Sample records for renal lesions due

  1. [Managing focal incidental renal lesions]. (United States)

    Nicolau, C; Paño, B; Sebastià, C


    Incidental renal lesions are relatively common in daily radiological practice. It is important to know the different diagnostic possibilities for incidentally detected lesions, depending on whether they are cystic or solid. The management of cystic lesions is guided by the Bosniak classification. In solid lesions, the goal is to differentiate between renal cancer and benign tumors such as fat-poor angiomyolipoma and oncocytoma. Radiologists need to know the recommendations for the management of these lesions and the usefulness of the different imaging techniques and interventional procedures in function of the characteristics of the incidental lesion and the patient's life expectancy.

  2. Blunt Renal Trauma in a Pre-Existing Renal Lesion

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    G.V. Soundra Pandyan


    Full Text Available A 70-year-old male presented with direct trauma to his loin with gross hematuria, as an isolated case of blunt renal trauma (BRT due to a traffic accident. A pre-existing renal lesion (PERL was strongly suspected by his past history of gross macroscopic hematuria and monotrauma to the kidney without other associated injuries. Spiral CT scan with contrast and a retrograde pyelogram (RGP confirmed an occult complex renal cyst. The gold standard of CT diagnosis in this situation is stressed. Computed tomography is particularly useful in evaluating traumatic injuries to kidneys with pre-existing abnormalities. The decision on the initial course of conservative management, ureteral retrograde stenting to drain extravasation, and its final outcome are discussed. Radical nephroureterectomy was carried out by a transperitoneal approach with an early vascular control of the renal pedicle. A brief review of recent literature has been undertaken.

  3. TCM Researches on Chronic Renal Tubulointerstitial Lesions

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    LI Hang; XIONG Jing; ZHOU Quan-rong


    @@ Researches in recent years show that progressive deterioration of the renal function caused by kidney diseases mainly relies on the severity of renal tubulointerstitial lesions (RTIL).Therefore,imp-ortance should be attached to RTIL.With its very complicated pathogenesis,RTIL is manifested as the local in flammation in renal interstitium at early stage,followed by secretion of cellular factor and then phenotype variation,apoptosis and excessive pro-liferation of renal tubular epithelial cell(RTEC),as well as increase in synthesis and decrease in degradation of extracellular matrix(ECM),causing excessive deposition of ECM and eventually-renal interstitial fibrosis(RIF).ws.

  4. Transient renal dysfunction with reversible splenial lesion. (United States)

    Watanabe, Toru; Matsuda, Tomoka; Kitagata, Ryoichi; Tajima, Iwao; Ono, Hiroyuki; Hirano, Keiko; Shirai, Masami; Endoh, Akira; Hongo, Teruaki


    We report the case of a 6-month-old boy with transient renal dysfunction who had an intensified signal in the splenium of the corpus callosum on magnetic resonance imaging. He presented to hospital with fever and sudden disturbance of consciousness. Cerebrospinal fluid analysis did not show pleocytosis. The mild consciousness disturbance disappeared after 30 min, but the splenial signal persisted even after 8 days. Further, renal glucosuria, increased excretion of select amino acids, and abnormal fractional excretion of electrolytes were observed, indicating renal tubular dysfunction. The abnormal urinary findings spontaneously resolved by day 9 of hospitalization. The splenial lesion took 21 days to normalize. There were no signs of neurological complications 2 months later. This case suggests the possibility of renal involvement in splenial lesions.

  5. Renal infarction due to lupus vasculopathy. (United States)

    Varalaxmi, B; Sandeep, P; Sridhar, A V S S N; Raveendra, P; Kishore, C Krishna; Ram, R; Kumar, V Siva


    In the ISN/RPS 2003 classification of lupus nephritis (LN) renal vascular lesions are not mentioned. We present a patient with postpartum lupus vasculopathy. The renal biopsy in our patient showed concentric intimal thickening with narrowed lumen. No inflammatory changes were found. It also revealed immunoglobulin and complement deposition on the wall of the arteriole. These changes indicate lupus vasculopathy. The glomeruli revealed diffuse proliferative glomerulonephritis, with wire loops and cellular crescent in one glomerulus. The patient showed improvement with immunosuppression.

  6. Diphenylamine-induced renal lesions in the chicken. (United States)

    Sorrentino, F; Fella, A; Pota, A


    Chronic intoxication with diphenylamine (DPA), which causes a cystic kidney disease in the rat and the guinea-pig, caused degeneration of the renal tubular epithelium in the chicken. This was similar to but much more serious than that preceding the formation of cysts in the rodents, but did not actually result in cyst formation, probably because of the high mortality rate observed in the birds even at this early stage. In the chicken until now it had been possible to obtain a pattern of renal cysts only with polychlorinated biphenyls (PCB) which also induce the "chick oedema" syndrome. The renal lesions due to DPA in the chicken were similar to those produced by PCB, but were not accompanied by oedema, which suggests that "chick oedema" caused by PCB is not due to renal insufficiency. The differences in the renal lesions noted in the various animal species give credit to the hypothesis that DPA may have two effects on the tubular epitelium, one stimulating cell proliferation and one leading to degeneration. Cysts may be formed only in those species in which there is cell proliferation.

  7. CT imaging of mass-like renal lesions in children

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    Lee, Edward Y. [Children' s Hospital Boston, Harvard Medical School, Department of Radiology, Boston, MA (United States)


    Mass-like renal lesions in children occur in a diverse spectrum of conditions including benign and malignant neoplasm, infection, infarction, lymphatic malformation, and traumatic injury. Although mass-like renal lesions can sometimes be suspected on plain radiographs and evaluated with US in children, subsequent CT is usually performed for the confirmation of diagnosis and further characterization. The purpose of this pictorial essay was to review the CT imaging findings of both common and uncommon mass-like renal lesions in pediatric patients. Understanding the characteristic CT appearance of mass-like renal lesions in children enables an accurate diagnosis and optimizes patient management. (orig.)

  8. High rate of benign histology in radiologically suspect renal lesions

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    Lindkvist Pedersen, Christina; Winck-Flyvholm, Lili; Dahl, Claus;


    or radical nephrectomy between November 2010 and July 2013. All patients underwent a multiphase helical computed tomography (CT), which revealed suspected renal malignancy. The exclusion criteria were cystic tumours, biopsy before surgery, and disseminated and locally advanced disease. Lesions were defined......INTRODUCTION: The objective of this study was to determine the incidence of benign renal lesions for clinically localised renal masses and the need for new diagnostic procedures to assess these lesions. MATERIAL AND METHODS: This retrospective study included patients who underwent partial.......4% of patients with intermediate tumours, p renal masses ≤ 4 cm even though CT revealed a suspect renal lesion. The need for new diagnostic approaches for clinically localised renal lesions is evident. FUNDING: not relevant. TRIAL REGISTRATION...

  9. Segmental Renal Infarction due to Blunt Trauma. (United States)

    Alevizopoulos, Aristeidis; Hamilton, Lauren; Stratu, Natalia; Rix, Gerald


    Segmental renal infarction is a rare situation which has been reported so far in the form of case reports. It's caused usually by cardiac conditions, such as atrial fibrillation, and systemic diseases (e.g. systemic lupus erythematous). We are presenting a case of a 31 year old healthy male, who sustained a left segmental renal infarction, following a motorbike accident. We report his presentation, management and outcome. We also review the literature in search of the optimal diagnostic and treatment pathway. To our knowledge, this is the first report of segmental renal infarction due to blunt trauma.

  10. Periungual Lesion due to Secondary Syphilis. (United States)

    Noriega, Leandro; Gioia Di Chiacchio, Nilton; Cury Rezende, Flávia; Di Chiacchio, Nilton


    Several countries experience a new epidemic of syphilis, mainly due to the changes in risk behaviors. Dermatologists play an important role in the diagnosis, since cutaneous manifestations are frequent during disease progression. We report a rare case of secondary syphilis with periungual involvement. Syphilis, especially in the secondary form, may present with different clinical features, affecting different organs, and mimicking many diseases. Although nail apparatus lesions are more common in the primary form of the disease, they may also be present in the secondary and tertiary forms. Therefore, a comprehensive knowledge of the diverse forms of syphilis presentation is important for an early diagnosis and timely treatment.

  11. Acute renal failure due to rhabdomyolyisis

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    Nieto-Ríos, John Fredy


    Full Text Available Acute renal failure is a frequent cause of morbidity and mortality in emergency, hospitalization and critical care services. In 15 % of cases it is due to rhabdomyolysis, in which there is breakdown of skeletal muscle with massive necrosis and leakage of muscle cell contents into the circulation. It has many different etiologies. The rhabdomyolysis-induced acute kidney injury results from the combination of several mechanisms, including tubular obstruction, vasoconstriction and oxidative stress. The most important therapeutic measures are: Aggressive repletion of fluids, forced diuresis and avoidance of exposure to nephrotoxic substances. In cases of severe uremia, metabolic acidosis, hiperkalemia or fluid overload it is necessary to start renal replacement therapy. As a rule, kidney function is completely recovered, but these patients have higher risk of future chronic kidney disease.

  12. Renal lesions associated with autoimmune pancreatitis: CT findings

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    Triantopoulou, Charikleia; Maniatis, Petros; Siafas, Ioannis; Papailiou, John (CT and Radiology Dept., ' Konstantopouleion' General Hospital, Athens (Greece)), e-mail:; Malachias, George; Anastopoulos, John (Radiology Dept., ' Sismanogleio' General Hospital, Athens (Greece))


    Background: Autoimmune pancreatitis (AIP) is a chronic inflammatory condition characterized by IgG4-positive plasma cells. Recent evidence suggests that it is a systemic disease affecting various organs. Tubulointerstitial nephritis has been reported in association with AIP. Purpose: To investigate the incidence and types of renal involvement in patients with AIP. Material and Methods: Eighteen patients with no history of renal disease and a diagnosis of AIP (on the basis of histopathologic findings or a combination of characteristic imaging features, increased serum IgG4 levels, and response to steroid treatment) were included. All patients underwent computed tomography (CT) imaging and follow-up ranged from 6 months to 2 years. CT images were reviewed for the presence of renal lesions. Results: Seven patients had renal involvement (38.8%). None of the lesions was visible on non-contrast-enhanced CT scan. Parenchymal lesions appeared as multiple nodules showing decreased enhancement (four cases). Pyelonephritis, lymphoma, and metastases were considered in the differential diagnosis. An ill-defined low-attenuation mass-like lesion was found in one patient, while diffuse thickening of the renal pelvis wall was evident in the last two cases. Renal lesions regressed in all patients after steroid treatment, the larger one leaving a fibrous cortical scar. Conclusion: Different types of renal lesions in patients with AIP are relatively common, appearing as multiple nodules with decreased enhancement. These findings support the proposed concept of an IgG4-related systemic disease. Autoimmune disease should be suspected in cases of renal involvement in association with pancreatic focal or diffuse enlargement.

  13. Isolated renal hydatid presenting as a complex renal lesion followed by spontaneous hydatiduria

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    Anil; Bhaya; Archana; P; Shinde


    Echinococcosis is a zoonotic disease. Liver is the most common site of involvement. Renal involvement is seen in 2% to 3% of patients. Computed tomography findings in renal hydatid typically include: a cyst with thick or calcified wall, unilocular cyst with detached membrane, a multiloculated cyst with mixed internal density and daughter cysts with lower density than maternal matrix. Rarely type Ⅳ hydatid cysts may mimic hypovascular renal cell carcinoma. We report a case of previously asymptomatic middle aged female who presented with mild intermittent pain and a complex renal lesion on imaging which was considered to be a hypovascular renal carcinoma or urothelial neoplasm. However, by serendipity, the patient had spontaneous hydatiduria and later was definitively diagnosed and stented. Hydatid disease should always be considered amongst the top differential diagnosis of an isolated "complex" renal lesion which remains indeterminate on imaging.

  14. Imaging features, follow-up, and management of incidentally detected renal lesions

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    Bradley, A.J., E-mail: [Department of Radiology, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Lim, Y.Y.; Singh, F.M. [Department of Radiology, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom)


    Incidental renal masses are common findings on cross-sectional imaging. Most will be readily identified as simple cysts, but with an inexorable rise in abdominal imaging, [particularly computed tomography (CT)], coupled with a rise in the incidence of renal cancer, the likelihood of detecting a malignant mass is increasing. This review informs the radiologist which lesions can be safely ignored, which will require further imaging for accurate categorization, and which require referral for consideration of treatment. For the small proportion of lesions that are indeterminate, careful attention to imaging technique, and the use of unenhanced and contrast-enhanced CT or magnetic resonance imaging (MRI) in all but a few specific instances will accurately characterize such lesions. The figures have been chosen to illustrate specific imaging features of common renal lesions. Management options for malignant, or presumed malignant, renal masses include active surveillance, percutaneous ablation, laparoscopic or open, partial or total nephrectomy. Biopsy has a role in determining the nature of masses that remain indeterminate on cross-sectional imaging, prior to definitive treatment. Common pitfalls in assessing incidental renal lesions are emphasized; some of these are due to sub-optimal imaging techniques and others to errors in interpretation.

  15. Evaluation of a liquid embolization agent (Onyx) for transcatheter embolization for renal vascular lesions

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    Rennert, Janine; Herold, T.; Schreyer, A.G.; Jung, E.M.; Mueller-Wille, R.; Zorger, N. [Inst. fuer Roentgendiagnostik, Klinikum der Univ. Regensburg (Germany); Banas, B.; Feuerbach, S. [Medizinische Klinik, Nephrologie, Univ. Regensburg (Germany); Lenhart, M. [Klinik fuer Diagnostische und Interventionelle Radiologie, Sozialstiftung Bamberg (Germany)


    Purpose: to evaluate the therapeutic outcome after endovascular treatment of renal vascular lesions using the liquid embolization agent, Onyx. Materials and methods: between 2004 and 2008 nine patients with renal vascular lesions were treated with transcatheter arterial embolization using Onyx. The renal vascular lesions consisted of 4 AV-fistulas, a pseudoaneurysm, bleeding from a single subsegmental artery, diffuse parenchymal bleeding after trauma, septic embolizations and multiple aneurysms in endocarditis. All patients underwent selective angiography of the renal artery. A dimethyl sulfoxide (DMSO)-compatible microcatheter was used and Onyx was injected. The technical and clinical success rate, examination time and procedure-related complications were documented. Results: the overall technical and clinical success rate was 100%. One patient had to be treated twice due to recurrent bleeding after an accidental puncture with a drainage catheter. No loss of viable renal tissue occurred in 4 cases. In 4 patients mild to moderate parenchyma loss was noted. In one patient having diffuse renal bleeding, occlusion of the main renal artery was performed. No procedure-related complications were noted. The mean examination time was 16.17 min when treating with Onyx alone and 60 min when using a combination of Onyx and coils. Within an average follow-up period of 21 months, no recurrent renal bleeding or recurrent AV-fistulas occurred. Conclusion: Onyx is an effective embolization agent for the treatment of renal vascular lesions. It allows controlled and quick application with low complication rates and a short examination time as a standalone agent or in combination with coils. (orig.)

  16. Renal injury due to hepatic hydatid disease. (United States)

    Altay, Mustafa; Unverdi, Selman; Altay, Fatma Aybala; Ceri, Mevlüt; Akay, Hatice; Ozer, Hüseyin; Kiraç, Halil; Denizli, Nazim; Yilmaz, Bilal; Güvence, Necmettin; Duranay, Murat


    Many studies on renal hydatid disease have been reported in the literature, and the disease process appears to be well defined. However, renal injury without direct renal invasion remains poorly understood. The present study aims to define the frequency and the property of the renal involvement in hydatid disease. Eighty patients older than 18 years and diagnosed with liver echinococcosis were included in the study. The echinococcosis was diagnosed by the haemagglutination test and abdominal ultrasonography. Twenty-four-hour protein excretion was measured for patients who had elevated serum creatinine levels or whose urinalyses were positive for haematuria or proteinuria. Subsequently, renal biopsy was performed, and the specimens were examined by light microscopy and immunofluorescence staining. Haematuria was detected in 11 patients (13.75%), and proteinuria was detected in nine patients (11.25%). Percutaneous renal biopsy was applied to nine patients who gave signed consents to undergo the test. We detected four immunoglobulin A nephritis (together with tubulointerstitial nephritis in one patient), one membranoproliferative glomerulonephritis, one immunoglobulin M nephritis together with mesangiocapillary glomerulonephritis, one membranous glomerulonephritis, one amyloidosis and one tubulointerstitial nephritis. Renal hydatid cyst was detected only in four patients (5%). Hydatid disease, which affects the kidney, is not rare, and we suggest that urinalysis and, if indicated, renal biopsy should be performed for hepatic hydatid disease diagnosis.

  17. Renal infarct: a rare disease due to a rare etiology (United States)

    Akshintala, Divya; Bansal, Saurabh K.; Emani, Vamsi Krishna; Yadav, Manajyoti


    Renal infarction is caused by profound hypoperfusion secondary to embolic/thrombotic occlusion of the renal artery or vasospasm of the renal artery. We present a case of a 54-year-old patient who presented with nausea, vomiting, and vague abdominal pain. He had frequent episodes of migraine headaches and he treated himself with as needed rizatriptan. CT scan of the abdomen showed renal cortical infarction. After extensive investigations, etiology of his renal infarct was deemed to be due to rizatriptan. PMID:26091657

  18. Renal infarct: a rare disease due to a rare etiology

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    Divya Akshintala


    Full Text Available Renal infarction is caused by profound hypoperfusion secondary to embolic/thrombotic occlusion of the renal artery or vasospasm of the renal artery. We present a case of a 54-year-old patient who presented with nausea, vomiting, and vague abdominal pain. He had frequent episodes of migraine headaches and he treated himself with as needed rizatriptan. CT scan of the abdomen showed renal cortical infarction. After extensive investigations, etiology of his renal infarct was deemed to be due to rizatriptan.

  19. Occult Renal Granulomatous Inflammatory Lesions in Granulomatosis with Polyangiitis Detected by 18F-FDG PET/CT. (United States)

    Fu, Zhanli; Liu, Meng; Li, Ziao; Zhang, Jin; Li, Qian


    A 33-year-old woman with a 7-month history of granulomatosis with polyangiitis F-FDG PET/CT scan due to low-grade intermittent fever and elevation of serum inflammatory markers, which revealed multiple hypermetabolic lesions in bilateral kidneys. Biopsy of a lesion showed granulomatosis with polyangiitis, consistent with renal involvement of granulomatosis with polyangiitis.

  20. Evaluation of renal lesions and clinicopathologic correlation in rheumatoid arthritis

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    Periyasamy Muthukumar


    Full Text Available The most common causes of renal disease in rheumatoid arthritis (RA are glomerulonephritis (GN, amyloidosis, tubulo-interstitial nephritis, and drug toxicity. Our aim was to evaluate the clinicopathologic correlation of renal lesions and to assess the course and prognosis of renal disease in patients with RA. We conducted a prospective observational study in all adult patients with RA between July 2010 and June 2015. The total number of patients studied was 90, with a female:male ratio of 2.3:1. Mean follow-up duration was 30 ± 6.5 months. About 54 patients (60% were asymptomatic. The most common symptom was edema legs (30%, followed by oliguria (10%. About 18 patients (20% presented with the nephrotic syndrome, 15 patients (16.6% with nephritic syndrome, and 30 (33% with asymptomatic urinary abnormalities. Chronic kidney disease (CKD was seen in 48 of 90 patients (53%.The most common renal pathology noted was mesangioproliferative GN followed by membranous nephropathy (MN. IgM with C3 deposits was the most common immunofluorescence pattern observed. Among the patients who had glomerular diseases, complete remission was seen in nine patients, partial remission in 15, and persistent proteinuria in 14. Duration of RA and a high erythrocyte sedimentation rate correlated significantly with persistent proteinuria. Only one patient in the glomerular disease group progressed to dialysis-dependent renal failure. On followup, 11 out of 48 CKD patients showed a significant decrease in estimated glomerular filtration rate and worsened to the next stage of CKD. Renal disease in RA presents with varied renal pathology. MN was seen frequently and was not associated with gold or penicillamine usage. Relatively high incidence of CKD was noted. Hence, it is important to monitor renal function abnormalities periodically in these patients.

  1. A rare case of acute renal infarction due to idiopathic renal arterial thrombosis

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    FU Zhi-fang; ZHANG Zhi-gang; LIU Xin-min


    @@ Because of the lack of specific clinical signs and symptoms,acute renal infarction is apt to be missed in diagnosis and hence has a"low"incidence.In this report,a case of acute renal infarction due to idiopathic renal arterial thrombosis is presented.

  2. Spectrum of Lesions Affecting the Renal Pelvis and Pelviureteric Junction: A 13-Year Retrospective Analysis (United States)

    Kini, Hema; Suresh, Pooja Kundapur; Guni, Laxman Prabhu Gurupur; Bhat, Shaila; Kini, Jyoti Ramanath


    Introduction Both, the renal pelvis and the ureter, are affected by developmental, reactive and neoplastic disorders, though rare in incidence. Aim This series of cases were analysed to study the clinicopathological characteristics of the common and comparatively rare lesions involving the renal pelvis and pelviureteric junction. Materials and Methods A retrospective collection of 476 nephrectomies and pelviureteric junction resections, received over a period of 13 years from 2001 to 2013 was done. The patients’ clinical details were obtained and the histopathological findings reviewed. The lesions were classified into non-neoplastic and neoplastic categories. Results Primary involvement of the renal pelvis and pelviureteric junction was seen in 105 of 476 specimens. The mean age was 54.5 years with a male to female ratio of 2.2:1. The non-neoplastic lesions accounted for 76.2% of cases with a majority being pelviureteric junction obstruction due to inflammation induced fibromuscular hypertrophy (68.6%) causing hydronephrosis. Urothelial carcinomas were encountered in 20% of the cases. A majority of the urothelial carcinomas were infiltrative (81%) and high grade (71%) tumours. Conclusion Renal pelvis, a conduit to propel urine, can be the site for numerous disorders. Non-neoplastic lesions were more common than neoplasms. Pelviureteric junction obstruction due to inflammation induced fibromuscular hypertrophy was the commonest lesion in our study. In the neoplastic category, urothelial carcinoma was most common. However, rare lesions such as hamartomatous fibroepithelial polyp, Von Brunn’s nests, flat urothelial hyperplasia and intramuscular haemangioma of upper ureter at the pelviureteric junction were encountered along with occasional cases of tuberculosis and squamous cell carcinomas. PMID:27042468

  3. Occult renal cell carcinoma with acrometastasis and ipsilateral juxta-articular knee lesions mimicking acute inflammation

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    Bhaskar Borgohain


    Full Text Available Generally, skeletal peripheral metastases below the elbow and the knee are rare. Skeletal metastases to the hand or foot are very rare; but when they do it may be a revealing clinical finding. Purely lytic lesions are commonly seen in metastases from lung, renal, and thyroid tumors, but they are also known to occur in primary myeloma, brown tumor and lymphomas. A 70-year-old man was brought to the emergency department with acute painful swelling involving his right hand and the right knee. Due to significant accompanying soft tissue swellings cellulitis, acute osteomyelitis and gouty arthropathy were included in the initial differential diagnosis. Radiographs showed pure lytic bony lesion with complete disappearance of lower two third of the second metacarpal, trapezium and trapezoid bones of the right hand along with a lytic subarticular lesion of medial condyle of ipsilateral femur. Chest X-ray (CXR was normal but sonography of the abdomen readily demonstrated a large renal mass, later confirmed at biopsy as renal cell carcinoma (RCC. Clinicians should be cognizant of the strong association between digital acrometastases and renal cell carcinoma in male patients with normal CXR findings. In suspected hand acrometastasis associated with a soft tissue component outside the contours of normal bone, screening the abdomen by sonography should be done prior to bone biopsy and before costly or time-consuming investigations are offered. Metastatic RCC should be included in the differential diagnosis of all unilateral expansile bony lesions of the digit. It is particularly important if such lesion/lesions are accompanied by local inflammation. Screening the abdomen by sonography may be of particular value in such elderly male patient when Chest X-ray shows no abnormality.

  4. Post-renal acute renal failure due to a huge bladder stone. (United States)

    Celik, Orcun; Suelozgen, Tufan; Budak, Salih; Ilbey, Yusuf Ozlem


    A 63-year old male was referred to our emergency unit due to acute renal failure. The level of serum renal function tests levels, blood urea nitrogen (BUN)/creatinine, were 63 mmol/L/848 μmol/L. CT (Computarised Tomography) scan showed a huge bladder stone (5 cm x 6 cm x 5 cm) with increased bladder wall thickness. Post-renal acute renal failure due to bilateral ureterohydronephrosis was diagnosed. The huge bladder stone was considered to be the cause of ureterohydronephrosis and renal failure. The patient was catheterised and received haemodialysis immediately. He received haemodialysis four times during ten days of hospitalization and the level of serum renal function tests levels (BUN/ creatinine) decreased 18 mmol/L/123 μmol/L. After improvement of renal function, we performed cystoscopy that demonstrated normal prostatic urethra and bladder neck and bilaterally normal ureteral orifices. Bladder wall was roughly trabeculated and Bladder outlet was completely obstructed by a huge bladder stone. After cystoscopy open, cystolithotomy was performed to remove calcium phosphate and magnesium ammonium phosphate stone weighing 200 g removed. Four days after operation the patient was discharged uneventfully and urethral catheter was removed on the seventh day. Post-renal acute renal failure due to large bladder stones is rare in literature. According to the our knowledge; early diagnosis of the stone avoid growth to large size and prevent renal failure.

  5. Renal uptake of /sup 67/Ga-citrate in renal amyloidosis due to Familiar Mediterranean Fever

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    Banzo-Marraco, J.; Abos-Olivares, M.D.; Iribar-Ibabe, M.C.; Prats-Rivera, E.; Banzo-Marraco, J.I.; Teijeiro-Vidal, J.; Nerin-Mora, E.; Nerin de la Puerta, I.


    Renal uptake of /sup 67/Ga-citrate is described in a patient with biopsy-proven amyloidosis of the kidneys, due to Familiar Mediterranean Fever. After administration 150 MBq (4mCi) /sup 67/Ga-citrate, scans were done at 48, 72, and 120 h. Intense uptake was noted in both kidneys. A renal biopsy done 5 days after the /sup 67/Ga-citrate scan revealed a pattern typical of amyloidosis. Gallium scanning can be useful in patients with fever of unknown origin. Renal amyloidosis can be considered when renal uptake of /sup 67/Ga-citrate associated with nephrotic syndrome is observed.

  6. Vascular, hepatic and renal lesions by Dirofilaria immitis invasion in dogs

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    S.A. Pasca


    Full Text Available Morphological investigations were conducted on four bodies of dogs who died due to severe clinical symptoms following a massive invasion of cardiac and pulmonary Dirofilaria. The subjects were monitored clinically and diagnosed serologically positive for the Heartworm disease. The necropsy examination of the cardiovascular system (right ventricle and pulmonary artery revealed the presence of 25 adult parasites in one dog with length ranging between 8 and 33cm. Macroscopically, lesions consistently observed were represented by the right ventricular dilatation and the diffuse wall thickening of the pulmonary artery. Parasitic invasion secondary lesions were present in the lungs, liver and kidneys (cardiac and vascular lesions. The histological examination mainly revealed myocardial injury, vascular (dystrophic, pulmonary (circulatory and inflammatory, hepatic (degenerative and renal (degenerative and inflammatory damage.

  7. Pulmonary thromboembolism associated with renal insufficiency due to renal artery thrombosis

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    Vučičević-Trobok Jadranka


    Full Text Available Pulmonary thromboembolism is a clinical and pathophysiological condition caused by occlusion of pulmonary arteries by thrombotic embolus. Deep venous thrombosis needn't necessarily be evident. Acute renal insufficiency is a syndrome manifested by rapid decrease or even complete urinary retention which may be due to obturation of renal arteries by a thrombus. The condition is clinically manifested by hematuria, oliguria, anuria and death due to uremia. Case Report The patient had a history of disease and a chest X-ray finding both irrelevant for establishing the working diagnosis. Blood gas analysis presented prominent hypoxemia with hyperventilation and ECG finding exhibited right heart overload, pointing to pulmonary thromboembolism. On the third day of treatment with heparin, the patient developed hematuria, oliguria and excessive elevation of nitrogen in blood as a sign of acute renal insufficiency, leading to fatal outcome. Autopsy revealed deep venous thrombosis of the left femoral vein, with massive pulmonary thromboembolism and thrombosis of both femoral arteries, inducing acute renal failure. Discussion Although the patient had a typical radiologic presentation of pulmonary thromboembolism, treatment with heparin was initiated on the basis of his blood gas analysis and ECG findings. Deep venous thrombosis was not clinically evident and acute renal failure could not be explained during patient's lifetime. Conclusion This is a rare case of acute renal failure due to a rare occurrence of bilateral acute thrombosis of renal arteries.

  8. Renal, gastric and thyroidal amyloidosis due to familial Mediterranean fever. (United States)

    Kavukçu, S; Türkmen, M; Eroğlu, Y; Canda, T; Yörükoğlu, K; Iğci, E; Büyükgebiz, A


    Chronic renal failure developed in a 10-year-old girl due to renal amyloidosis secondary to familial Mediterranean fever (FMF). During management of the chronic renal failure by hemodialysis and of FMF with colchicine, goiter and hypothroidism were observed. Thyroid fine-needle aspiration and gastric endoscopical biopsies, performed when recurrent abdominal pain could not be controlled, revealed amyloid deposits in both thyroid and gastric tissues. After 6 months' therapy with colchicine and levothyroxine, there was no significant change in the thyroid volume. This is the first case in which gastric amyloidosis secondary to FMF in childhood has been demonstrated. Patients with amyloidosis secondary to FMF who have thyroid enlargement and unexplained gastrointestinal symptoms despite adequate therapy should be evaluated with imaging studies and biopsy examinations.

  9. Resolution of cortical lesions on serial renal scans in children with acute pyelonephritis

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    Agras, Koray; Tuncel, Altug; Atan, Ali [Numune Teaching and Research Hospital, Department of Urology, Ankara (Turkey); Ortapamuk, Huelya; Naldoeken, Seniha [Numune Teaching and Research Hospital, Department of Nuclear Medicine, Ankara (Turkey)


    The ideal time for distinguishing a renal scar from acute inflammatory lesions by renal DMSA scintigraphy remains controversial. To determine the time needed for resolution of lesions after acute pyelonephritis. A total of 105 children with acute pyelonephritis underwent renal sonography, voiding cystourethrography and baseline DMSA scintigraphy. Two subsequent scans were performed during the 6th and 12th months in patients with abnormal findings on the previous scan. The baseline DMSA scintigraphy revealed cortical lesions in 37 patients. At 6 months, 13 patients (38.2%) were found to have cortical lesions. At 12 months, 6 patients (17.6%) were found to have persistent renal cortical lesions. The resolution rates for lesions detected on the first scan were 61.8% and 82.4% on the 6- and 12-month scans, respectively. Vesicoureteric reflux, and bilaterality or multifocality were not relevant for resolution of lesions. Female gender seemed to be associated with a higher persistence rate. The renal cortical defects present at 6 months have a high rate of resolution later during follow-up. DMSA scintigraphy performed 12 months after the infection provides more reliable data regarding persistence of renal cortical lesions. (orig.)


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    N Ataei


    Full Text Available "nUrinary tract infection (UTI may lead to irreversible changes in renal parenchyma. Early diagnosis using scintigraphy with technetium-99m-labeled dimercaptosuccinic acid (DMSA scan and early treatment may decrease or prevent development of renal parenchymal lesions. The aim of this study was to assess the occurrence of renal parenchymal lesion in children admitted with a first-time symptomatic UTI and to evaluate the relation between renal parenchymal damage and severity of vesicoureteral reflux (VUR. A total of 102 children with first time acute pyelonephritis (APN were enrolled in the study. All children studied with DMSA scan and ultrasonography (US. Voiding cystourethrography (VCUG was performed in 98 children when urine culture became negative. Changes on the DMSA scan and US were found in 178 (88% and 5 (2.4% out of 203 renal units during the acute phase, respectively. All abnormal renal units on US showed severe parenchymal involvement on DMSA. We also found significant correlation between severity of VUR and abnormal US results on kidneys. Of 40 kidneys with reflux, 38 (95% were found to have abnormal renal scan. Among 155 kidneys with non-refluxing ureters 132 (85.2% revealed parenchymal changes on renal cortical scintigraphy. Kidneys with moderate to severe reflux were more likely to have severe renal involvement. We found a high incidence of renal parenchymal changes in children with APN. Additionally, renal involvement was significantly higher in children with moderate to severe reflux. When there are high-grade VUR and female gender, the risk of renal parenchymal involvement is higher.

  11. Incidence of renal carcinoma in non-functioning kidney due to renal pelvic stone disease (United States)



    The objective of This study was to report our pathological findings in nephrectomy specimens from patients treated for non-functioning hydronephrotic kidney due to renal pelvic stone disease. A total of 97 patients who underwent nephrectomy for non-functioning hydronephrotic kidneys between January, 2011 and June, 2014 were retrospectively reviewed. A non-functioning kidney was defined as one having paper-thin parenchyma on urinary ultrasound or computed tomography, exhibiting no contrast visualization in the collecting duct system on intravenous urography and having a split renal function of <10% on nuclear renal function studies. Following pathological evaluation, 9 patients were diagnosed with xanthogranulomatous pyelonephritis, 9 with malignant tumors and 79 with chronic pyelonephritis. Of the patients with chronic pyelonephritis, 2 also had renal adenomas. The malignant tumors included 3 transitional cell carcinomas (TCC), 2 squamous cell carcinomas (SCC), 3 renal cell carcinomas (RCC) (1 sarcomatoid, 1 papillary and 1 clear cell RCC), whereas 1 patient had concurrent RCC and TCC. In conclusion, non-functioning kidneys, particularly those with kidney stones, should be managed as possible malignancies, due to the higher incidence of malignant tumors in such patients compared with the normal population. PMID:26171211

  12. T2 weighted MRI for assessing renal lesions in transgenic mouse models of tuberous sclerosis

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    Kalogerou, Maria; Zhang, Yadan; Yang, Jian; Garrahan, Nigel [Institute of Medical Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN (United Kingdom); Paisey, Stephen; Tokarczuk, Paweł; Stewart, Andrew [School of Bioscience, Cardiff University, Museum Avenue, Cardiff CF10 3AX (United Kingdom); Gallacher, John [Department of Primary Care and Public Health, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4YS (United Kingdom); Sampson, Julian R. [Institute of Medical Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN (United Kingdom); Shen, Ming Hong, E-mail: [Institute of Medical Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN (United Kingdom)


    Objective: Transgenic mouse models of tuberous sclerosis (TSC) develop renal cysts, cystadenomas, solid adenomas and carcinomas. Identification and characterisation of these lesions in vivo may help in TSC pre-clinical trials. This study was to evaluate T2 weighted MRI for assessment of renal lesions in two Tsc mouse models. Materials and Methods: Tsc1{sup +/−}, Tsc2{sup +/−} and wild type mice were subjected to a first MRI scan at 12 months of age and a second scan 2 months later. One Tsc2{sup +/−} mouse was treated with rapamycin for two months after the initial scan. Immediately following the second scan, mice were sacrificed and MRI images were compared to renal histological findings. Results: MRI identified all types of Tsc-associated renal lesions in both Tsc1{sup +/−} and Tsc2{sup +/−} mice. The smallest detectable lesions were <0.1 mm{sup 3}. Eighty three percent of all renal lesions detected in the first scan were re-identified in the second scan. By MRI, these lesions demonstrated significant growth in the 9 untreated Tsc1{sup +/−} and Tsc2{sup +/−} mice but shrinkage in the rapamycin treated Tsc2{sup +/−} mouse. Between the two scans, MRI also revealed significant increase in both the total number and volume of lesions in untreated mice and decrease in the rapamycin treated mouse, respectively. In comparison to histological analysis MRI detected most cysts and cystadenomas (66%) but only a minority of solid tumours (29%). Conclusion: These results suggest that T2 weighted MRI may be a useful tool for assessing some renal lesions in pre-clinical studies using Tsc mouse models. However, improved sensitivity for T2 weighted MRI is required, particularly for solid renal lesions.

  13. Pulmonary Lymphangitic Carcinomatosis due to Renal Cell Carcinoma. (United States)

    Guddati, Achuta K; Marak, Creticus P


    Renal cell carcinoma is an aggressive disease with a high rate of mortality. It is known to metastasize to the lung, liver, bone and brain. However, manifestation through lymphatic spread to the lungs is rare. Lymphangitic carcinomatosis is commonly observed in malignancies of the breast, lung, pancreas, colon and cervix. It is unusual to observe lymphangitic carcinomatosis of the lungs due to renal cell carcinoma. Lymphangitic carcinomatosis of the lungs may result in severe respiratory distress and may be the direct cause of death. Currently, there are no known modalities of preventing or slowing lymphangitic carcinomatosis besides treating the primary tumor. However, early detection may change the course of the disease and may prolong survival. This is compounded by the difficulty involved in diagnosing lymphangitic carcinomatosis of the lung which frequently involves lung biopsy. Immunohistochemical studies are often used in conjunction with regular histochemistry in ascertaining the primary tumor and in differentiating it from pulmonary metastasis. In this case report, we describe the presentation and clinical course of renal cell carcinoma in a patient which manifested as lymphangitis carcinomatosa of the lungs. The patient underwent surgical resection of the primary tumor with lymph node resection but presented with a fulminant lymphangitic carcinomatosis of the lungs within two weeks. Immunohistochemistry of the tissue obtained by the biopsy confirmed the diagnosis which was subsequently corroborated during his autopsy. This case illustrates the necessity of an urgent follow-up of chemotherapy and immunotherapy in such patients.

  14. Pulmonary Lymphangitic Carcinomatosis due to Renal Cell Carcinoma

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    Achuta K. Guddati


    Full Text Available Renal cell carcinoma is an aggressive disease with a high rate of mortality. It is known to metastasize to the lung, liver, bone and brain. However, manifestation through lymphatic spread to the lungs is rare. Lymphangitic carcinomatosis is commonly observed in malignancies of the breast, lung, pancreas, colon and cervix. It is unusual to observe lymphangitic carcinomatosis of the lungs due to renal cell carcinoma. Lymphangitic carcinomatosis of the lungs may result in severe respiratory distress and may be the direct cause of death. Currently, there are no known modalities of preventing or slowing lymphangitic carcinomatosis besides treating the primary tumor. However, early detection may change the course of the disease and may prolong survival. This is compounded by the difficulty involved in diagnosing lymphangitic carcinomatosis of the lung which frequently involves lung biopsy. Immunohistochemical studies are often used in conjunction with regular histochemistry in ascertaining the primary tumor and in differentiating it from pulmonary metastasis. In this case report, we describe the presentation and clinical course of renal cell carcinoma in a patient which manifested as lymphangitis carcinomatosa of the lungs. The patient underwent surgical resection of the primary tumor with lymph node resection but presented with a fulminant lymphangitic carcinomatosis of the lungs within two weeks. Immunohistochemistry of the tissue obtained by the biopsy confirmed the diagnosis which was subsequently corroborated during his autopsy. This case illustrates the necessity of an urgent follow-up of chemotherapy and immunotherapy in such patients.

  15. Supra-Acetabular Brown Tumor due to Primary Hyperparathyroidism Associated with Chronic Renal Failure

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    Rosaria M. Ruggeri


    Full Text Available A 63-year-old woman presented to the Orthopedic Unit of our hospital complaining of right hip pain of 6 months'duration associated with a worsening limp. Her past medical history included chronic renal insufficiency. Physical examination revealed deep pain in the iliac region and severe restriction of the right hip's articular function in the maximum degrees of range of motion. X-rays and CT scan detected an osteolytic and expansive lesion of the right supra-acetabular region with structural reabsorption of the right iliac wing. 99mTc-MDP whole-body bone scan showed an abnormal uptake in the right iliac region. Bone biopsy revealed an osteolytic lesion with multinucleated giant cells, indicating a brown tumor. Serum intact PTH was elevated (1020 pg/ml; normal values, 12 62 pg/ml, but her serum calcium was normal (total = 9.4 mg/dl, nv 8.5–10.5; ionized = 5.0 mg/dl, nv 4.2–5.4 due to the coexistence of chronic renal failure. 99mTc-MIBI scintigraphy revealed a single focus of sestamibi accumulation in the left retrosternal location, which turned out to be an intrathoracic parathyroid adenoma at surgical exploration. After surgical removal of the parathyroid adenoma, PTH levels decreased to 212 pg/ml. Three months after parathyroidectomy, the imaging studies showed complete recovery of the osteolytic lesion, thus avoiding any orthopedic surgery. This case is noteworthy because (1 primary hyperparathyroidism was not suspected due to the normocalcemia, likely attributable to the coexistence of chronic renal failure; and (2 it was associated with a brown tumor of unusual location (right supra-acetabular region.

  16. Massive hematuria due to a congenital renal arteriovenous malformation mimicking a renal pelvis tumor: a case report

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    Sountoulides P


    Full Text Available Abstract Introduction Congenital renal arteriovenous malformations (AVMs are very rare benign lesions. They are more common in women and rarely manifest in elderly people. In some cases they present with massive hematuria. Contemporary treatment consists of transcatheter selective arterial embolization which leads to resolution of the hematuria whilst preserving renal parenchyma. Case presentation A 72-year-old man, who was heavy smoker, presented with massive hematuria and flank pain. CT scan revealed a filling defect caused by a soft tissue mass in the renal pelvis, which initially led to the suspicion of a transitional cell carcinoma (TCC of the upper tract, in view of the patient's age and smoking habits. However a subsequent retrograde study could not depict any filling defect in the renal pelvis. Selective right renal arteriography confirmed the presence of a renal AVM by demonstrating abnormal arterial communication with a vein with early visualization of the venous system. At the same time successful selective transcatheter embolization of the lesion was performed. Conclusion This case highlights the importance of careful diagnostic work-up in the evaluation of upper tract hematuria. In the case presented, a congenital renal AVM proved to be the cause of massive upper tract hematuria and flank pain in spite of the initial evidence indicating the likely diagnosis of a renal pelvis tumor.

  17. Diffusion-weighted imaging of focal renal lesions: a meta-analysis

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    Lassel, E.A.; Schoenberg, S.O.; Michaely, H.J. [Medical Faculty Mannheim, Heidelberg University, Institute of Clinical Radiology and Nuclear Medicine, Mannheim (Germany); Rao, R. [University of Texas Medical Branch, Galveston, TX (United States); Schwenke, C. [SCO:SSiS - Statistical Consulting, Berlin (Germany)


    Contrast-enhanced MRI can only distinguish to a limited extent between malignant and benign focal renal lesions. The aim of this meta-analysis is to review renal diffusion-weighted imaging (DWI) to compare apparent diffusion coefficient (ADC) values for different renal lesions that can be applied in clinical practice. A PubMed search was performed to identify relevant articles published 2004-2011 on renal DWI of focal renal lesions. ADC values were extracted by lesion type to determine whether benign or malignant. The data table was finalised in a consensus read. ADC values were evaluated statistically using meta-regression based on a linear mixed model. Two-sided P value <5 % indicated statistical significance. The meta-analysis is based on 17 studies with 764 patients. Renal cell carcinomas have significant lower ADC values than benign tissue (1.61 ± 0.08 x 10{sup -3} mm{sup 2}/s vs 2.10 ± 0.09 x 10{sup -3} mm{sup 2}/s; P < 0.0001). Uroepithelial malignancies can be differentiated by lowest ADC values (1.30 ± 0.11 x 10{sup -3} mm{sup 2}/s). There is a significant difference between ADC values of renal cell carcinomas and oncocytomas (1.61 ± 0.08 x 10{sup -3} mm{sup 2}/s vs 2.00 ± 0.08 x 10{sup -3} mm{sup 2}/s; P < 0.0001). Evaluation of ADC values can help to determine between benign and malignant lesions in general but also seems able to differentiate oncocytomas from malignant tumours, hence potentially reducing the number of unnecessarily performed nephrectomies. (orig.)

  18. Bosniak classification of renal cystic lesions according to multidetector computed tomography findings* (United States)

    de Miranda, Christiana Maia Nobre Rocha; Maranhão, Carol Pontes de Miranda; dos Santos, Carla Jotta Justo; Padilha, Igor Gomes; de Farias, Lucas de Pádua Gomes; da Rocha, Milzi Sarmento


    Renal cystic lesions are usually diagnosed in the radiologists’ practice and therefore their characterization is crucial to determine the clinical approach to be adopted and prognosis. The Bosniak classification based on computed tomography findings has allowed for standardization and categorization of lesions in increasing order of malignancy (I, II, IIF, III and IV) in a simple and accurate way. The present iconographic essay developed with multidetector computed tomography images of selected cases from the archives of the authors’ institution, is aimed at describing imaging findings that can help in the diagnosis of renal cysts. PMID:25741060

  19. Evaluation of hyperdense renal lesions incidentally detected on single-phase post-contrast CT using dual-energy CT (United States)

    Park, Jung Jae; Park, Byung Kwan


    Objective: To investigate the utility of dual-energy CT (DECT) for differentiating between solid and benign cystic lesions presenting as hyperdense renal lesions incidentally detected on single-phase post-contrast CT. Methods: 90 hyperdense renal lesions incidentally detected on single-phase post-contrast CT were evaluated with follow-up DECT. DECT protocols included true non-contrast (TNC), DE corticomedullary and DE late nephrographic phase imaging. The CT numbers of hyperdense renal lesions were calculated on linearly blended and iodine overlay (IO) images, and the results were compared. Results: In total, 47 benign cystic and 43 solid renal lesions were analyzed. For differentiating between solid and benign cystic lesions on the two phases, the specificity and accuracy of all lesions and lesions  0.05). For all types of lesions ≥1.5 cm, the CT numbers between linearly blended and IO images and between TNC and virtual non-contrast images were not statistically different (p > 0.05). Conclusion: DECT may be useful for differentiating between solid and benign cystic lesions presenting as hyperdense renal lesions incidentally detected on single-phase post-contrast CT, particularly with the size ≥1.5 cm. Advances in knowledge: DECT may be used to characterize hyperdense renal lesions ≥1.5 cm incidentally detected on single-phase post-contrast CT, without the use of TNC images. PMID:27043480

  20. Kidney transplantation: the use of living donors with renal artery lesions. (United States)

    Nahas, W C; Lucon, A M; Mazzucchi, E; Scafuri, A G; Neto, E D; Ianhez, L E; Arap, S


    A shortage of organs for transplantation has forced surgeons to optimize the use of marginal organs, such as kidneys with arterial disease. We present a retrospective study of the outcome of donors with renal artery disease and recipients of kidneys from living related and unrelated donors. Kidneys with vascular abnormalities from healthy living donors were grafted into 11 recipients. These kidney transplants comprised 1.8% of those performed at our institution. The vascular abnormalities were aneurysms in 3 cases, atherosclerotic lesions in 4 and fibromuscular dysplasia in 4. After nephrectomy all abnormalities were corrected under hypothermic conditions during bench surgery except in 3 cases of ostial atherosclerotic plaque, which was left in the donors. The renal artery was anastomosed to the external iliac artery in 5 cases and to the internal iliac artery in 6. The ureter was reimplanted using an extravesical technique. All patients had immediate diuresis and no delayed post-transplant graft dysfunction was observed. One patient died of an unrelated cause and 3 had post-transplant graft function loss due to acute vasculopathy in 1, post-diarrhea with acute arterial thrombosis in 1 and recurrence of the hemolytic-uremic syndrome in 1. All remaining patients are well with median serum creatinine of 1.4 mg./dl. (normal 0.4 to 1.4). All donors are well and normotensive with normal renal function. The use of kidneys with arterial disease from living donors with unilateral disease is safe. Complete informed consent regarding the risks and benefits by donor and recipient is mandatory.

  1. Polypoid Gallbladder Lesion in the Context of Renal Cell Carcinoma


    Barbara Seeliger MD; Cosimo Callari MD; Michele Diana MD; Didier Mutter MD, PhD, FACS; Jacques Marescaux MD, FACS, HON FRCS, HON FJSES


    Introduction. The only curative therapeutic approach for renal cell carcinoma (RCC) is surgery. Laparoscopic surgery for RCC has become an established surgical procedure with equivalent cancer-free survival rate, following the same surgical oncological principles as open surgery. Metastatic RCC of the gallbladder is a rare phenomenon. Hence, there are few reports regarding their management. Case Presentation. We report 2 cases of gallbladder metastasis from clear cell RCC treated by laparosco...

  2. End-stage renal disease due to delayed diagnosis of renal tuberculosis: a fatal case report

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    Elizabeth De Francesco Daher

    Full Text Available Renal TB is difficult to diagnose, because many patients present themselves with lower urinary symptoms which are typical of bacterial cystitis. We report a case of a young woman with renal TB and ESRD. She was admitted with complaints of adynamia, anorexia, fever, weight loss, dysuria and generalized edema for 10 months. At physical examination she was febrile (39ºC, and her abdomen had increased volume and was painful at palpation. Laboratorial tests showed serum urea=220mg/dL, creatinine=6.6mg/dL, hemoglobin=7.9g/dL, hematocrit=24.3%, leukocytes=33,600/mm³ and platelets=664,000/mm³. Urinalysis showed an acid urine (pH=5.0, leukocyturia (2+/4+ and mild proteinuria (1+/4+. She was also oliguric (urinary volume <400mL/day. Abdominal echography showed thick and contracted bladder walls and heterogeneous liquid collection in the left pelvic region. Two laparotomies were performed, in which abscess in pelvic region was found. Anti-peritoneal tuberculosis treatment with rifampin, isoniazid and pyrazinamide was started. During the follow-up, the urine culture was found to be positive for M. tuberculosis. Six months later the patient had complaints of abdominal pain and dysuria. New laboratorial tests showed serum urea=187mg/dL, creatinine=8.0mg/dL, potassium=6.5mEq/L. Hemodialysis was then started. The CT scan showed signs of chronic nephropathy, dilated calyces and thinning of renal cortex in both kidneys and severe dilation of ureter. The patient developed neurologic symptoms, suggesting tuberculous meningoencephalitis, and died despite of support measures adopted. The patient had ESRD due to secondary uropathy to prolonged tuberculosis of urinary tract that was caused by delayed clinical and laboratorial diagnosis, and probably also due to inadequate antituberculous drugs administration.

  3. [Fluoroquinolone induced acute renal failure. General review about a case report with crystalluria due to ciprofloxacin]. (United States)

    Montagnac, Richard; Briat, Claude; Schillinger, Francis; Sartelet, Hervé; Birembaut, Philippe; Daudon, Michel


    A 58 year-old woman developed an acute renal failure very quickly after ingestion of two 500 mg tablets of ciprofloxacin, without any other identifiable risk factor. Renal biopsy was performed. No sign of acute interstitial nephritis was observed but tubular lesions were found, accompanied by deposits of a brown-yellowish substance identified by infrared microscopy as a ciprofloxacin salt. The outcome was favourable. This observation gives the opportunity to remind the different forms of quinolone-induced renal injury and to discuss the possible ways for preventing renal side-effects related to the quinolone use.

  4. Respiratory failure, coma and cutaneous lesions due to disseminated strongyloidiasis

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    Mani R


    Full Text Available Objective: To enhance the clinician's awareness of Strongyloidiasis as a cause of critical illness. Design: A case report. Setting: A 600- bed, tertiary care hospital in New Delhi, India. Patient: A 53 years old diabetic male, presenting with acute respiratory failure, having received treatment for 2 weeks for acute bronchitis that included corticosteroids. He had a history of receiving several courses of treatment for Strongyloides stercoralis larvae detected in his stools. During this admission, he went on to develop neurological signs, cutaneous lesions and acute respiratory distress syndrome (ARDS. Negative stool examinations led to the diagnosis being delayed until the 7th day, when the larvae were demonstrated in the skin lesions and tracheal aspirate. Conclusion: Awareness of the varied presentations of Strongyloidiasis and a diligent search for the larvae at various sites are crucial for early diagnosis.

  5. PARP Inhibition Attenuates Histopathological Lesion in Ischemia/Reperfusion Renal Mouse Model after Cold Prolonged Ischemia

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    Raimundo M. G. del Moral


    Full Text Available We test the hypothesis that PARP inhibition can decrease acute tubular necrosis (ATN and other renal lesions related to prolonged cold ischemia/reperfusion (IR in kidneys preserved at 4°C in University of Wisconsin (UW solution. Material and Methods. We used 30 male Parp1+/+ wild-type and 15 male Parp10/0 knockout C57BL/6 mice. Fifteen of these wild-type mice were pretreated with 3,4-dihydro-5-[4-(1-piperidinylbutoxyl]-1(2H-isoquinolinone (DPQ at a concentration of 15 mg/kg body weight, used as PARP inhibitor. Subgroups of mice were established (A: IR 45 min/6 h; B: IR + 48 h in UW solution; and C: IR + 48 h in UW solution plus DPQ. We processed samples for morphological, immunohistochemical, ultrastructural, and western-blotting studies. Results. Prolonged cold ischemia time in UW solution increased PARP-1 expression and kidney injury. Preconditioning with PARP inhibitor DPQ plus DPQ supplementation in UW solution decreased PARP-1 nuclear expression in renal tubules and renal damage. Parp10/0 knockout mice were more resistant to IR-induced renal lesion. In conclusion, PARP inhibition attenuates ATN and other IR-related renal lesions in mouse kidneys under prolonged cold storage in UW solution. If confirmed, these data suggest that pharmacological manipulation of PARP activity may have salutary effects in cold-stored organs at transplantation.

  6. Unusual finding in pediatric Churg-Strauss: renal lesions on CT

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    Oldan, Jorge; McCauley, Roy [Tufts Medical Center, Department of Radiology, Boston, MA (United States); Pilichowska, Monica [Tufts Medical Center, Department of Pathology, Boston, MA (United States); Milner, Lawrence [Tufts Medical Center, Department of Nephrology, Boston, MA (United States); Lopez-Benitez, Jorge M. [Tufts Medical Center, Department of Rheumatology, Boston, MA (United States)


    After a 19-year-old female experienced several weeks of unrelieved fevers, an abdominal CT revealed multiple low-attenuation renal lesions. As the differential included lymphoma, infections and infarcts, a core biopsy of the kidney was performed, which revealed changes consistent with Churg-Strauss syndrome. (orig.)

  7. Lithium-induced Nephrotoxicity: A Case Report of Renal Cystic Disease Presenting as a Mass Lesion

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    Yvonne McCartney


    Full Text Available Lithium is an effective therapeutic agent used in the management of bipolar disorder. However, lithium is also associated with several side effects, including renal toxicity. We present a case of a symptomatic cystic mass lesion in the kidney of a patient who had a history of lithium therapy for the management of bipolar disorder.

  8. Apraxia related with subcortical lesions due to cerebrovascular disease. (United States)

    Tabaki, N E; Vikelis, M; Besmertis, L; Vemmos, K; Stathis, P; Mitsikostas, D D


    To examine whether ideomotor apraxia exists in patients with subcortical ischemic lesions. A matched-control, prospective and multi-centered research design was used. Ideomotor apraxia, anxiety and depression were assessed by the Movement Imitation Test and the Hamilton scales, respectively. Forty two consecutive patients with subcortical ischemic stroke and an equal number of healthy participants, matched in age and sex were included. Paired-sample t-tests showed that patients had significantly more apractic elements in their movements (t = 5.03, P Imitation Test. Ischemic damage of subcortical modular systems may affect praxis.

  9. Role of tissue harmonic imaging in characterization of cystic renal lesions. (United States)

    Mohammed, Asmi; Sandhu, Manavjit S; Lal, Anupam; Sodhi, Kushaljit S; Sud, Kamal; Kohli, Harbir S


    To determine the utility of tissue harmonic imaging in evaluating cystic renal lesions and to compare these findings with conventional ultrasound guidance (USG) and CT. Thirty patients, detected with cystic renal lesions on routine USG (over a period of 18 months from July 2004 to December 2005 at the Postgraduate Institute of Medical Education and Research Chandigarh, Chandigarh, India) were included in this study. All patients underwent a conventional gray scale ultrasound study (GSI), followed by tissue harmonic imaging (THI) sonography on the same machine (advance technology limited high definition imaging 5000). Computed tomography of abdomen was carried out within one week of the ultrasound examinations. All images were evaluated for size, number, and location of lesions. The findings of THI sonography, conventional USG and CT of abdomen were recorded in their respective proformas. The images obtained by GSI, THI, and contrast enhanced CT were also evaluated for image quality, lesion conspicuity, and fluid-solid differentiation. Tissue harmonic imaging showed better image quality in 27 of 34 lesions, improvement in lesion conspicuity was found in 27 of 34 cystic lesions, and an improved solid-fluid differentiation in 30 of 34 lesions when compared to GSI. The THI provided additional information as compared to GSI in 8 patients. The grading of CT scan was significantly higher in overall image quality (p=0.007) and lesion conspicuity (p=0.004), but was non-significant for fluid-solid differentiation (p=0.23). Tissue harmonic imaging provides better image quality, lesion delineation, and superior characterization than conventional gray scale sonography.

  10. Renal amyloidosis due to familial Mediterranean fever misdiagnosed

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    Iman Hama


    Full Text Available Familial Mediterranean fever (FMF, MIM 249100 is an autosomal recessive disease affecting mainly patients of the Mediterranean basin. It is an autoinflammatory periodic disorder characterized by recurrent episodes of fever and abdominal pain, synovitis, and pleuritis. The major complication of FMF is the development of renal AA amyloidosis. Treatment with colchicine prevents the occurrence of recurrent seizures and renal amyloidosis. The disease is caused by mutations in the MEFV gene. We report here the cases of two unrelated patients, who have been late diagnosed with FMF complicated by renal amyloidosis. We focus on the importance of early diagnosis of FMF, both to start rapidly treatment with colchicine and avoid renal amyloidosis, and to provide genetic counseling to families.

  11. [Syncope due to parapharyngeal space lesions syncope-syndrome]. (United States)

    Córdoba López, A; Torrico Román, P; Inmaculada Bueno Alvarez-Arenas, M; Monterrubio Villar, J; Corcho Sánchez, G


    The clinic association between tumors in the neck and syncopal attacks has been well documented but uncommon. The pathogenesis of this type of syncope has been attributed to an specific sinus node disfunction and several diseases that affect pacemaker activity, cardiac output and blood supply to the brain are able to produce it. The most common reflex cardiovascular sindromes linked to the IX nerve are carotid sinus syndrome and glossopharyngeal neuralgia-asystole syndrome. Some patients with a pathological involvement of the parapharyngeal space also suffers from syncope but the clinical picture of these patients differs so greatly from the other two syndromes, which suggests specific aetiological, clinical and therapeutical features so the term "parapharyngeal space lesiones syncope-syndrome" has been proposed for this entity. We report a case of a patient with a neck tumor in the parapharyngeal space with syncope as the major symptom.

  12. Gonadal vein tumor thrombosis due to renal cell carcinoma

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    Hamidreza Haghighatkhah


    Full Text Available Renal cell carcinoma (RCC had a tendency to extend into the renal vein and inferior vena cava, while extension into the gonadal vein has been rarely reported. Gonadal vein tumor thrombosis appears as an enhancing filling defect within the dilated gonadal vein anterior to the psoas muscle and shows an enhancement pattern identical to that of the original tumor. The possibility of gonadal vein thrombosis should be kept in mind when looking at an imaging study of patients with RCC

  13. Gonadal vein tumor thrombosis due to renal cell carcinoma. (United States)

    Haghighatkhah, Hamidreza; Karimi, Mohammad Ali; Taheri, Morteza Sanei


    Renal cell carcinoma (RCC) had a tendency to extend into the renal vein and inferior vena cava, while extension into the gonadal vein has been rarely reported. Gonadal vein tumor thrombosis appears as an enhancing filling defect within the dilated gonadal vein anterior to the psoas muscle and shows an enhancement pattern identical to that of the original tumor. The possibility of gonadal vein thrombosis should be kept in mind when looking at an imaging study of patients with RCC.

  14. Association between renal cystic lesions and bilateral Wilms' tumours

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    Simanovsky, Natalia; Hiller, Nurith [Hadassah-Hebrew University Medical Center at Mt Scopus, Department of Medical Imaging, POB 12000, Jerusalem (Israel); Revel-Vilk, Shoshana; Weintraub, Michael [Hadassah-Hebrew University Medical Center, Department of Pediatric Hematology/ Oncology, Jerusalem (Israel)


    Evaluate a potential association between Wilms' tumour (WT) and renal cystic lesions. Digital records and imaging files of consecutive patients diagnosed with WT between 2004 and 2014 were retrospectively reviewed under an Institutional Review Board waiver of informed consent. The locations of renal cysts seen on US, CT, and/or MRI were recorded and compared with the locations of newly developed WT. A total of 48 patients (mean age 3 years 9 months) presented with newly diagnosed WT in the study period. Mean follow-up was 4.5 (range 1-10) years. WT was unilateral in 40 children, bilateral in 8. Renal cysts were identified in only one of the forty patients (2.5 %) with unilateral disease - in the contralateral kidney. In contrast, renal cysts were found in seven of eight patients with bilateral WT (87.5 %), in two of whom, new tumours developed in the same location where cysts had been seen on previous imaging studies. Renal cystic lesions in patients with Wilms' tumour should be regarded as potential tumour precursors, and followed with frequent imaging. (orig.)

  15. POEMS syndrome with vascular lesions and renal carcinoma - possible role of cytokines. (United States)

    Pasqui, A L; Bova, G; Saletti, M; Bruni, F; Di Renzo, M; Auteri, A


    We describe here the case of a 60 years man with POEMS syndrome associated with renal tumor and vascular lesions. The patient had osteosclerotic myeloma IgA-lambda, polyneuropathy, endocrinopathy and skin changes. In addition, he developed renal clear cell carcinoma and gangrena of lower limbs. The humoral study showed thrombocytosis, high levels of IL-1beta and IL-6 and of some coagulative/fibrinolytic and endothelial factors (von Willebrand factor, plasmin-antiplasmine complexes, plasminogen activator). We suggest the hypothesis that these factors are capable of determining some manifestations of POEMS syndrome.

  16. NSAID nephrotoxicity revisited: acute renal failure due to parenteral ketorolac. (United States)

    Perazella, M A; Buller, G K


    The success of ketorolac as a nonnarcotic analgesic is likely to propagate its widespread use to control moderate to severe postoperative pain. Indeed, of the patients treated with ketorolac and described in the medical literature, nearly 90% had had a major surgical procedure. Since any such procedure may be associated with significant third-spacing of the fluid and result in renal hypoperfusion, care must be taken in administering ketorolac. Close attention to urine output and parameters of renal function must be maintained. Moreover, postoperative ketorolac therapy should be avoided in patients who have conditions that predispose to NSAID nephrotoxicity (as in our Case 1). Likewise, in nonsurgical patients the same degree of caution should be used with ketorolac as with any oral NSAID. Finally, since ketorolac is excreted almost entirely by the kidney, either elderly patients or patients with underlying renal insufficiency must have an adjustment of the dosing interval, or this medication should be avoided in such patients altogether.

