M. Abu-Hishmeh, Alamgir Sattar, Z. Zarlasht, Mohamed Ramadan, A. Abdel-Rahman, S. Hinson, N. Shabarek
Systemic lupus erythematosus (SLE) is an autoimmune multisystem disease that is characterized by various antibodies to nuclear and cytoplasmic antigens and diagnosed by either fulfilling the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria, American College of Rheumatology (ACR) criteria or by Renal Biopsy. Renal involvement is common in SLE and is primarily related to anti-double-stranded DNA antibodies. However, small group of SLE nephritis patients have shown negative anti-dsDNA and ANA. We present a case of 25-year-old female who presented with proteinuria and negative serum antibodies except anti-Ro/SSA. Renal biopsy was performed and was consistent with class IV lupus nephritis (LN). In this report, we highlight the possible role of anti-Ro antibodies in the pathogenesis and the prognosis of LN, although the mechanism is yet to be understood. Anti-Ro/SSA antibodies might play an important role in the pathogenesis and prognosis in LN. However, further studies are required to understand the exact mechanism. World J Nephrol Urol. 2016;5(2):48-49 doi: http://dx.doi.org/10.14740/wjnu272e
{"title":"Rare Case of Lupus Nephritis With Negative Antinuclear Antibodies, Double-Stranded DNA Antibodies and Positive Anti-Ro/SSA Antibodies","authors":"M. Abu-Hishmeh, Alamgir Sattar, Z. Zarlasht, Mohamed Ramadan, A. Abdel-Rahman, S. Hinson, N. Shabarek","doi":"10.14740/WJNU272E","DOIUrl":"https://doi.org/10.14740/WJNU272E","url":null,"abstract":"Systemic lupus erythematosus (SLE) is an autoimmune multisystem disease that is characterized by various antibodies to nuclear and cytoplasmic antigens and diagnosed by either fulfilling the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria, American College of Rheumatology (ACR) criteria or by Renal Biopsy. Renal involvement is common in SLE and is primarily related to anti-double-stranded DNA antibodies. However, small group of SLE nephritis patients have shown negative anti-dsDNA and ANA. We present a case of 25-year-old female who presented with proteinuria and negative serum antibodies except anti-Ro/SSA. Renal biopsy was performed and was consistent with class IV lupus nephritis (LN). In this report, we highlight the possible role of anti-Ro antibodies in the pathogenesis and the prognosis of LN, although the mechanism is yet to be understood. Anti-Ro/SSA antibodies might play an important role in the pathogenesis and prognosis in LN. However, further studies are required to understand the exact mechanism. World J Nephrol Urol. 2016;5(2):48-49 doi: http://dx.doi.org/10.14740/wjnu272e","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"5 1","pages":"48-49"},"PeriodicalIF":0.0,"publicationDate":"2016-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67239130","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}
F. Elzein, Abdulla Aljaberi, S. Asiri, A. Alghamdi
Echinococcal cyst commonly involves the liver and the lungs. Renal hydatid cyst is unusual and tends to occur in association with other organ involvement. Isolated hydatid cyst is extremely rare and can mimic renal tumors. Hence, this diagnosis should be entertained in patients from endemic areas with solitary renal lesions. Although eosinophilia is a suggestive criterion, its absence should not dissuade from pursuing this diagnosis. We here describe a patient with prolonged history of lumbar pain resulting from a large hydatid cyst treated by nephrectomy with a pre- and postoperative course of albendazole and praziquantel. World J Nephrol Urol. 2016;5(1):16-19 doi: http://dx.doi.org/10.14740/wjnu246w
