Preoperative Kidney Research Articles

A0867 Association between Preoperative Renin-Angiotensin System Inhibitor Use and Postoperative Acute Kidney Injury Risk in Patients with Hypertension

A0867 Association between Preoperative Renin-Angiotensin System Inhibitor Use and Postoperative Acute Kidney Injury Risk in Patients with Hypertension

Heart failure and the risk of acute kidney injury in relation to ejection fraction in patients undergoing coronary artery bypass grafting

BackgroundWe studied the association between heart failure with reduced or preserved ejection fraction (EF) and the risk of acute kidney injury (AKI) in patients undergoing coronary artery bypass surgery (CABG). MethodsWe included all patients who underwent isolated CABG in Sweden 2003 to 2013. AKI was defined according to the Kidney Disease Improving Global Outcomes definition, as an increase in postoperative serum creatinine concentration by ≥26 μmol/L or ≥50%, compared to preoperative values. Adjusted odds ratios (OR) for AKI were calculated using logistic regression for patients with and without heart failure, and among patients with heart failure, by EF categories (<30% severely reduced; 30–40% moderately reduced; ≥50% preserved). ResultsIncluded were 36,403 patients of whom 3914 (11%) had heart failure. In patients with heart failure, 26% developed AKI compared with 14% in patients without heart failure. After adjustment for background characteristics, including preoperative kidney function and EF, the OR for AKI was 1.12 (95% CI 1.02–1.23) in patients with heart failure compared with no heart failure. Among patients with heart failure, the adjusted OR for AKI among patients with EF <30% vs. ≥50% was 1.32 (95% CI 1.06–1.65) and for 30–49% vs. ≥50% 1.06 (95% CI 0.87–1.28), respectively. ConclusionPatients with heart failure who underwent CABG had an increased risk for AKI postoperatively even after adjustment for comorbidity such as EF. Among patients with heart failure, having a severely reduced EF was associated with AKI compared to patents with preserved EF.

End-Stage Kidney Disease following Surgical Management of Kidney Cancer.

We investigated the incidence of ESKD after surgical management of kidney cancer in the Australian state of Queensland, and described patterns in the initiation of kidney replacement therapy resulting from kidney cancer across Australia. All newly diagnosed cases of kidney cancer in the Australian state of Queensland between January of 2009 and December of 2014 were ascertained through the Queensland Cancer Registry. There were 2739 patients included in our analysis. Patients who developed ESKD were identified using international classification of disease-10-coded hospital administrative data. Incidence rate and 3-year cumulative incidence were calculated, and multivariable Cox proportional hazards models were used to identify factors associated with ESKD. Additional descriptive analysis was undertaken of Australian population data. The incidence rate of ESKD in all patients was 4.9 (95% confidence interval [95% CI], 3.9 to 6.2) per 1000 patient-years. The 3-year cumulative incidence was 1.7%, 1.9%, and 1.0% for all patients, and patients managed with radical or partial nephrectomy, respectively. Apart from preoperative kidney disease, exposures associated with increased ESKD risk were age≥65 years (adjusted hazard ratio [aHR], 2.0; 95% CI, 1.2 to 3.2), male sex (aHR, 2.3; 95% CI, 1.3 to 4.3), preoperative diabetes (aHR, 1.8; 95% CI, 1.0 to 3.3), American Society of Anesthesiologists classification ≥3 (aHR, 4.0; 95% CI, 2.2 to 7.4), socioeconomic disadvantage (aHR, 1.6; 95% CI, 0.9 to 2.7), and postoperative length of hospitalization ≥6 days (aHR, 2.1; 95% CI, 1.4 to 3.0). Australia-wide trends indicate that the rate of kidney replacement therapy after oncologic nephrectomy doubled between 1995 and 2015, from 0.3 to 0.6 per 100,000 per year. In Queensland between 2009 and 2014, one in 53 patients managed with radical nephrectomy and one in 100 patients managed with partial nephrectomy developed ESKD within 3 years of surgery. This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_09_28_CJASNPodcast_18_1_.mp3.

