Abstracted/ Indexed in: Ulrich's International Periodical Directory, Google Scholar, SCIRUS, getCITED
Quarterly published in print and online "Inventi Impact: Urology & Nephrology (Formerly Inventi Impact: Kidney)" publishes high quality unpublished as well as high impact pre-published research and reviews catering to the needs of researchers and professionals. The journal welcomes papers in all the areas of nephrology practices and clinical research. It encourages submissions of latest findings related to pathogenesis and treatment of kidney diseases, hypertension, acid-base and electrolyte disorders, dialysis therapies, and kidney transplantation.
We report a case of IgG4-related disease presenting both tubulointerstitial nephritis\nand retroperitoneal fibrosis causing acute renal failure in a 63-year-old male. He was\nadmitted to our hospital because of acute renal failure requiring emergent hemodialysis.\nComputed tomography showed a soft-tissue density mass with an irregular\nborder in the retroperitoneum. The mass involved bilateral ureters and had caused\nacute renal failure by bilateral hydronephrosis. Because of a history of uveitis and\nhigh IgG4 levels, we considered a diagnosis of retroperitoneal fibrosis, IgG4-related\ndisease. Kidney biopsy revealed IgG4-related kidney disease with interstitial nephritis.\nAfter relief of urinary obstruction by inserting ureteral catheters into the bilateral\nureters, renal function recovered....
Background: The utility of dipstick proteinuria for predicting microalbuminuria in non-diabetic lifestyle-related diseases
compared with the urine protein-to-creatinine ratio (uPCR) and the effect of dipstick proteinuria on the cut-off
value (CO) and accuracy of uPCR are unclear.
Methods: The subjects included Japanese patients ≥ 18 years old with lifestyle-related diseases who had an estimated
glomerular filtration rate of ≥ 15 ml/min/1.73 m2 and uPCR of < 0.5 g/gCr at initiation. Urine dipstick, uPCR and
urine albumin-to-creatinine ratio (uACR) were measured three times per case. Microalbuminuria was defined as uACR
of 30–299 mg/gCr for at least 2 of 3 measurements. Youden’s Index was used as the optimal CO. Factors associated
with microalbuminuria were analyzed using a logistic regression model.
Results: In 313 non-diabetic cases (median 70.8 years old), 3 dipstick proteinuria measurements were independently
useful for detecting microalbuminuria, and the CO was set when a trace finding was obtained at least 1 of 3 times
(sensitivity 0.56, specificity 0.80, positive predictive value [PPV] 0.73, negative predictive value [NPV] 0.65). A single
uPCR measurement was more useful than 3 dipstick measurements, and was useful for detecting microalbuminuria
even in cases with three consecutive negative proteinuria findings, indicating that the CO of the second uPCR with
G1-3a (n = 136) was 0.06 g/gCr (sensitivity 0.76, specificity 0.84. PPV 0.68, NPV 0.89), while that with G3-b4 (n = 59) was
0.10 g/gCr (sensitivity 0.56, specificity 0.91. PPV 0.83, NPV 0.71). The sum of 3 uPCRs was useful for detecting microalbuminuria
in cases with G1-3a (sensitivity 0.67, specificity 0.94, PPV 0.82, NPV 0.86) and G3b-4 (sensitivity 0.78, specificity
0.94, PPV 0.91 NPV 0.83), with both COs being 0.23 g/gCr. These COs of microalbuminuria did not change when
trace or more proteinuria was included, although the sensitivity increased. A high uPCR and low urine specific gravity
or creatinine level were independent factors for uACR ≥ 30 mg/gCr in cases with negative proteinuria, although the
uPCR was a major predictive factor of a uACR ≥ 30 mg/gCr.
Conclusions: The uPCR (preferably determined using early-morning urine), including in dipstick-negative proteinuria
cases with non-diabetic lifestyle-related diseases, can aid in the early detection of microalbuminuria....
