Significant Impairment Of Renal Function Research Articles

Effect of Multiple Access Tracts During Percutaneous Nephrolithotomy on Renal Function: Evaluation of Risk Factors for Renal Function Deterioration

To assess the impact of multiple access tracts during percutaneous nephrolithotomy (PCNL) on short- and midterm renal function, and to determine risk factors predicting renal function deterioration and/or recoverability. Patients undergoing PCNL with multiple punctures were prospectively enrolled. Preoperative evaluation included dimercaptosuccinic acid and diethylenetriaminepentaacetic acid renography. Patients were classified according to baseline renal function into patients with normal (<1.4 mg/dL) serum creatinine (group A) and patients with elevated (≥1.4 mg/dL) serum creatinine (group B). Patients were followed with serial serum creatinine evaluations and a repeated renography at 12 months. Factors evaluated for possible impact on renal function changes included preoperative renal function, number of access tracts, hypertension, and diabetes mellitus. There were 102 patients 21 to 65 (mean 39.9) years who completed the study. Fifty patients (group A) had normal preoperative serum creatinine levels and glomerular filtration rate (GFR), which showed no statistically significant change 12 months after PCNL. Fifty-two patients had baseline renal impairment (group B), and they experienced statistically significant worsening of the serum creatinine level and GFR at 12 months postoperatively (P<0.001). Ten (19.23%) patients in group B had a significant deterioration of GFR more than 25%. Independent risk factors for this poor outcome were elevated (≥1.4 mg/dL) preoperative serum creatinine level, diabetes, and hypertension. PCNL with multiple tracts carries a risk of adversely affecting renal function. Preoperative baseline renal impairment, diabetes, and hypertension are risk factors for significant renal function deterioration after the procedure.

Combined statin-fibrate therapy-induced rhabdomyolysis: Case report

Introduction Rhabdomyolysis is a rare, but serious and potentially fatal adverse reaction of the statin application that may be developed in any time of therapy. It is characterized by massive destruction of muscles associated with the large increase of creatine kinase (CK) leading to myoglobinuria and potential acute renal failure. Combined statin-fibrate therapy increases the risk of rhabdomyolysis, especially in elderly and diabetic patients. Case report An 81-year-old male was admitted to Coronary Care Unit of the Emergency Center, Clinical Center of Serbia (CCS) with the clinical picture and electrocardiogram of the acute anterior wall myocardial infarction complicated with pulmonary edema. Laboratory tests on admission showed higher elevated values of serum creatinine 179 μmol/L and BUN 9.2 mmol/L (eGFR 32 mL/min/1.73m2), CK 309 U/L (on day 2: 3476 U/L) and mixed hyperlipidemia (total cholesterol 10.3 mmol/L, HDL 2.26 mmol/L, TG 4.85 mmol/L). The patient was treated with thrombolysis medication therapy (Alteplase), anticoagulant and dual antiplatelet therapy, diuretics, organic nitrates, angiotensin-converting enzyme (ACE) inhibitors, antibiotics, and proton pump inhibitors. During seven days, his therapy included combined pravastatin 20 mg and fenofibrate (160 mg), which was discontinued due to pains and weakness of muscles and significantly elevated CC to 7080 U/L (upper limit 200 U/L), but no significant deterioration of renal function was observed. Discontinuation of therapy resulted in CC level normalization and improvement of clinical condition. Conclusion Combined statin and fibrate therapy requires strict clinical control and monitoring of CK i transaminases. Four-time or higher increase of CK requires discontinuation of therapy. In addition, patients are advised to report immediately any pains in muscles, sensibility, weakness or cramps.

