII) in a tertiary referral center. The present study seeks to summarize contemporary management of pediatric grade IV renal injury due to blunt trauma at our tertiary care center and to assess the functional outcomes in the subgroup who needed MII. A retrospective review was performed on children≤18 years with abdominal blunt trauma managed at our tertiary care facility over the past 10 years (January 2008-January 2018) to identify those with grade IV renal injuries. Data collected included demographic data like age, sex, mechanism of injury, incidence of hematuria, incidence of pre-existing urologic conditions, associated non-renal injuries, transfusion requirements, imaging findings, type of interventions, length of hospital stay, complications and outcomes on follow up. Review of our institutional database identified 10 children with grade IV renal injury. Mean age was 11.7±3.6 years (range, 6-18) and majority (6/10) were male. Motor vehicle collision and fall from heights were the commonest mechanisms of injury. While one patient responded to non-operative management, one girl needed emergency renal exploration and later nephrectomy. Eight needed minimally invasive interventions following initial non-operative management. One patient needed nephrectomy due to delayed hemorrhage while three patients needed delayed open reconstruction. The salvage rate in the group which needed interventions was 87.5% (7 of 8) however, the functional outcome was good only in 50% (4 of 8) of patients. The outcomes were better in those who were managed with MII earlier (3/4) compared to those who underwent delayed intervention (1/4). The median hospital stay was 11.5 days (range 7-34 days). Pediatric patients with non-exsanguinating grade IV renal injuries due to blunt trauma who fail non-operative management and need minimal invasive interventions have good renal salvage rates however, the functional outcomes are poorer. Judicious and early use of these minimally invasive interventions, instead of persisting with non-operative management can possibly improve these functional outcomes.

P0371DENTAL CARIES INDUCED BY CNM-POSITIVE STREPTOCOCCUS MUTANS DERIVED FROM IGA NEPHROPATHY PATIETNS IN RATS INDUCED GLOPERULONEPHRITIS LIKE IGA NEPHROPATHY

Abstract Background and Aims IgA nephropathy (IgAN) is one of most common primary glomerulonephritis, whose pathogenesis had remained unclear. We had reported that Cnm-(+)Streptococcus mutans, a kinds of major dental caries bacteria. Cnm-(+)S. mutans had strong collagen binding ability, resulting in high pathogenicity. We reported that the prevalence of Cnm-(+)S. mutans in IgA nephropathy is significantly higher than that in control (Misaki-T et al, Clin Exp Nephrol 2015; 19:844-50), and that Cnm-(+)S. mutans in IgA nephropathy was associated with proteinuria (Misaki-T et al, Sci Rep 2016). We also reported C.rectus and S. mutans increased proteinuria synergistically (Misaki-T et al, Nephron, 2018). In this point, there is no direct evidence that Cnm-(+)S. mutans could induce IgA nephropathy. In this study, we evaluated the renal lesions in rats which had dental caries induced by Cnm-(+)S. mutans derived from IgA nephropathy patient to confirm the pathogenesis of IgA nephropathy like lesions induced by Cnm-(+)S mutans. Method Cmn-(+)S. mutans from saliva of IgA nephropathy patients was orally administrated into 4 weeks old male Sprague-Dawley rats. Addition of sugar to water had been kept during study period to develop dental carits. At week 34 after the infection, blood, urine, and kidney samples were evaluated. Kidney samples were stained by Periodic Acid-Schiff (PAS), IgA, C3. Historical evaluation by electron microscope analysis was also performed. Results At week 34, plaque score and dental caries score in infectious rats significantly elevated, compared with control rats (P&amp;lt;0.001) (Figure 1). These findings suggested Cmn-(+)S. mutans from IgA nephropathy patients induced dental caries in rats. PAS staining revealed the significant mesangial proliferation. At week 34, the prevalence of IgA deposition in infections rats was higher than that in control rats (52.4% vs 4%), and the prevalence of C3 deposition in infectious rats was also higher than that in control rats (42% vs 11%) (Figure 2). Incidence of hematuria was also significantly higher in dental caries group than control. Electron microscopy analysis revealed high dense deposit in mesangial areas. Conclusion Cmn-(+)S. mutans from saliva of IgA nephropathy patients could induce IgA-dominant infection-associated glomerulonephritis, or IgA nephropathy.

