Large Kidney Research Articles

Prenatal Ultrasound Diagnostics of Autosomal Recessive Polycystic Kidney Disease in Fetus: Clinical Case

Background. Autosomal recessive polycystic kidney disease is a rare congenital anomaly with poor prognosis. It characterized by the development of cysts in kidneys parenchyma, secondary dilatation, and hyperplasia of normally formed collecting tube in kidneys.Clinical case description. Autosomal recessive polycystic kidney disease was diagnosed in the fetus via ultrasound in the third trimester of pregnancy, signs of “large hyperechogenic kidneys” were revealed. The fetal kidneys were significantly enlarged, the parenchyma was thickened, and there was no cortico-medullary differentiation. The renal pelvises and bladder were identified. Amniotic fluid volume was normal. The ultrasound diagnosis was confirmed with magnetic resonance imaging. Female child born at full term, weight — 4500 grams, she was discharged home in satisfactory condition. At the age of 7 months, child physical development corresponds to her age. Ultrasound examination shows the persistence of pronounced increase in the size of kidneys, parenchyma thickening and no cortico-medullary differentiation. The renal pelvises and bladder are not dilatated. Urine analysis results: epithelia in large quantities, single leukocytes and isomorphic erythrocytes, as well as protein of 0.066 g/l. Blood creatinine and blood urea were within normal ranges.Conclusion. Amniotic fluid volume and presence of urine in the bladder are the most important characteristics of the kidney functioning in case of antenatal ultrasound signs of autosomal recessive polycystic kidney disease. The absence of amniotic fluid at visualization of “large hyperechogenic kidneys” is considered as poor prognostic feature. MRI is crucial to clarify the diagnosis of autosomal recessive polycystic kidney disease and allows adequately estimate the amniotic fluid volume in the third trimester of pregnancy.

Влияние эндовидеоскопических операций при нефролитиазе на функциональное состояние почек

Introduction. In recent years, there has been a persistent trend towards an increase in the incidence of urolithiasis. The treatment of large and complex kidney stones greatest difficulty is one of the challenges. Such stones, as well as surgical methods of their removal, can have an adverse effect on the functional state of the kidneys, which confers a significant medical, social and economic problem. The purpose of this study is to identify factors affecting the functional state of the kidneys in the postoperative period when using various video endoscopic methods of surgical treatment of patients with large and complex kidney stones. Materials and methods. We analyzed the results of treatment of 97 patients with large and complex kidney stones. Depending on the treatment, all these patients were divided into three groups: 1st – 44 (45,36%) patients who underwent percutaneous nephrolithotripsy in prone position, 2nd – 29 (29,9%) patients who underwent percutaneous nephrolithotripsy in the supine position, 3rd – 24 (24,74%) of the patient who underwent pyelolithotomy with laparoscopic and retroperitoneoscopic approaches. Assessment of the area and density of stones was performed by computed tomography. The glomerular filtration rate (GFR) was calculated by CKD-PI formula and dynamic nephroscintigraphy was used to assess of each kidney function. Results. In the postoperative period, the decrease in GFR was most pronounced in the group of patients after percutaneous nephrolithotripsy in the supine position. Among the most significant factors worsening this indicator were the volume of intraoperative (r=0,410, p<0,001, n=97) and postoperative blood loss (r=0,294, p <0.01, n=97), duration of surgery (r=0,187, p <0,1, n=97), density (r=0,426, p <0,001, n=97) and the area (r=0,554, p <0,001, n=97) of the concretion, as well as the body mass index (r=0,294, p <0,01, n=97). Conclusions. The most significant factors that have a negative impact on the functional state of the kidneys were the density and area of the stone, the patient's body mass index and the volume of intraoperative blood loss. The least deterioration of kidney function in the postoperative period was observed with endoscopic pyelolithotomy, and the greatest – with percutaneous nephrolithotripsy in the patient's back position.

Deletion of the Natural Killer Cell Receptor NKG2C Encoding KLR2C Gene and Kidney Transplant Outcome.