In the decades, since the advent of shockwave lithotripsy, instrumentation and\ntechniques in both ureteroscopic and percutaneous stone management have\nimproved exponentially, leading to both increased success and lower complication\nrates. As a result, there have been some controversies revolving around the\ntherapeutic modality of choice for specific stones in terms of their size and location.\nThis review seeks to provide some clarity to the decision-making process\nwith emphasis on patient comfort and choice and due consideration being given\nto the potential complications associated with the various treatment modalities....
Background: To what extent uric acid (UA) levels and/or metabolic syndrome (Mets) contribute to\nthe onset of chronic kidney disease (CKD) is largely unknown. The present study explores how these\ntwo factors have an association with the new incidence of CKD. Methods: Study design is a cohort\nstudy. A total of 14,485 participants were eligible for the cross-sectional analysis on UA levels and\nthe prevalence of Mets. Among those individuals, 8,223 participants without CKD and 4,839 without\nMets were eligible for the longitudinal analysis of the new incidence of CKD. Parameters monitored\nwere body mass index, systolic and diastolic blood pressure, serum creatinine concentration, estimated\nglolerular filtration rate, lipid profiles, plasma glucose, HbA1c. The primary predictor was the\nlevel of UA and Mets to explain the newly-developed CKD. The observation period was 4 years. Results:\nIn a cross-sectional analysis, higher UA levels were associated with the greater prevalence of\nMets. In addition, UA levels were associated with the numbers of the Mets constituents in both genders.\nIn a longitudinal analysis, higher UA levels were associated with the greater rate of CKD and the\ngreater incidence of Mets. In addition, the incidence of CKD at year 4 was influenced by the presence\nof hyperuricemia, but not by that of the Mets. The odd ratio (OR) to predict the CKD incidence was\n1.42 (95% confidence intervals (CI), 0.52 to 3.78) in the presence of Mets alone, 2.10 (95% CI, 1.36 to\n3.23) in the presence of hyperuricemia alone, and 3.56 (95% CI, 1.55 to 8.21) in the presence of both.\nConclusion: Hyperuricemia has a greater association with the incidence of CKD than Mets does.\nHyperuricemia complicated by Mets is additionally detrimental....
Background: Researchers have developed several equations to predict glomerular filtration rate (GFR) in patients\nwith chronic kidney diseases (CKD). However, there are scarcely any studies performed to discern the best equation\nto estimate GFR in patients with pure obstructive nephropathy. In present study, we assessed the suitability of six\nprediction equations and compared their performance in eGFR evaluation for Chinese patients with obstructive\nnephropathy.\nMethods: A total of 245 adult patients with obstructive nephropathy were enrolled. We evaluated the performance\nof the 3 Modification of Diet in Renal Disease equations (MDRD) (the original MDRD7, 7MDRD; the abbreviated\nMDRD, aMDRD; and re-expressed abbreviated MDRD, re-aMDRD) and 3 Chronic Kidney Disease Epidemiology\nCollaboration equations (CKD-EPI) (CKD-EPI equation based on creatinine alone, CKD-EPIcr; CKD-EPI equation based\non cystatin C alone, CKD-EPIcys; CKD-EPI equation based on combined creatinine-cystatin, CKD-EPIcr-cys). The\nmeasured GFR (mGFR) by 99mTc-DTPA renal dynamic imaging method was used as the reference GFR.\nResults: The mean age of the study population was 51.61 Ã?Â± 14.17 and 131 were male (53.47 %). The mean\nmeasured GFR was 66.54 Ã?Â± 23.99 ml/min/1.73 m2. Overall, the CKD-EPIcr-cys equation gave the best performance\nwith the best correlation (R = 0.72) and agreement (Ã¢Ë?â??34.87, 40.83). CKD-EPIcr-cys equation also exhibited the highest\naccuracy (69.39 %, P < 0.01) and diagnostic efficacy (ROCAUC = 0.874) with the smallest bias (2.98, P < 0.01). In the\nsubgroup of the lowest GFR, CKD-EPIcys equation exhibited the highest accuracy (52.69 %) and the smallest bias\n(0.27). In the youngest age subgroup, CKD-EPIcys equation had the highest accuracy (71.64 %) and the smallest bias\n(Ã¢Ë?â??1.24). In other subgroups stratified by GFR, age and gender, CKD-EPIcr-cys equation remained the best\nperformance.\nConclusion: The 3 CKD-EPI equations performed better than the 3 MDRD equations in estimating GFR in Chinese\nobstructive nephropathy patients; while the CKD-EPI equation based on combined creatinine-cystatin C provided\nthe best estimation of GFR....