{"title":"Isolated Hydatid Cyst of the Kidney","authors":"F. Elzein, Abdulla Aljaberi, S. Asiri, A. Alghamdi","doi":"10.14740/WJNU246W","DOIUrl":"https://doi.org/10.14740/WJNU246W","url":null,"abstract":"Echinococcal cyst commonly involves the liver and the lungs. Renal hydatid cyst is unusual and tends to occur in association with other organ involvement. Isolated hydatid cyst is extremely rare and can mimic renal tumors. Hence, this diagnosis should be entertained in patients from endemic areas with solitary renal lesions. Although eosinophilia is a suggestive criterion, its absence should not dissuade from pursuing this diagnosis. We here describe a patient with prolonged history of lumbar pain resulting from a large hydatid cyst treated by nephrectomy with a pre- and postoperative course of albendazole and praziquantel. World J Nephrol Urol. 2016;5(1):16-19 doi: http://dx.doi.org/10.14740/wjnu246w","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"5 1","pages":"16-19"},"PeriodicalIF":0.0,"publicationDate":"2016-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67238969","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}
AbdulWahab Hritani, F. Jo-Hoy, A. Siddiqi, Candice Baldeo, Andreea Poenariu
Kidney infarction is an uncommon thromboembolic complication of atrial fibrillation (AF). Diagnosis of this condition can be challenging due to its rarity and the fact that its presentation is associated with a multitude of other pathologies. No treatment guidelines have been established so far; however, multiple modalities have been employed, including systemic thrombolytics, intra-arterial thrombolytics and anticoagulants. In this article, we review acute renal infarction pathogenesis with a focus on AF as an important etiology. World J Nephrol Urol. 2016;5(1):11-15 doi: http://dx.doi.org/10.14740/wjnu242e
{"title":"Acute Renal Infarction Pathogenesis and Atrial Fibrillation: Case Report and Literature Review","authors":"AbdulWahab Hritani, F. Jo-Hoy, A. Siddiqi, Candice Baldeo, Andreea Poenariu","doi":"10.14740/WJNU242E","DOIUrl":"https://doi.org/10.14740/WJNU242E","url":null,"abstract":"Kidney infarction is an uncommon thromboembolic complication of atrial fibrillation (AF). Diagnosis of this condition can be challenging due to its rarity and the fact that its presentation is associated with a multitude of other pathologies. No treatment guidelines have been established so far; however, multiple modalities have been employed, including systemic thrombolytics, intra-arterial thrombolytics and anticoagulants. In this article, we review acute renal infarction pathogenesis with a focus on AF as an important etiology. World J Nephrol Urol. 2016;5(1):11-15 doi: http://dx.doi.org/10.14740/wjnu242e","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"5 1","pages":"11-15"},"PeriodicalIF":0.0,"publicationDate":"2016-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67238553","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: Multiple sclerosis (MS) is the most common disabling neurological disorder affecting young adults. Lower urinary tract dysfunction (LUTD) is common during the course of MS and is responsible for an organic impact on the upper urinary tract and for impaired quality of life. Experimental autoimmune encephalomyelitis (EAE), an animal model of MS, is characterized in mice by paralysis of the tail and hind limbs progressing to paraplegia, but urinary parameters and voiding behavior are not well understood. We aimed to study micturition behavior of both healthy and EAE mice to determine changes induced by EAE. Methods: Bladder function study included micturition behavior and filling cystometry. Results: EAE mice developed profound bladder dysfunction characterized by a decrease in urine volume per micturition (138.8 ± 20 vs. 213 ± 17.5 µL, P = 0.018), significantly more frequent postvoid residual urine (30% vs. 61%, P = 0.0496), and increased postvoid residual volume (260 ± 15 vs. 197.5 ± 12 µL, P = 0.045). Cystometric analysis showed significantly more frequent detrusor overactivity (69% vs. 1%, P < 0.0001). Conclusions: Our study, characterizing bladder dysfunction in EAE mice by clinical and cystometric examination, showed that dysfunction was similar to neurological bladder disorders found in human multiple sclerosis and makes this model promising to assess new compounds. World J Nephrol Urol. 2016;5(1):4-10 doi: http://dx.doi.org/10.14740/wjnu245w
背景:多发性硬化症(MS)是影响年轻人的最常见的致残性神经系统疾病。下尿路功能障碍(LUTD)在MS过程中很常见，是对上尿路的器质性影响和生活质量受损的原因。实验性自身免疫性脑脊髓炎(EAE)是多发性硬化症的一种动物模型，其特征是小鼠的尾巴和后肢瘫痪进展为截瘫，但泌尿参数和排尿行为尚不清楚。我们的目的是研究健康小鼠和EAE小鼠的排尿行为，以确定EAE引起的变化。方法:膀胱功能研究包括排尿行为和膀胱充盈术。结果:EAE小鼠出现了严重的膀胱功能障碍，其特征是每次排尿量减少(138.8±20比213±17.5µL, P = 0.018)，排空后残尿频率显著增加(30%比61%，P = 0.0496)，排空后残尿量增加(260±15比197.5±12µL, P = 0.045)。膀胱测量分析显示，逼尿肌过度活动明显增加(69% vs. 1%， P < 0.0001)。结论:我们的研究，通过临床和膀胱检查表征了EAE小鼠的膀胱功能障碍，显示功能障碍与人类多发性硬化症中发现的神经性膀胱疾病相似，使该模型有望评估新化合物。世界肾脏病杂志，2016;5(1):4-10 doi: http://dx.doi.org/10.14740/wjnu245w
