Terminal Kidney Research Articles

V05-11 LAPAROSCOPIC MANAGEMENT OF XANTHOGRANULOMATOUS PYELONEPHRITIS – COMPARISON OF TWO DIFFERENT YET SIMILAR CASES

You have accessJournal of UrologyCME1 May 2022V05-11 LAPAROSCOPIC MANAGEMENT OF XANTHOGRANULOMATOUS PYELONEPHRITIS – COMPARISON OF TWO DIFFERENT YET SIMILAR CASES Catarina Laranjo Tinoco, Andreia Cardoso, Ricardo Matos Rodrigues, Sara Anacleto, Ana Sofia Araújo, Mário Cerqueira Alves, and Emanuel Carvalho-Dias Catarina Laranjo TinocoCatarina Laranjo Tinoco More articles by this author , Andreia CardosoAndreia Cardoso More articles by this author , Ricardo Matos RodriguesRicardo Matos Rodrigues More articles by this author , Sara AnacletoSara Anacleto More articles by this author , Ana Sofia AraújoAna Sofia Araújo More articles by this author , Mário Cerqueira AlvesMário Cerqueira Alves More articles by this author , and Emanuel Carvalho-DiasEmanuel Carvalho-Dias More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002579.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Xanthogranulomatous pyelonephritis (XGPN) is a destructive form of chronic pyelonephritis with frequent involvement of adjacent organs (with abscesses and fistulas). We present a video comparison of the laparoscopic nephrectomy of two XGPN cases. METHODS: In this video we present two cases of laparoscopic nephrectomy of XGPN cases – a simpler case (patient 1) and a more complex one with the intraoperative diagnosis and repair of a pyeloduodenal fistula (patient 2). Both patients were middle-aged females with a history of urolithiasis, who presented to the emergency department (ER) with similar symptoms: flank pain and weight loss in the previous month. The computed tomography scans showed typical signs of XGPN of right kidney: an enlarged kidney with important dilation and densification of the collecting system, caused by urinary stones. The patients were admitted to the urology ward and started on intravenous (IV) antibiotics. Patient 1 was submitted to ultrasound-guided percutaneous nephrostomy and psoas drain placement and was discharged after 9 days, with both catheters and oral antibiotics. She was readmitted after 3 months for the elective right nephrectomy. Patient 2’s also had a percutaneous nephrostomy placed by the Urology team and a hepatic drain in an abscess placed by the Radiology team. The patient stayed in the hospital for 2 weeks and was discharged after drains removal. Her right nephrectomy was scheduled for 1.5 months after. The definitive treatment of this condition is surgical with nephrectomy, drainage of concomitant abscesses and removal of the involved tissues. Our video presents and compares these patients’ laparoscopic surgeries. RESULTS: The surgical time was 2 hours in patient 1 and 4 hours in patient 2, with no intraoperative complications. Patient 1 recovered quickly and was discharged after 3 days. Patient 2 was required to stay on bowel rest with a nasogastric tube placed for 3 days. She started solid food ingestion on day 5 with great tolerance and was discharged on post-operative day 8. No post-operative complications were observed. The pathology report was similar for both patients: terminal kidney with XGPN. CONCLUSIONS: Laparoscopic management of xanthogranulomatous pyelonephritis is challenging due to the loss of anatomical planes and inflamed tissues, so a systematic approach is advisable. The management of pyeloduodenal fistulas can also be made by laparoscopy, as demonstrated in our video, the first reported case of laparoscopic treatment of this kind of fistula. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e519 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Catarina Laranjo Tinoco More articles by this author Andreia Cardoso More articles by this author Ricardo Matos Rodrigues More articles by this author Sara Anacleto More articles by this author Ana Sofia Araújo More articles by this author Mário Cerqueira Alves More articles by this author Emanuel Carvalho-Dias More articles by this author Expand All Advertisement PDF DownloadLoading ...

Clinical and diagnostic significance of endothelial dysfunction and serotonin levels in children with hemolytic-uremic syndrome

Hemolytic-uremic syndrome is a serious problem in pediatrics and pediatric nephrology. Hemolytic-uremic syndrome is one of the leading causes of acute kidney injury with potential transformation into terminal chronic kidney disease. Currently, the endothelial dysfunction is strongly associated with changes in the serotonergic system in the pathogenesis of hemolytic-uremic syndrome. There are few studies that have revealed an increase in the blood plasma serotonin concentration in children with hemolytic-uremic syndrome, but its role in the pathogenesis of chronic kidney disease has been insufficiently studied. The progressive course of hemolytic-uremic syndrome, up to the terminal stage of renal failure, requires the search for markers of renal tissue damage as prognostically significant factors for the development of nephrosclerosis, which is of particular importance for optimizing the management of such children.

