Perirenal Fluid Research Articles

Retroperitoneal biloma—A rare differential diagnosis of perirenal fluid accumulation

IntroductionNontraumatic biliary rupture and retroperitoneal biloma infrequently occur. Here, we report a case of retroperitoneal biloma due to spontaneous left hepatic duct perforation, which was difficult to differentiate from a perirenal abscess.Case presentationA 94‐year‐old female patient was hospitalized with symptoms of fatigue and right back pain that lasted for 5 days. Computed tomography revealed fluid accumulation in the retroperitoneum, and urinary extravasation and right perinephric abscess were suspected. Antimicrobial treatment and drainage with ureteral stents and urethral catheters demonstrated no symptom improvement. Ultrasound‐guided puncture of the abscess revealed the presence of bile. Pigtail catheter drainage improved symptoms and inflammatory response. After diagnosis, endoscopic retrograde cholangiopancreatography revealed bile leakage, and a bile duct stent was inserted.ConclusionBiloma can cause perirenal fluid accumulation, and they should be considered an origin of perirenal fluid accumulation when urinary tract lesions are excluded.

A case of Perforated Retroperitoneal Appendicitis Mimicking Pyelonephritis

Introduction: Appendicitis is one of the most commonly diagnosed surgical diseases in childhood with emergency abdominal pain. Retrocecal retroperitoneal appendicitis is uncommon and potentially difficult to diagnose. This condition might present with atypical clinical, and radiological signs. Here, we present a patient with perforated retrocecal appendicitis in whom the clinical findings mimicked acute pyelonephritis. Case Report: A 3-year-old boy presented with right flank pain, fever, and vomiting since a two days. The abdomen was soft but right costovertebral angle tenderness positive. There was pyuria. The clinical impression was pyelonephritis. Ultrasonography showed perirenal fluid collection but did not show any collections pericecal area. In the Multi-detector CT (MDCT) MDCT a long inflamed retrocecal retroperitoneal appendix was seen with surrounding inflammation that extended to anterior pararenal space, and retroperitoneal air. At surgery, there was retrocecal retroperitoneal appendicitis with perforation and retroperitoneal collection. Appendectomy and drainage were performed. Conclusions: Patients with retroperitoneal appendicitis is that these patients often present with atypical and less severe abdominal complaints. In this situation, MDCT could be a rapid and efficient tool for localizing the appendix and for the differential diagnosis.

Coexistence of acute pancreatitis and an obstructing upper ureteral calculus: does a calculus cause pancreatitis? a case report.

A 36-year-old male patient presented with epigastric, and right loin pain with decreased urine output for 3 days. On physical examination, he had central abdominal and right flank tenderness. An abdominal ultrasound showed mild to moderate ascites, a hyperechoic pancreas, a small (26×77mm) left kidney with increased echogenicity, right renal hypertrophy with moderate hydronephrosis, and a dilated upper ureter due to a 10mm obstructing stone with a perirenal fluid collection. The diagnosis of acute pancreatitis with an obstructing right upper ureteric stone was established. Under spinal anesthesia, an emergency ureteroscopy with laser fragmentation of the stone was performed, and a JJ stent was inserted. He developed postobstructive diuresis and his renal function was improved with a rapid decline of pancreatic enzymes as well. Two theories explain the presentation of acute pancreatitis by ureteral obstruction. First, the obstructed severe hydronephrotic kidney compresses the duodenum and head of the pancreas, obstructing the distal part of the common bile duct and triggering the elevation of pancreatic duct pressure, bile reflux, trypsin activation, and pancreatic autodigestion. The second theory states that acute pancreatitis develops when urine is extravasated from an obstructed kidney into the adjacent tissues, irritating the uncinate process of the pancreas. Although mentioning ureteral obstruction as a cause of pancreatitis is scarce, the clinician should be aware that in each case of ureteral obstruction, the emergence of acute pancreatitis is a possible complication.

