Current Issue : October - December Volume : 2020 Issue Number : 4 Articles : 5 Articles
There has been a global increase in the incidence of acute kidney injury (AKI), including among\ncritically-ill surgical patients. AKI prediction score provides an opportunity for early detection of patients who are at\nrisk of AKI; however, most of the AKI prediction scores were derived from cardiothoracic surgery. Therefore, we\naimed to develop an AKI prediction score for major non-cardiothoracic surgery patients who were admitted to the\nintensive care unit (ICU).\nMethods: The data of critically-ill patients from non-cardiothoracic operations in the Thai Surgical Intensive Care\nUnit (THAI-SICU) study were used to develop an AKI prediction score. Independent prognostic factors from\nregression analysis were included as predictors in the model. The outcome of interest was AKI within 7 days after\nthe ICU admission. The AKI diagnosis was made according to the Kidney Disease Improving Global Outcomes\n(KDIGO)-2012 serum creatinine criteria. Diagnostic function of the model was determined by area under the\nReceiver Operating Curve (AuROC). Risk scores were categorized into four risk probability levels: low...........................
Atypical hemolytic uremic syndrome (aHUS) is a life-threatening disease that leads to end-stage\nkidney disease if only a poor response to plasma exchanges (PEs) or eculizumab therapy is achieved.\nCase presentation: A 58-year-old Japanese man presented with thrombocytopenia, anemia, and kidney failure\nrequiring dialysis without any underlying disease. A kidney biopsy revealed marked mesangiolysis in all glomeruli,\ncompatible with thrombotic microangiopathy (TMA). Based on the positive anti- factor H antibody and negative\nresult for secondary TMA, we diagnosed him as aHUS. Despite eculizumab administration after eight sessions of PE,\nneither platelet normalization nor kidney recovery was achieved. Eight months later, we discontinued eculizumab\ntherapy due to anaphylactic reaction. At 15 months after the onset of TMA, his platelet count increased gradually\nfrom 40.......................
Sarcoidosis is a multisystem inflammatory disorder and can affect any organ; however, ureteric\ninvolvement is extremely rare with only four cases reported in the literature to date, all of which were diagnosed\nwith surgical ureteral resection including a nephroureterectomy. This study reports the first case of ureteric\nsarcoidosis controlled with medical therapy where a differential diagnosis was performed based on the diagnostic\nclue of hypercalcemia. A definitive diagnosis was established without surgical resection of the ureter.\nCase presentation: A 60-year-old man presented with anorexia and weight loss. Blood tests showed renal\ndysfunction and hypercalcemia. Computed tomography revealed left hydronephrosis associated with left lower\nureteral wall thickening, which showed high signal intensity on diffusion-weighted magnetic resonance imaging.\nSimilarly, we detected a bladder tumor on cystoscopy, and a 2-cm-long stenosis was revealed by retrograde\nureterography; therefore, ureteral cancer was suspected. Meanwhile, considering the clinical implication of\nhypercalcemia, a differential diagnosis of sarcoidosis was established based on elevated levels of sarcoidosis\nmarkers. Fluorodeoxyglucose positron emission tomography showed fluorodeoxyglucose accumulation in the left\nlower ureter, skin, and muscles, suggestive of ureteric sarcoidosis with systemic sarcoid nodules. For a definitive\ndiagnosis, transurethral resection of the bladder tumor and ureteroscopic biopsy were performed. Histopathological\nexamination revealed ureteric sarcoidosis with bladder urothelial carcinoma. Following an oral administration of\nprednisolone, hypercalcemia instantly resolved, the renal function immediately improved, and the left ureteral\nlesion showed complete resolution with no recurrence.\nConclusions: In this case, the co-occurrence of ureteral lesion with bladder tumor evoked a diagnosis of ureteral\ncancer. However, considering a case of ureteral lesion complicated with hypercalcemia, assessment for differential\ndiagnosis was performed based on the calcium metabolism and sarcoidosis markers. In cases of suspected ureteric\nsarcoidosis from the assessment, pathological evaluation with ureteroscopic biopsy should be performed to avoid\nnephroureterectomy....
Grynfelttâ??Lesshaft hernia is a kind of lumbar abdominal wall hernia in which clinical presentations\nmay vary from an asymptomatic bulge in the lumbar area to a symptomatic lumbar mass with back pain. It has\nbeen accepted to be a rare entity, and incarceration of the kidney through this hernia is shown to be very rare, and\nvery few previous cases have been reported in this regard.\nWe present a case of renal pelvic and ureteropelvic junction incarceration in a Grynfeltt-Lesshaft hernia and provide\nan overview of the existing literature on it.\nCase presentation: A 76-year-old lady presented to the outpatient clinic with the chief complaint of right flank\npain and swelling. Computed tomography (CT) scan of the abdomen was revealed a large herniated sac (60*30\nmm) in the upper lumbar triangle with protrusion of retroperitoneal and omental fat, right renal pelvis,\nureteropelvic junction and proximal ureter with consecutive hydronephrosis. Herniated retroperitoneal and omental\nfat was reduced, and closure of the abdominal wall defect was done using retro-muscular Mesh and was fixed to\nthe fascia. The patient was discharged 24 h after the surgery without any complications.\nConclusion: Kidney herniation through the lumbar triangle is extremely rare, and the diagnosis requires careful\nclinical evaluation. CT scan is the modality of choice for the assessment. Management through surgery should be\ndone in symptomatic patients....
Rho-associated, coiled-coil containing kinases (ROCK) were originally identified as\neffectors of the RhoA small GTPase and found to belong to the AGC family of serine/threonine\nkinases. They were shown to be downstream effectors of RhoA and RhoC activation. They signal\nvia phosphorylation of proteins such as MYPT-1, thereby regulating many key cellular functions\nincluding proliferation, motility and viability and the RhoA/ROCK signaling has been shown to be\ndeeply involved in arterial hypertension, cardiovascularâ??renal remodeling, hypertensive\nnephropathy and posttransplant hypertension. Given the deep involvement of ROCK in\ncardiovascularâ??renal pathophysiology and the interaction of ROCK signaling with other signaling\npathways, the reports of trials on the clinical beneficial effects of ROCKâ??s pharmacologic targeting\nare growing. In this current review, we provide a brief survey of the current understanding of\nROCK-signaling pathways, also integrating with the more novel data that overall support a relevant\nrole of ROCK for the cardiovascular-renal physiology and pathophysiology....
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