Peri-operative renal morbidity secondary to gentamicin and flucloxacillin chemoprophylaxis for hip and knee arthroplasty

This retrospective cohort study uses serum creatinine levels to assess the effect of gentamicin and flucloxacillin on renal function in hip and knee arthroplasty patients. Serum creatinine levels were recorded pre-operatively and at two points post-operatively (sample 1 and sample 2) for all patients undergoing hip and knee arthroplasty. Either cefuroxime, or gentamicin and flucloxacillin were used for chemoprophylaxis. The Risk, Injury, Failure, Loss, End Stage classification was used to assess renal injury. The differences in mean percentage change between the two groups were 5.86% (p = 0.077) and 11.34% (p = 0.030) at sample 1 and sample 2, respectively. Two patients (1.62%) receiving cefuroxime were exposed to renal risk or worse at some point. A total of nine patients (6.04%) receiving flucloxacillin and gentamicin were exposed to renal risk. Of these, three (2.01%) sustained renal injury and two (1.34%) sustained renal failure. The risk of being exposed to renal risk was 3.75 times greater for the gentamicin and flucloxacillin group. The risks of sustaining a significant deterioration of renal function were 1.9 and 17 times greater for the gentamicin and flucloxacillin group at the first and second post-operative samples, respectively. Flucloxacillin and gentamicin significantly worsens renal function post-operatively compared with cefuroxime.

Radiofrequency ablation (RFA) of renal cell carcinoma (RCC): experience in 200 tumours

ObjectivesTo evaluate our clinical experience with percutaneous image-guided radiofrequency ablation (RFA) of 200 renal tumours in a large tertiary referral university institution.Patients and MethodsImage-guided RFA (ultrasonography or computed tomography [CT]) of 200 renal tumours in 165 patients from June 2004 to 2012 was prospectively evaluated. Institutional Review Board approval was granted.The treatment response and technical success were defined by absence of contrast enhancement within the tumour on contrast enhanced CT or magnetic resonance imaging. Both major and minor complications, glomerular filtration rate (GFR) before and after RFA, the management and outcomes of the complications, as well as oncological outcome were prospectively documented. Multivariate analysis was used to determine variables associated with major complications and also the percentage GFR change after RFA. The overall (OS), 5-year cancer-specific (CSS), local recurrence-free (LRFS) and metastasis-free survival (MFS) rates are presented using the Kaplan–Meier curves. Results In all, 200 tumours were RF ablated with a mean (range) tumour size of 2.9 (1–5.6) cm and the mean (range) patient age was 67.7 (21–88.6) years with a mean follow-up period of 46.1 months. The primary technical and overall technical success rate was 95.5% and 98.5%, respectively. Two independent predictors of successful RFA in a single sitting were tumour size (<3 cm) and exophytic location in multivariate logistic regression analysis. Major complications included ureteric injury (six patients), calyceal-cutaneous fistula (one), acute tubular necrosis (one) and abscess (two). Two independent predictors of ureteric injury were central location and lower pole position. Within this cohort of patients, only four patients developed significant renal function deterioration i.e. >25% decreased in GFR. In all, 161 (98%) patients of the 165 patients have preservation of renal function. Any change in renal function after RFA was not influenced by tumour factors or solitary kidney status. In our clinical series, this yielded a 5-year OS, CSS, LRFS and MFS rates of 75.8%, 97.9%, 93.5% and 87.7% respectively. ConclusionsImage-guided RFA is a safe, nephron sparing and effective treatment for small renal cell carcinoma (RCC) tumours with a low rate of recurrence and has good 5-year CSS and MFS rates.

PROGRESSING CHRONIC KIDNEY DISEASE AND THE 12-MONTH DYNAMICS OF CARDIOVASCULAR RISK FACTORS IN PATIENTS WITH ARTERIAL HYPERTENSION AND TYPE 2 DIABETES MELLITUS