Endovascular mechanical thrombectomy versus thrombolysis in patients with iliofemoral deep vein thrombosis - a systematic review and meta-analysis.

Background: This study sought to compare effectiveness and safety of percutaneous mechanical thrombectomy (PMT) and thrombolysis alone (THR) in patients with acute or subacute iliofemoral deep vein thrombosis (IfDVT). Patients and methods: Observational and randomized trials, published between January 2001 to February 2019 were identified by searching MEDLINE. Studies on deep venous thrombosis (DVT) treated with either THR or PMT adjunctive to conventional anticoagulation and compressive intervention were included. Meta-analysis of proportions was conducted to assess effectiveness outcomes of successful lysis and primary patency, post-thrombotic syndrome (PTS), valvular reflux, recurrent DVT, as well as safety outcomes of major bleeding, hematuria, and pulmonary embolism. Results: Of 77 identified records, 17 studies including 1417 patients were eligible. Pooled proportion of successful lysis was similar between groups (THR: 95% [I2=68.4%], PMT 96%, [I2=0%]; Qbet [Cochran's Q between groups] 0.3, p=0.61). However, pooled proportion of 6-month primary patency was lower after THR than after PMT (68% [I2=15.6%] versus 94%; Qbet 26.4, p<0.001). Considerable heterogeneity within groups did not allow for between-group comparison of PTS and recurrent DVT. Major bleeding was more frequent after THR than after PMT (6.0% [I2=0%] versus 1.0% [I2=0%]; Qbet 12.3, p<0.001). Incidence of hematuria was lower after THR as compared to PMT (2% [I2=56%] versus 91.3% [I2=91.7%]; Qbet 714, p<0.001). Incidences of valvular reflux and pulmonary embolism were similar across groups (THR: 61% versus PMT: 53%; Qbet 0.7, p=0.39 and THR: 2% versus PMT: 1%; Qbet 1.1, p=0.30, respectively). Conclusions: In patients with iliofemoral DVT, percutaneous mechanical thrombectomy was associated with a higher cumulative 6-month primary patency and a lower incidence of major bleeding compared to thrombolysis alone. Risk of hemolysis from mechanical thrombectomy needs further consideration.

Therapeutic effect of RIRS combined with acupoint stimulation on upper urinary calculi

Objective To explore the clinical effect of retrograde intrarenal surgery (RIRS) combined with acupoint stimulation in the treatment of upper urinary calculi. Methods A total of 138 cases of upper urinary calculi with RIRS in our hospital from October 2016 to August 2017 were selected. The patients were randomly divided into two groups: treatment group (RIRS combined with acupoint stimulation) and control group (RIRS). Double foot-Sanyinjiao, double elbow-Quchi, double knee-Zusanli, double above the ankle-Sanyinjiao were selected. The time of acupoint stimulation was selected first day after the operation, and 2 acupoint treatments were performed daily for 5-day. The postoperative complications were evaluated at 4 week after operation. At the 1 week, 2 weeks, 4 weeks and 6 weeks after operation, KUB, Doppler ultrasound or CT examination of urinary system were performed to observe the stone free rate (SFR). Results SFR in the treatment group was higher than that of the control group after the operation (P<0.05). The incidence of hematuria and the number of nocturia in the treatment group were lower than control group in eraly time of postoperation (P<0.05). Conclusions RIRS combined with acupoint stimulation can improve the SFR and reduce compications. Key words: Urinary Calculi; Ureteroscopes; Acupressure

Serum IgA/C3 and glomerular C3 staining predict severity of IgA nephropathy.

The aim of this study was to determine whether serum immunoglobulin A/complement factor 3 (IgA/C3) ratio and glomerular C3 staining predict outcome in IgA nephropathy. We collected data for 44 IgA nephropathy children treated with multi-drug combination therapy. The children were retrospectively divided into four groups based on serum IgA/C3 ratio and glomerular C3 staining: group A, IgA/C3 ratio >2.68 (median) and glomerular C3 staining ≥2.0, n=9; group B, IgA/C3 ratio >2.68 and glomerular C3 staining <2.0, n=7; group C, IgA/C3 ratio <2.68 and glomerular C3 staining ≥2.0, n=7; and group D, IgA/C3 ratio <2.68 and glomerular C3 staining <2.0, n=21. Clinical features; pathology at the first and second renal biopsy and at the latest follow up; and prognosis were analyzed for the four groups. At the most recent follow up, urinary protein excretion, incidence of hematuria, and serum creatinine in group A were all higher than in group D. At the second biopsy, crescent absence/presence ratio; mesangial hypercellularity, segmental glomerulosclerosis or adhesion, endocapillary hypercellularity, and tubular atrophy/interstitial fibrosis as well as crescents and global glomerulosclerosis (MESTCG) score; and clonicity index in group A were higher than in group D. All patients in group D had normal urine, and the prevalence of persistent nephropathy in group A was higher than in group D. Serum IgA/C3 ratio and glomerular C3 staining can predict outcome in IgA nephropathy.