Incidence of Acute Kidney Injury Following Liver Transplantation

Introduction Acute kidney injury (AKI) is a common postoperative complication following liver transplantation (LT) with an incidence ranging from 40% to 70%. The aim of this study was to analyze the incidence of AKI following LT by using KDIGO criteria and compare patients who developed AKI with those who did not. Materials and Methods We retrospectively analyzed the data of 65 consecutive patients who underwent LT in Baskent University Hospital between January 2015 to May 2017. Demographic, preoperative, and intraoperative data were collected. Results The median age of the overall population was 25±24 years and 12 (38%) of them were female. There were 34 pediatric patients younger than 18 years. This group had a median age of 64±72 months and 14 (41%) of them were female. AKI occurred in 16 (47%) pediatric patients during the first week following LT with stage 1, stage 2, and stage 3 AKI frequencies of 43.8%, 50 %, and 6.3%, respectively. When compared with those who developed AKI, the median age, body weight, MELD scores (model for end-stage liver disease), PELD scores (pediatric end-stage liver disease), graft recipient ratio were similar between the pediatric patients who did not develop AKI. Among living donors, significantly lower percentage of patients developed AKI (39% vs 61%, p=.018).There were also statistical differences between the two groups in terms of number of patients who had preoperative kidney dysfunction (80% vs 20%, p=.047) and mortality rates (31% vs 6 %, p=.047). Renal replacement therapy (RRT) was initiated in 18.8% of pediatric liver transplant recipients. The percentage of patients older than 18 years were 48% (n=31). This group had a median age of 46±17 years and 7 (23%) of them were female. AKI occurred in 15 (48%) adult patients during the first week following LT with stage 1, stage 2, and stage 3 AKI frequencies of 43%, 21%, and 21%, respectively. When compared with those who developed AKI, the median age, body weight, and MELD scores were similar between the pediatric patients who did not develop AKI. Compared with those who did not develop AKI postoperatively, those who did had significantly lower levels of creatinine (1.9±1.9 mg/dl vs 0.7±0.1 mg/dl, p=.013), given higher amounts of crystalloids (73±32 ml/kg vs 106±33 ml/kg, p=.018) and had lower urine output intraoperatively (11±9 ml/kg vs 20±9 ml/kg, p=.018). Requirement for RRT was seen in 43% of adult liver transplant recipients. There was a higher mortality rate in patients with AKI following LT (89% vs 11%, p=.003). Conclusion Our results indicates that AKI occurred in more than half of adult patients after LT and about half of pediatric liver transplant recipients according to KDIGO criteria in our cohort. Mortality of patients with AKI was significantly higher for both adult and pediatric groups.

The influence of oxygen delivery during cardiopulmonary bypass on the incidence of delirium in CABG patients; a retrospective study.

Introduction:Postoperative delirium is the most common neurological complication of cardiac surgery. Hypoxia has been shown to increase the risk of postoperative delirium. The possibility to continuously monitor oxygen delivery (DO2) during cardiopulmonary bypass (CPB) offers an adequate approximation of the oxygen status in a patient. This study investigates the role of oxygen delivery during cardiopulmonary bypass in the incidence of postoperative delirium.Methods:Three hundred and fifty-seven adult patients who underwent normothermic coronary artery bypass grafting (CABG) surgery were included in this retrospective study. The nadir indexed DO2 (DO2i) value on bypass, the total time under the critical DO2i level and the area under the curve (AUC) for critical DO2i were determined. Delirium was identified by the postoperative administration of haloperidol.Results:The mean nadir DO2i significantly differed, comparing the group of patients with postoperative delirium to the group without. Multivariate analysis only identified age, pre-existing cognitive impairment, preoperative kidney dysfunction and cross-clamp time as independent risk factors for delirium. The results also indicated that patients of older age were more sensitive to a declined DO2i.Conclusion:A low DO2i during cardiopulmonary bypass is significantly associated with the incidence of postoperative delirium in CABG patients. However, the role of DO2 as an independent predictor of delirium could not be proven.