Natural killer (NK) cells may contribute to antibody-mediated rejection (ABMR) of renal allografts. The role of distinct NK cell subsets in this specific context, such as NK cells expressing the activating receptor NKG2C, is unknown. Our aim was to investigate whether KLRC2 gene deletion variants which determine NKG2C expression affect the pathogenicity of donor-specific antibodies (DSA) and, if so, influence long-term graft survival. We genotyped the KLRC2 wt/del variants for two distinct kidney transplant cohorts, (i) a cross-sectional cohort of 86 recipients who, on the basis of a positive post-transplant DSA result, all underwent allograft biopsies, and (ii) 1,860 recipients of a deceased donor renal allograft randomly selected from the Collaborative Transplant Study (CTS) database. In the DSA+ patient cohort, KLRC2 wt/wt (80%) was associated with antibody-mediated rejection (ABMR; 65% versus 29% among KLRC2 wt/del subjects; P=0.012), microvascular inflammation [MVI; median g+ptc score: 2 (interquartile range: 0-4) versus 0 (0-1), P=0.002], a molecular classifier of ABMR [0.41 (0.14-0.72) versus 0.10 (0.07-0.27), P=0.001], and elevated NK cell-related transcripts (P=0.017). In combined analyses of KLRC2 variants and a functional polymorphism in the Fc gamma receptor IIIA gene (FCGR3A-V/F158), ABMR rates and activity gradually increased with the number of risk genotypes. In DSA+ and CTS cohorts, however, the KLRC2 wt/wt variant did not impact long-term death-censored graft survival, also when combined with the FCGR3A-V158 risk variant. KLRC2 wt/wt may be associated with DSA-triggered MVI and ABMR-associated gene expression patterns, but the findings observed in a highly selected cohort of DSA+ patients did not translate into meaningful graft survival differences in a large multicenter kidney transplant cohort not selected for HLA sensitization.

Ureterorenoscopic Lithotripsy for Pediatric Kidney Stones Using Holmium:Yttrium-Aluminum-Garnet Laser Devices: 15 W vs 30 W.

Introduction: We aimed to compare the effectiveness of 15- and 30-W holmium:yttrium-aluminum-garnet (Ho:YAG) laser devices used in the treatment of pediatric kidney stones. Methods: Eighty-six consecutive pediatric patients who underwent retrograde intrarenal surgery (RIRS) between February 2010 and August 2020 were enrolled in the study. After exclusion criteria were applied, the data of 79 children were evaluated retrospectively. Patients were divided into two groups according to the laser device power of 15 W (Group 15: N = 30) and 30 W (Group 30: N = 49). The groups were compared according to demographic characteristics, stone feature, and clinical efficacy. Results: The age, gender, height, weight, and stone characteristics were similar between the groups. The mean operation time was shorter in Group 30. The stone-free rate after the first RIRS session (SF1) was 66.7% in Group 15 and 83.3% in Group 30. The SF1 for 20-mm or larger kidney stones was found to be 0% in Group 15 and 62.5% in Group 30. However, there was no statistically significant difference between the two groups in terms of stone-free rate. Conclusions: In pediatric kidney stone treatment, 30-W Ho:YAG laser devices should be preferred as they shorten the operation time compared with 15-W devices and provide the final stone-free status with fewer procedures, especially in large kidney stones.