Background: Multiple myeloma (MM) is a malignant neoplasm associated with kidney involvement in nearly half of
the patients. Cast nephropathy, monoclonal immunoglobulin deposition disease (MIDD), and light chain (AL) amyloidosis
are the most common monoclonal immunoglobulin-mediated causes of renal injury.
Cardiac involvement is also present in MM, characterized by restrictive cardiomyopathy generated by light chain
deposit or amyloid. Thromboembolic complications such as deep vein thrombosis or pulmonary embolism are also
Case presentation: We present an unusual multidisciplinary case of a woman with a newly diagnosed MM associated
with severe proteinuria and high natriuretic peptide. A renal and fat pad biopsy with Congo red staining were
performed but amyloid deposition was not discovered. While immunofluorescence on fresh frozen unfixed tissue was
not contributory, the immunofluorescence on fixed tissue and electron microscopy revealed the correct diagnosis.
During subsequent investigations, two intracardiac right-sided masses and massive pulmonary embolism were also
Conclusions: This case highlights that multiple organ involvement in patients with MM may result from a combination
of paraprotein-dependent and -independent factors. Moreover, renal diseases induced by monoclonal gammopathies
are a group of complex and heterogeneous disorders. Their subtle presentation and their potential multiorgan
involvement require the expertise of a multidisciplinary team able to provide the most appropriate diagnostic
and therapeutic assessment....
Background. To measure International Normalized Ratio (INR) in hemodialysis patients with tunneled dialysis catheters (TDCs),
blood sampling is frequently obtained via the catheter at the start of the session. INR measurements via finger-prick point of care
testing (POCT) and via blood sampling taken from the dialysis circuit are evaluated as alternatives. Methods. In 14 hemodialysis
patients with TDCs, treated with vitamin K antagonists (VKA), INR measurements via POCT were compared with plasma INR
samples taken via the catheter at the start of dialysis and via the dialysis circuit after 30 and 60 minutes during 3 nonconsecutive
dialysis sessions. Results. Blood samples taken at the start of dialysis at the catheter site were frequently contaminated with heparin
originating from the locking solution (unfractionated heparin concentration (UFH) >1.0 IU/ml in 13.2%). POCT INR at the start
of dialysis was not different from plasma INR after 30 and 60 minutes (Wilcoxon test p 0.113, n 37, and p 0.631, n 36,
respectively). Moreover, there was no difference between POCT INR at the start of dialysis and POCT INR after 30 and 60 minutes
(Wilcoxon test p 0.797 and p 0.801, respectively; n 36). Passing and Bablok regression equation was used, y 0.460 + 0.733x;
n 105. Treatment decisions based on these 2 methods showed a very good overall agreement (kappa 0.810; 95% CI:
0.732–0.889; n 105). Conclusions. Measuring plasma INR via the TDC at the start of dialysis should be abandoned. Measuring
POCT INR via a finger prick at the start or even after 30 to 60 minutes is an alternative. The most elegant alternative is to take
plasma INR samples via the dialysis circuit 30 minutes or later after the start of the dialysis....