Low Mean Arterial Blood Pressure is Independently Associated with Postoperative Acute Kidney Injury After Living Donor Liver Transplantation: A Propensity Score Weighing Analysis

BackgroundAs end-stage liver disease progresses, renal blood flow linearly correlates with mean arterial blood pressure (MBP) due to impaired autoregulation. We investigated whether the lower degree of postoperative MBP would predict the occurrence of postoperative acute kidney injury (AKI) after liver transplantation.Material/MethodsThis retrospective study enrolled 1,136 recipients with normal preoperative kidney function. Patients were categorized into two groups according to the averaged postoperative MBP: <90 mmHg (MBPbelow90) and ≥90 mmHg (MBPover90). The primary endpoint was occurrence of postoperative AKI, defined by the creatinine criteria of the Kidney Disease Improving Global Outcomes. The logistic regression model with inverse probability treatment weighting (IPTW) of propensity score was used to compare the risk of postoperative AKI between two groups.ResultsMBPbelow90 group (83.0±5.1 mmHg) showed higher prevalence and risk of postoperative AKI (74.2% versus 62.6%, p<0.001; IPTW-OR 1.34 [1.12–1.61], p=0.001) compared with MBPover90 group (97.3±5.2 mmHg). When stratified by quartiles of baseline cystatin C glomerular filtration ratio (GFR), the association between MBPbelow90 and postoperative AKI remained significant only with the lowest quartile (cystatin C GFR ≤85 mL/min/1.73 m2; IPTW-OR 2.24 [1.53–3.28], p<0.001), but not with 2nd–4th quartiles.ConclusionsOur results suggest that maintaining supranormal MBP over 90 mmHg may be beneficial to reduce the risk of post-LT AKI, especially for liver transplant recipients with cystatin C GFR ≤85 mL/min/1.73 m2.

Preoperative chronic kidney disease to predict oncological outcomes after radical cystectomy in patients with muscle-invasive bladder cancer.

427 Background: Chronic kidney disease (CKD) is common in elderly patients with bladder cancer. In addition, increasing evidence has suggested that preoperative renal insufficiency indicates poor prognosis in bladder cancer. We aimed to evaluate the impact of CKD on oncologic outcomes in muscle-invasive bladder cancer patients who underwent radical cystectomy. Methods: A total of 581 patients who underwent radical cystectomy at four medical centers between January 1995 and February 2017 were examined retrospectively. We investigated oncologic outcomes, including progression-free, cancer-specific, and overall survival (PFS, CSS, and OS, respectively) stratified by preoperative CKD status (CKD vs. non-CKD). We performed a Cox proportional hazards regression analysis using inverse probability of treatment weighting (IPTW) to evaluate the impact of preoperative CKD on prognosis and developed the prognostic factor-based risk stratification nomogram. Results: Of the 581 patients, 215 (37%) were diagnosed with CKD before radical cystectomy. Before the background adjustment, PFS, CSS, and OS after radical cystectomy were significantly lower in the CKD group compared to the non-CKD group. Background-adjusted IPTW analysis showed that preoperative CKD was significantly associated with poor PFS, CSS, and OS after radical cystectomy. The nomogram for predicting 5-year PFS and OS probability showed significant correlation with actual PFS and OS ( c-index = 0.73 and 0.77, respectively). Conclusions: Muscle-invasive bladder cancer patients with preoperative CKD had a significantly lower survival probability than those without CKD.

LAPAROSCOPIC HEMINEPHRECTOMY OF A HORSESHOE KIDNEY WITH ADVANCED RENAL-CELL CARCINOMA. DESCRIPTION OF A SINGLE CASE

A 64-year-old woman with a 9-cm advanced tumor in the left moiety of a horseshoe kidney was treated through a laparoscopic approach. The left part of kidney had 3 arteries (2 from aorta, 1 from left common iliac artery) and 5 veins. A pre-operative kidney computed tomography angiography revealed the invasion in lumbar and iliac muscles. Clamping of blood vessels was performed and isthmus was dissected with bipolar hook and Simon Renal Pole Clamp®. Renal parenchyma sutured with Vicryl 2-0 filament. Removal of locally advanced tumor was performed with 10-mm Ligasure®. Laparoscopic heminephrectomy are safe and efficient treatment method of horseshoe kidney tumors in case of proper approach according to the location of the lesion and the surgeon&gt;s experience.