Evolutionary profile of pyonephrosis after surgical treatment, about 23 cases

ObjectivesTo describe the evolving profile of pyonephrosis after surgical treatment, identifying their epidemiological, clinical, paraclinical, and therapeutic aspects. Materials and methodsDescriptive retrospective study spread over a period of 5 years (2015–2019) including patients with pyonephrosis in the urology department. Results23 cases of pyonephrosis were collected. The average age of patients was 49 years (27–71 years), with male predominance (69.56%). It was found that the main element of the patient's medical history was urolithiasis (57%). Lower back pain is the main sign found in (96%) of cases, followed by infectious agents found in (42%) and a large kidney (21%). Renal ultrasound allowed us to evoke the diagnosis in 41% of cases and urine CT scan confirmed diagnosis in the majority of cases. The etiology was lithiasis in 78.26% of cases. Cytobacteriological urine examination (CEBU) isolated germs in 15 patients (65.21%) predominance of Escherichia coli in 7 cases (30.43%). The treatment included a nephrectomy preceded by a Subcutaneous nephrovesical bypass in 21 patients. The outcome was reassuring in 70.7% of cases, the main complications were parietal suppuration (30.43%), followed by chronic kidney failure (8.69%), enteroenteric fistula (4.34%), and digestive fistula (4.34%). The mortality was (8.69%). ConclusionPyonephrosis is a condition that is becoming increasingly rare. The reduction of its incidence may be related to recent advances in medical imaging which allow early diagnosis of causative conditions and their treatment.

Meta-Analysis of Laparoscopic Pyelolithotomy versus Percutaneous Nephrolithotomy as a Treatment of Large Kidney Stones

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Recurrent deep venous thrombosis of lower extremities as a result of compression of large horseshoe kidney cysts in double inferior vena cava - Successfully treatment with sclerotherapy.

Horseshoe kidney is a well-known congenital anomaly and the most common anomaly of the upper urinary tract. This condition is rarely associated with anomalous inferior vena cava (IVC). Polycystic horseshoe kidney is a very rare occurrence and however IVC anomalies common with polycistic disease are an increasingly recognized risk factor for iliofemoral deep venous thrombosis. We present a case of 75-year-old patient with recurrent deep vein thrombosis (DVT) of right leg as a result of compression of large horseshoe kidney cysts in double inferior vena cava. Large renal cyst were successful treated percutaneously punctured for the relief of compression and received injection of acidic solutions of 95% ethanol under ultrasound guidance for prevention against re-accumulation of cyst fluid. Percutaneous aspiration with ultrasound guidance with injection of sclerosing solutions as a relatively simple procedure and can be the method of choice for treatment of renal cysts. Also, any recurrent deep vein thrombosis on lower extremity requires additional evaluation in the form of an ultrasound or multidetector computed tomography examination of the abdomen.

Is Guy’s stone score useful for predicting outcomes in percutaneous nephrolithotomy?

IntroductionPercutaneous Nephrolithotomy (PCNL) is currently the treatment of choice in large kidney stones. Guy’s stone score was developed to predict treatment outcomes. The aim of this study was to evaluate the relationship between Guy’s score and outcomes in our institution. Materials and MethodsThe medical records of patients diagnosed with urolithiasis and treated by PCNL were retrospectively evaluated between January 2017 and December 2018. Analyzed data included: age, sex, Guy's score based on preoperative findings, transfusion, stone-free rate and requirement of auxiliary procedures. Chi-square test was used for the comparison of proportions. Odds ratios (OR) with confidence intervals (CIs) of 95% were calculated by logistic regression. ResultsA total of 386 patients, 53.89% female, mean age of 45.59 ± 15 years were analyzed. Guy’s score was as follows: 112 patients (29.04%) were classified as Guy I, 92 patients (23.82%) as Guy II, 94 patients (24.34%) as Guy III, and 88 patients (22.80%) as Guy IV. There were no differences between groups in terms of blood transfusions. Stone-free rate was 96.43% (n = 108) for patients Guy I; 84.78% (n = 72) for Guy II; 76.59% (n = 72) for Guy III and 50% (n = 44) for Guy IV categories (p < 0.0001). Taking as a reference Guy I group, the OR to require new treatment for residual stones were: Guy II 4.85 (CI = 0.95 to 24.60, P = 0.05) to Guy III 8.25 (CI = 1.73 to 39.44, P = 0.008) and Guy IV 27 (CI = 5.84 to 124.70; p < 0.0001). ConclusionThere was a statistically significant association between Guy’s Score and stone-free rates following PCNL. Guy’s score was useful to predict results of PCNL in our group.

The ameliorative efficacy of Thymus vulgaris essential oil against Escherichia coli O157:H7-induced hematological alterations, hepatorenal dysfunction and immune-inflammatory disturbances in experimentally infected rats.