Aim. To assess the association between the 12-month dynamics of cardiovascular risk factors (CVD RFs), progressing chronic kidney disease (CKD), and individual baseline clinical and laboratory parameters in patients with arterial hypertension (AH) and Type 2 diabetes mellitus (DM-2) who received active antidiabetic treatment.Material and methods. In total, 122 patients with AH and DM-2 underwent the laboratory assessment of blood and urine samples at baseline and 12 months later, in order to evaluate the levels and dynamics of CVD RFs and CKD severity.Results. After 12 months of continuous therapy with antihypertensive and oral antidiabetic medications and statins, the carbohydrate metabolism parameters significantly improved. However, creatinine clearance decreased significantly (by 7,52%). The direction of renal function parameter changes was determined by the baseline CKD stage. Progressing CKD was also associated with obesity (O), atrial fibrillation (AF), and myocardial infarction (MI) in medical history. In patients with or without O, the albumin-creatinine ratio decreased by 59,8% and 34%, respectively. In participants with or without AF, microalbuminuria increased by 321% and decreased by 53,5%, respectively. In patients with MI in medical history, urine levels of creatinine decreased by 33,6%, while in the other patients, they increased by 5,4%. O was associated with a reduction in total cholesterol (TCH) by 5,5%, while in non-obese patients, TCH levels did not change substantially.Conclusion. In most patients with AH and DM-2, adequate glycemia control, standard antihypertensive treatment, and statin therapy for 12 months were associated with minimal changes in CVD RFs and with a significant deterioration in renal function. The latter was predicted by the CKD stage at baseline, O, MI in medical history, and AF.

Leishmaniasis cutánea y anfotericina B liposomal. Reporte de caso

Cutaneous leishmaniasis is a zoonosis caused by various species of Leishmania parasite. There are two types, known as New World and Old World leishmaniasis, which are caused by different species. The most common form of leishmaniasis in our area is mucocutaneous, which rarely has systemic involvement, even in HIV-positive patients. Glucantime is the first choice of therapy, or alternatively miltefosine, both of which have significant toxicity and can fail in a substantial number of cases. The alternative choice of treatment for these patients is amphotericin B, from which the liposomal form has less renal toxicity but a high cost and low availability. We report the case of a patient with chronic renal disease and cutaneous leishmaniasis, in whom Glucantime was contraindicated and therapeutic failure with miltefosine occurred. He was treated with liposomal amphotericin B in a single dose of 15mg/kg with adequate tolerance, no significant deterioration of renal function and resolution of skin lesions after 30 and 60 days of follow up.

Renal Function Outcomes Following Selective Angioembolization for Iatrogenic Vascular Lesions After Partial Nephrectomy

To report one of the largest series of clinical and renal function outcomes of treated iatrogenic vascular lesions (IVL) after partial nephrectomy (PN). Angioembolization (AE) is the treatment of choice for patients with these lesions, but the additional renal injury conferred by this treatment has not been well described. Patients who underwent open, laparoscopic, or robot-assisted PN from 2002 to 2012 were identified and those with AE were selected. Patients' charts were reviewed, and renal function was analyzed using estimated glomerular filtration rate (eGFR) and progression of chronic kidney disease (CKD) classification before and after PN and AE. There were 849 patients who underwent PN and an IVL developed in 28 (3.3%). Twenty (71%) presented with gross hematuria at a mean of 10.2 ± 7.7 days after PN and 8 (28%) needed transfusion. All patients had identifiable IVL at the time of selective AE, and technical success was achieved in 24/28 (86%), although 4 needed subsequent additional AE. The paired decrease in eGFR after PN was significant (P<0.01), while the paired change in eGFR after AE was not with either short-term (2.8 days) or intermediate-term (362 days) follow-up (P=0.50). Four patients experienced transient worsening in CKD classification after AE, although three experienced CKD stage improvement. Selective AE for IVL after PN is safe, efficacious, and does not lead to a significant impairment of renal function. It remains the preferred approach for the evaluation and management of post-PN hemorrhage.