Study on Chemical Composition of Urinary and Salivary Gland Stones in Relationship with Laboratory Parameters and Lifestyle Habits of Patients with Lithiasis

Lithiasis is a disease with increasing incidence, may occur in the urinary tract, salivary glands and bile ducts. Genetic susceptibility, diet, low fluid intake, endocrine disorders, infections and other factors can influence the development of the disease and its recurrences. The aim of the study was to reveal the relationship between chemical composition of the stones, lifestyle and dietary habits and the results of laboratory analysis in patients with urinary tract and salivary gland lithiasis. The data of 258 patients with urinary tract and salivary gland lithiasis collected between September 2009 � May 2016 were studied. The subjects were from the Urology and Oral Surgery Hospital, and from the Marmed and Procardia medical units in Tirgu Mures. We evaluated the lifestyle habits using a questionnaire, microscopical examination, size measurement and chemical analysis of the stones were made and we processed the results of urinary strip analysis and sediment. In a subgroup of patients (48 samples) calciuria, phosphaturia, serum uric acid, calcium, phosphate, alkaline phosphatase and parathormone (PTH) levels were determined; in case of pathological values calcitonin measurement and endocrinology consultation were performed. The most frequent composition was the combination of calcium oxalate and phosphate in case of both urinary and salivary gland stones, in several uroliths we detected uric acid/xanthine crystals, rarely cystine and carbonate were found. The incidence of hematuria and leukocyturia exceeded 70%. Excessive calcium intake was observed in the diet of the several patients having calcium oxalate stones. In the subgroup tested for biochemical and hormonal analyses we found increased serum PTH concentration in 20.83% of the patients. Some of the subjects had pathological serum calcium, uric acid and alkaline phosphatase results, or the elimination of minerals in the urine was out of the normal range. We found pathological laboratory results in several patients suffering from lithiasis. Proper diet and medical treatment in many cases could prevent the recurrences of stone formation, but first a complex investigation of the patients is necessary to adapt the treatment plan to individual requirements.

Meta-Analysis of Stenting versus Non-Stenting for the Treatment of Ureteral Stones.

Background and aimUreteroscopic lithotripsy (URL) and extracorporeal shock wave lithotripsy (ESWL) are two widely used methods for the treatment of ureteral stones. The need for ureteral stenting during these procedures is controversial. In this meta-analysis, we evaluated the benefits and disadvantages of ureteral stents for the treatment of ureteral stones.MethodsDatabases including PubMed, Embase and Cochrane library were selected for systematic review of randomized controlled trials (RCTs) comparing outcomes with or without stenting during URL and ESWL. Meta-analysis was performed using RevMan 5.3 and STATA 13.0 software.ResultsWe identified 22 RCTs comparing stenting and non-stenting. The stented group was associated with longer operation time (WMD: 4.93; 95% CI: 2.07 to 7.84; p < 0.001), lower stone-free rate (OR: 0.55; 95% CI: 0.34 to 0.89; p = 0.01). In terms of complications, the incidence of hematuria (OR: 3.68; 95% CI: 1.86 to 7.29; p < 0.001), irritative urinary symptoms (OR: 4.40; 95% CI: 2.19 to 9.10; p < 0.001), urinary infection (OR: 2.23; 95% CI: 1.57 to 3.19; p < 0.001), and dysuria (OR: 3.90; 95% CI: 2.51 to 6.07; p < 0.001) were significantly higher in the stented group. No significant differences in visual analogue score (VAS), stricture formation, fever, or hospital stay were found between stenting and non-stenting groups. The risk of unplanned readmissions (OR: 0.63; 95% CI: 0.41 to 0.97; p = 0.04) was higher in the non-stented group.ConclusionsOur analysis showed that stenting failed to improve the stone-free rate, and instead, it resulted in additional complications. However, ureteral stents are valuable in preventing unplanned re-hospitalization. Additional randomized controlled trials are still required to corroborate our findings.