Risk factors of long-term postoperative renal function after partial nephrectomy in a solitary kidney

AbstractThe effect of warm ischemia time (WIT) on longterm renal function after partial nephrectomy remains controversial. In this retrospectively cohort study, 75 solitary kidney patients were included and the effects of warm ischemia time, preoperative renal function and resected normal parenchyma volume on long-term renal function were evaluated. Multivariable analysis showed that the preoperative renal function baseline was significantly associated with renal function 12 months postoperation (P=0.01), adjusting for age and comorbidities factors. Meanwhile, perioperative acute renal failure (ARF) events significantly affected postoperative renal function at postoperative time points of 12 months (P=0.001) and 60 months (P=0.03), as well as renal function change at postoperative 12 months (P&lt;0.01). Warm ischemia time and resected normal parenchyma volume were not risk factors for long-term postoperative renal function, while the latter was significantly associated with renal function change (P=0.03 at 12 months, P&lt;0.01 at 36 and 60 months).In conclusion, the quality of preoperative kidney primarily determines long-term postoperative renal function, while the quantity of preserved functional parenchyma volume was the main determinant for long-term kidney recovery. ARF was an independent risk factor while WIT was indirectly associated with postoperative renal function by causing perioperative ARF.

The association of preoperative body mass index and acute kidney injury in liver transplantation recipients

The association of preoperative body mass index and acute kidney injury in liver transplantation recipients

The liver recipient with acute renal dysfunction: A single institution evaluation of the simultaneous liver-kidney transplant candidate.

The Organ Procurement Transplant Network (OPTN) listing criteria for simultaneous liver-kidney transplant (SLK) are not well defined. Concerns remain about rising numbers of SLKs, which divert quality kidneys from candidates awaiting kidney transplants (KT). We performed a retrospective review of liver transplants (LTs) at our center from 2004 to 2014; 127 recipients (liver transplant alone; 102 LTA, 25 SLK) were identified with short-term preoperative kidney dysfunction (creatinine >4mg/dL or preoperative hemodialysis [HD] for <6weeks). Both cohorts had comparable baseline demographic characteristics with the exception of higher model for end-stage liver disease (MELD) score in the LTA group (41.4 vs 32.9, P<.0001) and higher incidence of pre-LT diabetes in the SLK cohort (52% vs 26.5%, P=.0176). Duration of pre-LT HD was higher in SLK recipients, but the difference was not statistically significant (P=.39). Renal nonrecovery (RNR) rate in LTA cohort was low (<5%). No significant difference was noted in 1-year mortality, liver graft rejection/failure, or length of stay (LOS) between the cohorts. Thus, it appears that liver recipients with short-term (<6weeks) HD or AKI without HD have comparable outcomes between LTA and SLK. With provisions for a KT safety net, as proposed by OPTN, LTA may be the most adequate option for these patients.

High BMI and male sex as risk factor for increased short-term renal impairment in living kidney donors – Retrospective analysis of 289 consecutive cases

