{"title":"Cancer Antigen 125 and Nephrotic Syndrome","authors":"Edwin Castillo Velarde","doi":"10.14740/wjnu385","DOIUrl":"https://doi.org/10.14740/wjnu385","url":null,"abstract":"","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67239768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Foreign bodies in esophagus are more common in children, elderly and psychiatry patients. Different types of foreign bodies can get impacted in esophagus, such as coins, bone pieces and meat bolus. Approximately 80% of foreign bodies are said to pass spontaneously without any intervention. Emergent endoscopic retrieval or rigid esophagoscopy are the treatment of choice. Delayed diagnosis can lead to respiratory failure, sepsis or hemorrhage. Nevertheless, esophageal foreign bodies are no more matter of serious concerns to the surgeons in terms of early diagnosis and management given the advancement in the diagnostic tools. Eventually delayed management and complications due to prolonged foreign body impaction are less in the picture nowadays. Here we present a typical case of foreign body esophagus that presented with acute kidney injury which was delayed to reach help due to various factors, such as poor economic background of the patient, poor access to health service and prevalence of social beliefs. Cases of complications like respiratory failure, sepsis, mediastinitis and hemorrhage have been reported very frequently, but cases presenting with acute kidney injury seem to be reported very less in literature. Thus, we believe that this case will add acute kidney injury to another possible complication of delayed foreign body esophagus. World J Nephrol Urol. 2018;7(3-4):78-81 doi: https://doi.org/10.14740/wjnu366
{"title":"Unusual Case of Foreign Body Esophagus Presenting With Acute Kidney Injury: Case Report and Literature Review","authors":"S. Shahi, T. Bhandari, Tridip Bahadur Pantha","doi":"10.14740/WJNU366","DOIUrl":"https://doi.org/10.14740/WJNU366","url":null,"abstract":"Foreign bodies in esophagus are more common in children, elderly and psychiatry patients. Different types of foreign bodies can get impacted in esophagus, such as coins, bone pieces and meat bolus. Approximately 80% of foreign bodies are said to pass spontaneously without any intervention. Emergent endoscopic retrieval or rigid esophagoscopy are the treatment of choice. Delayed diagnosis can lead to respiratory failure, sepsis or hemorrhage. Nevertheless, esophageal foreign bodies are no more matter of serious concerns to the surgeons in terms of early diagnosis and management given the advancement in the diagnostic tools. Eventually delayed management and complications due to prolonged foreign body impaction are less in the picture nowadays. Here we present a typical case of foreign body esophagus that presented with acute kidney injury which was delayed to reach help due to various factors, such as poor economic background of the patient, poor access to health service and prevalence of social beliefs. Cases of complications like respiratory failure, sepsis, mediastinitis and hemorrhage have been reported very frequently, but cases presenting with acute kidney injury seem to be reported very less in literature. Thus, we believe that this case will add acute kidney injury to another possible complication of delayed foreign body esophagus. World J Nephrol Urol. 2018;7(3-4):78-81 doi: https://doi.org/10.14740/wjnu366","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"7 1","pages":"78-81"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42463268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Madison Lyon, S. White, Taylor A. Goodstein, Madeline Koerner, A. Colvin, C. O’Donnell, Janine L Oliver, Shandra S. Wilson
Background: Research looking at the effects of repeat transurethral resection of bladder tumor (TURBT) on long-term survival and recurrence of bladder cancer has mixed results, with some studies showing improvement and others showing unclear benefit. The purpose of this current study is to evaluate the differences in recurrence rates, progression, and survival for patients with non-muscle invasive bladder cancer (NMIBC) who underwent a second TURBT 2 - 6 weeks after an initial TURBT, as compared to patients who only had an initial TURBT. Methods: We performed a retrospective analysis of patients who received a TURBT at our institution over a 12-year period (2005 - 