Results of kidney transplant and monitoring of complications in the patients after kidney transplantation from living donors in Thai Nguyen National Hospital

This study aims to evaluate the results of kidney transplant surgery from living donors at Thai Nguyen National Hospital and investigate complications immediately after transplantation and the results of management of complications after kidney transplantation. The study used descriptive observation and whole sampling methods, on 29 patients with a kidney transplant were eligible for selection, with indications for a kidney transplant. Results showed that 24/29 (82.8%) of surgery cases are left kidney transplants, only 5/29 (17.2%) cases are right kidney transplants. End-to-end anastomosis was 24 cases, the remaining 5 cases are en to side. 100% of kidney transplants are placed in the right iliac fossa. There are 5 cases of gun barrel angioplasty; 29/29 cases of external iliac vein anastomosis. 100% of ureteral transplants to the bladder follow the Lich - Gregoir technique. All kidney transplant patients had urine on the operating table, the average urine volume after 24 hours was 6,327±2,479 ml. After 4 weeks, the urine volume was 2,983±1,784 ml. After 5 days, kidney function nearly returned to normal, average urea concentration: 8.2±6.0 mmol/l; creatinine: 118.3±27.52 μmol/l, kali: 4.1±0.6 mmol/l. timely treatment of surgical complications: perirenal fluid block (5/29); hematoma (1/29); treatment: re-operation, aspiration of fluid around the kidney; 3 cases supported hemodialysis. Infectious complications: infection at the surgical site (1/29); have urinary tract infections caused by E. coli and vaginal yeast (1/29). Treatment with antibiotics, urine culture, antibiotic susceptibility testing. In conclusions, 29/29 (100%) patients with a kidney transplant from living donors had successful surgery, the left kidney surgery was the main one. The majority of the surgical method was end-to-end anastomosis. Complications after transplantation are perirenal fluid mass, hematoma, infection with a low rate, the results of the management of complications are stable.

Renal tamponade in a patient with hydronephrosis-related Page kidney.

A 48-year-old woman presented with hyperreninemic hypertension and renal dysfunction and was diagnosed with hydronephrosis-related Page kidney. The pathophysiology was "renal tamponade", in which the kidney was compressed by the renal pelvis and Gerota's fascia, resulting in intrarenal microvascular ischemia. Ureteral stent placement promptly improved the hyperreninemic hypertension and renal dysfunction, and additional perirenal fluid drainage gradually improved these conditions. These observations indicated the following three points. First, renal compression-induced renin-angiotensin-aldosterone system upregulation plays an important role in the pathogenesis of Page kidney. Second, physicians should consider perirenal fluid drainage as a therapeutic option in addition to ureteral stenting in patients with hydronephrosis-related Page kidney. Third, bilateral perirenal subcapsular hematomas in this case could be caused by hydronephrosis. Hydronephrosis-induced intrarenal pressure elevation possibly caused chronic perirenal subcapsular hemorrhage at the vulnerable sites of the renal cortex and peeling of the renal capsule from the cortex, resulting in the bilateral massive subcapsular hematomas and Page kidney.

Imaging-Guided Percutaneous Transperitoneal Balloon Fenestration of Postrenal Transplant Lymphocele: A Case Report of Experience with New Technique

AbstractRenal transplantation is the treatment of choice for improved survival and quality of life in patients with end-stage renal disease. However, perirenal fluid collections are common surgical complications after renal transplant, with about 0.6 to 18% of patients developing a lymphocele. Conventional treatments include percutaneous aspiration and drainage, laparoscopic fenestration, and open surgical decompression stepwise. Recently, a new image-guided percutaneous transperitoneal balloon fenestration technique has been described as an alternative to the laparoscopic or surgical technique. We present the case of a 25-year-old male patient diagnosed with a lymphocele after 2 months of transplantation and no resolution of the lymphocele with percutaneous aspiration and drainage. We used this new technique under ultrasound and fluoroscopy guidance, which resulted in the resolution of the lymphocele at 1 month postprocedure. This case report highlights this new technique's potential role in successfully managing the posttransplant lymphocele in a minimally invasive manner.