  17. Acute Renal Failure due to Non-Traumatic Rhabdomyolysis

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    Nagehan Aslan


    Full Text Available Rhabdomyolysis is a musculoskeletal clinical and biochemical syndrome which is seen associated with traumatic and non-traumatic causes and is known as muscular dystrophy. Rhabdomyolysis which develops following crush-type trauma (Crush syndrome is rarely seen but is a well-known clinical event in the etiology of acute renal failure. Non-traumatic rhabdomyolysis is rare. The case is here presented of a patient who was diagnosed with rhabdomyolysis on presentation with acute renal failure and to whom repeated dialysis was applied.

  18. Laparoscopic nephrectomy for complete renal infarction due to post traumatic renal artery thrombosis. (United States)

    Gidaro, Stefano; Schips, Luigi; Cindolo, Luca; Ziguener, Richard


    We report a case of post traumatic thrombosis of the renal artery with renal infarction and associated liver injury. Conservative treatment was initially planned in consideration of the delayed diagnosis (> 3 hours), but the patient subsequently developed hypertension not controllable with anti-hypertensive drugs. He underwent laparoscopy with nephrectomy and liver injury repair. Hypertension resolved after nephrectomy without further medical treatment. Laparoscopic nephrectomy is not a standard procedure for renal trauma but it could be an option in selected patients.

  19. Molecular Mechanisms of Renal Cellular Nephrotoxicity due to Radiocontrast Media

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    Ashour Michael


    Full Text Available Modern iodinated radiocontrast media are all based on the triiodinated benzene ring with various chemical modifications having been made over the last few decades in order to reduce their toxicity. However, CIN remains a problem especially in patients with pre-existing renal failure. In vitro studies have demonstrated that all RCM are cytotoxic. RCM administration in vivo may lead to a decrease in renal medullary oxygenation leading to the generation of reactive oxygen species that may cause harmful effects to renal tissue. In addition, endothelin and adenosine release and decreased nitric oxide levels may worsen the hypoxic milieu. In vitro cell culture studies together with sparse in vivo rat model data have shown that important cell signalling pathways are affected by RCM. In particular, the prosurvival and proproliferative kinases Akt and ERK1/2 have been shown to be dephosphorylated (deactivated, whilst proinflammatory/cell death molecules such as the p38 and JNK kinases and the transcription factor NF-κB may be activated by RCM, accompanied by activation of apoptotic mediators such as caspases. Increasing our knowledge of the mechanisms of RCM action may help to develop future therapies for CIN.

  20. Simulated cystic renal lesions: quantitative X-ray phase-contrast CT--an in vitro phantom study

    National Research Council Canada - National Science Library

    Fingerle, Alexander A; Willner, Marian; Herzen, Julia; Münzel, Daniela; Hahn, Dieter; Rummeny, Ernst J; Noël, Peter B; Pfeiffer, Franz


    To determine if grating-based x-ray phase-contrast computed tomography (CT) can allow differentiation of simulated simple, protein-rich, hemorrhagic, and enhancing cystic renal lesions in an in vitro phantom...

  1. Lacrimal gland and perioptic nerve lesions due to Langerhans cell histiocytosis (2007: 9b)

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    Herman, M.; Demaerel, P.; Wilms, G. [University Hospitals Leuven, Department of Radiology, Leuven (Belgium); Gool, S. van [University Hospitals Leuven, Department of Pediactrics, Leuven (Belgium); Casteels, I. [University Hospitals Leuven, Department of Ophthalmology, Leuven (Belgium)


    We report a patient presenting with bilateral lacrimal gland involvement and perioptic nerve sheath lesions due to Langerhans cell histiocytosis (LCH) invasion. LCH is a rare multisystemic disease characterized by a clonal proliferation of Langerhans cells. All organs may be involved with a clinical spectrum ranging from a solitary bone lesion to a severe life-threatening multisystem disease. Osteolytic orbital bone lesions with extension into the adjacent orbital soft tissues have been described. To our knowledge, lacrimal gland involvement has probably been described only once before. Perioptic nerve lesions are also very rare, having been described only three times before. (orig.)

  2. Frequency and type of renal lesions in dogs naturally infected with leptospira species. (United States)

    Ortega-Pacheco, A; Colin-Flores, R F; Gutiérrez-Blanco, E; Jiménez-Coello, M


    The aim of this study was to determine the frequency and type of renal lesions associated with positive titers against Leptospira sp. in a stray dog population. Three hundred fifty pairs of kidneys and an equal number of serum samples were collected from dogs captured by the dog pound of Merida, Yucatan, Mexico. Euthanasia of dogs was performed following the regulations of the Official Mexican Health Ministry (NOM-033-ZOO-1995). Serum samples were evaluated with the microscopic agglutination test, and tissue samples were processed and fixed in paraffin. After staining with hematoxylin and eosin, the frequency of renal lesions was determined and classified. As an additional evaluation, samples with interstitial nephritis were stained by the Warthin-Starry method in order to observe the presence of spirochete forms that could be morphologically compatible with Leptospira spp. We found that 98% of cases presented at least one type of lesion. The main histological lesions found were mesangial proliferative glomerulonephritis (MPGN) in 63.7% (n= 223), mesangial proliferative glomerulonephritis and interstitial nephritis (MPGN+IN) in 34% (n= 119), nephrosclerosis in 0.57% (n= 2), mesangial glomerulonephritis in 0.28% (n= 1), and interstitial nephritis (IN) in 0.28% (n= 1). Thirty-four percent (n= 122) of the dogs were seropositive to Leptospira sp., mainly against serovar canicola. Among dogs with IN (alone or associated with MPGN) (n= 120), 49.1% were seropositive to Leptospira sp., but only 17% of them showed spirochete forms compatible with the bacteria. A statistical association between seropositive dogs and the presence of MPGN+IN was determined (P < 0.0001; odds ratio 2.7, confidence interval 1.7-4.5). We concluded that the frequency of renal lesions found in this study is high and L. canicola is probably the most common circulating serovar in dogs from this area. Dogs that have been in contact with Leptospira spp. have a higher risk of developing renal lesions of

  3. Demyelinating Peripheral Neuropathy Due to Renal Cell Carcinoma (United States)

    Nishioka, Kenya; Fujimaki, Motoki; Kanai, Kazuaki; Ishiguro, Yuta; Nakazato, Tomoko; Tanaka, Ryota; Yokoyama, Kazumasa; Hattori, Nobutaka


    Renal cell carcinoma (RCC) patients who develop a paraneoplastic syndrome may present with neuromuscular disorders. We herein report the case of a 50-year-old man who suffered from progressive gait disturbance and muscle weakness. The results of a nerve conduction study fulfilled the criteria of chronic inflammatory demyelinating polyneuropathy. An abdominal CT scan detected RCC, the pathological diagnosis of which was clear cell type. After tumor resection and a single course of intravenous immunoglobulin therapy, the patient's symptoms drastically improved over the course of one year. The patient's neurological symptoms preceded the detection of cancer. A proper diagnosis and the initiation of suitable therapies resulted in a favorable outcome. PMID:28049985

  4. A2 noradrenergic lesions prevent renal sympathoinhibition induced by hypernatremia in rats.

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    Gustavo Rodrigues Pedrino

    Full Text Available Renal vasodilation and sympathoinhibition are recognized responses induced by hypernatremia, but the central neural pathways underlying such responses are not yet entirely understood. Several findings suggest that A2 noradrenergic neurons, which are found in the nucleus of the solitary tract (NTS, play a role in the pathways that contribute to body fluid homeostasis and cardiovascular regulation. The purpose of this study was to determine the effects of selective lesions of A2 neurons on the renal vasodilation and sympathoinhibition induced by hypertonic saline (HS infusion. Male Wistar rats (280-350 g received an injection into the NTS of anti-dopamine-beta-hydroxylase-saporin (A2 lesion; 6.3 ng in 60 nl; n = 6 or free saporin (sham; 1.3 ng in 60 nl; n = 7. Two weeks later, the rats were anesthetized (urethane 1.2 g⋅kg(-1 b.wt., i.v. and the blood pressure, renal blood flow (RBF, renal vascular conductance (RVC and renal sympathetic nerve activity (RSNA were recorded. In sham rats, the HS infusion (3 M NaCl, 1.8 ml⋅kg(-1 b.wt., i.v. induced transient hypertension (peak at 10 min after HS; 9±2.7 mmHg and increases in the RBF and RVC (141±7.9% and 140±7.9% of baseline at 60 min after HS, respectively. HS infusion also decreased the RSNA (-45±5.0% at 10 min after HS throughout the experimental period. In the A2-lesioned rats, the HS infusion induced transient hypertension (6±1.4 mmHg at 10 min after HS, as well as increased RBF and RVC (133±5.2% and 134±6.9% of baseline at 60 min after HS, respectively. However, in these rats, the HS failed to reduce the RSNA (115±3.1% at 10 min after HS. The extent of the catecholaminergic lesions was confirmed by immunocytochemistry. These results suggest that A2 noradrenergic neurons are components of the neural pathways regulating the composition of the extracellular fluid compartment and are selectively involved in hypernatremia-induced sympathoinhibition.

  5. Renal infarction due to spontaneous dissection of the renal artery: an unusual cause of non-visceral type abdominal pain. (United States)

    Kang, James H-E; Kang, Jin-Yong; Morgan, Robert


    A 44-year-old man presented with very severe right upper quadrant pain of sudden onset. This was exacerbated by movement but unaffected by food or defaecation. It was continuous-day and night -but resolved over a 1-week period. The physical examination was normal at presentation, by which time the pain had resolved. His white cell count, alanine transaminase and C reactive protein were elevated but normalised after 10 days. An abdominal CT showed low density lesions in the right kidney consistent with segmental infarcts. CT angiogram showed a dissection of the right renal artery. The patient remained asymptomatic and normotensive when reviewed 1 month later.

  6. Therapeutic embolization of renal artery to control severe hypertension due to renal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Cotroneo, A.R.; Patane, D.; De Cinque, M.; Falappa, P.; Doglietto, G.


    In a young patient with a post-traumatic renal hematoma, severe systemic hypertension, secondary to the activation of the renin-angiotensin axis, developed. Because of persistent hypertension, after 3 months of drug therapy, selective percutaneous embolization of the damaged vessels was performed. One year after procedure, the patient is normotensive without drugs.

  7. Asymptomatic pontine and extra-pontine lesions in a patient with end-stage renal disease

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    Raj Kanwar Yadav


    Full Text Available Osmotic demyelination syndrome leading to central pontine/extra-pontine myelinolysis (CPM/EPM occurs mainly in patients with history of alcohol abuse, malnourishment, following liver transplantation and less commonly, in association with other systemic diseases. Asymptomatic CPM/EPM is rare. Patients with end-stage renal disease (ESRD who develop CPM/EPM are usually symptomatic with florid neurologic manifestations. Herein, we present a patient with ESRD on maintenance hemodialysis who was incidentally detected to have pontine and extra-pontine lesions suggestive of myelinolysis without any neurologic signs or symptoms.


    Directory of Open Access Journals (Sweden)

    SEVERO Luiz Carlos


    Full Text Available A case of sporotrichosis in a woman presenting 63 cutaneous lesions distributed all over the tegument is related. The patient had both humoral (Immunoglobulins and cellular (Lymphocytes subpopulations immunity within normal limits, but was under treatment with steroid during a long time (Prednisone 10 mg daily for 2 years, due to a sciatic pain. In addition a review of the Brazilian literature on this type of lesions was carried out and commented.

  9. Granulomatous Interstitial Nephritis and Acute Renal Failure due to Renal-limited Sarcoidosis

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    El-Reshaid Kamel


    Full Text Available Renal failure secondary to granulomatous sarcoidosis without clinical features or radiological evidence of disease is rare. In this case report, we describe a 14-year old girl who developed progressive renal failure over a two-month period which was associated with weight loss and epigastric pain. Physical examination did not show any abnormality. Laboratory investigations were normal except for normocytic normochromic anemia, high serum urea, high serum creatinine (452 tmol/L and polyclonal gammopathy. Percutaneous kidney biopsy showed severe interstitial nephritis with non-caseating granulomata. She was treated with tapered prednisone after a starting dose of 1 mg/kg. The treatment with prednisolone resulted in a complete remission that lasted up to two years of follow up. This case highlights the variable expression of sarcoidosis, which should be considered in the management of such disease.

  10. Severe hypertension due to renal polar artery stenosis in an adolescent treated with coil embolization

    Energy Technology Data Exchange (ETDEWEB)

    Docx, Martine K. [Koningin Paola Kinderziekenhuis, Department of Paediatrics, Chronic Diseases and Hypertension, Antwerp (Belgium); Vandenberghe, Philippe [Koningin Paola Kinderziekenhuis, Department of Paediatric Cardiology, Antwerp (Belgium); Maleux, Geert [University Hospitals Leuven, Department of Radiology, Leuven (Belgium); Gewillig, Marc [University Hospitals Leuven, Department of Paediatric Cardiology, Leuven (Belgium); Mertens, Luc [Hospital for Sick Children, Paediatric Cardiology, Toronto (Canada)


    A 12-year-old boy presented with severe arterial hypertension due to a severe subsegmental renal artery stenosis. Treatment consisted of selective embolization of the stenosed polar artery, which resulted in near normalization of the arterial pressures. Renal artery stenosis should always be considered, even in young adolescents, as a cause for arterial hypertension. Only selective angiography was able to demonstrate the subsegmental artery stenosis in this patient. (orig.)

  11. Hypertension and its correlation with renal lesions in dogs with leishmaniosis. (United States)

    Braga, Eveline Tozzi; Leite, João Henrique Artero de Carvalho; Rosa, Fernando Azadinho; Tivelli, Patrícia; Araújo, Amanda Mariano; de Almeida, Breno Fernando Martins; Ferrari, Heitor Flávio; Ciarlini, Paulo César; Machado, Gisele Fabrino; Marcondes, Mary


    To evaluate the prevalence of hypertension and its correlation with the severity of renal injury and proteinuria in dogs with leishmaniosis, sixty-six dogs were divided into two groups. Group 1 (G1) was composed of 54 dogs included in stage 1 of chronic kidney disease (CKD), and group 2 (G2) of twelve dogs in stages 2 and 3 of CKD. Prevalence of hypertension was 28.8%, comprising 22.2% of the dogs from G1 and 58.3% from G2 (P=0.011). The mean arterial blood pressure (BP) of dogs from G1 (135.7 ± 20.5) was lower than from G2 (170.0 ± 26.3) (P dogs, with 34% presenting hypertension. All dogs with hypertension had histopathological and laboratory evidence of glomerular disease. Although there was no statistically significant correlation between elevated BP and the severity of glomerular lesions (P=0.408), there was a statistically significant correlation between elevated BP and increased UP/C in the studied population (P=0.002). Thus, dogs with leishmaniosis and renal disease must be screened for the presence of hypertension so that treatment may be instituted as early as possible, in countries where treatment is allowed, to prevent the progression of renal damage.

  12. Relationship of Albuminuria and Renal Artery Stent Outcomes: Results From the CORAL Randomized Clinical Trial (Cardiovascular Outcomes With Renal Artery Lesions). (United States)

    Murphy, Timothy P; Cooper, Christopher J; Pencina, Karol M; D'Agostino, Ralph; Massaro, Joseph; Cutlip, Donald E; Jamerson, Kenneth; Matsumoto, Alan H; Henrich, William; Shapiro, Joseph I; Tuttle, Katherine R; Cohen, David J; Steffes, Michael; Gao, Qi; Metzger, D Christopher; Abernethy, William B; Textor, Stephen C; Briguglio, John; Hirsch, Alan T; Tobe, Sheldon; Dworkin, Lance D


    Randomized clinical trials have not shown an additional clinical benefit of renal artery stent placement over optimal medical therapy alone. However, studies of renal artery stent placement have not examined the relationship of albuminuria and treatment group outcomes. The CORAL study (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) is a prospective clinical trial of 947 participants with atherosclerotic renal artery stenosis randomized to optimal medical therapy with or without renal artery stent which showed no treatment differences (3(5.8% and 35.1% event rate at mean 43-month follow-up). In a post hoc analysis, the study population was stratified by the median baseline urine albumin/creatinine ratio (n=826) and analyzed for the 5-year incidence of the primary end point (myocardial infarction, hospitalization for congestive heart failure, stroke, renal replacement therapy, progressive renal insufficiency, or cardiovascular disease- or kidney disease-related death), for each component of the primary end point, and overall survival. When baseline urine albumin/creatinine ratio was ≤ median (22.5 mg/g, n=413), renal artery stenting was associated with significantly better event-free survival from the primary composite end point (73% versus 59% at 5 years; P=0.02), cardiovascular disease-related death (93% versus 85%; P≤ 0.01), progressive renal insufficiency (91% versus 77%; P=0.03), and overall survival (89% versus 76%; P≤0.01), but not when baseline urine albumin/creatinine ratio was greater than median (n=413). These data suggest that low albuminuria may indicate a potentially large subgroup of those with renal artery stenosis that could experience improved event-free and overall-survival after renal artery stent placement plus optimal medical therapy compared with optimal medical therapy alone. Further research is needed to confirm these preliminary observations.

  13. Renal failure due to renal vein thrombosis in a fetus with growth restriction and thrombophilia. (United States)

    Has, Recep; Corbacioglu Esmer, Aytul; Kalelioglu, Ibrahim H; Yumru, Harika; Yüksel, Atil; Ziylan, Orhan


    We report a case of renal vein thrombosis diagnosed at 27 weeks of gestation in a dichorionic twin pregnancy. The left kidney of one fetus was hyperechoic and enlarged with echoic streaks following the direction of interlobular veins and the loss of corticomedullary differentiation. In the following weeks, left kidney became smaller and echoic, and Doppler examination showed no flow in both artery and vein. The right kidney had totally normal appearance in the beginning, but it became enlarged and hyperechoic, and progressed into a small echoic kidney with no flow in artery and vein. In the postnatal ultrasound examination, both kidneys appeared hyperechoic with no vascularization in the hilum region. There was thrombosis in arteries and veins of both kidneys, as well as in the inferior vena cava. The investigation for thrombophilia resulted with the combined presence of heterozygote mutation in factor V Leiden and prothrombin 20210 genes.

  14. Prevalence of pancreatic, hepatic and renal microscopic lesions in post-mortem samples from Cavalier King Charles Spaniels


    Kent, Andrew C. C.; Constantino-Casas, Fernando; Rusbridge, Clare; Corcoran, Brendan; Carter, Margaret; Ledger, Tania; Watson, Penny J.


    This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by Wiley. Objectives: To describe the prevalence of pancreatic, hepatic and renal microscopic lesions in post-mortem samples from Cavalier King Charles Spaniels (CKCS) presented to a UK post-mortem collection scheme. Methods: Histopathology was performed on the organs of interest and the prevalence of microscopic lesions described, this was related back to the clinical signs shown an...

  15. A mouse model of early-onset renal failure due to a xanthine dehydrogenase nonsense mutation.

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    Sian E Piret

    Full Text Available Chronic kidney disease (CKD is characterized by renal fibrosis that can lead to end-stage renal failure, and studies have supported a strong genetic influence on the risk of developing CKD. However, investigations of the underlying molecular mechanisms are hampered by the lack of suitable hereditary models in animals. We therefore sought to establish hereditary mouse models for CKD and renal fibrosis by investigating mice treated with the chemical mutagen N-ethyl-N-nitrosourea, and identified a mouse with autosomal recessive renal failure, designated RENF. Three-week old RENF mice were smaller than their littermates, whereas at birth they had been of similar size. RENF mice, at 4-weeks of age, had elevated concentrations of plasma urea and creatinine, indicating renal failure, which was associated with small and irregularly shaped kidneys. Genetic studies using DNA from 10 affected mice and 91 single nucleotide polymorphisms mapped the Renf locus to a 5.8 Mbp region on chromosome 17E1.3. DNA sequencing of the xanthine dehydrogenase (Xdh gene revealed a nonsense mutation at codon 26 that co-segregated with affected RENF mice. The Xdh mutation resulted in loss of hepatic XDH and renal Cyclooxygenase-2 (COX-2 expression. XDH mutations in man cause xanthinuria with undetectable plasma uric acid levels and three RENF mice had plasma uric acid levels below the limit of detection. Histological analysis of RENF kidney sections revealed abnormal arrangement of glomeruli, intratubular casts, cellular infiltration in the interstitial space, and interstitial fibrosis. TUNEL analysis of RENF kidney sections showed extensive apoptosis predominantly affecting the tubules. Thus, we have established a mouse model for autosomal recessive early-onset renal failure due to a nonsense mutation in Xdh that is a model for xanthinuria in man. This mouse model could help to increase our understanding of the molecular mechanisms associated with renal fibrosis and the

  16. Stereotactic body radiotherapy of primary and metastatic renal lesions for patients with only one functioning kidney

    Energy Technology Data Exchange (ETDEWEB)

    Svedman, Christer; Sandstroem, P.; Wersaell, Peter (Dept. of General Oncology, Radiumhemmet, Karolinska Univ. Hospital, Stockholm (Sweden)); Karlsson, Kristin; Rutkowska, Eva; Lax, Ingmar (Dept. of Hospital Physics, Karolinska Univ. Hospital, Stockholm (Sweden)); Blomgren, H. (Malzoni Radiosurgery Inst., Agropoli (Italy))


    Background. About 2% of patients with a carcinoma in one kidney develop either metastases or a new primary tumor in the contralateral kidney. Often, renal cancers progress rapidly at peripheral sites and a metastasis to the second kidney may not be the patient's main problem. However, when an initial renal cancer is more indolent yet spreads to the formerly unaffected kidney or a new primary tumor forms there, local treatment may be needed. Stereotactic body radiotherapy (SBRT) has been demonstrated as a valuable treatment option for tumors that cause local symptoms. Presented here is a retrospective analysis of patients in whom SBRT was used to control primary or metastatic renal disease. Patients and methods. Seven patients with a mean age of 64 (44-76) were treated for metastases from a malignant kidney to its contralateral counterpart. Dose/fractionation schedules varied between 10 Gyx3 and 10 Gyx4 depending on target location and size, given within one week. Follow-up times for patients who remained alive were 12, 52 and 66 months and for those who subsequently died were 10, 16, 49 and 70 months. Results. Local control, defined as radiologically stable disease or partial/complete response, was obtained in six of these seven patients and regained after retreatment in the one patient whose lesion progressed. Side effects were generally mild, and in five of the seven patients, kidney function remained unaffected after treatment. In two patients, the creatinine levels remained moderately elevated at approximately 160 mumol/L post treatment. At no time was dialysis required. Conclusion. These results indicate that SBRT is a valuable alternative to surgery and other options for patients with metastases from a cancer-bearing kidney to the remaining kidney and provides local tumor control with satisfactory kidney function

  17. Urinary Albumin Levels are Independently Associated with Renal Lesion Severity in Patients with Lupus Nephritis and Little or No Proteinuria (United States)

    Ding, Jin; Zheng, Zhaohui; Li, Xueyi; Feng, Yuan; Leng, Nan; Wu, Zhenbiao; Zhu, Ping


    Background Systemic lupus erythematosus (SLE) leads to renal lesions, which may be clinically silent in patients with little or no proteinuria. Early detection of these lesions may improve prognosis, but early markers are controversial. This study aimed to determine renal marker proteins associated with renal lesion severity in patients with lupus nephropathy (LN) and little or no proteinuria. Material/Methods Patients with LN and little or no proteinuria (<0.5 g/24 hours) (n=187) that underwent kidney biopsy were grouped according to: low severity (Class I or II; n=116) versus high severity (Class III, IV, or V; n=71). Disease status was determined according to the SLE disease activity index (SLEDAI). Renal marker proteins (serum β2-macroglobulin, urinary β2-macroglobulin, albumin, IgG, and α1-macroglobulin) were measured using radioimmunoassay. Results Compared with the low severity group, patients in the high severity group had higher urinary albumin (11.60±8.94 versus 7.08±10.07 μg/mL, p=0.008) and urinary IgG (13.21±9.35 versus 8.74±8.90 μg/mL, p=0.007) levels. Multivariate conditional logistic regression analysis showed that urinary albumin (odds ratio (OR)=1.417, 95% confidence interval (95% CI): 1.145–1.895, p=0.001) and SLEDAI (OR=2.004, 95% CI: 1.264–3.178, p=0.003) were independently associated with severe renal lesions in these patients. Using an optimal cutoff point of urinary albumin of 7.53 μg/mL resulted in 67% sensitivity and 82% specificity for the detection of high severity renal lesions. Conclusions Urinary albumin levels and SLEDAI were independently associated with histological severity of renal lesions in patients with LN and little or no proteinuria. These parameters could be used to help select patients for renal biopsy. PMID:28157833

  18. A rare cause of anemia due to upper gastrointestinal bleeding: Cameron lesion

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    Ismet Özaydın


    Full Text Available Asymptomatic large hiatal hernias may lead to iron deficiency anemia due to occult and massive bleeding from linear gastric erosions or ulcers on the mucosal folds at the level of the diaphragm called the Cameron lesions. The diagnosis is usually made during upper gastrointestinal system endoscopies. Current therapy includes the medication with proton pump inhibitors in combination with oral iron supplements and in some cases surgical reconstruction of hiatal hernia with fundoplication. We present a case of a 78-year-old woman who was admitted to the outpatient clinic with the diagnosis of iron deficiency anemia without signs of acute gastrointestinal bleeding. She was treated with medication and her follow-up gastroscopy showed a total cure. She is asymptomatic for two years after treatment with proton pump inhibitors and iron supplements. Cameron lesions should be kept in mind as an unusual cause of iron deficiency anemia due to gastrointestinal bleeding. 

  19. Unusual Upper Gastrointestinal Bleeding due to Late Metastasis from Renal Cell Carcinoma: A Case Report

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    Wen-Tsan Chang


    Full Text Available A case of recurrent massive upper gastrointestinal bleeding originating from metastatic renal cell carcinoma is reported. A 63-year-old woman underwent right nephrectomy 9 years previously and experienced no recurrence during follow-up. A gradually enlarging ulcerative tumor over the bulb of the duodenum and four subsequent episodes of massive bleeding from this tumor occurred between June 2001 and March 2002. The patient underwent surgery in April 2002 for intractable bleeding from the tumor. Renal cell carcinoma metastasis to the duodenum was confirmed from the surgical specimen. Upper gastrointestinal bleeding due to malignancy is very rare and the duodenum is the least frequently involved site. Furthermore, a solitary late renal cell carcinoma metastasis 9 years after a nephrectomy is extremely uncommon. This case suggests that life-long follow-up of renal cell carcinoma patients is necessary, owing to unpredictable behavior and the possibility of long disease-free intervals. In nephrectomized patients suffering from gastrointestinal bleeding, complete evaluation, especially endoscopic examination, is indicated. The possibility of late recurrent renal cell carcinoma metastasis to the gastrointestinal tract should be kept in mind, although it is rare. If the patient is fit for surgery, metastatectomy is the first choice of treatment.

  20. Lesions in canine stifle joints due to trochleoplasties as treatment for medial patellar luxation

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    Johannes Hans van der Zee


    Full Text Available Lesions in canine stifle joints after previous trochleoplasty surgery were documented. Infour clinical cases arthrotomies were performed due to stifle pain after previous trochleardeepening procedures. A small area of hyaline cartilage remained in the groove of the stiflesin cases where previous wedge trochleoplasties had been performed. All of the stifles hadsignificant areas of eburnation on the axial aspect of the medial trochlear ridge. The stifle jointsof a dog that was euthanased due to severe irreversible osteo-arthritis were photographed.The dog had undergone previous surgery for patellar luxation and cranial cruciate ligamentruptures. The trochlear grooves in this dog had almost no visible articular cartilage left.

  1. Fever of unknown origin (FUO) in a renal transplant recipient due to drug fever from sirolimus. (United States)

    Sharif, Sairah; Kong, May W; Drakakis, James; Cunha, Burke A


    A variety of medications may cause drug fever. Drug fevers may persist for days to weeks until diagnosis is considered. The diagnosis of drug fever is confirmed when there is resolution of fever within 3 days after the medication is discontinued. Only rarely do undiagnosed drug fevers persist for over 3 weeks to meet fever of unknown origin (FUO) criteria. FUOs due to drug fever are uncommon, and drug fevers due to immunosuppressive drugs are very rare. This is a case of a 58-year-old female renal transplant recipient who presented with FUO that remained undiagnosed for over 8 weeks. We believe this is the first reported case of an FUO due to drug fever from sirolimus in a renal transplant recipient.

  2. A case of primary renal allograft dysfunction due to myeloma cast nephropathy

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    Umesh Lingaraj


    Full Text Available We report a rare case of primary renal allograft dysfunction due to myeloma cast nephropathy in a patient with no overt clinical features of multiple myeloma preceding his transplantation. A 45-year-old man on hemodialysis for six months for end-stage kidney disease due to presumed chronic glomerulonephritis developed immediate graft dysfunction post-transplantation. The graft biopsy was diagnostic of myeloma cast nephropathy. Other criteria for lambda light chain multiple myeloma were fulfilled with immunofixation electrophoresis and bone marrow biopsy. He was treated with plasmapheresis, bortezomib and high-dose dexamethasone. However, the patient succumbed to septicemia on the 37 th post-operative day. This is probably the first report of primary renal allograft dysfunction due to myeloma cast nephropathy diagnosed within the first week posttransplanation in a patient with unrecognized multiple myeloma.

  3. A case of primary renal allograft dysfunction due to myeloma cast nephropathy. (United States)

    Lingaraj, Umesh; Vankalakunti, Mahesha; Radhakrishnan, Hemachandar; Sreedhara, C G; Rajanna, Sunil


    We report a rare case of primary renal allograft dysfunction due to myeloma cast nephropathy in a patient with no overt clinical features of multiple myeloma preceding his transplantation. A 45-year-old man on hemodialysis for six months for end-stage kidney disease due to presumed chronic glomerulonephritis developed immediate graft dysfunction post-transplantation. The graft biopsy was diagnostic of myeloma cast nephropathy. Other criteria for lambda light chain multiple myeloma were fulfilled with immunofixation electrophoresis and bone marrow biopsy. He was treated with plasmapheresis, bortezomib and high-dose dexamethasone. However, the patient succumbed to septicemia on the 37 th post-operative day. This is probably the first report of primary renal allograft dysfunction due to myeloma cast nephropathy diagnosed within the first week post-transplanation in a patient with unrecognized multiple myeloma.

  4. Acute renal failure and arterial hypertension due to sub capsular hematoma: is percutaneous drainage a feasible treatment?

    DEFF Research Database (Denmark)

    Kobel, Marie Cæcilie; Nielsen, Tommy Kjærgaard; Graumann, Ole

    Percutaneous drainage proved to be successful in managing a renal subcapsular haematoma that was causing acute renal failure and hypertension in a 74-year-old woman. The patient presented with oliguria, nausea and malaise 2 days after a ureteronephroscopic procedure with biopsies of a suspected...... urothelial neoplasm in the right renal pelvis. The left kidney had recently been removed due to renal cell carcinoma. At admission, the patient's blood pressure and plasma creatinine levels were massively elevated. Ultrasonography revealed a moderate right-sided renal subcapsular haematoma. When the patient...

  5. Lunar Phases and Emergency Department Visits for Renal Colic Due to Ureteral Calculus.

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    Andy W Yang

    Full Text Available Urolithiasis affects an estimated 5% of the population and the lifetime risk of passing a stone in the urinary tract is estimated to be 8-10%. Urinary calculus formation is highly variable and while certain risk factors such as age, gender, seasonality, anatomic abnormality, and metabolic diseases have been identified, not much is known regarding the association of environmental factors such as lunar phases on renal colic. We conducted a retrospective study to test the hypothesis that full moon phase is an environmental factor associated for increased emergency department (ED visits for renal colic due to ureteral calculus.We analyzed 559 renal colic diagnoses by the ED at the University of Nebraska Medical Center in a 24-month period and compared them with corresponding lunar phases as well as supermoon events. The lunar phases were defined as full moon ± two days, new moon ± two days, and the days in-between as normal days according to the lunar calendar. Supermoon event dates were obtained from NASA.90 cases (16.1% were diagnosed during full moon phase, 89 cases (15.9% were diagnosed during new moon phase, and 380 cases (68.0% were diagnosed during normal days. The incidence of renal colic showed no statistically significant association with lunar phases or supermoon events.In this retrospective longitudinal study with adequate power, neither full moon phase nor supermoon event exhibited an association with increased renal colic diagnoses due to ureteral calculus by the ED at the University of Nebraska Medical Center.

  6. [Necrotizing tonsillitis and renal vein thrombosis due to acute myeloid leukaemia]. (United States)

    Akram, Javed; Josefsson, Pernilla; Rømeling, Frans


    A 37-year-old woman was admitted to hospital with severe tonsillitis with unilateral necrotizing tonsillitis. She suddenly got fever, malaise, difficulties swallowing, pain in the throat and deterioration despite four days of penicillin treatment. During hospitalisation, she experienced abdominal pain, and blood tests showed pancytopenia. She was transferred to a haematological department, where a bone marrow biopsy showed acute myeloid leukaemia. Subsequently, an abdominal computed tomography with intravenous contrast revealed bilateral renal vein thrombosis, probably because of coagulopathy due to leukaemia.

  7. Protective effects of leflunomide on renal lesions in a rat model if diabetic nephropathy. (United States)

    Zhang, Qing; Ji, Yongqiang; Lv, Wei; He, Tianwei; Wang, Jianping


    Diabetic nephropathy is one of the most common chronic complications of diabetes with poor efficacy of clinical treatment. This study investigated the protective effects of leflunomide, a new immunosuppressant, on tubulointerstitial lesions in a rat model of diabetic nephropathy. Diabetes was induced with streptozotocin (STZ, 50 mg/kg) by intraperitoneal injection in male Wistar rats. Two weeks after STZ injection, diabetic rats were treated daily for 8 weeks with low (5 mg/kg) and high dose (10 mg/kg) of leflunomide, and benazepril hydrochloride (4 mg/kg) as a positive control. In diabetic rats, the 24-h urine volume, urine protein and microalbumin, blood creatinine and urea nitrogen significantly increased, which were attenuated by leflunomide treatment in a dose-dependent manner (all p leflunomide treatment. Immunohistochemistry study and real-time polymerase chain reaction results demonstrated that osteopontin (OPN), transforming growth factor beta 1 (TGF-β1), α-smooth muscle actin and CD68 expression in the renal tubulointerstitial region were significantly increased in the diabetic rats, while these increases were inhibited by leflunomide treatment. These findings suggest that leflunomide protects the kidney injury of diabetic rats might through its inhibition of OPN/TGF-β1 mediated extracellular matrix deposition and tubulointerstitial fibrosis, as well as its inhibition on tubular epithelial-myofibroblast transdifferentiation.

  8. Renal thrombotic microangiopathy revisited: When a lesion is not a clinical finding

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    De Serres Sacha


    Full Text Available Despite advances in the field of thrombotic microangiopathy (TMA and associated syndromes such as thrombotic thrombocytopenic purpura (TTP and hemolytic uremic syndrome (HUS, they still leave several issues unresolved. For instance, actual diagnostic criteria on which therapeutic decisions rely are relatively narrow and focused on TTP-HUS, with the consequence that non-idiopathic and atypically-presenting TMA are overlooked. In addition, nosologic classifi-cations of TMA disorders have varied substantially over the years, but are still devised from historical rather than mechanistic data. As such, it is perhaps not surprising that even today TMA is erroneously used as an interchangeable term with TTP-HUS, and missed or inappropriately diagnosed on various occasions. Yet, recognizing TMA is of crucial importance given that this lesion often manifests with potentially reversible renal failure. In this editorial, which is presented from a Nephrologist′s perspective, we propose that TMA disorders need to be reclassified to include most types of presentations and confirmed or excluded through more elaborate diagnostic approaches.

  9. Prognostic Relationships between Microbleed, Lacunar Infarction, White Matter Lesion, and Renal Dysfunction in Acute Ischemic Stroke Survivors. (United States)

    Jeon, Jae Woong; Jeong, Hye Seon; Choi, Dae Eun; Ham, Young Rok; Na, Ki Ryang; Lee, Kang Wook; Shin, Jong Wook; Kim, Jei


    It is well known that renal dysfunction and cerebral small-vessel disease (SVD), including microbleed, lacunar infarction, and white matter lesion (WML), are associated with poor prognosis after ischemic stroke. However, the prognostic relationship between renal dysfunction and SVD has not been well evaluated in acute ischemic stroke survivors. Therefore, in this study, we evaluated the prognostic relationships between estimated glomerular filtration rate (eGFR) and cerebral SVD after acute ischemic stroke. We retrospectively reviewed the clinical and radiological data of acute ischemic stroke survivors with decreased eGFR (acute ischemic stroke survivors. Both renal impairment and the presence of SVD were predictors of poor poststroke survival. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  10. The Role of Speech Therapy in Patients Who Underwent Laryngeal Microsurgery due to Phonotraumatic Lesions and Lesions Unrelated to Phonotrauma (United States)

    Macedo, Claudia de Assis Corrêa de; Macedo, Evaldo Dacheux de; Malafaia, Osvaldo; Catani, Guilherme Simas do Amaral; Ido, Jorge Massaki; Stahlke, Henrique Jorge


    Introduction The role of the speech-language pathology in the multiprofessional team dealing with laryngology and the voice has been recognized for a long time. Scientific studies in this field recommend therapies for laryngeal microsurgeries; few of the studies, however, effectively evaluate the result of postoperative speech therapy. Objective To compare speech therapy evaluation and treatment among patients with phonotraumatic lesions and patients with lesions unrelated to phonotrauma who underwent laryngeal microsurgery. Methods This study was performed at IPO Hospital (Paranaense Institute of Otorhinolaryngology, Curitiba, Paraná, Brazil) between February 2010 and February 2011. Of 254 patients who underwent laryngeal microsurgery, 208 patients were included in the study and divided in two groups: group A with phonotraumatic lesions (n = 131) and group B with lesions unrelated to phonotrauma (n = 77). The number of sessions and the functional result after speech therapy were evaluated. Results The number of postoperative phonotherapy sessions after microsurgery was up to 10 sessions in 89.31% and 87.71% for groups A and B, respectively. Phonotherapy treatment showed a better functional evolution in group A (92.37%). Conclusion A significant difference was observed only in functional evolution, which was better in the group with phonotraumatic lesions (p < 0.0001). PMID:25992078

  11. The Role of Speech Therapy in Patients Who Underwent Laryngeal Microsurgery due to Phonotraumatic Lesions and Lesions Unrelated to Phonotrauma

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    Macedo, Claudia de Assis Corrêa de


    Full Text Available Introduction The role of the speech-language pathology in the multiprofessional team dealing with laryngology and the voice has been recognized for a long time. Scientific studies in this field recommend therapies for laryngeal microsurgeries; few of the studies, however, effectively evaluate the result of postoperative speech therapy. Objective To compare speech therapy evaluation and treatment among patients with phonotraumatic lesions and patients with lesions unrelated to phonotrauma who underwent laryngeal microsurgery. Methods This study was performed at IPO Hospital (Paranaense Institute of Otorhinolaryngology, Curitiba, Paraná, Brazil between February 2010 and February 2011. Of 254 patients who underwent laryngeal microsurgery, 208 patients were included in the study and divided in two groups: group A with phonotraumatic lesions (n = 131 and group B with lesions unrelated to phonotrauma (n = 77. The number of sessions and the functional result after speech therapy were evaluated. Results The number of postoperative phonotherapy sessions after microsurgery was up to 10 sessions in 89.31% and 87.71% for groups A and B, respectively. Phonotherapy treatment showed a better functional evolution in group A (92.37%. Conclusion A significant difference was observed only in functional evolution, which was better in the group with phonotraumatic lesions (p < 0.0001.

  12. Acute renal failure due to bilateral uric acid lithiasis in infants. (United States)

    Kaya, Mete; Boleken, M Emin; Soran, Mustafa; Kanmaz, Turan; Yücesan, Selçuk


    Acute renal failure (ARF) is one of the complications of urolithiasis, but the role of medical treatment to relieve urinary obstruction in children with ARF is uncertain. We report on infants with acute obstructive uric acid lithiasis. We describe presentation features as well as diagnosis methods and medical treatment in five infants who were admitted to our institution with ARF due to uric acid lithiasis. The medical treatments for all patients were fluid liberalization, urine alkalinization, and oral allopurinol. Two children underwent urinary diversion. Within 8 h, urine output improved in all patients, and the stones passed spontaneously. All obstructed kidneys were relieved with medical treatment, and no renal sequel remained. So this series has showed a role of medical therapy in acute obstructive uric acid lithiasis.

  13. Ability and utility of diffusion-weighted MRI with different b values in the evaluation of benign and malignant renal lesions

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    Doganay, S., E-mail: [Department of Radiology, Faculty of Medicine, Erciyes University, Kayseri (Turkey); Kocakoc, E. [Department of Radiology, Faculty of Medicine, Firat University, Elazig (Turkey); Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul (Turkey); Cicekci, M.; Aglamis, S. [Department of Radiology, Faculty of Medicine, Firat University, Elazig (Turkey); Akpolat, N. [Department of Pathology, Faculty of Medicine, Firat University, Elazig (Turkey); Orhan, I. [Department of Urology, Faculty of Medicine, Firat University, Elazig (Turkey)


    Aim: To evaluate the ability and the utility of diffusion-weighted (DW) magnetic resonance imaging (MRI) with high and low b values to visualize benign and malignant renal lesions, and to determine which b value (b = 100, 600, or 1000 s/mm{sup 2}) was most useful in differentiating benign from malignant renal lesions. Materials and methods: Fifty-eight patients with 67 renal lesions and 50 normal contralateral kidneys (as control) were enrolled in the study. DW imaging was performed with b values of 100, 600, and 1000 s/mm{sup 2}. Results of the histopathological evaluation were compared with the DW MRI results. Apparent diffusion coefficient (ADC) values, and the sensitivity and specificity for differentiating malignant renal lesions from benign renal lesions were calculated for each b value. Results: The mean ADC values of normal renal parenchyma with b = 100, 600, and 1000 s/mm{sup 2} values were (3.14 {+-} 0.54) x 10{sup -3}, (2.52 {+-} 0.30) x 10{sup -3}, and (2.16 {+-} 0.43) x 10{sup -3} mm{sup 2}/s, respectively. The mean ADC values of benign renal lesions (n = 35) with b = 100, 600, and 1000 s/mm{sup 2} values were (2.88 {+-} 0.88) x 10{sup -3}, (2.58 {+-} 0.91) x 10{sup -3}, and (2.10 {+-} 0.93) x 10{sup -3} mm{sup 2}/s, respectively. The mean ADC values of malignant renal lesions (n = 32) with b = 100, 600, and 1000 values were (2.74 {+-} 0.58) x 10{sup -3}, (2.09 {+-} 0.63) x 10{sup -3}, and (1.66 {+-} 0.51) x 10{sup -3} mm{sup 2}/s, respectively. Using DW imaging malignant renal lesions could be differentiated from benign renal lesions, and also angiomyolipomas and oncocytomas could be differentiated from renal cell carcinoma. Conclusions: DW MRI with quantitative ADC measurements can be useful in the differentiation of benign and malignant renal lesions. High b values (b = 600 and 1000 s/mm{sup 2}) had the best specificity and sensitivity.

  14. [Bilateral renal vein thrombosis and acute renal failure due to inferior vena cava filter thrombosis. Report of one case]. (United States)

    Vega, Jorge; Díaz, Rienzi


    Bilateral renal vein thrombosis is an unusual etiology of acute renal failure and usually is associated with nephrotic syndrome. We report a 77-year-old man, consulting in the emergency room for anuria that appeared 24 hours after a syncope. The patient was carrier of an inferior vena cava filter prophylactically installed 17 months earlier and was not receiving anticoagulation. Serum creatinine on admission was 5.45 mg/dl and blood urea nitrogen was 54 mg/dl. Computed tomography and Doppler ultrasonography showed an extensive thrombosis of inferior vena cava and both renal veins. Heparin therapy was started with a rapid recovery of renal function and diuresis.


    NARCIS (Netherlands)

    Bavinck, JNB; Tieben, LM; van der Woude, F; Tegzess, Adam; Hermans, J; ter Schegget, J; Vermeer, BJ


    Purpose: The purpose of this study was to investigate the effect of acitretin on the development of keratotic skin lesions, and on squamous cell carcinomas and basal cell carcinomas in a group of renal transplant recipients. Patients and Methods: Forty-four renal transplant recipients with more than

  16. [Peripheral nerve disease associated with acute renal failure due to bromate poisoning]. (United States)

    Deshimaru, M; Miyagawa, T; Sumiyoshi, S; Nomura, Y


    A case of 21 year old male with neuropathy caused by renal insufficiency was present. He had taken bromate (mixed powder of potassium bromate and sodium bromate) for the purpose of suicide and suffered from acute renal insufficiency and hard of hearing. Renal dysfunction improved gradually by peritoneal dialysis and hemodialysis. However, on the 32th day after the onset, burning pain appeared in the bilateral feets. Following this, he began to complain of the disturbances of superficial and deep sensory below the ankle jerks and the weakness of his toes. Considering the clinical features, we supposed that the disturbance of the peripheral nerve was caused by uremia due to taking bromate. N. suralis was biopsied on the 80th day after the onset and examined electron microscopically. Electroscopical findings was as follows. Degeneration of the Schwann cells and irregularity or destruction of the myelin sheaths were observed. The axoplasm of the myelinated nerve fiber were relatively preserved as compared with the changes of the myelin sheaths. In the unmyelinated nerve fibers, cavity formations were observed. The findings of regeneration were not observed. From the electron microscopical findings, we speculate that the changes of the Schwann cells and the myelin sheaths are primary resulting from the disturbance of the metabolism of the Schwann cells. We speculate that anemia and hypoproteinemia caused by bromate disturbed regeneration.

  17. Partial Recovery of Delayed Graft Function due to Cholesterol Emboli after Renal Transplantation

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    Ackoundou-N'Guessan C


    Full Text Available A 65-year-old man who received a deceased renal allograft in September 2001. The donor of the allograft was a 54-year-old hypertensive man who expired from intracerebral hemorrhage. Atheroma with hard plaques was present in both renal arteries and aortic patches. After vascular anastomosis and clamp release, the allograft recolo-ration was inadequate, and the patient remained anuric. Computerized tomography scan demonstrated disseminated infarction areas, suggesting cholesterol emboli, which was confirmed later by a graft biopsy. As approximately 50% of the renal parenchyma was perfused, graft nephrectomy was not indicated and dialysis was restarted. Diuresis was over 3000 ml/day and serum creatinine decreased and stabilized at 360 µmol/L by the 32 nd postoperative day. The allograft supported the patient for only two years, and he eventually was successfully retransplanted in June 2003. We believe that delayed graft function due to cholesterol emboli disease may be reversible if areas of infarction are not too large.

  18. Relapsing Urinary Tract Infection Due to Rectourethral Fistula in a Renal Transplant Recipient

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    Ayşegül ORUÇ KOÇ


    Full Text Available Objectives: Urinary tract infection (UTI is the most common cause of bacterial infection in renal transplant recipients. It occurs frequently in the early period because of the high-dose immunosuppressive agents and urethral catheterizations. Relapsing UTI may lead to graft dysfunction and further evaluations have to be performed for predisposing factors. We report the case of a renal transplant recipient who presented with relapsing bacterial UTI due to a rectourethral fistula. Case: A 24-year-old male patient underwent a successful renal transplantation from a living donor on May 2008. He had a history of surgical intervention for anal atresia and rectourethral fistula. He was hospitalized five times because of relapsing bacterial UTI after transplantation. We investigated the presence of an anatomical abnormality and found a rectourethral fistula. After the surgical repair of the fistula the UTI did not relapse. Conclusion: Relapsing infections are not uncommon and anatomical abnormalities can lead to relapsing UTI in transplant recipients. Further investigations must be performed regarding the factors that might contribute to the development of UTIs in the presence of relapsing UTI.

  19. Improvements of renal lesions and function by angiotensin and endothelin receptor antagonism in nitric oxide-deficient rats

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    Jean-Jacques Boffa


    Full Text Available In previous studies, we have observed that antagonism of angiotensin or endothelin receptors prevented the development of nephroangio- and glomerulo-sclerosis during hypertension by inhibiting collagen I gene synthesis, through a mechanism independent of systemic haemodynamics. The present study investigated whether treatment with angiotensin or endothelin receptor antagonists, given at doses that did not reduce blood pressure, could produce regression of renal sclerotic lesions and improve renal function during hypertension. Hypertension and renal vascular fibrosis were induced in rats by chronic inhibition of NO synthesis using NGnitro-L-arginine methyl ester (L-NAME. Systolic blood pressure gradually increased following L-NAME administration, reaching a plateau of 170 mmHg after four weeks of treatment. At the same time, urinary protein excretion and plasma creatinine concentration were increased ten- and three-fold compared with controls, respectively (p<0.001. This increase was accompanied by the appearance of sclerotic lesions within renal vessels and glomeruli, as evidenced by Masson's trichromic staining (sclerotic index 2.34±0.29 vs. 0.10±0.01 in L-NAME four weeks and control, respectively, p<0.001. Thereafter, the L-NAME treatment was combined with either losartan (an AT1receptor antagonist, bosentan (an ETA/B antagonist, co-treatment with both agents, or vehicle for an additional period of four weeks. Blockade of AT1and/or ETA/B-receptors significantly reduced urinary protein excretion and plasma creatinine levels (p<0.01 and substantially improved renal vascular histology (sclerotic index 1.78±0.13, 1.57±0.22 and 1.85±0.15 respectively, p<0.01, vs. L-NAME eight week without altering the L-NAME-induced increase of systolic pressure. These data indicate that angiotensin II and endothelin-1 participate in the mechanism(s of renal vascular fibrosis by increasing extracellular matrix formation. Treatment with their respective

  20. Progressive renal failure due to renal infiltration by BK polyomavirus and leukaemic cells: which is the culprit? (United States)

    Sangala, Nicholas; Dewdney, Alex; Marley, Nicholas; Cranfield, Tanya; Venkat-Raman, Gopalakrishnan


    Renal infiltration with leukaemic cells is a common finding in patients suffering with chronic lymphocytic leukaemia (CLL) but rarely does it lead to significant renal dysfunction. Similarly, BK nephropathy is a recognized cause of graft failure in renal transplant recipients but rarely causes significant disease in native kidneys. In the few reports where leukaemic infiltration of the kidney has led to significant renal impairment, the pathological process causing renal dysfunction is not identified on biopsy. In these cases, it is unclear whether BK polyomavirus (BKV) nephropathy has been excluded. We describe a case of dual pathologies in a patient with Binet stage C CLL and deteriorating renal function where renal biopsy reveals leukaemic infiltration of the kidney occurring alongside BKV nephropathy. The relative importance of each pathology in relation to the rapid decline to end-stage renal failure remains unclear, but the presence of both pathologies appears to impart a poor prognosis. Additionally, we describe the novel histological finding of loss of tubular integrity resulting in tubular infiltration and occlusion by leukaemic cells. It is possible that the patient with advanced CLL is at particular risk of BK activation, and the presence of BK nephropathy may compromise tubular integrity allowing leukaemic cell infiltration and obstruction of tubules. This case bares remarkable resemblance to the first and only other report of its kind in the literature. It is not clear how available immunocytochemistry for polyoma infection is outside transplant centres, and it is possible that BK nephropathy is being under-diagnosed in patients with CLL in the context of declining renal function. At present, the combination of BKV nephropathy and leukaemic infiltration represents a management conundrum and the prognosis is poor. Further research is required in order to better understand the pathological process and therefore develop management strategies.

  1. Alexia with agraphia due to the left posterior inferior temporal lobe lesion--neuropsychological analysis and its pathogenetic mechanisms. (United States)

    Kawahata, N; Nagata, K; Shishido, F


    We report three cases of alexia with agraphia due to the left posterior inferior temporal lesions. In Case 1, the reading disability was more prominent in the use of Kana than in the use of Kanji, which is similar to previously reported cases of alexia with agraphia due to angular gyrus lesion. In Cases 2 and 3, by contrast, the reading disability was more prominent in the use of Kanji than in the use of Kana. In spontaneous writing and dictation, the disability was more pronounced in the use of Kanji compared with the use of Kana. In each of the three cases, the CT scan and positron emission tomography showed a localized lesion in the lower part of the left posterior temporal lobe. A typical form of an alexia with agraphia could be caused not only by the left angular lesion but also by the left posterior inferior temporal lesion. We discuss the neuropsychological analysis and pathogenetic mechanisms of alexia with agraphia due to the left posterior inferior temporal lesion in the comparison of alexia with agraphia caused by the left angular lesion.

  2. [Urolithiasis due to renal tubular acidosis associated with Sjögren's syndrome]. (United States)

    Umekawa, T; Esa, A; Uemura, T; Kohri, K; Kurita, T; Ishikawa, Y; Iguchi, M; Kataoka, K


    We encountered 4 patients with urolithiasis due to renal tubular acidosis (RTA) associated with Sjögren's syndrome. Laboratory results about RTA in 4 patients with Sjögrenhs syndrome were not significantly different from those in patients who suffered from urolithiasis due to RTA without Sjögren's syndrome. The incidence of urolitiasis in these cases was suspected to be higher than that in RTA patients without Sjögren's syndrome, because all 4 patients in this study had urolithiasis. When we examine patients with bilateral and multiple urolithiasis, particularly in middle-aged women, we should bear in mind that RTA and Sjögren's syndrome may exist in the background.

  3. Renal failure due to granulomatous interstitial nephritis in native and allograft renal biopsies: experience from a tertiary care hospital. (United States)

    Gupta, Pallav; Rana, D S; Bhalla, A K; Gupta, Ashwini; Malik, Manish; Gupta, Anurag; Bhargava, Vinant


    Granulomatous interstitial nephritis is a rare cause of renal failure in both native and allograft renal biopsies. Drugs and sarcoidosis are the commonest causes of granulomatous interstitial nephritis as reported in Western countries. Unlike the west, tuberculosis is the commonest cause of granulomatous interstitial nephritis in Indian subcontinent. The etiological factors, clinical course, glomerular and tubulointerstitial changes associated with granulomatous interstitial nephritis have been analyzed in the present study along with the outcome in patients with granulomatous interstitial nephritis.

  4. Efficacy of magnetic resonance coronary angiography for evaluating coronary arterial lesions due to Kawasaki disease

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    Inaba, Rikako; Suzuki, Atsuko; Sato, Katsuhiko; Ono, Masae; Hosina, Kiyoshi; Furuyama, Tamio; Takemura, Atsusi; Korenaga, Tateo [Tokyo Teishin Hospital (Japan)


    To reduce the number of invasive X-ray coronary angiography (XCA) in patients with coronary arterial lesions (CAL) due to Kawasaki disease, we evaluated the efficacy of noninvasive magnetic resonance coronary angiography (MRCA). We preformed MRCA on 30 patients with Kawasaki disease (age 4 months to 37 years; medium 9 years) by SIEMENS MAGNETOM Symphony 1.5 T. MRCA with free respiration using navigator echo 3D fast low angle shot (3D-FLASH) was performed on 10 young children. Evaluation of MRCA was based on the findings of 2D echo cardiogram (30 patients) and XCA (14 patients). All 17 aneurysms (100%) were detected by MRCA; four out of five dilatations were detected by MRCA (80%), but a slight dilatation was not detected (i.e., appeared to be a normal coronary artery). We observed seven stenoses (100%) that were detected on XCA and one new stenosis on MRCA; both of two aortocoronary bypass graphs (one in each of two patients; 100%) were observed to be patent. These results demonstrated that MRCA was highly beneficial, first for detecting CAL after the acute phase even in young infants, second for reducing the number of XCA examination times for following up CAL, and third for screening of CAL in adults with a history of Kawasaki disease. (author)

  5. Analysis of the effects of different iodine concentrations on the characterization of small renal lesions detected by multidetector computed tomography scan: A pilot study

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    Lee, Hak Jong; Kim, Sang Youn; Cho, Jeong Yeon; Hwang, Sung Il; Moon, Min Hoan; Kim, Seung Hyup [Dept. of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of)


    Our objective was to compare the effects of different iodine concentrations on characterizing small renal lesions. Thirty-eight patients were enrolled in this study. All patients underwent an initial CT scan using 370 mgI/mL iodinated contrast media. Patients were then randomized into two groups for a follow-up CT. Group A (n = 19) received 250 mgI/mL iodinated contrast media, and group B (n = 19) received 300 mgI/mL contrast media. The mean Hounsfield units (HU values) of small renal lesions with a maximum size of less than 2 cm were calculated. Signal to noise ratios (SNR values) were likewise evaluated. Three uroradiologists assessed the lesion's conspicuity and the diagnostic influence of the artifact's proximity to the adjacent renal parenchyma. In group A, there were significant differences between the HU values of renal lesions and those of the adjacent renal parenchyma between the initial and follow-up CT. Conversely, in group B, there was no significant difference. Moreover, SNR values showed no statistically significant difference between both groups. Regarding lesion conspicuity, only one reader identified a significant difference (p = 0.032) in group A; whereas in group B, there was no statistical difference. The artifact's proximity to the adjacent renal parenchyma did not appear to have any diagnostic influence on differentiating the two (p < 0.05). In evaluating small renal lesions, 300 mgI/mL instead of 370 mgI/mL contrast media can be used; however, it is important to note that the use of 250 mgI/mL contrast media may reveal different results from that of 370 mgI/mL contrast media.

  6. Characterization of Small Focal Renal Lesions: Diagnostic Accuracy with Single-Phase Contrast-enhanced Dual-Energy CT with Material Attenuation Analysis Compared with Conventional Attenuation Measurements. (United States)

    Marin, Daniele; Davis, Drew; Roy Choudhury, Kingshuk; Patel, Bhavik; Gupta, Rajan T; Mileto, Achille; Nelson, Rendon C


    Purpose To determine whether single-phase contrast material-enhanced dual-energy material attenuation analysis improves the characterization of small (1-4 cm) renal lesions compared with conventional attenuation measurements by using histopathologic analysis and follow-up imaging as the clinical reference standards. Materials and Methods In this retrospective, HIPAA-compliant, institutional review board-approved study, 136 consecutive patients (95 men and 41 women; mean age, 54 years) with 144 renal lesions (111 benign, 33 malignant) measuring 1-4 cm underwent single-energy unenhanced and contrast-enhanced dual-energy computed tomography (CT) of the abdomen. For each renal lesion, attenuation measurements were obtained; attenuation change of greater than or equal to 15 HU was considered evidence of enhancement. Dual-energy attenuation measurements were also obtained by using iodine-water, water-iodine, calcium-water, and water-calcium material basis pairs. Mean lesion attenuation values and material densities were compared between benign and malignant renal lesions by using the two-sample t test. Diagnostic accuracy of attenuation measurements and dual-energy material densities was assessed and validated by using 10-fold cross-validation to limit the effect of optimistic bias. Results By using cross-validated optimal thresholds at 100% sensitivity, iodine-water material attenuation images significantly improved specificity for differentiating between benign and malignant renal lesions compared with conventional enhancement measurements (93% [103 of 111]; 95% confidence interval: 86%, 97%; vs 81% [90 of 111]; 95% confidence interval: 73%, 88%) (P = .02). Sensitivity with iodine-water and calcium-water material attenuation images was also higher than that with conventional enhancement measurements, although the difference was not statistically significant. Conclusion Contrast-enhanced dual-energy CT with material attenuation analysis improves specificity for

  7. Ataxia and tremor due to lesions involving cerebellar projection pathways: a DTI tractographic study in six patients. (United States)

    Marek, M; Paus, S; Allert, N; Mädler, B; Klockgether, T; Urbach, H; Coenen, V A


    Focal lesions of brainstem, thalamus, and subcortical white matter may cause movement disorders that are clinically indistinguishable from cerebellar symptoms. It is suspected that ataxia in these cases is due to damage of efferent or afferent pathways of the cerebellum. However, the precise anatomical correlate often remains undefined. We used deterministic diffusion tensor magnetic resonance imaging (DTI) tractography to study the anatomical relationship between lesions causing ataxia and efferent cerebellar pathways. Study subjects were six male patients with focal lesions of different etiology (demyelination, hemorrhage, ischemia, neoplasm) outside the cerebellum. Five patients had cerebellar-like ataxia with prominent contralateral upper limb involvement. One patient with an almost midline mesencephalic lesion had a symmetrical ataxic syndrome. We used 3T MRI (Intera, Philips Medical Systems, Best, Netherlands) and DTI tractography (32 directions, StealthViz DTI, Medtronic Navigation, Louisville, USA) to delineate the dentato-rubro-thalamo-cortical tract (DRT). In all patients, tractography demonstrated focal lesions affecting the DRT in different locations. We conclude that in vivo mapping of cerebral pathways using DTI tractography in patients with focal extracerebellar brain lesions may provide direct evidence of circumscribed damage to the DRT, causing unilateral cerebellar-like ataxia. Also, a unilateral mesencephalic lesion at the level of the crossing of the DRT may cause bilateral ataxia.

  8. Does helicobacter pylori infection in chronic renal failure increase the risk of gastroduodenal lesions? A prospective study

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    Abdulrahman Ibrahim


    Full Text Available Background: Helicobacter pylori (H.pylori plays an important role in gastroduodenal disease. However, there are few data concerning the epidemiology of H.pylori in patients with chronic renal failure and on hemodialysis (HD treatment. Aim of the study: This study is aimed to determine the epidemiology of H.pylori infection in patients with end stage renal disease (ESRD on Hemodialysis (HD. Patients and Methods: Ninety-six patients with dyspeptic complaints were included in the study. They were divided into two groups; group one consisted of 46 patients with ESRD on HD and group two (control of 50 patients without renal disease. All patients were subjected to upper gastrointestinal endoscopies, and gastric biopsies were obtained for histological evidence of H. pylori infection. Results: The mean age of both groups was similar. The prevalence of H.pylori among the two groups was not significantly different (45.7%Vs48%=p>0.05. The prevalence of duodenal ulcers was significantly higher in H.pylori positive than in H.pylori negative ESRD patients (p< 0.05. GERD was significantly lower in H.pylori positive patients in both groups (p< 0.001 and p< 0.01 respectively. Conclusion: This study showed a similar prevalence of H.pylori infection in both groups. H.pylori infection in patients with ESRD is probably associated with increased risk of gastroduodenal lesions

  9. Alexia without either agraphia or hemianopia in temporal lobe lesion due to herpes simplex encephalitis. (United States)

    Erdem, S; Kansu, T


    We report a case of alexia without either agraphia or hemianopia following herpes simplex encephalitis. The patient had a temporal lobe lesion with involvement of the occipitotemporal gyrus. This is an unusual cause of alexia without agraphia. The location of the lesion supports the view that transcallosal fibers from the right hemisphere to the left angular gyrus course inferior to the posterior horn of the left lateral ventricle and pass close to the left occipitotemporal gyrus.

  10. Renal sodium retention in cirrhotic rats depends on glucocorticoid-mediated activation of mineralocorticoid receptor due to decreased renal 11beta-HSD-2 activity

    DEFF Research Database (Denmark)

    Thiesson, Helle; Jensen, Boye L; Bistrup, Claus;


    rats with decompensated liver cirrhosis and ascites 7 wk after bile duct ligation (BDL). Renal 11beta-HSD-2 mRNA, protein, and activity were significantly decreased in decompensated rats. The urinary Na(+)/K(+) ratio was reduced by 40%. Renal epithelial sodium channel (ENaC) mRNA and immunostaining......, and reduced ascites formation to the same degree as direct inhibition of MR with K-canrenoate. Total potassium balance was negative in the BDL rats, whereas renal potassium excretion was unchanged. In the distal colon, expression of ENaC was increased in BDL rats. Fecal potassium excretion was increased...... by endogenous glucocorticoids. In addition, the overall potassium loss in the BDL model is due to increased fecal potassium excretion, which is associated with upregulation of ENaC in distal colon....