2017). Patients 18 years or older with high-grade pT1 or pTis pathology on initial TURBT were included. Patients with low-grade, pTa, or stage pT2 or greater on initial TURBT and patients with variant histology other than urothelial carcinoma were excluded from the study. Differences in overall survival, recurrence rates, and cancer progression were analyzed using Cox regression to event and Poisson regression to number of occurrences in patients who had repeat TURBT vs. those who did not. Cancer progression was measured as time to cystectomy. Results: One hundred fifty-three patients with a diagnosis of high-grade NMIBC were included in the study. Forty-six patients (30.1%) had a repeat TURBT. There was no significant difference in baseline characteristics including age, stage, or gender between the two groups. After a median follow-up of 67.5 months (range 7.5 - 200 months), there was no significant difference in overall survival (OS) (P = 0.63), cancer progression (P = 0.51) or recurrence rates (P = 0.60) for patients who underwent second-look TURBT compared to those who did not. Of those patients who underwent repeat TURBT, 32 (69.6%) had residual tumor and 13 (28.2%) had a change in stage. Of the patients that had a change in stage, five were upstaged to muscle invasive (pT2) disease. Conclusions: Our analysis did not show an association between second-look TURBT with overall survival, progression, or recurrence rate of bladder cancer as compared to no second-look TURBT. However, there was a small rate of upstaging to pT2 disease on repeat TURBT. Even though there was no change in OS, repeat TURBT has an important role in finding T2 disease, and this is so critical that continuing with this conservative approach of a second TURBT is still recommended. World J Nephrol Urol. 2018;7(3-4):63-66 doi: https://doi.org/10.14740/wjnu361w
{"title":"A Second-Look at the Repeat Resections of Bladder Tumors","authors":"Madison Lyon, S. White, Taylor A. Goodstein, Madeline Koerner, A. Colvin, C. O’Donnell, Janine L Oliver, Shandra S. Wilson","doi":"10.14740/WJNU361W","DOIUrl":"https://doi.org/10.14740/WJNU361W","url":null,"abstract":"Background: Research looking at the effects of repeat transurethral resection of bladder tumor (TURBT) on long-term survival and recurrence of bladder cancer has mixed results, with some studies showing improvement and others showing unclear benefit. The purpose of this current study is to evaluate the differences in recurrence rates, progression, and survival for patients with non-muscle invasive bladder cancer (NMIBC) who underwent a second TURBT 2 - 6 weeks after an initial TURBT, as compared to patients who only had an initial TURBT. Methods: We performed a retrospective analysis of patients who received a TURBT at our institution over a 12-year period (2005 - 2017). Patients 18 years or older with high-grade pT1 or pTis pathology on initial TURBT were included. Patients with low-grade, pTa, or stage pT2 or greater on initial TURBT and patients with variant histology other than urothelial carcinoma were excluded from the study. Differences in overall survival, recurrence rates, and cancer progression were analyzed using Cox regression to event and Poisson regression to number of occurrences in patients who had repeat TURBT vs. those who did not. Cancer progression was measured as time to cystectomy. Results: One hundred fifty-three patients with a diagnosis of high-grade NMIBC were included in the study. Forty-six patients (30.1%) had a repeat TURBT. There was no significant difference in baseline characteristics including age, stage, or gender between the two groups. After a median follow-up of 67.5 months (range 7.5 - 200 months), there was no significant difference in overall survival (OS) (P = 0.63), cancer progression (P = 0.51) or recurrence rates (P = 0.60) for patients who underwent second-look TURBT compared to those who did not. Of those patients who underwent repeat TURBT, 32 (69.6%) had residual tumor and 13 (28.2%) had a change in stage. Of the patients that had a change in stage, five were upstaged to muscle invasive (pT2) disease. Conclusions: Our analysis did not show an association between second-look TURBT with overall survival, progression, or recurrence rate of bladder cancer as compared to no second-look TURBT. However, there was a small rate of upstaging to pT2 disease on repeat TURBT. Even though there was no