E-scooter accidents: A rising cause of kidney injury

E-scooters recently gained mass expansion, leading to increased use-related injuries, most commonly head trauma, facial, and extremity fractures, while abdominal trauma with kidney involvement is less frequent. Here we present two cases of e-scooter-related high-grade blunt kidney trauma. The first case was a 24-year-old male presenting with right abdominal pain after e-scooter autonomous right fall. Focused assessment with sonography for trauma (FAST) was negative, while abdominal CT showed a 3 cm middle-renal laceration. Six-day CT showed minimal urinary extravasation. Neither anemization nor impaired kidney function was observed; the patient was discharged after 9 days. The second case was a 42-year-old male presenting with right flank pain and ipsilateral chest pain after autonomous right fall. Thoracic X-ray revealed multiple rib fractures, while abdominal echography showed a non-homogeneous right kidney with a 1.5 cm perirenal fluid layer. Abdominal CT revealed 2.5 × 4 × 3.5 cm full-thickness middle-upper renal parenchyma laceration and confirmed the perirenal hematoma, while demonstrating two hepatic lesions. A series of CT and ultrasounds confirmed the stability of the aforementioned lesions and reduction of the perirenal hematoma; laboratory findings didn't show anemization nor impaired renal function. The patient was discharged after 10 days. Widespread usage of e-scooter is accompanied by an uptick in traumatic events. The chance of renal trauma increases when lateral fall occurs. In our cases patients were hemodynamically stable, the kidney injury severity was high-grade, and non-operative management was effective. E-scooter accidents could lead to high-grade renal injuries, amenable of non-operative management; these events are expected to raise.

Intermittent quick-check CT fluoroscopy-guided percutaneous drainage placement in patients with infected renal and perirenal fluid collections: 11-year experience.

We aimed to evaluate technical and clinical success and safety of computed tomography fluoroscopy (CTF)-guided percutaneous pigtail drainage (PPD) placement in patients with infected renal and perirenal fluid collections. This retrospective analysis comprised 44 patients (52.27% men; age, 57.1±18.5 years) undergoing low-milliampere (10-20 mA) CTF-guided PPD placement in 61 sessions under local anesthesia from August 2005 to November 2016. Infected fluid collections (n=71) included infected renal cysts (12.68%), renal and perirenal abscesses due to comorbidities (23.94%), or fluid collections after renal surgery or urological intervention (63.38%). Technical success was defined as PPD placement with consecutive fluid aspiration, clinical success as normalization or marked improvement of clinical symptoms (e.g., flank pain, fever) and inflammatory parameters (leukocyte count, C-reactive protein) after minimally invasive combination therapy (intravenous broad-spectrum antibiotics and drainage). Complications were classified according to the CIRSE classification. Overall, 73 single lumen PPD (7.5-12 F) were utilized (1 PPD per session, 69.86%; 2 PPD per session, 15.07%). In 4 cases, PPD could not be inserted into the fluid collection (4.11%) or could not be aspirated (1.37%), yielding overall 94.5% primary technical success. Mean duration of functioning PPD before removal was 10.9 days. Adverse events within 30 days comprised PPD failure (2.27%) or secondary dislocation (Grade 3, 11.36%) and one death (Grade 6, unrelated to intervention, 2.27%). Additional invasive measures after primary CTF-guided PPD were required in 5 patients (nephrectomy 6.82%, partial nephrectomy 2.27%, surgical drainage 2.27%). Thus, clinical success using only minimally invasive measures was achieved in 39 of 44 patients (88.64%). Given a minor proportion of patients requiring surgical revision, combined antibiotics and CTF-guided PPD of infected renal and perirenal fluid collections provides an excellent technical and clinical outcome.

Reversal of Hepato-renal Impairment Induced by Meloxicam Paracetamol Toxicity in a Labrador Dog

An 8 years old male Labrador dog was referred to Small animal Medicine Referral Clinic, Veterinary Clinical complex, Veterinary College and Research Institute, Orathanadu for fever, anorexia, hematemesis and melenic stools. The dog on treatment with 2 ml of Meloxicam Paracetamol combination IM, along with Injection Oxytetracycline and fluid therapy for 3 days by locally and did not respond to treatment thus was referred. Clinical dullness, lethargy, respiratory distress, visible mucosal jaundice, ecchymosis on ventral abdomen was noticed. Physical examination revealed, halitosis, ulceration in the tip of the tongue, dehydration, pre scapular LN enlargement, distended abdomen, fluid thrill and splenomegaly. Hematology revealed anemia and thrombocytopenia. Biochemical analysis revealed Hyperbilirubinemia, Elevated BUN, Creatinine, AST, ALT, ALP and hypoalbuminemia. Abdominal ultrasound reveled splenomegaly, focal hyperechoic liver parenchyma, cortex echogenicity of right kidney and perirenal fluid accumulation. ECG revealed peaked T wave. Radiography revealed hepatosplenomegaly. Hemato-biochemical alteration was monitored before and after therapy. Animal was managed with fluid therapy, Acetylcysteine, Amino acid and supportives and the dog had an uneventful recovery.