Mortalidad de pacientes con enfermedad renal crónica terminal en un hospital de Huánuco, 2012-2016

Introducción. La enfermedad renal crónica (ERC) es considerada un problema de salud pública mundial y constituye una pérdida progresiva de la función renal. En el estadio 5, conocido como enfermedad renal crónica terminal, el paciente requiere terapia de reemplazo renal (TRR). Este trabajo se busca plasmar si el tipo de diálisis, el tipo de acceso y el tiempo total de TRR tienen relación con la mortalidad de pacientes con ERC en estadio cinco del hospital II-EsSalud de Huánuco. Métodos. Diseño Observacional, analítico, retrospectivo de casos y controles. Se identificaron 50 casos y 50 controles. Se realizaron análisis estadísticos a través de la prueba de Chi-2, Odds ratio con un nivel de confianza al 95%. Resultados. Se halló la asociación entre la mortalidad y los factores de riesgo estudiados como: el tipo de diálisis [P= 0,012; OR= 3,85 (IC 95%: 1,27 – 11,63)], el tipo de accesos [P= 0,017; OR= 4,04 (IC 95%:1,21- 13,43)] y el tiempo total de TRR [P= 0,037; OR=3,16 (IC 95%:1,03 – 9,68)], y el 67,7% de pacientes fue de sexo masculino. Se observó que se asociaban con mortalidad: la edad del paciente > 75 años, el género masculino, la frecuencia de más de 3 diálisis por semana y el lugar de procedencia. Conclusiones. Existe asociación entre el tipo de diálisis, el tipo de acceso y el tiempo total de TRR con la mortalidad de pacientes con ERC terminal.

RESULTS OF KIDNEY TRANSPLANTATION IN AKTOBE REGION OF KAZAKHSTAN

Aim:to analyse the results of the initial experience of kidney transplantation of the regional hospital of the Republic of Kazakhstan.Materials and methods.The results of kidney transplantations which were performed to 31 patients in the Aktobe Medical Center (AMC, Aktobesity) for the period from November 2014 to 2017 are presented. Kidney transplantations were performed in compliance with clinical protocols according to the generally accepted methodology. In 25 cases transplantation performed from a living donor, in 6 cases – from deceased donors. The most of living donors underwent laparoscopic nephroureterectomy with manual assistance (70.8%).Results.After nephrectomy operations complications were not observed in donors, all patients were discharged in a satisfactory state on the 5th–8th postoperative day. The following complications were observed in recipients in the early postoperative period: acute tubular necrosis – 1, postoperative bleeding (retroperitoneal hematoma) – 2, lymphorrhagia – 2, urinary leakages – 2. One recipient was died in the late postoperative period after infection complications and the development of sepsis.Conclusions.Kidney transplantation is undoubtedly effective method for treating patients with terminal chronic kidney failure. The results of the initial experience of kidney transplantation in the Aktobe regional hospital of the Republic of Kazakhstan are not differ from the average results of leading domestic and other foreign transplant clinics.

Assessment of oral and periodontal parameters in patients with end-stage chronic kidney disease

Aim: The purpose of the study was to assess the oral cavity status in patients with terminal chronic kidney disease (CKD) undergoing haemodialysis. Materials and Methods: The study comprised 69 patients with end-stage CKD undergoing haemodialysis regime. The data regarding the age, gender, environment, associated diseases were obtained from the clinical medical histories. The patients were submitted to clinical examination, which also included the periodontal probing and the gingival bleeding assessment. The type of edentulous ridge was recorded. Each patient filled a questionnaire offering data regarding the oral hygiene habits, diet, bad habits and the presence/absence of xerostomia. Results and Discussion: The main cause for end-stage CKD was renal, followed by diabetes mellitus and arterial hypertension. The main associated diseases to CKD were clearly secondary arterial hypertension and secondary anaemia; other associated diseases were represented by cardiac diseases, hepatitis, gastro-intestinal diseases, secondary hyperparathyroidism, cirrhosis, hypersplenism, epilepsy and neoplastic diseases. 62.31% of the patients accused frequent xerostomia. When recording the edentulous type, we observed a high percentage of complete tooth loss. Conclusions: There is a close link between the systemic changes in the CKD patient and the oral manifestations. Even 2 of the main causes of CKD (hypertension and diabetes mellitus) exert important changes on the tissues in the oral cavity, leading to significant tooth loss and masticatory impairment, thus, to a poor quality of life.