{"title":"Voiding Dysfunction in Mice With Experimental Autoimmune Encephalomyelitis: A Multiple Sclerosis-Like Disease","authors":"Lucie Evena, Ourdia Boualia, Mathieu Roumiguiea, Olivier Cuvillierb, Bernard Malavauda, Xavier Gamea","doi":"10.14740/WJNU245W","DOIUrl":"https://doi.org/10.14740/WJNU245W","url":null,"abstract":"Background: Multiple sclerosis (MS) is the most common disabling neurological disorder affecting young adults. Lower urinary tract dysfunction (LUTD) is common during the course of MS and is responsible for an organic impact on the upper urinary tract and for impaired quality of life. Experimental autoimmune encephalomyelitis (EAE), an animal model of MS, is characterized in mice by paralysis of the tail and hind limbs progressing to paraplegia, but urinary parameters and voiding behavior are not well understood. We aimed to study micturition behavior of both healthy and EAE mice to determine changes induced by EAE. Methods: Bladder function study included micturition behavior and filling cystometry. Results: EAE mice developed profound bladder dysfunction characterized by a decrease in urine volume per micturition (138.8 ± 20 vs. 213 ± 17.5 µL, P = 0.018), significantly more frequent postvoid residual urine (30% vs. 61%, P = 0.0496), and increased postvoid residual volume (260 ± 15 vs. 197.5 ± 12 µL, P = 0.045). Cystometric analysis showed significantly more frequent detrusor overactivity (69% vs. 1%, P < 0.0001). Conclusions: Our study, characterizing bladder dysfunction in EAE mice by clinical and cystometric examination, showed that dysfunction was similar to neurological bladder disorders found in human multiple sclerosis and makes this model promising to assess new compounds. World J Nephrol Urol. 2016;5(1):4-10 doi: http://dx.doi.org/10.14740/wjnu245w","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"5 1","pages":"4-10"},"PeriodicalIF":0.0,"publicationDate":"2016-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67238814","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}
We describe only the third case of bilateral renal metastases from a primary brain hemangiopericytoma (HPC) in a 58-year-old male. These rare malignant tumors were first described in 1942 and originate from pericytes located around capillaries. They can therefore originate from anywhere in the body. They may be confused with primary renal cell carcinoma when they metastasize to the kidneys. Surgical management remains the mainstay of treatment for renal involvement. World J Nephrol Urol. 2016;5(1):23-25 doi: http://dx.doi.org/10.14740/wjnu252w
{"title":"Bilateral Renal Involvement From a Primary Brain Tumor","authors":"A. Alleemudder, R. Pillai","doi":"10.14740/WJNU252W","DOIUrl":"https://doi.org/10.14740/WJNU252W","url":null,"abstract":"We describe only the third case of bilateral renal metastases from a primary brain hemangiopericytoma (HPC) in a 58-year-old male. These rare malignant tumors were first described in 1942 and originate from pericytes located around capillaries. They can therefore originate from anywhere in the body. They may be confused with primary renal cell carcinoma when they metastasize to the kidneys. Surgical management remains the mainstay of treatment for renal involvement. World J Nephrol Urol. 2016;5(1):23-25 doi: http://dx.doi.org/10.14740/wjnu252w","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"5 1","pages":"23-25"},"PeriodicalIF":0.0,"publicationDate":"2016-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67239086","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}
Ramnik Patel, Yew-Wei Tan, S. Patil, A. Cherian, B. More