BackgroundKidney transplantation represents the treatment of choice for end-stage renal disease (ESRD). However, nephrectomy bears certain short- as well as long-term risks for the healthy, voluntary donor. As obesity is increasing and is a known risk factor for surgical complications, we wanted to assess the impact of BMI on perioperative complication rates and renal function. Materials and methodsWe retrospectively assessed patients undergoing living donor kidney nephrectomy at our institution. We identified 289 donors that underwent unilateral nephrectomy between January 2006 and December 2015. Donors were categorized according to their BMI (BMI <25 kg/m2, BMI ≥25/<30 kg/m2, BMI ≥30 kg/m2). Where indicated, analysis of variance (ANOVA) was used to compare groups, a stepwise linear regression model was used to assess impact of BMI on the change of eGFR. Results126 donors (43.6%) had a BMI <25 while 120 (41.5%) had a BMI ≥25/<30 and 43 (14.9%) were obese with a BMI ≥30. BMI had no statistically significant influence on the percentage of laparoscopic approach (86.5% vs. 83.3% vs. 88.4%, p = 0.6564), on conversion rates (0% vs. 2.0% vs. 2.6%, p = 0.2879) or postoperative complication rates defined as Clavien Dindo ≥ II (8.7% vs. 13.3% vs. 14.0%, respectively; p = 0.4474). Notably, there were no Grade III or higher complications in any group. There was no difference in pre-operative kidney function, postoperative surgical site infection or systemic infection. BMI and male sex had a statistically significant influence on short-term decline of eGFR. ConclusionObese donors do not suffer from an increased risk of intraoperative or perioperative complication rates. However, male sex and high BMI are associated with a more pronounced short-term decline in renal function. The impact of BMI on long-term consequences for kidney donors needs to be defined in larger prospective cohorts.

Association of pre-operative estimated GFR on post-operative pulmonary complications in laparoscopic surgeries

Despite a large body of evidence showing the pandemic of chronic kidney disease, the impact of pre-operative kidney function on the risk of post-operative pulmonary complications (PPCs) is not well known. We used multivariable logistic regression analyses with 3-level hierarchical adjustments to identify the association of pre-operative estimated glomerular filtration rate (eGFR) with PPCs in laparoscopic surgeries. Among 452,213 patients between 2005 and 2013 in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Database, a total of 3,727 patients (0.9%) experienced PPCs. We found a gradient association between lower eGFR and higher likelihood of PPCs in the unadjusted model. In the case-mix adjusted model, a reverse-J-shaped association was observed; a small albeit significant association with the highest eGFR category emerged. Further adjustment slightly attenuated these associations, but the PPCs risk in the eGFR groups of <30, 30–60, and ≥120 mL/min/1.73 m2 remained significant: odds ratios (95% confidence intervals) of 1.82 (1.54–2.16), 1.38 (1.24–1.54), and 1.28 (1.07–1.53), respectively (reference: 90–120 mL/min/1.73 m2). Our findings propose a need for careful pre-operative evaluation of cardiovascular and pulmonary functions and post-operative fluid management among patients with not only lower but also very high eGFR.

Benign and tumor parenchyma metabolomic profiles affect compensatory renal growth in renal cell carcinoma surgical patients.

Background and objectivesPre-operative kidney volume is an independent predictor of glomerular filtration rate in renal cell carcinoma patients. Compensatory renal growth (CRG) can ensue prior to nephrectomy in parallel to tumor growth and benign parenchyma loss. We aimed to test whether renal metabolite abundances significantly associate with CRG, suggesting a causative relationship.Design, setting, participants, and measurementsTissue metabolomics data from 49 patients, with a median age of 60 years, were previously collected and the pre-operative fold-change of their contra to ipsi-lateral benign kidney volume served as a surrogate for their CRG. Contra-lateral kidney volume fold-change within a 3.3 +/- 2.1 years follow-up interval was used as a surrogate for long-term CRG. Using a multivariable statistical model, we identified metabolites whose abundances significantly associate with CRG.ResultsOur analysis found 13 metabolites in the benign (e.g. L-urobilin, Variable Influence in Projection, VIP, score = 3.02, adjusted p = 0.017) and 163 metabolites in the malignant (e.g. 3-indoxyl-sulfate, VIP score = 1.3, adjusted p = 0.044) tissues that significantly associate with CRG. Benign/tumor fold change in metabolite abundances revealed three additional metabolites with that significantly positively associate with CRG (e.g. p-cresol sulfate, VIP score = 2.945, adjusted p = 0.033).At the pathway level, we show that fatty-acid oxidation is highly enriched with metabolites whose benign tissue abundances strongly positively associate with CRG, both pre-operatively and long term, whereas in the tumor tissue significant enrichment of dipeptides and benzoate (positive association), glycolysis/gluconeogenesis, lysolipid and nucleotide sugar pentose (negative associations) sub-pathways, were observed.ConclusionThese data suggest that specific biological processes in the benign as well as in the tumor parenchyma strongly influence compensatory renal growth.