The purpose of the present study was to evaluate the possible ameliorative role of Thymus vulgaris (T. vulgaris) essential oil against Escherichia coli O157:H7 (E. coli O157:H7) deleterious effects in both blood and different tissues of rats by assessing the hematological, biochemical and immune-inflammatory parameters besides the histopathological alterations in the different organs. Forty male rats were randomly divided into four equal groups as follows: group I served as control, group II orally inoculated with E. coli O157:H7 at a dose of 1.0 × 109cfu/ml, group III orally received 250mg/kg BW T. vulgaris oil daily for 7days and group IV orally inoculated with E. coli O157:H7 as the same dose of group II and orally received T. vulgaris oil as the same dose and duration of group III. Bacterial challenge in groups II and IV was once at the beginning of experiment and administration of oil began after 72h from bacterial inoculation. At the end of the study, blood was sampled and complete blood picture, liver and kidney function alongside immunoglobulins and cytokines concentrations were estimated and tissues of large intestine (colon), liver and kidneys were collected for histopathological examinations. The results revealed that there was an increase of red blood cells count, hematocrit value and hemoglobin concentration besides white blood cells and thrombocytes counts and substantial increment of serum markers of hepatorenal damage such as the activities of transaminases and concentrations of bilirubin (total, direct and indirect), total proteins, albumin, creatinine and urea in E. coli O157:H7-challenged group. Also, there was a considerable increase in serum immunoglobulins M and G, interleukin 6 and 8 and tumor necrosis factor alpha as well as decreased serum alkaline phosphatase activity. Moreover, T. vulgaris oil could partially improve the hematological, biochemical and histopathological alterations induced by E. coli O157:H7 without any significant alterations in all measured parameters when used alone. The study concluded that the T. vulgaris oil relatively diminished the alterations in hematological parameters, hepatic and renal function markers and immune-inflammatory variables alongside the histopathological changes in different organs induced by E. coli O157:H7. The ameliorative effects of T. vulgaris oil are mediated through its anti-inflammatory, antioxidant and immunomodulatory activities.

Electrolyte Abnormalities in a Man With Plasma Cell Leukemia

A 77-year-old man with a history of cardiac transplantation and pulmonary tuberculosis was admitted for initiation of chemotherapy for multiple myeloma. His kidney function had worsened over several months, which was attributed to multiple myeloma–related kidney disease. Large bilateral kidney cysts precluded biopsy. Upon admission, he was found to have elevated gamma fraction and high IgG κ light chain levels. A peripheral smear showed over 20% plasma cells, diagnostic of progression from multiple myeloma to plasma cell leukemia.

Comprehensive quantitative analysis of alternative splicing variants reveals the HNF1B mRNA splicing pattern in various tumour and non-tumour tissues

Hepatocyte nuclear factor-1-beta (HNF1B) is a transcription factor and putative biomarker of solid tumours. Recently, we have revealed a variety of HNF1B mRNA alternative splicing variants (ASVs) with unknown, but potentially regulatory, functions. The aim of our work was to quantify the most common variants and compare their expression in tumour and non-tumour tissues of the large intestine, prostate, and kidney. The HNF1B mRNA variants 3p, Δ7, Δ7–8, and Δ8 were expressed across all the analysed tissues in 28.2–33.5%, 1.5–2%, 0.8–1.7%, and 2.3–6.9% of overall HNF1B mRNA expression, respectively, and occurred individually or in combination. The quantitative changes of ASVs between tumour and non-tumour tissue were observed for the large intestine (3p, Δ7–8), prostate (3p), and kidney samples (Δ7). Decreased expression of the overall HNF1B mRNA in the large intestine and prostate cancer samples compared with the corresponding non-tumour samples was observed (p = 0.019 and p = 0.047, respectively). The decreased mRNA expression correlated with decreased protein expression in large intestine carcinomas (p < 0.001). The qualitative and quantitative pattern of the ASVs studied by droplet digital PCR was confirmed by next-generation sequencing, which suggests the significance of the NGS approach for further massive evaluation of the splicing patterns in a variety of genes.