Ultrasound Findings and Laboratory Predictors of Early Mortality in Patients With Severe Yellow Fever.

OBJECTIVE. Yellow fever is a hemorrhagic disease caused by an arbovirus endemic in South America; outbreaks have occurred in recent years. The purpose of this study was to describe abdominal ultrasound findings in patients with severe yellow fever and correlate them with clinical and laboratory data. MATERIALS AND METHODS. A retrospective cohort study was performed between January and April 2018. The subjects were patients admitted to an ICU with polymerase chain reaction-confirmed yellow fever. Bedside sonography was performed within 48 hours of admission. Images were independently analyzed by two board-certified radiologists. Laboratory test samples were collected within 12 hours of image acquisition. Multivariable logistic regression analysis was performed to identify 30-day mortality predictors; p < .05 was considered statistically significant. RESULTS. Forty-six patients (40 [87%] men, six [13%] women; mean age, 47.5 ± 15.2 years) were evaluated with bedside sonography. Laboratory tests showed high serum levels of aspartate aminotransferase (5319 U/L), total bilirubin (6.2 mg/dL), and creati-nine (4.3 mg/dL). Twenty-six (56.5%) patients died within 30 days of admission (median time to death, 5 days [interquartile range, 2-9 days]). The most frequent ultrasound findings were gallbladder wall thickening (80.4%), increased renal cortex echogenicity (71.7%), increased liver parenchyma echogenicity (65.2%), perirenal fluid (52.2%), and ascites (30.4%). Increased renal echogenicity was associated with 30-day mortality (84.6% versus 55.0%; p = .046) and was an independent predictor of this outcome after multivariate analysis (odds ratio, 10.89; p = .048). CONCLUSION. Reproducible abdominal ultrasound findings in patients with severe yellow fever may be associated with severity of disease and prognosis among patients treated in the ICU.

Emergency retroperitoneal laparoscopic partial nephrectomy for ruptured renal angiomyolipomas: a retrospective single-center series of 15 cases

BackgroundTo assess the safety, tumor control and renal function preservation of the emergency retroperitoneal laparoscopic partial nephrectomy (LPN) for ruptured renal angiomyolipoma (AML) and summarize our single-center initial experience.MethodsWe performed a retrospective analysis of 15 patients pathologically confirmed renal AML treated with emergency retroperitoneal LPN between January 2016 and May 2019. The patient demographics, operation time, blood loss, transfusion requirements, complications and other surgical parameters were analyzed. Follow-up was performed by serum creatinine and imaging modalities.ResultsFifteen patients were performed with emergency LPN with the median age 41.6 years. The mean size of the renal AMLs was 7.8 cm. The mean size of the retroperitoneal hematomas was 8.5 cm. All the emergency surgeries were performed successfully without any conversion to nephrectomy or open surgery. The mean operative time was 101 min. The mean warm ischemia time was 28 min. The mean estimated blood loss was 311 ml. Five patients required intraoperative blood transfusion (33.3%, 5/15). The mean transfused RBC was 4 U (range 2-6 U), and the mean transfused plasma was 200 ml (range 200-400 ml). The mean drainage duration was 3 days (range 2–5 days). The mean postoperative hospitalization was 4.7 days. No patients experienced intraoperative complications. The mean serum creatine was slightly higher after surgery (53.1 vs. 55.9 μmol/L). One patient had postoperative perirenal fluid collection. No patients needed dialysis. No recurrence was observed in the patients at the median follow-up of 24.1 months.ConclusionsOur initial experience shows that the emergency retroperitoneal LPN is a safe, minimally invasive procedure for emergency patients with ruptured renal AMLs. It could be considered as an effective alternative to renal artery embolization in selected emergency patients.