Ferumoxytol-enhanced magnetic resonance angiography for the assessment of potential kidney transplant recipients

ObjectivesTraditional contrast-enhanced methods for scanning blood vessels using magnetic resonance imaging (MRI) or CT carry potential risks for patients with advanced kidney disease. Ferumoxytol is a superparamagnetic iron oxide nanoparticle preparation that has potential as an MRI contrast agent in assessing the vasculature.MethodsTwenty patients with advanced kidney disease requiring aorto-iliac vascular imaging as part of pre-operative kidney transplant candidacy assessment underwent ferumoxytol-enhanced magnetic resonance angiography (FeMRA) between December 2015 and August 2016. All scans were performed for clinical indications where standard imaging techniques were deemed potentially harmful or inconclusive. Image quality was evaluated for both arterial and venous compartments.ResultsFirst-pass and steady-state FeMRA using incremental doses of up to 4 mg/kg body weight of ferumoxytol as intravenous contrast agent for vascular enhancement was performed. Good arterial and venous enhancements were achieved, and FeMRA was not limited by calcification in assessing the arterial lumen. The scans were diagnostic and all patients completed their studies without adverse events.ConclusionsOur preliminary experience supports the feasibility and utility of FeMRA for vascular imaging in patients with advanced kidney disease due for transplant listing, which has the advantages of obtaining both arteriography and venography using a single test without nephrotoxicity.Key Points• Evaluation of vascular disease is important in planning kidney transplantation.• Standard vascular imaging methods are often problematic in kidney disease patients.• FeMRA has the advantage of arteriography and venography in a single test.• FeMRA is safe and non-nephrotoxic.• FeMRA is not limited by arterial calcification.

Bronchial microdialysis monitoring of inflammatory response in open abdominal aortic aneurysm repair; an observational study.

Aortic surgery results in ischemia–reperfusion injury that induces an inflammatory response and frequent complications. The magnitude of the inflammatory response in blood and bronchi may be associated with the risk of immediate complications. The purpose of the study was to evaluate bronchial microdialysis as a continuous monitoring of cytokines in bronchial epithelial lining fluid (ELF) and to determine whether bronchial ELF cytokine levels reflect the ischemia–reperfusion injury and risk for complications during open abdominal aortic aneurysm (AAA) repair. We measured cytokines in venous blood using microdialysis and in serum for comparison. Sixteen patients scheduled for elective open AAA repair were included in a prospective observational study. Microdialysis catheters were introduced into a bronchi and a cubital vein. Eighteen cytokines were measured using a Bio‐Plex Magnetic Human Cytokine Panel. Samples were collected before and during cross‐clamping of the aorta as well as from 0 to 60 min and from 60 to 120 min of reperfusion. The ELF levels of several cytokines changed significantly during reperfusion. In particular, IL‐6 increased more than 10‐fold and IL‐13 more than 5‐fold during ischemia and reperfusion. Also, the venous levels of several inflammatory and anti‐inflammatory cytokines increased and exhibited their highest concentration during reperfusion. Both bronchial and venous cytokine levels correlated with duration of the procedure, intensive care days, and preoperative kidney disease. Three patients suffered organ failure as a direct consequence of the procedure, and in these patients the bronchial ELF concentrations of 17 of 18 cytokines differed significantly from patients without such complications. Bronchial microdialysis is suited for continuous monitoring of inflammation during open AAA repair. The bronchial ELF cytokine levels may be useful in predicting immediate complications such as organ failure in patients undergoing vascular surgery.