Localized Cystic Disease of the Kidney: A Rare Cause of Hypertension in a Young Adult

Localized cystic disease of kidney (LCDK) is a rare, non-familial, non-progressive renal disorder that is not associated with cysts or disorders in other organs. Only a few cases have been reported in the literature. While this condition is morphologically identical to the autosomal dominant form of polycystic kidney disease, it is not inherited and is not associated with significant deterioration of renal function. We present a case of a 16-year-old male patient who suffered from hypertension for over two years. On imaging we found several, variable-sized cysts in the upper half of the right kidney. The left kidney and lower segment of the right kidney were normal. Selective renal vein catheterization and sampling showed markedly elevated renin level in the right upper segmental vein (92 pg/ml, normal value: 11-33 pg/ml). The patient underwent a right upper heminephrectomy and histopathology was suggestive of LCDK. After surgery, the patient's blood pressure returned to normal levels without any need of antihypertensive medication and he is under follow-up on outpatient basis for the past two years.

Atrial fibrillation types predict the development of contrast-induced nephropathy in patients with acute myocardial infarction treated invasively

Purpose: The aim of the study was to assess the clinical impact of atrial fibrillation (AF) types on developing contrast induced nephropathy (CIN) in patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention. Methods: We analyzed 2, 980 consecutive AMI-patients treated invasively, who were admitted to our center between 2003 and 2008. Data on in-hospital follow up were screened to identify subjects who developed CIN during index hospitalization. Additionally data on long-term follow up were collected to assess prognosis in this population. Results: CIN was recognized in 719 (24.13%) patients (CIN group), whereas in 2,261 (75.87%) patients (Control Group) no significant deterioration of renal function was detected. The incidence of atrial fibrillation was significantly higher in CIN group: 14.74% vs 7.8% (p<0.001). The incidence of pre-hospital non-permanent AF (AF Group 1), new-onset AF (AF Group 2) and permanent AF (AF Group 3) in CIN group was: 3.76%, 6.54% and 4.45% respectively. Apart from glomerular filtration rate < 60ml/min/m2 (HR 3.63) and left ventricular ejection fraction <35% (HR 2.63), new-onset AF (HR 2.50) as well as permanent AF (HR 2.03) were the most powerful independent predictors of CIN in the studied population. Long-term mortality was significantly higher in AF Group 2 and 3 than in AF Group 1 and CIN population free of this arrhythmia: 61.7% and 59.4% respectively vs 29.6% and 26.6% respectively (all p<0.001). ![Figure][1] Cumulative proportion of survival Conclusions: New-onset atrial fibrillation and permanent AF were strong independent risk factors for CIN in AMI-patients treated invasively. These two types of arrhythmia were also independently associated with significantly higher short- and long-term mortality in AMI-patients with concomitant CIN. [1]: pending:yes

Analysis of Effects of Fixation Type on Renal Function After Endovascular Aneurysm Repair

To report a prospective nonrandomized study comparing the effects of suprarenal (SR) vs. infrarenal (IR) stent-graft fixation on renal function in patients undergoing endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Patients with AAA undergoing elective EVAR between June 2008 and June 2010 were eligible for the comparative study of fixation method on renal function. Patients with impaired renal function [estimated creatinine clearance (eCrCl) <30 mL/min] or a history of renal impairment were not eligible. Renal function was assessed by measuring serum creatinine (SCr) and total proteins and microalbumin in the urine preoperatively, on postoperative day 1, and at 1, 6, and 12 months. The eCrCl was calculated using the Cockcroft-Gault formula. A standard preoperative hydration protocol was followed in all patients, and stent-graft choice was at the operator's discretion. Of 116 patients undergoing elective EVAR in the study period, 16 were ineligible, leaving 100 patients (95 men; median age 74 years) enrolled in the study (49 SR and 51 IR). There was no statistically significant difference between the groups in the prevalence of any risk factor, the baseline SCr and eCrCl values, contrast usage, or procedure duration. At the postoperative measurement, there was no significant deterioration of renal function in either group, although total urinary proteins increased significantly in both groups (IR p=0.01, SR p<0.001). At the 12-month follow-up, patients in the IR group had no significant alteration in any marker vs. baseline, while patients in the SR group had significant alterations in SCr (p=0.001), eCrCl (p<0.001), and microalbumin (p=0.04) in urine. The number of patients with a >20% decrease in eCrCl was not significantly different between the groups. No patient had an adverse renal event. Deterioration in renal function was observed 12 months after EVAR in patients receiving a stent-graft with suprarenal fixation, even though this did not seem to increase the likelihood of postoperative renal impairment. Furthermore, suprarenal fixation may be responsible for progressively significant proteinuria. Further studies are needed to determine the long-term impact of suprarenal fixation on renal function and investigate the potential risk of progressive renal disease in relation to type of fixation.