We report an ex-35 weeks gestational age preterm female infant with prenatally diagnosed cloacal exstrophy who developed ileo-ileal and ileo-exstrophic dual synchronous intussusceptions at the corrected age of 3 weeks. The infant presented with acute illness. Initial fluid resuscitation and antibiotic treatment improved clinical condition but developed bleeding and increasingly discolouration of the distal loop associated with metabolic acidosis and concern for bowel obstruction and ischemia. Radiographs were non-specific. At exploration an irreducible necrotic advanced ileo-ileal intussusception and a reducible but viable ileo-exstrophic intussusception were found. Resection of necrotic ileo-ileal intussusception with ileostomy formation on the proximal end and closure of the distal ileum with reduction of ileo-exstrophic intussusception was carried out uneventfully with good prognosis. World J Nephrol Urol. 2016;5(1):20-22 doi: http://dx.doi.org/10.14740/wjnu253w
{"title":"Neonatal Ileo-Ileal and Ileo-Cloacal Exstrophic Synchronous Dual Intussusceptions in a Preterm Infant With Cloacal Exstrophy","authors":"Ramnik Patel, Yew-Wei Tan, S. Patil, A. Cherian, B. More","doi":"10.14740/WJNU253W","DOIUrl":"https://doi.org/10.14740/WJNU253W","url":null,"abstract":"We report an ex-35 weeks gestational age preterm female infant with prenatally diagnosed cloacal exstrophy who developed ileo-ileal and ileo-exstrophic dual synchronous intussusceptions at the corrected age of 3 weeks. The infant presented with acute illness. Initial fluid resuscitation and antibiotic treatment improved clinical condition but developed bleeding and increasingly discolouration of the distal loop associated with metabolic acidosis and concern for bowel obstruction and ischemia. Radiographs were non-specific. At exploration an irreducible necrotic advanced ileo-ileal intussusception and a reducible but viable ileo-exstrophic intussusception were found. Resection of necrotic ileo-ileal intussusception with ileostomy formation on the proximal end and closure of the distal ileum with reduction of ileo-exstrophic intussusception was carried out uneventfully with good prognosis. World J Nephrol Urol. 2016;5(1):20-22 doi: http://dx.doi.org/10.14740/wjnu253w","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"5 1","pages":"20-22"},"PeriodicalIF":0.0,"publicationDate":"2016-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67239449","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}
Bhanu Mariyappa, S. Maruthayanar, N. Samnakay, A. Barker, J. Khosa
Normal 0 false false false MicrosoftInternetExplorer4 Background: The goal of treatment in vesicoureteral reflux (VUR) is to reduce the risk of reflux-associated pyelonephritis. Medical versus surgical treatment for VUR is still controversial, with surgery successful in majority of cases. There are not enough data available in literature on long-term incidence of urinary tract infection (UTI) after reimplantation. The aim of the study was to determine the long-term outcome after reimplantation with respect to UTI, renal scarring and potential risk factors for post-reimplant UTI. Methods: It is a retrospective review of 106 consecutive cases who underwent reimplantation for primary VUR. Results: Incidence of post-reimplant UTI is 12.8%. Majority of our patients were females and showed high grade reflux. Median age at surgery was 32 months. Thirteen patients had post-reimplant UTI. Of this, 12/13 were females, 12/13 had pre-reimplant febrile UTI, 10/13 had high grade VUR, 7/13 had urge incontinence and dysfunctional voiding, and 3/13 had constipation. Only two patients showed new scarring/worsening scarring. Conclusions: It is an established fact that ureteric reimplantation is effective in preventing UTI. Some continue to develop UTI even after successful correction of VUR and it is unclear as to why it happens. Various rates of post-reimplant UTI have been quoted in literature with non-febrile UTI of 40% and febrile UTI of 14%. In our study, febrile UTI rate was 4.9% and non-febrile UTI rate was 7.9%. Post-reimplant UTI resulting in new renal scars is rare. There are some possible risk factors for recurrent UTI after reimplantation, but unfortunately only few of them are reversible (bowel bladder dysfunction). Reimplantation for VUR is a very effective treatment. Incidence of post-reimplant UTI is 12.8% with development of new scars after such UTI is rare. Several risk factors contribute to such UTI. World J Nephrol Urol. 2016;5(1):1-3 doi: http://dx.doi.org/10.14740/wjnu237w