MP75-10 TAILORING ANTIBIOTIC PROPHYLAXIS FOR URETEROSCOPIC PROCEDURES BASED ON LOCAL RESISTANCE PROFILES MAY LEAD TO REDUCED RATES OF INFECTIONS AND UROSEPSIS

You have accessJournal of UrologyStone Disease: Surgical Therapy VII1 Apr 2017MP75-10 TAILORING ANTIBIOTIC PROPHYLAXIS FOR URETEROSCOPIC PROCEDURES BASED ON LOCAL RESISTANCE PROFILES MAY LEAD TO REDUCED RATES OF INFECTIONS AND UROSEPSIS Ariel Zisman, Shadie Badaan, Alexander Kastin, Alexander Kravtsov, David Kakiashvili, Gilad E. Amiel, and Michael Mullerad Ariel ZismanAriel Zisman More articles by this author , Shadie BadaanShadie Badaan More articles by this author , Alexander KastinAlexander Kastin More articles by this author , Alexander KravtsovAlexander Kravtsov More articles by this author , David KakiashviliDavid Kakiashvili More articles by this author , Gilad E. AmielGilad E. Amiel More articles by this author , and Michael MulleradMichael Mullerad More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2158AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Post ureteroscopy UTI rate is about 4%. AUA guidelines suggest prophylaxis treatment for proximal or impacted stones. We examined whether a double drug Antibiotic Prophylaxis Treatment (APT), an aminoglycoside and penicillin based on resistant bacteria strains we encounter in our institution may reduce urosepsis post-ureteroscopy. METHODS Between February 2015 and March 2016, we performed 344 ureteroscopies. Starting September, 2015 we changed the APT for endo-urological procedures according to the bacterial resistance profile in urine cultures at our institution. Inclusion criteria were adult patients referred to ureteroscopic treatment for a urinary stone, with or without prior stenting. Exclusion Criteria included integrated procedures (with PCNL), biopsies, pediatric or pregnant patients. Sepsis was defined as fever above 38.5 degrees Celsius with additional standard criteria (International Sepsis Definitions Conference). All patients had a urine culture taken prior to APT initiation. Fisher's exact test and T-test with a two-tailed P value < 0.05 denoted statistical significance. RESULTS 57 patients were excluded. Group 1 (n=106) were the last to receive the conventional APT (PO Ciprofloxacin 500mg X 2), while the second group (n=181) were the first to receive the new regimen (IV Gentamycin 240mg & Ampicillin 1gr X 3) prior to ureteroscopy. 65 patients had a preoperative positive culture. A significant percentage of both groups had a preoperative positive urine culture (29%-group 1; 18%-group 2). Seven out of 9 septic events developed in those patients (P<0.001). Patients undergoing RIRS procedures were at increased risk for a septic event when treated with conventional APT (7/9 events; P<0.01). No significant correlation was found between preoperative kidney drainage (stent or nephrostomy tube) and sepsis. CONCLUSIONS Our study demonstrates that a significant portion of patients undergoing ureteroscopic treatment for urinary stones have positive preoperative urine culture, despite previous treatment. Standard, ‘one size fits all' APT is not sufficient according to our data. A regimen tailored to the local bacterial resistance strains can lower the rate of sepsis significantly. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1006-e1007 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Ariel Zisman More articles by this author Shadie Badaan More articles by this author Alexander Kastin More articles by this author Alexander Kravtsov More articles by this author David Kakiashvili More articles by this author Gilad E. Amiel More articles by this author Michael Mullerad More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Preoperative kidney function linked to mortality and readmission outcomes at Day 90 and 30 in older emergency surgical patients