Colistin effectiveness and nephrotoxicity: experience from a tertiary care burns unit in Oman

The emergence of multiple drug-resistant (MDR) Gram-negative bacteria and the lack of new antibiotics to combat them have led to the revival of colistin, a drug which was abandoned because of its toxicity. Recent reports showed the drug is effective and relatively safe in burns patients. In this article, we present our experience with the drug. A retrospective study over a period of 2 years was carried out. Forty-eight patients treated with colistin were reviewed and the outcome and nephrotoxicity were assessed. The most prevalent MDR organism in our burns unit was Acinetobacter species. MDR Pseudomonas aeruginosa was seen in few cases and it was always associated with Acinetobacter species infection. The maximum cumulative dose was 193,000,000 international units. The maximum duration was 45 days. The mortality was 33.3 %. Renal function test impairment or worsening was seen in 14 patients (29%). There was no statistically significant impairment of renal function. The P value for creatinine was 0.1236. Colistin is useful for treating multidrug-resistant organism infections in burns patients when no alternative is available. Renal impairment is a major side effect of this antibiotic and the risk maybe higher in burns patients because the burn itself can cause acute kidney injury. Level of Evidence: Level IV, therapeutic study

Renal Impairment in a “Real-Life” Cohort of Anticoagulated Patients With Atrial Fibrillation (Implications for Thromboembolism and Bleeding)

Renal dysfunction is highly prevalent among patients with atrial fibrillation (AF) and confers an increased risk of thrombotic and bleeding complications. We evaluated the effect of renal function on prognosis in anticoagulated patients with AF and assessed the changes in renal function during a long-term follow-up period. We recruited 978 consecutive stable anticoagulated patients with AF from our outpatient anticoagulation clinic (international normalized ratio 2.0 to 3.0 within the previous 6 months). The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease equation at inclusion and 2 years of follow-up. Adverse events were recorded during follow-up (thrombotic/vascular events, major bleeding episodes, and mortality). Longitudinal changes in renal function were analyzed in 886 patients (90.6%). At baseline, the median eGFR using the Modification of Diet in Renal Disease equation was 70.24 ml/min/1.73 m(2) (interquartile range 46.79 to 72.52). During follow-up, a low eGFR was associated with thrombotic/vascular events, with every 30 ml/min/1.73 m(2) eGFR decrease (hazard ratio 1.42, 95% confidence interval [CI] 1.11 to 1.83, p = 0.006), bleeding (hazard ratio 1.44, 95% CI 1.08 to 1.94, p = 0.015), and mortality (hazard ratio 1.47, 95% CI 1.13 to 1.91, p = 0.004). After excluding patients with a baseline eGFR <30 ml/min/1.73 m(2), the mean eGFR in our cohort decreased >10 ml/min/1.73 m(2) in 181 patients (21%) during the follow-up period. The variables associated with severe renal impairment during follow-up were heart failure (odds ratio 3.58, 95% CI 1.36 to 9.42, p = 0.010), basal eGFR (odds ratio 6.34, 95% CI 2.44 to 16.50, p <0.001), and CHADS2 (Congestive heart failure, Hypertension, Age >75 years, Diabetes mellitus, and previous Stroke or transient ischemic attack [doubled]) score (odds ratio 1.63, 95% CI 1.19 to 2.23, p = 0.003). In conclusion, the presence of impaired renal function was closely related to thrombotic/vascular events, bleeding, and mortality in anticoagulated patients with AF. During follow-up, 1/5 of the patients had significant impairment in renal function. Importantly, normal or mild renal dysfunction at baseline did not exclude the subsequent development of severe renal dysfunction during the follow-up period.

