Current Issue : October - December Volume : 2017 Issue Number : 4 Articles : 7 Articles
Purpose. To determine whether kidney sizes were changed after ureteral stents were instilled, and if so, what parameters were\nsignificant. Methods. Parenchymal width (PW) of 98 patients with unilateral ureteral stents was measured from the coronal view\nof CT scans for both stented and unstented contralateral kidney. The mean PW and % change of mean PW were calculated\nbefore stenting and at the time of last stent change. Estimated glomerular filtrate rate (eGFR) was recorded as well. Results. The\nmean duration of ureteral stent indwelled was 15.6 Ã?± 10.2 (mean Ã?± SD) months.The change of mean PW of stented kidneys and\nunstented contralateral kidneys was âË?â??16.9 Ã?± 16.4 (mean Ã?± SD)% and 3.6 Ã?± 10.7%, respectively. eGFR before and at the time of the\nlast stent change did not show significant difference (...
Background: There are three minimally invasive methods for the management of large upper impacted ureteral\nstones: mini-percutaneous nephrolithotomy (MPCNL), transurethral ureteroscope lithotripsy (URSL), and\nretroperitoneal laparoscopic ureterolithotomy (RPLU). This study aimed to compare MPCNL, URSL, and RPLU, and to\nevaluate which one is the best choice for large upper impacted ureteral stones.\nMethods: Between January 2012 and December 2015, at the Department of Urology, Huai�an First People�s\nHospital, 150 consecutively enrolled patients with a large upper impacted ureteral stone (>15 mm) were included.\nThe patients were randomly divided (1:1:1) into the MPCNL, URSL, and RPLU groups. The primary endpoint was\nsuccess of stone removal measured 1 month postoperatively and the secondary endpoints were intraoperative and\npostoperative parameters and complications.\nResults: Fifteen patients needed auxiliary ESWL after URSL, and 3 patients after MPCNL, but none after RPLU. The\nstone clearance rate was 96% (48/50) in the MPCNL group and 72% (33/46) in the URSL group. In the RPLU group\nthe stones were completely removed and the stone clearance rate was 100% (48/48) (P = 0.021 vs. URSL; P = 0.083\nvs. MPCNL). Operation-related complications were similar among the three groups (all P > 0.05). Hospital stay was\nshorter in the URSL group compared with MPCNL (P = 0.003). Operation time was the shortest with URSL and the\nlongest with MPCNL (all P < 0.05).\nConclusions: MPCNL and RPUL are more suitable for upper ureteral impacted stones of >15 mm. URSL could be\nconsidered if the patient is not suitable for general anesthesia, or the patient requests transurethral uretroscopic surgery....
Background: An irreversible renal function impairment is called chronic renal\nfailure (CRF) which finally leads to the ââ?¬Å?end-stage renal diseaseââ?¬Â (ESRD)\nand requires renal replacement therapies. The aim of this study is to evaluate\nthe incidence, prevalence of epidemiological indicators (age, sex), and causes\nof chronic renal failure in children in Mashhad (one of the big cities of Iran).\nMethods: This is a cross-sectional study that was conducted on patientsââ?¬â?¢\nrecords over a seven-year period (2008-2014) in Doctor Sheikh Childrenââ?¬â?¢s\nHospital of Mashhad. The inclusion criteria were all children under 20 years\nold diagnosed with ESRD, with a GFR less than 15 ml/min/1.73 m2 who were\nreferred to the hospital during the study period. Patientsââ?¬â?¢ information, such as\nage, gender, onset of dialysis, causes of constructing renal failure, and positive\nor negative antigen of hepatitis B was extracted from their records. Data were\nanalyzed using SPSS 16 software. Results: A total of 326 patients were studied,\nof which, 56.4% were male. 45.1% were from 7 to 18 years. 56.4% of patients\nwere on hemodialysis and others were on peritoneal dialysis. The most common\ncause of chronic renal failure in the study was respectively reflux nephropathy\n(32.9%), nephrotic syndrome (8.9%), neurogenic bladder (5.5%),\nstones (2.5%), glomerulopathy (2.1%) and cystinosis (1.5%) and (20.9%) had\nunknown cause. During the 7-year period of study considering the treatment\noutcomes, 69.3% of patients needed to continue the dialysis; 10.4% underwent\ntransplantation; 10.4% unfortunately died despite of treatment and 1.5% were\ncured. Conclusions: It is hoped that considering the clinical symptoms of children with chronic renal failure and the diagnosis of the cause, we can reduce\ncomplications of the disease with a quick diagnosis and treatment, as\nwell as appropriate follow-up....
Background: Whilst still rare, the incidence of paediatric stone disease is increasing in developed countries and it is\nimportant to evaluate the aetiology. We set up a dedicated renal stone service for children combining medical and\nsurgical expertise in 1993 and now have a large case series of children to investigate the epidemiology.\nMethods: A retrospective hospital note review of children presenting with kidney stones during the last 22 years\n(1993ââ?¬â??2015) was conducted. All patients had a comprehensive infective and metabolic screen and were classified\nas metabolic, infective or idiopathic stone disease.\nResults: Five hundred eleven patients (322 male) were reviewed. The median age of presentation was 4.4y for\nmales (1 m-16.6y) and 7.3y (1ââ?¬â??18.5y) for females with a median height and weight on the 25th centile for male and\non 10th and 25th for female, respectively. One hundred seventy five (34%) had an underlying metabolic\nabnormality, 112 (22%) had infective stones and 224 (44%) were classified as idiopathic.\nOf the 175 patients with a metabolic abnormality: 91 (52%) had hypercalciuria (76 persistent and 15 transient),\n37 (21%) hyperoxaluria, 38 (22%) cystinuria, 3 (2%) abnormalities in the purine metabolism and the remainder\nother metabolic abnormalities. Bilateral stones occurred in 27% of the metabolic group compared to 16% in\nthe non-metabolic group (OR 0.2, p < 0.05). Urinary tract infection was a common complication (27%) in the\nmetabolic group.\nConclusions: In this paper, we present the largest cohort of paediatric stone disease reported from a developed\ncountry giving details on both, clinical and laboratory data. We show that in the majority of the patients there is\nan identifiable underlying metabolic and/or infective aetiology emphasizing the importance of a full work up to\nprovide adequate treatment and prevent recurrence. Moreover, we show that stone disease in children, in\ncontrast to the adult population, does not seem to be associated with obesity, as children have a weight below\naverage at presentation....
