Current Issue : July - September Volume : 2017 Issue Number : 3 Articles : 8 Articles
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: Radical nephrectomy for renal cell carcinoma (RCC) is a risk factor for the development of chronic\nkidney disease (CKD), and the possibility of postoperative deterioration of renal function must be considered before\nsurgery. We investigated the contribution of the aortic calcification index (ACI) to the prediction of deterioration of\nrenal function in patients undergoing radical nephrectomy.\nMethods: Between January 1995 and December 2012, we performed 511 consecutive radical nephrectomies for\npatients with RCC. We retrospectively studied data from 109 patients who had regular postoperative follow-up of\nrenal function for at least five years. The patients were divided into non-CKD and pre-CKD based on a preoperative\nestimated glomerular filtration rate (eGFR) of �60 mL/min/1.73 m2 or <60 mL/min/1.73 m2, respectively. The ACI\nwas quantitatively measured by abdominal computed tomography before surgery. The patients in each group were\nstratified between low and high ACIs. Variables such as age, sex, comorbidities, and pre- and postoperative renal\nfunction were compared between patients with a low or high ACI in each group. Renal function deterioration-free\ninterval rates were evaluated by Kaplan-Meier analysis. Factors independently associated with deterioration of renal\nfunction were determined using multivariate analysis.\nResults: The median age, preoperative eGFR, and ACI in this cohort were 65 years, 68 mL/min/1.73 m2, and 8.3%,\nrespectively. Higher ACI (�8.3%) was significantly associated with eGFR decline in both non-CKD and pre-CKD\ngroups. Renal function deterioration-free interval rates were significantly lower in the ACI-high than ACI-low strata\nin both of the non-CKD and pre-CKD groups. Multivariate analysis showed that higher ACI was an independent risk\nfactor for deterioration of renal function at 5 years after radical nephrectomy.\nConclusions: Aortic calcification burden is a potential predictor of deterioration of renal function after radical\nnephrectomy....
Objective. To determine the significance of high serum ferritin observed in Indigenous Australian patients on maintenance\nhaemodialysis in the Northern Territory, we assessed the relationship between ferritin and transferrin saturation (TSAT) as\nmeasures of iron status and ferritin and C-reactive protein (CRP) as markers of inflammation. Methods. We performed a\nretrospective cohort analysis of data from adult patients (�18 years) on maintenance haemodialysis (>3months) from2004 to 2011.\nResults.There were 1568 patients. The mean age was 53.9 (11.9) years. 1244 (79.3%) were Indigenous. 44.2% (...
Background: Delta neutrophil index (DNI), representing an elevated fraction of circulating immature granulocytes\nin acute infection, has been reported as a useful marker for predicting mortality in patients with sepsis. The aim of\nthis study was to evaluate the prognostic value of DNI in predicting mortality in septic acute kidney injury (S-AKI)\npatients treated with continuous renal replacement therapy (CRRT).\nMethod: This is a retrospective analysis of consecutively CRRT treated patients. We enrolled 286 S-AKI patients who\nunderwent CRRT and divided them into three groups based on the tertiles of DNI at CRRT initiation (high, DNI > 12.\n0%; intermediate, 3.6ââ?¬â??12.0%; low, < 3.6%). Patient survival was estimated with the Kaplan-Meier method and Cox\nproportional hazards models to determine the effect of DNI on the mortality of S-AKI patients.\nResults: Patients in the highest tertile of DNI showed higher Acute Physiology and Chronic Health Evaluation II\nscore (highest tertile, 27.9 Ã?± 7.0; lowest tertile, 24.6 Ã?± 8.3; P = 0.003) and Sequential Organ Failure Assessment score\n(highest tertile, 14.1 Ã?± 3.0; lowest tertile, 12.1 Ã?± 4.0; P = 0.001). The 28-day mortality rate was significantly higher in\nthe highest tertile group than in the lower two tertile groups (P < 0.001). In the multiple Cox proportional hazard\nmodel, DNI was an independent predictor for mortality after adjusting multiple confounding factors (hazard ratio,\n1.010; 95% confidence interval, 1.001ââ?¬â??1.019; P = 0.036).\nConclusion: This study suggests that DNI is independently associated with mortality of S-AKI patients on CRRT....
Introduction: Hyperuricemia is defined as a level of serum uric acid greater\nthan or equal to 70 mg/l (420 �¼mol/l) in men and 60 mg/l (360 �¼mol/l) in\nwomen. Several studies have shown that it is a risk factor or a factor of progression\nof chronic kidney disease. Recent experimental and epidemiological\ndata correlate the association of hyperuricemia with chronic kidney disease\n(CKD), arterial hypertension and cardiovascular diseases, thus raising the\nquestion of the usefulness of therapeutics in the prevention of renal diseases.\nThe objective of this study is to seek a link between chronic kidney disease\nand hyperuricemia. Materials and Methods: This is a descriptive and analytical\nstudy conducted at hemodialysis unit and cardiology service of General\nHospital of National reference of Nâ��Djamena (Chad) from 1th January to 1th\nOctober 2013 (10 months). We included all chronic kidney disease patients\nhospitalized in hemodialysis unit and cardiology service who presented associated\nhyperuricemia. Results: There were 712 CKD patients who were hospitalized.\nAmong them, there were 108 patients who were included in the\nstudy and who had hyperuricemia as a prevalence of 15.20%. The average age\nof patients was 35.5 years and the sex ratio was 3/1. The age group between 40\nto 60 years represented 54.6%. There were 41.7% of traders. Hypertensive patients\naccounted for 49.1%; association of diabetes and hypertension was\nnoted in 12.90%. Renal insufficiency was moderate in 43.5% of patients.\nHyperuricemia was present in more than 90% of patients. Profession, age,\nhematuria, proteinuria and hypertension were statistically positively related to\nhyperuricemia. Treatment consisted of prescribing allopurinol in 84% of patients.\nIn more than 11% of patients the progression was unfavorable. Conclusion:\nThe implication of hyperuricemia in chronic kidney disease has been\nproved in several recent studies. However, randomized studies at very long\nscales have to be carried out to conclude from its real impact on the prevention\nand treatment of chronic kidney disease....