Correlation between renal histopathology and renal ultrasound in dogs

Fifty-three privately owned dogs were included in the study. Ultrasonography of the kidneys was performed ante mortem. All the dogs died or were euthanized for reasons unrelated to this study. Histopathology of both kidneys was performed, and a degeneration and an inflammation score ranging from zero to two was assigned by consensus between two pathologists. A numerical score based on a three level semi-quantitative scale (0, 0.5, 1) was assigned by consensus between two of the authors to the following ultrasonographic abnormalities: cortico-medullary definition, echogenicity of the renal cortex, echogenicity of the medulla, renal shape, cysts, scars, mineralizations, subcapsular perirenal fluid accumulation, pyelectasia. The scores deriving from the consensus were summed to create a summary index called renal ultrasound score (RUS). Statistically significant differences in cortico-medullary definition, echogenicity of the renal cortex, echogenicity of the medulla, renal shape, scars and pyelectasia were evident between the degeneration score groups. There were significantly different distributions of cortico-medullary definition, renal shape and scars between the inflammatory score groups. There were statistically significant differences in the RUS between the degenerative score groups (F = 24.154, p-value<.001). Post-hoc tests revealed significant differences between all groups. There were no significant differences in the RUS between the inflammatory score groups (F = 1.312, p-value = .264). Post-hoc tests revealed no significant differences between groups. The results of the present study suggest that the number and severity of the ultrasonographic abnormalities are correlated with the severity of the kidney degeneration. On the other hand, inflammation showed poor influence on the ultrasonographic appearance of the kidneys.

03:18 PM Abstract No. 365 A feasibility and safety study of RAST (robotically assisted sonic therapy) for renal ablation

Robotically assisted sonic therapy is a non-invasive, non-thermal ablation technique that uses high-amplitude focused ultrasound to fractionate tissue. The purpose of this study was to determine the safety and efficacy of RAST to create renal ablation zones in a pig model. Renal RAST was performed on 15 kidneys in live pigs. All treatments were performed using a therapy transducer with co-axial imaging probe and proprietary software (VortxRx, HistoSonics, Inc.). Treatments were planned as either a 2.5 cm sphere (n=12) or a smaller ellipsoid (n=3) in the lower pole of each kidney, intentionally including the central collecting system. Animals underwent immediate post-procedure CT or MRI. Four animals were survived for 28 days with follow-up imaging. All kidneys were harvested and processed for histopathology. CT and MRI images were reviewed to characterize the ablation zone and adjacent structures. All procedures were well-tolerated and technically successful. Histology demonstrated complete lysis of the targeted renal parenchyma. The spherical ablation zones had a mean diameter of 2.3±0.3 cm, mean volume of 8.3±2.4 cm3, and were highly spherical (Φ=0.996). Ellipsoid ablations had a mean volume of 5.0±0.3 cm3. Ablation zone volume decreased by 96% at 4 weeks. Temporary obstruction of the collecting system with debris was noted in 5/15 kidneys on day 0 and resolved by 1 week. There were small perirenal fluid collections (12/15), an ischemic wedge lateral to the ablation (15/15), but no urinary leaks or renal artery or venous thrombosis. Other minor complications included minimal body wall edema (n=1) and submucosal colonic hemorrhage (n=1). No other injuries were observed by gross inspection or pathology. The central collecting system was preserved after RAST with intact urothelium. Renal RAST was well-tolerated and technically successful in human-sized pigs. Further investigation in a tumor model appears warranted.

Perinephric transplant fluid collection approach and management.

Renal transplant is the treatment of choice for end-stage renal disease. Perirenal fluid collections are a common surgical complication postrenal transplant that may lead to early graft loss, considerable morbidity, and excess financial loss, if not diagnosed and managed early. The causes of posttransplant fluid collections are urinary leak, lymphocele, hematoma, and seroma, which can be further complicated by abscess formation if becomes infected. Urine leak is considered the most common urological complication postrenal transplant. Diagnosis can be made by biochemical analysis of the fluid drainage with the simultaneous comparison to that of serum. Radiological imaging is also essential for confirming the diagnosis of urinary leak that may not necessarily identify the site of the leak. The management of urinary leak is usually surgical unless the leak is small. The choice of surgery depends on the location of the leak, the vascularization of the involved ureter, and the presence of any complications caused by the leak. This article reviews the differential diagnoses of perirenal fluid collections in postrenal transplant period and focuses on the clinical assessment of urinoma and management options according to the latest evidence-based medicine.