change in OS, repeat TURBT has an important role in finding T2 disease, and this is so critical that continuing with this conservative approach of a second TURBT is still recommended. World J Nephrol Urol. 2018;7(3-4):63-66 doi: https://doi.org/10.14740/wjnu361w","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"7 1","pages":"63-66"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45277356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A rare case of Jackstone calculus in the bladder that was incidentally detected on a computed tomography (CT) examination in a patient with non-specific abdominal pain is described. Jackstone calculus represents a rare entity characterized by a central dense core with peripheral projections that resembles a children’s toy. It is important to recognize this entity because it is conducive to fragmentation through lithotripsy. Jackstone calculi are usually described in veterinary literature, but they are rare in humans. In human patients, their formations are caused by urinary obstructions. World J Nephrol Urol. 2018;7(3-4):85-87 doi: https://doi.org/10.14740/wjnu372
{"title":"A Large Jackstone Calculus Incidentally Detected on CT Examination: A Case Report With Literature Review","authors":"B. Brogna, F. Flammia, F. Flammia, U. Flammia","doi":"10.14740/WJNU372","DOIUrl":"https://doi.org/10.14740/WJNU372","url":null,"abstract":"A rare case of Jackstone calculus in the bladder that was incidentally detected on a computed tomography (CT) examination in a patient with non-specific abdominal pain is described. Jackstone calculus represents a rare entity characterized by a central dense core with peripheral projections that resembles a children’s toy. It is important to recognize this entity because it is conducive to fragmentation through lithotripsy. Jackstone calculi are usually described in veterinary literature, but they are rare in humans. In human patients, their formations are caused by urinary obstructions. World J Nephrol Urol. 2018;7(3-4):85-87 doi: https://doi.org/10.14740/wjnu372","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"7 1","pages":"85-87"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45653844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: To present our experience with semi-rigid ureteroscopy (URS) and pneumatic lithotripsy in the treatment of ureteral stones in symptomatic pregnant women. Methods: This study was performed on 55 pregnant women with symptomatic obstructing unilateral ureteral calculi requiring surgical intervention. The patients were treated by URS stone extraction with pneumatic lithotripsy, and Double J (DJ) stent placement were routinely done in all patients. The incidence of premature uterine contractions (PUC) due to URS was recorded. In addition to the details of the procedures, serum magnesium, calcium and glucose levels were also measured. Results: All the patients underwent a successful URS with intracorporeal pneumatic lithotripsy. No perioperative fetal complications were detected, and all patients completed the full term of pregnancy. Seven patients had a postoperative PUC. An increased risk of PUC was found in patients with fever and renal colic at the initial presentation. PUC was more frequent in patients with lower serum magnesium levels. Univariate analysis showed that fever at initial presentation, high serum glucose and lower serum magnesium levels were indicative for PUC. Also, the combination of preoperative complicated renal colic with fever is also a prognostic indicator for development of PUC. Multivariate analysis showed that fever at initial presentation and lower serum magnesium levels are an independent prognostic marker for PUC. Conclusions: URS with pneumatic lithotripsy is an effective and safe treatment for pregnant women with obstructing unilateral ureteric calculi. Patients with fever at initial presentation and lower serum magnesium level are the most important factors affecting the preterm complications. World J Nephrol Urol. 2018;7(3-4):67-72 doi: https://doi.org/10.14740/wjnu373