{"title":"Incidence of Post-Ureteric Reimplantation Urinary Tract Infection in Primary Vesicoureteral Reflux","authors":"Bhanu Mariyappa, S. Maruthayanar, N. Samnakay, A. Barker, J. Khosa","doi":"10.14740/WJNU237W","DOIUrl":"https://doi.org/10.14740/WJNU237W","url":null,"abstract":"Normal 0 false false false MicrosoftInternetExplorer4 Background: The goal of treatment in vesicoureteral reflux (VUR) is to reduce the risk of reflux-associated pyelonephritis. Medical versus surgical treatment for VUR is still controversial, with surgery successful in majority of cases. There are not enough data available in literature on long-term incidence of urinary tract infection (UTI) after reimplantation. The aim of the study was to determine the long-term outcome after reimplantation with respect to UTI, renal scarring and potential risk factors for post-reimplant UTI. Methods: It is a retrospective review of 106 consecutive cases who underwent reimplantation for primary VUR. Results: Incidence of post-reimplant UTI is 12.8%. Majority of our patients were females and showed high grade reflux. Median age at surgery was 32 months. Thirteen patients had post-reimplant UTI. Of this, 12/13 were females, 12/13 had pre-reimplant febrile UTI, 10/13 had high grade VUR, 7/13 had urge incontinence and dysfunctional voiding, and 3/13 had constipation. Only two patients showed new scarring/worsening scarring. Conclusions: It is an established fact that ureteric reimplantation is effective in preventing UTI. Some continue to develop UTI even after successful correction of VUR and it is unclear as to why it happens. Various rates of post-reimplant UTI have been quoted in literature with non-febrile UTI of 40% and febrile UTI of 14%. In our study, febrile UTI rate was 4.9% and non-febrile UTI rate was 7.9%. Post-reimplant UTI resulting in new renal scars is rare. There are some possible risk factors for recurrent UTI after reimplantation, but unfortunately only few of them are reversible (bowel bladder dysfunction). Reimplantation for VUR is a very effective treatment. Incidence of post-reimplant UTI is 12.8% with development of new scars after such UTI is rare. Several risk factors contribute to such UTI. World J Nephrol Urol. 2016;5(1):1-3 doi: http://dx.doi.org/10.14740/wjnu237w","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"5 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2016-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67238448","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}
Tom T. Liu, M. Zamkanei, Selina L. Liu, Jessica Liu, M. Parmar
Chronic kidney disease (CKD) is a major public health problem. Estimated glomerular filtration rates based on serum creatinine values are used to diagnose this condition, and accuracy of laboratory testing is a crucial step in diagnosing and managing these patients efficiently in a timely manner. Spuriously elevated creatinine values have been reported due to the interference of other substances, including paraproteins. Paraproteins can interfere with the determination of various clinically important analytes in an unpredictable manner. While mild to moderate degrees of interference affecting the measurement of serum creatinine values have been previously reported, we present a case of a patient with markedly elevated serum creatinine who was referred for emergent assessment for possible consideration of renal replacement therapy. A thorough history and repeat laboratory investigations at several laboratories ultimately revealed the initial serum creatinine level to be spuriously high, i.e. “pseudohypercreatinimea” due to immunoglobulin interference. Further investigations ultimately led to the diagnosis of Waldenstrom’s macroglobulinemia and the patient was appropriately treated. However, this case sheds light on the importance of being aware of a spuriously high creatinine value and its possible causes, as it can have significant diagnostic implications. World J Nephrol Urol. 2016;5(4):83-84 doi: https://doi.org/10.14740/wjnu282w