PU.1 Regulates Cathepsin S Expression in Large Yellow Croaker (Larimichthys crocea) Macrophages

Different morphologies have been detected in teleost macrophages. In this study, two macrophage cell lines were sub-cloned from a large yellow croaker head kidney cell line, LYCK. One type of sub-cloned cells was fusiform but the other was round, named LYC-FM and LYC-RM cells respectively, based on their morphologies. Both types showed the characteristics of macrophages, including expression of macrophage-specific marker genes, possession of phagocytic and bactericidal activities, and production of reactive oxygen species (ROS) and nitric oxide (NO). The transcription factor PU.1, crucial for the development of macrophages in mammals, was found to exist in two transcripts, PU.1a and PU.1b, in large yellow croaker, and constitutively expressed in LYC-FM and LYC-RM cells. The expression levels of PU.1a and PU.1b could be upregulated by recombinant large yellow croaker IFN-γ protein (rLcIFN-γ). Further studies showed that both PU.1a and PU.1b increased the expression of cathepsin S (CTSS) by binding to different E26−transformation−specific (Ets) motifs of the CTSS promoter. Additionally, we demonstrated that all three domains of PU.1a and PU.1b were essential for initiating CTSS expression by truncated mutation experiments. Our results therefore provide the first evidence that teleost PU.1 has a role in regulating the expression of CTSS.

Apolipoprotein A-IV concentrations and clinical outcomes in a large chronic kidney disease cohort: Results from the GCKD study.

BackgroundChronic kidney disease (CKD) represents a chronic proinflammatory state and is associated with very high cardiovascular risk. Apolipoprotein A‐IV (apoA‐IV) has antiatherogenic, antioxidative, anti‐inflammatory and antithrombotic properties and levels increase significantly during the course of CKD.ObjectivesWe aimed to investigate the association between apoA‐IV and all‐cause mortality and cardiovascular outcomes in the German Chronic Kidney Disease study.MethodsThis was a prospective cohort study including 5141 Caucasian patients with available apoA‐IV measurements and CKD. The majority of the patients had an estimated glomerular filtration rate (eGFR) of 30–60 ml/min/1.73m2 or an eGFR >60 ml/min/1.73m2 in the presence of overt proteinuria. Median follow‐up was 6.5 years. The association of apoA‐IV with comorbidities at baseline and endpoints during follow‐up was modelled adjusting for major confounders.ResultsMean apoA‐IV concentrations of the entire cohort were 28.9 ± 9.8 mg/dl. Patients in the highest apoA‐IV quartile had the lowest high‐sensitivity C‐reactive protein values despite the highest prevalence of diabetes, albuminuria and the lowest eGFR. Each 10 mg/dl higher apoA‐IV translated into lower odds of prevalent cardiovascular disease (1289 cases, odds ratio = 0.80, 95% confidence interval [CI] 0.72–0.86, p = 0.0000003). During follow‐up, each 10 mg/dl higher apoA‐IV was significantly associated with a lower risk for all‐cause mortality (600 cases, hazard ratio [HR] = 0.81, 95% CI 0.73–0.89, p = 0.00004), incident major adverse cardiovascular events (506 cases, HR = 0.88, 95% CI 0.79–0.99, p = 0.03) and death or hospitalizations due to heart failure (346 cases, HR = 0.84, 95% CI 0.73–0.96, p = 0.01).ConclusionsThese data support a link between elevated apoA‐IV concentrations and reduced inflammation in moderate CKD. ApoA‐IV appears to be an independent risk marker for reduced all‐cause mortality, cardiovascular events and heart failure in a large cohort of patients with CKD.

Evaluation of the Outcome of Pyeloplasty in Children with Poorly Functioning Kidneys due to Unilateral Ureteropelvic Junction Obstruction.