{"title":"Role of Semi-Rigid Ureteroscopy and Pneumatic Lithotripsy in the Treatment of Ureteral Stones in Pregnant Women","authors":"Essa A. Adawi, M. Ghanem, A. Ghanem","doi":"10.14740/WJNU373","DOIUrl":"https://doi.org/10.14740/WJNU373","url":null,"abstract":"Background: To present our experience with semi-rigid ureteroscopy (URS) and pneumatic lithotripsy in the treatment of ureteral stones in symptomatic pregnant women. Methods: This study was performed on 55 pregnant women with symptomatic obstructing unilateral ureteral calculi requiring surgical intervention. The patients were treated by URS stone extraction with pneumatic lithotripsy, and Double J (DJ) stent placement were routinely done in all patients. The incidence of premature uterine contractions (PUC) due to URS was recorded. In addition to the details of the procedures, serum magnesium, calcium and glucose levels were also measured. Results: All the patients underwent a successful URS with intracorporeal pneumatic lithotripsy. No perioperative fetal complications were detected, and all patients completed the full term of pregnancy. Seven patients had a postoperative PUC. An increased risk of PUC was found in patients with fever and renal colic at the initial presentation. PUC was more frequent in patients with lower serum magnesium levels. Univariate analysis showed that fever at initial presentation, high serum glucose and lower serum magnesium levels were indicative for PUC. Also, the combination of preoperative complicated renal colic with fever is also a prognostic indicator for development of PUC. Multivariate analysis showed that fever at initial presentation and lower serum magnesium levels are an independent prognostic marker for PUC. Conclusions: URS with pneumatic lithotripsy is an effective and safe treatment for pregnant women with obstructing unilateral ureteric calculi. Patients with fever at initial presentation and lower serum magnesium level are the most important factors affecting the preterm complications. World J Nephrol Urol. 2018;7(3-4):67-72 doi: https://doi.org/10.14740/wjnu373","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"7 1","pages":"67-72"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45091604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Louardi, Abdessamad Elbahri, Y. E. Harrech, M. Alami, A. Ameur
Renal pedicle avulsion in a hemodynamically stable patient is particularly rare. This may be due to relatively well-protected position of the kidneys in the retroperitoneum surrounded by abdominal viscera anteriorly and dense musculature/spine posteriorly. We present a case of hemodynamically stable renal pedicle avulsion injury following closed abdominal trauma. World J Nephrol Urol. 2018;7(3-4):82-84 doi: https://doi.org/10.14740/wjnu370
{"title":"Renal Pedicle Avulsion in a Hemodynamically Stable Patient: A Case Report","authors":"N. Louardi, Abdessamad Elbahri, Y. E. Harrech, M. Alami, A. Ameur","doi":"10.14740/WJNU370","DOIUrl":"https://doi.org/10.14740/WJNU370","url":null,"abstract":"Renal pedicle avulsion in a hemodynamically stable patient is particularly rare. This may be due to relatively well-protected position of the kidneys in the retroperitoneum surrounded by abdominal viscera anteriorly and dense musculature/spine posteriorly. We present a case of hemodynamically stable renal pedicle avulsion injury following closed abdominal trauma. World J Nephrol Urol. 2018;7(3-4):82-84 doi: https://doi.org/10.14740/wjnu370","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"7 1","pages":"82-84"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48839525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Asif Khan, Khine Lam, S. El‐Sayegh, Elie J. El-Charabaty
C3 glomerulonephritis is rare form of membranoproliferative glomerulonephritis, which result from defects in complement regulatory proteins that promotes excessive activation of alternative complement pathway. Kidney disease is common complication of multiple myeloma (MM). Most common renal complications in MM include monoclonal immunoglobulin deposition disease and myeloma cast nephropathy. Moreover, monoclonal Ig, through the interference of the complement alternative pathway has been shown to play the synergistic role towards renal damage. Up to 50% of MM patients present with renal impairment at diagnosis, 20% may present with acute kidney injury, and 10% require dialysis. In this case report, we describe a case of MM with cast nephropathy with mesangial staining for C3 consistent with C3 glomerulopathy, and the interrelationship between MM and complement system that leads to C3 glomerulopathy. A 59-year-old Trinidadian man with a 2-year history of hypertension presented with nausea and vomiting associated with a generalized weakness for the past 3 months. On admission laboratory results were as follows: hemoglobin 9.1 g/dL; red blood count 1.45 × 10 6 /mm 3 ; white cell count 3.2 × 10 3 /mm 3 ; platelet count 94 × 10 3 /mm 3 ; blood urea nitrogen 94 mg/dL; serum creatinine 10.47 mg/dL (patient had a baseline creatinine level of 1.5 mg/dL); sodium 130 mEq/L; potassium 6.2 mEq/L; bicarbonate 14 mEq/L; total protein 7.0 g/dL; albumin 2.9 g/dL; alkaline phosphatase 57; AST and ALT normal; lipase 102 U/L; urine analysis showed 2+ protein with bland urine sediment and microscopic hematuria (3 - 6/HPF). 