  11. Presence of Kimmelstiel-Wilson like lesions in canine renal faillure


    Vala, Helena; Mega, A. C.; Mesquita, J.; Nóbrega, C.; Cruz, R.; Esteves, F.; C. Santos; Teixeira de Lemos, E.; Reis, F.


    Background: Nodular increases in mesangial matrix is the definition of Kimmelstiel-Wilson (K-W) lesions. In man, focal mesangiolyses and K-W nodules were positively associated with diabetes, proteinuria and hyalinization of afferent and efferent arterioles. Although, nodular sclerotic lesions may also occur in the absence of diabetic nephropathy and are clinically related to hypertension, smoking, hypercholesterolemia, among others. This study aimed to assess the presence of nodular ...

  12. Case report: percutaneous cryoablation of a small renal lesion necessitating modified lateral decubitus position. (United States)

    McClung, Chris; Wright, Andrew; Pierce, Ken; Posniak, Harold; Perry, Kent


    When performing percutaneous cryoablation for renal masses, the standard patient positioning has been the prone position. We present a case in which placing the patient in a modified lateral decubitus position aided in the access of probe placement for percutaneous cryoablation.

  13. Bosniak classification of renal cystic lesions according to multidetector computed tomography findings; Classificacao de Bosniak das lesoes cisticas renais segundo achados na tomografia computadorizada multidetectores

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    Miranda, Christiana Maia Nobre Rocha de; Padilha, Igor Gomes; Farias, Lucas de Padua Gomes de; Rocha, Milzi Sarmento da, E-mail: [Universidade Federal de Alagoas (UFAL), Maceio, AL (Brazil); Maranhao, Carol Pontes de Miranda; Santos, Carla Jotta Justo dos [Clinica de Medicina Nuclear e Radiologia de Maceio (MedRadiUS), Maceio, AL (Brazil)


    Renal cystic lesions are usually diagnosed in the radiologists' practice and therefore their characterization is crucial to determine the clinical approach to be adopted and prognosis. The Bosniak classification based on computed tomography findings has allowed for standardization and categorization of lesions in increasing order of malignancy (I, II, IIF, III and IV) in a simple and accurate way. The present iconographic essay developed with multidetector computed tomography images of selected cases from the archives of the authors' institution, is aimed at describing imaging findings that can help in the diagnosis of renal cysts. (author)

  14. Successful Salvage of a Renal Allograft after Acute Renal Vein Thrombosis due to May-Thurner Syndrome

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    Omkar U. Vaidya


    Full Text Available A 68-year-old Caucasian female with a past medical history of a deceased donor kidney transplant four months prior was admitted with a two-day history of anuria and acute kidney injury. A renal ultrasound demonstrated thrombus in the transplanted kidney's renal vein that extended into the left iliac vein as well as into the left femoral venous system. Catheter-guided tissue thrombolytics were infused directly into the clot. Within twelve hours of initiating thrombolytic infusion, there was brisk urine output. Interval venography demonstrated decreasing clot burden. At the time of discharge her creatinine was 0.78 mg/dL, similar to her baseline value prior to presentation. The patient was noted to have May-Thurner syndrome on intravascular ultrasound (IVUS. Angioplasty followed by stent placement was done. Unique to our case report was the timing of the presentation of renal vein thrombosis (four months after transplant and the predisposing anatomy consistent with May-Thurner syndrome, which was diagnosed with IVUS and successfully treated with local thrombolytics.

  15. Papillary muscle rupture due to acute myocardial infarction followed by cardiogenic shock, pulmonary edema, and acute renal failure

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    Ilić Radoje


    Full Text Available Aim. The case of successful surgical treatment of anterolateral papillary muscle rupture due to acute myocardial infarction with cardiogenic shock, pulmonary edema and acute renal failure. Case report. A 62-year old male from Belgrade with chest pain, hypotension and a new heart murmur refused hospitalization at the Military Medical Academy. On the third day of his illness he was readmitted to MMA as an emergency due to hemoptysis. Examination revealed mitral valve anterolateral papillary muscle rupture. The patient, with signs of cardiogenic shock and acute renal failure, was immediately operated on. The surgery was performed using extracorporeal circulation. An artificial mitral valve was implanted, and myocardial revascularization accomplished with one venous graft of the left anterior descending artery. On the second postoperative day, hemodialysis was carried out due to acute renal failure. On the 28th postoperative day, the patient was discharged from the hospital being hemodynamically stable with normal renal function and balanced anticoagulation. The case is interesting in terms of unrecognized papillary muscle rupture that led to the development of cardiogenic shock, hemoptysis and acute renal failure. Conclusion. Papillary muscle rupture is a fatal complication of acute myocardial infarction. Early recognition and urgent surgical intervention were lifesaving in the case of complete papillary muscle rupture. Surgical treatment, regardless of high risk, is the procedure of choice.

  16. Branchio-oto-renal syndrome caused by partial EYA1 deletion due to LINE-1 insertion

    DEFF Research Database (Denmark)

    Morisada, Naoya; Rendtorff, Nanna Dahl; Nozu, Kandai


    A 7-year-old Japanese girl with conductive deafness and preauricular fistulae developed proteinuria. She had renal insufficiency, and ultrasound revealed bilateral small kidneys. These findings indicated that she had branchio-oto-renal (BOR) syndrome. In the present patient, we identified, by using...

  17. Acción urológica frente a lesiones renales en el politraumatizado

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    Pedro Luis Pedroso Fernández


    Full Text Available Se aborda la problemática de los traumatismos renales tomando en consideración a diferentes autores, así como la experiencia personal del autor del artículo y se plantean pautas, no solamente para la acción inmediata sino también para el seguimiento posterior, con el objetivo de elevar la calidad asistencial en el politraumatizado

  18. A Case of Progressive Tubulo-Interstitial Nephritis due to Culture-negative Renal Tuberculosis

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    El-Reshaid Kamel


    Full Text Available This report describes a woman with progressive renal failure without proteinuria, urinary obstruction or overt systemic disease. The progressive renal disease without pelvicalyceal deformities in the left kidney was not consistent with the vesicoureteric reflux nephropathy. A needle biopsy of the left kidney showed interstitial caseating granulomata. The patient did not have clinical, radiological or urine culture evidence of renal tuberculosis. She improved after treatment with antituberculous therapy. This case report demonstrates the value of kidney biopsy in establishing the diagnosis of such common and treatable disease even if clinically silent and urine culture negative.

  19. Imaging the renal lesion with dual-energy multidetector CT and multi-energy applications in clinical practice: what can it truly do for you?

    Energy Technology Data Exchange (ETDEWEB)

    Mileto, Achille; Marin, Daniele [Duke University Medical Center, Department of Radiology, Durham, NC (United States); Sofue, Keitaro [Duke University Medical Center, Department of Radiology, Durham, NC (United States); Kobe University School of Medicine, Department of Radiology, Kobe (Japan)


    Many fortuitously detected renal lesions are incompletely characterised at traditional MDCT imaging, thus posing daily challenges to radiologists and referring physicians. There is burgeoning evidence that dual-energy MDCT and multi-energy applications provide an added value over traditional MDCT imaging in renal lesion characterisation and throughput. This special report gives a vendor-neutral outlook on technical essentials, recommended protocols, high-yield clinical opportunities and reviews radiation dose aspects of dual-energy MDCT imaging and multi-energy applications in renal lesions. In addition to a guide on interpretative traps and emerging problems, we provide an update on new, potential imaging horizons. Dual-energy MDCT and multi-energy applications can facilitate the imaging interpretation and throughput of renal lesions. Conjointly with capitalisation on the benefits, familiarity with dual- and multi-energy data sets as well as continuous scrutiny of interpretative traps can be the keys to the successful implementation and enhanced clinical acceptance of this powerful technique in the imaging community. Continuous advances in hardware and computer interfaces are expected to pave the way for the further expansion of the application spectrum. (orig.)

  20. A rare case of renal vein thrombosis due to urinary obstruction. (United States)

    Jana, Tanima; Orlander, Philip R; Molony, Donald A


    Renal vein thrombosis (RVT) is an uncommon condition in adults and may be caused by endothelial damage, stasis, or hypercoagulable states. RVT is commonly identified in patients with nephrotic syndrome or malignancy. We present the case of a 57-yearold man with no past medical history who presented with a 1-month history of abdominal pain, dysuria, and hematuria. Initial laboratory studies were consistent with acute kidney injury (AKI). Imaging revealed bladder distension, enlargement of the prostate, bilateral hydronephrosis, and left renal vein thrombosis extending into the inferior vena cava. His renal failure and presenting symptoms resolved with placement of a Foley catheter and ureteral stent. The patient was discharged on anticoagulation. Here, we report a rare case of RVT that appears to have occurred as a consequence of obstructive uropathy causing massive bladder distention resulting in compression of the renal vein.

  1. Visceral leishmaniasis due to Leishmania infantum with renal involvement in HIV-infected patients


    Vassallo, Matteo; Moranne, Olivier; Ambrosetti, Damien; Jeandel, Pierre-Yves; Pomares, Christelle; Cassuto, Elisabeth; Boscagli, Annick; Giraud, Guillaume; Montagne, Nathalie; Dentone, Chiara; Demacina, Ilaria; Villaggio, Barbara; Secondo, Giovanni; Ferrea, Giuseppe; Passeron, Corinne


    Background We describe histological, clinical findings and outcomes of renal involvement during Leishmania infantum infection in four HIV-infected patients in South France and North Italy hospital settings. Cases presentation Four HIV-infected Caucasian patients (age 24-49) performed renal biopsy during episodes of visceral leishmaniasis. They presented severe immunosuppression, frequent relapses of visceral leishmaniasis during a follow-up period of several years and partial or complete reco...



    Foyaca-Sibat H. MD.; Ibañez-Valdés LdeF. MD,


    ABSTRACT We report one patient with Klippel-Feil (KFS) syndrome, other associated anomalies, uncontrolled arterial hypertension, and renal artery stenosis. Because this patient underwent for surgical revascularization with unsuccessful result, all proposed way of treatments are revised, and we have hypothesized that probably for patients with KFS and unilateral renal artery stenosis, medical treatment with ACE inhibitors can provide more benefits than surgical revascularization or percutan...

  3. Right hand predominant constructional apraxia due to right hemisphere infarction without corpus callosum lesions. (United States)

    Kobayashi, Zen; Watanabe, Mayumi; Karibe, Yuri; Nakazawa, Chika; Numasawa, Yoshiyuki; Tomimitsu, Hiroyuki; Shintani, Shuzo


    A 74-year-old right-handed woman without cognitive impairment suddenly developed nonfluent aphasia. Brain MRI showed acute infarction in the right frontal lobe and insula without involvement of the corpus callosum. A neurological examination demonstrated not only transcortical motor aphasia, but also ideomotor apraxia and right hand predominant constructional apraxia (CA). To date, right hand predominant CA has only been reported in patients with corpus callosum lesions. The right hand predominant CA observed in our patient may be associated with the failure to transfer information on the spatial structure from the right hemisphere to the motor cortex of the left hemisphere.

  4. Resolution of Ecchymotic Lesions due to Fluoxetine and Escitalopram after Introduction of Reboxetine

    Directory of Open Access Journals (Sweden)

    Sibel Kocbiyik


    Full Text Available Antidepressants, frequently prescribed in depression and anxiety disorders, are known to be responsible for an increase in bleeding. Yet, it has rarely been reported that SSRI treatment has unfavorable effects on hemostasis. The most frequently reported side effects of SSRIs on the hematologic system are prolonged bleeding time, impaired thrombocyte aggregation and activity. Here we present a case in whom ecchymotic lesions occurred with esscitalopram and fluoxetine, which disappeared with reboxetine. [Cukurova Med J 2015; 40(Suppl 1: 90-93

  5. Visuomotor performance in a patient with visual agnosia due to an early lesion. (United States)

    Dijkerman, H Chris; Lê, Sandra; Démonet, Jean-François; Milner, A David


    We tested a patient with visual agnosia who had suffered severe bilateral brain damage early in life, on a series of visuomotor tasks. The broad pattern of results confirms that S.B., like the extensively tested patient D.F., shows an impressive array of preserved skills, despite his severe perceptual problems. Also like D.F., S.B. shows certain subtle visuomotor difficulties that can be related to the idea that his partially intact occipito-parietal areas are unable to benefit from interactions with the apparently severely damaged occipito-temporal regions. Unlike D.F., however, he is able to make accurate discriminations of simple visual features, such as object width and orientation, albeit with very slow response times. We hypothesize that several factors such as the early onset of S.B.'s lesion and the long period since his brain lesion have allowed his brain to compensate to a degree what has been impossible in D.F., whose brain damage occurred in adulthood. This may include an element of 'rewiring' and self-monitoring of visuomotor processes that allow S.B. to achieve perceptual access to visual information processed in the dorsal stream: information that is normally only available for on-line visuomotor control.

  6. Accelerated forgetting of contextual details due to focal medio-dorsal thalamic lesion

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    Sicong eTu


    Full Text Available Effects of thalamic nuclei damage and related white matter tracts on memory performance are still debated. This is particularly evident for the medio-dorsal thalamus which has been less clear in predicting amnesia than anterior thalamus changes. The current study addresses this issue by assessing 7 thalamic stroke patients with consistent unilateral lesions focal to the left medio-dorsal nuclei for immediate and delayed memory performance on standard visual and verbal tests of anterograde memory, and over the long-term (> 24 hrs on an object-location associative memory task. Thalamic patients showed selective impairment to delayed recall, but intact recognition memory. Patients also showed accelerated forgetting of contextual information after a 24 hour delay, compared to controls. Importantly, the mammillothalamic tract was intact in all patients, which suggests a role for the medio-dorsal nuclei in recall and early consolidation memory processes.

  7. Chronic disfiguring facial lesions in an immunocompetent patient due to Exophiala spinifera: a case report and review of literature. (United States)

    Singh, Gagandeep; Shivaprakash, M R; De, Dipankar; Gupta, Prerna; Gupta, Sunita; Kanwar, A J; Chakrabarti, Arunaloke


    Exophiala spinifera is a rare fungus causing chromoblastomycosis or different types of phaeohyphomycosis (cutaneous, subcutaneous, disseminated and cyst phaeohyphomycosis). We report a case of a young male with phaeohyphomycosis due to E. spinifera, who had multiple itchy painful papular lesions disfiguring his face for 4 years. His diagnosis was delayed and had received antibacterial and antileishmanial therapy elsewhere without any improvement. While he reported to our hospital, the histopathology of the biopsy collected from the lesion demonstrated acute on chronic inflammation with granuloma formation and darkly pigmented fungal elements. The isolate grown on culture was identified as E. spinifera on the basis of morphological characters. The identification of the isolate was further confirmed by sequencing of the ITS region of ribosomal DNA. After treatment with oral itraconazole, he had marked clinical improvement.

  8. Renoscintigraphy in assessment of renal lesions in children after hemolytic-uremic syndrome; Renoscyntygrafia w ocenie skutkow uszkodzenia nerek u dzieci po przebytym zespole hemolityczno-mocznicowym

    Energy Technology Data Exchange (ETDEWEB)

    Lass, P.; Marczak, E.; Romanowicz, G. [Akademia Medyczna, Gdansk (Poland); and others


    The aim of the study was to assess the role of renoscintigraphic examination in monitoring of patients after the hemolytic-uremic syndrome. 27 children mean 9 years the hemolytic-uremic syndrome underwent the complex of biochemical, ultrasound and renoscintigraphic examinations. The abnormal renoscintigraphic was seen in 85.1% of children, while the alternative test described the renal lesion in 29-66%. Renoscintigraphic examination seems to be the most sensitive in monitoring of remote sequel in patients after HUS. Those patients should undergone long-lasting observation, for the sake of possibility of development of renal insufficiency. (author). 14 refs.

  9. Angiodysplastic lesions as a cause of colonic bleeding in patients with chronic renal disease: Is there an association?

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    Georgios Galanopoulos


    Full Text Available Gastrointestinal bleeding due to angiodysplastic lesions of the large bowel is a common problem among patients receiving hemodialysis and may sometimes be life-threatening. Several hypotheses have been advanced in order to explain the increased incidence of these lesions in this cohort of patients, including degenerative, metabolic, circulatory and other systemic factors. In terms of diagnosis, several advances have been made with sophisticated techniques, but endoscopy seems to be the most effective, having a dual role in diagnosis and treatment. Although most bleeds stop spontaneously, conservative treatment may not be enough. Endoscopic treatment, embolization with infusion of vasopressin, surgical resection of the bleeding intestinal segment and hormone administration may be useful therapeutic tools.

  10. [Acute renal failure due to obstructive ureteral stone associated with norovirus gastroenteritis in an infant with congenital solitary kidney]. (United States)

    Kato, Taiki; Hamano, Atsushi; Kawamura, Hideki


    We report a 35 month-old boy with acute renal failure caused by an obstructive ureteral stone associated with norovirus gastroenteritis. He visited his family physician because of fever, abdominal pain and vomiting. He was diagnosed as acute gastroenteritis. The symptoms relieved once, but abdominal pain and vomiting recurred two days after the visit and the volume of urine decreased. He was diagnosed as norovirus gastoenteritis and acute renal failure which was unresponsive to fluid replacement. Ultrasound study of the abdomen showed a solitary kidney with mild hydronephrosis. He was then admitted to our hospital. He was finally diagnosed as acute postrenal failure due to obstructive ureteral stone with left solitary kidney by abdominal computer tomography (CT). We performed transurethral catheterization immediately. The creatinine and blood urea nitrogen returned to normal level in 2 days. The CT performed on the 28th day post operation showed disappearance of the stone after uric alkalization. Recently, some cases of postrenal failure due to bilateral obstructive ureteral stones, mainly ammonium acid urate stones, associated with viral gastroenteritis were reported. As clinical features, they are common in boys three years or younger after an episode of rotavirus gastroenteritis with high uric acid concentration. By far, the most common cause of acute renal failure in patients with severe gastroenteritis is prerenal failure resulting from hypovolemia. But postrenal cause due to bilateral obstructive stones should be taken in a consideration.

  11. Are liver and renal lesions in East Greenland polar bears (Ursus maritimus associated with high mercury levels?

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    Born Erik W


    Full Text Available Abstract Background In the Arctic, polar bears (Ursus maritimus bio-accumulate mercury as they prey on polluted ringed seals (Phoca hispida and bearded seals (Erignathus barbatus. Studies have shown that polar bears from East Greenland are among the most mercury polluted species in the Arctic. It is unknown whether these levels are toxic to liver and kidney tissue. Methods We investigated the histopathological impact from anthropogenic long-range transported mercury on East Greenland polar bear liver (n = 59 and kidney (n = 57 tissues. Results Liver mercury levels ranged from 1.1–35.6 μg/g wet weight and renal levels ranged from 1–50 μg/g wet weight, of which 2 liver values and 9 kidney values were above known toxic threshold level of 30 μg/g wet weight in terrestrial mammals. Evaluated from age-correcting ANCOVA analyses, liver mercury levels were significantly higher in individuals with visible Ito cells (p Conclusion Based on these relationships and the nature of the chronic inflammation we conclude that the lesions were likely a result of recurrent infections and ageing but that long-term exposure to mercury could not be excluded as a co-factor. The information is important as it is likely that tropospheric mercury depletion events will continue to increase the concentrations of this toxic heavy metal in the Sub Arctic and Arctic marine food webs.


    Directory of Open Access Journals (Sweden)

    Foyaca-Sibat H. MD.


    Full Text Available ABSTRACT We report one patient with Klippel-Feil (KFS syndrome, other associated anomalies, uncontrolled arterial hypertension, and renal artery stenosis. Because this patient underwent for surgical revascularization with unsuccessful result, all proposed way of treatments are revised, and we have hypothesized that probably for patients with KFS and unilateral renal artery stenosis, medical treatment with ACE inhibitors can provide more benefits than surgical revascularization or percutaneous transluminal angioplasty. We considered that those patients should be manage by a team of medical doctors being aware of their common associated anomalies, identifying all of them when it is possible then, making an integral evaluation of the each individual situation for establishing their medical priorities in order, and then address its treatments accordingly. If at this stage any surgical treatment is required, is important to bring those problems to the anesthesiologist’s attention for a very careful manipulation of the neck and head during induction of anesthesia. The final results will be strongly related with the capacity of management of the underlying cardio-respiratory, renal, skeletal, urogenital, and nervous system problems. . We also propose the term of Klippel-Feil syndrome "Plus" for those patients with cervical vertebral fusion and many other associated deformities rather than to add new eponyms to the long list that already exist. _____________ RESUMEN: HIPERTENSION RENOVASCULAR DEBIDO A ESTENOSIS DE LA ARTERIA RENAL EN EL SÍNDROME DE KLIPPEL-FEIL Reportamos un paciente afectado por un syndrome de Klippel-Feil, otras anormalias congenitas, hipertension arterial incontrolada y una estenosis unilateral de la arteria renal. Este paciente fue sometido a un tratamiento quirÚrgico de la estenosis de la arteria renal, cuyos resultados fueron no satisfactorios por lo que revisamos todas las alternativas de tratamiento para la estenosis

  13. Absorption fever characteristics due to percutaneous renal biopsy-related hematoma. (United States)

    Hu, Tingyang; Liu, Qingquan; Xu, Qin; Liu, Hui; Feng, Yan; Qiu, Wenhui; Huang, Fei; Lv, Yongman


    This study aims to describe the unique characteristics of absorption fever in patients with a hematoma after percutaneous renal biopsy (PRB) and distinguish it from secondary infection of hematoma.We retrospectively studied 2639 percutaneous renal biopsies of native kidneys. We compared the clinical characteristics between 2 groups: complication group (gross hematuria and/or perirenal hematoma) and no complication group. The axillary temperature of patients with a hematoma who presented with fever was measured at 06:00, 10:00, 14:00, and 18:00. The onset and duration of fever and the highest body temperature were recorded. Thereafter, we described the time distribution of absorption fever and obtained the curve of fever pattern.Of 2639 patients, PRB complications were observed in 154 (5.8%) patients. Perirenal hematoma was the most common complication, which occurred in 118 (4.5%) of biopsies, including 74 small hematoma cases (thickness ≤3 cm) and 44 large hematoma cases (thickness >3 cm). Major complications were observed in only 6 (0.2%) cases resulting from a large hematoma. Of 118 patients with a perirenal hematoma, absorption fever was observed in 48 cases. Furthermore, large hematomas had a 5.23-fold higher risk for absorption fever than the small ones.Blood pressure, renal insufficiency, and prothrombin time could be risk factors for complications. Fever is common in patients with hematoma because of renal biopsy and is usually noninfectious. Evaluation of patients with post-biopsy fever is necessary to identify any obvious infection sources. If no focus is identified, empiric antibiotic therapy should not be initiated nor should prophylactic antibiotics be extended for prolonged durations. Absorption fevers will resolve in time without specific therapeutic interventions.

  14. Carnitine Profile and Effect of Suppletion in Children with Renal Fanconi Syndrome due to Cystinosis


    Besouw, M.; Cornelissen, E.; Cassiman, D.; Kluijtmans, L.; L. van den Heuvel; Levtchenko, E


    Background: Cystinosis is an autosomal recessive disorder marked by intralysosomal cystine accumulation. Patients present with generalized proximal tubular dysfunction called renal Fanconi syndrome. Urinary carnitine loss results in plasma and muscle carnitine deficiency, but no clinical signs of carnitine deficiency have been described. Also, the optimal dose of carnitine supplementation is undefined. This study aimed to determine whether currently recommended carnitine doses result in adequ...

  15. Sudden Infant Death With Area Postrema Lesion Likely Due to Wrong Use of Insecticide. (United States)

    Lavezzi, Anna M; Cappiello, Achille; Termopoli, Veronica; Bonoldi, Emanuela; Matturri, Luigi


    We report a noteworthy case of a 7-month-old infant who suddenly and unexpectedly died during her sleep. After a complete postmortem examination, review of the clinical history, and detailed death scene investigation, the death remained unexplained, leading to a diagnosis of sudden infant death syndrome. However, an extensive review of the brainstem neuropathology revealed a severe alteration in the area postrema (a highly vascular structure lying at the base of the fourth ventricle outside of the blood-brain barrier). The alteration was likely due to massive and repeated to a common household insecticide in the last few weeks of life. These results provide an explanation for this sudden infant death, allowing a differential diagnosis from sudden infant death syndrome.

  16. Subcutaneous phaeohyphomycosis due to Alternaria infectoria in a renal transplant patient: surgical treatment with no long-term relapse. (United States)

    Salido-Vallejo, Rafael; Linares-Sicilia, María José; Garnacho-Saucedo, Gloria; Sánchez-Frías, Marina; Solís-Cuesta, Francisco; Gené, Josepa; Moreno-Giménez, José Carlos


    Phaeohyphomycosis can be caused by a number of different species, being the most common Alternaria alternata and Alternaria infectoria. The biggest risk factor for the development of the infection is immunosuppression. We present the case of a 64-year-old male renal transplant patient who came to hospital for presenting a tumour in the Achilles region which had been gradually growing in size. A skin biopsy was taken for histological study and culture of fungi and mycobacteria. Blood tests and imaging studies were performed. Histopathology study and cultures identified A. infectoria as the causal agent. Imaging studies ruled out internal foci of infection. The lesion was surgically removed with no signs of recurrence after 24 months of follow-up. There are no treatment guidelines at present for cutaneous and subcutaneous Alternaria spp. infections. Various systemic antifungals have been used, either in combination with surgical removal or alone, with varying results. Surgery alone could be useful in the treatment of solitary, localised lesions in transplant patients in whom there are difficulties in controlling immunosuppression. Copyright © 2012 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

  17. Oral lesions associated with renal secondary hyperparathyroidism in an English bulldog/ Lesões orais associadas ao hiperparatireoidismo renal secundário em um Buldogue Inglês

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    Antônio Carlos Faria dos Reis


    Full Text Available Renal secondary hyperparathyroidism is a complex clinical syndrome frequently described in dogs. However, in most cases, lesions are characterized by fibrous osteodystrophy of facial bones, affecting principally the mandible and the maxilla. There are few reports of renal secondary hyperparathyroidism associated with facial tumorous masses in the dog; similar findings in dogs have not been previously described in Brazil. This report describes the clinical, pathological, and radiological findings of this syndrome in a 14-month-old dog with oral tumorous-like lesions. The pathogenesis associated with this disease is also discussed.Hiperparatireoidismo renal secundário é uma síndrome clínica complexa freqüentemente descrita em cães. Entretanto, na maioria dos casos as lesões são caracterizadas por osteodistrofia fibrosa dos ossos faciais, afetando principalmente a mandíbula e a maxila. Existem poucos relatos do hiperparatireoidismo renal secundário associada a massas tumorais na face de cães; achados semelhantes em cães não foram anteriormente descritos no Brasil. Este relato descreve os achados clínicos, patológicos e radiológicos dessa síndrome em um cão de 14 meses de idade com lesões semelhantes a tumores na cavidade bucal. A patogenia associada a essa doença também é discutida.

  18. Prospective Study to Assess Progression of Renal Markers after Interruption of Tenofovir due to Nephrotoxicity

    Directory of Open Access Journals (Sweden)

    Anna Bonjoch


    Full Text Available Background. Prospective studies about the reversibility of tenofovir disoproxil fumarate- (TDF- related renal impairment remain scarce. Methods. This is an observational prospective study including all patients that presented at our HIV Unit who interrupted TDF owing to nephrotoxicity. We assessed the evolution of renal parameters after discontinuation of this drug. Results. We included 59 patients, who were followed up for 72 weeks. Most were male (41, 69.5%, median (IQR age was 53 (44; 58 years, and median time receiving TDF-containing regimens was 55.4 (28; 87.7 months. Most patients were receiving PI-based treatments (67%. At the final visit, most of the subjects showed complete recovery (35, 59.3% or improvement (13 subjects, 22%. Significant improvements were observed in creatinine levels (from 84.9 [73.8; 97.5] to 78 [69.6; 91] μmol/L, p=0.013, estimated glomerular filtration rate (eGFR, CKD EPI equation, from 87.7 [67; 99] to 89.9 [73.6; 99.3] mL/min/1.73 m2, p=0.017, and number of patients with eGFR <60 mL/min/1.73 m2 (from 9 [15.3%] to 1 [1.7%], p=0.031. A trend toward significance was observed in abnormal urine proteinuria/creatinine ratio (from 22 [37%] to 8 [13.6%], p=0.057. Conclusions. Our results corroborate the high frequency of complete or partial renal recovery in patients receiving TDF-containing regimens who discontinued therapy owing to nephrotoxicity.

  19. Acute Hemolysis with Renal Failure due to Clostridium Bacteremia in a Patient with AML (United States)

    Medrano-Juarez, R. M.; Sotello, D.; D'Cuhna, L.; Payne, J. D.


    We present a case of acute hemolytic anemia, renal failure, and Clostridium perfringens bacteremia in a patient with acute myelogenous leukemia. The high fatality of C. perfringens bacteremia requires that clinicians recognize and rapidly treat patients at risk for this infection. Although other hemolytic processes are in the differential diagnosis of these events, the presence of high fever, chills, and rapidly positive blood cultures may help narrow the diagnosis. Most cases of C. perfringens bacteremia have a concomitant coinfection, which makes broad spectrum empiric therapy essential. There is a high mortality rate of C. perfringens infections associated with leukemia.

  20. Encephalopathy and Hypotonia due to Baclofen Toxicity in a Patient with End-Stage Renal Disease


    Ijaz, Mohsin; Tariq, Hassan; KASHIF,MUHAMMAD; Marquez, Jose Gomez


    Patient: Female, 57 Final Diagnosis: Baclofen toxicity Symptoms: Encephalopathy • hypotonia Medication: Baclofen Clinical Procedure: Hemodialysis Specialty: Critical Care Objective: Unusual or unexpected effect of treatment Background: Baclofen is a centrally acting gamma-aminobutyric acid agonist used for the symptomatic relief of skeletal muscle spasm and spasticity in traumatic spinal cord lesions, multiple sclerosis, cerebral palsy, and stroke. It is also used in the treatment of chronic ...

  1. Renal transplant failure due to urologic complications: Comparison of static fluid with contrast-enhanced magnetic resonance urography

    Energy Technology Data Exchange (ETDEWEB)

    Blondin, D. [University Hospital Duesseldorf, Institute of Diagnostic Radiology, Moorenstr. 5, D-40225 Duesseldorf (Germany)], E-mail:; Koester, A.; Andersen, K.; Kurz, K.D.; Moedder, U.; Cohnen, M. [University Hospital Duesseldorf, Institute of Diagnostic Radiology, Moorenstr. 5, D-40225 Duesseldorf (Germany)


    Purpose: Postrenal reasons of renal transplant failure can be assessed by magnetic resonance urography. This study was designed to retrospectively compare the diagnostic accuracy of static fluid (T2-)MRU compared to contrast enhanced (CE-)MRU in patients with renal transplant failure. Material and methods: Thirty-five consecutive patients (14 female, 21 men; mean age 48.6 years) with renal transplant failure and sonographically detected hydronephrosis were examined both with T2-MRU as well as CE-MRU resulting in 39 MRU examinations. MRU was performed both using T2-weighted HASTE-sequence (T2-MRU) as well as Gadolinium-enhanced 3D-FLASH-sequence (CE-MRU) on a 1.5-T clinical MRI scanner (Magnetom Vision, Siemens Medical Solutions). Subjective image quality of resulting maximum intensity projection was assessed in consensus by two readers blinded to the final diagnosis, using a five point scale. MRU findings were correlated to sonography, operative results or clinical follow up. Results: CE-MRU yielded a sensitivity of 85.7% (T2-MRU 76.2%), and a specificity of 83.3% (T2-MRU: 73.7%), however statistical significance was not reached. The subjective image quality was significantly better in CE-MRU. Conclusions: Only concerning subjective image quality CE-MRU proved superior to T2-MRU. Yet, there was no significant difference in diagnostic accuracy between T2- and CE-MRU. Thinking of incipient nephrogenic systemic fibrosis, T2-MRU can be used as reliable alternative in patients with decreased renal transplant function due to urological complications.

  2. Renal transplant failure due to urologic complications: Comparison of static fluid with contrast-enhanced magnetic resonance urography. (United States)

    Blondin, D; Koester, A; Andersen, K; Kurz, K D; Moedder, U; Cohnen, M


    Postrenal reasons of renal transplant failure can be assessed by magnetic resonance urography. This study was designed to retrospectively compare the diagnostic accuracy of static fluid (T2-)MRU compared to contrast enhanced (CE-)MRU in patients with renal transplant failure. Thirty-five consecutive patients (14 female, 21 men; mean age 48.6 years) with renal transplant failure and sonographically detected hydronephrosis were examined both with T2-MRU as well as CE-MRU resulting in 39 MRU examinations. MRU was performed both using T2-weighted HASTE-sequence (T2-MRU) as well as Gadolinium-enhanced 3D-FLASH-sequence (CE-MRU) on a 1.5-T clinical MRI scanner (Magnetom Vision, Siemens Medical Solutions). Subjective image quality of resulting maximum intensity projection was assessed in consensus by two readers blinded to the final diagnosis, using a five point scale. MRU findings were correlated to sonography, operative results or clinical follow up. CE-MRU yielded a sensitivity of 85.7% (T2-MRU 76.2%), and a specificity of 83.3% (T2-MRU: 73.7%), however statistical significance was not reached. The subjective image quality was significantly better in CE-MRU. Only concerning subjective image quality CE-MRU proved superior to T2-MRU. Yet, there was no significant difference in diagnostic accuracy between T2- and CE-MRU. Thinking of incipient nephrogenic systemic fibrosis, T2-MRU can be used as reliable alternative in patients with decreased renal transplant function due to urological complications.

  3. An estimation of the global burden of disease due to skin lesions caused by arsenic in drinking water. (United States)

    Fewtrell, Lorna; Fuge, Ron; Kay, David


    The global burden of disease due to skin lesions caused by arsenic in drinking water was estimated by combining country-based exposure data with selected exposure-response relationships derived from the literature. Populations were considered to be exposed to elevated arsenic levels if their drinking water contained arsenic concentrations of 50 microg I(-1) or greater. Elevated arsenic concentrations in drinking water result in a significant global burden of disease, even when confining the health outcome to skin lesions. The burden of disease was particularly marked in the World Health Organization (WHO) comparative risk assessment (CRA) 'Sear D' region, which includes Bangladesh, India and Nepal. Unsurprisingly, Bangladesh was the worst affected country with 143 disability adjusted life years (DALYs) per 1,000 population. Although this initial estimate is subject to a large degree of uncertainty, it does represent an important first step in allowing the comparison of the problem relating to elevated arsenic in drinking water to other environmental health outcomes.

  4. Serotonin syndrome due to fluoxetine and tramadol in renal impaired patient

    Directory of Open Access Journals (Sweden)

    Rajnish Raj


    Full Text Available Serotonin syndrome causes confusion or altered mental status; other symptoms include myoclonus, shivering, tremors, diaphoresis, hyperreflexia, incoordination, fever and diarrhoea. Tramadol possesses dual pharmacological effects i.e., a weak opiate agonist at mu, kappa and delta opiate receptors along with reuptake inhibition of norepinephrine and serotonin. Risk associated with tramadol increases when co-administered with serotonergic antidepressants or MAOIs (monoamine oxidase inhibitors and in renal impaired. The incidence of this syndrome is less than 1% as most of the cases remain unreported. The case highlights the fact that interaction between serotonergic agents like fluoxetine and tramadol especially in the presence of co-morbid medical illness can lead to serotonin syndrome. [Int J Basic Clin Pharmacol 2014; 3(1.000: 227-229

  5. Hypokalemic periodic paralysis due to proximal renal tubular acidosis in a case with membranoproliferative glomerulonephritis. (United States)

    Santra, Gouranga; De, Dibyendu; Sinha, Pradip Kumar


    Proximal renal tubular acidosis (pRTA) is a rare disorder. Hypokalemia may be associated with it; occasionally leading to features like hypokalemic periodic paralysis. Though pRTA is a tubulointerstitial kidney disease, glomerulonephritis may occasionally lead to pRTA by tubular damage through leaking proteins, cytokines or by inflammatory infiltrates. In our reported case a 27 year old male had recurrent episodes of hypokalemic quadriparesis. Investigations revealed features of pRTA including hypokalemia and non-anion-gap hyperchloremic metabolic acidosis. His urine pH dropped to 5 with NH4Cl loading test. Kidney biopsy showed membranoproliferative glomerulonephritis with tubulointerstitial damage. Hypokalemic periodic paralysis and pRTA are uncommon associations of membranoproliferative glomerulonephritis.

  6. Ventral simultanagnosia and prosopagnosia for unfamiliar faces due to a right posterior superior temporal sulcus and angular gyrus lesion. (United States)

    Sakurai, Yasuhisa; Hamada, Kensuke; Tsugawa, Naoya; Sugimoto, Izumi


    We report a patient with ventral simultanagnosia, prosopagnosia for "unfamiliar faces" (dorsal prosopagnosia), spatial agraphia, and constructional disorder, particularly on the left spatial side, due to a lesion in the right posterior superior and middle temporal gyri and angular gyrus. The patient showed impairment of fundamental visual and visuospatial recognition, such as in object size, configuration, and horizontal point location, which probably underlay the mechanism of simultanagnosia and prosopagnosia. This case also suggests that the coexistence of simultanagnosia and prosopagnosia results from a right hemispheric insult, and damage to the temporoparietal area interrupts the incorporation of spatial information into object recognition. This disconnection of information flow, together with impaired object recognition per se, may impair the parallel processing of multiple objects, leading to object-by-object or part-by-part recognition.

  7. Renal angiomyolipoma

    DEFF Research Database (Denmark)

    Holm-Nielsen, P; Sørensen, Flemming Brandt


    lesion. Three cases of renal angiomyolipoma, 2 of which underwent perfusion-fixation, were studied by electron microscopy to clarify the cellular composition of this lesion. In the smooth muscle cells abundant accumulation of glycogen was found, whereas the lipocytes disclosed normal ultrastructural......-specific vesicular structures. These findings suggest a secondary vascular damage, i.e. the thickened vessels may not be a primary, integral part of renal angiomyolipoma. Evidence of a common precursor cell of renal angiomyolipoma was not disclosed. It is concluded that renal angiomyolipoma is a hamartoma composed...

  8. CT features of renal infarction

    Energy Technology Data Exchange (ETDEWEB)

    Suzer, Okan; Shirkhoda, Ali; Jafri, S. Zafar; Madrazo, Beatrice L.; Bis, Kostaki G.; Mastromatteo, James F


    Purpose: To demonstrate the different patterns of renal infarction to avoid pitfalls. To present 'flip-flop enhancement' pattern in renal infarction. Materials and methods: Retrospective review of a total of 41 renal infarction in 37 patients were done. These patients underwent initial CT and the diagnosis of renal infarction was confirmed with either follow up CT or at surgery. Results: Twenty-three patients had wedge-shaped focal infarcts, nine patients had global and five patients had multifocal infarcts of the kidneys. Cortical rim sign was seen predominantly with global infarcts. In five patients, a 'flip-flop enhancement' pattern was observed. In two patients, planned renal biopsies due to tumefactive renal lesions were cancelled because of 'flip-flop enhancement' pattern on follow up CTs. Conclusion: Although most of our cases were straightforward for the diagnosis of renal infarction, cases with tumefactive lesions and global infarctions without the well-known cortical rim sign were particularly challenging. We describe a new sign, flip-flop enhancement pattern, which we believe solidified the diagnosis of renal infarction in five of our cases. The authors recommend further investigations for association of flip-flop enhancement and renal infarction.

  9. Acute renal failure due to abdominal compartment syndrome: report on four cases and literature review

    Directory of Open Access Journals (Sweden)

    Cleva Roberto de


    Full Text Available We report on 4 cases of abdominal compartment syndrome complicated by acute renal failure that were promptly reversed by different abdominal decompression methods. Case 1: A 57-year-old obese woman in the post-operative period after giant incisional hernia correction with an intra-abdominal pressure of 24 mm Hg. She was sedated and curarized, and the intra-abdominal pressure fell to 15 mm Hg. Case 2: A 73-year-old woman with acute inflammatory abdomen was undergoing exploratory laparotomy when a hypertensive pneumoperitoneum was noticed. During the surgery, enhancement of urinary output was observed. Case 3: An 18-year-old man who underwent hepatectomy and developed coagulopathy and hepatic bleeding that required abdominal packing, developed oliguria with a transvesical intra-abdominal pressure of 22 mm Hg. During reoperation, the compresses were removed with a prompt improvement in urinary flow. Case 4: A 46-year-old man with hepatic cirrhosis was admitted after incisional hernia repair with intra-abdominal pressure of 16 mm Hg. After paracentesis, the intra-abdominal pressure fell to 11 mm Hg.

  10. [Traumatic and iatrogenic lesions of abdominal vessels]. (United States)

    Farah, I; Tarabula, P; Voirin, L; Magne, J L; Delannoy, P; Gattaz, F; Guidicelli, H


    Gravity of abdominal vessels traumatisms is secondary to multiple factors. It depends on the type of injured vessels, aetiology and associated lesions. Between September 1984 and March 1995, 22 abdominal vessel traumatisms in 16 patients (mean age: 39 years) were treated. At surgical exploration, 4 aortic and 2 renal vein lesions, 7 iliac artery and 3 renal artery contusions, 2 superior mesenteric artery dissections; 3 infra-renal vena cava ruptures and 1 superior mesenteric vein dilaceration were found. All lesions were caused by penetrant wounds secondary to firearm or blade injury or secondary to injuries due to ski or traffic accidents. In 5 cases, lesions were iatrogenic. There was no mortality in the post-operative period, 14 patients out of the 16 patients operated on have been followed during a period from 1 to 120 months.

  11. Renal dysfunction due to hydronephrosis by SAPHO syndrome: a case report


    Kakoki, Katsura; Miyata, Yasuyoshi; Enokizono, Mikako; Uetani, Masataka; Sakai , Hideki


    Key Clinical Message Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis (SAPHO) syndrome shows varied pathological symptoms. This is the first report of hydronephrosis due to the mechanical compression of bilateral ureters as a result of SAPHO syndrome. From our experience, MRI is the most useful imaging examination to check the upper urinary tract in SAPHO syndrome.

  12. Renal dysfunction due to hydronephrosis by SAPHO syndrome: a case report. (United States)

    Kakoki, Katsura; Miyata, Yasuyoshi; Enokizono, Mikako; Uetani, Masataka; Sakai, Hideki


    Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis (SAPHO) syndrome shows varied pathological symptoms. This is the first report of hydronephrosis due to the mechanical compression of bilateral ureters as a result of SAPHO syndrome. From our experience, MRI is the most useful imaging examination to check the upper urinary tract in SAPHO syndrome.

  13. IgG4-related disease: description of a case with pulmonary lesions, mediastinal lymphadenopathies and rapidly progressive renal failure

    Directory of Open Access Journals (Sweden)

    Loreto Fernández Lorente


    Full Text Available This is a case report of a 73-year-old man with new-onset acute renal failure while being investigated for pulmonary infiltrates and mediastinal lymphadenopathies. Urine tests showed tubular range proteinuria with no microhaematuria. Immunology tests showed elevated serum IgG and hypocomplementaemia (classical pathway activation. Renal biopsy and clinical-pathological correlation were crucial in this case, reinforcing their important role in the final diagnosis of acute kidney injury.

  14. [A Case of Clinically Mild Encephalitis/encephalopathy with a Reversible Splenial Lesion due to Dengue Fever]. (United States)

    Saito, Nobuo; Kitashouji, Emi; Kojiro, Maiko; Furumoto, Akitugu; Morimoto, Konosuke; Morita, Kouichi; Ariyoshi, Koya


    Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) has been recently proposed as a clinical-radiological syndrome. Several causes of MERS have been reported including infectious diseases. We present herein on a case of MERS induced by dengue fever in a Japanese traveler. A 48-year-old male returning from Thailand and Cambodia was admitted for an unknown fever. Following admission, the dengue virus was diagnosed with a positive RT-PCR result. On day 5 of the illness, regardless of reduced fever, weakness suddenly developed in both upper limbs. A cerebral MRI showed hyperintensities in the splenium of the corpus callosum on T2-weighted and diffusion-weighted images. The symptoms resolved completely within two days of onset. The patient was diagnosed as having MERS due to the MRI features and the mild clinical course. Although only a few cases of MERS caused by dengue fever have been reported, the condition is possibly underdiagnosed. It is hypothesized that dengue fever can induce MERS as dengue fever can cause increased endothelium permeability and hypo-sodium which have been proposed in the pathogenesis of MERS. However, there is currently limited evidence for this. Further research is recommended to demonstrate a causal association between dengue fever and MERS.

  15. Traumatic duodenal lesions in children due to two-point seat-belt: the seat-belt syndrome. (United States)

    Guanà, R; Sangiorgio, L; Tessiatore, P; Seymandi, P


    Two consecutive children, motor vehicle accident victims, were treated between December 2006 and January 2007. They reported duodenal perforations due to lap-belt action. In the first case (a 9-year-old boy), symptoms became immediately evident after the trauma. Early computerized tomography (CT) scan demonstrated biliaryhemoperitonitis and free sub-diaphragmatic air. At the laparotomy a complete duodenal transection, at the level of duodenal bulb, was found. In the second patient, early X-ray and CT scan revealed no free abdominal air; only the second CT scan, repeated after 48 hours, when general conditions of the girl become critical, demonstrated biliary peritonitis and aerial extraluminal gas image in the right peri-kidney space. At the surgical exploration a duodenal laceration was noted, at the passage between the second and the third duodenal portion, in the postero-lateral wall, with an extension of 6 cm. In both children direct suture of duodenal injury without stoma construction was performed. Not early or late postoperative complications were registered (follow-up: 18 months). In the traumatic duodenal lesions an early diagnosis is not always possible because of the paucity of the clinical signs. Tightened clinical and radiological monitoring of the patient is fundamental in the successive hours to the trauma. Early diagnosis and high level of suspicious rest crucial for better prognosis in this group of patients.

  16. Syndrome-Specific Deficits of Performance and Effects of Practice on Arm Movements with Deafferentation due to Posterior Thalamic Lesion

    Directory of Open Access Journals (Sweden)

    Thomas Platz


    Full Text Available Aiming and tapping movements were analysed repeatedly over a three-week period in a patient who was hemideafferented due to an ischaemic posterior thalamic lesion. Contrasting behaviour observed in six healthy subjects, nine hemiparetic patients and one patient with hemianopic stroke, allowed the determination of behavioural deficits related to deafferentation. Finger tapping was not impaired specifically and did not improve with practice in the deafferented patient. When aiming movements were investigated, accuracy of the first, largely preprogrammed, phase of movement and timing of the late homing-in phase were impaired specifically in the deafferented patient. Practice led to a step-like change in preprogramming amplitude of the ballistic movement component, a gradual improvement of temporal efficiency of the early movement phase and a more marked improvement of the homing-in phase. Qualitatively comparable but quantitatively less marked effects of practice were documented for hemiparetic patients. These results demonstrated that deafferentation affects preprogrammed aspects of movement and those influenced by current control and that motor learning is possible with central deafferentation, even for aspects of performance that are impaired specifically. It is postulated that motor learning was mediated by changes in strategy (motor programming and improved efficiency of intact motor control processes (visuomotor control.

  17. CPU0213,a novel endothelin receptor antagonist,ameliorates septic renal lesion by suppressing ET system and NF-κB in rats

    Institute of Scientific and Technical Information of China (English)

    Haibo HE; De-zai DAI; Yin DAI


    Aim: To examine whether a novel endothelin receptor antagonist, CPU0213, is effective in relieving the acute renal failure (ARF) of septic shock by suppressing the activated endothelin-reactive oxygen species (ET-ROS) pathway and nuclear factor kappa B (NF-κB). Methods: The cecum was ligated and punctured in rats under anesthesia. CPU0213 (30 mg·kg-1·d-1, bid, sc×3 d) was administered 8 h after surgical operation. Results: In the untreated septic shock group, the mean arterial pressure and survival rate were markedly decreased (P<0.01), and heart rate, weight index of kidney, serum creatinine and blood urea nitrogen, 24 h urinary protein and creatinine were significantly increased (P<0.01). The levels of ET-1, total NO synthetase (tNOS), indusible nitric oxide synthetase (iNOS), nitric oxide (NO), and ROS in serum and the renal cortex were markedly increased (P< 0.01). The upregulation of the mRNAlevels of preproET-1, endothelin converting enzyme, ETA, ETB, iNOS, and tumor necrosis factor-alpha in the renal cortex was significant (P<0.01). The protein amount of activated NF-κB was significantly increased (P<0.01) in comparison with the sham operation group. All of these changes were significantly reversed after CPU0213 administration. Conclusion: Upregulation of the ET signaling pathway and NF-κB play an important role in the ARF of septic shock. Amelioration of renal lesions was achieved by suppressing the ETA and ETB receptors in the renal cortex following CPU0213 medication.

  18. MRI in callosal apraxia and agraphia due to a traumatic lesion in the posterior trunk of the corpus callosum

    Energy Technology Data Exchange (ETDEWEB)

    Yasumura, Shuichi; Ito, Naoki; Terunuma, Hiroshi; Matsuzaki, Takayuki; Iwabuchi, Reiko


    We discussed functional topography of the corpus callosum in a case with ideo-motor apraxia and agraphia of the left hand due to a traumatic callosal hematoma confirmed by MRI. The patient was a 35-year-old right-handed woman with head injury in a traffic accident. On admission she was semi-comatose with left oculomotor palsy and her left upper limb showed a decorticate rigidity by noxious stimuli, however, she became alert within 14 days. X-ray CT showed an abnormal high density area in the posterior part of the trunk of the corpus callosum on admission. MRI (inversion recovery technique) on the 60th hospital day showed a low intensity area extending for about 2 cm posteriorly from the center of the trunk. Sequential neuropsychological examinations for the callosal disconnection syndrome were performed. The patient showed ideo-motor apraxia and agraphia in her left hand only. Her response to verbal commands were all parapraxic except for correct use of a comb and a tooth brush. Her writings with her left hand were those of scrawls due to apraxia. These apraxia and agraphia of the left hand were transient and recovered completely within 80 days of onset. Transient impairement of bimanual coordination movement was also observed. Ataxie optique, callosal pseudoneglect, left hand tactile anomia, difficulty of somesthetic transfer or diagonistic dyspraxia was not observed. Based on the neuropsychological and the MRI findings we suggest that the lesion in the posterior part of the trunk of the corpus callosum is important for causing ideo-motor apraxia and agraphia of the left hand.

  19. Acute Lymphocytic Leukemia with Bilateral Renal Masses Masquerading as Nephroblastomatosis

    Directory of Open Access Journals (Sweden)

    Poonam Thakore


    Full Text Available Acute lymphoblastic leukemia (ALL is the most common malignancy in the pediatric patient population. However, renal involvement as the primary manifestation of ALL is rare. We report a case of a 4-year-old boy with bilateral renal lesions resembling nephroblastic rests as the first finding of early stage ALL preceding hematological changes and subsequent classic clinical findings by two weeks. These renal hypodensities completely resolved after one week of induction chemotherapy. This case demonstrates that renal involvement can be the only initial presenting finding of leukemia. Children with lesions resembling nephroblastic rests need appropriate surveillance due to the risk of malignant disease.

  20. Comparison of macroscopic and microscopic (stereomicroscopy and scanning electron microscopy) features of bone lesions due to hatchet hacking trauma. (United States)

    Nogueira, Luísa; Quatrehomme, Gérald; Bertrand, Marie-France; Rallon, Christophe; Ceinos, Romain; du Jardin, Philippe; Adalian, Pascal; Alunni, Véronique


    This experimental study examined the lesions produced by a hatchet on human bones (tibiae). A total of 30 lesions were produced and examined macroscopically (naked eye) and by stereomicroscopy. 13 of them were also analyzed using scanning electron microscopy. The general shape of the lesion, both edges, both walls, the kerf floor and the extremities were described. The length and maximum width of the lesions were also recorded. The microscopic analysis of the lesions led to the description of a sharp-blunt mechanism. Specific criteria were identified (lateral pushing back, fragmentation of the upraising, fossa dug laterally to the edge and vertical striae) enabling the forensic expert to conclude that a hacking instrument was used. These criteria are easily identifiable using scanning electron microscopy, but can also be observed with stereomicroscopy. Overall, lateral pushing back and vertical striae visible using stereomicroscopy and scanning electron microscopy signal the use of a hacking tool.

  1. Renal Osteodystrophy

    Directory of Open Access Journals (Sweden)

    Aynur Metin Terzibaşoğlu


    Full Text Available Chronic renal insufficiency is a functional definition which is characterized by irreversible and progressive decreasing in renal functions. This impairment is in collaboration with glomeruler filtration rate and serum creatinine levels. Besides this, different grades of bone metabolism disorders develop in chronic renal insufficiency. Pathologic changes in bone tissue due to loss of renal paranchyme is interrelated with calcium, phosphorus vitamine-D and parathyroid hormone. Clinically we can see high turnover bone disease, low turnover bone disease, osteomalacia, osteosclerosis and osteoporosis in renal osteodystropy. In this article we aimed to review pathology of bone metabolism disorders due to chronic renal insufficiency, clinic aspects and treatment approaches briefly.

  2. Sudden onset of sleep due to hypothalamic lesions in neuromyelitis optica spectrum disorder positive for anti-aquaporin-4 antibody. (United States)

    Okuma, H; Matsumura, K; Hatanaka, Y; Saito, F; Sonoo, M


    We report a patient with neuromyelitis optica spectrum disorders who presented with sudden onset of sleep as the sole manifestation. Magnetic resonance imaging investigation revealed lesions in the hypothalamus bilaterally, which vanished completely after methylprednisolone pulse therapy.

  3. Light and electron microscopic lesions in peripheral nerves of broiler chickens due to roxarsone and lasalocid toxicoses. (United States)

    Gregory, D G; Vanhooser, S L; Stair, E L


    This paper characterizes the light microscopic and ultrastructural lesions in peripheral nerves caused by feeding lasalocid and roxarsone to broiler chickens. The birds were given three different doses of each compound: the standard industrial dose, 150% of the standard dose, and 200% of the standard dose. It was necessary to deprive the birds of water for 4 hours daily and heat-stress them in order to reproduce the lesion. Each compound caused mild microscopic lesions of swollen axons, digestion chambers, shrunken axons, or vacuoles where axons were missing. Ultrastructural changes included formation of myelin ellipsoids, vacuoles within or beneath the myelin sheath, and unraveling of myelin. These lesions were most frequently found in the birds receiving lasalocid.

  4. Ankaferd Blood Stopper for Controlling Gastrointestinal Bleeding due to Distinct Benign Lesions Refractory to Conventional Antihemorrhagic Measures

    Directory of Open Access Journals (Sweden)

    Mevlut Kurt


    Full Text Available OBJECTIVE: To assess the hemostatic efficacy of the Ankaferd Blood Stopper (ABS, Ankaferd Health Products Ltd, Turkey hemostatic agent for controlling gastrointestinal bleeding associated with various benign lesions refractory to conventional antihemorrhagic measures.

  5. IgG4-related disease: description of a case with pulmonary lesions, mediastinal lymphadenopathies and rapidly progressive renal failure. (United States)

    Fernández Lorente, Loreto; Álvarez, Dolores López; López, Virginia García; Kollros, Vesna Abujder; Ariza, Aurelio; Gálvez, Alejandro; Bonet, Josep


    This is a case report of a 73-year-old man with new-onset acute renal failure while being investigated for pulmonary infiltrates and mediastinal lymphadenopathies. Urine tests showed tubular range proteinuria with no microhaematuria. Immunology tests showed elevated serum IgG and hypocomplementaemia (classical pathway activation). Renal biopsy and clinical-pathological correlation were crucial in this case, reinforcing their important role in the final diagnosis of acute kidney injury. Copyright © 2015. Published by Elsevier España, S.L.U.

  6. A single center kidney transplant experience among ten Caucasian females with end-stage renal disease due to scleroderma
. (United States)

    Saxena, Nishkarsh; Djamali, Arjang; Astor, Brad C; Mohamed, Maha; Mandelbrot, Didier; Parajuli, Sandesh


    There is limited information on kidney transplant recipients with end-stage renal disease (ESRD) due to scleroderma. We conducted an observational study on kidney transplant recipients with ESRD due to scleroderma who received kidney transplant at our center between 01/1994 and 06/2013. During the study period, there were 10 kidney transplant recipients, all of whom were Caucasian females. Seven of them were living-donor kidney transplant recipients, and the mean age at time of transplant was 56.6 ± 11.99 years. The mean post-transplant follow-up was 76.75 ± 56.18 months; the mean dialysis vintage was 46.4 ± 80.35 months, ranging from 8 to 272 months; and the mean serum creatinine (Cr) levels at 3, 6, and 12 months were 1.31 ± 0.47 mg/dL, 1.35 ± 0.51 mg/dL, and 1.34 ± 0.49 mg/dL, respectively. There were 5 graft failures with median graft survival of 101 months. None had recurrence of scleroderma renal crisis. In those without graft failure, the mean serum Cr at last follow-up was 0.96 ± 0.39 mg/dL. Six patients were on angiotensin converting enzyme inhibitors (ACE-I) after transplant. In univariate analysis, none of the factors including, age at time of transplant, dialysis vintage, use of ACE-I, living-donor transplant, cytomegalovirus infection, and serum Cr at 1 year were predictive of graft failure. In our study, we hoped to find outcomes and various factors associated with graft failure in these patients. We found a wide variation in outcomes after kidney transplantation. More studies are needed to assess the factors that may influence the graft survival in this rare disease.

  7. Malignancy rates and diagnostic performance of the Bosniak classification for the diagnosis of cystic renal lesions in computed tomography - a systematic review and meta-analysis

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    Sevcenco, Sabina; Shariat, Shahrokh F. [Medical University of Vienna, Department of Urology, Vienna (Austria); Spick, Claudio; Helbich, Thomas H.; Baltzer, Pascal A. [Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, General Hospital Vienna, Vienna (Austria); Heinz, Gertraud [University Hospital of Sankt-Poelten, Department of Radiology, Poelten (Austria); Klingler, Hans C. [Wilhelminenspital, Department of Urology, Vienna (Austria); Rauchenwald, Michael [Donauspital, Department of Urology, Vienna (Austria)


    To systematically review the literature on the Bosniak classification system in CT to determine its diagnostic performance to diagnose malignant cystic lesions and the prevalence of malignancy in Bosniak categories. A predefined database search was performed from 1 January 1986 to 18 January 2016. Two independent reviewers extracted data on malignancy rates in Bosniak categories and several covariates using predefined criteria. Study quality was assessed using QUADAS-2. Meta-analysis included data pooling, subgroup analyses, meta-regression and investigation of publication bias. A total of 35 studies, which included 2,578 lesions, were investigated. Data on observer experience, inter-observer variation and technical CT standards were insufficiently reported. The pooled rate of malignancy increased from Bosniak I (3.2 %, 95 % CI 0-6.8, I{sup 2} = 5 %) to Bosniak II (6 %, 95 % CI 2.7-9.3, I{sup 2} = 32 %), IIF (6.7 %, 95 % CI 5-8.4, I{sup 2} = 0 %), III (55.1 %, 95 % CI 45.7-64.5, I{sup 2} = 89 %) and IV (91 %, 95 % CI 87.7-94.2, I{sup 2} = 36). Several study design-related influences on malignancy rates and subsequent diagnostic performance indices were identified. The Bosniak classification is an accurate tool with which to stratify the risk of malignancy in renal cystic lesions. (orig.)

  8. Wegener's granulomatosis with renal involvement: patient survival and correlations between initial renal function, renal histology, therapy and renal outcome. (United States)

    Andrassy, K; Erb, A; Koderisch, J; Waldherr, R; Ritz, E


    Patient survival and renal outcome were followed in 25 patients with biopsy confirmed Wegener's granulomatosis and renal involvement. Fourteen out of 25 patients required dialysis on admission, 11/25 patients did not. All patients were treated with a novel protocol comprising methylprednisolone and cyclophosphamide. The median follow-up observation was 36 months (12-113 months). With the exception of 1 patient (who died from causes not related to Wegener's granulomatosis) all patients are alive. Among the patients initially requiring dialysis (n = 14) 4 are in terminal renal failure after 0, 7, 21 and 38 months respectively. In the nondialysis group (n = 11) only 1 patient subsequently required chronic dialysis 30 months after clinical admission. Renal failure was due to non-compliance with immunosuppressive therapy in at least 2 patients. Percentage of obsolescent glomeruli and the degree of tubulointerstitial lesions, but not active glomerular lesions (crescents, necroses) predicted renal outcome. The major cause of renal functional impairment was relapse of Wegener's granulomatosis usually within 2 years after clinical remission. Therefore prolonged treatment with cyclophosphamide for at least 2 years after clinical remission is recommended. Two patients with initially negative immunohistology had a second renal biopsy which revealed de novo appearance of mesangial IgA deposits.

  9. Adhesions due to peritoneal carcinomatosis caused by a renal carcinoma leading to mechanical gastric outlet obstruction: a case report

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    Gruttadauria Salvatore


    Full Text Available Abstract Introduction Gastric outlet obstruction is a clinical syndrome caused by a variety of mechanical obstructions. Peptic ulcer disease used to be responsible for most gastric outlet obstruction, but in the last 40 years the prevalence of malignant tumors has risen significantly. Adhesive disease is an infrequent and insidious cause of mechanical gastric outlet obstruction. Case presentation We report the case of a 78-year-old Caucasian man who had a clinical history of a right nephrectomy for malignancy three years earlier and who was admitted for a severe gastric outlet obstruction (score of 1 confirmed both by an upper endoscopy and by a fluoroscopic view after contrast injection. A computed tomography scan and a laparotomy, with omental biopsies, showed a peritoneal carcinomatosis with the development of abdominal adhesions that prompted an abnormal gastric rotation around the perpendicular axis of his antrum with a dislocation in the empty space of his right kidney. Symptoms disappeared after surgical bypass through a gastrojejunostomy. Conclusions Our patient experienced a very rare complication characterized by the development of adhesions due to peritoneal carcinomatosis caused by a renal carcinoma treated with nephrectomy. These adhesions prompted an abnormal dislocation of his antrum, as an internal hernia, in the empty space of his right kidney.