Large Peri-Renal Fluid Collection Involving Gerotaʼs Fascia After Acute Pancreatitis

A 19-year-old male presented with third episode of recurrent idiopathic acute pancreatitis. Upon presentation, a CT scan of the abdomen was notable for acute fluid collection formation at the tail of the pancreas (figure 1). The patient was medically managed with aggressive hydration and pain control and was discharged in good health. He presented again after 4 weeks with left flank pain, nausea and vomiting. A repeat CT scan of the abdomen demonstrated a peri-renal fluid collection beneath the Gerota's fascia of the left kidney. The patient was afebrile with stable vital signs. Urinanalysis was unremarkable. Complete blood counts and basic metabolic profile were normal. Urology consultation was obtained for concern for renal compromise from compression effects given the size of the fluid collection, and possible hemorrhage into the peri-renal space from an undetected renal angiolipoma. The patient denied any history of trauma. Urology deemed the fluid not consistent with the kidney origin given no trauma history and no visible tumor on the imaging. MRI of the abdomen performed after four days revealed increasing size of the encapsulated renal fluid collection measuring 17 cm x 12 cm x 12 cm (figure 3). A CT guided drainage of the fluid collection was performed and one liter of dark green non-turbid fluid was drained (figure 4). Investigation of the fluid demonstrated white blood cell count of 4070, amylase of >13000, and lipase of >30000 consistent with pancreatic fluid. Acute and chronic pancreatitis are known to have complications which include the development of a pseudocyst. Pseudocysts occur weeks after the onset of pancreatitis and account for an incidence rate of nearly 5-15%.However, Pseudocysts which have involved the Gerota's fascia of the magnitude seen in our case have very rarely been reported in English literature.In majority of the cases, ultrasonographic or CT guided aspirations were the main stay of therapy which demonstrated definitive resolution. It is postulated that the autolytic nature of pancreatic enzymes allows the fluids to dissect through fascial planes leading to distant pseudocyst formation. Pancreatic pseudocysts with atypical locations such as the peri-renal space are radiologically challenging to diagnose as they often mimic an underlying malignant process or traumatic history. These atypical locations pose and therapeutic challenges which may encompass surgical, percutaneous, or transgastric intervention.1314_A.tif Figure 1: A computed tomography (CT) coronal view image of the abdomen was notable for acute fluid collection “phlegmon” formation at the tail of the pancreas1314_B.tif Figure 2: A computed tomography (CT) abdomen axial image revealing development of peri-renal subcapsular fluid accumulation1314_C.tif Figure 3: Magnetic resonance cholangiopancreatography image demonstrating peri-renal fluid collection involving the Gerota's fascia of the left kidney and measured 17 cm x 12 cm x 12 cm.

Acalculous cholecystitis associated with hantaan virus: a case report

Introduction: Acute acalculous cholecystitis (AAC) still remains one of the most elusive diagnoses. It occurs in various conditions. Although AACs caused by viral infections are rare, various viruses have been revealed to cause AAC. Here we present a case in which a man suffered from AAC caused by a hantaan virus infection. Case report: A 37-year-old man was referred to the emergency room for myalgia and fever that began 4 days ago. He suffered oliguria and abdominal pain for 2 days. At the time of his visit to the emergency room, he experienced a fever spiking up to 38.3°C. An initial blood sample objectified the following pathologic results: white blood cell - 11610/ul; C-reactive protein - 10.65 mg/dL; total bilirubin - 2.22 mg/dL; direct bilirubin - 1.83 mg/dL; ALT - 157IU/L; Alkaline Phosphatase - 591IU/L. In the computed tomography, bilateral perirenal fluid collections and bilateral flexural effusion were shown and acute hepatopathy and cholecystopathy were also shown. Because there was no definite tenderness around the patient's right upper quadrant from physical examination and his cholecystopathy looked like it was from secondary change according to acute hepatopathy, we decided to perform conservative care without surgical treatment. The following day, in viral antibody test, Hantaan virus antibody was detected. After conservative management, the patient's condition improved. The patient was discharged on day of hospital stay #10 without any symptoms. Conclusion: Hantaan virus infection should be suspected as a causative agent of AAC, particularly when there is abnormal liver function tests and abdominal pain.