To analyze the outcome of upfront pyeloplasty in kidneys of children with unilateral ureteropelvic junction obstruction (UPJO). Thirty-three consecutive cases with split renal function (SRF) of ≤20% on dynamic renal scintigraphy (DRS) underwent upfront pyeloplasty with a nephrostomy tube and trans-anastomotic stent. Outcome was analyzed based on symptomatic relief, nephrostomy output, surgical complications and changes noted in pre-and post-operative findings on renal ultrasound (US), and DRS. The most common symptom was abdominal lump in <5-year age group (79%) and abdominal pain in >5-year age group (93%). Postoperatively, symptoms were relieved in all (100%), parenchymal thickness (PT) on US improved in 82% and SRF improved significantly (>5%) in 75.8% of patients. The improvement was more significant in patients with abdominal lump and large kidneys. The mean nephrostomy output showed an inverse relationship with age at pyeloplasty and a direct correlation with the change in PT and SRF. The degree of improvement in SRF also was inversely related to the age at pyeloplasty with a significantly better outcome in <2-year-age. Although age at pyeloplasty, nephrostomy output and change in PT individually showed significant correlation with change in SRF, multiple regression analysis showed PT as the only significant factor. Upfront pyeloplasty should be the first option in children with poorly functioning kidneys as it has a favorable outcome in almost all the cases with a very low incidence of complications. The degree of improvement in SRF can be predicted by the nephrostomy output and improvement in PT on US.

Practical Issues in the Management of Polycystic Kidney Disease: Blood Pressure and Water Balance.

Autosomal dominant polycystic kidney disease is the most common hereditary renal disease affecting more than 13 million people worldwide. Renal function deteriorates as the cysts in both kidneys increase in number and size, which eventually results in end-stage kidney failure. Until recently, conservative management for chronic kidney disease such as blood pressure control, low sodium diet, adequate water intake, and weight control were known for the only treatment of polycystic kidney disease. However, the introduction of disease-modifying drug has led to the new paradigm shift in the management of polycystic kidney disease. Tolvaptan, the vasopressin V2 receptor antagonist, has been introduced to the patients with large kidneys since it can inhibit cyclic adenosine monophosphate, attenuates cyst growth, and delays renal failure. This article reviews the two important practical issues in the management of polycystic kidney disease: blood pressure and water balance. Firstly, the article will review the pathogenesis of high blood pressure in polycystic kidney disease and will demonstrate the current up-to-date management plan for blood pressure control. Secondly, this article will explain the mechanism of Tolvaptan on the treatment of polycystic kidney disease and its possible adverse effect on water and sodium balance.

Assessment of Endotoxins and cytokines in acute-on-chronic liver failure (ACLF) patients with large ascites and acute kidney injury with slow albumin, furosemide and vasoconstrictors therapy (SAFI+T) versus albumin and vasoconstrictors and oral diuretics

Background and Aim: ACLF with AKI has a high short term mortality due to increased portal hypertension, gut permeability and associated increased inflammation due to PAMPs, DAMPs and endotoxemia. A response guided continuous low-dose albumin and terlipressin infusions with furosemide (SAFI+T) shall improve renal perfusion, fluid mobilization reduces gut congestion thereby decreasing endotoxemia and cytokine storm, may improve survival.

RISK OF OCCURRENCE AND WAYS TO IMPROVE THE TREATMENT OF UROLITHIASIS IN PATIENTS WITH A SINGLE KIDNEY.

The aim: To summarize the state of the problem of urolithiasis in patients with a single kidney and consider current views on improving its treatment based on the analysis of world literature. Materials and methods: The study conducted a thorough analysis of modern scientific literature sources in the international scientometric database, which highlighted the development of urolithiasis in patients with a single kidney and the peculiarities of its treatment. The main ways to improve treatment are identified. A critical assessment of the achievements and shortcomings of various surgical treatments. The authors' own developments are presented in the article. Conclusions: The topographic position of the kidney in the retroperitoneal space affects not only the occurrence of pathological processes in the kidney, but also the surgical strategy in the treatment of nephrolithiasis. Percutaneous nephrolithotomy is the main treatment for large (> 2 cm) or complex kidney stones. Patients with a single kidney are more prone to bleeding with PCNL treatment than patients with bilateral kidneys because they have an increased thickness of the renal parenchyma as a result of compensatory hypertrophy. RIRS is a reliable choice for patients with a single kidney who is contraindicated in PCNL.