  10. Vesicourethral reflux-induced renal failure in a patient with ICF syndrome due to a novel DNMT3B mutation. (United States)

    Kutluğ, Seyhan; Ogur, Gönül; Yilmaz, Aysegül; Thijssen, Peter E; Abur, Ummet; Yildiran, Alisan


    ICF syndrome is a primary immunodeficiency disease characterized by hypo- or agammaglobulinemia, centromeric instability mainly on chromosomes 1, 9, and 16 and facial anomalies. ICF syndrome presents with frequent respiratory tract infections in infancy. A 20-month-old female patient was referred to our clinic due to frequent lower respiratory tract infections. ICF syndrome was considered because of comorbidity of hypogammaglobulinemia, facial anomalies, and neuromotor growth retardation. Metaphase chromosome analysis revealed centromeric instability on chromosomes 1, 9, and 16 and through Sanger a previously unreported homozygous missense mutation (c.1805T>C; [p.V602A]) was identified in the DNMT3B, confirming ICF1. The patient was found to have a breakdown in renal function 1 year later; the urinary system was examined and bilateral vesicoureteral reflux was found, warranting the need for dialysis in time. This report expands the mutation spectrum of ICF1 and is the first to describe bilateral vesicoureteral reflux accompanying ICF syndrome. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  11. Spontaneous Retroperitoneal Hemorrhage (Wunderlich Syndrome due to Large Upper Pole Renal Angiomyolipoma: Does Robotic-Assisted Laparoscopic Partial Nephrectomy Have a Role in Primary Treatment?

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    Achilles Ploumidis


    Full Text Available Spontaneous rapture with consequent retroperitoneal hemorrhage (Wunderlich’s syndrome is the complication mostly feared from large renal angiomyolipomas (RAMLs. In hemodynamic stable patients, minimal invasive therapies have superseded open surgery as the mainstay of treatment, with contemporary cases mostly treated by selective arterial embolization. Robotic-assisted laparoscopic partial nephrectomy (RALPN is an established minimal access treatment that has been used in the past for benign and malignant lesions of the kidney in the elective setting, but rarely in urgent situations as primary treatment. We present a case of a ruptured RAML in a young female treated effectively by RALPN.

  12. Validity of semi-quantitative scale for brain MRI in unilateral cerebral palsy due to periventricular white matter lesions: Relationship with hand sensorimotor function and structural connectivity

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    Simona Fiori


    Conclusion: The sqMRI scale demonstrates first evidence of construct validity against impaired motor and sensory function measures and brain structural connectivity in a cohort of children with UCP due to PWM lesions. More severe lesions correlated with poorer paretic hand sensorimotor function and impaired structural connectivity in the hemisphere contralateral to the clinical side of hemiplegia. The quantitative structural MRI scoring may be a useful clinical tool for studying brain structure–function relationships but requires further validation in other populations of CP.

  13. Increased expression of p38 mitogen- activated protein kinase is related to the acute renal lesions induced by gentamicin

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    Volpini R.A.


    Full Text Available Mitogen-activated protein kinases (MAPK may be involved in the pathogenesis of acute renal failure. This study investigated the expression of p-p38 MAPK and nuclear factor kappa B (NF-kappaB in the renal cortex of rats treated with gentamicin. Twenty rats were injected with gentamicin, 40 mg/kg, im, twice a day for 9 days, 20 with gentamicin + pyrrolidine dithiocarbamate (PDTC, an NF-kappaB inhibitor, 14 with 0.15 M NaCl, im, twice a day for 9 days, and 14 with 0.15 M NaCl , im, twice a day for 9 days and PDTC, 50 mg kg-1 day-1, ip, twice a day for 15 days. The animals were killed 5 and 30 days after the last of the injections and the kidneys were removed for histological, immunohistochemical and Western blot analysis and for nitrate determination. The results of the immunohistochemical study were evaluated by counting the p-p38 MAPK-positive cells per area of renal cortex measuring 0.05 mm². Creatinine was measured by the Jaffé method in blood samples collected 5 and 30 days after the end of the treatments. Gentamicin-treated rats presented a transitory increase in plasma creatinine levels. In addition, animals killed 5 days after the end of gentamicin treatment presented acute tubular necrosis and increased nitrate levels in the renal cortex. Increased expression of p-p38 MAPK and NF-kappaB was also observed in the kidneys from these animals. The animals killed 30 days after gentamicin treatment showed residual areas of interstitial fibrosis in the renal cortex, although the expression of p-p38 MAPK in their kidneys did not differ from control. Treatment with PDTC reduced the functional and structural changes induced by gentamicin as well as the expression of p-p38 MAPK and NF-kappaB. The increased expression of p-p38 MAPK and NF-kappaB observed in these rats suggests that these signaling molecules may be involved in the pathogenesis of tubulointerstitial nephritis induced by gentamicin.

  14. Hidrocolpo por ectopia ureteral em hemivagina associado a displasia renal: relato de caso e revisão da literatura Congenital hydrocolpos due to ectopic ureter in hemivagina associated with renal dysplasia: a case report and review of the literature

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    Mario Flores Barba


    Full Text Available Os autores apresentam um caso de displasia renal associada a ectopia ureteral vaginal homolateral, com uretero-hidronefrose contralateral devida a compressão por hidrocolpo causado pela ectopia e por um septo vaginal oblíquo. Os exames de imagem utilizados foram urografia excretora, cistografia, ultra-sonografia, tomografia computadorizada e cintilografia renal com Tc-99m-DMSA. Foi realizada revisão da literatura sobre casos de hidrocolpo associado a malformações urinárias.The authors report a case of congenital hydrocolpos due to vaginal malformation (vaginal septae associated with ectopic ureter and renal displasia. Several imaging diagnostic procedures (ultrasonography, nuclear medicine, intravenous urography and computed tomography were performed. A review of the literature on hydrocolpos and its association with urinary malformations is also presented.

  15. Clinical response to glycyrrhizinic acid in genital infection due to human papillomavirus and low-grade squamous intraepithelial lesion

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    Marcelino Hernandez Valencia


    Full Text Available Human papilloma virus (HPV can infect any of the mucosal areas of the body and cause cervical cancer. Until recently, no specific treatments were available for this condition; therefore, any damaged tissue had to be removed or destroyed, which may have presented obstetrical repercussions for some women. Recently, new drugs have been developed that have shown to be effective for the cure of HPV infection. Glycyrrhizinic acid (GA has shown fewer side effects and its systemic use makes it possible to reach difficultto- treat lesions. The purpose of this study was to evaluate the clinical outcome of GA to eliminate the epithelial lesion and HPV. We carried out a longitudinal, descriptive study that included women of reproductive age who were diagnosed with HPV associated with low-grade squamous intraepithelial lesion (LSIL. Subjects began treatment based on GA using two routes of administration - systemic (oral and topical (spray - with assessments every month to determine the clinical changes of the lesions through colposcopy and Papanicolaou (Pap smear. Simple statistics were used along with two-tailed Student’s t-test; P<0.05 was considered statistically significant before and after treatment. There were 70 eligible patients, of whom 62 fulfilled the inclusion criteria. Age of subjects was 27.8±9.5 years. At the time of the study, 100% of the patients had HPV infection, 40% were associated with LSIL, and only 16% used a barrier contraceptive (condom method. Resolution was achieved in all patients from 4 weeks of treatment initiation and improvement was achieved in the majority of patients at 12 weeks (74% (P<0.001. However, there was persistence of LSIL in 27.7% of patients and only one patient progressed to cervical intraepithelial neoplasia (CIN II. The use of GA proved to be effective in resolving clinical HPV lesions. For cervical lesions with epithelial changes (LSIL, treatment may be required for a longer period as with other drugs used

  16. Papilledema due to a permanent catheter for renal dialysis and an arteriovenous fistula: a "two hit" hypothesis. (United States)

    Simon, Melissa A; Duffis, Ennis J; Curi, Michael A; Turbin, Roger E; Prestigiacomo, Charles J; Frohman, Larry P


    Elevated intracranial pressure in patients with chronic renal failure has several potential causes. Its rare occurrence secondary to the hemodynamic effects of hemodialysis is described and the findings support a multifactorial etiology ("two hits").

  17. Aquaporin-1 Protein Levels Elevated in Fresh Urine of Renal Cell Carcinoma Patients: Potential Use for Screening and Classification of Incidental Renal Lesions

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    Shilpa Sreedharan


    Full Text Available Introduction and Objectives. There are over 65,000 new cases of renal cell carcinoma (RCC each year, yet there is no effective clinical screening test for RCC. A single report claimed no overlap between urine levels of aquaporin-1 (AQP1 in patients with and without RCC (Mayo Clin Proc. 85:413, 2010. Here, we used archived and fresh RCC patient urine to validate this report. Methods. Archived RCC, fresh prenephrectomy RCC, and non-RCC negative control urines were processed for Western blot analysis. Urinary creatinine concentrations were quantified by the Jaffe reaction (Nephron 16:31, 1976. Precipitated protein was dissolved in 1x SDS for a final concentration of 2 μg/µL creatinine. Results. Negative control and archived RCC patient urine failed to show any AQP1 protein by Western blot analysis. Fresh RCC patient urine is robustly positive for AQP1. There was no signal overlap between fresh RCC and negative control, making differentiation straightforward. Conclusions. Our data confirms that fresh urine of patients with RCC contains easily detectable AQP1 protein. However, archival specimens showed an absence of detectable AQP1 indistinguishable from negative control. These findings suggest that a clinically applicable diagnostic test for AQP1 in fresh urine may be useful for detecting RCC.

  18. A new mouse model for renal lesions produced by intravenous injection of diphtheria toxin A-chain expression plasmid

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    Nakamura Shingo


    Full Text Available Abstract Background Various animal models of renal failure have been produced and used to investigate mechanisms underlying renal disease and develop therapeutic drugs. Most methods available to produce such models appear to involve subtotal nephrectomy or intravenous administration of antibodies raised against basement membrane of glomeruli. In this study, we developed a novel method to produce mouse models of renal failure by intravenous injection of a plasmid carrying a toxic gene such as diphtheria toxin A-chain (DT-A gene. DT-A is known to kill cells by inhibiting protein synthesis. Methods An expression plasmid carrying the cytomegalovirus enhancer/chicken β-actin promoter linked to a DT-A gene was mixed with lipid (FuGENE™6 and the resulting complexes were intravenously injected into adult male B6C3F1 mice every day for up to 6 days. After final injection, the kidneys of these mice were sampled on day 4 and weeks 3 and 5. Results H-E staining of the kidney specimens sampled on day 4 revealed remarkable alterations in glomerular compartments, as exemplified by mesangial cell proliferation and formation of extensive deposits in glomerular basement membrane. At weeks 3 and 5, gradual recovery of these tissues was observed. These mice exhibited proteinuria and disease resembling sub-acute glomerulonephritis. Conclusions Repeated intravenous injections of DT-A expression plasmid DNA/lipid complex caused temporary abnormalities mainly in glomeruli of mouse kidney. The disease in these mice resembles sub-acute glomerulonephritis. These DT-A gene-incorporated mice will be useful as animal models in the fields of nephrology and regenerative medicine.

  19. Spiral swimming behavior due to cranial and vertebral lesions associated with Cytophaga psychrophila infections in salmonid fishes (United States)

    Kent, M.L.; Groff, J.M.; Morrison, J.K.; Yasutake, W.T.; Holt, R.A.


    C. psychrophila infections of the cranium and anterior vertebrae in salmonid fishes were associated with ataxia, spiral swimming along the axis of the fish, and death. The syndrome was observed in 2-10% of underyearling coho salmon Oncorhynchus kisutch, rainbow troutSalmo gairdneri, and steelhead trout S. gairdneri at several private, state, and federal hatcheries in Washington and Oregon, USA, between 1963 and 1987. Affected fish did not recover and ultimately died. Histological examination consistently revealed subacute to chronic periostitis, osteitis, meningitis, and ganglioneuritis. Inflammation and periosteal proliferation of the anterior vertebrae at the junction of the vertebral column with the cranium with extension into the cranial case was a consistent feature. The adjacent nervous tissue, particularly the medulla, was often compressed by the proliferative lesion, and this may have caused the ataxia. Though bacteria were seldom observed in these lesions. C. psychrophilawas isolated in culture from the cranial cavity of all affected fish that were tested. Epidemiological observations suggested that this bacterium is the causative agent because the spiral swimming behaviour and lesions were observed only in populations that had recovered from acute C. psychrophila infections.

  20. Comparison of 1.0 M gadobutrol and 0.5 M gadopentate dimeglumine-enhanced MRI in 471 patients with known or suspected renal lesions: Results of a multicenter, single-blind, interindividual, randomized clinical phase III trial

    NARCIS (Netherlands)

    B. Tombach (Bernd); K. Bohndorf (Klaus); W. Brodtrager (Wolfgang); C.D. Claussen (Claus); C. Düber (Christoph); M. Galanski (Michael); E. Grabbe (Eckhardt); G. Gortenuti (Giacomo); M. Kuhn (Michael); W. Gross-Fengels (Walter); R. Hammerstingl (Renate); B. Happel (Brigitte); G. Heinz-Peer (Gertraud); G. Jung (Gregor); T. Kittner (Thomas); R. Lagalla; P. Lengsfeld (Philipp); R. Loose (Reinhard); R.H.G. Oyen (Raymond); P. Pavlica (Pietro); C. Pering (Christiane); R. Pozzi Mucelli (Roberto Silvio); T. Persigehl (Thorsten); P. Reimer (Peter); N.S. Renken (Nomdo); G.M. Richter (Götz); E.J. Rummeny (Ernst); F. Schäfer (Fritz); M. Szczerbo-Trojanowska (Malgorzata); A. Urbanik (Andrzej); T.J. Vogl (Thomas); P. Hajek (Paul)


    textabstractThe purpose of this phase III clinical trial was to compare two different extracellular contrast agents, 1.0 M gadobutrol and 0.5 M gadopentate dimeglumine, for magnetic resonance imaging (MRI) in patients with known or suspected focal renal lesions. Using a multicenter, single-blind, in

  1. Dosagem de marcadores de lesão endotelial em pacientes com doença renal crônica em hemodiálise Endothelial lesion markers dosage in chronic renal disease patients undergoing hemodialysis

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    Cláudia Maria Pereira Alves


    atherosclerotic disease as the main cause of death. Inflammation and endothelial dysfunction are directly associated with atherosclerosis. Furthermore, the infection resulting from hepatitis C virus, common among such patients, would be another worsening factor of the inflammatory state. Increased levels of endothelial dysfunction markers are found in chronic renal disease and hepatitis C, which could be important markers of atherosclerosis among these subjects. OBJECTIVE: To compare endothelial activity in patients undergoing hemodialysis with and without hepatitis C. METHODOLOGY: We selected 28 patients undergoing hemodialysis and classified them into two groups: 1-HCV(+: 18 patients (anti-HCV[+] and PCR[+] and 2-HCV(-: 10 patients (anti-HCV[-]. Before the first weekly dialysis, blood samples from both groups were collected for ICAM-1, VEGF, ALT and TAP serum dosage. RESULTS: ICAM-1 levels were high in 60.71%. The highest levels were found in HCV(+ group, though not statistically significant (p = 0.2024. There was no correlation between ICAM-1 levels and the hemodialysis time or ALT levels in any group. On the other hand, VEGF levels were normal in 92.85%. Only two patients HCV(+ had high levels. There was also no correlation between VEGF levels and the dialysis time or ALT levels. CONCLUSION: Patients undergoing hemodialysis have high endothelial lesion, nevertheless, the presence of HCV chronic infection did not prove to be an aggravating factor. This result may be due to the small number of patients, hence further analyses with a larger sample are required for definitive conclusions.

  2. Cervical myelopathy due to single level disc herniation presenting as intramedullary mass lesion: What to do first?

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    Murat Sakir Eksi


    Full Text Available Cervical myelopathy (CM is mostly a degenerative process ending in myelopathic and/or radiculopathic syndromes. On T2-weighted magnetic resonance imaging (MRI, CM appears as a hyperintense area near the spondylotic spine. This high intensity signal depends on the impact of outer forces and their duration. It also determines the prognosis of the surgical candidate. A 40-year-old male patient admitted to our clinic with right upper extremity weakness and hypoesthesia that had started 2 months earlier. On neurological examination there was 2/5 motor weakness of right biceps brachii, and hypoesthesia over right C6 dermatome. Right upper extremity deep tendon reflexes were hypoactive, but lower ones were hyperactive. After clinical and radiological work-up, preliminary diagnosis was directed to a spinal intramedullary tumor. Total resection of the herniated cervical disc fragment and the mass lesion was managed. Pathology of the mass lesion was compatible with subacute infarct tissue and inflammatory response. Final diagnosis was CM under effect of cervical disc herniation. Contrast-enhanced spinal cord myelopathic lesions are very rare and resemble much more tumors and inflammatory processes. However, the principal treatment approach totally differs depending on pathology. When there are both a disc herniation and a high clinical suspicion; biopsy should be delayed. The most probable solution will be surgery for the disc disease with thorough preoperative scanning of vascular malformations; clinical and radiological close follow-up after surgery. Biopsy or surgical resection can be performed if patient deteriorates despite the primary surgery.

  3. Should Steroid Therapy Be Necessarily Needed for Autoimmune Pancreatitis Patients with Lesion Resected due to Misdiagnosed or Suspected Malignancy?

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    Wenchuan Wu


    Full Text Available To explore whether steroid therapy should be needed for autoimmune pancreatitis patients after operation, eight AIP patients receiving operation were enrolled in this study from January 2007 to July 2013. All patients underwent liver function, CA19-9, and contrast-enhanced CT and/or MRI. Tests of IgG and IgG4 were performed in some patients. Tests of serum TB/DB, γ-GT, and γ-globulin were undergone during the perioperative period. Six cases receiving resection were pathologically confirmed as AIP patients and two were confirmed by intraoperative biopsy. For seven patients, TB/DB level was transiently elevated 1 day or 4 days after operation but dropped below preoperative levels or to normal levels 7 days after operation, and serum γ-GT level presented a downward trend. Serum γ-globulin level exhibited a downward trend among six AIP patients after resection, while an upward trend was found in another two AIP patients receiving internal drainage. Steroid therapy was not given to all six AIP patients until two of them showed new lines of evidence of residual or extrapancreatic AIP lesion after operation, while another two cases without resection received steroid medication. Steroid therapy might not be recommended unless there are new lines of evidence of residual extrapancreatic AIP lesions after resection.

  4. Assessment of dysphonia due to benign vocal fold lesions by acoustic and aerodynamic indices: a multivariate analysis. (United States)

    Cantarella, Giovanna; Baracca, Giovanna; Pignataro, Lorenzo; Forti, Stella


    The goal was to identify acoustic and aerodynamic indices that allow the discrimination of a benign organic dysphonic voice from a normal voice. Fifty-three patients affected by dysphonia caused by vocal folds benign lesions, and a control group were subjected to maximum phonation time (MPT) measurements, GRB perceptual evaluations and acoustic/aerodynamic tests. All analyzed variables except the airflow variation coefficient were significantly different between the two groups. The unique significant factors in the discrimination between healthy and dysphonic subjects were the aerodynamic indices of MPT and Glottal efficiency index, and the acoustic index Shimmer. These results show that a combination of three parameters can discriminate a voice deviance and highlight the importance of a multidimensional assessment for objective voice evaluation.

  5. Frequent development of inflammatory lesions and lymphoid foci in the kidneys of Japanese wild crows (Corvus macrorhynchos and Corvus corone) as a result of the entry of causal agents via the renal portal blood. (United States)

    Hirata, Akihiro; Yonemaru, Kayoko; Kubo, Masahito; Murakami, Mami; Sakai, Hiroki; Yanai, Tokuma; Masegi, Toshiaki


    Although the increase in the number of wild crows is causing social problems in urban areas, crows play an increasingly important role in monitoring serious infectious diseases, such as highly pathogenic avian influenza and West Nile fever. To gain a better understanding of normal conditions and common disorders in crows, we conducted a retrospective study of wild crows captured in central Japan in the 1990s and examined the necropsy findings from 166 jungle crows (Corvus macrorhynchos) and 74 carrion crows (Corvus corone). We found frequent development of lymphoid foci and inflammatory lesions in the kidneys of both species of crows. These findings were unrelated to place or date of capture, indicating the universality of renal lesion developments in the Corvus species. In the kidneys, suppurative granulomas were concentrated in the renal cortex and the vein wall, indicating the haematoegenous spread of causal agents. However, the glomeruli remained intact, unlike the spreading of causal agents via arterial blood, which strongly suggested the renal portal blood as a possible entry route of causal agents. The renal lymphoid foci showed the same distribution as the granulomas, supporting the possibility of external agents entering through renal portal blood. We also identified types of parasites in Japanese wild crows by means of histopathological analysis. We hope that our data will contribute to the appropriate evaluation and a better understanding of pathological conditions in Japanese wild crows.

  6. ``Aggressive`` renal angiomyolipoma

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    Cittadini, G. Jr. [Univ. of Genoa (Italy). Dept. of Radiology; Pozzi Mucelli, F. [Univ. of Trieste (Italy). Dept. of Radiology; Danza, F.M. [Catholic Sacro Cuore Univ., Rome (Italy). Dept. of Radiology; Derchi, L.E. [Univ. of Genoa (Italy). Dept. of Radiology; Pozzi Mucelli, R.S. [Univ. of Trieste (Italy). Dept. of Radiology


    We describe the US and CT examinations of 4 patients with renal angiomyolipoma with an `aggressive` appearance, and review the literature. The imaging findings in 4 patients with benign renal angiomyolipomas associated with thrombosis of the renal vein and/or inferior vena cava are presented. CT demonstrated fat densities within both tumor and thrombus. In one patient, small lymph nodes with low density internal areas were detected in the para-aortic region. When considering our patients together with those reported in the literature, we found that most angiomyolipomas with venous invasion were large and centrally located within the kidney. Venous thrombosis was observed in 9 lesions of the right kidney, and in only 4 of the left one. One patient only had symptoms due to the thrombus; 10 had problems due to the tumor; and 3 were asymptomatic. Only 4 patients with pararenal enlarged lymph nodes have been reported on in the imaging literature. Fat-containing nodes were detected by CT in one case only; the others had enlarged nodes of soft-tissue density. In one patient the diagnosis of hamartomatous lymph node invasion was established by angiography. In patients with renal angiomyolipoma, demonstration of both fatty thrombus and the fatty infiltration of lymph nodes of the renal hilum cannot be regarded as an indication of malignancy, but only of local aggessive behavior. Conservative treatment seems possible. Detection of enlarged lymph nodes of soft tissue density may cause difficult diagnostic problems, with the diagnosis addressed only by the presence of associated lesions. (orig./MG).

  7. Diagnosis and differential diagnosis of renal occuping lesions by contrast-enhanced ultrasound%肾脏占位病变的超声造影诊断及鉴别诊断

    Institute of Scientific and Technical Information of China (English)

    刘春英; 王晓芳; 谢晴; 万贝贝; 盛夏; 王曼; 赵琳辉


    Objective To explore the diagnostic value of contrast - enhanced ultrasound( CEUS) in renal occuping lesions so as to improve the diagnosis and differential diagnosis level. Methods CEUS features of renal occuping lesions confirmed by pathology in 35 patients were retrospectively analyzed in combination with literature review. The enhancement degree, the homogeneity of enhancement, the pseudocapsule, the washing - in and washing - out time and the enhancement pattern were observed. Results CEUS showed there were 28 cases of malignant tumor, and 7 cases of benign lesions. Malignant tumors including 17 cases of renal cell carcinoma and 11 cases of renal pelvic carcinoma, benign lesions including 4 cases of renal angiomyolipoma and 3 cases of renal cysts. Most of renal cell carcinoma showed fast wash - in and fast wash - out, obviously heterogeneous diffuse enhancement and pseudocapsule formation. Most of renal pelvic carcinoma showed slow wash - in and fast wash - out, obviously homogeneous diffuse enhancement. Most of renal angiomyolipoma displayed fast wash - in and slow wash - out, centripetal enhacement, homogeneous and obvious enhacement. No enhancement was found in renal cysts. Conclusion CEUS has high value in diagnosis of renal occuping lesions and differential diagnosis of benign and malignant lesions.%目的 探讨超声造影对肾脏占位病变的诊断价值,提高其诊断及鉴别诊断水平.方法 对35例经穿刺或手术病理结果证实为肾脏占位病变患者的超声造影表现进行回顾分析,观察其增强程度、增强均匀度、假包膜征、增强、消退时间及增强方式.结果 超声造影示恶性肿瘤28例,良性病变7例.恶性肿瘤中肾癌17例,肾盂癌11例;良性病变中肾血管平滑肌脂肪瘤4例,肾囊肿3例.肾癌多表现为快进快出、弥漫性不均匀性明显增强及假包膜形成;肾盂癌多表现为慢进快出和弥漫性均匀性不明显增强;肾血管平滑肌脂肪多表现为快

  8. Secondary oxalosis due to excess vitamin C intake: A cause of graft loss in a renal transplant recipient

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    S Yaich


    Full Text Available Renal oxalate deposition can be seen with primary hyperoxaluria, malabsorptive states, ethylene glycol toxicity and, rarely, with excessive vitamin C ingestion. We report a case of secondary hyperoxaluria in which the diagnosis was not considered initially because there was no past history of urinary calculi and no evidence of nephrocalcinosis on plain X-ray of the abdomen and ultrasonography. The disease was detected and diagnosed only after kidney transplantation. Secondary oxalosis can cause graft loss or delayed graft function. Biopsy of the allograft should be carefully examined for oxalate deposits even in the absence of a family history. When oxalosis is diagnosed, intensifying hemodialysis (HD to eliminate calcium oxalate can help in the recovery of renal function in some cases. Systematic vitamin C supplementation in HD patients should be avoided as it can be a cause of secondary oxalosis.


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    Full Text Available Primary renal lymphoma (PRL is rare. They are variants of extranodal non-Hodgkins lymphoma. Lymphomatous involvement of the kidney is often seen as a part of disseminated disease. PRL can mimic other renal lesions such as renal cell carcinoma, renal abscess, and metastasis and may have aggressive clinical course. Pathological data are scanty and prognosis is usually poor with median survival less than a year. We present a rare case of a 22 year-old male who presented with acute febrile illness, respiratory problems and acute kidney injury. The clinical diagnosis was missed partly due to absence of obvious renal symptoms like renal mass lesion, gross hematuria or abdominal pain. However, radiological investigations combined with renal histology helped in establishing the diagnosis in the present case

  10. Acidosis láctica por metformina desencadenada por una insuficiencia renal aguda Metformin-induced lactic acidosis due to acute renal failure

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    M.D. Macías-Robles


    Full Text Available La acidosis láctica es una complicación grave pero infrecuente asociada al empleo de metformina. Se discuten los mecanismos fisiopatológicos implicados en la acidosis láctica, con especial atención al papel potencial del fármaco. Presentamos un caso severo de este efecto secundario de la metformina en una paciente con diabetes tipo 2 que ingresó en el Servicio de Urgencias Hospitalario por un cuadro de insuficiencia renal aguda. El diagnóstico quedó apoyado por unos niveles séricos elevados de la biguanida, procedimiento escasamente utilizado en la práctica clínica. El tratamiento consiste en suspender la administración del fármaco e iniciar de forma inmediata la hemodiálisis con bicarbonato, lo cual proporciona un tratamiento sintomático y etiológico al eliminar del suero tanto el lactato como el antidiabético oral. Los síntomas de la acidosis láctica por metformina son inespecíficos y el comienzo es sutil, lo que hace necesario un alto nivel de sospecha para establecer un diagnostico precoz.Lactic acidosis is a serious but uncommon side effect of metformin use. We discuss the pathophysiological mechanisms of lactic acidosis with particular regard to the role played by the drug as a potential cause of the entity. We report on a severe case of this kind of drug toxicity in a patient with type 2 diabetes mellitus, admitted to the emergency department with acute renal failure symptoms. The diagnosis was supported by elevated serum levels of the biguanide, a procedure scarcely used in clinical practice. The management of this complication consists in drug discontinuation and hemodialysis with bicarbonate that provides symptomatic and ethiological treatment by removing both the lactate and the hypoglycemic agent from the serum. Since the symptoms of metformin-associated lactic acidosis are unspecific and its onset is subtle, a high level of suspicion is needed to establish an early diagnosis.

  11. Renal infarction due to polyarteritis nodosa in a patient with angioimmunoblastic T-cell lymphoma: a case report and a brief review of the literature. (United States)

    Ambrosio, Maria Raffaella; Rocca, Bruno Jim; Ginori, Alessandro; Onorati, Monica; Fabbri, Alberto; Carmellini, Mario; Lazzi, Stefano; Tripodi, Sergio


    Angioimmunoblastic T-cell lymphoma is one of the most common subtypes of peripheral T-cell lymphoma (15-20% of all cases), accounting for approximately 1-2% of all non-Hodgkin lymphomas. It often presents autoimmune phenomena including hemolytic anemia, thrombocytopenia, glomerulonephrities and circulating immune complexes. Polyarteritis nodosa is an autoimmune disease characterized by necrotizing vasculitis of medium vessels, which rarely develops in association with hematological malignant disorders. Herein we report the case of a 40-year-old man who underwent lymph node biopsy in the suspicious of sarcoidosis. On the basis of histological and immunohistochemical findings, the diagnosis of angioimmunoblastic T-cell lymphoma was performed. The patient was successfully treated with cytarabine-based regimen for 6 cycles. Three months after the initial diagnosis of angioimmunoblastic T-cell lymphoma, a whole body computed tomography showed a lesion in the lower pole of the left kidney. Renal cell carcinoma was suspected, thus a nephrectomy was carried out. The histological findings were compatible with polyarteritis nodosa. To the best of our knowledge, the association between polyarteritis nodosa and angioimmunoblastic T-cell lymphoma has been described only once. This relation may be secondary to the induction of an autoimmune phenomenon by the lymphoma with the formation of circulating immune complexes, leading to vessels walls injury. A careful evaluation is needed in the management of angioimmunoblastic T-cell lymphoma patients with signs of renal failure in order to avoid delay of treatment and organ damage.

  12. Renal infarction due to polyarteritis nodosa in a patient with angioimmunoblastic T-cell lymphoma: a case report and a brief review of the literature

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    Ambrosio Maria


    Full Text Available Abstract Angioimmunoblastic T-cell lymphoma is one of the most common subtypes of peripheral T-cell lymphoma (15-20% of all cases, accounting for approximately 1-2% of all non-Hodgkin lymphomas. It often presents autoimmune phenomena including hemolytic anemia, thrombocytopenia, glomerulonephrities and circulating immune complexes. Polyarteritis nodosa is an autoimmune disease characterized by necrotizing vasculitis of medium vessels, which rarely develops in association with hematological malignant disorders. Herein we report the case of a 40-year-old man who underwent lymph node biopsy in the suspicious of sarcoidosis. On the basis of histological and immunohistochemical findings, the diagnosis of angioimmunoblastic T-cell lymphoma was performed. The patient was successfully treated with cytarabine-based regimen for 6 cycles. Three months after the initial diagnosis of angioimmunoblastic T-cell lymphoma, a whole body computed tomography showed a lesion in the lower pole of the left kidney. Renal cell carcinoma was suspected, thus a nephrectomy was carried out. The histological findings were compatible with polyarteritis nodosa. To the best of our knowledge, the association between polyarteritis nodosa and angioimmunoblastic T-cell lymphoma has been described only once. This relation may be secondary to the induction of an autoimmune phenomenon by the lymphoma with the formation of circulating immune complexes, leading to vessels walls injury. A careful evaluation is needed in the management of angioimmunoblastic T-cell lymphoma patients with signs of renal failure in order to avoid delay of treatment and organ damage.

  13. Renal cell carcinoma with metastasis to the submandibular and parotid glands A case report

    NARCIS (Netherlands)

    Smits, J.G.; Slootweg, P.J.


    Differential diagnosis between acinic cell carcinoma and renal cell carcinoma is an oft-quoted problem. A case is presented of a 60-year-old woman with metastatic lesions from a renal cell carcinoma to the parotid as well as the submandibular gland. Appropriate diagnosis was delayed due to lack of c

  14. Modeling and Simulation for Estimating the Influence of Renal Dysfunction on the Hypouricemic Effect of Febuxostat in Hyperuricemic Patients Due to Overproduction or Underexcretion of Uric Acid. (United States)

    Hirai, Toshinori; Kimura, Toshimi; Echizen, Hirotoshi


    Whether renal dysfunction influences the hypouricemic effect of febuxostat, a xanthine oxidase (XO) inhibitor, in patients with hyperuricemia due to overproduction or underexcretion of uric acid (UA) remains unclear. We aimed to address this question with a modeling and simulation approach. The pharmacokinetics (PK) of febuxostat were analyzed using data from the literature. A kinetic model of UA was retrieved from a previous human study. Renal UA clearance was estimated as a function of creatinine clearance (CLcr) but non-renal UA clearance was assumed constant. A reversible inhibition model for bovine XO was adopted. Integrating these kinetic formulas, we developed a PK-pharmacodynamic (PK-PD) model for estimating the time course of the hypouricemic effect of febuxostat as a function of baseline UA level, febuxostat dose, treatment duration, body weight, and CLcr. Using the Monte Carlo simulation method, we examined the performance of the model by comparing predicted UA levels with those reported in the literature. We also modified the models for application to hyperuricemia due to UA overproduction or underexcretion. Thirty-nine data sets comprising 735 volunteers or patients were retrieved from the literature. A good correlation was observed between the hypouricemic effects of febuxostat estimated by our PK-PD model and those reported in the articles (observed) (r=0.89, p<0.001). The hypouricemic effect was estimated to be augmented in patients with renal dysfunction irrespective of the etiology of hyperuricemia. While validation in clinical studies is needed, the modeling and simulation approach may be useful for individualizing febuxostat doses in patients with various clinical characteristics.

  15. Assessment of the structural brain network reveals altered connectivity in children with unilateral cerebral palsy due to periventricular white matter lesions. (United States)

    Pannek, Kerstin; Boyd, Roslyn N; Fiori, Simona; Guzzetta, Andrea; Rose, Stephen E


    Cerebral palsy (CP) is a term to describe the spectrum of disorders of impaired motor and sensory function caused by a brain lesion occurring early during development. Diffusion MRI and tractography have been shown to be useful in the study of white matter (WM) microstructure in tracts likely to be impacted by the static brain lesion. The purpose of this study was to identify WM pathways with altered connectivity in children with unilateral CP caused by periventricular white matter lesions using a whole-brain connectivity approach. Data of 50 children with unilateral CP caused by periventricular white matter lesions (5-17 years; manual ability classification system [MACS] I = 25/II = 25) and 17 children with typical development (CTD; 7-16 years) were analysed. Structural and High Angular Resolution Diffusion weighted Images (HARDI; 64 directions, b = 3000 s/mm(2)) were acquired at 3 T. Connectomes were calculated using whole-brain probabilistic tractography in combination with structural parcellation of the cortex and subcortical structures. Connections with altered fractional anisotropy (FA) in children with unilateral CP compared to CTD were identified using network-based statistics (NBS). The relationship between FA and performance of the impaired hand in bimanual tasks (Assisting Hand Assessment-AHA) was assessed in connections that showed significant differences in FA compared to CTD. FA was reduced in children with unilateral CP compared to CTD. Seven pathways, including the corticospinal, thalamocortical, and fronto-parietal association pathways were identified simultaneously in children with left and right unilateral CP. There was a positive relationship between performance of the impaired hand in bimanual tasks and FA within the cortico-spinal and thalamo-cortical pathways (r(2) = 0.16-0.44; p treatment may elucidate the neurological correlates of improved functioning due to intervention.

  16. Cutaneous fungal infection in a renal transplantation patient due to a rare fungus belonging to order Pleosporales

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    S Galipothu


    Full Text Available Fungal infections are being increasingly reported from immuno-compromised as well as immuno-competent patients. Transplant patients are on long term immunosuppressive therapy which makes them highly vulnerable to opportunistic fungal infections .These infections can be cutaneous or systemic. Several fungi have been reported to be the culprits such as Candida spp., Aspergillus spp., C. neoformans, P. carinii, and zygomycetes group of fungi. Cutaneous infections are most commonly caused by Pityriasis (tinea versicolor, dermatophytes, and candida sp but these days the demtiaceous fungi are becoming more frequently reported .Here we report a case of post renal transplant cutaneous infection caused by dematiaceous fungus belonging to the order Pleosporales

  17. [Two elderly case reports of renal excretion type drug poisoning caused by dehydration that was due to poor eating in home care]. (United States)

    Ibata, Takeshi; Hinokiyama, Hiromi; Nakashita, Chisako; Mito, Saori; Doi, Seiko; Shiki, Satomi; Hata, Akiko; Sato, Miyuki; Komuro, Ryutaro; Iijima, Hohei


    The elderly patients are susceptible to acute renal failure due to dehydration or infection. Therefore, the drug should be administered with caution. We report two cases of acute renal failure from dehydration that led to a subsequent drug poisoning. Case 1: An 85-year-old woman with a history of colorectal cancer surgery was admitted to our emergency department for appetite loss and weakness. Because she was given a normal amount of drugs under the condition of poor oral intake, she was hospitalized by digitalism. Case 2: A 72-year-old woman was admitted to our emergency department for disturbance of consciousness and appetite loss. The medication given by a staff in geriatric health services facility appeared to have caused a pilsicainide poisoning. As the elderly patients were given a normal amount of drugs under the poor oral intake condition, blood levels of renal excretion type drug had increased in both cases. Medication management for the elderly should be comprehensively considered the background of the individual.

  18. Interstitial renal fibrosis due to multiple cisplatin treatments is ameliorated by semicarbazide-sensitive amine oxidase inhibition. (United States)

    Katagiri, Daisuke; Hamasaki, Yoshifumi; Doi, Kent; Negishi, Kousuke; Sugaya, Takeshi; Nangaku, Masaomi; Noiri, Eisei


    Elucidation of acute kidney diseases and disorders (AKD), including acute kidney injury (AKI), is important to prevent their progression to chronic kidney disease. Current animal AKI models are often too severe for use in evaluating human AKI. Therefore, new animal models of mild kidney injury are needed. Here a new clinically relevant animal model using multiple low doses of cisplatin (CP) was used to evaluate AKD. When 10 mg/kg CP was administered intraperitoneally once weekly for three times to L-type fatty acid-binding protein (L-FABP) transgenic mice, moderate renal interstitial fibrosis and tubule dilatation occurred, accompanied by brush-border loss. Urinary L-FABP, a promising biomarker of AKI, changed more drastically than blood urea nitrogen or creatinine. Preventing fibrosis in organs was also studied. Oral administration of a recently reported selective semicarbazide-sensitive amine oxidase inhibitor, PXS-4728A, for 1 week attenuated kidney injury and interstitial fibrosis compared with vehicle. Inhibition of renal lipid accumulation in semicarbazide-sensitive amine oxidase inhibitor-treated mice, together with reduced oxidative stress and L-FABP suppression in proximal tubules, suggested an antifibrotic effect of semicarbazide-sensitive amine oxidase inhibition in this CP-AKD model, a representative onco-nephrology. Thus, semicarbazide-sensitive amine oxidase inhibitors may be promising candidates for the prevention of chronic kidney disease in patients using CP to treat malignancy.

  19. Alterations of renal phenotype and gene expression profiles due to protein overload in NOD-related mouse strains

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    Agarwal Anupam


    Full Text Available Abstract Background Despite multiple causes, Chronic Kidney Disease is commonly associated with proteinuria. A previous study on Non Obese Diabetic mice (NOD, which spontaneously develop type 1 diabetes, described histological and gene expression changes incurred by diabetes in the kidney. Because proteinuria is coincident to diabetes, the effects of proteinuria are difficult to distinguish from those of other factors such as hyperglycemia. Proteinuria can nevertheless be induced in mice by peritoneal injection of Bovine Serum Albumin (BSA. To gain more information on the specific effects of proteinuria, this study addresses renal changes in diabetes resistant NOD-related mouse strains (NON and NOD.B10 that were made to develop proteinuria by BSA overload. Methods Proteinuria was induced by protein overload on NON and NOD.B10 mouse strains and histology and microarray technology were used to follow the kidney response. The effects of proteinuria were assessed and subsequently compared to changes that were observed in a prior study on NOD diabetic nephropathy. Results Overload treatment significantly modified the renal phenotype and out of 5760 clones screened, 21 and 7 kidney transcripts were respectively altered in the NON and NOD.B10. Upregulated transcripts encoded signal transduction genes, as well as markers for inflammation (Calmodulin kinase beta. Down-regulated transcripts included FKBP52 which was also down-regulated in diabetic NOD kidney. Comparison of transcripts altered by proteinuria to those altered by diabetes identified mannosidase 2 alpha 1 as being more specifically induced by proteinuria. Conclusion By simulating a component of diabetes, and looking at the global response on mice resistant to the disease, by virtue of a small genetic difference, we were able to identify key factors in disease progression. This suggests the power of this approach in unraveling multifactorial disease processes.

  20. Renal trauma in occult ureteropelvic junction obstruction: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Sebastia, M.C.; Rodriguez-Dobao, M.; Quiroga, S.; Pallisa, E.; Martinez-Rodriguez, M.; Alvarez-Castells, A. [Dept. of Radiology, Hospital General Universitari Vall d`Hebron, Barcelona (Spain)


    The aim of this study was to present CT findings of occult ureteropelvic junction obstruction in patients with renal trauma and to describe the clinical signs and singular CT features that are characteristically observed with trauma and are relevant to management of these patients. We retrospectively reviewed 82 helical CT studies in patients with renal trauma referred to our institution. We found 13 cases of occult preexisting renal pathology, six of which were occult ureteropelvic junction obstructions. The clinical presentation, radiologic findings of trauma according to the Federle classification, and CT findings of obstructed ureteropelvic junction are presented. We found three category-I lesions (one in a horseshoe kidney), two of them treated with nephrostomy because of increased ureteropelvic junction obstruction due to pelvic clots; two category-II lesions (parenchymal and renal pelvis lacerations) that had presented only with microhematuria; and one category-IV lesion (pelvic laceration alone). Pelvic extension was demonstrated in all the cases with perirenal collections. The CT studies in all the cases with suspected ureteropelvic junction obstruction showed decreased parenchymal thickness and enhancement, and dilatation of the renal pelvis and calyx, with a normal ureter. Computed tomography can provide information to confidently diagnose underlying ureteropelvic junction obstruction in renal trauma, categorize the traumatic injury (at times clinically silent) and facilitate proper management according to the singularities observed, such us rupture of the renal pelvis alone (Federle category IV) and increasing ureteropelvic obstruction due to clots which can be decompressed by nephrostomy. (orig.) With 6 figs., 3 tabs., 13 refs.

  1. 18 F-FDG avid lesion due to coexistent fibrous dysplasia in a child of embryonal rhabdomyosarcoma: Source of false positive FDG-PET

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    Basu Sandip


    Full Text Available With increasing use of 18 F-fluorodeoxyglucose (FDG-positron emission tomography (PET in the current oncological practice, there is a growing body of evidence of false positive scans due to various benign conditions. In this communication we present intensely avid 18 F-FDG uptake in fibrous dysplasia of right tibia in a 12-year-old child suffering from embryonal rhabdomyosarcoma (ERMS that could have been easily mistaken to be a metastatic focus if not carefully correlated. The patient was a case of ERMS (presenting with left cervical mass with intrathoracic extension who was treated successfully with chemotherapy and was referred for FDG-PET to evaluate the disease status. His whole body survey was unremarkable except for an intensely avid FDG uptake (SUV max 8.5 in shaft of right tibia. The scan was extended up to foot in view of the fact that a prior bone scan had shown a focal uptake in the similar location. Efforts were undertaken to elucidate the exact etiopathology of the aforementioned 18 F-FDG uptake because the rest of the whole body survey was unremarkable. A plain radiograph (both anteroposterior and lateral views of the right tibia showed patchy sclerosis involving the middle diaphysis of the right tibia suggesting a fibrous defect. The computed tomography (CT scan of the same region showed cortical thickening and increased density within the medullary cavity in the shaft of the tibia. A histopathological diagnosis was sought for and the lesion was subsequently proven to be fibrous dysplasia by histopathology of the bone piece obtained from the right tibial lesion by J needle biopsy. The present case is a useful addition to the current body of literature of false positive 18 F-FDG-PET study due to a benign skeletal pathology and underscores the importance of high index of suspicion and careful clinicoradiopathologic correlation, whenever one comes across such an unusual PET finding.

  2. Arterial spin labeling MR imaging for characterisation of renal masses in patients with impaired renal function: initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Pedrosa, Ivan [Beth Israel Deaconess Medical Center and Harvard Medical School, Department of Radiology, Boston, MA (United States); UT Southwestern Medical Center, Department of Radiology, Dallas, TX (United States); Rafatzand, Khashayar; Robson, Philip; Alsop, David C. [Beth Israel Deaconess Medical Center and Harvard Medical School, Department of Radiology, Boston, MA (United States); Wagner, Andrew A. [Beth Israel Deaconess Medical Center and Harvard Medical School, Surgery, Division of Urology, Boston, MA (United States); Atkins, Michael B. [Beth Israel Deaconess Medical Center and Harvard Medical School, Hematology/Oncology, Boston, MA (United States); Rofsky, Neil M. [University of Texas Southwestern Medical Center, Departments of Radiology, Dallas, TX (United States)


    To retrospectively evaluate the feasibility of arterial spin labeling (ASL) magnetic resonance imaging (MRI) for the assessment of vascularity of renal masses in patients with impaired renal function. Between May 2007 and November 2008, 11/67 consecutive patients referred for MRI evaluation of a renal mass underwent unenhanced ASL-MRI due to moderate-to-severe chronic or acute renal failure. Mean blood flow in vascularised and non-vascularised lesions and the relation between blood flow and final diagnosis of malignancy were correlated with a 2-sided homogeneous variance t-test and the Fisher Exact Test, respectively. A p value <0.05 was considered statistically significant. Seventeen renal lesions were evaluated in 11 patients (8 male; mean age = 70 years) (range 57-86). The median eGFR was 24 mL/min/1.73 m{sup 2} (range 7-39). The average blood flow of 11 renal masses interpreted as ASL-positive (134 +/- 85.7 mL/100 g/min) was higher than that of 6 renal masses interpreted as ASL-negative (20.5 +/- 8.1 mL/100 g/min)(p = 0.015). ASL-positivity correlated with malignancy (n = 3) or epithelial atypia (n = 1) at histopathology or progression at follow up (n = 7). ASL detection of vascularity in renal masses in patients with impaired renal function is feasible and seems to indicate neoplasia although the technique requires further evaluation. (orig.)

  3. 类风湿关节炎肾脏损害20例临床分析%The analysis of renal lesion by rheumatoid arthritis in 20 patients

    Institute of Scientific and Technical Information of China (English)

    俞东容; 鲁盈; 李亚好; 毛俐婵


    目的 进一步了解类风湿关节炎(RA)肾损害的特点.方法 对我科收治的20例RA合并肾损害患者的临床特点进行分析.结果 以慢性肾炎表现者8例,肾病综合征(NS)表现4例,慢性间质性肾炎3例,慢性肾功能不全表现4例,急性肾功能不全1例;其中呈肾炎表现患者血免疫球蛋白升高,红细胞沉降率增快,多数患者C反应蛋白、类风湿因子升高,7例患者进行了肾活检,其中3例膜性肾病(MN),3例Iga肾病,1例并发血管炎.结论 肾炎是RA肾损害的常见表现,而系膜增生性肾炎、膜性肾病是RA并发肾炎的常见病理类型;RA的基础病变之一为血管炎,可发生坏死性肾小球肾炎.免疫功能紊乱在RA并发肾损害中可能起重要的作用.%Objective To investigate the features of renal lesion in patients with rheumatoid arthritis (RA). Methods The clinical pathology changes of 20 patients with renal lesion by RA were analyzed. Results The clinical features of patients showed chronic glomerulonephritis in 8 cases,nephritic syndrome 4 cases, chronic interstitial nephritis in 3 cases, chronic renal failure in 4 cases, and acute renal failure in 1 case. The patients with glomerulonephritis accompanied with the increase of immunoglobulin, erythrocyte sedimentation rate, C-reactive protein or rheumatoid factor. Kidney biopsy of 7 patients found membranous nephro-pathy in, IgA nephropathy in 3 and vasculitis in 1. Conclusion The common renal lesion in RA is glomerulonephritis, with mesangial proliferative glomerulonephritis or membranous nephropathy. One of the basic pathoh,gi,.al changes is vasculitis,which could result in necrotizing vasculitis.The disorder of immunologic function couht play important role in renal damage in patients with RA.

  4. Emergency Pancreatoduodenectomy with Preservation of Gastroduodenal Artery for Massive Gastrointestinal Bleeding due to Duodenal Metastasis by Clear Cell Renal Cell Carcinoma in a Patient with Celiac Artery Stenosis

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    Kyriakos Neofytou


    Full Text Available Duodenal metastasis from renal cell carcinoma is rare, and even rarer is a massive gastrointestinal bleeding from such tumours. Coeliac occlusive disease, although rarely symptomatic, can lead to ischaemic changes with anastomotic dehiscence and leaks when a patient undergoes pancreatoduodenectomy. A 41-year-old man with known metastasis to the adrenal glands and the second part of the duodenum close to the ampulla of Vater from clear cell renal cell carcinoma was admitted to our department due to massive gastrointestinal bleeding from the duodenal metastasis. Endoscopic control of the bleed was not possible, while the bleeding vessel embolization was able to control the haemorrhage only temporarily. An angiography during the embolization demonstrated the presence of stenosis of the coeliac artery and also hypertrophic inferior pancreaticoduodenal arteries supplying the proper hepatic artery via the gastroduodenal artery (GDA. The patient underwent emergency pancreatoduodenectomy with preservation of the gastroduodenal artery. The patient had an uneventful recovery and did not experience further bleeding. Also the blood flow to the liver was compromised as shown by the normal liver function tests (LFTs postoperatively. To the best of our knowledge, this is the first report of a preservation of the GDA during an emergency pancreatoduodenectomy.

  5. Cortical Blindness due to Bilateral Occipital Infarcts in a Renal Failure Patient with Prostate Cancer: A Rare Complication of Hemodialysis

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    O. G. Doluoglu


    Full Text Available Loss of vision is a rare complication seen in hemodialysis patients. It is thought to develop because of the hypotension that can be observed during dialysis. This paper involves a patient with acute loss of vision during hemodialysis due to bilateral occipital infarcts.

  6. Valoración de las lesiones oculares producidas en los accidentes de tráfico Assessment of ocular injuries due to traffic accidents

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    J.A. Menéndez


    Full Text Available Objetivo: Analizar cómo se realiza, desde el punto de vista pericial, la valoración de las lesiones y secuelas oculares de los accidentes de tráfico en nuestro medio. Método: Hemos realizado un estudio retrospectivo de 127 informes sobre lesiones oculares realizados en la Sección de Oftalmología de la Clínica Médico Forense de Madrid durante cinco años (del 2002 al 2006, analizando las siguientes variables: la proporción que representan los accidentes de tráfico (ATF, el tipo de lesión producida en el ATF, la duración media de la baja, las secuelas más frecuentes y la puntuación total media asignada a estas secuelas oculares. Resultados: Los ATF son la causa de la cuarta parte de las secuelas oculares que vemos. Las lesiones más frecuentemente producidas son traumatismos cráneo-encefálicos, contusiones oculares directas y esguinces cervicales. Hemos hallado un alto porcentaje de casos (22%, en los que no encontramos lesiones objetivas que justifiquen las molestias alegadas por el lesionado, o bien estas no guardan relación evidente con el accidente de tráfico sufrido. Conclusiones: Que los ATF son una de las causas más frecuentes de secuelas oculares (diplopias, disminuciones de agudeza visual…, con una puntuación media de 15 puntos y una duración media de la baja de 71 días, hay un importante porcentaje de reclamaciones injustificadas. Considera necesario revisar el actual Baremo de la Ley 34/2003, subsanando los errores y deficiencias que presenta, e incluyendo secuelas oculares típicamente postraumáticas que actualmente no recoge, para facilitar la valoración de las secuelas oculares.Aim: To analyse how it is performed, from expert evidence view point, the assessment of ocular injuries and after-effects due to traffic accidents in our area. Method: We have accomplished a retrospective study of 127 reports on ocular injuries, carried out in the Ophthalmologic Section of the Medical Forensic Clinic of Madrid for

  7. Comparison of two recombinant erythropoietin formulations in patients with anemia due to end-stage renal disease on hemodialysis: A parallel, randomized, double blind study

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    Ávila-Albuerne Yisel


    Full Text Available Abstract Background Recombinant human erythropoietin (EPO is used for the treatment of last stage renal anemia. A new EPO preparation was obtained in Cuba in order to make this treatment fully nationally available. The aim of this study was to compare the pharmacokinetic, pharmacodynamic and safety properties of two recombinant EPO formulations in patients with anemia due to end-stage renal disease on hemodialysis. Methods A parallel, randomized, double blind study was performed. A single 100 IU/Kg EPO dose was administered subcutaneously. Heberitro (Heber Biotec, Havana, formulation A, a newly developed product and Eprex (CILAG AG, Switzerland, formulation B, as reference treatment were compared. Thirty-four patients with anemia due to end-stage renal disease on hemodialysis were included. Patients had not received EPO previously. Serum EPO level was measured by enzyme immunoassay (EIA during 120 hours after administration. Clinical and laboratory variables were determined as pharmacodynamic and safety criteria until 216 hours. Results Both groups of patients were similar regarding all demographic and baseline characteristics. EPO kinetics profiles were similar for both formulations; the pharmacokinetic parameters were very close (i.e., AUC: 4667 vs. 4918 mIU.h/mL; Cmax: 119.1 vs. 119.7 mIU/mL; Tmax: 13.9 vs. 18.1 h; half-life, 20.0 vs. 22.5 h for formulations A and B, respectively. The 90% confidence intervals for the ratio between both products regarding these metrics were close to the 0.8 – 1.25 range, considered necessary for bioequivalence. Differences did not reach 20% in any case and were not determined by a formulation effect, but probably by a patients' variability effect. Concerning pharmacodynamic features, a high similitude in reticulocyte counts increments until 216 hours and the percentage decrease in serum iron until 120 hours was observed. There were no differences between formulations regarding the adverse events and their

  8. Comparison of two recombinant erythropoietin formulations in patients with anemia due to end-stage renal disease on hemodialysis: A parallel, randomized, double blind study (United States)

    Pérez-Oliva, Jorge F; Casanova-González, Martha; García-García, Idrian; Porrero-Martín, Pedro J; Valenzuela-Silva, Carmen M; Hernández-Montero, Tairí; Lagarde-Ampudia, Marcia; Casanova-Kutsareva, Yuri; Ávila-Albuerne, Yisel; Vargas-Batista, Alicia; Bobillo-López, Hailen; Herrera-Valdés, Raúl; López-Saura, Pedro A


    Background Recombinant human erythropoietin (EPO) is used for the treatment of last stage renal anemia. A new EPO preparation was obtained in Cuba in order to make this treatment fully nationally available. The aim of this study was to compare the pharmacokinetic, pharmacodynamic and safety properties of two recombinant EPO formulations in patients with anemia due to end-stage renal disease on hemodialysis. Methods A parallel, randomized, double blind study was performed. A single 100 IU/Kg EPO dose was administered subcutaneously. Heberitro (Heber Biotec, Havana, formulation A), a newly developed product and Eprex (CILAG AG, Switzerland, formulation B), as reference treatment were compared. Thirty-four patients with anemia due to end-stage renal disease on hemodialysis were included. Patients had not received EPO previously. Serum EPO level was measured by enzyme immunoassay (EIA) during 120 hours after administration. Clinical and laboratory variables were determined as pharmacodynamic and safety criteria until 216 hours. Results Both groups of patients were similar regarding all demographic and baseline characteristics. EPO kinetics profiles were similar for both formulations; the pharmacokinetic parameters were very close (i.e., AUC: 4667 vs. 4918 mIU.h/mL; Cmax: 119.1 vs. 119.7 mIU/mL; Tmax: 13.9 vs. 18.1 h; half-life, 20.0 vs. 22.5 h for formulations A and B, respectively). The 90% confidence intervals for the ratio between both products regarding these metrics were close to the 0.8 – 1.25 range, considered necessary for bioequivalence. Differences did not reach 20% in any case and were not determined by a formulation effect, but probably by a patients' variability effect. Concerning pharmacodynamic features, a high similitude in reticulocyte counts increments until 216 hours and the percentage decrease in serum iron until 120 hours was observed. There were no differences between formulations regarding the adverse events and their intensity. The more

  9. Effects of Liraglutide on Renal Lesions in Diabetic Rats%利拉鲁肽对糖尿病大鼠肾脏病变的影响

    Institute of Scientific and Technical Information of China (English)

    李里; 卢松


    Objective To investigate the effects of liraglutide on renal lesions in diabetic rats. Methods The type 2 diabetes mellitus (T2DM)rat model was established by feeding high - fat and high - sugar foods for 1 month and intraperitoneal injection of small dose of streptozotocin(STZ,30 mg / kg). The adult male Sprague - Dawley rats were randomly divided into the normal control group(NC group),dia-betes group(DM group),liraglutide 100 μg / kg group(L100 group)and liraglutide 200 μg / kg group(L200 group). The NC group and the DM group were intraperitoneally injected by normal saline,the L100 group and L200 groups respectively received the intervention of li-raglutide 100 μg / kg and 200 μg / kg by intraperitoneal injection,twice daily. After 12 - week intervention,the body weight( BW),kidney weight( KW),kidney / body weight ratio( KW / BW),24h urinary protein excretory(24 hUPE),serum creatinine( Scr)and blood urea nitrogen ( BUN)were detected. The changes of the renal tissue morphology and structure were observed under the optical and electron micro-scope. Results Liraglutide could inhibit the increase of KW / BW ratio,mean glomerular volume( MGV)and mesangial area ratio( FMA), decrease the urinary protein level and improve the renal function( P ﹤ 0. 05);which could alleviate the pathological changes of foot process fusion,basilar membrane thickening and mesangial hyperplasia. Compared with the L100 group,the improvement of various indexes in the L200 group was more significant and the alleviation of the pathological changes were more obvious. Conclusion Liraglutide has the pro-tective effect on the kidney in diabetic rat,the effect of 200 μg / kg(twice daily)is better than that of 100 μg / kg.%目的:探讨利拉鲁肽对糖尿病大鼠肾脏病变的影响。方法高脂高糖饲料喂养1个月后,予小剂量链脲佐菌素(STZ,30 mg / kg)腹腔注射诱导建立2型糖尿病大鼠模型。将雄性 SD 大鼠,随机分为正常对照组(NC

  10. A case of pathology-proven neuromyelitis optica spectrum disorder with Sjögren syndrome manifesting aphasia and apraxia due to a localized cerebral white matter lesion. (United States)

    Sawada, Jun; Orimoto, Ryosuke; Misu, Tatsuro; Katayama, Takayuki; Aizawa, Hitoshi; Asanome, Asuka; Takahashi, Kae; Saito, Tsukasa; Anei, Ryogo; Kamada, Kyousuke; Miyokawa, Naoyuki; Takahashi, Toshiyuki; Fujihara, Kazuo; Hasebe, Naoyuki


    A woman with Sjögren syndrome manifesting as aphasia with a left deep cerebral white matter lesion tested positive for anti-aquaporin 4 (AQP4) antibody. Open biopsy of the lesion revealed active demyelination with edematous changes and the preservation of most axons, indicating a non-necrotic demyelinating lesion. Immunostaining for AQP4 was diffusely lost, whereas the loss of glial fibrillary acidic protein immunostaining was limited but with highly degenerated astrocytic foot processes in perivascular areas. These results suggested neuromyelitis optica spectrum disorder (NMOSD) pathology rather than Sjögren-related vasculitis. Only cerebral cortical symptoms with a cerebral white matter lesion could be observed in NMOSDs.

  11. Pyelo-cystic Reflux in F-18 FDG PET Scan Due to Ureteral Obstruction

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    Reyhan, Mehmet [Baskent Univ., Adana (Turkmenistan)


    A 72-year-old woman with a history of cervical cancer was treated with brachytherapy and chemotherapy. Combined F-18 FDG PET/CT performed for restaging demonstrated increased FDG uptake in a hypodense cystic lesion at the posterior part of the right renal cortex and a hypermetabolic soft tissue mass at the right parailiac region suggestive of a metastatic lymph node causing ureteral obstruction. There had been no FDG uptake in the cystic lesion on the FDG PET/CT study performed 1 year before. These findings suggest that the increased FDG uptake in the cystic lesion was caused by pyelocystic reflux due to ureteral obstruction secondary to parailiac lymph node metastasis (Figs. 1 and 2). Several renal lesions may have increased metabolism, such as renal cell carcinoma, lymphoma, oncocytoma, adult Wilms' tumor, angiomyolipoma, metastatic lesions, xanthogranulo-matous pyelonephritis and infected cyst. Most of these lesions are solid. Some infected renal cysts may be FDG avid, but in this situation increased FDG uptake is observed on the wall of the cyst. In our case, FDG uptake was seen in the entire cystic lesion. The patient had no symptoms or laboratory findings related to infection. Cysts are the most common space-occupying lesions of the kidney. The vast majority of these are simple cysts that are usually unilateral and solitary. Simple cysts are asymptomatic, except when complications exist such as hemorrhage, infection or rupture. There have been a few reports on spontaneous communications between renal cysts and the pyelocaliceal system, in most cases involving ruptures of the cysts into the pyelocaliceal system due to increased intracystic pressure caused by bleeding or infection of the cyst. In the present case, the cause of the connection between the cystic cavity and the pyelocaliceal system is the increased pressure in the renal pelvic cavity due to the ureteral obstruction secondary to parailiac lymph node metastasis.

  12. T-Cell Cytokine Gene Polymorphisms and Vitamin D Pathway Gene Polymorphisms in End-Stage Renal Disease due to Type 2 Diabetes Mellitus Nephropathy: Comparisons with Health Status and Other Main Causes of End-Stage Renal Disease

    Directory of Open Access Journals (Sweden)

    Alicja E. Grzegorzewska


    Full Text Available Background. T-cell cytokine gene polymorphisms and vitamin D pathway gene polymorphisms were evaluated as possibly associated with end-stage renal disease (ESRD resulting from type 2 diabetes mellitus (DM nephropathy. Methods. Studies were conducted among hemodialysis (HD patients with ESRD due to type 2 DM nephropathy, chronic glomerulonephritis, chronic infective tubulointerstitial nephritis, and hypertensive nephropathy as well as in healthy subjects. A frequency distribution of T-cell-related interleukin (IL genes (IL18 rs360719, IL12A rs568408, IL12B rs3212227, IL4R rs1805015, IL13 rs20541, IL28B rs8099917, IL28B, and rs12979860 and vitamin D pathway genes (GC genes: rs2298849, rs7041, and rs1155563; VDR genes: rs2228570, rs1544410; and RXRA genes: rs10776909, rs10881578, and rs749759 was compared between groups. Results. No significant differences in a frequency distribution of tested polymorphisms were shown between type 2 DM nephropathy patients and controls. A difference was found in IL18 rs360719 polymorphic distribution between the former group and chronic infective tubulointerstitial nephritic patients (Ptrend=0.033, which also differed in this polymorphism from controls (Ptrend=0.005. Conclusion. T-cell cytokine and vitamin D pathway gene polymorphisms are not associated with ESRD due to type 2 DM nephropathy in Polish HD patients. IL18 rs360719 is probably associated with the pathogenesis of chronic infective tubulointerstitial nephritis.