Background: The ability of antihyperuricemic therapy to exert renoprotective effects in patients with chronic\nkidney disease (CKD) is controversial. In the present study, we studied patient characteristics that may mask\nfavorable impact of antihyperuricemic therapy on the progression of CKD.\nMethods: This was a single-center, retrospective, follow-up study. One-hundred and seventy-eight CKD patients\nwith hyperuricemia who received febuxostat therapy were included in this study. Mean serum uric acid (mUA)\nlevel after treatment and changes in estimated glomerular filtration rate (Ã?â?eGFR) over 6 months were measured\nand their correlation was examined. Patients were divided into two groups based on mUA, and their Ã?â?eGFR\nwere compared. These analyses were evaluated in various subgroups.\nResults: Febuxostat therapy markedly decreased UA level in any CKD stage patients without resulting in serious\nadverse events. eGFRs of CKD patients in the mUA < 6.0 mg/dl group were maintained, whereas those in the\nmUA ââ?°Â¥ 6.0 mg/dl group decreased. A significant inverse correlation was observed between mUA and Ã?â?eGFR\n(r = âË?â??0.16, p = 0.019). The renoprotective effects of febuxostat were significant in the following subgroups: male\npatients, age < 70 years, systolic blood pressure < 130 mmHg, normal cholesterol levels, and absence of diabetes.\nCoexisting vascular risk factors appear to exert additive masking effects against febuxostat renoprotection.\nConclusions: The results of this study suggest that various vascular risk factors markedly attenuate the\nrenoprotective effects of febuxostat....
Background.The polymorphism R229Q is one of the most commonly reported podocin sequence variations among steroid-resistant\nnephrotic syndromes (SRNS).Aimof the Study.We investigated the frequency and risk of this polymorphism among a group of Iraqi\nchildren with SRNS and steroid-sensitive nephrotic syndrome (SSNS). Patients andMethods.Aprospective case control studywhich\nwas conducted in Al-Imamein Al-Kadhimein Medical City, spanning the period from the 1st of April 2015 to 30th of November\n2015. Study sample consisted of 54 children having NS, divided into 2 groups: patients group consisted of 27 children with SRNS,\nand control group involved 27 children with SSNS. Both were screened by real time polymerase chain reaction for R229Q in exon\n5 of NPHS2 gene. Results. Molecular study showed R229Q polymorphism in 96.3% of SRNS and 100% of SSNS. There were no\nphenotypic or histologic characteristics of patients bearing homozygous R229Q polymorphism and the patients with heterozygous\nR229Q polymorphism. Conclusion. Polymorphism R229Q of NPHS2 gene is prevalent in Iraqi children with SRNS and SSNS.\nFurther study needs to be done, for other exons and polymorphism of NPHS2 gene in those patients....
Background: Many controversies exist regarding the management of dialysis-requiring acute kidney injury (D-AKI).\nNo clear evidence has shown that the choice of dialysis modality can change the survival rate or kidney function\nrecovery of critically ill patients with D-AKI.\nMethods: We conducted a retrospective study investigating patients (ââ?°Â¥16 years old) admitted to an intensive care\nunit with D-AKI from 1999 to 2012. We analyzed D-AKI incidence, and outcomes, as well as the most commonly\nused dialysis modality over time. Outcomes were based on hospital mortality, renal function recovery (estimated\nglomerular filtration rate-eGFR), and the need for dialysis treatment at hospital discharge.\nResults: In 1,493 patients with D-AKI, sepsis was the main cause of kidney injury (56.2%). The comparison between\nthe three study periods, (1999ââ?¬â??2003, 2004ââ?¬â??2008, and 2009ââ?¬â??2012) showed an increased in incidence of D-AKI\n(from 2.56 to 5.17%; p = 0.001), in the APACHE II score (from 20 to 26; p < 0.001), and in the use of continuous renal\nreplacement therapy (CRRT) as initial dialysis modality choice (from 64.2 to 72.2%; p < 0.001). The mortality rate\n(53.9%) and dialysis dependence at hospital discharge (12.3%) remained unchanged over time. Individuals who\nrecovered renal function (33.8%) showed that those who had initially undergone CRRT had a higher eGFR than\nthose in the intermittent hemodialysis group (54.0 Ã?â?? 46.0 ml/min/1.73 m2, respectively; p = 0.014). In multivariate\nanalysis, type of patient, sepsis-associated AKI and APACHE II score were associated to death. For each additional\nunit of the APACHE II score, the odds of death increased by 52%. The odds ratio of death for medical patients with\nsepsis-associated AKI was estimated to be 2.93 (1.81ââ?¬â??4.75; p < 0.001).\nConclusion: Our study showed that the incidence of D-AKI increased with illness severity, and the use of CRRT also\nincreased over time. The improvement in renal outcomes observed in the CRRT group may be related to the better\nbaseline kidney function, especially in the dialysis dependence patients at hospital discharge....
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