Sonographic assessment of the prevalence and evolution of fluid collections as a complication of kidney transplantation.

Aim of the study: The aim of this study is to assess the prevalence and evolution of perirenal fluid collections in a group of 488 patients who have undergone kidney transplantation. Material and methods: Sonographic documentation of 488 deceased-donor kidney recipients was evaluated for the prevalence of perirenal fluid collections and their evolution in time, depending on selected demographic features of the patients, time of detection, initial dimensions and precise position of the collection relative to the kidney and the location of the transplanted organ in the right or left iliac fossa. The collected data were used for statistical analysis to determine the strength of the potential relationships. Results: In 146 out of 488 subjects perirenal fluid collections were found. In 1/3 of the patients more than one fluid collection was diagnosed. Over 40% of fluid collections were detected within 10 days from the date of the first scan and 24.11% were detected within 10–20 days from the date of the first scan. The majority of fluid collections were located near the lower pole of the kidney. Perihilar collections were the least common. Collections encapsulating the kidney and subcutaneous collections were the largest in size on average. A statistically significant difference between the size of collections located on the surface and the size of those located near the upper pole of the transplanted kidney was demonstrated. However, no correlation was proven to exist between the persistence of the fluid collection and its position relative to the transplanted kidney and its initial size. Conclusions: The correct evaluation of a fluid collection’s dynamics of development and nature requires periodic follow-up of the recipient, preferably in a single clinical center. Ultrasonography is an inexpensive, non-invasive and repeatable method for the determination of the presence of fluid collections. However, the decision whether treatment is necessary requires the sonographic image to be compared with the laboratory signs of inflammation and biochemical analysis of the contents of fluid collections.

Bilateral perirenal fluid accumulation associated with tetralogy of fallot

This report describes a case of spontaneously developing bilateral perirenal fluid accumulation in a patient under monitoring for tetralogy of Fallot. The causal pathophysiology of perirenal fluid accumulation in patients with tetralogy of Fallot is unidentified. As a result of comprehensive examinations we establish that perirenal fluid develops due to high hematocrit. Perirenal fluid did not relapse after repeated phlebotomy treatment. Our case is the first to describe the combination of tetralogy of Fallot and perirenal fluid accumulation in the literature

Tubeless versus standard percutaneous nephrolithotomy in pediatric patients: a systematic review and meta-analysis

This systematic review and meta-analysis was designed to evaluate the post-operative outcomes between tubeless and standard percutaneous nephrolithotomy (PCNL) among children. Literature searches were performed following the Cochrane guidelines. We conducted a systematic review and meta-analysis that included three trials investigating the outcomes including the length of hospital stay, operation time, hemoglobin decrease, blood transfusion rate, perirenal fluid presence, post-operative fever, stone clearance rate, and the need for a second operation. The patients who underwent tubeless PCNL had shorter length of hospitalization compared to standard PCNLs (mean difference -1.57, 95% confidence interval -3.2 to 0.07, p = 0.06). No significant decrease was detected in hemoglobin after tubeless PCNL compared to standard PCNL (mean difference 0.05, 95% confidence interval -0.03 to 0.13, p = 0.21). There were no significant differences in operation time (p = 0.7), perirenal fluid presence (p = 0.15), post-operative fever (p = 0.72), stone clearance (p = 0.68), and the need for a second operation (p = 0.90). This study showed no significant difference between tubeless and standard PCNLs in children. However, due to the lack of data, the results should be mentioned prudently. Future randomized trials with more sample sizes and longer follow-ups are warranted.

Perirenal fluid collection in renal parenchymal disease: the kidney sweat sign.

Perirenal fluid collection in renal parenchymal disease: the kidney sweat sign.