Understanding lupus nephritis: diagnosis, management, and treatment options

Systemic lupus erythematosus (SLE) predominantly affects women in their reproductive years. Renal disease (glomerulonephritis) is one of the most frequent and serious manifestations of SLE. Of the various histological types of lupus glomerulonephritis, diffuse proliferative nephritis carries the worst prognosis. Combined with high-dose prednisone, mycophenolate mofetil (MMF) has emerged as a first-line immunosuppressive treatment, although data regarding the efficacy of MMF on the long-term preservation of renal function are forthcoming. Cyclophosphamide is reserved for more severe forms of lupus nephritis, such as crescentic glomerulonephritis with rapidly deteriorating renal function, patients with significant renal function impairment at presentation, and refractory renal disease. Evidence for the calcineurin inhibitors in the treatment of lupus nephritis is weaker, and it concerns patients who are intolerant or recalcitrant to other agents. While further controlled trials are mandatory, B cell modulation therapies, such as rituximab, belimumab and epratuzumab are confined to refractory disease. Non-immunosuppressive measures, such as angiotensin-converting enzyme inhibitors, vigorous blood pressure control, prevention and treatment of hyperlipidemia and osteoporosis, are equally important.

Evaluation of urine biomarkers of kidney injury in polycystic kidney disease

Progressive disruption of renal tubular integrity in the setting of increased cellular proliferation and apoptosis is a feature of ADPKD. Here we evaluated the effect of these processes on the expression of NGAL and IL-18, markers of tubular injury, in rodent models and in the cyst fluid and urine of patients with ADPKD. Two mouse models where Pkd2 was inactivated which resulted in early or adult onset cysts, were used to evaluate NGAL levels. Further, the Han:SPRD rat model of polycystic disease was used to study IL-18 levels. In four annual serial urine samples from 107 patients with ADPKD in the Consortium for Radiologic Imaging for the Study of Polycystic Kidney Disease (CRISP) study, NGAL and IL-18 excretion rates were determined in conjunction with measures of total kidney volume and estimated GFR (eGFR) by the MDRD equation. Kidneys from affected mice and rats showed prominent expression of NGAL and IL-18/IL-18R, respectively, in epithelial cells lining kidney cysts. In human ADPKD cyst fluid, both NGAL and IL-18 were elevated. In CRISP patients, the mean percentage increase in total kidney volume was 5.4 /year and the mean decline in eGFR 2.4 mL/min/year. The trend of increased mean urine NGAL and IL-18 over three years was statistically significant; however, there was no association of tertiles of IL-18 or quartiles of NGAL and the change in total kidney volume or eGFR over this period. Thus, urinary NGAL and IL-18 excretion are mildly and stably elevated in ADPKD, but do not correlate with changes in total kidney volume or kidney function. This may be due, in part, to the lack of communication between individual cysts and the urinary collecting system in this disorder.

Editorial Commentary: Renal failure after cardiac transplantation: Of bravery, wisdom and honesty