  13. A Case of Hereditary Leiomyomatosis and Renal Cell Carcinoma

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    Sarah Mehrtens


    Full Text Available A 49-year-old lady presented with multiple recurring painful lesions over her thighs, arms, and back. Past medical history included a left sided nephrectomy for renal cell carcinoma and a hysterectomy for multiple uterine fibroids (leiomyomas. Histopathological examination revealed changes consistent with pilar leiomyomas. Gene mutation analysis confirmed a diagnosis of hereditary leiomyomatosis and renal cell carcinoma. Hereditary leiomyomatosis and renal cell carcinoma is an uncommon autosomal dominant condition characterised by the concurrent presentation of cutaneous and uterine leiomyomas. Renal cell carcinoma associated with this condition is more aggressive and a significant cause of mortality. Due to this association with potentially fatal renal cell carcinoma we felt that it was important to highlight this case with an update on pathophysiology and management.

  14. Renal involvement in antiphospholipid syndrome. (United States)

    Pons-Estel, Guillermo J; Cervera, Ricard


    Renal involvement can be a serious problem for patients with antiphospholipid syndrome (APS). However, this complication has been poorly recognized and studied. It can be present in patients who have either primary or systemic lupus erythematosus-associated APS. Clinical and laboratory features of renal involvement in APS include hypertension, hematuria, acute renal failure, and progressive chronic renal insufficiency with mild levels of proteinuria that can progress to nephrotic-range proteinuria. The main lesions are renal artery stenosis, venous renal thrombosis, and glomerular lesions (APS nephropathy) that may be acute (thrombotic microangiopathy) and/or chronic (arteriosclerosis, arterial fibrous intimal hyperplasia, tubular thyroidization, arteriolar occlusions, and focal cortical atrophy). APS can also cause end-stage renal disease and allograft vascular thrombosis. This article reviews the range of renal abnormalities associated with APS, and their diagnosis and treatment options.

  15. Coexistence of pheochromocytoma with uncommon vascular lesions

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    Sunil Kumar Kota


    Full Text Available Background: Pheochromocytoma/paragangliomas have been described to be associated with rare vascular abnormalities like renal artery stenosis. Coexistence of physiologically significant renal artery lesions is a compounding factor that alters management and prognosis of pheochromocytoma patients. Apart from individual case reports, data on such association in Indian population is not available. The aim of this study is to find the nature and prevalence of associated vascular abnormalities. Materials and Methods: From 1990 to 2010, a total of 50 patients were diagnosed with pheochromocytoma/paragangliomas. Hospital charts of these patients were reviewed retrospectively to identify those with unusual vascular abnormalities. Available literature was also reviewed. Results: Of the 50 patients with pheochromocytoma, 7 (14% had coexisting vascular lesions including renal artery stenosis in 4, aortoarteritis in 1, aortic aneurysm in 1 and inferior vena cava thrombosis in 1. Pheochromocytoma was adrenal in 42 and extra adrenal in 8. Laparoscopic adrenalectomy was done in the patients. One patient with renal artery stenosis due to intimal fibrosis was subjected to percutaneous balloon angioplasty; the other three improved after adrenalectomy and lysis of fibrous adhesive bands. The patient with aortoarteritos was treated with oral steroids. Inferior vena cava thrombosis was reversed with anticoagulants. The patient with abdominal aortic aneurysm was advised for annual follow-up on account of its size of 4.5 cm and asymptomatic presentation. Conclusion: There are multiple mechanisms that can lead to renal artery stenosis and other vascular abnormalities in a case of pheochromocytoma. A high index of suspicion is necessary to enable both entities to be diagnosed preoperatively and allow proper planning of surgical therapy. Incomplete diagnosis may lead to persistent hypertension postoperatively in a case of associated renal artery stenosis.

  16. Invalidity of SUV Measurements of Lesions in Close Proximity to Hot Sources due to “Shine-Through” Effect on FDG PET-CT Interpretation

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    Yiyan Liu


    Full Text Available It is well known that many technical and physiologic factors can affect the reliability of the standardized uptake value (SUV on FDG PET-CT. Another potential problem of which we may be aware but has not been previously discussed is significant SUV overestimation of lesions in the direct neighborhood of large hot sources, namely, areas with high FDG uptake or activity such as a tumor, myocardium, urinary bladder, kidney, or gastrointestinal tract. The magnitude of SUV overestimation of the lesions directly neighboring the large hot sources is varied among the different cases, and it is possibly secondary to “shine-through” effect of the hot sources, which would warrant further systematic investigation such as phantom simulation experiment. If the lesion is in the close territory of the hot source, measured SUV is often overestimated and invalid. Visual interpretation should be used for evaluation of FDG avidity of the lesion.

  17. Malignant renal tumors in children

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    Justin Scott Lee


    Full Text Available Renal malignancies are common in children. While the majority of malignant renal masses are secondary to Wilms tumor, it can be challenging to distinguish from more aggressive renal masses. For suspicious renal lesions, it is crucial to ensure prompt diagnosis in order to select the appropriate surgical procedure and treatment. This review article will discuss the common differential diagnosis that can be encountered when evaluating a suspicious renal mass in the pediatric population. This includes clear cell sarcoma of the kidney, malignant rhabdoid tumor, renal medullary carcinoma and lymphoma. 

  18. 89Zr-bevacizumab PET visualizes heterogeneous tracer accumulation in tumor lesions of renal cell carcinoma patients and differential effects of antiangiogenic treatment

    NARCIS (Netherlands)

    Oosting, Sjoukje F; Brouwers, Adrienne H; van Es, Suzanne C; Nagengast, Wouter B; Oude Munnink, Thijs H; Lub-de Hooge, Marjolijn N; Hollema, Harry; de Jong, Johan R; de Jong, Igle J; de Haas, Sanne; Scherer, Stefan J; Sluiter, Wim J; Dierckx, Rudi A; Bongaerts, Alfons H H; Gietema, Jourik A; de Vries, Elisabeth G E


    UNLABELLED: No validated predictive biomarkers for antiangiogenic treatment of metastatic renal cell carcinoma (mRCC) exist. Tumor vascular endothelial growth factor A (VEGF-A) level may be useful. We determined tumor uptake of (89)Zr-bevacizumab, a VEGF-A-binding PET tracer, in mRCC patients before

  19. 89Zr-bevacizumab PET visualizes heterogeneous tracer accumulation in tumor lesions of renal cell carcinoma patients and differential effects of antiangiogenic treatment

    NARCIS (Netherlands)

    Oosting, Sjoukje F; Brouwers, Adrienne H; van Es, Suzanne C; Nagengast, Wouter B; Oude Munnink, Thijs H; Lub-de Hooge, Marjolijn N; Hollema, Harry; de Jong, Johan R; de Jong, Igle J; de Haas, Sanne; Scherer, Stefan J; Sluiter, Wim J.; Dierckx, Rudi A; Bongaerts, Alfons H H; Gietema, Jourik A; de Vries, Elisabeth G E

    UNLABELLED: No validated predictive biomarkers for antiangiogenic treatment of metastatic renal cell carcinoma (mRCC) exist. Tumor vascular endothelial growth factor A (VEGF-A) level may be useful. We determined tumor uptake of (89)Zr-bevacizumab, a VEGF-A-binding PET tracer, in mRCC patients before

  20. Neonatal multiorgan failure due to ACAD9 mutation and complex I deficiency with mitochondrial hyperplasia in liver, cardiac myocytes, skeletal muscle, and renal tubules. (United States)

    Leslie, Nancy; Wang, Xinjian; Peng, Yanyan; Valencia, C Alexander; Khuchua, Zaza; Hata, Jessica; Witte, David; Huang, Taosheng; Bove, Kevin E


    Complex I deficiency causes Leigh syndrome, fatal infant lactic acidosis, and neonatal cardiomyopathy. Mutations in more than 100 nuclear DNA and mitochondrial DNA genes miscode for complex I subunits or assembly factors. ACAD9 is an acyl-CoA dehydrogenase with a novel function in assembly of complex I; biallelic mutations cause progressive encephalomyopathy, recurrent Reye syndrome, and fatal cardiomyopathy. We describe the first autopsy in fatal neonatal lethal lactic acidosis due to mutations in ACAD9 that reduced complex I activity. We identified mitochondrial hyperplasia in cardiac myocytes, diaphragm muscle, and liver and renal tubules in formalin-fixed, paraffin-embedded tissue using immunohistochemistry for mitochondrial antigens. Whole-exome sequencing revealed compound heterozygous variants in the ACAD9 gene: c.187G>T (p.E63*) and c.941T>C (p.L314P). The nonsense mutation causes late infantile lethality; the missense variant is novel. Autopsy-derived fibroblasts had reduced complex I activity (53% of control) with normal activity in complexes II to IV, similar to reported cases of ACAD9 deficiency.

  1. IgA肾病患者肾小管中P-gp表达与肾脏病理及肾功能损害的相关性%The effects of renal tubular P-gp expression on pathological lesion and renal function in IgA nephropathy

    Institute of Scientific and Technical Information of China (English)

    杨汝春; 王永钧; 鲁盈; 厉春萍; 朱晓玲


    Objective To explore the effects of P- glycoprotein (P- gp) expression in renal tubules on renal pathological lesion and renal function in progression of Ig Anephropathy (IgAN). Methods One hungdred and eighty eight(188) patients with primary IgAN diagnosed by renal biopsy were studied. Clinical data, including age, sex; serum creatinine level (Scr), creatinine clearance rate (Ccr), 24h urinary excretion of protien(24hUP) and Blood urea nitrogen(BUN) were detected before renal biopsy. The assessment of renal pathological lesion was according to Lee SM and Katafuchi semiquantitative scoring system. Immuno-histochemistry was performed to detect the expression of P- gp in nephridial tissue. The relationship between P- gp expressions and Scr, Ccr, 24hUP, BUN, or pathological lesion semiquantitative scores were analyzed. Results P- gp expression level in kidney of IgAN patients showed statistically significant negative correlations with Ccr, and significant negative correlations with 24hUP, Scr, BUN and pathological lesion semiquantitative scores. Conclusion P- gp expression and transport Mediated by P- gp possibly participate in protecting renal function and preventing progression ofkidney pathological injury.%目的 通过对IgA肾病肾小管中P-糖蛋白(P-glycoprotein,P-gp)表达与肾脏病理损害相关性的研究,探讨肾小管功能及其损伤在IgA肾病进展中的作用的关系.方法以经肾活检诊断的188例原发性IgA肾病患者为研究对象,肾活检前检查患者24h尿蛋白(24hUP)、肌酐清除率(Ccr)、血肌(Scr)、尿素氮(BuN)等.肾脏病理损害主要参考Lee分级、Katafuchi半定量积分标准和Andreoli病理活动性/慢性指数评分标准.采用免疫组化方法测定肾组织中P-gp表达,统计分析肾小管P-gp蛋白表达与肾脏病理损害积分以及患者肾功能的相关性.结果 IgA肾病肾小管中P-gp表达与肾脏病理损害Lee分级和Katafuchi半定量积分均呈显著负相关,P-gp与肾小

  2. Premalignant Lesions in the Kidney

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    Ziva Kirkali


    Full Text Available Renal cell carcinoma (RCC is the most malignant urologic disease. Different lesions, such as dysplasia in the tubules adjacent to RCC, atypical hyperplasia in the cyst epithelium of von Hippel-Lindau syndrome, and adenoma have been described for a number of years as possible premalignant changes or precursor lesions of RCC. In two recent papers, kidneys adjacent to RCC or removed from other causes were analyzed, and dysplastic lesions were identified and defined in detail. Currently renal intraepithelial neoplasia (RIN is the proposed term for classification. The criteria for a lesion to be defined as premalignant are (1 morphological similarity; (2 spatial association; (3 development of microinvasive carcinoma; (4 higher frequency, severity, and extent then invasive carcinoma; (5 progression to invasive cancer; and (6 similar genetic alterations. RIN resembles the neoplastic cells of RCC. There is spatial association. Progression to invasive carcinoma is described in experimental cancer models, and in some human renal tumors. Similar molecular alterations are found in some putative premalignant changes. The treatment for RCC is radical or partial nephrectomy. Preneoplastic lesions may remain in the renal remnant in patients treated by partial nephrectomy and may be the source of local recurrences. RIN seems to be a biologic precursor of some RCCs and warrants further investigation. Interpretation and reporting of these lesions would reveal important resources for the biological nature and clinical significance. The management of RIN diagnosed in a renal biopsy and partial nephrectomy needs to be answered.

  3. Respiratory Syncytial Virus Aggravates Renal Injury through Cytokines and Direct Renal Injury

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    Songhui Zhai


    Full Text Available The purpose of this study was to investigate the relationship between renal injury and reinfection that is caused by respiratory syncytial virus (RSV and to analyze the mechanism of renal injury. Rats were repeatedly infected with RSV on days 4, 8, 14, and 28, then sacrificed and examined on day 56 after the primary infection. Renal injury was examined by transmission electron microscopy and histopathology. The F protein of RSV was detected in the renal tissue by indirect immunofluorescence. Proteinuria and urinary glycosaminoglycans (GAGs, serum levels of albumin, urea nitrogen, and creatinine, secretion of cytokines, T lymphocyte population and subsets, and dendritic cell (DC activation state were examined. The results showed that renal injury was more serious in the reinfection group than in the primary infection group. At a higher infection dose, 6×106 PFU, the renal injury was more severe, accompanied by higher levels of proteinuria and urinary GAGs excretion, and lower levels of serum albumin. Podocyte foot effacement was more extensive, and hyperplasia of mesangial cells and proliferation of mesangial matrix were observed. The maturation state of DCs was specific, compared with the primary infection. There was also a decrease in the ratio of CD4+ to CD8+T lymphocytes, due to an increase in the percentage of CD8+T lymphocytes and a decrease in the percentage of CD4+T lymphocytes, and a dramatic increase in the levels of IL-6 and IL-17. In terms of the different reinfection times, the day 14 reinfection group yielded the most serious renal injury and the most significant change in immune function. RSV F protein was still expressed in the glomeruli 56 days after RSV infection. Altogether, these results reveal that RSV infection could aggravate renal injury, which might be due to direct renal injury caused by RSV and the inflammatory lesions caused by the anti-virus response induced by RSV.

  4. What nephrolopathologists need to know about antiphospholipid syndrome-associated nephropathy: Is it time for formulating a classification for renal morphologic lesions? (United States)

    Mubarak, Muhammed; Nasri, Hamid


    Antiphospholipid syndrome (APS) is a systemic autoimmune disorder which commonly affects kidneys. Directory of Open Access Journals (DOAJ), Google Scholar, PubMed (NLM), LISTA (EBSCO) and Web of Science have been searched. There is sufficient epidemiological, clinical and histopathological evidence to show that antiphospholipid syndrome is a distinctive lesion caused by antiphospholipid antibodies in patients with different forms of antiphospholipid syndrome. It is now time to devise a classification for an accurate diagnosis and prognostication of the disease. Now that the morphological lesions of APSN are sufficiently well characterized, it is prime time to devise a classification which is of diagnostic and prognostic utility in this disease.

  5. A case of testicular tumor with uncommon clinical course: testicular lesion that was initially not palpable led to a wrong diagnosis of huge retroperitoneal hematoma due to trauma


    沖, 守; 由井, 康雄; 吉田, 和弘; 秋元, 成太


    A case of testicular tumor with uncommon clinical course is presented. Although the patient underwent abdominal trauma and was diagnosed as having retroperitoneal hematoma, a retroperitoneal bulky tumor was revealed at surgery. After that left orchiectomy was performed because the testicular swelling gradually developed. The retroperitoneal tumor was confirmed to be a secondary lesion metastasized from left testicular carcinoma.


    Institute of Scientific and Technical Information of China (English)

    任淑婷; 于琳华; 徐长福; 李恒力; 党双锁; 成少利; 郑黎明


    Objective To study the pathogenesis of hepatitis B virus ( HBV ) on kidney tissues. Methods HBsAg and HBcAg in paraffin-embedded renal biopsy tissues from 27 cases of glomerulonephritis with positive serum HBV markers were observed by using immunohistochemistry. In addition, in situ polymerse chain reaction (IS-PCR) was performed in 5 cases with positive HBsAg and HBcAg in renal tissue of the 27-case glomerulonephritis to reveal the state of renal HBV DNA. Results Twenty cases (20/27,74.07%) were positive with HBAg which were mainly diffusely distributed in epithelial cells of renal tubule. Four cases (4/5,80% ) were positive with HBV DNA whose distribution was the same of that of HBAg. Conclusion Renal lesions due to HBV are not only the results of immunologic response, but also the outcome of direct invasion and duplication of HBV in epithelial cells of renal tubule.

  7. Renovascular hypertension due to insufficient collateral flow in segmental artery occulusion

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    Park, Y. H.; Lee, S. Y.; Kim, S. H.; Sohn, H. S.; Chung, S. K. [College of Medicine, The Catholic Univ. of Korea, Seoul (Korea, Republic of)


    We report a case in which a 33-year-old woman with renovascular hypertension due to insufficient collateral flow in segmental renal artery occlusion demonstrated abnormality on captopril renal scintigram. Baseline renal scintigram with DTPA showed normal perfusion and excretion in left kidney and captopril renal scintigram with DTPA showed a focal area of decreased perfusion and delayed clearance in lower half of left kidney, suggesting segmental renal artery stenosis. Selective left renal arteriography showed complete obstruction in proximal portion of anterior segmental artery with multiple small collateral vessels from posterior segmental artery and capsular artery and delayed opacification in lower half of left kidney. These findings are suggestive of segmental hypoperfusion due to insufficient collateral blood flow resulting to positive captopril response. Patient's blood pressure have been controlled well with ACE (angiotensin converting enzyme) inhibitor and calcium channel blocker for 2 year. Follow-up baseline renal scintigram with MAG3 showed normal perfusion and excretion in left kidney and captopril renal scintigram with MAG3 showed a focal area of decreased perfusion and delayed clearance in lower lateral portion of left kidney, which was smaller size than that of previous renal scintigram. And captopril renal scintigram with DMSA demonstrated a small area of decreased DMSA uptake on this lesion compared to baseline DMSA scintigram.

  8. Renal flagellate infections in reptiles: 29 cases. (United States)

    Juan-Sallés, Caries; Garner, Michael M; Nordhausen, Robert W; Valls, Xavier; Gallego, Miguel; Soto, Sara


    Renal infection with flagellated protozoa was retrospectively evaluated in 29 reptiles, including 12 turtles, 7 tortoises, and 6 chameleons; overall, 20 species of reptiles were represented. Most cases presented with nonspecific clinical signs or a combination of several concurrent diseases. Nineteen of 29 reptiles had tubulointerstitial nephritis associated with flagellates, and this lesion was considered contributory to death in 15 cases, although concurrent diseases were frequent. Infection was invasive into the renal interstitium in three reptiles due to tubular rupture and in one chameleon also spread to adjacent tissues, coelomic cavity, and blood vessels due to renal rupture. Cytologic or ultrastructural evaluation of trophozoites in two cases was consistent with diplomonad flagellates. Renal disease was often complicated with soft-tissue mineralization and/or gout. Gastrointestinal and cloacal infection with flagellates and inflammation were frequent in reptiles in which the digestive tract was available for histopathologic examination, and this supports the possibility of infections ascending the urinary tract from the cloaca. Renal disease associated with flagellate protozoa is rare in vertebrates but appears to be relevant in reptiles, particularly chelonians and chameleons.

  9. Skin Findings in Renal Transplantation Patients

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    Demet Kartal


    Full Text Available Objective: It was aimed to identify skin findings those were seen in patients who undergone renal transplantation. Methods: Patients who have been followed in Erciyes University Nephrology Hospital renal transplantation outpatient clinic were included in the study. They were evaluated for dermatologic findings during routine controls. Age, gender, transplantation date, identity of organ donor, history of medications, dermatological history and dermatological findings during examination were recorded. Biopsy was performed when needed. Results: In total 94 patients, 25 female (26.6% and 69 male (73.4%, were recruited to the study. Mean age was 36±10 years. The most frequent skin finding was drug-related acne (n=20. Most common infectious disease was verruca (n=17. There were viral disease other than verruca such as herpes zoster (n=3, superficial mycosis such as onychomycosis (n=5, tinea versicolor, tinea pedis and bacterial skin disease (n=2, and paronychia (n=1 and pre-malign lesions such as actinic cheilitis and bowenoid papulosis. Besides these, stria (n=3, kserosis (n=2, cornu cutaneum, café-au-lait spots, sebaceous hyperplasia and seborrheic dermatitis, skin tag, hypertrichosis, unguis incarinatus and calcinosis were other skin findings those were seen. No malign skin lesion was observed in any of patients. Conclusion: Miscellaneous skin lesions should develop in patients those undergone renal transplantation due to long-term utilization of various immunosuppressive drugs.

  10. Acute renal failure after rifampicin Insuficiência renal aguda por rifampicina

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    Adriana Weinberg


    Full Text Available A patient with miliary tuberculosis and a chronic urogenital focus is described, who had a borderline renal function at diagnosis and developed overt renal failure upon daily treatment with rifampin (RMP, isoniazid (INH and ethambutol (EMB. This is the first Brazilian report of BMP induced renal damage. A renal biopsy taken on the third day of oliguria showed recent tubular necrosis with acute interstitial inflammation and granuloma formation. The aspect of the granulomatous lesion hightly suggested drug etiology because of the lack of palisading, high incidence of neutrophils and absence of facid-fast bacilli. This is the first presentation of an acute granulomatous interstitial nephritis probably due to RMP. Furthermore the pathogenesis of the renal damage caused by tuberculosis and RMP are discussed.Apresentamos um paciente com tuberculose miliar a partir de um foco crônico urogenital. Em sua entrada no hospital tinha uma função renal limítrofe e desenvolveu franca insuficiência renal na vigência da terapêutica específica constituída por RMP, INH e EMB. Bióp-sia renal realizada no 3° dia de uremia revelou necrose tubular recente, com inflamação intersticial aguda, permeada por granulomas. As formações granulomatosas foram altamente sugestivas de reação alérgica à droga devido à ausência de paliçadas, alta incidência de neutrófilos e o não encontro de bacilos-álcool-ácido-resistentes. Esta é a primeira descrição de nefrite intersticial granulomatosa provavelmente causada pela RMP. São discutidos os principais aspectos fisiopatogênicos da insuficiência renal causada pela tuberculose acrescida dos efeitos nefrotóxicos da RMP.

  11. A diagnostic conundrum: acute interstitial nephritis due to armodafinil versus acute cellular rejection in a renal transplant recipient--a case report. (United States)

    Baradhi, K M; Gohh, R


    Acute interstitial nephritis is a well-recognized cause of acute kidney injury in native kidneys. While the most common etiology being drug-induced, other causes are infectious, autoimmune, and idiopathic forms of disease. Drug-induced acute interstitial nephritis is not only uncommon in renal transplant recipients but is difficult to diagnose as it mimics acute cellular rejection histologically. We have described herein a renal transplant recipient with acute kidney injury to highlight the difficulties to distinguish acute interstitial nephritis from acute cellular rejection.

  12. Oral manifestations of allograft recipients before and after renal transplantation

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    Gita Rezvani


    Full Text Available Renal transplantation is considered the best treatment option for patients with end-stage renal disease. In this study, the prevalence of oral lesions was studied in a cohort of renal transplant recipients before and after transplantation. Fifty-nine kidney transplant recipients were examined one week before and four months after transplantation. The information gathered included age, sex, smoking history, duration on dialysis, drugs and their doses. There were 41 males (69.5% and 18 females (30.5% with a mean age of 37 years. Before surgery, two patients had non-specific lesions and two other patients had leukoedema. Following transplantation, 24 patients (40.7% did not have any specific lesion. In six patients, we observed non-specific erythematous lesions (10.2%. Other recorded observations are as follows: Gingival hyperplasia in five patients (8.5%, oral candidiasis of the erythematous type in five patients (8.5%, hairy leukoplakia in four patients (6.8% and leukoedema in seven patients (11.9%. In our study patients, the prevalence of oral lesions increased after transplantation, although it was lower than that reported in other studies. This could be due to the differences in sample size, differences between Iranian race and other races and different pharmaceutical formulation of the drug produced in Iran.

  13. Sociodemographic and Geographic Predictors of Quality of Care in United States Patients With End-Stage Renal Disease Due to Lupus Nephritis (United States)

    Plantinga, Laura C.; Drenkard, Cristina; Patzer, Rachel E.; Klein, Mitchel; Kramer, Michael R.; Pastan, Stephen; Lim, S. Sam; McClellan, William M.


    Objective To describe end-stage renal disease (ESRD) quality of care (receipt of pre-ESRD nephrology care, access to kidney transplantation, and placement of permanent vascular access for dialysis) in US patients with ESRD due to lupus nephritis (LN-ESRD) and to examine whether quality measures differ by patient sociodemographic characteristics or US region. Methods National surveillance data on patients in the US in whom treatment for LN-ESRD was initiated between July 2005 and September 2011 (n = 6,594) were analyzed. Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (95% CIs) were determined for each quality measure, according to sociodemographic factors and US region. Results Overall, 71% of the patients received nephrology care prior to ESRD. Black and Hispanic patients were less likely than white patients to receive pre-ESRD care (OR 0.73 [95% CI 0.63–0.85] and OR 0.73 [95% CI 0.60–0.88], respectively) and to be placed on the kidney transplant waitlist within the first year after the start of ESRD (HR 0.78 [95% CI 0.68–0.91] and HR 0.82 [95% CI 0.68–0.98], respectively). Those with Medicaid (HR 0.51 [95% CI 0.44–0.58]) or no insurance (HR 0.36 [95% CI 0.29–0.44]) were less likely than those with private insurance to be placed on the waitlist. Only 24% had a permanent vascular access, and placement was even less likely among the uninsured (OR 0.62 [95% CI 0.49–0.79]). ESRD quality-of-care measures varied 2–3-fold across regions of the US, with patients in the Northeast and Northwest generally having higher probabilities of adequate care. Conclusion LN-ESRD patients have suboptimal ESRD care, particularly with regard to placement of dialysis vascular access. Minority race/ethnicity and lack of private insurance are associated with inadequate ESRD care. Further studies are warranted to examine multilevel barriers to, and develop targeted interventions to improve delivery of, care among patients with LN-ESRD. PMID:25692867

  14. Rapidly progressive renal disease as part of Wolfram syndrome in a large inbred Turkish family due to a novel WFS1 mutation (p.Leu511Pro)

    DEFF Research Database (Denmark)

    Yuca, Sevil Ari; Rendtorff, Nanna Dahl; Boulahbel, Houda


    Wolfram syndrome, also named "DIDMOAD" (diabetes insipidus, diabetes mellitus, optic atrophy, and deafness), is an inherited association of juvenile-onset diabetes mellitus and optic atrophy as key diagnostic criteria. Renal tract abnormalities and neurodegenerative disorder may occur in the thir...

  15. Low Birth Weight due to Intrauterine Growth Restriction and/or Preterm Birth: Effects on Nephron Number and Long-Term Renal Health

    Directory of Open Access Journals (Sweden)

    Vladislava Zohdi


    Full Text Available Epidemiological studies have clearly demonstrated a strong association between low birth weight and long-term renal disease. A potential mediator of this long-term risk is a reduction in nephron endowment in the low birth weight infant at the beginning of life. Importantly, nephrons are only formed early in life; during normal gestation, nephrogenesis is complete by about 32–36 weeks, with no new nephrons formed after this time during the lifetime of the individual. Hence, given that a loss of a critical number of nephrons is the hallmark of renal disease, an increased severity and acceleration of renal disease is likely when the number of nephrons is already reduced prior to disease onset. Low birth weight can result from intrauterine growth restriction (IUGR or preterm birth; a high proportion of babies born prematurely also exhibit IUGR. In this paper, we describe how IUGR and preterm birth adversely impact on nephrogenesis and how a subsequent reduced nephron endowment at the beginning of life may lead to long-term risk of renal disease, but not necessarily hypertension.

  16. Severe Uncompensated Metabolic Alkalosis due to Plasma Exchange in a Patient with Pulmonary-Renal Syndrome: A Clinician’s Challenge

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    Mohsin Ijaz


    Full Text Available Metabolic alkalosis secondary to citrate toxicity from plasma exchange is very uncommon in patients with normal renal function. In patients with advanced renal disease this can be a fatal event. We describe a case of middle-aged woman with Goodpasture’s syndrome treated with plasma exchange who developed severe metabolic alkalosis. High citrate load in plasma exchange fluid is the underlying etiology. Citrate metabolism generates bicarbonate and once its level exceeds the excretory capacity of kidneys, the severe metabolic alkalosis ensues. Our patient presented with generalized weakness, fever, and oliguria and developed rapidly progressive renal failure. Patient had positive serology for antineutrophilic cytoplasmic antibodies myeloperoxidase (ANCA-MPO and anti-glomerular basement membrane antibodies (anti-GBM. Renal biopsy showed diffuse necrotizing and crescentic glomerulonephritis with linear glomerular basement membrane staining. Patient did not respond to intravenous steroids. Plasma exchange was started with fresh frozen plasma but patient developed severe metabolic alkalosis. This metabolic alkalosis normalized with cessation of plasma exchange and initiation of low bicarbonate hemodialysis. ANCA-MPO and anti-GBM antibodies levels normalized within 2 weeks and remained undetectable at 3 months. Patient still required maintenance hemodialysis.

  17. Optimising drug prescribing and dispensing in subjects at risk for drug errors due to renal impairment : improving drug safety in primary healthcare by low eGFR alerts

    NARCIS (Netherlands)

    Joosten, Hanneke; Drion, Iefke; Boogerd, Kees J.; van der Pijl, Emiel V.; Slingerland, Robbert J.; Slaets, Joris P. J.; Jansen, Tiele J.; Schwantje, Olof; Gans, Reinold O. B.; Bilo, Henk J. G.


    Objectives: To assess the risk of medication errors in subjects with renal impairment (defined as an estimated glomerular filtration rate (eGFR) Design: Clinical survey. Setting: The city of Zwolle, The Netherlands, in a primary care setting including 22 community pharmacists and 65 general practiti

  18. Upregulation of the transcription factor TFEB in t(6;11)(p21;q13)-positive renal cell carcinomas due to promoter substitution

    NARCIS (Netherlands)

    Kuiper, RP; Schepens, M; Thijssen, J; van Asseldonk, M; van den Berg, E; Bridge, J; Schuuring, E; Schoenmakers, EFPM; van Kessel, AG


    The MITF/TFE subfamily of basic helix-loop-helix leucine-zipper (bHLH-LZ) transcription factors consists of four closely related members, TFE3, TFEB, TFEC and MITF, which can form both homo- and heterodimers. Previously, we demonstrated that in t(X;1)(p11;q21)-positive renal cell carcinomas (RCCs),

  19. Upregulation of the transcription factor TFEB in t(6;11)(p21;q13)-positive renal cell carcinomas due to promoter substitution

    NARCIS (Netherlands)

    Kuiper, RP; Schepens, M; Thijssen, J; van Asseldonk, M; van den Berg, E; Bridge, J; Schuuring, E; Schoenmakers, EFPM; van Kessel, AG


    The MITF/TFE subfamily of basic helix-loop-helix leucine-zipper (bHLH-LZ) transcription factors consists of four closely related members, TFE3, TFEB, TFEC and MITF, which can form both homo- and heterodimers. Previously, we demonstrated that in t(X;1)(p11;q21)-positive renal cell carcinomas (RCCs),

  20. Complete renal recovery from severe acute renal failure after thrombolysis of bilateral renal vein thrombosis. (United States)

    Ramadoss, Suresh; Jones, Robert G; Foggensteiner, Lukas; Willis, Andrew P; Duddy, Martin J


    A previously healthy young man presented with acute renal failure due to extensive spontaneous deep vein thrombosis, including the inferior vena cava (IVC) and both renal veins. The patient was treated with selectively delivered thrombolytic therapy over a 7-day-period, which resulted in renal vein patency and complete recovery of renal function. A stent was placed over a segment stenosis of the IVC. No thrombophilic factors were identified. Bilateral renal vein thrombosis in young fit individuals is an unusual cause of acute renal failure. Thrombolytic therapy, even with delay, can completely restore renal function.

  1. Evaluation of the polymerase chain reaction in the diagnosis of cutaneous leishmaniasis due to Leishmania major: a comparison with direct microscopy of smears and sections from lesions

    DEFF Research Database (Denmark)

    Andresen, K; Gaafar, A; El-Hassan, A M


    We have compared the sensitivity of the polymerase chain reaction (PCR) as a diagnostic tool against conventional microscopical diagnostic techniques in patients with cutaneous leishmaniasis from the Sudan. Twenty-eight patients were diagnosed according to clinical criteria followed by microscopi......We have compared the sensitivity of the polymerase chain reaction (PCR) as a diagnostic tool against conventional microscopical diagnostic techniques in patients with cutaneous leishmaniasis from the Sudan. Twenty-eight patients were diagnosed according to clinical criteria followed......%, respectively. The PCR should be considered as a valuable and sensitive diagnostic tool in the diagnosis of cutaneous leishmaniasis; it has the added advantage of identification of the species of Leishmania causing the lesion....

  2. Management of acute ischemic stroke due to tandem occlusion: should endovascular recanalization of the extracranial or intracranial occlusive lesion be done first? (United States)

    Rangel-Castilla, Leonardo; Rajah, Gary B; Shakir, Hakeem J; Shallwani, Hussain; Gandhi, Sirin; Davies, Jason M; Snyder, Kenneth V; Levy, Elad I; Siddiqui, Adnan H


    OBJECTIVE Acute tandem occlusions of the cervical internal carotid artery and an intracranial large vessel present treatment challenges. Controversy exists regarding which lesion should be addressed first. The authors sought to evaluate the endovascular approach for revascularization of these lesions at Gates Vascular Institute. METHODS The authors performed a retrospective review of a prospectively maintained, single-institution database. They analyzed demographic, procedural, radiological, and clinical outcome data for patients who underwent endovascular treatment for tandem occlusions. A modified Rankin Scale (mRS) score ≤ 2 was defined as a favorable clinical outcome. RESULTS Forty-five patients were identified for inclusion in the study. The average age of these patients was 64 years; the mean National Institutes of Health Stroke Scale score at presentation was 14.4. Fifteen patients received intravenous thrombolysis before undergoing endovascular treatment. Thirty-seven (82%) of the 45 proximal cervical internal carotid artery occlusions were atherothrombotic in nature. Thirty-eight patients underwent a proximal-to-distal approach with carotid artery stenting first, followed by intracranial thrombectomy, whereas 7 patients underwent a distal-to-proximal approach (that is, intracranial thrombectomy was performed first). Thirty-seven (82%) procedures were completed with local anesthesia. For intracranial thrombectomy procedures, aspiration alone was used in 15 cases, stent retrieval alone was used in 5, and a combination of aspiration and stent-retriever thrombectomy was used in the remaining 25. The average time to revascularization was 81 minutes. Successful recanalization (thrombolysis in cerebral infarction Grade 2b/3) was achieved in 39 (87%) patients. Mean National Institutes of Health Stroke Scale scores were 9.3 immediately postprocedure (p acute carotid artery stenting and mechanical thrombectomy concurrently. Proximal-to-distal and aspiration

  3. 超声造影检查在肾脏占位性病变性质判断中的应用%Application of contrast-enhanced ultrasound in diagnosis of renal occupied lesions

    Institute of Scientific and Technical Information of China (English)

    张凡; 宋烨; 李园; 葛岚; 王秀艳; 梁皓


    Objective To evaluate the application value of contrast-enhanced ultrasound ( CEUS) in the diagnosis of renal occupied lesions systematically.Methods The related literatures which used CEUS in the diagnosis of renal occu-pied lesions were searched from Pubmed, Embase, Cochrane Library, CBM and CNKI database.The heterogeneity test was conducted on these literatures by using Stata 12.0 and Meta-disc software.The weighted sensitivity, specificity, diagnosis odds ratio, positive likelihood ratio and negative likelihood ratio were calculated as well as the summary receiver operating characteristic ( SROC) curve.Results Fourteen literatures were included, the weighted sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio and negative likelihood ratio were 0.957, 0.748, 66.277, 3.797 and 0.057, respec-tively;and the SROC curve was 0.96.Conclusion Using CEUS has a low missed diagnosis rate, an relative high misdi-agnosis rate and small range of summary sensitivity in the differential diagnosis of renal occupied lesions.%目的:系统评价超声造影( CEUS )检查在肾脏占位性病变性质判断中的应用价值。方法检索Pubmed、Embase、Cochrane Library、中国生物医学文献数据库、中国期刊网数据库中应用CEUS检查判断肾占位性病变良恶性的相关文献,使用STATA12.0及Meta-disc软件对纳入的文献数据进行异质性检验,计算其汇总灵敏度、特异度、诊断比值比、阳性似然比和阴性似然比,绘制受检者工作特征曲线( SROC )。结果共纳入14篇文献, CEUS检查判断肾占位性病变性质的汇总灵敏度、特异度、诊断比值比、阳性似然比和阴性似然比分别为0.957、0.748、66.277、3.797和0.057,SROC曲线下面积为0.96。结论应用CEUS检查判断肾脏占位性病变性质的漏诊率较低,而误诊率相对偏高,汇总敏感性的变化范围较小。

  4. Radiologic Evaluation of Small Renal Masses (II: Posttreatment Management

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    J. Santos


    Full Text Available The increase in the detection of small renal masses (SRMs and their best knowledge leads to a change in the therapeutic management of these lesions. The use of a less aggressive surgical technique or even an expectant attitude is the current tendency, in order to preserve as much renal function as possible. Imaging techniques are essential in the followup of these lesions. It allows us to know the postsurgical changes and possible complications due to treatment and the presence of local recurrence and metastases. Furthermore, a close radiological followup of SRM related to ablative treatments is mandatory. The purpose of this article is to reveal the imaging features of complications due to surgical or ablative treatments, local recurrence and metastasis, as well as their followup.

  5. Nodular lesions and mesangiolysis in diabetic nephropathy. (United States)

    Wada, Takashi; Shimizu, Miho; Yokoyama, Hitoshi; Iwata, Yasunori; Sakai, Yoshio; Kaneko, Shuichi; Furuichi, Kengo


    Diabetic nephropathy is a leading cause of end-stage renal failure all over the world. Advanced human diabetic nephropathy is characterized by the presence of specific lesions including nodular lesions, doughnut lesions, and exudative lesions. Thus far, animal models precisely mimicking advanced human diabetic nephropathy, especially nodular lesions, remain to be fully established. Animal models with spontaneous diabetic kidney diseases or with inducible kidney lesions may be useful for investigating the pathogenesis of diabetic nephropathy. Based on pathological features, we previously reported that diabetic glomerular nodular-like lesions were formed during the reconstruction process of mesangiolysis. Recently, we established nodular-like lesions resembling those seen in advanced human diabetic nephropathy through vascular endothelial injury and mesangiolysis by administration of monocrotaline. Here, in this review, we discuss diabetic nodular lesions and its animal models resembling human diabetic kidney lesions, with our hypothesis that endothelial cell injury and mesangiolysis might be required for nodular lesions.

  6. Lesiones macroscópicas gastrointestinales y renales en pollos de engorda, criados con niveles altos de proteína de soya en la dieta


    René Morales López; Teresa Casaubon Huguenin; Ernesto Ávila González


    Para evaluar posibles lesiones gastrointestinales en pollos y su relación con un síndrome caracterizado por baja ganancia de peso, eliminación de alimento semidigerido en heces y moco de color naranja, que en México ha representado pérdidas para la industria, se desarrolló un estudio con pollos de engorda utilizando dietas altas en proteína sorgo más soya (T3:26% y T4:30%), en relación con dos dietas testigo adecuadas en proteína, una con sorgo más soya (T2:22%) y otra con sorgo, girasol y gl...

  7. Vitamin E mitigates cisplatin-induced nephrotoxicity due to reversal of oxidative/nitrosative stress, suppression of inflammation and reduction of total renal platinum accumulation. (United States)

    Darwish, Mostafa A; Abo-Youssef, Amira M; Khalaf, Marwa M; Abo-Saif, Ali A; Saleh, Ibrahim G; Abdelghany, Tamer M


    Cisplatin (CP) is one of the most effective chemotherapeutic agents. Unfortunately, CP-induced nephrotoxicity hampered its use. This study aims to investigate the effect of vitamin E (Vit E) on CP-induced nephrotoxicity. Male white albino rats were divided to four group's six rats each and received either, 1% tween 80 in normal saline or Vit E (75 mg/kg) per day for 14 consecutive days or a single injection of CP (6 mg/kg) alone or CP (6 mg/kg) together with Vit E (75 mg/kg per day for 14 consecutive days). Five days after the CP injection, rats were euthanized; blood samples were collected; kidneys were dissected; and biochemical, immunohistochemical, and histological examinations were performed. Our results revealed that CP treatment significantly increased serum levels of creatinine and urea. Moreover, reduced glutathione (GSH) content as well as superoxide dismutase (SOD) and catalase (CAT) activities were significantly reduced with concurrent increase in kidney malondialdehyde (MDA) content following CP treatment. Vit E successfully lowered serum levels of urea and creatinine, enhanced creatinine clearance and diuresis, and normalized relative kidney/body weight. Furthermore, Vit E successfully normalized renal MDA and nitrite concentrations, elevated GSH level, and restored CAT and SOD activities in renal tissues. Histopathological examination of rat kidney revealed that Vit E significantly mitigated CP-induced renal damage. Importantly, administration of Vit E reduced kidney total platinum concentration indicating a role of platinum renal accumulation on the ability of Vit E to protect against CP nephrotoxicity.

  8. Visceral leishmaniasis in a kidney transplant recipient: parasitic interstitial nephritis, a cause of renal dysfunction. (United States)

    Dettwiler, S; McKee, T; Hadaya, K; Chappuis, F; van Delden, C; Moll, S


    Visceral leishmaniasis (VL) due to Leishmania infantum is an endemic parasitic infection in the Mediterranean area. It most commonly affects immunosuppressed individuals, especially HIV patients and less frequently organ transplant recipients. Renal involvement seems to be frequent and is mostly associated with tubulointerstitial nephritis, as described in autopsy reports. In the 61 cases of renal transplant recipients with VL reported in the literature, renal dysfunction was noted at clinical presentation and was more frequently observed as a complication of antiparasitic therapy. However, no pathological analysis of the allograft lesions was reported. We present the case of a Swiss renal transplant recipient who developed VL after vacations in Spain and Tunisia, complicated by acute parasitic nephritis in the renal allograft 3 months after a well-conducted treatment of liposomal amphotericin B.

  9. Renal tuberculosis

    Directory of Open Access Journals (Sweden)

    Džamić Zoran


    Full Text Available Tuberculosis is still a significant health problem in the world, mostly in developing countries. The special significance lies in immunocompromised patients, particularly those suffering from the HIV. Urogenital tuberculosis is one of the most common forms of extrapulmonary tuberculosis, while the most commonly involved organ is the kidney. Renal tuberculosis occurs by hematogenous dissemination of mycobacterium tuberculosis from a primary tuberculosis foci in the body. Tuberculosis is characterized by the formation of pathognomonic lesions in the tissues - granulomata. These granulomata may heal spontaneously or remain stable for years. In certain circumstances in the body associated with immunosuppression, the disease may be activated. Central caseous necrosis occurs within tuberculoma, leading to formation of cavities that destroy renal parenchyma. The process may gain access to the collecting system, forming the caverns. In this way, infection can be spread distally to renal pelvis, ureter and bladder. Scaring of tissue by tuberculosis process may lead to development of strictures of the urinary tract. The clinical manifestations are presented by nonspecific symptoms and signs, so tuberculosis can often be overlooked. Sterile pyuria is characteristic for urinary tuberculosis. Dysuric complaints, flank pain or hematuria may be presented in patients. Constitutional symptoms of fever, weight loss and night sweats are presented in some severe cases. Diagnosis is made by isolation of mycobacterium tuberculosis in urine samples, by cultures carried out on standard solid media optimized for mycobacterial growth. Different imaging studies are used in diagnostics - IVU, CT and NMR are the most important. Medical therapy is the main modality of tuberculosis treatment. The first line anti-tuberculosis drugs include isoniazid, rifampicin, pyrazinamide and ethambutol. Surgical treatment is required in some cases, to remove severely damaged kidney, if

  10. Cinnabar Induces Renal Inflammation and Fibrogenesis in Rats

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    Ying Wang


    Full Text Available The purpose of this study was to investigate whether cinnabar causes renal inflammation and fibrosis in rats. Rats were dosed orally with cinnabar (1 g/kg/day for 8 weeks or 12 weeks. The control rats were treated with solvent (5% carboxymethylcellulose solution over the same time periods, respectively. Renal mercury (RHg, urinary mercury (UHg, serum creatinine (SCr, urine kidney injury molecule 1 (KIM-1, renal pathology, and renal mediators were examined. At both 8 weeks and 12 weeks, RHg, UHg, and urine KIM-1 were significantly higher in the cinnabar group than in the control group, although SCr was unchanged. Kidney lesions in the cinnabar-treated rats occurred mainly in the tubules and interstitium, including vacuolization, protein casts, infiltration of inflammatory cells, and slight increase in interstitial collagen. In addition, mild mesangial proliferation was observed in glomeruli. Moreover, the expression of inflammatory and fibrogenic mediators was upregulated in the cinnabar group. In conclusion, cinnabar may cause kidney damage due to the accumulation of mercury, and renal inflammation and slight fibrogenesis may occur in rats. In the clinic, the potential risk of renal injury due to the prolonged consumption of cinnabar should be considered even though the agent is relatively nontoxic.

  11. Renal tubule cell repair following acute renal injury. (United States)

    Humes, H D; Lake, E W; Liu, S


    Experimental data suggests the recovery of renal function after ischemic or nephrotoxic acute renal failure is due to a replicative repair process dependent upon predominantly paracrine release of growth factors. These growth factors promote renal proximal tubule cell proliferation and a differentiation phase dependent on the interaction between tubule cells and basement membrane. These insights identify the molecular basis of renal repair and ischemic and nephrotoxic acute renal failure, and may lead to potential therapeutic modalities that accelerate renal repair and lessen the morbidity and mortality associated with these renal disease processes. In this regard, there is a prominent vasoconstrictor response of the renal vasculature during the postischemic period of developing acute renal failure. The intravenous administration of pharmacologic doses of atrial natriuretic factor (ANF) in the postischemic period have proven efficacious by altering renal vascular resistance, so that renal blood flow and glomerular filtration rate improve. ANF also appears to protect renal tubular epithelial integrity and holds significant promise as a therapeutic agent in acute renal failure. Of equal or greater promise are the therapeutic interventions targeting the proliferative reparative zone during the postischemic period. The exogenous administration of epidermal growth factor or insulin-like growth factor-1 in the postischemic period have effectively decreased the degree of renal insufficiency as measured by the peak serum creatinine and has hastened renal recovery as measured by the duration of time required to return the baseline serum creatinine values. A similarly efficacious role for hepatocyte growth factor has also been recently demonstrated.

  12. Assessment of the structural brain network reveals altered connectivity in children with unilateral cerebral palsy due to periventricular white matter lesions

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    Kerstin Pannek


    Conclusion: This study shows that network-based analysis of structural connectivity can identify alterations in FA in unilateral CP, and that these alterations in FA are related to clinical function. Application of this connectome-based analysis to investigate alterations in connectivity following treatment may elucidate the neurological correlates of improved functioning due to intervention.

  13. Mastite com lesões sistêmicas por Staphylococus aureus subesp. aureus em coelhos Mastitis with systemic lesions due to Staphylococus aureus subesp. aureus in rabbits

    Directory of Open Access Journals (Sweden)

    Sandra Davi Traverso


    Full Text Available Em uma criação composta por 1800 coelhos, 33% das matrizes apresentaram mastite e lesões cutâneas crostosas e purulentas. Estes animais apresentavam-se entre 10 a- 12 meses de idade e em segunda parição. Quinze coelhos afetados foram sacrificados e necropsiados. Na necropsia, além das lesões cutâneas haviam microabscessos em diversos órgãos. Das amostras coletadas isolou-se Staphylococcus aureus subesp. aureus. S. aureus subesp. aureus também foi isolado de "swab" nasal coletado do tratador encarregado de fazer o diagnóstico de gestação nas coelhas. Histologicamente, havia formação de múltiplos abscessos, presença de bactérias gram positivas em vasos sangüíneos e linfáticos, além de êmbolos bacterianos nos tecidos. Nas mamas, observou-se tecido glandular normal associado a abscessos multifocais delimitados.At a commercial rabbitry which was composed of 1800 New Zealand White rabbits, 30% of the does had presented mastitis and purulent cutaneal lesions. The age of the animals ranged from 10 to 12 months and were at the second parturition. At necropsy, microabscesses were observed in several organs. Bacteriological samples collected from affected animals resulted Staphylococcus aureus subesp. aureus.. Additionally, the same agent has been isolated from a nasal swab collected from the person responsible for the pregnancy diagnosis. Histologically, there were multiple abscesses, gram positive bacteria within blood and lymphatic vessels, and bacterial emboli scattered in the tissues. In the mammas, normal glandular tissue associated with multifocal abscesses were observed.

  14. Trauma renal Renal trauma

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    Gerson Alves Pereira Júnior


    Full Text Available Apresentamos uma revisão sobre trauma renal, com ênfase na avaliação radiológica, particularmente com o uso da tomografia computadorizada, que tem se tornado o exame de eleição, ao invés da urografia excretora e arteriografia. O sucesso no tratamento conservador dos pacientes com trauma renal depende de um acurado estadiamento da extensão da lesão, classificado de acordo com a Organ Injury Scaling do Colégio Americano de Cirurgiões. O tratamento conservador não-operatório é seguro e consiste de observação contínua, repouso no leito, hidratação endovenosa adequada e antibioti- coterapia profilática, evitando-se uma exploração cirúrgica desnecessária e possível perda renal. As indicações para exploração cirúrgica imediata são abdome agudo, rápida queda do hematócrito ou lesões associadas determinadas na avaliação radiológica. Quando indicada, a exploração renal após controle vascular prévio é segura, permitindo cuidadosa inspeção do rim e sua reconstrução com sucesso, reduzindo a probabilidade de nefrectomia.We present a revision of the renal trauma with emphasis in the radiographic evaluation, particularly CT scan that it has largely replaced the excretory urogram and arteriogram in the diagnostic worh-up and management of the patient with renal trauma. The successful management of renal injuries depends upon the accurate assessment of their extent in agreement with Organ Injury Scaling classification. The conservative therapy managed by careful continuous observation, bed rest, appropriate fluid ressuscitation and prophylactic antibiotic coverage after radiographic staging for severely injured kidneys can yield favorable results and save patients from unnecessary exploration and possible renal loss. The indications for immediate exploratory laparotomy were acute abdomen, rapidly dropping hematocrit or associated injuries as determinated from radiologic evaluation. When indicated, renal exploration

  15. Characterization of complex renal cysts

    DEFF Research Database (Denmark)

    Graumann, Ole; Osther, Susanne Sloth; Osther, Palle Jörn Sloth


    Abstract Objective. Complex renal cysts represent a major clinical problem, since it is often difficult to exclude malignancy. The Bosniak classification system, based on computed tomography (CT), is widely used to categorize cystic renal lesions. The aim of this study was to evaluate critically ...... of this "new" classification strategy is, however, still missing. Data on other imaging modalities are too limited for conclusions to be drawn.......Abstract Objective. Complex renal cysts represent a major clinical problem, since it is often difficult to exclude malignancy. The Bosniak classification system, based on computed tomography (CT), is widely used to categorize cystic renal lesions. The aim of this study was to evaluate critically...... available data on the Bosniak classification. Material and methods. All publications from an Entrez Pubmed search were reviewed, focusing on clinical applicability and the use of imaging modalities other than CT to categorize complex renal cysts. Results. Fifteen retrospective studies were found. Most...

  16. Renal arteriography (United States)

    ... Read More Acute arterial occlusion - kidney Acute kidney failure Aneurysm Atheroembolic renal disease Blood clots Renal cell carcinoma Renal venogram X-ray Review Date 1/5/2016 Updated by: Jason Levy, ...

  17. Clinicopathological conference (CPC: renal transplant recipient with pulmonary nodules = Conferencia clínico-patológica (CPC: trasplantado renal con nódulos pulmonares

    Directory of Open Access Journals (Sweden)

    Alonso Encarnación, Alexánder


    Full Text Available We present the case of a 41 year-old man, who had a renal transplantation in 2005. He was admitted to the hospital because of 10 days of fever, diarrhea and respiratory symptoms. During his stay, a nodular lesion in the skin, several pulmonary nodules and colon ulcers were documented; due to his past medical history he was highly suspicious of having a fungal infection; antifungal therapy was started, but he died due to respiratory insufficiency.

  18. Imaging of renal osteodystrophy

    Energy Technology Data Exchange (ETDEWEB)

    Jevtic, V. E-mail:


    Chronic renal insufficiency, hemodialysis, peritoneal dialysis, renal transplantation and administration of different medications provoke complex biochemical disturbances of the calcium-phosphate metabolism with wide spectrum of bone and soft tissue abnormalities termed renal osteodystrophy. Clinically most important manifestation of renal bone disease includes secondary hyperparathyroidism, osteomalacia/rickets, osteoporosis, adynamic bone disease and soft tissue calcification. As a complication of long-term hemodialysis and renal transplantation amyloid deposition, destructive spondyloarthropathy, osteonecrosis, and musculoskeletal infections may occur. Due to more sophisticated diagnostic methods and more efficient treatment classical radiographic features of secondary hyperparathyroidism and osteomalacia/rickets are now less frequently seen. Radiological investigations play an important role in early diagnosis and follow-up of the renal bone disease. Although numerous new imaging modalities have been introduced in clinical practice (scintigraphy, CT, MRI, quantitative imaging), plain film radiography, especially fine quality hand radiograph, still represents most widely used examination.

  19. Can renal infarction occur after renal cyst aspiration? Case report. (United States)

    Emre, Habib; Soyoral, Yasemin Usul; Tanik, Serhat; Gecit, Ilhan; Begenik, Huseyin; Pirincci, Necip; Erkoc, Reha


    Renal infarction (RI) is a rarely seen disorder, and the diagnosis is often missed. The two major causes of RI are thromboemboli originhating from a thrombus in the heart or aorta, and in-situ thrombosis of a renal artery. We report a case of RI that developed due to renal artery and vein thrombosis, as confirmed by pathological evaluation of the nephrectomy material, three weeks after renal cyst aspiration.

  20. How to manage hypertension with atherosclerotic renal artery stenosis? (United States)

    Ricco, Jean-Baptiste; Belmonte, Romain; Illuminati, Guilio; Barral, Xavier; Schneider, Fabrice; Chavent, Bertrand


    The management of atherosclerotic renal artery stenosis (ARAS) in patients with hypertension has been the topic of great controversy. Major contemporary clinical trials such as the Cardiovascular Outcomes for Renal Artery lesions (CORAL) and Angioplasty and Stenting for Renal Atherosclerotic lesions (ASTRAL) have failed to show significant benefit of revascularization over medical management in controlling blood pressure and preserving renal function. We present here the implications and limitations of these trials and formulate recommendations for management of ARAS.

  1. Incidental solid renal mass in a cadaveric donor kidney

    Directory of Open Access Journals (Sweden)

    R M Meyyappan


    Full Text Available The number of patients living with end-stage renal disease (ESRD is increasing in our country and demand for renal grafts is ever increasing. Cadaver renal transplantation is being established as a viable supplement to live transplantation. We present a case where a mass lesion was encountered in the donor kidney from a cadaver. Enucleation of the lesion was done and we proceeded with the grafting. Histopathological examination showed a ′Renomedullary interstitial cell tumour′, a rare benign lesion. Post transplant, the renal function recovered well and the patient is asymptomatic. Such incidental renal masses present an ethical dilemma to the operating surgeon.

  2. Evaluation of absorbed dose in studies of renal function due to {sup 123}I/{sup 131}I (hippuran) e {sup 111}In (DPTA); Evaluacion de la dosis absorbida durante estudios de la funcion renal debido al {sup 123}I/{sup 131}I (hippuran) e {sup 111}In (DPTA)

    Energy Technology Data Exchange (ETDEWEB)

    Vasquez, M.V.; Castillo, C.E.; Rojas, R.; Cabrera, C.; Abanto, D.; Morgan, A. [Universidad Nacional de Trujillo (UNT), Area de Fisica Medica, Trujillo (Peru); Diaz, E.E., E-mail: [Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (Brazil)


    The absorbed dose of the kidneys during renal function studies of adult patients is estimated through biokinetics of radiopharmaceuticals containing the {sup 123}I/{sup 131}I (hippuran) e {sup 111}In (DPTA). Using the methodology MIRD and representation Cristy-Eckerman for adult kidneys, it is shown that dosimetric contributions of organs of biokinetics {sup 123}I/{sup 131}I (hippuran) e {sup 111}In (DPTA) are significant, in estimative of dose for renal function studies. Dosimetric contributions (body and whole bladder, kidneys excluding) are given by 11.90% (for {sup 123}I), 4.97% (for {sup 131}I) and 28.32% (for {sup 111}In). In all cases, the dosimetric contributions are mainly due to photons issued by the whole body.

  3. Relationship of gene polymorphisms of angiotensin convertion enzyme, aldosterone synthase and α-adducin with subclinical renal lesion%血管紧张素转换酶醛固酮合酶α-内收蛋白基因多态性与肾损害的关系

    Institute of Scientific and Technical Information of China (English)

    陈慧; 林慧中; 陈燕; 骆杰伟; 吴小盈; 李德育; 伍延安; 沈晓丽


    Objective To investigate the relationship of gene polymorphisms of angiotensin eonvertion enzyme (ACE), aldosterone synthase (CYP11B2)and α-adducin with subclinical renal lesion. Methods I/D polymorphism of ACE gene, -344T/C polymorphism of CYP11B2 gene and 460G/T polymorphism of α-adduein gene were detected by polymerase chain reaction (PCR) and restrictive fragment length polymorphism(RFLP) in 604 normotensive subjects and 1081 primary hypertensive patients whose creatinine (Cr) were less than 2mg/L. The primary hypertensive and normotensive subjects were divided respectively into normal group (Ccr≥60ml/min) and subclinical renal lesion (Ccr<60 ml/min) group, according to creatinine clearance rate (Ccr) calculated by Cockcroft-Gault equation. Results ANOVA, contingency X2 and partition of chi-square were selected. The frequencies of different genotypes of ACE, CYP11B2, and α-adducin were in agreement with Hardy-Weinberg equilibrium in our study. Normal renal function group (A group, n=512) and subclinical renal lesion group (B group, n=92) in normotensive subjects, and normal renal function group (C group, n=828) and subclinical renal lesion group (D group, n=252) in hypertensive patients were compared. The patients in B and D groups were older than those in A and C groups (P0.05).ACE-DD基因型分布频率在高血压肾损害组最高为22.6%(57/252),α-adducin-TT基因型分布频率在血压肾功能正常组最低为13.3%(68/512),分别与其他3组比较,差异有统计学意义(均为P0.05).CYP11B2各基因型的分布频率4组比较,差异无统计学意义(均为P>0.05). 结论 随增龄,肾功能异常增加,ACE-DD基因型与高血压肾损害相关,α-adducin-TT基因型与高血压和肾损害均相关,但未发现CYP11B2基因多态性与肾损害的关系.

  4. Pediatric Renal Neoplasms. (United States)

    Ranganathan, Sarangarajan


    Renal tumors in childhood consist of a diverse group of tumors ranging from the most common Wilms' tumor, to the uncommon and often fatal rhabdoid tumor. Diagnosis is based on morphologic features and aided by ancillary techniques such as immunohistochemistry and cytogenetics. Molecular techniques have helped identify a group of pediatric renal cell carcinomas that have specific translocations, called translocation-associated carcinomas. Differential diagnosis of the various tumors is discussed. Pathogenesis and nephroblastomatosis, the precursor lesions of Wilms tumor, also are discussed briefly, as are the handling of these tumor specimens and prognostic factors. Copyright © 2009 Elsevier Inc. All rights reserved.

  5. IgG4-related inflammatory pseudotumor of the renal pelvis involving renal parenchyma, mimicking malignancy. (United States)

    Park, Ho Gyun; Kim, Kyoung Min


    IgG4-related disease is a recently recognized systemic disease characterized by storiform fibrosis with infiltration of IgG4-positive plasma cells. In rare incidences, IgG4-related renal disease can present as a solitary mass lesion at renal pelvis and can pose a diagnostic challenge since these lesions mimic malignancy. Herein, we present a rare case of IgG4-related disease presenting as inflammatory pseudotumor lesion, involving the renal pelvis and also neighboring renal parenchyma. A 75-year-old man with no history of IgG4-related disease underwent computed tomography (CT) scan for evaluation of prostatic cancer. The CT scan incidentally revealed a mass lesion located at the right renal pelvis. Radiologic findings were highly suggestive of malignancy. Therefore, the patient underwent right nephroureterectomy. Microscopically, the mass lesion showed storiform fibrosis with diffuse and intense inflammatory cell infiltration. Infiltrating cells were mainly histiocytes and plasma cells. Tubulointerstitium adjacent to the lesion also showed fibrosis with abundant plasmacytic infiltration. Immunohistochemical staining revealed the presence of IgG4-positive plasma cells in both the mass lesion and tubulointerstitium (mean of 94/HPF per field). Considering these findings, we diagnosed the mass lesion as IgG4-related inflammatory pseudotumor of the renal pelvis. In patients with renal pelvic masses, IgG4-related inflammatory pesudotumor should be considered in the differential diagnosis to avoid unnecessary surgical intervention.

  6. Incidence and outcome of patients starting renal replacement therapy for end-stage renal disease due to multiple myeloma or light-chain deposit disease: an ERA-EDTA Registry study

    DEFF Research Database (Denmark)

    Tsakiris, D.J.; Stel, V.S.; Finne, P.;


    of death and survival rates of RRT for ESRD due to MM or LCDD in the ERA-EDTA Registry. Methods. Thirteen national registries providing data on patients who started RRT from 1986-2005 to the ERA-EDTA Registry participated. Incidence per million population (pmp) of RRT for ESRD due to MM or LCDD and other...

  7. Characteristic findings in images of extra-pancreatic lesions associated with autoimmune pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Fujinaga, Yasunari, E-mail: [Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621 (Japan); Kadoya, Masumi [Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621 (Japan); Kawa, Shigeyuki [Center of Health, Safety and Environmental Management, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621 (Japan); Hamano, Hideaki [Department of Medicine, Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621 (Japan); Ueda, Kazuhiko; Momose, Mitsuhiro; Kawakami, Satoshi; Yamazaki, Sachie; Hatta, Tomoko; Sugiyama, Yukiko [Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621 (Japan)


    Purpose: Autoimmune pancreatitis is a unique form of chronic pancreatitis characterized by a variety of extra-pancreatic involvements which are frequently misdiagnosed as lesions of corresponding organs. The purpose of this study was to clarify the diagnostic imaging features of extra-pancreatic lesions associated with autoimmune pancreatitis. Materials and methods: We retrospectively analyzed diagnostic images of 90 patients with autoimmune pancreatitis who underwent computer-assisted tomography, magnetic resonance imaging, and/or gallium-67 scintigraphy before steroid therapy was initiated. Results: AIP was frequently (92.2%) accompanied by a variety of extra-pancreatic lesions, including swelling of lachrymal and salivary gland lesions (47.5%), lung hilar lymphadenopathy (78.3%), a variety of lung lesions (51.2%), wall thickening of bile ducts (77.8%), peri-pancreatic or para-aortic lymphadenopathy (56.0%), retroperitoneal fibrosis (19.8%), a variety of renal lesions (14.4%), and mass lesions of the ligamentum teres (2.2%). Characteristic findings in CT and MRI included lymphadenopathies of the hilar, peri-pancreatic, and para-aortic regions; wall thickening of the bile duct; and soft tissue masses in the kidney, ureters, aorta, paravertebral region, ligamentum teres, and orbit. Conclusions: Recognition of the diagnostic features in the images of various involved organs will assist in the diagnosis of autoimmune pancreatitis and in differential diagnoses between autoimmune pancreatitis-associated extra-pancreatic lesions and lesions due to other pathologies.