24-h urine protein was 2 g/day. Renal ultrasound was significant for a right renal 0.6 cm cyst. The patient was admitted to ICU and was subsequently hemodialyzed due to worsening hyperkalemia and acute kidney injury. Serologies were notable for positive anti-dsDNA antibody and low levels of C3 (46 mg/dL) with normal C4 were observed. Immunofixation by electrophoresis showed free lambda. Serum plasma electrophoresis showed two M-spikes: Lambda light chains and IgG Lambda. A renal biopsy was performed and cast nephropathy was identified with mesangial staining for C3. Bone marrow biopsy was performed and showed CD 56-positive plasma cell myeloma. Patient was treated with Velcade, Cytoxan, and dexamethasone. The patient was subsequently discharged on chemotherapy and intermittent hemodialysis therapy. Follow-up evaluation of the alternative complement pathway showed normal activity level. This case illustrated myeloma kidney associated with mesangial C3 deposition in glomeruli and C3 hypocomplementemia. Our hypothesis is that in monoclonal gammopathy induced C3 glomerulopathy; paraprotein itself is acting as a trigger that excessively activates and dysregulates the AC pathway systemically. Thus, it is highly feasible to tailor the treatment to reduce the amount of paraproteins in C3 glomerulopathy associated with myeloma kidney, as opposed to conventio
{"title":"A Case of Myeloma Kidney With Glomerular C3 Deposition","authors":"Asif Khan, Khine Lam, S. El‐Sayegh, Elie J. El-Charabaty","doi":"10.14740/WJNU359W","DOIUrl":"https://doi.org/10.14740/WJNU359W","url":null,"abstract":"C3 glomerulonephritis is rare form of membranoproliferative glomerulonephritis, which result from defects in complement regulatory proteins that promotes excessive activation of alternative complement pathway. Kidney disease is common complication of multiple myeloma (MM). Most common renal complications in MM include monoclonal immunoglobulin deposition disease and myeloma cast nephropathy. Moreover, monoclonal Ig, through the interference of the complement alternative pathway has been shown to play the synergistic role towards renal damage. Up to 50% of MM patients present with renal impairment at diagnosis, 20% may present with acute kidney injury, and 10% require dialysis. In this case report, we describe a case of MM with cast nephropathy with mesangial staining for C3 consistent with C3 glomerulopathy, and the interrelationship between MM and complement system that leads to C3 glomerulopathy. A 59-year-old Trinidadian man with a 2-year history of hypertension presented with nausea and vomiting associated with a generalized weakness for the past 3 months. On admission laboratory results were as follows: hemoglobin 9.1 g/dL; red blood count 1.45 × 10 6 /mm 3 ; white cell count 3.2 × 10 3 /mm 3 ; platelet count 94 × 10 3 /mm 3 ; blood urea nitrogen 94 mg/dL; serum creatinine 10.47 mg/dL (patient had a baseline creatinine level of 1.5 mg/dL); sodium 130 mEq/L; potassium 6.2 mEq/L; bicarbonate 14 mEq/L; total protein 7.0 g/dL; albumin 2.9 g/dL; alkaline phosphatase 57; AST and ALT normal; lipase 102 U/L; urine analysis showed 2+ protein with bland urine sediment and microscopic hematuria (3 - 6/HPF). 