The same story has been presented on teaching rounds for the past 20 years: “Mr B. is a 63-year-old who underwent cardiac transplant 6 years ago. He was transplanted for ischemic heart disease and his current comorbidities include hypertension, hyperlipidemia, diabetes and progressive renal insufficiency.” At this point the temptation is to initiate an erudite discussion outlining the incidence of post-transplant renal dysfunction and its impact on outcomes. The brave clinician will implicate the immunosuppressive drugs in the etiology of renal dysfunction and attempt to summarize a complex literature that highlights the pathophysiology of calcineurin inhibitor (CNI)-induced nephrotoxicity. After all, the drugs must play an important role in the etiology, because the patient did not have significant antecedent renal dysfunction. The wise clinician will broaden the discussion to include other potential causes of renal insufficiency ranging from common comorbidities to peri-operative ischemic insults. The honest clinician will simply note that we actually have an inadequate understanding of the complex interactions of underlying disease processes, clinical events and post-transplant therapeutics in the development of one of the most common and important complications after cardiac transplantation. In a recent analysis of 69,321 recipients of non-renal solid-organ transplantation, 16% of patients developed renal dysfunction within 3 years, and nearly 30% of these patients required dialysis or renal transplantation. 1 Further, incident renal failure was associated with a 4.5-fold increase in mortality. The registry of the International Society for Heart and Lung Transplantation demonstrated that significant renal functional impairment after cardiac transplantation occurs in 26% of recipients at 12 months and 30% at 5 years, and nearly 6.5% of the cardiac transplant patients require renal replacement therapy by 10 years. 2

Renal function after nephron-sparing surgery for renal tumors

Nephron sparing surgery (NSS) is a technique more frequently utilized in the case of surgical treatment of kidney tumor. The aim of the study is to assess renal function in patients treated with NSS for renal tumors. Twenty patients, after NSS performed for renal tumor, were included in the study. In each patient dynamic renal scintigraphy was performed before surgical treatment (test No. 1) and after a mean interval of 12 months after surgical procedure (test No. 2). In each test renographic curves were evaluated. Creatinine levels and GFR rates were also assessed. Mean GFR was 84 ml/min/1.73 m2 before surgery, and 79 ml/min/1.73 m2 after surgical procedure. Mean change of GFR value after the surgical procedure was -5.1 (p >0.058). On renography significant deterioration of renal function was observed in the operated kidneys of 4 patients (20%) after NSS, insignificant deterioration - in four patients (20%) and improvement of renal function of operated kidney was found in one patient. In 12 patients (60%) no change was observed. The relative percentage GFR-share of operated kidney decreased by the average value of 3.8% (p >0.005). Multifactorial analysis did not identify significant effect of potential risk factors on the function of the kidney subjected to NSS. Preliminary results of this study confirm that deterioration of renal function after NSS is a rare event.

Renal function in type 1 diabetics one year after successful pancreas transplantation

The effect of pancreas transplantation on renal function remains a matter of debate. The purpose of this retrospective, single-unit study is a preliminary analysis of renal function one yr after pancreas transplant (pancreas alone [PTA] or pancreas after kidney [PAK]). Fifty-nine patients were included. Serum creatinine and estimated glomerular filtration rate (eGFR) levels were compared three, six, and 12 months post-transplantation for the whole sample and separately for PTA and PAK and high (>45 mL/min/1.73 m(2)) and low (≤45 mL/min/1.73 m(2)) pre-transplant eGFR subgroups. Overall, eGFR did not change significantly (p = 0.228) at the end of the first year post-transplant, with patients of low initial eGFR presenting a more prominent trend toward stable or improved levels. In the PAK subgroup, eGFR was significantly improved (p = 0.035). High eGFR subgroup demonstrated no significant deterioration in renal function, while patients with low initial eGFR had significantly higher levels 3 (p = 0.012) and six months (p = 0.009) post-transplant. Our study shows that renal function did not deteriorate significantly one yr after pancreas transplant (PTA or PAK), even in patients with substantial pre-existing renal dysfunction. Evaluation at a wider scale and identification of risk factors for potential deterioration are challenges for future research.

When is it necessary to perform nuclear renogram in patients with a unilateral neonatal hydronephrosis?