Background: Elderly patients with advanced chronic kidney disease (CKD) have a high risk of death before reaching\nend-stage kidney disease. In order to allocate resources, such as advanced care nephrology where it is most needed, it\nis essential to know which patients have the highest absolute risk of advancing to renal replacement therapy (RRT).\nMethods: We included all nephrology-referred CKD stage 3b-5 patients in Sweden 2005ââ?¬â??2011 included in the Swedish\nrenal registry (SRR-CKD) who had at least two serum creatinine measurements one year apart (+/âË?â?? 6 months).\nWe followed these patients to either initiation of RRT, death, or September 30, 2013. Decline in estimated glomerular\nfiltration rate (eGFR) (%) was estimated during the one-year baseline period. The patients in the highest tertile\nof progression (>18.7% decline in eGFR) during the initial year of follow-up were classified as ââ?¬Å?fast progressorsââ?¬Â.\nWe estimated the cumulative incidence of RRT and death before RRT by age, eGFR and progression status\nusing competing risk models.\nResults: There were 2119 RRT initiations (24.2%) and 2060 deaths (23.5%) before RRT started. The median progression\nrate estimated during the initial year was âË?â??8.8% (Interquartile range [IQR] - 24.5ââ?¬â??6.5%). A fast initial progression rate was\nassociated with a higher risk of RRT initiation (Sub Hazard Ratio [SHR] 2.24 (95% confidence interval [CI] 2.00ââ?¬â??2.51) and\nalso a higher risk of death before RRT initiation (SHR 1.27 (95% CI 1.13ââ?¬â??1.43). The five year probability of RRT\nwas highest in younger patients (<65 years) with fast initial progression rate (51% in CKD stage 4 and 76% in\nstage 5), low overall in patients >75 years with a slow progression rate (7, 13, and 25% for CKD stages 3b, 4\nand 5 respectively), and slightly higher in elderly patients with a fast initial progression rate (28% in CKD stage 4 and\n47% in CKD stage 5) or with diabetic kidney disease.\nConclusions: The 5-year probability of RRT was low among referred slowly progressing CKD patients >75 years of age\nbecause of the competing risk of death....
Nephrolithiasis accelerates the renal failure in the patients with ADPKD. In order to evaluate the role of percutaneous\nnephrolithotomy in management of calculus in these patients, 11 patients with autosomal dominant polycystic kidney disease\nand renal stones were included in the study. Two patients had bilateral renal stones. All patients were treated by percutaneous\nnephrolithotomy under ultrasound guidance. 13 percutaneous nephrolithotomy procedures were performed in 1 stage by the\nurology team under ultrasound guidance. 5 people received second operation with flexible nephroscopy in lateral position. The\nsuccess rate and morbidity and mortality of the technique and hospital stay were recorded. Results. The puncture procedure was\nfully successful in all cases. The renal function improved in these patients. 5 patients had moderate fever after the surgery. 5 patients\nreceived flexible nephroscopy to take out the residual calculi. 2 persons had ESWL therapy after the surgery. Conclusion. PCNL is\nan ideal, safe, and effective method to remove the stones from those patients with no definite increase in the risk of complication.\nThe outcome and stone-free rate are satisfactory comparable to the PCNL in the patients without ADPKD....
Background: To compare the treatment outcomes between percutaneous nephrolithotomy (PCNL) and retrograde\nintrarenal surgery (RIRS) for the management of stones larger than 2 cm in patients with solitary kidney.\nMethods: One hundred sixteen patients with a solitary kidney who underwent RIRS (n = 56) or PCNL (n = 60) for\nlarge renal stones (>2 cm) between Jan 2010 and Nov 2015 have been considered. The patients� characteristics, stone\ncharacteristics, operative time, incidence of complications, hospital stay, and stone-free rates (SFR) have been evaluated.\nResults: SFRs after one session were 19.6% and 35.7% for RIRS and PCNL respectively (p = 0.047), but the SFR at 3\nmonths follow-up comparable in both groups (82.1% vs. 88.3%, p = 0.346). The calculated mean operative time for RIRS\nwas longer (p < 0.001), but the mean postoperatively hospital stay was statistically significantly shorter (p < 0.001) and\naverage drop in hemoglobin level was less (p = 0.040). PCNL showed a higher complication rate, although this\ndifference was not statistically significant.\nConclusions: Satisfactory stone clearance can be achieved with multi-session RIRS in the treatment of renal\nstones larger than 2 cm in patients with solitary kidney. RIRS can be considered as an alternative to PCNL in\nselected cases....
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