  8. Aortic dissection or renal infarction: Multislice computed tomographic angiography can tell

    Directory of Open Access Journals (Sweden)

    Stojanović Miloš


    Full Text Available Introduction. Acute renal infarction as a consequence of renal artery occlusion often goes unrecognized, mostly due to the non-specific clinical features. A quick diagnosis, ideally within three hours of presentation, is a key to renal function recovery. Case Outline. A 62-year-old male patient was admitted with a sudden abdominal pain, right flank pain and nausea. He had a diastolic hypertension at admission and his previous medical history showed atrial fibrillation. Initial clinical diagnosis was aortic dissection. Laboratory findings included elevated lactate dehydrogenase (LDH and serum creatinine levels. There were no signs of aortic dissection or aneurismatic lesions registered during a multislice computed tomographic (MSCT angiography. However, MSCT angiography demonstrated left “upper” renal artery thrombosis and renal infarction - avascular area of the upper two thirds of the left kidney sharply demarcated from the surrounding parenchyma. Both kidneys excreted the contrast. Anticoagulant therapy was initiated, along with antiarrythmic and antihypertensive medications. The follow-up by computed tomography was performed after nine weeks, and it showed a partial revascularization of the previously affected area. Conclusion. Concomitant presence of flank/abdominal pain, an increased risk for thromboembolism and an elevated LDH suggested a possibility of renal infarction. MSCT angiography is a non-invasive and accurate method in the diagnosis of renal artery occlusion and the resulting renal infarction.

  9. Failure of posaconazole therapy in a renal transplant patient with invasive aspergillosis due to Aspergillus fumigatus with attenuated susceptibility to posaconazole

    NARCIS (Netherlands)

    Kuipers, S.; Bruggemann, R.J.M.; Sevaux, R.G. de; Heesakkers, J.P.F.A.; Melchers, W.J.G.; Mouton, J.W.; Verweij, P.E.


    We report the case of a kidney transplant recipient with invasive aspergillosis due to Aspergillus fumigatus resistant to voriconazole and intermediately susceptible to posaconazole who failed posaconazole therapy. Plasma posaconazole concentrations indicated an unfavorable ratio of the area under t

  10. Changes of the cerebral metabolite patterns in patients undergoing hemodialysis due to chronic renal failure: evaluation with proton magnetic resonance spectroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Baik, Hye Won; Yu, Hyeon; Yu, Soo Jeong; Kim, Gi Hyeon [Chung-Ang University Medical Center, College of Medicine, Seoul (Korea, Republic of)


    We wanted to evaluate the cerebral metabolites in patients with chronic renal failure (CRF) and who were undergoing hemodialysis by performing proton MR spectroscopy and were wanted to evaluate the correlation between the changes in the cerebral metabolite ratios and the duration after starting the initial hemodialysis. Proton MR spectroscopy was performed in 15 patients with CRF and who were undergoing hemodialysis and in ten healthy volunteers. The changes in N-acetylaspartate (NAA), choline-containing compounds (Cho), myo-inositol (Myo), glutamine/glutamate complex (Glx), and creatine (Cr) were analyzed. MR spectroscopy was performed before and after hemodialysis. For the patients with CRF before hemodialysis, the Cho/Cr ratio in the gray matter ({rho} < 0.001) and the Myo/Cr ratio in both the gray and white matter ({rho} < 0.01) were significantly elevated compared with those in the control subjects. For the patients with CRF after hemodialysis, their Cho/Cr ratios were significantly reduced in both the gray and white matter compared with that before hemodialysis ({rho} < 0.05). There was a significant positive correlation between the Cho/Cr ratio and serum Cr in the gray matter of CRF patients after hemodialysis (r = 0.54, {rho} < 0.05). The cerebral metabolite ratios were not significantly correlated with the duration after starting the initial hemodialysis. The cerebral metabolite patterns are significantly different between the patients with CRF and who are undergoing hemodialysis and the normal controls. The cerebral metabolite ratios are not significantly correlated with the duration after starting the initial hemodialysis.

  11. Verminous Arteritis Due to Crassicauda sp. in Cuvier's Beaked Whales (Ziphius Cavirostris). (United States)

    Díaz-Delgado, J; Fernández, A; Xuriach, A; Sierra, E; Bernaldo de Quirós, Y; Mompeo, B; Pérez, L; Andrada, M; Marigo, J; Catão-Dias, J L; Groch, K R; Edwards, J F; Arbelo, M


    The vascular system of Cuvier's beaked whales (CBW) (Ziphius cavirostris; family Ziphiidae), an extremely deep, prolonged-diving cetacean, is increasingly receiving anatomic and physiologic study due to possible anthropogenic interactions; however, vascular pathology rarely has been reported in this species. Thirteen CBW stranded in the Canary Islands from June 2008 to June 2014 were autopsied. A careful dissection of the thoracic and abdominal vasculature was performed on these animals. All had moderate to severe and extensive chronic fibrosing arteritis with aneurysms, hemorrhages, and thrombosis primarily involving the mesenteric and gastroepiploic arteries and the thoracic and abdominal aorta. Microscopically, the lesions varied from subacute subintimal hemorrhages and severe neutrophilic, eosinophilic, and histiocytic dissecting arteritis with intralesional nematode larvae to marked, chronic, fibrosing arteritis with thickening and distortion of the vascular wall with calcification and occasional cartilage metaplasia. In addition, adult nematodes in renal arteries and veins, renal parenchyma and/or ureter were identified morphologically as Crassicauda sp. Nucleic acid sequenced from renal nematodes from 2 animals yielded closest nucleotide identity to C. magna The pathogenesis is proposed to involve a host response to larval migration from the intestine to the kidney through the mesenteric arteries, abdominal aorta, and renal arteries. Severe consequences for such lesions are possible and could vary from reduced vascular compliance to chronic renal disease and predisposition to the development of disseminated intravascular coagulation and multiorgan failure. Severe chronic arteritis in CBW is associated with renal parasitism by Crassicauda spp.

  12. Evaluation of absorbed dosis during studies of renal function due AI {sup 123}I / {sup 131}I (Hippuran) and {sup 111} In (DPTA); Evaluacion de la dosis absorbida durante estudios de la funcion renal debido AI I{sup 123} / I{sup 131} (Hippuran) E In{sup 111} (DPTA)

    Energy Technology Data Exchange (ETDEWEB)

    Arteaga, Marcial V.V.; Diestra, Carlos E.C.; Villanueva, Raul A.S.; Alegria, Roberto R.; Salvatierra, Carlos C.; Rosales, Jorge M.; Gonzalez, Denis A.; Cruz, Carlos A.M., E-mail: [Universidad Nacional de Trujillo (UNT), Trujillo (Peru). Fisica Medica; Rios, Edulfo E.D., E-mail: [Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS (Brazil)


    Using the MIRD methodology and Cristy-Eckerman representation for for adult kidneys, it proves that the dosimetric contributions of bodies of the biokinetics of {sup 123} I / {sup 131}I (Hippuran) and {sup 111}In (DTPA) are significant, in the estimated of dose, during studies of renal function. Dosimetric contributions (whole body and urinary bladder, kidney excluding) are given by 11.90% (for {sup 123}I), 4.97% (for {sup 131}I) and 28.32% (for {sup 111} In). In all cases, the dosimetric contributions are mainly due to photons emitted by the entire body.

  13. Cutaneous manifestations in renal failure patients: A case series

    Directory of Open Access Journals (Sweden)

    Banerjee S


    Full Text Available Cutaneous involvement in renal disease is due to a host of factors ranging from metabolic disturbances to immunosuppressive drugs. Herein we report a series of six cases of renal failure with varied cutaneous manifestations ranging from infections to neoplasms due to prolonged immunosuppression. Our first case had cutaneous cryptococcosis where skin lesions gave a clue to the diagnosis of altered sensorium and underlying meningitis. The second case initially presented with florid warts and was treated successfully but later presented with an explosive recurrence of skin lesions due to malignant transformation. Our third case had basal cell carcinoma over the presternal region that was successfully treated with liquid nitrogen cryotherapy. Our fourth case had diabetic nephropathy that presented with septicemia and purpura fulminans. The last case had cutaneous manifestations of drug therapy because of heparin infusion. To conclude, cutaneous manifestations in patients with renal failure are varied and a high degree of suspicion is needed for early diagnosis and aggressive treatment to effectively combat mortality and morbidity.

  14. Lesiones laborales



    Las lesiones laborales se producen por un esfuerzo repetitivo, cuando un exceso de presión se ejerce sobre una parte del cuerpo provocando lesiones óseas, articulares, musculares y daños en los tejidos. Los accidentes laborales también pueden producir una lesión en el organismo y esto sumado a diversos factores es un problema para la reinserción laboral de los trabajadores de la energía eléctrica. Objetivo: Establecer cuáles son las lesiones más frecuentes que afectan a los ...

  15. Renal Artery Stent Outcomes (United States)

    Murphy, Timothy P.; Cooper, Christopher J.; Matsumoto, Alan H.; Cutlip, Donald E.; Pencina, Karol M.; Jamerson, Kenneth; Tuttle, Katherine R.; Shapiro, Joseph I.; D’Agostino, Ralph; Massaro, Joseph; Henrich, William; Dworkin, Lance D.


    BACKGROUND Multiple randomized clinical trials comparing renal artery stent placement plus medical therapy with medical therapy alone have not shown any benefit of stent placement. However, debate continues whether patients with extreme pressure gradients, stenosis severity, or baseline blood pressure benefit from stent revascularization. OBJECTIVES The study sought to test the hypothesis that pressure gradients, stenosis severity, and/or baseline blood pressure affects outcomes after renal artery stent placement. METHODS Using data from 947 patients with a history of hypertension or chronic kidney disease from the largest randomized trial of renal artery stent placement, the CORAL (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) study, we performed exploratory analyses to determine if subsets of patients experienced better outcomes after stent placement than the overall cohort. We examined baseline stenosis severity, systolic blood pressure, and translesion pressure gradient (peak systolic and mean) and performed interaction tests and Cox proportional hazards analyses for the occurrence of the primary endpoint through all follow-up, to examine the effect of these variables on outcomes by treatment group. RESULTS There were no statistically significant differences in outcomes based on the examined variables nor were there any consistent nonsignificant trends. CONCLUSIONS Based on data from the CORAL randomized trial, there is no evidence of a significant treatment effect of the renal artery stent procedure compared with medical therapy alone based on stenosis severity, level of systolic blood pressure elevation, or according to the magnitude of the transstenotic pressure gradient. (Benefits of Medical Therapy Plus Stenting for Renal Atherosclerotic Lesions [CORAL]; NCT00081731) PMID:26653621

  16. Transjugular renal biopsy in the treatment of patients with cirrhosis and renal abnormalities. (United States)

    Jouët, P; Meyrier, A; Mal, F; Callard, P; Guettier, C; Stordeur, D; Trinchet, J C; Beaugrand, M


    When renal lesions are suspected in patients with cirrhosis, clotting disorders often preclude percutaneous renal biopsy. This study was undertaken to determine whether transjugular renal biopsy is possible, safe, and useful in such patients. From 1987 to 1994, 70 patients with cirrhosis and clotting disorders underwent transjugular renal biopsies, providing renal tissue in 55. Of these 55 patients, 41 were Child-Pugh class B or C, 35 were alcoholic, serum creatinine levels were > or = 130 micromol/L in 46, and proteinuria was > or = 0.5 g/d in 37. Clinically significant complications of transjugular renal biopsy were persistent hematuria in 4 and perirenal hematoma in 4, requiring blood transfusions in 1 and 2 cases, respectively. There were no deaths related to renal biopsy. Renal lesions were identified as glomerular in 41 (74.5%), interstitial in 7, and end-stage in 2 and were absent in 5. Transjugular renal biopsy influenced treatment in 21 patients (38%), including 11 who were proposed for liver transplantation and 4 who had chronic liver rejection. Decisions based on results of transjugular renal biopsy were to perform liver transplantation in 8 and combined renal and liver transplantation in 5, whereas 2 were refused. In 6 other patients, the results of renal biopsy modified the medical regimen. We conclude that transjugular renal biopsy may be a useful procedure in patients with cirrhosis and clotting disorders. This technique does not entail undue risks and may influence treatment decisions, particularly in patients proposed for liver transplantation.

  17. Need for Renal Biopsy Registry in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Al-Homrany Mohammad


    Full Text Available Many renal lesions may result in chronic kidney disease if not detected early or treated properly. Glomerulonephritis is considered one of the leading causes of end-stage renal disease. The prevalence of different renal lesions were identified by inconsistent studies. The causes of inconsistencies include lack of unified methods in diagnosing and processing renal biopsies by different pathologists, patients selection′s bias for renal biopsy, and the variable policies and protocols adopted by different nephrologists. Establishment of renal biopsy registry may help to surmount these differences. In addition, combined data obtained from renal biopsy renal and replacement therapy registries can help study the long-term outcome of patients with renal diseases.

  18. Repair of lamellar scleral lesions in dogs with preserved equine renal capsule: short report Reparação de lesões lamelares esclerais em cães com cápsula renal de eqüino preservada: relato curto

    Directory of Open Access Journals (Sweden)

    Alexandre Lima de Andrade


    Full Text Available PURPOSE: To evaluate the u se of equine renal capsule preserved in glycerin to repair lamellar scleral lesions in dogs. METHODS: Twelve healthy mongrel dogs, male and female, weighing 12 kg were used. The study was both clinical and morphological, and performed on the first, third, seventh, 15th, 30th and 60th day after surgery. Temporal canthotomy was performed after standard preoperative and general anesthesia. Conjunctival and scleral square incisions of 0.5x0.5 cm were carried out in a one o'clock position, near the limbus. A fragment of hydrated biological prosthesis, of the same shape, was sutured with 7-0 vicryl® in an interrupted suture. RESULTS: The clinical evaluation showed blepharospasm/photophobia until the 7th day after surgery. Conjunctival edema appeared up to the 5th day after surgery. Mucoid ocular discharge was sustained until the 10th day after surgery. Hyperemia was observed until the end of the evaluation period. There were no signs of graft extrusion in all animals. The anterior and posterior segments did not show clinical signs of inflammation. The optical microscopy morphological evaluation showed an inflammatory exudation with acute aspects in the early and intermediate periods, and inflammatory exudation with chronic aspects in the late periods. There was incorporation of the implant by the recipient's sclera. CONCLUSION: These results suggest that the equine renal preserved capsule could be a useful alternative tissue to repair lamellar corneal lesions in dogs and humans.OBJETIVO: Avaliar o uso da cápsula renal de eqüino preservada em glicerina 98% no reparo de lesões lamelares esclerais em cães. MÉTODOS: Foram utilizados 12 cães, machos e fêmeas, com peso médio de 12kg. Foram realizadas avaliações clínica e morfológica aos 1, 3, 7, 15, 30 e 60 dias de pós-operatório. Após anestesia geral e procedimentos padrões de preparo do campo operatório, foi realizada cantotomia temporal, seguida de incis

  19. Calciphylaxis following acute renal injury: a case and literature review


    Oda, Tomoko; Sawada, Yu; YAMAGUCHI, TAKASHI; Ohmori, Shun; Omoto, Daisuke; Haruyama, Sanehito; Yoshioka, Manabu; Okada, Etsuko; Nakamura, Motonobu


    Background Calciphylaxis following acute renal failure is rare. Findings We report A 57-year-old male with an acute renal failure associated with necrotizing fasciitis. We also review the cases of calciphylaxis due to acute renal disorder further. Conclusions It should be kept in mind that calciphylaxis is observed in patient with not only chronic renal disease but also acute renal failure.

  20. Renal involvement in antiphospholipid syndrome. (United States)

    Sciascia, Savino; Cuadrado, Maria José; Khamashta, Munther; Roccatello, Dario


    Antiphospholipid syndrome (APS) is an autoimmune disease defined by the presence of arterial or venous thrombotic events and/or pregnancy morbidity in patients who test positive for antiphospholipid antibodies (aPLs). APS can be isolated (known as primary APS) or associated with other autoimmune diseases, such as systemic lupus erythematosus (SLE; known as secondary APS). The kidney is a major target organ in APS and renal thrombosis can occur at any level within the vasculature of the kidney (renal arteries, intrarenal arteries, glomerular capillaries and renal veins); events reflect the site and size of the involved vessels. Histological findings vary widely, including ischaemic glomeruli and thrombotic lesions without glomerular or arterial immune deposits on immunofluorescence. Renal prognosis is affected by the presence of aPLs in patients with lupus nephritis and can be poor. In patients with SLE and aPLs, biopsy should be performed because inflammatory and thrombotic lesions require different therapeutic approaches. Renal involvement in patients with definite APS is treated by anticoagulation with long-term warfarin. The range of renal manifestations associated with APS is broadening and, therefore, aPLs have increasing relevance in end-stage renal disease, transplantation and pregnancy.

  1. Failure of Posaconazole Therapy in a Renal Transplant Patient with Invasive Aspergillosis Due to Aspergillus fumigatus with Attenuated Susceptibility to Posaconazole ▿


    Kuipers, Saskia; Brüggemann, Roger J. M.; Ruud G.L. de Sévaux; Heesakkers, John P. F. A.; Melchers, Willem J. G.; Mouton, Johan W.; Verweij, Paul E.


    We report the case of a kidney transplant recipient with invasive aspergillosis due to Aspergillus fumigatus resistant to voriconazole and intermediately susceptible to posaconazole who failed posaconazole therapy. Plasma posaconazole concentrations indicated an unfavorable ratio of the area under the concentration-time curve over the MIC. Posaconazole should be used with caution for invasive aspergillosis caused by strains with attenuated posaconazole susceptibility, as drug exposure may be ...

  2. Renal perfusion scintiscan (United States)

    Renal perfusion scintigraphy; Radionuclide renal perfusion scan; Perfusion scintiscan - renal; Scintiscan - renal perfusion ... supply the kidneys. This is a condition called renal artery stenosis. Significant renal artery stenosis may be ...

  3. Spinal cord lesions - The rehabilitation perspective. (United States)

    Faria, Filipa


    The present study provides an overview of the spinal cord injury focusing mainly on aspects related to rehabilitation. Spinal cord injury affects young people in an active phase of life, determining severe handicaps. Most of the lesions are traumatic, caused by car accidents. Until fifty years ago, the survival of individuals with spinal cord injury was very reduced and the leading cause of death was renal failure. Due to developments in medical knowledge and technical advances, the survival rates have significantly improved. The causes of death have also changed being respiratory complications, particularly pneumonia, the leading causes. Immediately after a spinal cord lesion there is a phase of spinal shock which is characterized by flaccid paralysis and bladder and bowel retention. Progressively there is a return of the spinal cord automatism with the beginning of some reflex activities. Based on neurological evaluation it is pos-sible to predict motor and functional recovery and establish the rehabilitation program. We can consider three phases on the rehabilitation program: the first while the patient is still in bed, directed to prevent or treat complications due to immobility and begin sphincters reeducation; the second phase is intended to achieve wheelchair autonomy; the last phase is training in ortostatism. The rehabilitation program also comprises sports and recreational activities, psychological and social support in order to achieve an integral of the individual with a spinal cord injury. © 2006 Sociedade Portuguesa de Pneumologia/SPP.

  4. Percutaneous thermal ablation of renal neoplasms; Perkutane Thermoablation von Nierentumoren

    Energy Technology Data Exchange (ETDEWEB)

    Tacke, J. [Inst. fuer Diagnostische und Interventionelle Radiologie/Neuroradiologie, Klinikum Passau (Germany); Mahnken, A.H.; Guenther, R.W. [Klinik fuer Radiologische Diagnostik, Universitaetsklinikum Aachen (Germany)


    Due to modern examination techniques such as multidetector computed tomography and high-field magnetic resonance imaging, the detection rate of renal neoplasms is continually increasing. Even though tumors exceeding 4 cm in diameter rarely metastasize, all renal lesions that are possible neoplasms should be treated. Traditional treatment techniques include radical nephrectomy or nephron-sparing resection, which are increasingly performed laparoscopically. Modern thermal ablation techniques such as hyperthermal techniques like radiofrequency ablation RFA, laser induced thermal ablation LITT, focused ultrasound FUS and microwave therapy MW, as well as hypothermal techniques (cryotherapy) may be a useful treatment option for patients who are unfit for or refuse surgical resection. Cryotherapy is the oldest and best known thermal ablation technique and can be performed laparoscopically or percutaneously. Since subzero temperatures have no antistyptic effect, additional maneuvers must be performed to control bleeding. Percutaneous cryotherapy of renal tumors is a new and interesting method, but experience with it is still limited. Radiofrequency ablation is the most frequently used method. Modern probe design allows volumes between 2 and 5 cm in diameter to be ablated. Due to hyperthermal tract ablation, the procedure is deemed to be safe and has a low complication rate. Although there are no randomized comparative studies to open resection, the preliminary results for renal RFA are promising and show RFA to be superior to other thermal ablation techniques. Clinical success rates are over 90% for both, cryo- and radiofrequency ablation. Whereas laser induced thermal therapy is established in hepatic ablation, experience is minimal with respect to renal application. For lesions of more than 2 cm in diameter, additional cooling catheters are required. MR thermometry offers temperature control during ablation. Microwave ablation is characterized by small ablation volumes

  5. Severe Bloodstream Infection due to KPC-Producer E coli in a Renal Transplant Recipient Treated With the Double-Carbapenem Regimen and Analysis of In Vitro Synergy Testing (United States)

    Oliva, Alessandra; Cipolla, Alessia; Gizzi, Francesca; D’Abramo, Alessandra; Favaro, Marco; De Angelis, Massimiliano; Ferretti, Giancarlo; Russo, Gianluca; Iannetta, Marco; Mastroianni, Claudio M.; Mascellino, Maria T.; Vullo, Vincenzo


    Abstract Transplant recipients are at high risk of infections caused by multidrug resistant microorganisms. Due to the limited therapeutic options, innovative antimicrobial combinations against carbapenem-resistant Enterobacteriaceae causing severe infections are necessary. A 61-year-old woman with a history of congenital solitary kidney underwent renal transplantation. The postoperative course was complicated by nosocomial pneumonia due to Stenotrophomonas maltophilia and pan-sensitive Escherichia coli, successfully treated with antimicrobial therapy. On postoperative day 22, diagnosis of surgical site infection and nosocomial pneumonia with concomitant bacteremia due to a Klebisella pneumoniae carbapenemase-producer E coli was made. The patient was treated with the double-carbapenem regimen (high dose of meropenem plus ertapenem) and a potent synergistic and bactericidal activity of this un-conventional therapeutic strategy was observed in vitro. Despite a microbiological response with prompt negativity of blood cultures, the patient faced a worse outcome because of severe hemorrhagic shock. The double-carbapenem regimen might be considered as a rescue therapy in those subjects, including transplant recipients, in whom previous antimicrobial combinations failed or when colistin use might be discouraged. Performing in vitro synergy testing should be strongly encouraged in cases of infections caused by pan-drug resistant strains, especially in high-risk patients. PMID:26886594

  6. Severe Bloodstream Infection due to KPC-Producer E coli in a Renal Transplant Recipient Treated With the Double-Carbapenem Regimen and Analysis of In Vitro Synergy Testing: A Case Report. (United States)

    Oliva, Alessandra; Cipolla, Alessia; Gizzi, Francesca; D'Abramo, Alessandra; Favaro, Marco; De Angelis, Massimiliano; Ferretti, Giancarlo; Russo, Gianluca; Iannetta, Marco; Mastroianni, Claudio M; Mascellino, Maria T; Vullo, Vincenzo


    Transplant recipients are at high risk of infections caused by multidrug resistant microorganisms. Due to the limited therapeutic options, innovative antimicrobial combinations against carbapenem-resistant Enterobacteriaceae causing severe infections are necessary.A 61-year-old woman with a history of congenital solitary kidney underwent renal transplantation. The postoperative course was complicated by nosocomial pneumonia due to Stenotrophomonas maltophilia and pan-sensitive Escherichia coli, successfully treated with antimicrobial therapy. On postoperative day 22, diagnosis of surgical site infection and nosocomial pneumonia with concomitant bacteremia due to a Klebisella pneumoniae carbapenemase-producer E coli was made. The patient was treated with the double-carbapenem regimen (high dose of meropenem plus ertapenem) and a potent synergistic and bactericidal activity of this un-conventional therapeutic strategy was observed in vitro. Despite a microbiological response with prompt negativity of blood cultures, the patient faced a worse outcome because of severe hemorrhagic shock.The double-carbapenem regimen might be considered as a rescue therapy in those subjects, including transplant recipients, in whom previous antimicrobial combinations failed or when colistin use might be discouraged. Performing in vitro synergy testing should be strongly encouraged in cases of infections caused by pan-drug resistant strains, especially in high-risk patients.

  7. Small renal Oncocytomas: Differentiation with multiphase CT

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    Gakis, Georgios, E-mail: [Department of Urology, University Hospital Tuebingen, Eberhard-Karls University, Hoppe-Seyler Strasse 3, Tuebingen (Germany); Kramer, Ulrich [Department of Radiology, University Hospital Tuebingen, Eberhard-Karls University, Tuebingen (Germany); Schilling, David; Kruck, Stephan; Stenzl, Arnulf [Department of Urology, University Hospital Tuebingen, Eberhard-Karls University, Hoppe-Seyler Strasse 3, Tuebingen (Germany); Schlemmer, Hans-Peter [Department of Radiology, University Hospital Tuebingen, Eberhard-Karls University, Tuebingen (Germany)


    Objectives: To evaluate characteristic imaging findings of tumor attenuation in multiphase computed tomography (CT) between renal oncocytomas and clear-cell renal cell carcinoma (ccRCC) of small tumor size ({<=}5 cm). Methods: We retrospectively identified 20 patients with complete four-phase CT with either histologically confirmed small renal oncocytoma (N = 10) or ccRCC (N = 10) who underwent subsequent total or partial nephrectomy. Exclusion criteria for RCC were non-clear-cell components in histology and a tumor diameter >5 cm. The relative attenuation of solid renal lesions and normal renal cortex was determined in the unenhanced, corticomedullary, nephrographic and excretory phase. Statistical comparison was carried out by Wilcoxon Rank Sum Test. Results: Mean tumor size of renal oncocytomas was 2.8 {+-} 0.4 cm (1.2-5) and of ccRCC 2.5 {+-} 0.2 cm (1.7-4.4; p = 0.57). All lesions were homogenous without extended areas of necroses. In the nephrographic phase, the difference of attenuation between renal cortex and tumor lesion was highest in both entities (oncocytoma, 48.1 {+-} 5.2 HU; ccRCC, 67.5 {+-} 12.1) but not between entities (p = 0.30). In the corticomedullary phase, renal oncocytomas showed greater isodensity to the normal renal cortex (13.9 {+-} 4.3 HU) compared to clear-cell RCC (51.5 {+-} 5.0 HU; p = 0.003). No further significant differences were found for the unenhanced and excretory phase. Conclusions: In this study, the maximum tumor-to-kidney contrast coincided with the nephrographic phase which was thus the most reliable for the detection of a renal lesion <5 cm. For lesion characterization, the corticomedullary phase was most useful for differentiating both entities. This finding is particularly important for the preoperative planning of a partial nephrectomy.

  8. Pink lesions. (United States)

    Giacomel, Jason; Zalaudek, Iris


    Dermoscopy (dermatoscopy or surface microscopy) is an ancillary dermatologic tool that in experienced hands can improve the accuracy of diagnosis of a variety of benign and malignant pigmented skin tumors. The early and more accurate diagnosis of nonpigmented, or pink, tumors can also be assisted by dermoscopy. This review focuses on the dermoscopic diagnosis of pink lesions, with emphasis on blood vessel morphology and pattern. A 3-step algorithm is presented, which facilitates the timely and more accurate diagnosis of pink tumors and subsequently guides the management for such lesions.

  9. Protocol biopsies for renal transplantation

    Directory of Open Access Journals (Sweden)

    Rush David


    Full Text Available Protocol biopsies in renal transplantation are those that are procured at predetermined times post renal transplantation, regardless of renal function. These biopsies have been useful to study the natural history of the transplanted kidney as they have detected unexpected - i.e. "subclinical" pathology. The most significant subclinical pathologies that have been detected with protocol biopsies have been acute lesions, such as cellular and antibody mediated rejection, and chronic lesions, such as interstitial fibrosis and tubular atrophy, and transplant glomerulopathy. The potential benefit of early recognition of the above lesions is that their early treatment may result in improved long-term outcomes. Conversely, the identification of normal histology on a protocol biopsy, may inform us about the safety of reduction in overall immunosuppression. Our centre, as well as others, is attempting to develop non-invasive methods of immune monitoring of renal transplant patients. However, we believe that until such methods have been developed and validated, the protocol biopsy will remain an indispensable tool for the complete care of renal transplant patients.

  10. Ultrasonography in chronic renal failure

    Energy Technology Data Exchange (ETDEWEB)

    Buturovic-Ponikvar, Jadranka E-mail:; Visnar-Perovic, Alenka


    Many chronic renal diseases lead to the final common state of decrease in renal size, parenchymal atrophy, sclerosis and fibrosis. The ultrasound image show a smaller kidney, thinning of the parenchyma and its hyperechogenicity (reflecting sclerosis and fibrosis). The frequency of renal cysts increases with the progression of the disease. Ultrasound generally does not allow for the exact diagnosis of an underlying chronic disease (renal biopsy is usually required), but it can help to determine an irreversible disease, assess prognosis and avoid unnecessary diagnostic or therapeutic procedures. The main exception in which the ultrasound image does not show a smaller kidney with parenchymal atrophy is diabetic nephropathy, the leading cause of chronic and end-stage renal failure in developed countries in recent years. In this case, both renal size and parenchymal thickness are preserved until end-stage renal failure. Doppler study of intrarenal vessels can provide additional information about microvascular and parenchymal lesions, which is helpful in deciding for or against therapeutic intervention and timely planning for optimal renal replacement therapy option.

  11. The evaluation of renal function and disease in patients with cirrhosis. (United States)

    Francoz, Claire; Glotz, Denis; Moreau, Richard; Durand, François


    The MELD score has shown that, besides markers of liver function, serum creatinine has a strong prognostic value in cirrhosis. However, even though creatinine has a good prognostic value, it is an inaccurate marker of renal function in cirrhosis. Creatinine and creatinine-based equations tend to overestimate glomerular filtration rate (GFR), and creatinine clearance from timed urine collection also overestimates GFR. Hence, clearance of exogenous markers such as iohexol remains the only reliable method for assessing precisely GFR in cirrhosis. Whereas these investigations are limited by their costs and complexity, and they can hardly be repeated at short intervals, serum cystatin C could be an alternative, although it needs further validation. Accurate markers and/or specific equations are therefore still needed to assess GFR in cirrhotic patients. Pre-renal failure and hepatorenal syndrome (HRS) are the main causes of acute renal failure in cirrhosis. Both result from decreased renal blood flow and both can result in acute tubular necrosis. HRS is not always fully reversible with liver transplantation possibly due to underlying chronic kidney damage. A number of cirrhotic patients with acute renal failure may also have chronic kidney damage ("acute-on-chronic renal failure"); furthermore, cirrhotic patients frequently have co-morbidities such as diabetes that may result in chronic impairment in renal function. Since conventional urinary markers are biased in cirrhosis, a biopsy is the only way to document and quantify renal lesions; moreover, transvenous route should be preferred to percutaneous route. In candidates for transplantation, attention should therefore be focused on vascular lesions which may represent a risk factor for nephrotoxicities induced by calcineurin-inhibitors.

  12. Acute renal infarction secondary to atrial fibrillation - mimicking renal stone picture. (United States)

    Salih, Salih Bin; Al Durihim, Huda; Al Jizeeri, Ahmed; Al Maziad, Ghassan


    Acute renal infarction presents in a similar clinical picture to that of a renal stone. We report a 55-year-old Saudi female, known to have atrial fibrillation secondary to mitral stenosis due to rheumatic heart disease. She presented with a two day history of right flank pain that was treated initially as a renal stone. Further investigations confirmed her as a case of renal infarction. Renal infarction is under-diagnosed because the similarity of its presentation to renal stone. Renal infarction should be considered in the differential diagnosis of loin pain, particularly in a patient with atrial fibrillation.

  13. Cerebral mass lesion due to cytomegalovirus in a patient with AIDS: case report and literature review Lesão expansiva cerebral devida a citomegalovírus: relato de caso e revisão da literatura

    Directory of Open Access Journals (Sweden)

    José E. Vidal


    Full Text Available Cytomegalovirus (CMV disease in acquired immunodeficiency syndrome (AIDS patients most commonly presents as chorioretinitis and gastro-intestinal infection. Neurological involvement due to CMV may cause several clinical presentations: polyradiculitis, myelitis, encephalitis, ventriculo-encephalitis, and mononeuritis multiplex. Rarely, cerebral mass lesion is described. We report a 39 year-old woman with AIDS and previous cerebral toxoplasmosis. She presented with fever, seizures, and vulval ulcers. Her chest X-ray showed multiple lung nodules, and a large frontal lobe lesion was seen in a brain computed tomography scan. She underwent a brain biopsy through a frontal craniotomy, but her condition deteriorated and she died in the first postoperative day. Histopathological studies and immunohistochemistry disclosed CMV disease, and there was no evidence of cerebral toxoplasmosis, bacterial, mycobacterial or fungal infection. CMV disease should be considered in the differential diagnosis of cerebral mass lesion in AIDS patients. High suspicion index, timely diagnostic procedures (surgical or minimally invasive, and proper utilization of prophylactic and therapeutic medication could improve outcome of these patients.As doenças causadas pelo citomegalovírus (CMV em pacientes com a síndrome da imunodeficiência adquirida apresentam-se principalmente como corioretinite ou comprometimento gastrointestinal. No sistema nervoso central, o CMV pode causar diversas síndromes clínicas: poliradiculite, mielite, encefalite, ventrículo-encefalite e mononeurite múltipla. Raramente, lesões expansivas cerebrais são descritas. Os autores relatam o caso de uma paciente de 39 anos com antecedentes de infecção pelo HIV e toxoplasmose cerebral, que apresentou-se com febre, convulsões e úlceras vulvares. O raios-X de tórax demonstrou múltiplos nódulos pulmonares e a tomografia computadorizada de crânio evidenciou extensa lesão no lobo frontal esquerdo


    Directory of Open Access Journals (Sweden)

    R. Suganya Gnanadeepam


    Full Text Available BACKGROUND The kidney and the skin are the two large networks of the body with abundant blood supply associated with various cutaneous manifestations. This study aims to detect the various cutaneous manifestations and its incidence in patients with chronic renal failure and renal transplantation. MATERIALS AND METHODS This study was done for a period of 1 year from January 2016 to December 2016 at Nephrology OPD ward and Medicine wards, Government KAPV Medical College Hospital, Trichy. During this period, 100 patients who had the presence of skin manifestations were selected and studied (80 renal failure patients and 20 renal transplantation patients. RESULTS Most of the specific cutaneous manifestations of chronic renal failure and renal transplantation were noted in this study. Pruritus and xerosis were the most common manifestations noted in chronic renal failure while infections was commonly noted in renal transplantation patients. CONCLUSION Pruritus and xerosis were the most common among the specific cutaneous manifestations in chronic renal failure followed by nail abnormalities and pigmentary changes. Cutaneous manifestations of renal transplantation were mostly due to infections of which fungal infection is the most common followed by viral infection.


    Directory of Open Access Journals (Sweden)

    A. V. Govorov


    Full Text Available Renal cryoablation is an alternative minimally-invasive method of treatment for localized renal cell carcinoma. The main advantages of this methodology include visualization of the tumor and the forming of "ice ball" in real time, fewer complications compared with other methods of treatment of renal cell carcinoma, as well as the possibility of conducting cryotherapy in patients with concomitant pathology. Compared with other ablative technologies cryoablation has a low rate of repeat sessions and good intermediate oncological results. The studies of long-term oncological and functional results of renal cryoablation are presently under way.

  16. Renal distribution of Vasohibin-1 in patients with chronic kidney disease. (United States)

    Hinamoto, Norikazu; Maeshima, Yohei; Saito, Daisuke; Yamasaki, Hiroko; Tanabe, Katsuyuki; Nasu, Tatsuyo; Watatani, Hiroyuki; Ujike, Haruyo; Kinomura, Masaru; Sugiyama, Hitoshi; Sonoda, Hikaru; Kanomata, Naoki; Sato, Yasufumi; Makino, Hirofumi


    Experimental studies have demonstrated the involvement of angiogenesis-related factors in the progression of chronic kidney disease (CKD). There have so far been no reports investigating the distribution and clinical roles of Vasohibin-1 (VASH-1), a negative feedback regulator of angiogenesis, in CKD. We recruited 54 Japanese CKD patients and 6 patients who had normal renal tissues excised due to localized renal cell carcinoma. We evaluated the correlations between the renal expression level of VASH-1 and the clinical/histological parameters. VASH-1 was observed in renal endothelial/mesangial cells, crescentic lesions and interstitial inflammatory cells. Significant positive correlations were observed between 1) crescent formation and the number of VASH-1+ cells in the glomerulus (r=0.48, p=0.001) or cortex (r=0.64, p<0.0001), 2) interstitial cell infiltration and the number of VASH-1+ cells in the cortex (r=0.34, p=0.02), 3) the glomerular VEGFR-2+ area and the number of VASH-1+ cells in the glomerulus (r=0.44, p=0.01) or medulla (r=0.63, p=0.01). These results suggest that the renal levels of VASH-1 may be affected by local inflammation, crescentic lesions and VEGFR-2.


    Directory of Open Access Journals (Sweden)



    Full Text Available Renal failure in obstetrics is rare but important complication, associated with significant mortality and long term morbidity.1,2 It includes acute renal failure due to obstetrical complications or due to deterioration of existing renal disease. AIMS AND OBJECTIVES: To evaluate the etiology and outcome of renal failure in obstetric patients. METHODS: We prospectively analyzed 30 pregnant and puerperal women with acute renal failure or pre-existing renal disease developing renal failure during pregnancy between November 2007 to sep-2009. Patients who presented/developed ARF during the hospital stay were included in this study. RESULTS: Among 30 patients, mean age was 23 years and 33 years age group. 12 cases (40% patients were primigravidae and 9(30% patients were multigravidae and 9 cases (30% presented in post-partum period. Eighteen cases (60% with ARF were seen in third trimester, followed by in postpartum period 9 cases (30%. Most common contributing factors to ARF were Pre-eclampsia, eclampsia and HELLP syndrome 60%, sepsis 56.6%, post abortal ARF 10%. DIC 40%. Haemorrhage as the aetiology for ARF was present 46%, APH in 20% and PPH in 26.6%. The type of ARF was renal in (63% and prerenal (36%; Oliguric seen in 10 patients (33% and high mortality (30%. Among the 20 pregnant patients with ARF, The average period of gestation was 33±2 weeks (30 -36 weeks, 5 cases (25% presented with intrauterine fetal demise and 18 cases (66% had preterm vaginal delivery and 2 cases (10% had induced abortion. And the average birth weight was 2±0.5 kg (1.5 kg. Eight cases (26% required dialysis. 80% of patients recovered completely of renal functions. 63% patients recovered without renal replacement therapy whereas 17% required dialysis. the maternal mortality was 20%, the main reason for mortality was septic shock and multi organ dysfunction (66%. CONCLUSION: ARF related pregnancy was seen commonly in the primigravidae and in the third trimester, the most

  18. Radiological classification of renal angiomyolipomas based on 127 tumors

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    Prando Adilson


    Full Text Available PURPOSE: Demonstrate radiological findings of 127 angiomyolipomas (AMLs and propose a classification based on the radiological evidence of fat. MATERIALS AND METHODS: The imaging findings of 85 consecutive patients with AMLs: isolated (n = 73, multiple without tuberous sclerosis (TS (n = 4 and multiple with TS (n = 8, were retrospectively reviewed. Eighteen AMLs (14% presented with hemorrhage. All patients were submitted to a dedicated helical CT or magnetic resonance studies. All hemorrhagic and non-hemorrhagic lesions were grouped together since our objective was to analyze the presence of detectable fat. Out of 85 patients, 53 were monitored and 32 were treated surgically due to large perirenal component (n = 13, hemorrhage (n = 11 and impossibility of an adequate preoperative characterization (n = 8. There was not a case of renal cell carcinoma (RCC with fat component in this group of patients. RESULTS: Based on the presence and amount of detectable fat within the lesion, AMLs were classified in 4 distinct radiological patterns: Pattern-I, predominantly fatty (usually less than 2 cm in diameter and intrarenal: 54%; Pattern-II, partially fatty (intrarenal or exophytic: 29%; Pattern-III, minimally fatty (most exophytic and perirenal: 11%; and Pattern-IV, without fat (most exophytic and perirenal: 6%. CONCLUSIONS: This proposed classification might be useful to understand the imaging manifestations of AMLs, their differential diagnosis and determine when further radiological evaluation would be necessary. Small (< 1.5 cm, pattern-I AMLs tend to be intra-renal, homogeneous and predominantly fatty. As they grow they tend to be partially or completely exophytic and heterogeneous (patterns II and III. The rare pattern-IV AMLs, however, can be small or large, intra-renal or exophytic but are always homogeneous and hyperdense mass. Since no renal cell carcinoma was found in our series, from an evidence-based practice, all renal mass with detectable

  19. Acute renal dysfunction in liver diseases

    Institute of Scientific and Technical Information of China (English)


    Renal dysfunction is common in liver diseases, either as part of multiorgan involvement in acute illness or secondary to advanced liver disease. The presence of renal impairment in both groups is a poor prognostic indicator. Renal failure is often multifactorial and can present as pre-renal or intrinsic renal dysfunction. Obstructive or post renal dysfunction only rarely complicates liver disease. Hepatorenal syndrome (MRS) is a unique form of renal failure associated with advanced liver disease or cirrhosis, and is characterized by functional renal impairment without significant changes in renal histology. Irrespective of the type of renal failure, renal hypoperfusion is the central pathogenetic mechanism, due either to reduced perfusion pressure or increased renal vascular resistance. Volume expansion, avoidance of precipitating factors and treatment of underlying liver disease constitute the mainstay of therapy to prevent and reverse renal impairment. Splanchnic vasoconstrictor agents, such as terlipressin, along with volume expansion, and early placement of transjugular intrahepatic portosystemic shunt (TIPS) may be effective in improving renal function in HRS. Continuous renal replacement therapy (CRRT) and molecular absorbent recirculating system (MARS) in selected patients may be life saving while awaiting liver transplantation.

  20. Renal infarction secondary to ketamine abuse. (United States)

    Chen, Chin-Li; Chen, Jin-Li; Cha, Tai-Lung; Wu, Sheng-Tang; Tang, Shou-Hung; Tsao, Chih-Wei; Meng, En


    Renal infarction is an uncommon condition that resulted from inadequate perfusion of the kidney and is easily missed diagnosed due to its nonspecific clinical presentations. Major risk factors for renal infarction are atrial fibrillation, previous embolism, and ischemic and valvular heart disease. Progressive decrease in renal function or even death can occur if renal infarction is not diagnosed accurately and promptly. Ketamine abuse may cause variable urinary tract injury. However, renal infarction caused by ketamine abuse has never been reported. To our knowledge, this is the first documented case of renal infarction following nasal insufflation of ketamine.

  1. Parasellar lesions

    Energy Technology Data Exchange (ETDEWEB)

    Ruscalleda, J. [Hospital Sant Pau, Radiology Department, Neuroradiology, Barcelona (Spain)


    The sellar and parasellar region is an anatomically complex area that represents a crucial crossroad of important adjacent structures, e.g. orbits, cavernous sinus and its content, polygon of Willis, hypothalamus through the pituitary stalk and dural reflections forming the diaphragm sellae and the walls of the cavernous sinuses. Although the cavernous sinus represents the most relevant parasellar structure, from the practical and clinical point of view all the structures that surround the sella turcica can be included in the parasellar region. CT and, mainly, MRI are the imaging modalities to study and characterise the normal anatomy and the majority of processes in this region. We present a practical short review of the most relevant CT and MRI characteristics, such as location, nature of contrast enhancement and presence of cystic components, together with clinical findings, which permit differentiation of the most frequent and less common lesions found in the parasellar region. Learning objectives: A short review of the anatomy and clinical symptoms related to the parasellar region. Radiological characterisation, mainly by MRI, of the many lesions that alter the structure and function of sellar and parasellar anatomy. Description of the MRI features that permit differentiation among less common lesions. (orig.)

  2. Neonatal renal vein thrombosis. (United States)

    Brandão, Leonardo R; Simpson, Ewurabena A; Lau, Keith K


    Neonatal renal vein thrombosis (RVT) continues to pose significant challenges for pediatric hematologists and nephrologists. The precise mechanism for the onset and propagation of renal thrombosis within the neonatal population is unclear, but there is suggestion that acquired and/or inherited thrombophilia traits may increase the risk for renal thromboembolic disease during the newborn period. This review summarizes the most recent studies of neonatal RVT, examining its most common features, the prevalence of acquired and inherited prothrombotic risk factors among these patients, and evaluates their short and long term renal and thrombotic outcomes as they may relate to these risk factors. Although there is some consensus regarding the management of neonatal RVT, the most recent antithrombotic therapy guidelines for the management of childhood thrombosis do not provide a risk-based algorithm for the acute management of RVT among newborns with hereditary prothrombotic disorders. Whereas neonatal RVT is not a condition associated with a high mortality rate, it is associated with significant morbidity due to renal impairment. Recent evidence to evaluate the effects of heparin-based anticoagulation and thrombolytic therapy on the long term renal function of these patients has yielded conflicting results. Long term cohort studies and randomized trials may be helpful to clarify the impact of acute versus prolonged antithrombotic therapy for reducing the morbidity that is associated with neonatal RVT.

  3. Pulmonary cystic disease associated with integumentary and renal manifestations. (United States)

    Cayetano, Katherine S; Albertson, Timothy E; Chan, Andrew L


    A 69-year-old man with multiple skin lesions on his face, neck and upper torso, which first appeared in the 3rd decade of his life, was admitted to our hospital. He had cystic changes in his lungs noted on chest computed tomography (CT) scanning, as well as a left kidney mass. This patient exhibited a rare complex of renal, cutaneous and pulmonary manifestations, eponymously named Birt-Hogg-Dube syndrome, with characteristic skin features (fibrofolliculomas, trichodiscomas and acrochordons). This syndrome is due to an autosomal dominant germ-line mutation of the folliculin (FLCN) gene located at chromosome 17p11.2. Diagnosis and differentiation from other disease complexes including the skin, kidneys and lungs are important in prognostication and management of potentially life-threatening complications such as renal cell carcinoma and pneumothoraces.

  4. Renal cancer

    NARCIS (Netherlands)

    Corgna, Enrichetta; Betti, Maura; Gatta, Gemma; Roila, Fausto; De Mulder, Pieter H. M.


    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all acknowle

  5. Renal fallure

    Institute of Scientific and Technical Information of China (English)


    920705 Endothelin and acute renal failure:study on their relationship and possiblemechanisms. LIN Shanyan(林善锬), et al.Renal Res Lab, Huashan Hosp, Shanghai MedUniv, Shanghai, 200040. Natl Med J China 1992;72(4): 201-205. In order to investigate the role of endothelin

  6. Renal cancer.

    NARCIS (Netherlands)

    Corgna, E.; Betti, M.; Gatta, G.; Roila, F.; Mulder, P.H.M. de


    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all

  7. Renal cancer

    NARCIS (Netherlands)

    Corgna, Enrichetta; Betti, Maura; Gatta, Gemma; Roila, Fausto; De Mulder, Pieter H. M.


    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all

  8. Endocarditis-associated Brain Lesions in Slaughter Pigs

    DEFF Research Database (Denmark)

    Karstrup, C.C.; Jensen, H.E.; Aalbæk, B.


    Left-sided valvular endocarditis (LSVE) is a common finding in slaughter pigs. The lesion is often associated with renal thromboembolism, but information on embolization to other organs is sparse. This study focuses on the presence and type of endocarditis-associated brain lesions (EABLs......-situ hybridization examinations. These examinations identified 11 cases of Streptococcus suis, six cases of Erysipelothrix rhusiopathiae, one Streptococcus spp. and two cases that remained aetiologically undetermined. One of the S. suis cases had a dual infection with S. suis in the aortic valve lesions...... and Streptococcus dysgalactiae subsp. equisimilis in the atrioventricular valve lesions. Renal infarcts were present in eight cases. Focal encephalitis was found in 12 cases, with the number of lesions ranging from one to 11. Most pigs had less than four microscopical lesions. Acute lesions were characterized...

  9. Multiple renal aspergillus abscesses in an AIDS patient: contrast-enhanced helical CT and MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Heussel, C.P.; Kauczor, H.U.; Thelen, M. [Dept. of Radiology, Johannes Gutenberg Univ., Mainz (Germany); Heussel, G. [Dept. of Internal Medicine, Johannes Gutenberg Univ., Mainz (Germany); Jahn, B. [Inst. of Microbiology, Johannes Gutenberg Univ., Mainz (Germany)


    Renal insufficiency or allergic reactions for X-ray contrast agents are frequent limitations in immunocompromised hosts such as neutropenic or AIDS patients. Due to a better tolerance of contrast agents in MRI, this technique is well suited for investigation of parenchymal organs. We demonstrate an allergic AIDS patient who presented with fever and flank pain. At sonography, anechoic renal lesions were supposed to be non-complicated cysts; however, on T2-weighted MRI, the center was of high signal. Dynamic contrast-enhanced MRI of the kidneys demonstrated an enhancing rim with ill-defined margins. The lesions were supposed to be multiple bilateral abscesses. Due to the multiple dynamic contrast series, a delayed enhancement of renal parenchyma was detectable adjacent to the lesion. This was suggested as accompanying local pyelonephritis and an infectious etiology became more reliable. Aspergillus fumigatus was identified by CT-guided biopsy as the underlying microorganism. The MR appearance of this manifestation has not been described previously. (orig.) With 5 figs., 15 refs.

  10. Scleroderma Renal Crisis: A Pathology Perspective

    Directory of Open Access Journals (Sweden)

    Ibrahim Batal


    Full Text Available Scleroderma renal crisis (SRC is an infrequent but serious complication of systemic sclerosis (SSc. It is associated with increased vascular permeability, activation of coagulation cascade, and renin secretion, which may lead to the acute renal failure typically associated with accelerated hypertension. The histologic picture of SRC is that of a thrombotic microangiopathy process with prominent small vessel involvement manifesting as myxoid intimal changes, thrombi, onion skin lesions, and/or fibrointimal sclerosis. Renal biopsies play an important role in confirming the clinical diagnosis, excluding overlapping/superimposed diseases that might lead to acute renal failure in SSc patients, helping to predict the clinical outcome and optimizing patient management. Kidney transplantation may be the only treatment option available for a subset of SRC patients who develop end-stage renal failure despite aggressive angiotensin-converting enzyme inhibitor therapy. However, the posttransplant outcome for SSc patients is currently suboptimal compared to the general renal transplant population.

  11. Hyperdense Renal Cyst. A Case Report

    Directory of Open Access Journals (Sweden)

    José Jamil Torres Aranda


    Full Text Available Increased radiological tests have facilitated the discovery of kidney cysts, which sometimes do not meet clear criteria for benignity or malignancy. Among these lesions, the hyperdense cysts pose a challenge to all those responsible for their diagnosis and treatment. For such reasons we decided to present the case of a 23-year-old female patient with a history of sickle cell anemia, who attended the emergency department of the Dr. Gustavo Aldereguía Lima University General Hospital due to colic-like pain in the left lumbar region unresponsive to analgesics. She was diagnosed with category II renal cyst according to Bosniak classification using computed tomography with and without intravenous contrast.

  12. An unusual Case of Transitional Cell Carcinoma of Renal Pelvis Presenting with Brain Metastases

    Directory of Open Access Journals (Sweden)

    MR Razzaghi


    Full Text Available ABSTRACT: Introduction & Objective: Transitional cell carcinoma of renal pelvis presenting with brain metastases is a very rare case which should be diagnosed and treated in order to prevent further damages. Case: We report a rare case, who had presented with a constellation of neurological symptoms (due to multiple brain metastases, but without any urological symptoms. During evaluation of patient, we found transitional cell carcinoma (TCC of left renal pelvis, for which palliative radical nephroureterectomy was performed . Conclusion: Although transitional cell carcinoma of renal pelvis presenting with brain metastases is a very rare case, but the patient was managed with gamma knife stereotactic radiosurgery for the metastatic lesions. Afterward he received four cycles of paclitaxel and carboplatin chemotherapy. The patient is alive with stable disease at 32- months’ follow-up.

  13. Renal teratogens. (United States)

    Morgan, Thomas M; Jones, Deborah P; Cooper, William O


    In utero exposure to certain drugs early in pregnancy may adversely affect nephrogenesis. Exposure to drugs later in pregnancy may affect the renin-angiotensin system, which could have an impact on fetal or neonatal renal function. Reduction in nephron number and renal function could have adverse consequences for the child several years later. Data are limited on the information needed to guide decisions for patients and providers regarding the use of certain drugs in pregnancy. The study of drug nephroteratogenicity has not been systematized, a large, standardized, global approach is needed to evaluate the renal risks of in utero drug exposures.

  14. Evaluation of the absorbed dose during studies of the renal function due to I{sup 123} / I{sup 131} (hippuran) and In{sup 111} (DTPA); Evaluacion de la dosis absorbida durante estudios de la funcion renal debido a I{sup 123} / I{sup 131} (hippuran) e In{sup 111} (DPTA)

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    Vasquez, M.; Castillo, C.; Sarachaga, R.; Rojas, R.; Zelada, L.; Melendez, J.; Gomez, M. [Universidad Nacional de Trujillo, Av. Juan Pablo II s/n, Ciudad Universitaria, Trujillo (Peru); Diaz, E., E-mail: [Universidade Federal do Rio Grande do Sul, Av. Paulo Gamma 110, Bairro Farropilhas, Porto Alegre, RS 90040-060 (Brazil)


    Using the methodology MIRD and representation Cristy-Eckerman for kidneys, bladder, and whole body as organs of the bio-kinetics of I{sup 123} / I{sup 131} (hippuran) and the In{sup 111} (D PTA), the absorbed dose for studies of the renal function of adults due to the I{sup 123} is 0,0071 mGy/MBq where 88.16% corresponds to its auto-dose and 11,96% to the organs of their bio-kinetics; while for the I{sup 131} their dose is 0,032 mGy/MBq where 95,03% corresponds to its auto-dose and 4,97% to the organs of their bio-kinetics. For the In{sup 111} their dose is 0,0168 mGy/MBq where 71,68% corresponds to their auto-dose and 28,32% to the organs of their bio-kinetics. In all the cases the dosimetric contributions of the organs of the bio-kinetics (whole body and urinary bladder) are very significant, and this fundamentally is due to the photons of the whole body. (Author)

  15. Renal rickets-practical approach

    Directory of Open Access Journals (Sweden)

    Manisha Sahay


    Full Text Available Rickets/osteomalacia is an important problem in a tropical country. Many cases are due to poor vitamin D intake or calcium deficient diets and can be corrected by administration of calcium and vitamin D. However, some cases are refractory to vitamin D therapy and are related to renal defects. These include rickets of renal tubular acidosis (RTA, hypophosphatemic rickets, and vitamin D dependent rickets (VDDR. The latter is due to impaired action of 1α-hydroxylase in renal tubule. These varieties need proper diagnosis and specific treatment.

  16. Endourological Evaluation and Management of Leukoplakia of the Renal Pelvis

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    Hidehiro Kakizaki


    Full Text Available Since August 1989, we have seen 4 patients with leukoplakia of the renal pelvis associated with a longstanding renal stone. In 2 of them, excretory or retrograde pyelography revealed multiple filling defects in the left renal pelvis as well as a renal stone, although urine cytological examination was negative. One of the other 2 patients underwent extracorporeal shock wave lithotripsy (ESWL for the renal stone, but this was not followed by the passage of stone fragments. The renal stone in the remaining patient was associated with staghorn calculi. For stone extraction as well as endoscopic evaluation of the intrapelvic lesion, percutaneous nephroscopy was performed. A small to large amount of tissue-like white debris in sheets characteristic of leukoplakia was found in the renal pelvis with stones embedded in it and was removed directly by forceps or suction and then by irrigating with saline. We propose that 1 the endourological approach should be recommended for patients with renal pelvic lesions associated with longstanding renal stones or for patients who show difficulty in passing stone fragments after ESWL and 2 this entity of leukoplakia should be kept in mind for the differential diagnosis of renal pelvic lesions associated with renal stones.

  17. Quantitative analysis of microcirculation in renal solid lesions with gamma curve fitting technique of contrast-enhanced ultrasound%肾脏良恶性病灶微循环血流灌注定量分析中超声造影伽马拟合分析技术的应用

    Institute of Scientific and Technical Information of China (English)

    李萍; 李凤华; 方华; 顾莉红; 杜晶; 黄翼然


    目的 评估超声造影伽马拟合分析技术对肾脏肿瘤微循环血流灌注定量分析的价值.方法 对50例肾脏实质内占位性病灶进行超声造影,将经DICOM3.0格式保存的动态图像导入SW-UCS-1型超声分析软件进行脱机分析,根据时间-强度曲线(TIC),得到上升支斜率(a3)、下降支曲率(a2)、达到时间(AT)、达峰时间(TTP)、基础强度(BI)、峰值强度、增强强度(AMP)、曲线下面积(AUC)、平均通过时间(MTT)、灌注指数(PI)等,并比较定量参数在肾脏恶性肿瘤和肾脏血管平滑肌脂肪瘤之间的差异.结果 肾脏恶性肿瘤多见灌注模式为快进快出,而慢进慢出多见于肾脏血管平滑肌脂肪瘤.肾脏恶性肿瘤和肾脏血管平滑肌脂肪瘤灌注模式分别为:快进快出28例和0例,快进慢出4例和1例,慢进快出5例和1例,慢进慢出1例和10例.TIC分析定量参数a3、AUC和PI在肾脏良恶性肿瘤比较中差异有统计学意义(P<0.05).结论 超声造影伽马拟合分析技术可以对肿瘤微循环血流灌注进行定量分析,有助于肾脏良恶性肿瘤鉴别.%Objective To evaluate the role of gamma curve fitting technique of contrast-enhanced ultrasound in quantitative analysis of microcirculation in renal solid lesions. Methods A total of fifty patients with renal parenchyma solid lesions were performed contrast-enhanced ultrasound. The images were analysed by computer with gamma fitting analysis of contrast-enhanced ultrasonic system. The quantitative parameters were obtained by the time-intensity curves, such as ascending slope (a3), descending slope (a2), arrival time (AT), time to peak intensity (TTP), basic intensity (BI), peak intensity, amplification (AMP), area under the curve (AUC), mean transit time (MTT) and perfusion index (PI). The parameters were compared between renal malignant and benign solid lesions. Results Fast-in and fast-out was the main perfusion mode in renal malignant tumors while slow-in and

  18. Sarcoidose renal

    Directory of Open Access Journals (Sweden)



    Full Text Available Em uma mulher de 62 anos, branca, em avaliação pré-operatória de facectomia, foram detectadas alterações urinárias, tendo sido firmados os diagnósticos de calculose renal esquerda e exclusão renal homolateral. No pré-operatório da nefrectomia foram evidenciados processo pulmonar intersticial bilateral e adenopatia torácica, cuja investigação foi adiada para após a cirurgia. No rim retirado foram detectados granulomas epitelióides não necrotizantes, o mesmo ocorrendo posteriormente em biópsia transbrônquica. A paciente foi tratada com metilprednisolona, com discreta melhora pulmonar, o que não ocorreu com a função renal. O diagnóstico final foi de sarcoidose com envolvimento pulmonar, ganglionar torácico e renal.

  19. Renal failure

    Institute of Scientific and Technical Information of China (English)


    930150 Epidermal growth factor and its recep-tor in the renal tissue of patients with acute re-nal failure and normal persons.LIU Zhihong(刘志红),et al.Jinling Hosp,Nanjing,210002.Natl Med J China 1992;72(10):593-595.Epidermal growth factor(EGF)and its receptor(EGF-R)were identified by immunohis-tochemical method(4 layer PAP)in the renaltissue specimens obtained from 11 normal kid-neys and 17 cases of acute renal failure(ARF).The quantitative EGF and EGF-R in the tissuewere expressed as positive tubules per mm~2.The amount of EGF and EGF-R in renal tissue

  20. Craniofacial brown tumor as a result of secondary hyperparathyroidism in chronic renal disease patient: A rare entity (United States)

    Verma, Pradhuman; Verma, Kanika Gupta; Verma, Dinesh; Patwardhan, Nitin


    Brown tumors are erosive bony lesions caused by rapid osteoclastic activity and peritrabecular fibrosis due to primary or secondary hyperparathyroidism resulting in a local destructive phenomenon. The differential diagnosis based on histological examination is only presumptive. Clinical, radiological and laboratory data are necessary for definitive diagnosis. Here, we report a very rare case of brown tumor involving maxilla and mandible, which is the result of secondary hyperparathyroidism in 30-year-old female patient with chronic renal disease. PMID:25328310

  1. Renal failure

    Institute of Scientific and Technical Information of China (English)


    2005234 Association between serum fetuin-A and clinical outcome in end-stage renal disease patients. WANG Kai(王开), Dept Renal Dis, Renji Hosp Shanghai, 2nd Med Univ, Shanghai 200001. Chin J Nephrol, 2005;21(2):72-75. Objective: To investigate the change of serum fetuin-A level before and after dialysis, and the association of serum fetuin-A level with clinical parameters

  2. Renal failure

    Institute of Scientific and Technical Information of China (English)


    950351 Serum erythropoietin levels in chronic renalinsufficiency.ZHAI Depei(翟德佩),et al.DeptNephrol.General Hosp,Tianjin Med Univ,Tianjin,300000.Tianjin Med J 1995;23(1):19-21.Patients with chronic renal insufficiency(CRI) areoften associated with anemia.The deficiency of EPOproduction in the kidney is thought to be a key factorin the pathogenesis of renal anemia.Serum erythropoi-

  3. Renal failure

    Institute of Scientific and Technical Information of China (English)


    2008463 Protective effect of recombination rat augmenter of liver regeneration on kidney in acute renal failure rats. TANG Xiaopeng(唐晓鹏), et al. Dept Nephrol, 2nd Affili Hosp Chongqing Med Univ, Chongqing 400010.Chin J Nephrol 2008;24(6):417-421. Objective To investigate the protective effects of recombination rat augmenter of liver regeneration (rrALR) on tubular cell injury and renal dysfunction

  4. Renal Hemangiopericytoma

    Directory of Open Access Journals (Sweden)

    İbrahim Halil Bozkurt


    Full Text Available Hemangiopericytoma is an uncommon perivascular tumor originating from pericytes in the pelvis, head and tneck, and the meninges; extremely rarely in the urinary system. We report a case of incidentally detected renal mass in which radiologic evaluation was suggestive of renal cell carcinoma. First, we performed partial nephrectomy, and then, radical nephrectomy because of positive surgical margins and the pathological examination of the surgical specimen that revealed a hemangiopericytoma. No additional treatment was administered.