Long-term follow up of pediatric immunoglobulin A nephropathy treated with tonsillectomy plus methylprednisolone pulse therapy.

The aim of this study was to clarify the long-term efficacy of tonsillectomy plus methylprednisolone pulse therapy (tonsillectomy pulse therapy [TMP]) for pediatric immunoglobulin A nephropathy (IgAN). The clinical and laboratory findings as well as the prognosis for IgAN treated with TMP at long-term follow up were evaluated. We collected data on 33 IgAN children treated with TMP. The children were retrospectively divided into two groups. Group 1 consisted of 18 children treated with TMP as the initial therapy, and group 2 consisted of 15 children treated with TMP as rescue therapy for IgAN relapse. The clinical features, and laboratory and pathological findings, including those at first and second renal biopsy as well as at the latest follow up, were analyzed for both groups. Mean urinary protein excretion, incidence of hematuria, and serum creatinine in groups 1 and 2 were all decreased significantly after TMP compared with beforehand. The percentage of glomeruli showing crescents after TMP in groups 1 and 2 was significantly lower than before TMP. At the most recent follow up, 94% of patients in group 1 and 87% in group 2 had normal urine, 6% in group 1 and 13% in group 2 had minor urinary abnormalities, and no patients in either group had active renal disease or renal insufficiency. TMP is effective in ameliorating urinary abnormalities and improving the long-term outcome of pediatric IgAN both as an initial and as a rescue treatment.

Livestock diseases in sub-Himalayan temperate region: A Garrett’s ranking analysis

Fifteen clusters of villages were identified and selected for the purpose of study. In general, these villages are located at 32.6°N (latitude); 76.3°E (longitude); 1,290.8 m (altitude). The area is characterized by mild summer and moderate to severe winter having the mean monthly minimum temperature varying from 5.0±0.9 °C in January to 20.4±1.2 °C in June. Garett’s ranking technique was followed to analyse the particular problem or disease perceived by the farmers as well as identify by the multidiscipline teams in livestock. In cattle, highest incidence of haematuria (16.74%) was recorded followed by repeat breeding (14.97%). Whereas in case of buffalo emaciation / weakness (17.24%), GI parasitic infections (16.09%), and tick/ lice infestation (16.09%) were the major problems. Parasitic infections (36.84%), diarrhoea/ dysentery (31.57%) and tick / lice infestation (14.03%) were recorded as major problem in goats. The major disease/ disorder observed in bullocks were haematuria (28.23%), urinary problem (24.70%) and parasitic infestation (16.47 %). In the horse/ ponies parasitic infestation (37.93%) followed by weakness (24.13%) and tick/ lice infestation (17.24%) and parasitic infections (31.81%) followed by mange (27.27%) were the major health problem in the pet’s animals. The study enlighted the animal health scenario in the region.

Relationship between genotypes and clinical manifestation, pathology, and cccDNA in Chinese children with hepatitis B virus-associated glomerulonephritis.

Hepatitis B virus-associated glomerulonephritis (HBV-GN) is one of the extrahepatic manifestations after HBV infection, which would cause great clinical harm to people. The present study was undertaken to investigate the HBV-GN genotypes and its clinical relevance in Chinese children. A total of 41 HBV-infected children diagnosed with HBV-GN were enrolled in the study. All patients underwent liver and kidney biopsy. The genotypes and cccDNA were detected in their serum samples to analyze the relationship between HBV genotypes and clinical characteristics, cccDNA, and pathology. Among the 41 children with HBV-GN, 29 (70.7%) had genotype C, 10 (24.4%) had genotype B, 2 (4.9%) had genotype B/C, and none of them had genotype non-B/C. Most children had genotypes B or C; moreover, the genotype C was the most frequent one. The incidence of hematuria and albuminuria, reduction in complement C3, increase in serum alanine aminotransferase levels and renal insufficiency in the children with genotype C were significantly higher than those in the children with genotype B (P<0.05); however, there was no statistically significant difference in hypertension and hepatomegaly (P>0.05). The frequency of HBV cccDNA positive in the genotype C group was significantly higher than that in the genotype B group (72.4% vs. 30.0%, P<0.05). No difference was observed in hepatic inflammation grades and stages of fibrosis between the two groups (P>0.05). Genotype C was the most frequent genotype in the described group of patients with HBV-GN, and the liver and kidney damage indicators were more likely to occur in patients with genotype C.