917 Successful transplantation of kidneys from standard criteria donors with different severities of terminal acute kidney injury

917 Successful transplantation of kidneys from standard criteria donors with different severities of terminal acute kidney injury

Results of a Randomised, Multi-Centre, Single-Blind Trial to Compare the Efficacy, Acceptability and Safety of a New 2-Litre Gut Cleansing Solution Versus a Standard 4-Litre PEG+E Solution

*S1555 Results of a Randomised, Multi-Centre, Single-Blind Trial to Compare the Efficacy, Acceptability and Safety of a New 2-Litre Gut Cleansing Solution Versus a Standard 4-Litre PEG+E Solution Christian Ell, Hans-Juergen Gruss AIM:Todemonstrate that aneworal gut cleansing solutionNRL994 is as effectiveas the existing polyethylene glycol 3350 plus electrolytes (PEG+E) solution as a bowel preparation prior to colonoscopy. METHODS: The study was carried out as a randomised, single-blind, active-controlled, multi-centre study with two parallel treatment groups. Only patients (aged: 18-85 years) scheduled to undergo routine colonoscopy without history of colonic surgery, presence of colonic obstruction/ perforation of the colon, severe cardiovascular conditions and terminal kidney or liver diseases were eligible. Both gut lavage solutions were taken as half dose the eveningbefore followedbytheotherhalf onthemorningof thecolonoscopy.Primary efficacy criteria was the gut cleansing quality, as judged by a blinded expert panel on the basis of videotapes. Secondary endpoints were the degree of gut cleansing in predefined gut segments, overall gut cleansing, evaluation of taste, patient’s satisfaction and acceptability and a full safety assessment. RESULTS: A total of 359 patients (180 with NRL994 and 179 with PEG+E) in 12 centres received study medication. 9 patients withdrew during the study. 42 cases were major protocol violators, mainly related to the absence of a videotape recording. Therefore, 308 patients (153 with NRL994 and 155 with PEG+E) were analysed for the primary efficacy endpoint. The overall success rate was 88.9% in the NRL994 group and 94.8% in thePEG+Egroup.NRL994 is as effective as PEG+E.Themean scores of gut cleansingwere 2.5+/ 0.5 in theNRL994groupand2.5+/ 0.4 in thePEG+E group. Patients consistently preferredNRL994 overPEG+E, assessedby the degree of patient satisfaction, overall acceptability of the gut cleansing solution and taste assessment. Both treatments were well tolerated and had similar adverse event profileswith frequentmild treatment-relatedmalaise, nausea, unspecifiedabdominal pain and vomiting. No relevant shifts in the laboratory tests were observed. CONCLUSION: The study has shown that the new 2 litre NRL994 gut lavage solution proved to be as effective as the existing 4-litre PEG+E solution. Patients consistently preferred NRL994 to PEG+E. Both treatments proved to be safe and generally well tolerated. This new lower volume bowel cleansing solution provides abetterpatientacceptabilitywithout any lossof efficacyor enhanced safety concerns. Comparison of Endoscopic Experience Obtained in an American and a British Gastroenterology Training Program Sean Weaver, Sanjib Mohanty, David Fine, Paul Winwood, Kim Isaacs, Ian Grimm Introduction: Endoscopy represents a central part of gastroenterology training but very little is known about the experience gained in training. The recommendations for endoscopic experience by the ASGE, and the joint advisory group (JAG) for endoscopy in Britian, suggest a relatively low volume of experience to become competent. Three year American programs are shorter than British training which has a minimum of four dedicated years. However many British trainees do more and intercalate a higher research degree. There have been concerns that if the intensity and length of British training are shortened then endoscopic training will suffer. Methods: The records of endoscopic experience from 11 trainees completing the gastroenterology program at the University of North Carolina at Chapel Hill were compared with 9 trainees within one year of completion of training in the British region of Wessex. Results: American and British trainees significantly exceeded both British and American recommendations for experience in both upper and lower gastrointestinal endoscopy. British trainess carried out significantly more upper gastrointestinal endoscopy (mean 2429 vs 662 p<0.05; ASGE recommendation 130; JAG guideline 300) and tended to carry out more colonoscopy (mean 664 vs 483 ns; ASGE recommendation 140; JAG guideline 200). The recommendation of 200 ERCP procedures was only reached by some trainees in both America (3/11; mean 172) and Britain (7/8; mean 198). All procedures in America were supervised by a trainer. In Britain supervision was often indirect once competence was demonstrated. Conclusions: In both training programs trainees get extensive experience in both upper and lower gastrointestinal endoscopy. Obtaining appropriate experience in ERCP is not always achieved which has resulted in some programs training only some of its trainees. The reasons why British trainees gain more upper gastrointestinal experience are probably dependent on length of training (including 8/9 having a research degree), differences in endoscopic practice between the two countries, and time spent outside a tertiary referral teaching hospital environment. There is evidence that training in general endoscopy in Britain would be adequate if British training is shortened or made less intense.