  5. Acute pancreatitis, acute hepatitis and acute renal failure favourably resolved in two renal transplant recipients. (United States)

    Voiculescu, Mihai; Ionescu, Camelia; Ismail, Gener; Mandache, Eugen; Hortopan, Monica; Constantinescu, Ileana; Iliescu, Olguta


    Renal transplantation is often associated with severe complications. Except for acute rejection, infections and toxicity of immunosuppressive treatment are the most frequent problems observed after transplantation. Infections with hepatic viruses (HBV, HDV, HCV, HGV) and cytomegalic virus (CMV) are the main infectious complications after renal transplantation. Cyclosporine toxicity is not unusual for a patient with renal transplantation and is even more frequent for patients with hepatic impairment due to viral infections. The subjects of this report are two renal transplant recipients with acute pancreatitis, severe hepatitis and acute renal failure on graft, receiving immunosuppressive therapy for maintaining renal graft function

  6. Imaging inflammatory acne: lesion detection and tracking (United States)

    Cula, Gabriela O.; Bargo, Paulo R.; Kollias, Nikiforos


    It is known that effectiveness of acne treatment increases when the lesions are detected earlier, before they could progress into mature wound-like lesions, which lead to scarring and discoloration. However, little is known about the evolution of acne from early signs until after the lesion heals. In this work we computationally characterize the evolution of inflammatory acne lesions, based on analyzing cross-polarized images that document acne-prone facial skin over time. Taking skin images over time, and being able to follow skin features in these images present serious challenges, due to change in the appearance of skin, difficulty in repositioning the subject, involuntary movement such as breathing. A computational technique for automatic detection of lesions by separating the background normal skin from the acne lesions, based on fitting Gaussian distributions to the intensity histograms, is presented. In order to track and quantify the evolution of lesions, in terms of the degree of progress or regress, we designed a study to capture facial skin images from an acne-prone young individual, followed over the course of 3 different time points. Based on the behavior of the lesions between two consecutive time points, the automatically detected lesions are classified in four categories: new lesions, resolved lesions (i.e. lesions that disappear completely), lesions that are progressing, and lesions that are regressing (i.e. lesions in the process of healing). The classification our methods achieve correlates well with visual inspection of a trained human grader.

  7. Lingual metastasis from renal cell carcinoma: a case report and literature review

    Directory of Open Access Journals (Sweden)

    Camillo Porta


    Full Text Available Renal cell carcinoma (RCC accounts for the 3% of all solid tumors. Despite continuous improvement in the therapy regimen, less has been achieved in terms of enabling an earlier diagnosis: the neoplasia usually reveals its presence at an advanced stage, obviously affecting prognosis. The most frequent sites of secondary disease are shown to be lungs (50-60%, bone (30-40%, liver (30-40% and brain (5%; while the head and neck district seems to account for less than 1% of patients with primary kidney lesion. We report here the case of a 70-year old man who presented with acute renal failure due to abdominal recurrence of RCC 18 years post nephrectomy. After a few months of follow up without any systemic therapy due to the renal impairment, the patient presented a vascularized tongue lesion that was demonstrated to be a secondary localization of the RCC. This lesion has, therefore, been treated with microsphere embolization to stop the frequent bleeding and to lessen the unbearable concomitant symptoms it caused, such as dysphagia and pain. A tongue lesion that appears in a RCC patient should always be considered suspect and a multidisciplinary study should be conducted both to assess whether it is a metastasis or a primary new lesion and to understand which method should be selected, if necessary, to treat it (surgery, radiation or embolization. Lingual metastasis should be examined accurately not only because they seem to implicate a poor prognosis, but also because they carry a burden of symptoms that not only threatens patients’ lives but also has a strong impact on their quality of life.

  8. 尿蛋白标志物对儿童IgA肾病和IgM肾病肾脏病理损伤的预测价值%Urinary protein markers predict the severity of renal histological lesions in children with IgA nephropathy and IgM nephropathy

    Institute of Scientific and Technical Information of China (English)

    王雪芹; 李梦霞; 李晓忠; 朱雪明; 封其华; 李艳红


    目的 比较儿童IgM肾病(IgMN)和IgA肾病(IgAN)的临床表现、病理损伤及尿蛋白标志物水平变化,探讨尿蛋白标志物对IgAN和IgMN患儿肾脏病理损伤严重程度的预测价值.方法 选择2002年1月至2014年10月行肾组织活检的74例患儿为研究对象.检测活检当日晨尿中IgG、清蛋白(Alb)、转铁蛋白(TRF)、α1-微球蛋白(α1-MG)、β2-微球蛋白(β2-MG)和N-乙酰-β-葡萄糖苷酶(NAG)水平.采用系膜细胞增生(MC)、肾小球硬化(GS)、肾小管间质损伤(TID)的评分半定量评估肾脏病理损伤严重程度.以多因素Logistic回归分析评估在校正混杂因素后尿液蛋白与肾脏病理损伤的关系,用受试者工作特征曲线下面积(AUC)评价尿液蛋白对肾脏病理损伤严重程度的预测价值.结果 74例患儿中,IgAN 44例,IgMN 30例.IgAN患儿尿oα1-MG和Alb水平高于IgMN患儿;然而,校正年龄后,差异无统计学意义.多因素Logistic回归分析显示,尿液蛋白中TRF与IgAN和IgMN患儿严重MC(>5个系膜细胞/系膜区)显著相关(B=0.010);Alb与严重GS(≥10%肾小球节段性黏连或硬化)显著相关(B=0.001);NAG与严重TID(局灶或弥散性肾小管间质病变)显著相关(B =0.038).尿β2-MG与严重MC、GS、TID无显著相关.尿TRF预测严重MC的AUC值为0.85(P <0.001).尿Alb预测严重GS的AUC值为0.78 (P =0.002).尿NAG预测严重TID的AUC值为0.78(P =0.003).结论 尿蛋白标志物是预测儿童IgAN和IgMN肾脏病理损伤严重程度的指标.其中尿TRF、Alb和NAG具有更好的预测价值.%Objective To compare the clinical manifestations,renal histological lesions,and the levels of urinary protein markers between the children with IgA nephropathy (IgAN) and those with IgM nephropathy (IgMN), and to determine whether urinary protein markers could predict the severity of renal histological lesions in children with IgAN and IgMN.Methods Seventy-four children with renal biopsy-proven IgAN and IgMN from

  9. Case report of a symptomatic giant renal oncocytoma.

    LENUS (Irish Health Repository)

    Ahmad, Sarfraz


    Renal oncocytomas are benign tumours, often asymptomatic, and picked incidentally on radiological imaging. We present a case report of a symptomatic giant renal oncocytoma in a 61-year old man having lower back\\/right flank pain. A large right renal mass was identified on abdominal CT scan. Radiological features were not sufficient to differentiate this lesion from renal cancer. Right radical nephrectomy was performed. Typical features of oncocytoma, without evidence of malignancy, were seen on histological examination of the specimen. In this report, we discuss literature review of radiological, genetic, and pathological characteristics of renal oncocytoma.

  10. Effect of renal revascularization on the development of renal dysfunction in atherosclerotic ischemic nephropathy


    Rodrigo Hagemann; Vanessa dos Santos Silva; Roberto Jorge da Silva Franco; Pasqual Barretti; Luis Cuadrado Martin


    Chronic kidney disease (CKD) is characterized by a progressive loss of renal function and its main causes are hypertension and diabetes mellitus. Among the causes of hypertension is atherosclerotic renal disease (ARD). The development of CKD in patients with ARD appears to be due not only to the involvement of the main renal arteries, but also of the renal microcirculation, which may explain the fact that the success of the procedure does not guarantee an improvement in the progression of CKD...

  11. Brown tumour in phalanx of the ring finger due to chronic kidney failure. A case report. (United States)

    Forigua V, J E; Brunicardi H, R A; Morales V, C A; Archila, M Del P; Chaparro Rivera, D M


    Brown tumours are highly vascular lytic bone lesions found in primary and secondary hyperparathyroidism. The brown term is given due to the red-brown colour of the tissue, which is due to the accumulation of hemosiderin. The case is presented of a 29 year-old male with chronic renal failure, who had a mass in the tip of the ring finger after a trauma of 4 months onset, which had increased progressively in size and pain. He was treated surgically, by amputation, with no recurrence 10 months after the surgery. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. N-acetil-β-D-glicosaminidase como biomarcador precoce de disfunção renal para a exposição ocupacional ao chumbo inorgânico N-acetyl-β-D-glucosaminidase as an early biomarker of renal dysfunction due to occupational exposure to inorganic lead

    Directory of Open Access Journals (Sweden)

    Leandro Nishikawa Gonçales


    Full Text Available OBJETIVO: Este estudo teve como objetivo averiguar a atividade enzimática da N-acetil-β-D-glicosaminidase (NAG como possível biomarcador precoce de disfunção renal para a exposição ocupacional ao chumbo inorgânico. MATERIAIS E MÉTODOS: Foi selecionado um grupo de 30 pessoas do sexo masculino expostas ao chumbo inorgânico em uma fábrica de baterias localizada no estado do Paraná. Fizeram parte do grupo os funcionários que mostraram valores de chumbo sanguíneo inferiores a 40 mg/dl. O grupo controle foi representado por 15 adultos saudáveis com similaridade em relação à idade e ao gênero do grupo exposto. Foram determinados os níveis de plumbemia, do ácido d-aminolevulínico urinário e a atividade da NAG urinária. RESULTADOS E DISCUSSÃO: Foi evidenciado que a atividade urinária da NAG foi significativamente maior (p OBJECTIVE: This study aimed to verify the enzymatic activity of N-acetyl-β-D-glucosaminidase (NAG as a possible early biomarker of renal dysfunction due to occupational exposure to inorganic lead. MATERIALS AND METHODS: We selected a group of 30 males that had been exposed to inorganic lead in a battery factory in the state of Paraná. This group comprised those employees whose blood lead levels were below 40 mg/dl. The control group consisted of 15 healthy adults of similar age and gender compared with the exposed group. Blood lead concentrations, d-aminolevulinic acid levels and urinary NAG activity were measured. RESULTS AND DISCUSSION: It was shown that urinary NAG activity was significantly higher (p < 0.05, U test of Mann-Whitney in the exposed group in comparison to the control group, and there was a significant negative correlation (p < 0.05, Spearman Rank Order correlation between the biological indicator of lead exposure and urinary NAG activity. CONCLUSION: The results showed that the increase of urinary NAG activity may be used as an early biomarker of the exposure to inorganic lead.

  13. Renal (uremic) encephalopathy in a goat. (United States)

    Radi, Z A; Thomsen, B V; Summers, B A


    Renal encephalopathy was diagnosed in a 2-year-old male boar goat with a history of chronic weight loss and ataxia. Histopathological examination of the brain revealed a striking myelin vacuolation distributed mainly in two patterns: (i) along the junction of the neocortex and corona radiata, and (ii) in the bundles of the internal capsule as it dissects through the basal nuclei. The kidneys had diffuse severe tubular and glomerular necrosis and degeneration. The neural lesions are consistent with renal (uremic) encephalopathy. To the authors' knowledge, this is the first report of renal encephalopathy in a goat.

  14. Mandibular brown tumor in renal osteodystrophy

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jin Woo; Choi, Bo Ram; Huh, Kyung Hoe; Yi, Won Jin; Choi, Soon Chul [Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul (Korea, Republic of); Gang, In Tae [Department of Oral and Maxillofacial Surgery, Kangnam Sacred Heart Hospital, Hallym Medical Center, Seoul (Korea, Republic of)


    Brown tumor is a histologically benign lesion that is a serious complication of renal osteodystrophy because it may result in severe deformity and discomfort. We report a case of brown tumor, which occurred in a 35-year-old woman with chronic renal failure, who had been treated with hemodialysis for 14 years. The lesion was found on the lingual side of the mandible. Standard panoramic radiograph showed generally decreased bone mineral density, loss of lamina dura, and thin cortical plates. Computed tomography (CT) revealed multilocular expansible lesions with heterogeneous attenuation in the anterior mandible, as well as generalized trabecular alteration with homogeneous sclerosis, and thinning or obliteration of cortical plates. Excision of the mandibular lesion and curettage of the affected bone were performed.

  15. Breast Metastasis from Renal Cell Carcinoma: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seon Jeong; Kim, Ji Young; Jeong, Myeong Ja; Kim, Jae Hyung; Kim, Soung Hee; Kim, Soo Hyun; Jun, Woo Sun; Kim, Hyun Jung; Han, Se Hwan [Sanggye Paik Hospital, Seoul (Korea, Republic of)


    Metastatic breast cancer from renal cell carcinoma is extremely rare and has non-specific findings that include a well circumscribed lesion without calcification on mammography and a well circumscribed hypoechoic lesion without posterior acoustic shadowing on sonography. We report a case of metastatic breast cancer from renal cell carcinoma and describe the radiologic findings in a 63-year-old woman who has no history of primary neoplasm.

  16. The radiological diagnosis and treatment of renal angiomyolipoma-current status.

    LENUS (Irish Health Repository)

    Halpenny, D


    Angiomyolipomas (AMLs) are the most common benign renal neoplasm and are often discovered incidentally. Due to both an increase in the use of imaging, as well as advances in imaging technology, they are being increasing identified in the general population. As these lesions are benign, there is good evidence that the majority of them can be safely followed up without treatment. However, there is an increasing wealth of information available suggesting there are individuals with AMLs where prophylactic treatment is indicated to prevent complications such as haemorrhage. In such cases, treatment with radiological interventional techniques with subselective particle embolization has superseded surgical techniques in most cases. Even in emergency cases with catastrophic rupture, prompt embolization may save the patient with the additional benefit of renal salvage. Confident identification of a lesion as an AML is important as its benign nature obviates the need for surgery in most cases. The presence of fat is paramount in the confirmatory identification and characterization of these lesions. Although fat-rich AMLs are easy to diagnose, some lesions are fat poor and it is these cases where newer imaging techniques, such as in-phase and out-of-phase magnetic resonance imaging (MRI) may aid in making a confident diagnosis of AML. In this paper, we comprehensively review the imaging techniques in making a diagnosis of AML, including features of both characteristic lesions as well as atypical lesions. In addition, we discuss current guidelines for follow-up and prophylactic treatment of these lesions, as well as the increasing role that the interventional radiologist has to play in these cases.

  17. Renal angiomyolipoma in Birt-Hogg-Dube syndrome: A case study supporting overlap with tuberous sclerosis complex. (United States)

    Dow, Eryn; Winship, Ingrid


    Birt-Hogg-Dube syndrome (BHD) is an autosomal dominant disease characterised by benign cutaneous lesions, pulmonary cysts, and an increased risk of renal tumors. This rare condition is due to a mutation in the folliculin (FLCN) gene on chromosome 17q11.2, which has a role in the mechanistic/mammalian target of rapamycin (mTOR) signaling pathway of tumorigenesis. This case illustrates a patient with BHD and a renal angiomyolipoma, a neoplastic lesion not usually associated with BHD but common in Tuberous Sclerosis Complex (TSC). There is both clinical and molecular overlap between BHD and TSC, which may arise from similarities in function of the TSC and FLCN proteins in the mTOR pathway; this case further demonstrates this potential correlation. © 2016 Wiley Periodicals, Inc.

  18. Percutaneous radial intervention for complex bilateral renal artery stenosis using paclitaxel eluting stents. (United States)

    Granillo, Gastón A Rodriguez; van Dijk, Lukas C; McFadden, Eugène P; Serruys, Patrick W


    Techniques used in the coronary circulation may be useful in peripheral intervention. We report a case of bilateral renal artery stenosis treated via a radial approach by direct stenting with distal protection at a right ostial lesion and modified crush stenting at a left renal bifurcation lesion using paclitaxel-eluting stents.

  19. Renal Cysts (United States)

    ... as “simple” cysts, meaning they have a thin wall and contain water-like fluid. Renal cysts are fairly common in ... simple kidney cysts, meaning they have a thin wall and only water-like fluid inside. They are fairly common in ...

  20. Renal failure

    Institute of Scientific and Technical Information of China (English)


    970363 Effect on serum PTH and 1, 25(OH)2 D3levels of rapid correction of metabolic acidosis in CRFpatients with secondary hyperparathyroidism. YUANQunsheng(袁群生), et al. Renal Div, PUMC Hosp,Beijing, 100730. Chin J Nephrol 1996; 12(6): 328-331.

  1. Drug-induced renal injury

    African Journals Online (AJOL)

    Drugs can cause acute renal failure by causing pre-renal, intrinsic or post-renal toxicity. Pre-renal ... incidence of drug dose adjustment in renal impairment in the SAMJ. ... Fever, haemolytic anaemia, thrombocytopenia, renal impairment and.

  2. [Chronic atrophic polychondritis and renal and cardiopulmonary amylosis: a case report and literature review (author's transl)]. (United States)

    Lambrozo, J; Baubion, D; Brodaty, Y; Leclerc, J P


    Glomerular lesions with a nephrotic syndrome and impaired renal function developed secondary to a chronic atrophic polychondritis confirmed by auricular biopsy. In the absence of renal histology data, the possibility of an iatrogenic complication or a renal lesion specific to the affection itself were successively eliminated. Pos-mortem histological examination demonstrated renal and cardiopulmonary amylosis, the latter being clinically asymptomatic. The probable autoimmune origin of the chronic atrophic polychondritis has to be discussed in parallel with the dysimmunity mechanism responsible for the amyloid lesions, but no relationship between them was demonstrated.

  3. Current status of renal biopsy for small renal masses. (United States)

    Ha, Seung Beom; Kwak, Cheol


    Small renal masses (SRMs) are defined as radiologically enhancing renal masses of less than 4 cm in maximal diameter. The incidence of renal cell carcinoma (RCC) has increased in recent years, which is mainly due to the rise in incidental detection of localized SRMs. However, the cancer-specific mortality rate is not increasing. This discrepancy may be dependent on the indolent nature of SRMs. About 20% of SRMs are benign, and smaller masses are likely to have pathologic characteristics of low Fuhrman grade and clear cell type. In addition, SRMs are increasingly detected in elderly patients who are likely to have comorbidities and are a high-risk group for active treatment like surgery. As the information about the nature of SRMs is improved and management options for SRMs are expanded, the current role of renal mass biopsy for SRMs is also expanding. Traditionally, renal mass biopsy has not been accepted as a standard diagnostic tool in the clinical scenario because of several issues about safety and accuracy. However, current series on SRM biopsy have reported high diagnostic accuracy with rare complications. Studies of modern SRM biopsy have reported diagnostic accuracy greater than 90% with very high specificity. Also, current series have shown very rare morbid cases caused by renal mass biopsy. Currently, renal biopsy of SRMs can be recommended in most cases except when patients have imaging or clinical characteristics indicative of pathology and in cases in which conservative management is not considered.

  4. Current Status of Renal Biopsy for Small Renal Masses (United States)

    Ha, Seung Beom


    Small renal masses (SRMs) are defined as radiologically enhancing renal masses of less than 4 cm in maximal diameter. The incidence of renal cell carcinoma (RCC) has increased in recent years, which is mainly due to the rise in incidental detection of localized SRMs. However, the cancer-specific mortality rate is not increasing. This discrepancy may be dependent on the indolent nature of SRMs. About 20% of SRMs are benign, and smaller masses are likely to have pathologic characteristics of low Fuhrman grade and clear cell type. In addition, SRMs are increasingly detected in elderly patients who are likely to have comorbidities and are a high-risk group for active treatment like surgery. As the information about the nature of SRMs is improved and management options for SRMs are expanded, the current role of renal mass biopsy for SRMs is also expanding. Traditionally, renal mass biopsy has not been accepted as a standard diagnostic tool in the clinical scenario because of several issues about safety and accuracy. However, current series on SRM biopsy have reported high diagnostic accuracy with rare complications. Studies of modern SRM biopsy have reported diagnostic accuracy greater than 90% with very high specificity. Also, current series have shown very rare morbid cases caused by renal mass biopsy. Currently, renal biopsy of SRMs can be recommended in most cases except when patients have imaging or clinical characteristics indicative of pathology and in cases in which conservative management is not considered. PMID:25237457

  5. An unexpected lumbar lesion

    Directory of Open Access Journals (Sweden)

    Laura Beard


    Full Text Available This case report details an interesting case of suspected spinal bifida in an obstetric patient who presented for an elective cesarean section. A large scarred/dimpled area, surrounded by significant hair growth in the region of the lumbar spine had been missed in multiple antenatal and preoperative assessments and was recognized on the day of the surgery as the patient was being prepared for spinal anesthesia. The patient was uncertain regarding the pathology of the lesion, and all investigations relating to this had been undertaken in Pakistan where she lived as a child. General anesthesia was undertaken because magnetic resonance imaging had not been performed and tethering of the spinal cord could not be ruled out clinically. The patient suffered from significant blood loss intra and postoperatively, requiring a two unit blood transfusion. She was discharged after 5 days in the hospital. This case highlights the need for thorough examination in all obstetric patients presenting to the preoperative clinic, focusing on the airway, vascular access, and lumbar spine. Patients may not always disclose certain information due to a lack of understanding, embarrassment, forgetfulness, or language barriers. Significant aspects of their care may have been undertaken abroad and access to these notes is often limited. Preoperative detection of the lesion would have allowed further investigation and imaging of the lesion and enabled more comprehensive discussions with the patient regarding anesthetic options and risk.

  6. Biopsy results of Bosniak 2F and 3 cystic lesions

    DEFF Research Database (Denmark)

    Rasmussen, René; Hørlyck, Arne; Nielsen, Tommy Kjærgaard

    Purpose: The distinction between benign and malignant complex cystic renal lesions remains a challenge. Bosniak 2F lesions are often followed with repeated CT for a minimum of five years, often entailing a high exposure to radiation. The aim of the present study was to evaluate whether biopsy could...... be helpful in clinical decisions. Material and Methods: From March 2013 - December 2014 a total of 295 percutaneous ultrasound guided biopsies from 287 patients with a suspected malignant renal lesion were performed at our institution. All cases were reviewed in PACS by (RR) and lesions presenting...... with a cystic change were re-evaluated and re-categorized after the Bosniak classification system. The re-evaluation and re-categorization was performed in consensus by a junior radiologist (RR) and an uro-radiological expert (OG). Results: Biopsies from eighteen Bosniak 2F cystic lesions were pathologically...

  7. Solitary lucent epiphyseal lesions in children

    Energy Technology Data Exchange (ETDEWEB)

    Gardner, D.J.; Azouz, E.M.


    We evaluated retrospectively the varying radiographic appearances of 15 solitary lucent epiphyseal lesions occurring in children. Imaging modalities used included plain films, conventional tomography, nuclear scintigraphy, and computed tomography. 40% of the lesions (6) were due to osteomyelitis. The remaining lesions included tuberculosis (1), foreign body granuloma (1), chondroblastoma (2), chondromyoxid fibroma (1), enchondroma (1), osteoid osteoma (2), and eosinophilic granuloma (1). Although the radiographic appearances of such lesions may be particularly characteristic, pathologic correlation is frequently necessary. The high incidence of osteomyelitis in our cases emphasizes its importance as a cause for a lucent epiphyseal lesion.

  8. Ocular lesions and experimental choline deficiency Lesiones oculares y deficiencia experimental de colina

    Directory of Open Access Journals (Sweden)

    Georgina P. Ossani


    Full Text Available Previous studies have shown ocular haemorrhages in choline-deficient rats. The aim of this paper is to study further the relationship between ocular and renal lesions and biochemical alterations in rats fed a choline-deficient diet. Fifty one weanling male Wistar rats, were divided into two groups. Thirty one of them were fed a choline-deficient diet and the rest was fed a choline-supplemented diet ad libitum. Animals from both groups were killed between the fifth and the eighth day. Urea, creatinine and homocysteine concentrations in blood were determined. Eyes were used for light microscopy study; high resolution light microscopy and the study of the retina as "rétine a plat". Kidneys were studied by light microscopy. Choline-supplemented rats did not show ocular or renal lesion. Choline-deficient rats that showed renal lesions, tubular or cortical necrosis, did not always have ocular changes. There were no ocular changes in the only choline-deficient rat without renal lesion. The ocular changes consisted mainly in haemorrhage in both cameras and ciliary and vitreous bodies. Correlations between ocular and renal lesion (r=0.72, pEstudios previos han demostrado hemorragia ocular en ratas deficientes en colina. El objetivo de este trabajo es profundizar en la relación entre las alteraciones oculares, renales y bioquímicas en ratas deficientes en colina. Cincuenta y una ratas Wistar macho recién destetadas fueron divididas en dos grupos: treinta y una fueron alimentadas con una dieta colino deficiente y el resto con colina suplementada ad-libitum. Los animales de ambos grupos fueron sacrificados entre el quinto y el octavo día. Se midió la concentración de urea, creatinina y homocisteína en sangre. Los ojos fueron estudiados por microscopía de luz, microscopía óptica de alta resolución y para el estudio de la retina como retina plana. Los riñones fueron estudiados por microscopía de luz. Las ratas suplementadas con colina no

  9. An unusual cause of acute renal failure: renal lymphoma. (United States)

    Ozaltin, Fatih; Yalçin, Bilgehan; Orhan, Diclehan; Sari, Neriman; Caglar, Melda; Besbas, Nesrin; Bakkaloglu, Aysin


    Renal involvement is a common finding in non-Hodgkin's lymphoma (NHL). Acute renal failure at initial presentation due to lymphomatous infiltration of the kidneys has been described infrequently. We report a 17-year-old male who presented with acute renal failure due to massive lymphomatous infiltration of the kidneys, which necessitated hemodialysis. The diagnosis of B-cell NHL was established by tru-cut biopsy of the kidneys and the patient had an excellent response to high-dose chemotherapy with no major complication. The presence of extrarenal involvement in the testes and the retroperitoneal lymph nodes made the diagnosis of primary renal lymphoma debatable. However, considering the delay in diagnosis and the high proliferative rate of B-cell NHL, we might postulate that the disease had originated primarily in the kidneys. We recommend that in NHL cases with severe renal involvement, full-dose chemotherapy should be instituted with meticulous clinical and laboratory follow-up in order to improve clinical and renal failure status rapidly and to avoid further dissemination of NHL.

  10. Renal Toxicities of Targeted Therapies. (United States)

    Abbas, Anum; Mirza, Mohsin M; Ganti, Apar Kishor; Tendulkar, Ketki


    With the incorporation of targeted therapies in routine cancer therapy, it is imperative that the array of toxicities associated with these agents be well-recognized and managed, especially since these toxicities are distinct from those seen with conventional cytotoxic agents. This review will focus on these renal toxicities from commonly used targeted agents. This review discusses the mechanisms of these side effects and management strategies. Anti-vascular endothelial growth factor (VEGF) agents including the monoclonal antibody bevacizumab, aflibercept (VEGF trap), and anti-VEGF receptor (VEGFR) tyrosine kinase inhibitors (TKIs) all cause hypertension, whereas some of them result in proteinuria. Monoclonal antibodies against the human epidermal growth factor receptor (HER) family of receptors, such as cetuximab and panitumumab, cause electrolyte imbalances including hypomagnesemia and hypokalemia due to the direct nephrotoxic effect of the drug on renal tubules. Cetuximab may also result in renal tubular acidosis. The TKIs, imatinib and dasatinib, can result in acute or chronic renal failure. Rituximab, an anti-CD20 monoclonal antibody, can cause acute renal failure following initiation of therapy because of the onset of acute tumor lysis syndrome. Everolimus, a mammalian target of rapamycin (mTOR) inhibitor, can result in proteinuria. Discerning the renal adverse effects resulting from these agents is essential for safe treatment strategies, particularly in those with pre-existing renal disease.

  11. Renal failure (chronic)


    Clase, Catherine


    Chronic renal failure is characterised by a gradual and sustained decline in renal clearance or glomerular filtration rate (GFR). Continued progression of renal failure will lead to renal function too low to sustain healthy life. In developed countries, such people will be offered renal replacement therapy in the form of dialysis or renal transplantation. Requirement for dialysis or transplantation is termed end-stage renal disease (ESRD).Diabetes, glomerulonephritis, hypertension, pyelone...

  12. Unilateral renal cell carcinoma with coexistent renal disease: a rare cause of end-stage renal disease. (United States)

    Peces, R; Alvarez-Navascués, R


    Renal cell carcinoma (RCC) is a disorder encompassing a wide spectrum of pathological renal lesions. Coexistence of unilateral RCC and associated pathology in the contralateral kidney is an unusual and challenging therapeutic dilemma that can result in renal failure. So far, data on unilateral RCC with chronic renal failure necessitating renal replacement therapy have not been published. The aim of the present study was to evaluate the incidence of end-stage renal disease (ESRD) from unilateral RCC, and to assess the associated pathology and possible pathogenic factors. In 1999, a survey of the 350 patients treated by chronic dialysis in Asturias, Spain, was carried out to identify and collect clinical information on patients with primary unilateral RCC whilst on their renal replacement programme. Seven patients were identified as having ESRD and unilateral RCC, giving an incidence of 2% of patients treated by dialysis. There was a wide spectrum of associated disease and clinical presentation. All patients underwent radical or partial nephrectomy and were free of recurrence 6--64 months after surgery. Six patients were alive and free of malignancy recurrence for 6--30 months after the onset of haemodialysis. ESRD is rare in association with unilateral RCC, but does contribute to significant morbidity. However, the data presented here are encouraging and suggest that cancer-free survival with renal replacement therapy can be achieved in such patients.


    Directory of Open Access Journals (Sweden)

    Anusha Harihara Gopalan


    Full Text Available BACKGROUND HELLP is the acronym for haemolysis, elevated liver enzymes and low platelet count. HELLP syndrome is a form of severe preeclampsia with an incidence of 0.2-0.6% of all pregnancies. The aim of our study is to evaluate the trend of renal dysfunction in HELLP syndrome patients. MATERIALS AND METHODS This is a cross-sectional observational study conducted in Department of Obstetrics and Gynaecology, Institute of Maternal and Child Health, Government Medical College, Kozhikode, during the period of 12 months from January 2013 to December 2013. All patients with HELLP syndrome were included in the study and their renal function tests monitored. RESULTS Results were renal dysfunction prevalence in HELLP syndrome patients is 77%. The renal impairment recovered by 6 days on an average. All had normal renal function tests at the time of discharge. Patients with renal function derangement had a mean duration of hospital stay and transfusion requirements more than the patients without renal function derangement, which was statistically significant (p value 0.036. Haemodialysis required for one out of 60 patients. One maternal mortality due to acute renal failure. CONCLUSION As the prevalence of renal dysfunction is high, some amount of renal impairment maybe a part of the HELLP syndrome disease spectrum itself. Though the incidence of progression to acute renal failure and dialysis is less, this is the important cause of morbidity and mortality in HELLP syndrome patients.

  14. Effect of sludge ice cooling on renal function and renal histology in the dog. (United States)

    Verbaeys, A; Oosterlinck, W; Lameire, N; Cuvelier, C; De Sy, W A


    The effect of sludge ice surface cooling on the compensatory hypertrophied dog kidney was investigated. Renal function was measured prior to and on days 1, 3 and 7 after the cooling procedure by means of inulin clearance, PAH clearance and sodium excretion capacity during normal hydration and after volume expansion. No alteration in renal function was shown. No freezing lesions or thromboses were seen on histological examination.

  15. Renal histology of mucocutaneous lymph node syndrome (Kawasaki disease). (United States)

    Salcedo, J R; Greenberg, L; Kapur, S


    Renal involvement is well described in patients with mucocutaneous lymph node syndrome (MCLNS), or Kawasaki disease and is manifested by mild azotemia, hematuria, pyuria or cylinduria, and more often, proteinuria. Renal morphology during the acute stages of the illness has never been reported. In this paper we describe the renal histopathologic changes in a child with MCLNS. The glomerular histopathologic findings suggest immune complex damage to the kidney as a possible mechanism of nephrotoxicity in MCLNS. Presence of kidney lesions, which speak in favor of the injurious role of immune complexes in MLCNS may be relevant to the understanding of the pathogenesis of the vascular lesions that are characteristic of this disease.

  16. European Veterinary Renal Pathology Service: A Survey Over a 7-Year Period (2008-2015). (United States)

    Aresu, L; Martini, V; Benali, S L; Brovida, C; Cianciolo, R E; Dalla Riva, R; Trez, D; Van Der Lugt, J J; Van Dongen, A; Zini, E


    The European Veterinary Renal Pathology Service (EVRPS) is the first Web-based registry for canine renal biopsy specimens in Europe. The aim was to verify whether differences exist between the clinical and laboratory presentation of dogs with nephropathy according to renal pathological findings, as defined by light and electron microscopy of renal biopsy specimens submitted to EVRPS. Renal biopsy specimens of dogs were collected from the archive of the service (n = 254). Cases were included if both light and electron microscopy were available (n = 162). Renal biopsy specimens were classified based on the morphological diagnoses. Thereafter, they were grouped into 3 disease categories, including immune-complex-mediated glomerulonephritis (ICGN), non-immune-complex-mediated GN (non-ICGN), and renal lesions not otherwise specified (RL-NOS). Differences among morphological diagnoses and among disease categories were investigated for clinical and laboratory variables. Serum albumin concentration was lower in dogs with ICGN than in those with non-ICGN (P = 0.006) or RL-NOS (P = 0.000), and the urine protein-to-creatinine ratio (UPC) was significantly higher in ICGN than in the other 2 disease categories. Regarding morphological diagnoses, albumin was significantly lower in amyloidosis (AMY) and membranous (MGN), membranoproliferative (MPGN) or mixed glomerulonephritis (MixGN) than in minimal change disease, primary (FSGS I) or secondary (FSGS II) focal and segmental glomerulosclerosis and juvenile nephropathies (JN). The UPC was higher in MPGN than in FSGS I and FSGS II. Dogs with ICGN, in particular MPGN, had higher protein loss than those with non-ICGN or RL-NOS, leading to more severe hypoalbuminemia. Clinical and laboratory differentiation among dogs with the different morphological diagnoses and among dogs with different disease categories was difficult due to overlapping results. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine

  17. Pregnancy in renal transplant recipients. (United States)

    Fuchs, Karin M; Wu, Danny; Ebcioglu, Zeynep


    Women with renal disease face increasing infertility and high-risk pregnancy as they approach end-stage renal disease due to uremia. Renal transplantation has provided these patients the ability to return to a better quality of life, and for a number of women who are of child bearing age with renal disease, it has restored their fertility and provided the opportunity to have children. But, although fertility is restored, pregnancy in these women still harbors risk to the mother, graft, and fetus. Selected patients who have stable graft function can have successful pregnancies under the supervision of a multidisciplinary team involving maternal fetal medicine specialists and transplant nephrologists. Careful observation and management are required to optimize outcome for mother and fetus.

  18. Utility evaluation on application of geometric mean depending on depth of kidney in split renal function test using 99mTc-MAG{sub 3}

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Byeul; Ahn, Sung Min [Dept. of Radiological Science, Gachon University, Incheon (Korea, Republic of); Lee, Wang Hui [Dept. of Nuclear Medicine, Gil-Hospital, Incheon (Korea, Republic of)


    99mTc-MAG{sub 3} Renal scan is a method that acquires dynamic renal scan image by using 99mTc-MAG{sub 3} and dynamically visualizes process of radioactive agent being absorbed to kidney and excreted continuously. Once the test starts, ratio in both kidneys in 1-2.5 minutes was measured to obtain split renal function and split renal function can be expressed in ratio based on overall renal function. This study is based on compares split renal function obtained from data acquired from posterior detector, which is a conventional renal function test method, with split renal function acquired from the geometric mean of values obtained from anterior and posterior detectors, and studies utility of attenuation compensation depending on difference in geometric mean kidney depth. From July, 2015 to February 2016, 33 patients who undertook 99mTc-MAG{sub 3} Renal scan(13 male, 20 female, average age of 44.66 with range of 5-70, average height of 160.40 cm, average weight of 55.40 kg) were selected as subjects. Depth of kidney was shown to be 65.82 mm at average for left and 71.62 mm at average for right. In supine position, 30 out of 33 patients showed higher ratio of deep-situated kidney and lower ratio of shallow-situated kidney. Such result is deemed to be due to correction by attenuation between deep-situated kidney and detector and in case where there is difference between the depth of both kidneys such as, lesions in or around kidney, spine malformation, and ectopic kidney, ratio of deep-situated kidney must be compensated for more accurate calculation of split renal function, when compared to the conventional test method (posterior detector counting)

  19. Renale Osteopathie


    Horn S


    Die renale Osteopathie umfaßt Erkrankungen des Knochens, die bei Patienten mit chronischen Nierenerkrankungen auftreten, wie den sekundären bzw. tertiären Hyperparathyreoidismus, die adynamische Knochenerkrankung und die Osteopathie nach Nierentransplantation. Durch die Identifikation des Kalzium-Sensing-Rezeptors bzw. des Vitamin D-Rezeptors hat sich unser Verständnis der Zusammenhänge in den letzten Jahren erheblich verbessert. Neue Medikamente versprechen effizientere Prophylaxe- und Thera...

  20. Renale Knochenerkrankungen

    Directory of Open Access Journals (Sweden)

    Mayer G


    Full Text Available Störungen des Mineral- und Knochenstoffwechsels sind bei fast allen Patienten mit chronischen Nierenerkrankungen anzutreffen. Pathogenetisch spielt eine Neigung zur Phosphatretention bei einer Reduktion der glomerulären Filtrationsrate die zentrale Rolle. Neben typischen, aber sehr variablen Veränderungen der Knochenstruktur (renale Osteopathie besteht auch eine sehr enge Assoziation zwischen diesen Störungen und dem massiv erhöhten kardiovaskulären Risiko der Patienten.

  1. Obesity and renal hemodynamics

    NARCIS (Netherlands)

    Bosma, R. J.; Krikken, J. A.; van der Heide, J. J. Homan; de Jong, P. E.; Navis, G. J.


    Obesity is a risk factor for renal damage in native kidney disease and in renal transplant recipients. Obesity is associated with several renal risk factors such as hypertension and diabetes that may convey renal risk, but obesity is also associated with an unfavorable renal hemodynamic profile

  2. Obesity and renal hemodynamics

    NARCIS (Netherlands)

    Bosma, R. J.; Krikken, J. A.; van der Heide, J. J. Homan; de Jong, P. E.; Navis, G. J.


    Obesity is a risk factor for renal damage in native kidney disease and in renal transplant recipients. Obesity is associated with several renal risk factors such as hypertension and diabetes that may convey renal risk, but obesity is also associated with an unfavorable renal hemodynamic profile inde

  3. Dieulafoy's lesion of duodenum: a case report

    Directory of Open Access Journals (Sweden)

    Wagholikar Gajanan D


    Full Text Available Abstract Background Dieulafoy's lesion is an uncommon but important cause of recurrent upper gastrointestinal bleeding. Extragastric location of Dieulafoy's lesion is rare. We report two cases of Dieulafoy's lesion of the duodenum and discuss the management of this extremely uncommon entity. Case presentation Two cases of massive upper gastro-intestinal bleeding in young adults due to Dieulafoy's lesion of the duodenum are reported. Endoscopic diagnosis was possible in both cases. Hemostasis was achieved successfully by endoscopic adrenaline injection. The endoscopic appearance, pitfalls in the diagnosis and management of this rare lesion are discussed. Conclusions Endoscopic diagnosis of extragastric Dieulafoy's lesion can be difficult because of the small size and obscure location of the lesion. Increased awareness and careful and early endoscopic evaluation following the bleeding episode are the key to accurate diagnosis. Adrenaline injection is one of the important endoscopic modalities for control of bleeding.

  4. Power doppler ultrasound findings of renal infarct after experimental renal artery occlusion: comparison with spiral CT

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Seung Eun; Shinn, Kyung Sub; Kim, Hak Hee; Mun, Seok Hwan; Lee, Young Joon; Lee, Bae Young; Choi, Byung Gil; Lee, Jae Mun; Lee, Hee Jeong [The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of)


    To evaluate the efficacy of power Doppler ultrasonography (PDUS) in depicting renal infarction in rabbits during experimental renal segmental arterial occlusion, and to compare the results with those of CT scanning. In 28 rabbits weighing 2.5 4kg, the segmental renal artery was occluded through the left main renal artery by embolization with Ivalon (Nycomed, Paris, France). Power Doppler ultrasonography and spiral CT scanning were performed before and at 2, 5, 8, 15, and 24 hours, and 3 and 7 days after occlusion of the segmental renal artery. The location of infarcted areas and collaterals, as seen on PDUS and CT scans, was evaluated by two radiologists. In all cases, as seen on power Doppler ultrasonography, infarcted areas-when compared with normal parenchyma, clearly demonstrated wedge-shaped perfusion defects in the kidney. The location of the lesion closely corresponded to the location seen during CT scanning. After renal arterial occlusion, transiently congested capsular arteries, which were named 'capsular sign', were seen in 63% of rabbits in the two and five-hour groups. No significant cortical rim sign was demonstrated on power Doppler ultrasonography, though it was noted on spiral CT at 15 and 24 hours, and 3 and 7 days after renal arterial occlusion. Power Doppler ultrasonography was useful for the diagnosis of renal infarction. Congested capsular artery seen in the early stage of renal infarction might be a characteristic finding of this condition, as seen on power Doppler ultrasonography.

  5. The role of intraoperative ultrasound in small renal mass robotic enucleation

    Directory of Open Access Journals (Sweden)

    Roberta Gunelli


    Full Text Available Introduction: As a result of the growing evidence on tumor radical resection in literature, simple enucleation has become one of the best techniques associated to robotic surgery in the treatment of renal neoplasia, as it guarantees minimal invasiveness and the maximum sparing of renal tissue, facilitating the use of reduced or zero ischemia techniques during resection. The use of a robotic ultrasound probe represents a useful tool to detect and define tumor location, especially in poorly exophytic small renal mass. Materials and methods: A total of 22 robotic enucleations were performed on < 3 cm renal neoplasias (PADUA score 18 Pz 6/7 e 4 Pz 8 using a 12-5 MHz robotic ultrasound probe (BK Drop-In 8826. Results: Once kidney had been isolated from the adipose capsule at the site of the neoplasia (2, the exact position of the lesion could be easily identified in all cases (22/22, even for mostly endophytic lesions, thanks to the insertion of the ultrasound probe through the assistant port. Images were produced and visualized by the surgeon using the TilePro feature of the DaVinci surgical system for producing a picture-in-picture image on the console screen. The margins of resection were then marked with cautery, thus allowing for speedy anatomical dissection. This reduced the time of ischemia to 8 min (6-13 and facilitated the enucleation technique when performed without clamping the renal peduncle (6/22. No complications due to the use of the ultrasound probe were observed. Conclusions: The use of an intraoperative robotic ultrasound probe has allowed for easier identification of small, mostly endophytic neoplasias, better anatomical approach, shorter ischemic time, reduced risk of pseudocapsule rupture during dissection, and easier enucleation in cases performed without clamping. It is noteworthy that the use of intraoperative ultrasound probe allows mental reconstruction of the tumor through an accurate 3D vision of the hidden field during

  6. Bilateral Renal Mass-Renal Disorder: Tuberculosis

    Directory of Open Access Journals (Sweden)

    Ozlem Tiryaki


    Full Text Available A 30-year-old woman has presented complaining of weakness and fatigue to her primary care physician. The renal sonography is a routine step in the evaluation of new onset renal failure. When the renal masses have been discovered by sonography in this setting, the functional imaging may be critical. We reported a case about bilateral renal masses in a young female patient with tuberculosis and renal insufficiency. Magnetic resonance (MR has revealed the bilateral renal masses in patient, and this patient has been referred to our hospital for further management. The patient’s past medical and surgical history was unremarkable.

  7. Distal renal tubular acidosis (United States)

    Renal tubular acidosis - distal; Renal tubular acidosis type I; Type I RTA; RTA - distal; Classical RTA ... excreting it into the urine. Distal renal tubular acidosis (Type I RTA) is caused by a defect ...

  8. Proximal renal tubular acidosis (United States)

    Renal tubular acidosis - proximal; Type II RTA; RTA - proximal; Renal tubular acidosis type II ... by alkaline substances, mainly bicarbonate. Proximal renal tubular acidosis (Type II RTA) occurs when bicarbonate is not ...

  9. Suture Granuloma Mimicking Renal Cell Carcinoma: Magnetic Resonance Imaging (MRI and Pathologic Correlation

    Directory of Open Access Journals (Sweden)

    İbrahim İlker Öz


    Full Text Available Solid renal masses are generally distinguished with contrast enhancement and intratumoral fatty foci by radiological examinations. The present of enhancement is most important criteria for diagnosis of malignant lesions. Generally, a contrast enhanced solid mass in kidney is accepted as a neoplasm. Foreign body granuloma is an extraordinary cause of enhanced solid renal mass. This case of a renal suture granuloma demonstrated peripheral enhanced exophytic renal mass mimic renal cell carcinoma, and underwent surgery. At the solid renal mass with different radiological features, biopsy is an option to determining the necessity of surgery as well as the surgical approach.

  10. Evaluation of Bosniak category IIF complex renal cysts

    DEFF Research Database (Denmark)

    Graumann, Ole; Osther, Susanne Sloth; Karstoft, Jens


    complex cystic lesions in the kidney (n = 550 in the same number of patients) were reclassified according to the Bosniak classification by two radiologists in consensus. If a patient had more than one lesion, only the highest Bosniak category was recorded. All Bosniak IIF lesions with ≥2-year follow......PURPOSE: To evaluate moderately complex renal cysts of Bosniak category IIF. MATERIALS AND METHODS: The regional ethics committee approved the study. In the period 2003-2009, radiological CT reports of 8,402 CT examinations of the kidneys were analysed retrospectively by one radiologist. All...... nephron-sparing approach to complex renal cysts. TEACHING POINTS : • The Bosniak classification is used to categorise complex renal cystic masses • BIIF cysts behave mostly as benign lesions • Radiological progression in complexity occurs in only 16 % of cases • BIIF category seems promising for clinical...

  11. Focus on renal congestion in heart failure. (United States)

    Afsar, Baris; Ortiz, Alberto; Covic, Adrian; Solak, Yalcin; Goldsmith, David; Kanbay, Mehmet


    Hospitalizations due to heart failure are increasing steadily despite advances in medicine. Patients hospitalized for worsening heart failure have high mortality in hospital and within the months following discharge. Kidney dysfunction is associated with adverse outcomes in heart failure patients. Recent evidence suggests that both deterioration in kidney function and renal congestion are important prognostic factors in heart failure. Kidney congestion in heart failure results from low cardiac output (forward failure), tubuloglomerular feedback, increased intra-abdominal pressure or increased venous pressure. Regardless of the cause, renal congestion is associated with increased morbidity and mortality in heart failure. The impact on outcomes of renal decongestion strategies that do not compromise renal function should be explored in heart failure. These studies require novel diagnostic markers that identify early renal damage and renal congestion and allow monitoring of treatment responses in order to avoid severe worsening of renal function. In addition, there is an unmet need regarding evidence-based therapeutic management of renal congestion and worsening renal function. In the present review, we summarize the mechanisms, diagnosis, outcomes, prognostic markers and treatment options of renal congestion in heart failure.


    Directory of Open Access Journals (Sweden)

    S. A. Ivanov


    Full Text Available In the recent years, the effectiveness of the treatment of even advanced cases of metastatic renal cell carcinoma is relatively high due to the possibility of targeted therapy, removal of metastatic lesions. Therefore, the issue of the quality of life of such patients often comes to the fore. This paper presents a clinical case of radical surgical treatment of metastasis located in the humerus, resulting in partial recovery of the limb function which eventually led to the improvement of the patient’s quality of life.

  13. Bilateral asynchronous renal cell carcinoma with metastatic involvement of the tongue. (United States)

    Ghazali, Naseem; Davis, Charlotte; Barrett, A W; Tighe, John V


    Renal cell carcinoma (RCC) has a propensity for distant organ metastasis and late recurrence, involving not only the ipsilateral but also contralateral kidney. Lingual metastasis by RCC is rare. We present an unusual case of bilateral asynchronous RCC. Involvement of the right kidney was discovered only after a metastatic tongue lesion was diagnosed. The original RCC had been treated by left nephrectomy 14 years previously. Due to end-stage primary pulmonary malignancy, and poor function of the remaining kidney, immunotherapy was unsuitable. Palliative local resection of the lingual metastasis alleviated functional difficulties and was preventative against airway obstruction, but the patient died five months later.

  14. Pregnancy in women with renal disease. Part II: specific underlying renal conditions. (United States)

    Vidaeff, Alex C; Yeomans, Edward R; Ramin, Susan M


    The obstetric outcome in women with kidney disease has improved in recent years due to continuous progress in obstetrics and neonatology, as well as better medical management of hypertension and renal disease. However, every pregnancy in these women remains a high-risk pregnancy. When considering the interaction between renal disease and pregnancy, maternal outcomes are related to the initial level of renal dysfunction more than to the specific underlying disease. With regards to fetal outcomes, though, a distinction may exist between renal dysfunction resulting from primary renal disease and that in which renal involvement is part of a systemic disease. In part II of this review, some specific causes of renal failure affecting pregnancy are considered.

  15. Spindle cell melanocytic lesions: part II--an approach to intradermal proliferations and horizontally oriented lesions. (United States)

    Sade, Shachar; Al Habeeb, Ayman; Ghazarian, Danny


    Melanocytic lesions show great morphological diversity in their architecture and the cytomorphological appearance of their composite cells. Whereas functional melanocytes show a dendritic cytomorphology and territorial isolation, lesional nevomelanocytes and melanoma cells typically show epithelioid, spindled or mixed cytomorphologies, and a range of architectural arrangements. Spindling is common to melanocytic lesions, and may either be a characteristic feature or a divergent appearance. The presence of spindle cells may mask the melanocytic nature of a lesion, and is often disconcerting, either due to its infrequent appearance in a particular lesion or its interpretation as a dedifferentiated phenotype. Spindle cell melanocytic lesions follow the full spectrum of potential biological outcomes, and difficulty may be experienced judging the nature of a lesion due to a lack of consistently reliable features to predict biological behaviour. Over time, recognition of numerous histomorphological features that may portend a more aggressive lesion have been identified; however, the translation of these features into a diagnostic entity requires a gestalt approach. Although most spindle cell melanocytic lesions may reliably be resolved through this standard approach, problem areas do exist for the surgical pathologist or dermatopathologist. With this review (part II of II), we complete our discussion of spindle cell melanocytic lesions, in order to: (1) model a systematic approach to such lesions; and (2) provide familiarity with those melanocytic lesions which either typically or occasionally display a spindled cytomorphology.

  16. Potential molecular therapy for acute renal failure. (United States)

    Humes, H D


    Ischemic and toxic acute renal failure is reversible, due to the ability of renal tubule cells to regenerate and differentiate into a fully functional lining epithelium. Recent data support the thesis that recruitment or activation of macrophages to the area of injury results in local release of growth factors to promote regenerative repair. Because of intrinsic delay in the recruitment of inflammatory cells, the exogenous administration of growth promoters early in the repair phase of acute renal failure enhances renal tubule cell regeneration and accelerates renal functional recovery in animal models of acute renal failure. Molecular therapy for the acceleration of tissue repair in this disease process may be developed in the near future.

  17. Testicular metastasis of renal cell carcinoma mimicking seminoma; Metastasis testicular de adenocarcinoma de celulas renales simulando un seminoma

    Energy Technology Data Exchange (ETDEWEB)

    Fernandez, P.; Marco, S. F.; Gil, S.; Cervera, J. [Hospital General de Castellon. (Spain)


    We report a case of renal cell carcinoma presenting with secondary signs resulting from this lesion, and review the pertinent literature. The interesting aspect of this case is its uncommon presentation as a testicular metastasis that mimicked a seminomatous lesion associated with a lytic lesion in ipsilateral ilium. These findings lend additional support to the need to perform thoracoabdominal computed tomography for staging of testicular neoplasms discovered by ultrasound prior to surgery. (Author) 21 refs.

  18. The wide spectrum of hyperechoic lesions of the breast

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    Linda, A., E-mail: [Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine (Italy); Zuiani, C.; Lorenzon, M.; Furlan, A.; Londero, V. [Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine (Italy); Machin, P. [Institute of Pathology, Ospedale De Gironcoli, Conegliano (Italy); Bazzocchi, M. [Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine (Italy)


    Although breast lesions are commonly detected because of their hypoechogenicity, some lesions may present with hyperechogenicity due to their histological components. Hyperechogenicity has been shown to be highly predictive of benignity; however, hyperechoic lesions can occasionally be malignant. This article reviews hyperechoic lesions of the breast, describes the underlying histological causes associated with hyperechogenicity, and the sonographic features useful for the differential diagnosis between benign and malignant hyperechoic lesions.

  19. Renale Osteopathie

    Directory of Open Access Journals (Sweden)

    Horn S


    Full Text Available Die renale Osteopathie umfaßt Erkrankungen des Knochens, die bei Patienten mit chronischen Nierenerkrankungen auftreten, wie den sekundären bzw. tertiären Hyperparathyreoidismus, die adynamische Knochenerkrankung und die Osteopathie nach Nierentransplantation. Durch die Identifikation des Kalzium-Sensing-Rezeptors bzw. des Vitamin D-Rezeptors hat sich unser Verständnis der Zusammenhänge in den letzten Jahren erheblich verbessert. Neue Medikamente versprechen effizientere Prophylaxe- und Therapiemöglichkeiten. Wir beeinflussen dadurch nicht nur die Morbidität und Lebensqualität, sondern auch die Mortalität unserer Patienten.

  20. Renal disease in pregnancy. (United States)

    Thorsen, Martha S; Poole, Judith H


    Anatomic and physiologic adaptations within the renal system during pregnancy are significant. Alterations are seen in renal blood flow and glomerular filtration, resulting in changes in normal renal laboratory values. When these normal renal adaptations are coupled with pregnancy-induced complications or preexisting renal dysfunction, the woman may demonstrate a reduction of renal function leading to an increased risk of perinatal morbidity and mortality. This article will review normal pregnancy adaptations of the renal system and discuss common pregnancy-related renal complications.

  1. How renal cells handle urea. (United States)

    Bagnasco, S M


    The urine concentration process requires an osmolality gradient along the renal cortico-medullary axis, with highest values in the renal papilla. NaCl and urea are the major solutes in the renal inner medulla, concentrations of urea up to 500-600 mM are found in the rat renal papilla. Urea can diffuse across cell membranes and contributes to balance intracellular and extracellular osmotic equilibrium. However, urea has perturbing effects on enzyme activity, and in concentrations above 300 mM is toxic for renal cultured cells. There is increasing evidence that urea can induce cellular responses distinct from those due to NaCl and other non-permeable solutes, including upregulation of immediate-early genes (IEGs). Urea transport by epithelial and endothelial cells is important for intra-medullary urea recycling and preservation of high urea concentration in the inner medulla. Trans-cellular movement of urea in cells expressing urea transporters may influence intracellular levels of this solute and modulate urea-induced signaling pathways. Regulation of urea transporters expression and activity can therefore be viewed as one aspect of cellular adaptation to urea. We have identified tonicity-responsive transcription as one mechanism regulating expression of the urea transporter UT-A. The short-term and long-term effects of variable extracellular urea concentration on the function of renal cells remain still unclear.

  2. Induction of proinflammatory cytokines and nitric oxide by Trypanosoma cruzi in renal cells. (United States)

    de Oliveira, Gabriel M; Yoshida, Nobuko; Higa, Elisa M S; Shenkman, Sérgio; Alves, Monique; Staquicini, Daniela; Cascabulho, Cynthia; Schor, Nestor


    Chagas disease is typically associated with cardiac involvement. During the acute phase of murine infection with Trypanosoma cruzi, severe acute myocarditis can develop. Prior to cardiac alteration, however, infected mice present with renal inflammatory infiltration causing acute kidney injury due to an ischemia/reperfusion lesion. Thus, the present study was undertaken in order to evaluate whether the parasites or some of their components would directly affect renal cells. As such, this study employed kidney cell lines (mesangial, epithelial, and proximal tubular) that mimic different regions of the renal system. Mesangial cells are more resistant to infection, showing reduced parasite internalization relative to epithelial and proximal tubular cells. Upon infection, mesangial cells produced more nitric oxide, tumor factor necrosis-α, and interferon-γ and showed decreased viability when compared to the other cell lines. These results indicate that the resistance of mesangial cells to infection may be related to the increased expression of nitric oxide and proinflammatory cytokines. Conversely, the high levels of nitric oxide produced by these cells caused impairment of cell integrity and viability. Higher nitric oxide concentrations promote cellular injury and can be involved in the genesis of ischemia/reperfusion lesions in acute kidney injury.

  3. Multiple Renal Abscesses due to ESBL Extended-Spectrum Beta-Lactamase-Producing Escherichia coli Causing Acute Pyelonephritis and Bacteremia: A Case Report with a Good Outcome (No Drainage Required) (United States)

    Qurash, Musaad; Saleh, Asem; Ali, Rasha


    Extended-spectrum beta-lactamase-producing Enterobacteriaceae urinary tract infections are challenging infections with increased mortality, morbidity, and failure of therapy. A 44-year-old Saudi male diabetic patient was seen at the ER of IMC Hospital with features of acute pyelonephritis: fever, burning urine, and left flank pain for three days. He was treated for cystitis at the Endocrine Clinic two weeks prior to his ER visit with nitrofurantoin and levofloxacin orally according to urine culture and sensitivity result. The patient was admitted, received IV meropenem, and continued to be febrile for three days. His urine and blood culture at ER grew the same ESBL-producing E. coli as in his urine culture from the Endocrine Clinic. His abdomen CT scan showed two left renal abscesses at the upper and middle poles. His temperature resolved on the fourth day of IV therapy. Intravenous meropenem was continued for 4 weeks after inserting PICC line and the patient was followed up by home healthcare. He was feeling better with occasional left flank pain and repeated abdomen CT scan showed complete resolution of both renal abscesses. PMID:28018690

  4. Endocarditis-associated Brain Lesions in Slaughter Pigs

    DEFF Research Database (Denmark)

    Karstrup, C.C.; Jensen, H.E.; Aalbæk, B.;


    Left-sided valvular endocarditis (LSVE) is a common finding in slaughter pigs. The lesion is often associated with renal thromboembolism, but information on embolization to other organs is sparse. This study focuses on the presence and type of endocarditis-associated brain lesions (EABLs). The br......Left-sided valvular endocarditis (LSVE) is a common finding in slaughter pigs. The lesion is often associated with renal thromboembolism, but information on embolization to other organs is sparse. This study focuses on the presence and type of endocarditis-associated brain lesions (EABLs......). The brains of 20 slaughter pigs with spontaneously arising LSVE and 11 controls were examined by sectioning half of a formalin-fixed brain into 4mm slices for histological examination. The aetiology of the endocarditis was determined by bacteriological and, in some cases, by fluorescence in...

  5. Renal calculus

    CERN Document Server

    Pyrah, Leslie N


    Stone in the urinary tract has fascinated the medical profession from the earliest times and has played an important part in the development of surgery. The earliest major planned operations were for the removal of vesical calculus; renal and ureteric calculi provided the first stimulus for the radiological investigation of the viscera, and the biochemical investigation of the causes of calculus formation has been the training ground for surgeons interested in metabolic disorders. It is therefore no surprise that stone has been the subject of a number of monographs by eminent urologists, but the rapid development of knowledge has made it possible for each one of these authors to produce something new. There is still a technical challenge to the surgeon in the removal of renal calculi, and on this topic we are always glad to have the advice of a master craftsman; but inevitably much of the interest centres on the elucidation of the causes of stone formation and its prevention. Professor Pyrah has had a long an...

  6. Renal histology and pregnancy performance in systemic lupus erythematosus. (United States)

    Devoe, L D; Loy, G L; Spargo, B H


    Previous reports indicate that maternal and fetal outcome in pregnancies complicated by systemic lupus erythematosus (SLE) may be strongly influenced by the presence of renal disease. As the relationship between renal histology and clinical function in SLE is not consistent, prospective data on the outcomes of such pregnancies would aid patient counselling. Fifteen women with SLE had 18 pregnancies subsequent to renal biopsies, performed from 3 months to 8 years prior to conception. Their renal function was evaluated before, during and after pregnancy. Fourteen of 15 patients had evidence of renal involvement, based on by light and electron microscopic sections: 7 had mesangial involvement (WHO Class II); 5 had active focal or diffuse glomerulonephritis (Classes III and IV); two had membranous involvement (Class V); 1, no evident disease. Perinatal outcome was similar whether lesions were milder (8 continuing pregnancies, 4 term deliveries) or more severe (6 continuing pregnancies, 3 term deliveries). Clinical renal function was normal in all but 3 cases at the beginning of pregnancy; 2 additional patients experienced moderate deteriorations in renal function during pregnancy but recovered normal function in the puerperium. Fetal outcome was abnormal (3 premature deliveries, 1 neonatal death, 1 spontaneous abortion) in all cases where renal function was decreased, while 10 of 13 pregnancies in patients with normal renal function ended in term deliveries. The data suggest that currently preconceptual renal histology provides a less accurate basis for perinatal counselling than does the assessment of clinical renal function.

  7. Intravenous Renal Cell Transplantation for Polycystic Kidney Disease (United States)


    reports 28.2 (per million population) PKD patients on dialysis in 1985, 62.9 in 2000 and 92.5 in 2011. Although these data may reflect better diagnosis ...improves renal function and structure in other models of renal failure: CKD due to cisplatin-mediated injury (4), diabetic nephropathy (Am J Physiol...cells prevents progression of chronic renal failure in rats with ischemic-diabetic nephropathy . Am J Physiol. Renal. 305:F1804- F1812 6. Mason SB

  8. Preeclampsia or initial diagnosis of chronic renal disease during pregnancy. (United States)

    Iavazzo, C; Kalmantis, K; Bozemberg, T; Ntziora, F; Ioakeimidis, A; Paschalinopoulos, D


    An unusual case of early nephrotic syndrome without hypertension which slightly resolved after delivery is documented. Renal biopsy was performed postpartum and the diagnosis was focal and segmental glomerulosclerosis with moderate chronic renal changes. It is questioned whether the case was due to preeclampsia or was the initial diagnosis of chronic renal disease which was made during pregnancy. The role of renal biopsy in such cases is briefly discussed (Tab. 2, Ref. 15). Full Text (Free, PDF)

  9. [Renal toxicity of antiviral drugs]. (United States)

    Frasca', Giovanni M; Balestra, Emilio; Tavio, Marcello; Morroni, Manrico; Manarini, Gloria; Brigante, Fabiana


    Highly effective and powerful antiviral drugs have been introduced into clinical practice in recent years which are associated with an increased incidence of nephrotoxicity. The need of combining several drugs, the fragility of the patients treated, and the high susceptibility of the kidney are all factors contributing to renal injury. Many pathogenetic mechanisms are involved in the nephrotoxicity of antiviral drugs, including drug interaction with transport proteins in the tubular cell; direct cytotoxicity due to a high intracellular drug concentration; mitochondrial injury; and intrarenal obstruction or stone formation due to the low solubility of drugs at a normal urinary pH. As a result, various clinical pictures may be observed in patients treated with antiviral drugs, ranging from tubular dysfunction (Fanconi syndrome, renal tubular acidosis, nephrogenic diabetes insipidus) to acute renal failure (induced by tubular necrosis or crystal nephropathy) and kidney stones. Careful attention should be paid to prevent renal toxicity by evaluating the glomerular filtration rate before therapy and adjusting the drug dosage accordingly, avoiding the combination with other nephrotoxic drugs, and monitoring renal parameters on a regular basis while treating patients.