Differences in clinical findings, pathology, and outcomes between C3 glomerulonephritis and membranoproliferative glomerulonephritis.

To clarify the clinical manifestations of pediatric complement component C3 glomerulonephritis (C3GN), we retrospectively evaluated differences in the clinicopathological findings and prognosis between C3GN and immune-complex-mediated membranoproliferative glomerulonephritis (IC-MPGN). Thirty-seven patients diagnosed with "idiopathic MPGN" were enrolled in this retrospective study. The patients were divided into two groups, with Group 1 consisting of 19 patients diagnosed with IC-MPGN and Group 2 consisting of 18 patients diagnosed with C3GN. The clinical findings and the prognosis were investigated for both groups. Thirteen patients in Group 2 were identified by mandatory annual school screening for urinary abnormalities. The incidence of macro-hematuria and the frequency of low serum C4 values were lower in Group 2 patients than in Group 1 patients. At the time of the second renal biopsy, urinary protein excretion, incidence of hematuria, frequency of low serum C3 values, and scores for mesangial proliferation, glomerular sclerosis, and interstitial fibrosis were higher in Group 2 patients than in Group 1 patients. At the most recent follow-up examination, the number of patients categorized as non-responding or with end-stage renal disease was higher in Group 2 patients than in Group 1 patients. Our results suggest that the treatment response and prognosis of patients with C3GN are worse than those of patients with IC-mediated MPGN. Therefore, in the clinical context regarding treatment options and prognosis, it may be useful to classify idiopathic MPGN as C3GN or IC-MPGN. In addition, long-term follow-up of C3GN is necessary.

Magnetic resonance imaging-guided focal laser ablation for prostate cancer: A phase I trial.

e16128 Background: The majority of patients with low risk prostate cancer (CaP) harbor indolent disease and maybe safely observed on active surveillance (AS). However more than 30% of those on AS will ultimately receive definitive treatment. Focal therapy offers a treatment alternative that may provide oncologic control while avoiding treatment-related morbidity. The objective of this study was to determine the safety and feasibility of magnetic resonance (MR) image-guided focal laser ablation (FLA) of biopsy confirmed and MR visible prostate cancer. Methods: MR image-guided FLA was performed for men with Gleason < 7(3+4) when < 3 cores were positive in a standard 12 core biopsy corresponding to locations of MR lesions, or < 4 cores positive on MR image-guided biopsy. MR localization of biopsy-positive lesions were targeted via a transperineal approach and treated with a laser thermal ablation system. Validated quality of life questionnaires were completed pre-procedure and at each subsequent followup visit. MR-imaging was performed at 6 and 12 month followup with repeat fusion-guided biopsy perfomed at 12 months post-procedure. Results: 15 patients were treated with a mean preoperative PSA of 7.04 (Table 1). 14 patients had complete 1 year followup of which 6 patients had Gleason 6 and 8 patients had Gleason 6 disease. Mean operative time was 3.8 hours per treatment session for 1 lesion ablated. The mean (±Std Dev) IPSS and SHIM scores were 6.5±4.1 and 18.9±6.9 respectively, with no significant differences in SHIM or IPSS at 12 month followup. PSA was significantly lower at 1 year followup versus preoperatively (7.0 vs. 4.5, P = 0.0007).Five Grade 1 adverse events (AEs) were note in 4 patients, consisting of 4 incidences of hematuria and a pressure blister. Grade 2 AEs consisted of a UTI and epididymitis, one of which was unrelated to the procedure. Gleason 6 prostate cancer was identified in 2 prior treated lesions at repeat biopsy, of which 1 was observed and 1 underwent radical prostatectomy. Conclusions: MR-image guided FLA is safe and feasible for men with low risk CaP with acceptable oncologic outcomes at 1 year followup. Focal therapy is a promising alternate treatment that allows for preservation of functional outcomes. Clinical trial information: NCI-11-C-0158.