To examine whether anteroposterior(AP) pelvic diameter on postnatal renal ultrasound scan (US) can predict both initial differential renal function (DRF) and deterioration in DRF in patients with prenatally diagnosed hydronephrosis. One hundred and thirty-three patients diagnosed with a unilateral prenatal hydronephrosis, confirmed postnatally, were evaluated. We tried to find the cutoff values for initial AP diameter and change in AP diameter based on initial DRF and renal outcome. Reduction of 5% or more was considered as deterioration in function. All patients had an initial US scan at a mean age of 1.62weeks (1-4) and nuclear renogram at 13.24weeks (7-21). All patients had a second US at a mean age of 10.58weeks (6-19). 119 patients had a second renogram. Initial mean pelvic diameter was 20.86 (11-49)mm. When AP pelvic diameter was less than 20mm, 98.6% of all renal units had a function of ≥40%. The cutoff point for AP pelvic diameter was 19.05 when DRF was ≥45% (P<0.001). When the reduction in hydronephrosis in pelvic diameter was analyzed to predict the initial renal function, a cutoff point of 1.3mm decrease was found when initial renal function was ≥40% (P<0.001). The reduction in AP pelvic diameter was 2.1mm when initial DRF was ≥45% (P=0.009). For all patients except 3 individuals, if there was a reduction in AP diameter or the AP diameter was stable, then no reduction in function was observed. When the AP pelvic diameter is less than 20mm at presentation, DRF is normal. If the AP diameter is stable or decreases, there is unlikely to be a significant deterioration in renal function. Consequently, in selected patients, congenital unilateral hydronephrosis can be followed with serial ultrasounds.

Initial Experience with Retroperitoneoscopic Microwave Ablation of Clinical T1aRenal Tumors

To evaluate the feasibility, safety, and efficacy of retroperitoneoscopic microwave ablation (MWA) for clinical stage T(1a) (cT(1a)) renal tumors. Consecutive renal cell carcinomas (RCCs) managed since April 2006 with a minimal follow-up of 12 months were included. A total of 23 tumors in 22 patients were managed with laparoscopic MWA. A cooled shaft needle antenna was inserted into the tumor under direct visual guidance. Microwaves were emitted at 50 W for 8 minutes and prolonged as necessary to ensure complete tumor kill. Short-term efficacy was assessed by contrast-enhanced CT at 1, 3, and 6 months, and every 6 months thereafter. Pathologic analysis revealed low-grade clear-cell RCC in all patients. Mean tumor size was 2.8 cm (range 0.9-4.0 cm). Excluding 5 lost patients, the initial ablation was successful in 17 (94.4%) of 18 tumors. One patient with an incomplete ablation lesion under strict surveillance had no evidence of disease progression at 31 months of follow-up. No recurrence was observed at a median follow-up of 20 months (range 12-45 mos). All 17 remaining patients had no clinical or radiographic evidence of disease at last follow-up. In addition, complications were mild and tolerable (18.2%), and there was no significant deterioration of renal function. Retroperitoneoscopic MWA appears to be a safe and effective technique for cT(1a) RCC in selected patients. Additional follow-up is needed to assess long-term effectiveness.

Statins and Postoperative Renal Function

Nowadays statins are a cornerstone in perioperative and long-term cardiovascular risk reduction in vascular surgery patients. As has been strongly advocated by the recent European Society of Cardiology guidelines for perioperative management statins should be prescribed to virtually all patients undergoing vascular surgery. This recommendation has subsequently been reinforced by the results of the DECREASE III trial. The results of this placebo-controlled randomized trial showed a two-fold reduction in perioperative cardiac complications in patients on statins. Though not powered for subgroup analyses there seemed to be no significant difference of effect in open or endovascular treated patients. The study by Moulakakis focusses on a different, less well understood, potential beneficial effect of statins in vascular surgery patients. In this retrospective study patients on statins experienced a significantly lower rate of renal function deterioration compared to patients not on statins when undergoing endovascular abdominal aneurysm repair requiring suprarenal fixation. Data on the potential renal protective effect of statins in patients undergoing EVAR are scarce. However in open vascular surgery large cohort studies have found similar results. Welten et al. studied 1944 patients undergoing open vascular surgery. In this population acute kidney injury, defined as >10% decrease in creatinine clearance, occurred in 664 (34%) patients within 2 days after surgery. Of the 664