Preliminary safety assessment of CIGB-210, an investigational peptide for HIV infection.

Current human immunodeficiency virus treatments need to be periodically administered lifelong. In this study we assess the effect of repeated doses of an anti-HIV peptide drug candidate in C57BL6 strain. Two schemes of up to 15 administrations and one of 30, daily dosing for 5days per week, all by the subcutaneous route were evaluated. Different dose concentrations of the peptide were assayed. CIGB-210 treated animals showed no symptoms or abnormal behavior as compared with placebo. All the animals gained weight during the study. Macroscopic evaluation showed no alterations in any of the organs studied. Microscopic analysis of the tissues did not show morphological changes in thymus, stomach, small and large intestines, kidney, brain, or cerebellum. The proliferative response of splenocytes and their capacity to secrete gamma interferon were not compromised by the repeated administration of CIGB-210. There were not statistically significant differences for any of the parameters evaluated during the study among treated and non-treated groups. We can conclude that CIGB-210 is well tolerated in C57BL6 mice in the dose concentration range explored and merits subsequent toxicological studies.

Fluoroscopy and CT guided translumbar tunneled dialysis catheter for hemodialysis access failure in a case of autosomal dominant polycystic kidney disease

Vascular access in hemodialysis is essential to end-stage renal disease (ESRD) patients' survival. Unfortunately, even after years of recent advances, a significant number of patients may develop multi-access failure for many reasons. In this situation, arterial-venous fistula (AVF) or catheters placement in traditional vascular sites (jugular, femoral, or subclavian) are not feasible. In this scenario, translumbar tunneled dialysis catheters (TLDCs) may be a salvage option. The use of central venous catheters (CVC) is associated with an increased incidence of venous stenosis that can progressively limit future vascular access routes. The common femoral vein can be used for temporary access in patients in whom traditional approaches for permanent central venous access may not be feasible because of either chronically occluded or not accessible vasculature; however, this location is not preferred for long-term venous access because of the high rate of catheter related blood stream infections (CRBSI). In these patients, a direct translumbar approach to the inferior vena cava is a lifesaving alternative. This approach has been described by several authors as a bail-out option. Fluoroscopy-guided access via a translumbar approach into the inferior vena cava bares the risk of hollow-organ perforation or severe bleeding from the inferior vena cava or even the aorta. To minimize the risk of complications caused by a translumbar central venous access, we hereby present a hybrid approach with CT-guided translumbar access of the inferior vena cava followed by a conventional implantation of the permanent central venous catheter. CT scan-guided access of IVC that further helps in our case as patient has large bulky kidneys secondary to autosomal dominant polycystic kidney disease.

Overview of urological complications before, during and after kidney transplantation.

The result of a kidney transplantation may be affected by certain congenital or acquired urological diseases that need to be addressed before, during or after the kidney transplant. Complications accompanying kidney transplantation are not fundamentally different from the events that accompany other difficult surgical procedures. However, their course is usually modified by adverse circumstances in the recipient - uremia, dialysis treatment, immunosuppression. The incidence of urological complications is reported in the range of 1 to 30 % of the transplants, and they represent up to one half of all surgical complications. They can cause a significant morbidity and mortality and can lead to a delayed onset of the function and even to a loss of the transplanted kidney.Urological complications that need to be addressed before kidney transplantation include anomalies or pathological changes in the lower urinary tract, pelvic involvement in atherosclerosis or previous kidney transplants, infectious foci in lithiasis or pyonephrosis, large polycystic kidneys and malignancies. During the kidney transplantation itself, vascular complications, and complications connected with the reconstruction of the lower urinary tract can occur. Other complications are bacterial and viral infections and malignancies. All these complications require a rapid and accurate diagnosis and subsequent targeted treatment with intention to maintain a functional kidney transplant (Fig. 11, Ref. 36). Text in PDF www.elis.sk Keywords: kidney transplantation, urological, vascular, infectious, bleeding, complications.