24-h urine protein was 2 g/day. Renal ultrasound was significant for a right renal 0.6 cm cyst. The patient was admitted to ICU and was subsequently hemodialyzed due to worsening hyperkalemia and acute kidney injury. Serologies were notable for positive anti-dsDNA antibody and low levels of C3 (46 mg/dL) with normal C4 were observed. Immunofixation by electrophoresis showed free lambda. Serum plasma electrophoresis showed two M-spikes: Lambda light chains and IgG Lambda. A renal biopsy was performed and cast nephropathy was identified with mesangial staining for C3. Bone marrow biopsy was performed and showed CD 56-positive plasma cell myeloma. Patient was treated with Velcade, Cytoxan, and dexamethasone. The patient was subsequently discharged on chemotherapy and intermittent hemodialysis therapy. Follow-up evaluation of the alternative complement pathway showed normal activity level. This case illustrated myeloma kidney associated with mesangial C3 deposition in glomeruli and C3 hypocomplementemia. Our hypothesis is that in monoclonal gammopathy induced C3 glomerulopathy; paraprotein itself is acting as a trigger that excessively activates and dysregulates the AC pathway systemically. Thus, it is highly feasible to tailor the treatment to reduce the amount of paraproteins in C3 glomerulopathy associated with myeloma kidney, as opposed to conventio","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"7 1","pages":"73-77"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48995458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Qu, E. Newnham, S. Ward, Louis L Huang, R. Macginley, L. McMahon
Background: Concerns have been raised regarding the use of various intravenous fluids resulting in hyperchloremic acidosis and associated acute kidney injury; however, this has primarily been in the context of resuscitation and critical care, and not ward-based medical or surgical patients who receive lower volumes of infusion fluid. We aimed to determine whether normal saline use is more likely to produce hyperchloremic metabolic acidosis than compound sodium lactate, in acute general medical and surgical patients. Methods: This was a retrospective study, conducted in 2015 in a metropolitan hospital in Melbourne, Australia, and of 1,158 sequentially admitted general medical and surgical patients receiving either intravenous normal saline or compound sodium lactate. Demographics, admission diagnosis, comorbidities, and medications were compared. Serum biochemistry results 24 - 48 h post-infusion were analyzed. Primary outcome was incidence of serum hyperchloremia post-infusion. In addition, mean shift in serum chloride concentration as well as mean normalized chloride concentration (mmol/L per day per L of infusion) were calculated. Acute kidney injuries and deaths during admission were also reported. Results: A total of 221 patients (169 medical and 52 surgical patients) were included for analysis (mean age 71.6 years, 72% female), with 174 normal saline and 61 compound sodium lactate infusions. No difference in hyperchloremia rate was found (normal saline vs. compound sodium lactate; n = 8 (4.6%) vs. n = 2 (3.3%), P = 1.0). Post-infusion serum chloride concentration was also not significantly different (99.0 ± 5.1 mmol/L vs. 100.0 ± 3.4 mmol/L, P = 0.1700) between infusion groups. Normal saline infusions resulted in an increase of mean normalized chloride concentration compared to compound sodium lactate (1.2 ± 4.0 mmol/L per day/L vs. -0.3 ± 1.5, P = 0.0121). Conclusions: We conclude that 2 - 3 L normal saline infusions in this population do not appear to be associated with hyperchloremic acidosis more frequently than compound sodium lactate infusions, allaying concerns of normal saline use in wards. World J Nephrol Urol. 2018;7(2):39-44 doi: https://doi.org/10.14740/wjnu339w
{"title":"Balanced Crystalloid Solution Versus Normal Saline on Biochemical Outcomes in Acute Medical and Surgical Patients","authors":"L. Qu, E. Newnham, S. Ward, Louis L Huang, R. Macginley, L. McMahon","doi":"10.14740/WJNU339W","DOIUrl":"https://doi.org/10.14740/WJNU339W","url":null,"abstract":"Background: Concerns have been raised regarding the use of various intravenous fluids resulting in hyperchloremic acidosis and associated acute kidney injury; however, this has primarily been in the context of resuscitation and critical care, and not ward-based medical or surgical patients who receive lower volumes of infusion fluid. We aimed to determine whether normal saline use is more likely to produce hyperchloremic metabolic acidosis than compound sodium lactate, in acute general medical and surgical patients. Methods: This was a retrospective study, conducted in 2015 in a metropolitan hospital in Melbourne, Australia, and of 1,158 sequentially admitted general medical and surgical patients receiving either intravenous normal saline or compound sodium lactate. Demographics, admission diagnosis, comorbidities, and medications were compared. Serum biochemistry results 24 - 48 h