IntroductionImpaired preoperative kidney function is associated with an increase in post-procedural major complications and mortality in older elective surgical population. However, little is known about the impact of poor kidney function on outcomes in emergency surgical setting in this age group. This study aimed to quantify the effect of impaired kidney function on 30 and 90 days mortality; and readmission within 30 days following an acute surgical admission in older patients. Material and methodsThe Older Persons Surgical Outcomes Collaboration 2015 cohort study, in four UK centres and one in Belgium, examined the above relationships. A logistic regression model was used to assess the odds of outcomes when comparing impaired eGFR to normal eGFR. A total of 402 patients were included with a mean age of 76.2 years (range 65–103 years), of which 209 (52%) were male. ResultsThe prevalence of eGFR <60ml/min/1.73m2 was 34.1% (N=137). Patients with an eGFR of <60ml/min/1.73m2 on admission were more likely to die at 30 and 90 days when compared to patients with eGFRs ≥60ml/min/1.73m2; respective adjusted OR=2.98 (95%CI 1.38–6.43, P=0.006) and 3.37 (95%CI 1.82–6.27, P<0.001). No differences were observed for 30-day readmission to hospital. ConclusionsAdmission eGFR provides prognostic information which is useful to clinicians in an acute surgical setting. Whether closer monitoring and focused management at improving kidney function improves outcome in this patient population warrants further investigation.

Autologous Blood Donation Before Hepatectomy in Patients With Chronic Kidney Disease

Autologous blood is sometimes collected before hepatectomy. The usefulness of autologous blood donation (ABD) has been reported in several studies. However, the relationship between ABD and CKD has never been studied. The aim of this study was to clarify the relationship between preoperative autologous blood donation (ABD) and chronic kidney disease (CKD) in anemia. Between January 2006 and December 2012, 70 patients made 2 ABDs ≥ 600 mL before hepatectomy. CKD stages were based on estimated glomerular filtration rates. Univariate analyses were performed using the Mann–Whitney U test for continuous variables and the chi-square test for nominal variables. Patients at CKD stages &amp;lt; G3b (n = 60) and ≥ G3b (n = 10) were compared. There were no significant differences in hemoglobin level at the initial hospital visit or total volume of ABD between the 2 groups. However, hemoglobin levels just before the first ABD, the second ABD, and resection, and just after resection were significantly lower in the CKD ≥ G3b group than those in the &amp;lt; G3b group (P &amp;lt; 0.05). CKD stage contributes to reductions in hemoglobin levels after ABD. We recommend the use of erythropoietin in CKD ≥ G3b cases that include ABDs.

Effect of benign and tumor parenchyma metabolomic profiles on compensatory renal growth in renal cell carcinoma surgical patients.

446 Background: Pre-operative kidney volume is an independent predictor of glomerular filtration rate in renal cell carcinoma patients. Compensatory renal growth (CRG) can ensue prior to nephrectomy in parallel to tumor growth and benign parenchyma loss. We aimed to test whether renal metabolite abundances significantly associate with CRG, suggesting a causative relationship. Methods: Tissue metabolomics data from 49 patients, with a median age of 60 years, were previously collected and the pre-operative fold-change of their contra to ipsi-lateral benign kidney volume served as a surrogate for their CRG. Contra-lateral kidney volume fold-change within a 3.3 +/- 2.1 years follow-up interval was used as a surrogate for long-term CRG. Using a multivariable statistical model we identified metabolites whose abundances significantly associate with CRG. Results: We identified 13 metabolites in the benign (e.g. L-urobilin) and 163 metabolites in the malignant (e.g. 3-indoxyl-sulfate) tissues to significantly associate with CRG. Benign/tumor fold change in metabolite abundances revealed three additional metabolites with a significant positive association with CRG (e.g. p-cresol sulfate). At the pathway level, we show that fatty-acid oxidation is highly enriched with metabolites whose benign tissue abundances strongly positively associate with CRG, whereas in the tumor tissue significant enrichment of dipeptides (positive association) and benzoate, glycolysis/gluconeogenesis, lysolipid and nucleotide sugar pentose (negative associations) sub-pathways were observed. The effect of metabolite abundances in the benign tissue on long term CRG provided further support for positive association of fatty-acid metabolism sub-pathway enrichment, where sphingolipid, monoacylglycerol, long chain fatty acids, and mid chain fatty acids were enriched for a negative association. Conclusions: These data suggest that specific biological processes in the benign as well as in the tumor parenchyma strongly influence compensatory renal growth.