{"title":"Pseudohypercreatininemia as an Initial Presentation of Waldenstrom’s Macroglobulinemia","authors":"Tom T. Liu, M. Zamkanei, Selina L. Liu, Jessica Liu, M. Parmar","doi":"10.14740/WJNU282W","DOIUrl":"https://doi.org/10.14740/WJNU282W","url":null,"abstract":"Chronic kidney disease (CKD) is a major public health problem. Estimated glomerular filtration rates based on serum creatinine values are used to diagnose this condition, and accuracy of laboratory testing is a crucial step in diagnosing and managing these patients efficiently in a timely manner. Spuriously elevated creatinine values have been reported due to the interference of other substances, including paraproteins. Paraproteins can interfere with the determination of various clinically important analytes in an unpredictable manner. While mild to moderate degrees of interference affecting the measurement of serum creatinine values have been previously reported, we present a case of a patient with markedly elevated serum creatinine who was referred for emergent assessment for possible consideration of renal replacement therapy. A thorough history and repeat laboratory investigations at several laboratories ultimately revealed the initial serum creatinine level to be spuriously high, i.e. “pseudohypercreatinimea” due to immunoglobulin interference. Further investigations ultimately led to the diagnosis of Waldenstrom’s macroglobulinemia and the patient was appropriately treated. However, this case sheds light on the importance of being aware of a spuriously high creatinine value and its possible causes, as it can have significant diagnostic implications. World J Nephrol Urol. 2016;5(4):83-84 doi: https://doi.org/10.14740/wjnu282w","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"5 1","pages":"83-84"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67240042","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. Takeuchi, Kazumasa Emori, M. Yoshitani, J. Soneda
Pyonephritis is defined as infected hydronephrosis complicated by infectious destruction of the renal parenchyma or the presence of pus in the dilated pyelocaliceal. Pyonephritis is challenging to treat only using antibiotics; it sometimes requires immediate interventional treatment, including surgical intervention, percutaneous drainage, or retrograde ureteric stent insertion, because if left untreated, it may cause sepsis-related disseminated intravascular coagulation (DIC). Here we report three cases of pyonephritis complicated by sepsis-induced DIC using recombinant human soluble thrombomodulin (rhTM) and percutaneous drainage. An 87-year-old female presented with high-grade fever, vomiting, and diarrhea. Non-contrast computed tomography and ultrasonography revealed a dilated ureter and upper ureteral stone in the left kidney. Antibiotic treatment was initiated, and a percutaneous nephrostomy (PCN) tube was inserted into the patient; puncture fluid revealed the presence of Escherichia coli . During treatment, the patient’s DIC score was four points, indicating that rhTM administration was required. A 75-year-old female presented with nausea, diarrhea, and deterioration of consciousness. Laboratory analysis revealed remarkably elevated levels of WBC and CRP, and imaging modalities revealed left-sided hydronephrosis. The patient’s DIC score at admission was six points; rhTM and anti-biotics were administered. A PCN tube was inserted into the patient on the following day. With worsening renal function and oliguria, the patient needed hemodialysis (polymyxin-B direct hemoperfusion and continuous hemodiafiltration). A 62-year-old female presented with high-grade fever and deterioration of consciousness. The patient’s DIC score at admission was four points; rhTM and antibiotics were administered. Imaging modalities showed left-sided hydronephrosis and, the patient required PCN tube insertion. Temporal hemodialysis alleviated the patient’s renal malfunction and septicemia. All three cases recovered from sepsis-related DIC. Immediate and intensive treatments for pyonephritis, including interventional drainage, hemodialysis, administration of antibiotics, and the management of DIC, are necessary to save patients from fatal conditions. World J Nephrol Urol. 2016;5(4):85-90 doi: https://doi.org/10.14740/wjnu283w