post-infusion were analyzed. Primary outcome was incidence of serum hyperchloremia post-infusion. In addition, mean shift in serum chloride concentration as well as mean normalized chloride concentration (mmol/L per day per L of infusion) were calculated. Acute kidney injuries and deaths during admission were also reported. Results: A total of 221 patients (169 medical and 52 surgical patients) were included for analysis (mean age 71.6 years, 72% female), with 174 normal saline and 61 compound sodium lactate infusions. No difference in hyperchloremia rate was found (normal saline vs. compound sodium lactate; n = 8 (4.6%) vs. n = 2 (3.3%), P = 1.0). Post-infusion serum chloride concentration was also not significantly different (99.0 ± 5.1 mmol/L vs. 100.0 ± 3.4 mmol/L, P = 0.1700) between infusion groups. Normal saline infusions resulted in an increase of mean normalized chloride concentration compared to compound sodium lactate (1.2 ± 4.0 mmol/L per day/L vs. -0.3 ± 1.5, P = 0.0121). Conclusions: We conclude that 2 - 3 L normal saline infusions in this population do not appear to be associated with hyperchloremic acidosis more frequently than compound sodium lactate infusions, allaying concerns of normal saline use in wards. World J Nephrol Urol. 2018;7(2):39-44 doi: https://doi.org/10.14740/wjnu339w","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"7 1","pages":"39-44"},"PeriodicalIF":0.0,"publicationDate":"2018-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47601722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. B. Lasfar, Y. Guedri, A. Azzebi, W. Sahtout, S. Mrabet, A. Fradi, S. Toumi, F. Sabri, S. Amor, D. Zallema, A. Achour
Background: Peritonitis is a major complication of peritoneal dialysis (PD), accounting for considerable mortality and hospitalization among PD patients. We have performed a single unit study examining rate of peritonitis, causative organisms, clinical outcomes and impact on technique failure and patient survival. Methods: It was a retrospective review of the medical records of 182 PD patients who were followed up from January 2006 through June 2016. We have listed 186 episodes of peritonitis. Results: The overall incidence of peritonitis during the 10-year study period was one episode every 27.25 month-patient. The mean time to first peritonitis after beginning PD was 14.25 ± 16 months (0 - 65). Gram-positive organisms were the main implicated agents and caused 27.92% of peritonitis. In multivariate Cox regression, no correlation was associated with diabetes, cardiovascular disease and residual renal function at baseline. In the Kaplan-Meier analysis, the peritonitis group was not correlated with more loss of residual renal function. More dropouts from PD were observed compared to the peritonitis-free group (P < 0.000), but no influence with patient survival. Conclusion: Gram-positive organisms were the main causative agents. And peritonitis was associated to technique failure but not with patient survival.Z World J Nephrol Urol. 2018;7(2):45-52 doi: https://doi.org/10.14740/wjnu349w
{"title":"Microbiology Risk Factors and Outcomes of Peritonitis in Tunisian Peritoneal Dialysis Patients","authors":"L. B. Lasfar, Y. Guedri, A. Azzebi, W. Sahtout, S. Mrabet, A. Fradi, S. Toumi, F. Sabri, S. Amor, D. Zallema, A. Achour","doi":"10.14740/WJNU349W","DOIUrl":"https://doi.org/10.14740/WJNU349W","url":null,"abstract":"Background: Peritonitis is a major complication of peritoneal dialysis (PD), accounting for considerable mortality and hospitalization among PD patients. We have performed a single unit study examining rate of peritonitis, causative organisms, clinical outcomes and impact on technique failure and patient survival. Methods: It was a retrospective review of the medical records of 182 PD patients who were followed up from January 2006 through June 2016. We have listed 186 episodes of peritonitis. Results: The overall incidence of peritonitis during the 10-year study period was one episode every 27.25 month-patient. The mean time to first peritonitis after beginning PD was 14.25 ± 16 months (0 - 65). Gram-positive organisms were the main implicated agents and caused 27.92% of peritonitis. In multivariate Cox regression, no correlation was associated with diabetes, cardiovascular disease and residual renal function at baseline. In the Kaplan-Meier analysis, the peritonitis group was not correlated with more loss