Background: There were 800 individual case reports of urogenital foreign\nbodies in the English literature from 1755 to 1999. The use of urogenital\nforeign bodies for sexual pleasure is a common occurrence in todayâ??s population.\nThe aim of this discussion is the management of scrotal injury\ncaused by magnetic urogenital foreign bodies. Case Presentation:\n56-year-old male with scrotal tissue entrapped between two opposed magnet\nrings. Self-reported attempts at removal were unsuccessful and caused\nfor presentation to the emergency department. Additional attempts at removal\nby medical staff unsuccessful in emergency department and therefore\nthe patient proceeded to the operating room. Intraoperatively the use of two\ncardiac magnets allowed for removal without a need for invasive surgical\nprocedure. Conclusion: Cardiac magnets are preferred means of removal for\nentrapped skin between magnetic foreign bodies that could be utilized at the\nbedside....
Introduction: Metformin-associated lactic acidosis (MALA) is a rare but life-threatening condition. Here, we report
the outcome of a patient with MALA complicated by acute coronary syndrome.
Case presentation: A 47-year-old obese woman of Caucasian ethnicity was admitted for syncope and tachypnea
with Kussmaul breathing. She had a type-2 diabetes and was on oral antidiabetic therapy. Hemoglobin A1c was
6.6%. On admission, a severe acute kidney injury (serum creatinine: 1251 μmol/L) with hyperkalemia (7.5 mmol/L)
and severe lactic acidosis (ph:7.042, bicarbonate: 9.9 mmol/L, partial pressure of carbon dioxide: 21.8 mmHg, lactate:
20.0 mmol/L) was found. Despite bicarbonate therapy, ph further decreased. Within 2.5 h of admission, a temporary
hemodialysis catheter was placed, and one session of a high-efficiency hemodialysis was performed. 8 h after admission,
a continuous venovenous hemodiafiltration was initiated and maintained for 2 days. The metformin therapy was
stopped. Supplemental oxygen, intravenous catecholamines (4 days) and antibiotic therapy (7 days) were applied.
During this therapy of lactic acidosis, an acute coronary syndrome evolved by day 2 after admission and resolved by
day 5 in hospital. After recovery, the patient was transferred to a general ward on day 7 and left the hospital on day 11.
By discharge, both the acute kidney injury and the acute coronary syndrome were reversible.
Conclusion: In the patient with MALA complicated by acute coronary syndrome, the combination of a high-efficiency
hemodialysis and, consecutively, continuous venovenous hemodiafiltration led to a favorable outcome....
Background: Currently used biomarkers for acute kidney injury (AKI), namely Ngal, SCr, and BUN, are\r\ninadequate for timely detection of AKI in preterm infants.\r\nMethods: Nuclear magnetic resonance (NMR) spectroscopy-based metabolic profiling was conducted on urines\r\nfrom 20 preterm infants to determine if novel metabolic biomarkers could be identified for early detection of AKI.\r\nUrines were collected from every patient each day for the first 14 days of life. NMR spectra were measured for all\r\nurines and metabolic profiling analysis conducted.\r\nResults: One metabolite, carnitine, increased significantly in urines of three extremely low birth weight (ELBW)\r\ninfants starting on day five of life. The three affected infants either received prolonged antibiotic treatment, extended\r\ntreatment with indomethacin, or both. One ELBW patient who received both treatments and reached the highest\r\nurinary carnitine level died on day 10 of life due to localized gut perforation complicated by suspected AKI.\r\nConclusions: It was concluded that carnitine increased in the three neonates in part due to antibiotic- and/\r\nor indomethacin-induced AKI. It is hypothesized that combined antibiotic and indomethacin treatment promoted\r\nAKI resulting in reduced proximal renal tubule reabsorption of carnitine and that Ã?Å¸-lactam antibiotics blocked renal\r\ncarnitine uptake by human organic cation transporter, hOCTN2....
� Copyright©2013. Inventi Journals Pvt.Ltd. All Right Reserved.