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R. Saoud, A. Hajj, M. Shahait, M. Bulbul, R. Nasr, W. Wazzan, M. Khauli, R. Dargham, A. Yacoubian, R. Khauli
Background: Several studies have alluded to a detrimental impact of the surgeon’s “learning curve” on outcomes of minimally invasive surgery. In this study, we evaluated the outcomes of robotic-assisted partial nephrectomy (RAPN) versus open partial nephrectomy (OPN) for kidney tumors, during the introduction of Robotic Urologic Oncology at our institution. Methods: A retrospective review of all consecutive partial nephrectomies (PN), RAPN and OPN, performed at the American University of Beirut Medical Center since the inception of the robotic program in July 2013 until July 2015. Thirty-four consecutive patients underwent PNs, 19 OPN and 15 RAPN. Preoperative variables (patient characteristics, tumor size, and RENAL score) and perioperative renal functional/patient outcomes (% change in glomerular filtration rate (GFR), ischemia time, blood loss, need for blood transfusions, total operating time, and length of hospital stay) were compared using SPSS. Results: Preoperative variables, including the size and RENAL score of the tumor were analyzed. The difference in the median size of the tumor between OPN and RAPN was not statistically significant (4.5 ± 2.7 cm vs. 3.6 ± 1.7 cm, respectively, P = 0.25). RENAL score was significantly higher for OPN compared to RAPN (7.3 ± 2.3 vs. 4.9 ± 1.5, respectively, P < 0.05). Mean operative time was significantly shorter for OPN vs. RAPN (178 ± 52 min vs. 296 ± 86 min, respectively, P < 0.05). Cold ischemia time was 24 ± 3 min in OPN, and warm ischemia time was 17.5 ± 2 min for RAPN; 10 out of the total 15 robotic cases were performed with a warm ischemia time of < 20 min. Intraoperative blood loss was comparable for both approaches (225 ± 132 mL in OPN vs. 243 ± 192 mL in RAPN), and there was no need for blood transfusions in either group. Hospital stay was significantly longer for OPN vs. RAPN (6 ± 1.6 days vs. 4 ± 0.9 days, respectively, P = 0.01). The change in GFR was comparable among both procedures (OPN = -9% vs. RAPN = -7%); pathological margin status was also comparable among both procedures, with 1/19 (5%) positive focal margins in OPN vs. 0/14 in RAPN. None of the robotic procedures required conversion to the laparoscopic or open approach. Conclusions: RAPN is currently an established approach for the treatment of kidney tumors with the advantages of decreased crude ischemia time and a shorter hospital stay, with comparable intraoperative blood loss and risk of GFR reduction. Our data show that tumor characteristics were not equivalent, with higher RENAL scores noted in patients allocated to OPN vs. RAPN, thus limiting a fair comparison of outcomes. However, the data confirm that with proper selection of patients for RAPN, outcomes were equivalent to OPN and were not jeopardized during the initial robotic learning curve. Larger prospective studies are needed to validate our results. World J Nephrol Urol. 2016;5(4):79-82 doi: https://doi.org/10.14740/wjnu286w
背景:一些研究暗示了外科医生的“学习曲线”对微创手术结果的不利影响。在本研究中，我们评估了机器人辅助部分肾切除术(RAPN)与开放式部分肾切除术(OPN)治疗肾肿瘤的效果，同时介绍了机器人泌尿肿瘤学。方法:回顾性分析自2013年7月至2015年7月机器人项目启动以来在贝鲁特美国大学医学中心进行的所有连续部分肾切除术(PN)、RAPN和OPN。34例连续行PNs, 19例行OPN, 15例行RAPN。术前变量(患者特征、肿瘤大小和肾评分)和围手术期肾功能/患者结局(肾小球滤过率(GFR)变化百分比、缺血时间、失血量、输血需求、总手术时间和住院时间)采用SPSS进行比较。结果:分析术前变量，包括肿瘤的大小和肾评分。OPN与RAPN的中位肿瘤大小差异无统计学意义(分别为4.5±2.7 cm与3.6±1.7 cm, P = 0.25)。OPN组肾功能评分明显高于RAPN组(分别为7.3±2.3比4.9±1.5,P < 0.05)。OPN的平均手术时间明显短于RAPN(分别为178±52 min和296±86 min, P < 0.05)。OPN组冷缺血时间为24±3 min, RAPN组热缺血时间为17.5±2 min;15例机器人中有10例在热缺血时间< 20分钟时进行手术。两种方法的术中出血量相当(OPN 225±132 mL vs RAPN 243±192 mL)，两组均无需输血。OPN组的住院时间明显长于RAPN组(分别为6±1.6天比4±0.9天，P = 0.01)。两种手术的GFR变化具有可比性(OPN = -9% vs. RAPN = -7%);两种手术的病理边缘状况也具有可比性，OPN的局灶边缘为1/19 (5%)，RAPN为0/14。所有的机器人手术都不需要转换为腹腔镜或开放式手术。结论:RAPN具有缩短粗缺血时间、缩短住院时间、术中出血量和降低GFR风险等优点，是目前治疗肾肿瘤的一种成熟方法。我们的数据显示肿瘤特征并不相同，分配给OPN和RAPN的患者肾脏评分更高，从而限制了结果的公平比较。然而，数据证实，通过正确选择患者进行RAPN，结果与OPN相当，并且在初始机器人学习曲线期间不会受到损害。需要更大规模的前瞻性研究来验证我们的结果。世界植物学报，2016;5(4):79-82 doi: https://doi.org/10.14740/wjnu286w
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