of residual renal function. More dropouts from PD were observed compared to the peritonitis-free group (P < 0.000), but no influence with patient survival. Conclusion: Gram-positive organisms were the main causative agents. And peritonitis was associated to technique failure but not with patient survival.Z World J Nephrol Urol. 2018;7(2):45-52 doi: https://doi.org/10.14740/wjnu349w","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"7 1","pages":"45-52"},"PeriodicalIF":0.0,"publicationDate":"2018-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43534453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wissal Sahtouta, Lilia Ben Lasfara, Awatef Azzebia, Radhouane Manib, Nedia Arifac, Sawsan Kacemd, Ferdaous Sabria, Yosra Guedria, Sanda Mrabeta, Dorsaf Zellamaa, Asma Fradia, Salma Toumia, Samira Ben Amora, A. Khelife, Moncef Moknif, Halim Trabelsid, Abdellatif Achoura
Epstein-Barr virus (EBV), a virus of the human Herpes viridae class, has a particular importance in renal transplantation because of its complex interaction with the immune system. Indeed, it causes both infectious mononucleosis (IM), immunopathological responses of the host, and at the extreme a malignant tumor, when the responses are altered. The lymphoproliferative syndromes induced by the EBV infection are lymphoid proliferations resulting from the loss of an EBV-specific cytotoxic T-cell response. About 10% of B-type lymphoproliferative syndromes including diffuse large B-cell lymphoma are EBV-positive. We report the case of a 23-year-old man who developed a tumor in the nasal cavity 6 months after renal transplantation. His nephropathy was membranoproliferative glomerulonephritis. The induction therapy indicated was antithymoglobulin (ATG) and solumedrol. In maintenance therapy, mycofenolate mofetil (MMF) and tacrolimus were used. Nasal biopsy has proved CD20-positive B-cell lymphoma. No other site of the disease has been identified. The immunosuppressive agents were modulated with a switch of tacrolimus by an m-TOR inhibitor and a progressive reduction of MMF. After three cycles of R CHOP followed by radiotherapy, he achieved complete remission with a stable graft function. World J Nephrol Urol. 2018;7(2):56-59 doi: https://doi.org/10.14740/wjnu352w
{"title":"Association Between Epstein Barr Virus Infection and Lymphoproliferative Syndrome in a Renal Transplant Patient","authors":"Wissal Sahtouta, Lilia Ben Lasfara, Awatef Azzebia, Radhouane Manib, Nedia Arifac, Sawsan Kacemd, Ferdaous Sabria, Yosra Guedria, Sanda Mrabeta, Dorsaf Zellamaa, Asma Fradia, Salma Toumia, Samira Ben Amora, A. Khelife, Moncef Moknif, Halim Trabelsid, Abdellatif Achoura","doi":"10.14740/WJNU352W","DOIUrl":"https://doi.org/10.14740/WJNU352W","url":null,"abstract":"Epstein-Barr virus (EBV), a virus of the human Herpes viridae class, has a particular importance in renal transplantation because of its complex interaction with the immune system. Indeed, it causes both infectious mononucleosis (IM), immunopathological responses of the host, and at the extreme a malignant tumor, when the responses are altered. The lymphoproliferative syndromes induced by the EBV infection are lymphoid proliferations resulting from the loss of an EBV-specific cytotoxic T-cell response. About 10% of B-type lymphoproliferative syndromes including diffuse large B-cell lymphoma are EBV-positive. We report the case of a 23-year-old man who developed a tumor in the nasal cavity 6 months after renal transplantation. His nephropathy was membranoproliferative glomerulonephritis. The induction therapy indicated was antithymoglobulin (ATG) and solumedrol. In maintenance therapy, mycofenolate mofetil (MMF) and tacrolimus were used. Nasal biopsy has proved CD20-positive B-cell lymphoma. No other site of the disease has been identified. The immunosuppressive agents were modulated with a switch of tacrolimus by an m-TOR inhibitor and a progressive reduction of MMF. After three cycles of R CHOP followed by radiotherapy, he achieved complete remission with a stable graft function. World J Nephrol Urol. 2018;7(2):56-59 doi: https://doi.org/10.14740/wjnu352w","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"7 1","pages":"56-59"},"PeriodicalIF":0.0,"publicationDate":"2018-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42000411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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