  10. Serum amylase activity and renal amylase activity clearance in patients with severely impaired renal function and in patients treated with renal allotransplantation. (United States)

    Pedersen, E B; Brock, A; Kornerup, H J


    Serum amylase activity was measured in 29 nondialysed patients with severe renal failure, in 24 uraemic patients treated with chronic haemodialysis, and in 29 patients treated with renal allotransplantation. Simultaneous measurement of renal amylase activity clearance (CAm) and creatinine clearance (CCr) was performed in 25 patients with severe renal failure and in 19 transplanted patients. Serum amylase activity was elevated in all three groups. CAm was significantly correlated to CCr both in the group with severe renal failure and in the transplanted group. Unlike in the group of transplanted patients, the ratio CAm/CCr was significantly increased in patients with severe impaired renal function. It is concluded that the elevation of serum amylase activity in patients with impaired renal function is primarily due to decreased glomerular filtration rate. The value of CAm/CCr for diagnosing acute pancreatitis is doubtful in patients with severe renal disease.

  11. Computed tomography of kidney with diuretics. A method for avoiding artifact due to nonionic contrast medium

    Energy Technology Data Exchange (ETDEWEB)

    Hiromura, Tadao; Terae, Satoshi; Takamura, Akio; Mizoe, Junetsu (Obihiro Kosei Hospital, Hokkaido (Japan)); Morita, Yutaka; Irie, Goro


    We devised a method for avoiding beam-hardening artifacts, which interfere with enhanced CT images of kidney due to nonionic contrast medium. The radiographic effect and the frequency of beam-hardening artifacts on enhanced CT of kidney were studied by prospective comparison among three groups: a group of 20 patients examined with furosemide (f-d.CT), a group of 20 patients examined without diuretics (non-d.CT) and a group of 20 patients examined after water intake (w-d.CT). In all patients of f-d.CT group, the renal parenchyma from the cortex to the papilla was almost evently enhanced, free from artifacts. The density of the renal papilla and pelvis in non-d.CT and w-d.CT groups was significantly higher than that in f-d.CT group, and artifacts were also observed in 14 (70%) of non-d.CT group and 12 (60%) of w.d.CT group, respectively. Satisfactory CT of kidney free from artifacts was obtained by f-d.CT, providing easy evaluation of renal pelvic or peripelvic lesions. In conclusion, this technique can be used in those pathologic cases of renal pelvis or peripelvic region, that are not clear on routine CT because of artifacts. (author).

  12. [Pulmonary-renal syndrome]. (United States)

    Risso, Jorge A; Mazzocchi, Octavio; De All, Jorge; Gnocchi, César A


    The pulmonary-renal syndrome is defined as a combination of diffuse alveolar hemorrhage and glomerulonephritis. The coexistence of these two clinical conditions is due to diseases with different pathogenic mechanisms. Primary systemic vasculitis and Goodpasture syndrome are the most frequent etiologies. Systemic lupus erythematosus, connective tissue diseases, negative anti neutrophil cytoplasmic antibody vasculitis and those secondary to drugs are far less common causes. An early diagnosis based on clinical, radiologic, laboratory and histologic criteria enables early treatment, thus diminishing its high morbidity-mortality rate. Therapy is based on high doses of corticosteroids, immunosuppressants, tumor necrosis factor inhibitors and plasmapheresis.

  13. Unique psoriatic lesion versus multiple lesions

    Directory of Open Access Journals (Sweden)

    Anca Chiriac


    Full Text Available Aim: To evaluate the number of lesions of psoriasis and to find risk factors for multiple lesions. Material and Methods: 1,236 patients (male 54.13%, female 45.87% with psoriasis were seen over a period of 8 years in an Outpatient Clinic. Patients filled out questionnaires containing age at onset, number of lesions and location at the beginning of the disease, gender, type and localization of psoriasis at the time of clinical examination, psoriasis family history, previous treatment, comorbidities, and social status. Results: The number of psoriasis lesions correlates with: onset age of psoriasis (F=8.902, p=0.0029; age at the moment of clinical examination (F=8.902, p=0.0029; residence in rural area (χ2=8.589, p=0.00338, 95%CI; alcohol intake (χ2=16.47, p=0.00005, 95%CI; smoking (χ2=8.408, p=0.00373, 95%CI; occupation: workers/pupils/students (χ2=14.11, p=0.0069, 95%CI. Conclusions: There is a correlation between number of psoriatic lesions and some factors. Multiple lesions were observed in older patients, smokers and drinkers, coming from rural area and social active (workers and pupils/students. No correlation was statistically proved between number of lesions and gender, comorbidities and family history of psoriasis.

  14. Renal malakoplakia presenting as a renal mass in a 55-year-old man: a case report

    Directory of Open Access Journals (Sweden)

    Abolhasani Maryam


    Full Text Available Abstract Introduction Malakoplakia is an uncommon chronic inflammatory condition that has a gross and microscopic appearance resembling that of xanthogranulomatous pyelonephritis. It is characterized by distinctive Michaelis-Gutmann bodies. Malakoplakia can affect any organ system but genitourinary tract involvement is the most common, particularly in immunocompromised individuals. Very rare cases have been reported to present as a unifocal lesion mimicking a renal tumor. Case presentation We report a case of renal malakoplakia in a 55-year-old Iranian man with a past history of recurrent urinary tract infections who presented with left flank pain. An ultrasound study showed a large solid left renal mass, and he underwent a left radical nephrectomy with a clinical diagnosis of a renal tumor. Pathology slides revealed the diffuse infiltration of sheets of Periodic Acid Schiff-positive histiocytes in his renal parenchyma; these cells showed strong immunoreactivity for CD 68. The final diagnosis was renal malakoplakia. Conclusion Renal malakoplakia must be kept in mind for patients presenting with a renal mass and a history of long-term recurrent renal infections or renal failure. The large, rapidly growing nodules of malakoplakia may mimic renal cell carcinoma in imaging studies. In these cases, a true cut needle biopsy may help the correct diagnosis and prevent unnecessary surgery.


    Directory of Open Access Journals (Sweden)

    Giulio Geraci


    Full Text Available Systemic lupus erythematosus (SLE is associated with a high prevalence of atherosclero-sis and an enhanced cardiovascular mortality. In adult subjects, several studies have shown the coexistence of SLE and renal artery stenosis, most of them with unilateral in-volvement or with renal dysfunction. We observed a 62-year-old man with SLE and a 10-year history of moderate-to-severe hy-pertension who was admitted to our hospital because of uncontrolled blood pressure val-ues (152/95 mmHg, despite drug therapy. No signs of renal impairment were evident. After an initial physical examination, which presented a periumbilical bruit, a renal ultra-sound was performed with evidence of bilateral renal artery stenosis. An angio-MR study also confirmed the diagnosis and showed a double renal artery on the right side. Many different factors can contribute to the bilateral renal artery stenosis in this patient. Chronic inflammatory state associated to SLE, metabolic alterations with dyslipidemia and steroid therapy may all be involved in the development of the renal atherosclerotic le-sions.

  16. Successful Treatment of Deep Cutaneous Zygomycosis Developing Early After Renal Transplantation

    Directory of Open Access Journals (Sweden)

    Bülent TOKGÖZ


    Full Text Available A 25-year-old male patient with end-stage renal disease due to chronic pyelonephritis who had undergone renal transplantation was admitted 20 days after the operation with complaints of nausea, vomiting and darkening in the skin of the transplantation site. A 30x30 cm area of skin at the transplantation site in the left inguinal area was dark colored and of necrotic appearance. Gram-negative and gram-positive bacilli were observed in the gram stain of the material taken from the lesion through thin needle aspiration. Surgical debridement of necrotic tissues at the lesion site was performed. There were fungi with bacterial groups and branched rough hyphae infiltrating the necrotic lipid and connective tissue. The venous wall was under the invasion of these fungi hyphae in the histopathological examination of the debridement material and a diagnosis of subcutaneous zygomycosis was established. Amphotericin B was administered for 14 days at a cumulative dose of 625 mg. The skin defect at the left lower quadrant was closed by placing a graft. The patient no longer required dialysis after two weeks of hospitalization. He was discharged 48 days later with total recovery of the lesion site and a serum creatinin level of 2 mg/dL, under treatment with cyclosporine 400 mg/day and prednisolone 20 mg/day.

  17. Renal involvement in non-Hodgkin lymphoma: proven by renal biopsy. (United States)

    Li, Shi-Jun; Chen, Hui-Ping; Chen, Ying-Hua; Zhang, Li-hua; Tu, Yuan-Mao; Liu, Zhi-hong


    To determine the spectrum of renal lesions in patients with kidney involvement in non-Hodgkin's lymphoma (NHL) by renal biopsy. The clinical features and histological findings at the time of the renal biopsy were assessed for each patient. We identified 20 patients with NHL and renal involvement, and the diagnosis of NHL was established following the kidney biopsy in 18 (90%) patients. The types of NHL include the following: chronic lymphocytic leukemia/small lymphocytic lymphoma (n = 8), diffuse large B-cell lymphoma (n = 4), T/NK cell lymphoma (n = 3), lymphoplasmacytic lymphoma (n = 2), cutaneous T-cell lymphoma (n = 1), mucosa-associated lymphoid tissue lymphoma (n = 1) and mantle cell lymphoma (n = 1). All presented with proteinuria, and 15 patients had impaired renal function. The pathological findings included (1) membranoproliferative glomerulonephritis-like pattern in seven patients; (2) crescent glomerulonephritis in four; (3) minimal-change disease in three, and glomeruli without specific pathological abnormalities in three; (4) intraglomerular large B-cell lymphoma in one; (5) intracapillary monoclonal IgM deposits in one; (6) primary diffuse large B-cell lymphoma of the kidneys in one; and (7) lymphoma infiltration of the kidney in eight patients. A wide spectrum of renal lesions can be observed in patients with NHL, and NHL may be first proven by renal biopsies for evaluation of kidney injury or proteinuria. Renal biopsy is necessary to establish the underlying cause of renal involvement in NHL.

  18. Histopathological characterization of a Cameron lesion. (United States)

    Katz, Jordan; Brar, Sonia; Sidhu, Jagmohan S


    Cameron lesions are linear erosions located at the neck of a hiatal hernia (HH) in patients with a large HH. The prevalence has been seen in up to 5% of patients with HH who undergo esophagogastroduodenoscopy, and they can be associated with overt gastrointestinal bleeding or anemia. These lesions occur due to vascular compression by the diaphragm in a large sliding HH. Histopathologic changes seen in the biopsy tissue of a Cameron lesion are due to ischemia, but this ischemia is reversible with treatment of HH. The existence of this entity and the histopathologic picture of a Cameron lesion is not well known to pathologists, and therefore, a microscopic picture of a Cameron lesion can be easily confused with ischemic gastritis. Ischemic gastritis is the result of atherosclerosis, usually seen in older people, unrelated to HH, and is not easily reversible. The authors received a gastric biopsy of a hiatal hernia without any associated clinical diagnosis of a Cameron lesion conveyed to the pathologist. This biopsy tissue showed ischemic changes in the gastric mucosa on microscopic examination. Diagnosis of ischemic gastritis was considered but ruled out after the case was discussed with the gastroenterologist. The correct diagnosis was made once the clinical diagnosis of HH with Cameron lesion (ie, a vertical red erosion) was made known to the pathologist. By reporting this case, the authors aim to increase awareness of Cameron lesion among pathologists so that they ask about the presence of a Cameron lesion before making the diagnosis of ischemic gastritis.

  19. Renal actinomycosis with concomitant renal vein thrombosis. (United States)

    Chang, Dong-Suk; Jang, Won Ik; Jung, Ji Yoon; Chung, Sarah; Choi, Dae Eun; Na, Ki-Ryang; Lee, Kang Wook; Shin, Yong-Tai


    Renal actinomycosis is a rare infection caused by fungi of the genus Actinomyces. A 74-year-old male was admitted to our hospital because of gross hematuria with urinary symptoms and intermittent chills. Computed tomography of the abdomen showed thrombosis in the left renal vein and diffuse, heterogeneous enlargement of the left kidney. After nephrectomy, sulfur granules with chronic suppurative inflammation were seen microscopically, and the histopathological diagnosis was renal actinomycosis. Our case is the first report of renal actinomycosis with renal vein thrombosis.


    Directory of Open Access Journals (Sweden)

    Soraia Geraldo Rozza Lopes


    Full Text Available El objetivo del estudio fue comprender el significado de espera del trasplante renal para las mujeres en hemodiálisis. Se trata de un estudio cualitativo-interpretativo, realizado con 12 mujeres en hemodiálisis en Florianópolis. Los datos fueron recolectados a través de entrevistas en profundidad en el domicilio. Fue utilizado el software Etnografh 6.0 para la pre-codificación y posterior al análisis interpretativo emergieron dos categorías: “las sombras del momento actual”, que mostró que las dificultades iniciales de la enfermedad están presentes, pero las mujeres pueden hacer frente mejor a la enfermedad y el tratamiento. La segunda categoría, “la luz del trasplante renal”, muestra la esperanza impulsada por la entrada en la lista de espera para un trasplante.

  1. Renal failure

    Institute of Scientific and Technical Information of China (English)


    930564 Dwell times affect the local host de-fence mechanism of peritoneal dialysis patients.WANG Tao(汪涛),et al.Renal Instit,SunYatsen Med Univ,Guangzhou,510080.Chin JNephrol 1993;9(2):75—77.The effect of different intraperitoneal awelltimes on the local host defence in 6 peritonealdialysis patients was studied.A significant de-crease in the number of peritoneal cells,IgG con-centration and the phagoeytosis and bactericidalactivity of macrophages was determined when thedwell time decreased from 12 to 4 hs or form 4 to0.5hs,but the peroxidase activity in macrophagesincreased significantly.All variables,except theperoxidase activity in macrophages,showed nosignificant difference between patients of high or

  2. Traumatismo renal


    Rocha, Sofia Rosa Moura Gomes da


    Introdução: A realização deste trabalho visa a elaboração de uma revisão sistematizada subordinada à temática da traumatologia renal. Objectivos: Os principais objectivos deste trabalho são: apurar a etiologia, definir a classificação, analisar o diagnóstico e expôr o tratamento e as complicações. Desenvolvimento: Os traumatismos são a principal causa de morte antes dos 40 anos. O rim é o órgão do aparelho génito-urinário mais frequentemente atingido. Os traumatismos renais são mais fre...

  3. Contrast Enhancement on CT Following Renal Cryoablation – Does It Represent Treatment Failure?

    DEFF Research Database (Denmark)

    Nielsen, Tommy Kjærgaard; Østraat, Øyvind; Andersen, Gratien;

    Aim: Renal cryoablation is a valid treatment option for localized pT1a renal cancer. Treatment success is typically defined as absence of contrast enhancement (CE) on follow-up imaging. We investigate the development of lesions that demonstrate CE on follow-up CT after renal cryoablation. Materials...... and methods: A retrospective review of laparoscopic and percutaneous cryoablation procedures from 2005 to 2012 was conducted. A total of 113 patients with a localized pT1a biopsy verified malignant renal lesion was identified. Of these, 34 patients (12 females and 22 males) experienced postoperative CE. Mean...

  4. Bilateral native kidney neoplasia detected by ultrasound in functionning renal allograft recipient. (United States)

    Noce, Annalisa; Iaria, Giuseppe; Durante, Olga; Sforza, Daniele; Canale, Maria Paola; Di Villahermosa, Simone Manca; Castagnola, Veronica; Tisone, Giuseppe; Di Daniele, Nicola


    We report the case of bilateral renal clear cell carcinoma in the native kidney, occurring fouryears after renal transplantation. Renal Doppler duplex sonography revealed large solid bilateral neoformation. Total-body computed tomography confirmed the presence of bilateral kidney lesions and also showed the presence of concomitant gross dyscariocinetic lesion of left hemotorax. The patient underwent bilateral native nephrectomy and the histological diagnosis was renal cell carcinoma. Subsequent left upper lobectomy revealed necrotic keratinizing squamous cell carcinoma. Then, the patients was switched tacrolimus to everolimus treatment and mycophenolate mofetil was reduced.

  5. An Incidental Renal Oncocytoma: 18F-Choline PET/MRI

    Directory of Open Access Journals (Sweden)

    Andrew Mallia


    Full Text Available PET/MRI is a new hybrid imaging modality and has the potential to become a powerful imaging tool. It is currently one of the most active areas of research in diagnostic imaging. The characterisation of an incidental renal lesion can be difficult. In particular, the differentiation of an oncocytoma from other solid renal lesions such as renal cell carcinoma (RCC represents a diagnostic challenge. We describe the detection of an incidental renal oncocytoma in a 79-year gentleman who underwent a re-staging 18F-Choline PET/MRI following a rise in PSA values (4.07, nadir 1.3.

  6. Diagnosing vascular causes of renal failure. (United States)

    Abuelo, J G


    The incidence of renal failure due to vascular diseases is increasing. Two reasons for this are the epidemic of atherosclerotic vascular disease in the aging population and the widespread use of vasoactive drugs that can adversely affect renal function. These vascular causes of renal failure include vasomotor disorders such as that associated with nonsteroidal antiinflammatory drugs, small-vessel diseases such as cholesterol crystal embolization, and large-vessel diseases such as renal artery stenosis. These causes of azotemia are less familiar to physicians than more classic causes, such as acute tubular necrosis, and are less likely to be recognized in their early stages. This article describes the various vascular diseases that impair renal function and outlines the steps necessary to identify them. Although some of these conditions, such as renal artery stenosis, can gradually impair function, the vascular causes of acute renal failure are emphasized in this article. Because the vasculitides primarily cause renal failure through secondary glomerulonephritis, they are mentioned only briefly. Extensive testing is rarely necessary because the cause is usually suspected through syndrome recognition. The diagnosis can then be confirmed by the results of one or two additional tests or by improved renal function after treatment.

  7. [A new case of pseudotumoral renal tuberculosis]. (United States)

    Sarf, I; Dahami, Z; Dakir, M; Aboutaeib, R; el Moussaoui, A; Joual, A; El Mrini, M; Meziane, F; Benjelloun, S


    The incidence of urogenital tuberculosis is still frequent and constitutes a current public health problem in Morocco, a country in which tuberculosis is endemic. The clinical presentation of this form of the disease may be misleading. The pseudotumoral type of renal tuberculosis is extremely uncommon, and in this study this disease has been described in a young patient. The radiological findings suggested the possibility of this lesion being renal cancer. The preliminary diagnosis was corrected and a definitive diagnosis of pseudotumor was made following pathological examination of the surgically-removed kidney.

  8. Cutaneous histoplasmosis in renal transplant recipients. (United States)

    Sun, N Z; Augustine, J J; Gerstenblith, M R


    Cutaneous histoplasmosis is a rare entity, although it can be seen in a substantial portion of renal transplant recipients with disseminated disease. The prognosis of disseminated disease is worse than isolated cutaneous involvement, and significant delays in diagnosis are reported. We reviewed reports of cutaneous histoplasmosis with and without dissemination in the setting of renal transplantation to examine incidence, timing of diagnosis, clinical features, and prognosis. Remarkable morphologic variability and the non-specific appearance of skin findings suggest that tissue culture is required for definitive diagnosis. Cutaneous lesions represent an easily accessible source for early diagnosis.

  9. Bilateral enlargement of the orbital muscles: first manifestation of renal adenocarcinoma; Espessamento da musculatura extrinseca orbitaria bilateralmente: manifestacao primaria de adenocarcinoma renal

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    Wolosker, Angela M. Borri; Bekhor, Daniel [Universidade Federal de Sao Paulo (UNIFESP), SP (Brazil). Escola Paulista de Medicina. Dept. de Diagnostico por Imagem; Goes, Paulo [Universidade Federal de Sao Paulo (UNIFESP), SP (Brazil). Escola Paulista de Medicina. Dept. de Oftalmologia; Attie, Greicie Cristina Gerra [Universidade Federal de Sao Paulo (UNIFESP), SP (Brazil). Escola Paulista de Medicina. Dept. de Patologia


    The authors present an unusual case of a patient with orbital metastases from renal carcinoma involving the extra ocular muscles bilaterally. The importance of computed tomography for the differential diagnosis with other orbital lesions is emphasized. (author)

  10. Sorafenib in renal cell carcinoma. (United States)

    Davoudi, Ehsan Taghizadeh; bin-Noordin, Mohamed Ibrahim; Javar, Hamid Akbari; Kadivar, Ali; Sabeti, Bahare


    Cancer is among most important causes of death in recent decades. Whoever the renal cell carcinoma incidence is low but it seems it is more complicated than the other cancers in terms of pathophysiology and treatments. The purpose of this work is to provide an overview and also deeper insight to renal cell carcinoma and the steps which have been taken to reach more specific treatment and target therapy, in this type of cancer by developing most effective agents such as Sorafenib. To achieve this goal hundreds of research paper and published work has been overviewed and due to limitation of space in a paper just focus in most important points on renal cell carcinoma, treatment of RCC and clinical development of Sorafenib. The information presented this paper shows the advanced of human knowledge to provide more efficient drug in treatment of some complicated cancer such as RCC in promising much better future to fight killing disease.

  11. Emphysematous prostatitis in renal transplant

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    Krishnaswamy Sampathkumar


    Full Text Available Urinary tract infections are common following renal transplant. The spectrum varies from asymptomatic bacteriuria to septicemia. Gas-producing infections of the urinary tract are rare but tend to have a grave prognosis when they do occur. We report a 57-year-old gentleman who underwent a renal transplant 20 months earlier. He presented to us with fever and dysuria. Clinical examination revealed a febrile and ill-looking patient with severe graft tenderness. An emergency pelvic CT scan revealed presence of emphysematous prostatitis, cystitis and pyelitis. Urine and blood cultures grew E. coli . Endoscopic abscess drainage was done and antibiotics given but he succumbed to his illness due to multiorgan failure within 48h. This is the first reported case of emphysematous prostatitis in a renal allograft recipient.

  12. Gastrointestinal complications in renal transplantation

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    Kamal Jeet Singh


    Full Text Available Objective: Gastrointestinal complications are responsible for substantial morbidity and mortality among renal allograft recipients. We retrospectively analyzed incidence of these complications and their impact on the patient outcome. Materials & Methods: Between 1998 to Aug 2002, 558 live related renal transplants were performed at our center. The immunosuppression used consisted mainly of cyclosporine, azathioprine and prednisolone, though varied in some patients. These patients were followed for any occurrence of significant gastrointestinal problems. Results: Out of the of 538 renal transplant recipients studied, gastro esophageal ulcerations were seen in 3% patients. Acute pancreatitis was observed in twelve (2.2% patients and four patients had acute intestinal obstruction secondary to fecal impaction. Infectious complications included acute diarrheas in 18% of patients. Three patients developed abdominal tuberculosis. Acute rejection episodes were encountered in 26% of the patients. During these episodes, 58% of patients experienced prolonged ileus. Most of these complications (66% occurred within first one-year post transplant. Three patients presenting with acute intestinal obstruction required laparotomy (two- bands, one-intussusception. There were four mortalities -two patients had severe pancreatitis, one patient had massive upper GI bleed and one succumbed due to perforation peritonitis. Conclusions: Gastrointestinal complications account for significant morbidity and mortality in renal transplant recipients. Paralytic ileus secondary to acute vascular rejection is quite common and resolves spontaneously with recovery of renal function.

  13. Renal lymphoma: spectrum of computed tomography findings; Linfoma renal: espectro de imagens na tomografia computadorizada

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    Maranhao, Carol Pontes de Miranda; Bauab Junior, Tufik [Faculdade de Medicina do Sao Jose do Rio Preto (FAMERP), SP (Brazil). Hospital de Base. Dept. de Imagem]. E-mail:


    Isolated renal lymphoma is rare due to the absence of lymphoid tissue in kidneys. Secondary involvement occurs more frequently and is reported in up to 1/3 of the autopsies of patients who died from lymphoma. Some authors believe this is actually the only existing form of renal lymphoma. The involvement of the kidney by lymphoma would occur through hematogenic metastasis or direct tumor invasion of the peri renal space. These different types of involvement determine the several forms of renal lymphoma presentation: multiple nodules, solitary mass, renal invasion from contiguous retroperitoneal disease, peri renal disease and diffuse infiltration. In this study the imaging findings features of the different forms of involvement are presented and discussed. (author)

  14. Renal disease in human immunodeficiency virus - Not just HIV-associated nephropathy. (United States)

    Vali, P S; Ismal, K; Gowrishankar, S; Sahay, M


    The aim of the study was to determine the various histopathological lesions in human immunodeficiency virus (HIV) patients with renal dysfunction and to establish clinicopathological correlation. Over a period of two years from January 2008 to March 2010, 27 HIV positive patients with renal dysfunction were subjected to renal biopsy. Of the 27 patients, 23 were males and four were females (85.2% males, 14.8% females). Mean age was 38.2 ± 10.36 (range 20 - 60) years. The probable mode of acquisition of HIV infection was sexual in 22 patients (81.5%). Thirteen patients (48%) had nephrotic proteinuria. The CD4 count ranged from 77 to 633/microliter. The kidneys were of normal size in 19 (70.4%) and bulky in eight (29.6%) patients. Thirteen patients required renal replacement therapy. Eleven patients had acute tubule-interstitial lesions (40.7%) while 15 (55.5%) had glomerular lesions. The various glomerular lesions were, focal segmental glomerulosclerosis in five, amyloidosis in three, diffuse proliferative GN in two, and membranoproliferative glomerulonephritis (GN), membranous GN, minimal change disease, diabetic nephropathy, crescentic GN, and thrombotic microangiopathy were seen in one each. None of the clinical or laboratory variables, except hypertension, was found to predict glomerular versus non-glomerular lesions on biopsy. In conclusion we show that a variety of glomerular and tubulointerstitial lesions can be seen on renal histology. Hence, renal biopsy is indicated in renal dysfunction associated with HIV for making proper diagnosis and therapy.

  15. Renal Primitive Neuroectodermal Tumor: A Case Report. (United States)

    Yang, Cheng; Xu, Hanjiang; Zhou, Jun; Hao, Zongyao; Wang, Jianzhong; Lin, Changmin; Zhang, Li; Zhu, Xia; Liang, Chaozhao


    Primitive neuroectodermal tumor (PNET) is a malignant small round cell tumor and typically arises from bone or soft tissue in adolescents and young adults. Renal PNET is extraordinarily rare and exhibits highly aggressive biological behavior with poor prognosis.We present here a new case of renal PNET in a 31-year-old female. The patients were referred to our hospital because of left flank pain with nausea and vomiting for 1 week. A computed tomography scan revealed a 14.7 × 12.7 cm well-defined, unevenly mass lesion with both solid and cystic components and the tumor was not enhanced uniformly.A preoperative diagnosis of cystic renal cell carcinoma and urinary tract infection was made. The patient undergone anti-inflammatory therapy followed by a left radical nephrectomy. Taken with morphological pattern and immunohistochemical markers, a diagnosis of renal PNET was made. Two cycles of combined chemotherapy were executed. At the 14-month follow-up, no evidence of metastasis or recurrence was indicated.This case reminds clinicians that for adolescents and young adults with a suspicious renal mass, a diagnosis of renal PNET should be always considered. An initial surgery followed by radiotherapy and chemotherapy is suggested for the therapeutic management.

  16. Hand-assisted laparoscopic nephrectomy as a minimally invasive option in the treatment of large renal specimens

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    M. Tobias-Machado


    Full Text Available INTRODUCTION: We describe our experience with hand-assisted laparoscopy (HAL as an option for the treatment of large renal specimens. MATERIALS AND METHODS: Between March 2000 and August 2004, 13 patients candidate to nephrectomies due to benign renal conditions with kidneys larger than 20 cm were included in a prospective protocol. Unilateral nephrectomy was performed in cases of hydronephrosis (6 patients or giant pyonephrosis (4 patients. Bilateral nephrectomy was performed in 3 patients with adult polycystic kidney disease (APKD with low back pain refractory to clinical treatment previous to kidney transplant. The technique included the introduction of 2 to 3 10 mm ports, manual incision to allow enough space for the surgeon's wrist without a commercial device to keep the pneumoperitoneum. The kidney was empty, preferably extracorporeally, enough to be removed through manual incision. We have assessed operative times, transfusions, complications, conversions, hospital stay and convalescence. RESULTS: The patients mean age (9 women and 4 men was 58 years. Mean operating time was 120 ± 10 min (hydronephrosis, 160 ± 28 min (pyonephrosis and 190 ± 13 min (bilateral surgery for APKD. There was a need for a conversion in 1 case and another patient needed a transfusion due to a lesion in the renal vein; 2 patients had minor complications. CONCLUSION: HAL surgery is a minimally invasive alternative in the treatment of large renal specimens, with or without significant inflammation.

  17. A re-appraisal of volume status and renal function impairment in chronic heart failure: combined effects of pre-renal failure and venous congestion on renal function. (United States)

    Sinkeler, Steef J; Damman, Kevin; van Veldhuisen, Dirk J; Hillege, Hans; Navis, Gerjan


    The association between cardiac failure and renal function impairment has gained wide recognition over the last decade. Both structural damage in the form of systemic atherosclerosis and (patho) physiological hemodynamic changes may explain this association. As regards hemodynamic factors, renal impairment in chronic heart failure is traditionally assumed to be mainly due to a decrease in cardiac output and a subsequent decrease in renal perfusion. This will lead to a decrease in glomerular filtration rate and a compensatory increase in tubular sodium retention. The latter is a physiological renal response aimed at retaining fluids in order to increase cardiac filling pressure and thus renal perfusion. In heart failure, however, larger increases in cardiac filling pressure are needed to restore renal perfusion and thus more volume retention. In this concept, in chronic heart failure, an equilibrium exists where a certain degree of congestion is the price to be paid to maintain adequate renal perfusion and function. Recently, this hypothesis was challenged by new studies, wherein it was found that the association between right-sided cardiac filling pressures and renal function is bimodal, with worse renal function at the highest filling pressures, reflecting a severely congested state. Renal hemodynamic studies suggest that congestion negatively affects renal function in particular in patients in whom renal perfusion is also compromised. Thus, an interplay between cardiac forward failure and backward failure is involved in the renal function impairment in the congestive state, presumably along with other factors. Only few data are available on the impact of intervention in volume status on the cardio-renal interaction. Sparse data in cardiac patients as well as evidence from cohorts with primary renal disease suggest that specific targeting of volume overload may be beneficial for long-term outcome, in spite of a certain further decrease in renal function, at least

  18. {sup 11}C-Acetate PET imaging for renal cell carcinoma

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    Oyama, Nobuyuki; Kusukawa, Naoya; Kaneda, Taisei; Miwa, Yoshiji; Akino, Hironobu; Yokoyama, Osamu [University of Fukui, Department of Urology, Fukui (Japan); Okazawa, Hidehiko; Fujibayashi, Yasuhisa [University of Fukui, Biomedical Imaging Research Center, Fukui (Japan); Yonekura, Yoshiharu [National Institute of Radiological Sciences, Chiba (Japan); Welch, Michael J. [Washington University School of Medicine, Mallinckrodt Institute of Radiology, Saint Louis, MO (United States)


    In this study, we investigated the effectiveness of positron emission tomography (PET) with {sup 11}C-acetate (AC) for evaluation of renal cell carcinoma. Enrolled in the study were 20 patients with suspected renal tumour, one of whom had three renal lesions. In all, 22 renal lesions were evaluated. Following administration of 350 MBq (10 mCi) of AC, whole-body PET images were obtained. Based on these PET findings, kidney lesions were scored as positive or negative. The PET results were correlated with the CT findings and histological diagnosis after surgery. In 18 patients, 20 tumours were diagnosed as renal cell carcinoma. Lesions in the remaining two patients were diagnosed as complicated cyst without malignant tissue. Of the 20 renal cell carcinomas. 14 (70%) showed positive AC PET findings; 6 were negative. The two patients with complicated cyst had negative AC PET findings. Of the 20 renal cell carcinomas, 19 were clear-cell carcinoma and 1 was a papillary cell carcinoma. This papillary cell carcinoma showed high AC uptake. AC demonstrates marked uptake in renal cell carcinoma. These preliminary data show that AC is a possible PET tracer for detection of renal cancer. (orig.)

  19. Visible and occult microscopic lesions of endometriosis

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    Khaleque Newaz Khan


    Full Text Available Endometriosis is a multifactorial disease mostly affecting women of reproductive age and is associated with chronic pelvic pain and infertility. Even after 300 years, most of the literature claims that pathogenesis and/or pathophysiology of endometriosis is still elusive. Recurrence of pain and lesion continues to occur after effective medical or surgical therapies. Once generated within the pelvis due to retrograde entry of menstrual debris, peritoneal endometriotic lesions time-dependently change their color appearance resulting from certain biochemical change within lesions. A variable pattern of endometriotic lesions within the pelvis can be detected by laparoscopy as visible peritoneal endometriosis. It is generally believed that besides ovarian steroid hormones, the growth of endometriosis can be regulated by the innate immune system in the pelvic microenvironment by their interaction with endometrial cells and immune cells. Even with the careful eyes of an expert surgeon, we may sometimes miss detecting peritoneal lesion within the peritoneal cavity or deep into the peritoneum. In such a case, random collection of normal peritoneum may carry the possibility to identify some hidden endometriotic lesions by microscopy and these lesions can be named as occult (invisible microscopic endometriosis (OME. Here, we discuss the color appearance of peritoneal lesions and activity of these lesions by analysis of a panel of activity markers. Finally we discuss our recent findings on OME, their biological and clinical significance, and try to make a possible link in the origin between visible endometriosis and OME.

  20. Contemporary evaluation and management of renal trauma. (United States)

    Chouhan, Jyoti D; Winer, Andrew G; Johnson, Christina; Weiss, Jeffrey P; Hyacinthe, Llewellyn M


    Renal trauma occurs in approximately 1%-5% of all trauma cases. Improvements in imaging and management over the last two decades have caused a shift in the treatment of this clinical condition. A systematic search of PubMed was performed to identify relevant and contemporary articles that referred to the management and evaluation of renal trauma. Computed tomography remains a mainstay of radiological evaluation in hemodynamically stable patients. There is a growing body of literature showing that conservative, non-operative management of renal trauma is safe, even for Grade IV-V renal injuries. If surgical exploration is planned due to other injuries, a conservative approach to the kidney can often be utilized. Follow up imaging may be warranted in certain circumstances. Urinoma, delayed bleeding, and hypertension are complications that require follow up. Appropriate imaging and conservative approaches are a mainstay of current renal trauma management.

  1. Renal involvement in primary antiphospholipid syndrome. (United States)

    Marcantoni, Carmelita; Emmanuele, Carmela; Scolari, Francesco


    Antiphospholipid syndrome is an autoimmune disorder characterized by recurrent venous or arterial thrombosis and/or pregnancy-related problems associated with persistently elevated levels of antiphospholipid antibodies. The kidney is a major target organ in both primary and secondary antiphospholipid syndrome. This review describes several aspects of the renal involvement in the primary form of the syndrome, in particular the histological pattern of the so-called antiphospholipid syndrome nephropathy (APSN). APSN is a vascular nephropathy characterized by small vessel vaso-occlusive lesions associated with fibrous intimal hyperplasia of interlobular arteries, recanalizing thrombi in arteries and arterioles, and focal atrophy, a constellation of morphological lesions suggestive of primary antiphospholipid syndrome.

  2. Possible role of WT1 in a human fetus with evolving bronchial atresia, pulmonary malformation and renal agenesis. (United States)

    Loo, Christine K C; Algar, Elizabeth M; Payton, Diane J; Perry-Keene, Joanna; Pereira, Tamara N; Ramm, Grant A


    The association of peripheral bronchial atresia and congenital pulmonary airway malformation (CPAM) has recently been recognised, but the pathology of the lesions evolving together has not been described. We present autopsy findings in a 20 week fetus showing areas of peripheral bronchial destruction and airway malformation consistent with developing CPAM in the right lung supporting a causal relationship between these lesions. This fetus also had congenital heart defect, bilateral renal agenesis and syndactyly. We identified another fetus from our autopsy files, with bilateral renal agenesis, similar right sided pulmonary malformation and cardiac defects. Similar bilateral renal agenesis and defects of the heart and lungs are found in wt1(-/-) mice and we have investigated the expression of WT1 in these fetuses. We hypothesise that the cardiac, liver, renal and possibly lung lesions in these two cases may arise due to mesenchymal defects consequent to WT1 misexpression and discuss evidence for this from the scientific literature. We used immunoperoxidase stains to analyse WT1 expression in autopsy hepatic tissue in both fetuses. We also investigated the expression of α-smooth muscle actin (α-SMA), a marker of activated hepatic stellate cells/myofibroblasts, and desmin in hepatic mesenchyme and compare these findings with control fetuses, without congenital malformations. We found reduced WT1 expression in hepatic mesothelium in both fetuses with malformations. There was also increased expression of α-SMA in liver perisinusoidal cells, as seen in the wt1(-/-) mouse model. We therefore propose that abnormality of WT1 signalling may be an underlying factor, as WT1 is expressed in coelomic lining cells from which mesenchyme is derived in many organs.

  3. Characteristics and Outcomes of Granulomatosis With Polyangiitis (Wegener) and Microscopic Polyangiitis Requiring Renal Replacement Therapy: Results From the European Renal Association-European Dialysis and Transplant Association Registry

    NARCIS (Netherlands)

    Hruskova, Z.; Stel, V.S.; Jayne, D.; Aasarod, K.; Meester, J. de; Ekstrand, A.; Eller, K.; Heaf, J.G.; Hoitsma, A.J.; Jimenez, C. Martos; Ravani, P.; Wanner, C.; Tesar, V.; Jager, K.J.


    BACKGROUND: This study describes the incidence and outcomes of European patients requiring renal replacement therapy (RRT) for kidney failure due to antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). STUDY DESIGN: Cohort study. SETTING & PARTICIPANTS: 12 renal registries providi

  4. Mechanisms by which heme oxygenase rescue renal dysfunction in obesity

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    Joseph Fomusi Ndisang


    Collectively, these data suggest that hemin ameliorates nephropathy by potentiating the expression of proteins of repair/regeneration, abating oxidative/inflammatory mediators, reducing renal histo-pathological lesions, while enhancing nephrin, podocin, podocalyxin, CD2AP and creatinine clearance, with corresponding reduction of albuminuria/proteinuria suggesting improved renal function in hemin-treated ZFs. Importantly, the concomitant potentiation regeneration proteins and podocyte cytoskeletal proteins are novel mechanisms by which hemin rescue nephropathy in obesity.

  5. Renal mass biopsy--a renaissance? (United States)

    Lane, Brian R; Samplaski, Mary K; Herts, Brian R; Zhou, Ming; Novick, Andrew C; Campbell, Steven C


    Advances in our understanding of the natural history and limited aggressive potential of many small renal masses, expanding treatment options and the integration of molecular factors into prognostic and therapeutic algorithms have stimulated renewed interest in percutaneous renal mass biopsy. A comprehensive literature review was performed using MEDLINE/PubMed to evaluate the indications, techniques, complications and efficacy of renal mass biopsy. Reported techniques of renal mass biopsy vary widely with different modes of radiographic guidance, needle size, number of cores and pathological analyses. Percutaneous renal mass biopsy with 2 or 3 cores using 18 gauge needles may improve diagnostic accuracy without increasing morbidity. Serious complications of percutaneous biopsy are rare and the minor complication rate in recent series has been less than 5%. The reported rate of technical failure of renal mass biopsy due to insufficient material was about 9% before 2001 and 5% in more recent studies. The likelihood of indeterminate or inaccurate pathological findings has decreased from 10% to 4% when comparing clinical studies before and since 2001. Currently a total success rate of greater than 90% is attainable using renal mass biopsy with standard histopathological analysis. Recent studies demonstrated that combining immunohistochemical and molecular analyses may further improve renal mass biopsy accuracy. Research on expanded analysis of percutaneous renal mass biopsy specimens should remain a top priority. Enhanced renal mass biopsy should not change treatment in most patients with small renal masses, who should be treated with surgical excision. However, future clinical algorithms will likely incorporate enhanced biopsy in situations in which decision making is more challenging.

  6. Renal carcinoma with brain metastases. Prognostic factors and treatment outcomes

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    A. V. Golanov


    Full Text Available Introduction. Surgical excision followed by whole-brain radiotherapy (WBRT is a traditional treatment option for solitary brain metastases (SBM of renal carcinoma. In the presence of multiple brain metastases of renal carcinoma WBRT remains to be the most common treatment option in this group of patients. However, the effectiveness of WBRT is insufficient due to radioresistance of renal carcinoma. After introduction of the standards in the radiosurgical practice, treatment options of renal carcinoma have been changed, since radiosurgery may overcome WBRT limitations in the treatment of brain metastases of radioresistant tumorsObjective: to study the effectiveness of stereotactic radiosurgery by using “Gamma Knife” device in the treatment of brain metastases of renal carcinoma.Materials and methods. We have analyzed results of the treatment of 112 patients with brain metastases of renal carcinoma who underwent radiosurgical treatment in Moscow Center “Gamma Knife”. Age median of the patients was 58 (33 –77 years. Total number of irradiated metastatic foci – 444, an average number of brain metastases in 1 patient was 4 (1–30. Twenty eight (25.0 % patients had a single brain metastasis. A median of cumulative volume of brain metastases for each patient was 5.9 (0.1–29.1 cm3. An average value of the marginal dose for metastatic lesion was 22 (12–26 Gy, mean value of isodose used for treatment planning was 64 (39-99 %.Results. An overall survival (OS rate after radiosurgical treatment was 37.7; 16.4 and 9.3 % for 12, 24 and 36 months, respectively. A median OS was 9.1 months (95% confidence interval (CI 7.1–11.8. New brain metastases (distant recurrences following radiosurgical treatment occurred in 44 (54.3 % patients, with a median of 10.1 months (95 % CI:7-18. Local recurrences after radiosurgical treatment were detected in 19 (17 % patients with a median time of 6.6 months (95 % CI 4.0–9.6. Factors associated with the best

  7. Sirolimus-associated proteinuria and renal dysfunction. (United States)

    Rangan, Gopala K


    Sirolimus is a novel immunosuppressant with potent antiproliferative actions through its ability to inhibit the raptor-containing mammalian target of rapamycin protein kinase. Sirolimus represents a major therapeutic advance in the prevention of acute renal allograft rejection and chronic allograft nephropathy. Its role in the therapy of glomerulonephritis, autoimmunity, cystic renal diseases and renal cancer is under investigation. Because sirolimus does not share the vasomotor renal adverse effects exhibited by calcineurin inhibitors, it has been designated a 'non-nephrotoxic drug'. However, clinical reports suggest that, under some circumstances, sirolimus is associated with proteinuria and acute renal dysfunction. A common risk factor appears to be presence of pre-existing chronic renal damage. The mechanisms of sirolimus-associated proteinuria are multifactorial and may be due to an increase in glomerular capillary pressure following calcineurin inhibitor withdrawal. It has also been suggested that sirolimus directly causes increased glomerular permeability/injury, but evidence for this mechanism is currently inconclusive. The acute renal dysfunction associated with sirolimus (such as in delayed graft function) may be due to suppression of compensatory renal cell proliferation and survival/repair processes. Although these adverse effects occur in some patients, their occurrence could be minimised by knowledge of the molecular effects of sirolimus on the kidney, the use of sirolimus in appropriate patient populations, close monitoring of proteinuria and renal function, use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers if proteinuria occurs and withdrawal if needed. Further long-term analysis of renal allograft studies using sirolimus as de novo immunosuppression along with clinical and laboratory studies will refine these issues in the future.

  8. Peripheral artery disease: a cause of refractory hypertension after renal transplantation. (United States)

    Dourado, Raquel; Gonçalves, Pedro de Araújo; Almeida, Manuel; Weigert, André; Bruges, Margarida; Gaspar, Augusta; Negrão, Acácio Pita; Machado, Domingos; Clemente, Belarmino; Teles, Rui; Machado, Francisco Pereira; Silva, Aniceto


    The authors report the case of a 44-year-old man, with a history of hypertension, smoking, peripheral artery disease and chronic renal failure. After renal transplantation, the patient developed persistent high blood pressure, despite optimal medical therapy. When angiotensin-converting enzyme (ACE) inhibitor therapy was begun, he developed acute anuric renal failure, which was reversed after interruption of the ACE inhibitor. After the initial clinical evaluation, the patient was referred for renal angiography, which revealed critical stenosis of the proximal left common iliac artery, just above the renal graft artery anastomosis. The patient underwent successful angioplasty and stenting of the lesion, with complete normalization of blood pressure.

  9. CT contrast enhancement following renal cryoablation – artefact or treatment failure?

    DEFF Research Database (Denmark)

    Nielsen, Tommy Kjærgaard; Østraat, Øyvind; Andersen, Gratien;

    Introduction and objective: Renal cryoablation is a valid treatment option for localized pT1a renal cancer. Treatment success is typically defined as absence of contrast enhancement (CE) and a decrease in size of the cryoablated renal mass (i.e. cryolesion) on follow-up imaging. We investigated...... the CT characteristics and treatment outcome of renal cryolesions demonstrating CE during postoperative follow-up. Material and methods: A retrospective review of Aarhus Cryoablation Register identified 113 patients with a pT1a biopsy verified malignant renal lesion who underwent primary laparoscopic...

  10. Enfermedad glomeruloquística en dos perros con insuficiencia renal


    Elizabeth Morales Salinas; Luis Ignacio Montesinos Ramírez; Luis Enrique García Ortuño; Augusto César Núñez Díaz; Linda Abril Camacho González


    Se describen dos casos de enfermedad glomeruloquística renal (EGQR) en perros con insufi ciencia renal. En los análisis de laboratorio de ambos animales se encontró hiperazotemia renal con anemia no regenerativa secundaria, asociada con insufi ciencia renal crónica. Las lesiones macroscópicas en los riñones de dichos perros fueron similares: se observaron múltiples pequeños quistes de 1 mm de diámetro en promedio, localizados principalmente en la corteza renal. En el examen histopatológico de...

  11. Coarctation of the aorta and renal artery stenosis in tuberous sclerosis

    Energy Technology Data Exchange (ETDEWEB)

    Flynn, P.M.; Robinson, M.B.; Stapleton, F.B.; Roy, S. III; Koh, G.; Tonkin, I.L.D.


    Among neurocutaneous disorders, coarctation of the abdominal aorta and renal artery stenosis have traditionally been associated with neurofibromatosis. We report a 5-year-old girl who was discovered to have bilateral renal artery stenosis, coarctation of the abdominal aorta, renal cysts and typical skin lesions of tuberous clerosis during the evaluation of asymptomatic hypertension. Renal vascular hypertension has not been reported previously in tuberous sclerosis. We conclude that the tuberous sclerosis complex should be expanded to include vascular malformations and the hypertension should not be assumed to be secondary to renal hamartomata or cysts in patients with tuberous sclerosis.

  12. Idiopathic retroperitoneal fibrosis involving a unilateral renal sinus: A case report and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seul Bi; Yoon, Jung Hee; Kim, Seung Ho; Lee, Ye Daum; Kim, Suk Jung; Lim, Yun Jung; Jung, Hyun Kyung; Lee, Jin Soo [Dept. of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)


    Idiopathic retroperitoneal fibrosis (RPF) is a rare disease entity and its etiology is uncertain. We report two similar cases which showed an uncommon presentation of idiopathic RPF. A 66-year-old woman and an 80-year-old man presented with incidental findings of left renal pelvic mass-like lesions. Computed tomography revealed a soft tissue density mass replacing the left renal pelvis, which was suspicious for renal pelvic cancer, and the diagnosis of idiopathic RPF was surgically confirmed. To the best of our knowledge, a few cases of idiopathic RPF presenting with features of a localized unilateral renal pelvic mass mimicking renal pelvic cancer have been reported.


    Directory of Open Access Journals (Sweden)

    Benny Young


    Full Text Available Background: The objectivity in management of renal bleeding is to preserve a significant renal parenchyma tissue and prevent associated morbidities like anemic shock or renal impairment from substantial nephron demise or obstructed uropathy. Trans-arterial embolization therapy by interventional radiology offers a high success rate with potential of reserving normal renal tissue. The selection material for renal arterial embolization largely depends on vasculature anatomy and end-point of procedure. N-butyl cyanoacrylate glue in our experience is applied in lesion supplied by small size of end-artery. 

  14. Ghost cell lesions

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    E Rajesh


    Full Text Available Ghost cells have been a controversy for a long time. Ghost cell is a swollen/enlarged epithelial cell with eosnophilic cytoplasm, but without a nucleus. In routine H and E staining these cells give a shadowy appearance. Hence these cells are also called as shadow cells or translucent cells. The appearance of these cells varies from lesion to lesion involving odontogenic and nonodontogenic lesions. This article review about the origin, nature and significance of ghost cells in different neoplasms.

  15. Small intestinal involvement by lymphoproliferative disorders post-renal transplantation: A report from the post-transplant lymphoproliferative disorder international survey

    Directory of Open Access Journals (Sweden)

    Hossein Khedmat


    Full Text Available In this study, data on post-renal transplant lymphoproliferative disorders (PTLD collected from the existing literature were pooled and analyzed to compare the characteristics, predictors and prognosis of small intestinal PTLDs. We performed a comprehensive search for the available data by Pubmed and Google scholar search engines for reports on this subject. Data from 18 previously published studies, comprising 120 renal allograft recipients, were included in the analysis. Renal transplant recipients with intestinal PTLD were significantly less likely to have Hogkin′s and Hogkin′s-like lesions (P = 0.044 and to be younger at the time of transplan-tation (P = 0.07. Except for Hodgkin′s-like lesions, histopathological evaluations elsewhere were comparable between the group with PTLD in the small intestine and age- and sex-matched renal transplant recipients with PTLD in other sites. The overall mortality was relatively higher in the control group (P = 0.09. When death only due to PTLD was used as the outcome, a trend toward better outcome was seen for the intestinal PTLD group compared with the other localizations (P = 0.1. The 1- and 5-year survival rates for intestinal PTLD patients were 57% and 37%, respectively, compared with 54% and 21%, respectively, for the control group. According to our findings based on analysis of international data, renal transplant patients with small intestinal PTLD are more likely to be of younger age but less frequently represent Hodgkin′s and Hodgkin′s-like lesions. They also have better patient survival compared with transplant recipients with PTLD in other locations. Further multi-center prospective studies are needed to confirm our results.

  16. Stent sizing strategies in renal artery stenting: the comparison of conventional invasive renal angiography with renal computed tomographic angiography

    Directory of Open Access Journals (Sweden)

    Jacek Kadziela


    Full Text Available Introduction : Randomized trials comparing invasive treatment of renal artery stenosis with standard pharmacotherapy did not show substantial benefit from revascularization. One of the potential reasons for that may be suboptimal procedure technique. Aim : To compare renal stent sizing using two modalities: three-dimensional renal computed tomography angiography (CTA versus conventional angiography. Material and methods: Forty patients (41 renal arteries, aged 65.1 ±8.5 years, who underwent renal artery stenting with preprocedural CTA performed within 6 months, were retrospectively analyzed. In CTA analysis, reference diameter (CTA-D and lesion length (CTA_LL were measured and proposed stent diameter and length were recorded. Similarly, angiographic reference diameter (ANGIO_D and lesion length (ANGIO_LL as well as proposed stent dimensions were obtained by visual estimation. Results: The median CTA_D was 0.5 mm larger than the median ANGIO_D (p < 0.001. Also, the proposed stent diameter in CTA evaluation was 0.5 mm larger than that in angiography (p < 0.0001. The median CTA_LL was 1 mm longer than the ANGIO_LL (p = NS, with significant correlation of these variables (r = 0.66, p < 0.0001. The median proposed stent length with CTA was equal to that proposed with angiography. The median diameter of the implanted stent was 0.5 mm smaller than that proposed in CTA (p < 0.0005 and identical to that proposed in angiography. The median length of the actual stent was longer than that proposed in angiography (p = 0.0001. Conclusions : Renal CTA has potential advantages as a tool adjunctive to angiography in appropriate stent sizing. Careful evaluation of the available CTA scans may be beneficial and should be considered prior to the planned procedure.

  17. Yellowish lesions of the oral cavity. Suggestion for a classification. (United States)

    Gómez, Iria; Varela, Pablo; Romero, Amparo; García, María José; Suárez, María Mercedes; Seoane, Juan


    The colour of a lesion is due to its nature and to its histological substratum. In order to ease diagnosis, oral cavity lesions have been classified according to their colour in: white, red, white and red, bluish and/or purple, brown, grey and/or black lesions. To the best of our knowledge, there is no such a classification for yellow lesions. So, a suggestion for a classification of yellowish lesions according to their semiology is made with the following headings: diffuse macular lesions, papular, hypertrophic, or pustular lesions, together with cysts and nodes. This interpretation of the lesions by its colour is the first step to diagnosis. It should be taken into account that, as happens with any other classification, the yellowish group of lesions includes items with different prognosis as well as possible markers of systemic disorders.

  18. Renal Cell Carcinoma Metastasized to Pagetic Bone. (United States)

    Ramirez, Ashley; Liu, Bo; Rop, Baiywo; Edison, Michelle; Valente, Michael; Burt, Jeremy


    Paget's disease of the bone, historically known as osteitis deformans, is an uncommon disease typically affecting individuals of European descent. Patients with Paget's disease of the bone are at increased risk for primary bone neoplasms, particularly osteosarcoma. Many cases of metastatic disease to pagetic bone have been reported. However, renal cell carcinoma metastasized to pagetic bone is extremely rare. A 94-year-old male presented to the emergency department complaining of abdominal pain. A computed tomography scan of the abdomen demonstrated a large mass in the right kidney compatible with renal cell carcinoma. The patient was also noted to have Paget's disease of the pelvic bones and sacrum. Within the pagetic bone of the sacrum, there was an enhancing mass compatible with renal cell carcinoma. A subsequent biopsy of the renal lesion confirmed renal cell carcinoma. Paget's disease of the bone places the patient at an increased risk for bone neoplasms. The most commonly reported sites for malignant transformation are the femur, pelvis, and humerus. In cases of malignant transformation, osteosarcoma is the most common diagnosis. Breast, lung, and prostate carcinomas are the most common to metastasize to pagetic bone. Renal cell carcinoma associated with Paget's disease of the bone is very rare, with only one prior reported case. Malignancy in Paget's disease of the bone is uncommon with metastatic disease to pagetic bone being extremely rare. We report a patient diagnosed with concomitant renal cell carcinoma and metastatic disease within Paget's disease of the sacrum. Further research is needed to assess the true incidence of renal cell carcinoma associated with pagetic bone.

  19. [Primary intestinal-type adenocarcinoma of the renal pelvis associated with lithiasis: a case report]. (United States)

    Renaud, Florence; Berthon, Nicolas; Lemaitre, Laurent; Castillo, Christine; Copin, Marie-Christine; Aubert, Sébastien; Leroy, Xavier


    A case of primary adenocarcinoma of the renal pelvis occurring in a 57-year-old woman who had no previous history is reported. The lesions were thought to be a renal destruction by pyelolithiasis upon symptomatology and imaging study data. A nephrectomy was thus performed. Macroscopic examination revealed voluminous and exophytic lesions surrounding lithiasis. Diagnosis of intestinal-type adenocarcinoma of the renal pelvis was established on histological examination. No evidence of other tumor localization was revealed by complete exploration. Primary adenocarcinoma of renal pelvis is a rare and often mucinous intestinal-type tumour. Chronic inflammation and renal lithiasis seem to be associated with this tumour. Few cases are reported and prognosis is doubtful. The main differential diagnosis to eliminate is secondary lesions to the kidney of adenocarcinoma from another origin. A careful pathological examination in case of pyelonephritic kidney is necessary to look for an associated tumour.

  20. Lesion activity assessment

    DEFF Research Database (Denmark)

    Ekstrand, K R; Zero, D T; Martignon, S


    in response to cariogenic plaque as well as lesion arrest. Based on this understanding, different clinical scoring systems have been developed to assess the severity/depth and activity of lesions. A recent system has been devised by the International Caries Detection and Assessment System Committee...... the activity of primary coronal and root lesions reliably and accurately at one examination by using the combined information obtained from a range of indicators--such as visual appearance, location of the lesion, tactile sensation during probing and gingival health....

  1. Nephrotic syndrome due to minimal change disease secondary to spider bite: clinico-pathological case of a non-described complication of latrodectism. (United States)

    Méndez, Gonzalo P; Enos, Daniel; Moreira, José Luis; Alvaredo, Fátima; Oddó, David


    The patient was an 18-year-old man who developed nephrotic syndrome after a 'wheat spider' bite (Latrodectus mactans). Due to this atypical manifestation of latrodectism, a renal biopsy was performed showing minimal change disease. The nephrotic syndrome subsided after 1 week without specific treatment. This self-limited evolution suggests that the mechanism of podocyte damage was temporary and potentially mediated by a secondary mechanism of hypersensitivity or direct effect of the α-latrotoxin. The patient did not show signs of relapse in subsequent checkup. This is the first reported case of nephrotic syndrome due to a minimal change lesion secondary to latrodectism.

  2. Nephrotic syndrome due to minimal change disease secondary to spider bite: clinico-pathological case of a non-described complication of latrodectism (United States)

    Enos, Daniel; Moreira, José Luis; Alvaredo, Fátima; Oddó, David


    Abstract The patient was an 18-year-old man who developed nephrotic syndrome after a ‘wheat spider’ bite (Latrodectus mactans). Due to this atypical manifestation of latrodectism, a renal biopsy was performed showing minimal change disease. The nephrotic syndrome subsided after 1 week without specific treatment. This self-limited evolution suggests that the mechanism of podocyte damage was temporary and potentially mediated by a secondary mechanism of hypersensitivity or direct effect of the α-latrotoxin. The patient did not show signs of relapse in subsequent checkup. This is the first reported case of nephrotic syndrome due to a minimal change lesion secondary to latrodectism. PMID:28396739

  3. Primary renal carcinoid tumor: A radiologic review

    Directory of Open Access Journals (Sweden)

    Leslie Lamb, MD, Msc, Bsc


    Full Text Available Carcinoid tumor is the classic famous anonym of neuroendocrine neoplasms. Primary renal carcinoid tumors are extremely rare, first described by Resnick and colleagues in 1966, with fewer than a total of 100 cases reported in the literature. Thus, given the paucity of cases, the clinical and histological behavior is not well understood, impairing the ability to predict prognosis. Computed tomography and (occasionally octreotide studies are used in the diagnosis and followup of these rare entites. A review of 85 cases in the literature shows that no distinctive imaging features differentiate them from other primary renal masses. The lesions tend to demonstrate a hypodense appearance and do not usually enhance in the arterial phases, but can occasionally calcify. Octreotide scans do not seem to help in the diagnosis; however, they are more commonly used in the postoperative followup. In addition, we report a new case of primary renal carcinoid in a horseshoe kidney.

  4. Differential diagnosis of focal lesions of the kidney in CT and MRT; Differentialdiagnose fokaler Nierenlaesionen in CT und MRT

    Energy Technology Data Exchange (ETDEWEB)

    Heckmann, M.; Heinrich, M.; Bautz, W.; Uder, M. [Universitaetsklinikum Erlangen (Germany). Radiologisches Inst.; Humke, U. [Katharinenhospital Stuttgart (Germany). Urologische Klinik


    The great majority of renal masses are found incidentally as a result of the use of ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI). If ultrasonography is not diagnostic CT or MRI should be initiated to differentiate lesions of the kidney that need surgical intervention from those that do not and from those that need follow-up examinations. Cystic renal masses are characterized by using the Bosniak classification, including category IIF. In solid lesions of the kidney first non-surgical lesions as well as lymphoma, renal infarction and nephritis should be excluded. Identifying fatty components in renal lesions is very important because in angiomyolipoma they are almost always present. CT and MRI are excellent for tumor detection. Careful evaluation of imaging finding combined with the patient's history should assist the radiologist in making the proper diagnosis or recommending the appropriate treatment in most cases. This article provides a review about renal masses, the imaging methods for their evaluation and their characteristic features at CT and MR imaging. Different lesions are demonstrated like xantogranulomatous pyelonephritis, acute pyelonephritis, renal infarction, lymphoma, angiomyolipoma, renal oncocytoma, cystic lesion and polycystic disease the kidney, echinococcosis, renal cystadenoma, metastases, renal cell carcinoma (RCC), and multiple bilateral RCC in patients with Hippel-Lindau-Syndrome. This article should help to differentiate complex cystic lesions of the kidney by using the Bosniak-classification, especially Bosniak Category IIF. Solid masses should be characterized and the major question to be answered is whether the mass represents a surgical or nonsurgical lesion or if follow-up studies are necessary. (orig.)

  5. Non invasive assessment of renal artery using dual MRA techniques compared with invasive renal angiography in cases of renovascular hypertension

    Directory of Open Access Journals (Sweden)

    Y. Ragab


    Conclusion: The combined approach of non-invasive CE MRA and PC MRA techniques achieves a very high specificity, PPV and NPV for the detection of renal arterial pathomorphologic features as compared to standard renal angiography. Adding PC MRA to CE MRA helps to differentiate between mild and moderate stenoses as well as moderate and sever arterial stenotic lesions. So, CE MRA is a morphological test while PC MRA helps in grading the arterial stenoses.

  6. [Bevacizumab as first-line therapy in metastatic renal cell carcinoma: Progression-free survival for 3 years]. (United States)

    Pichler, R; Horninger, W; Aigner, F; Heidegger, I


    We report the case of a 72-year-old woman who was diagnosed in 2006 with renal cell cancer (RCC) and had undergone consecutive tumor nephrectomy (clear-cell RCC, Fuhrmann grade II, stage pT3a, R0). Over the years, the patient underwent several surgical and radiological interventions due to various metastatic lesions. This case report describes the 3-year progression-free survival in a patient who underwent first-line therapy with the monoclonal antibody bevacizumab. Except for hypertension, the patient does not suffer currently from any other side effects of bevacizumab therapy.

  7. Differential renal glomerular changes induced by 5/6 nephrectomization between common marmoset monkeys (Callithrix jacchus) and rats. (United States)

    Suzuki, Yui; Yamaguchi, Itaru; Onoda, Noriko; Saito, Takashi; Myojo, Kensuke; Imaizumi, Minami; Takada, Chie; Kimoto, Naoya; Takaba, Katsumi; Yamate, Jyoji


    We have been investigating the relevance and availability of 5/6 nephrectomized (Nx) common marmoset monkeys (Callithrix jacchus) as a chronic renal failure model. As a part of this investigation, renal glomerular changes in the Nx marmosets were histopathologically and immunohistochemically evaluated, and then compared with those in 5/6 Nx SD rats. In the Nx marmosets, the blood and urine parameters were elevated, excluding urine protein; histopathologically, enlargement of Bowman's capsule and atrophy of the glomeruli were observed in all animals, and other slight changes were also observed in 1 or 2 marmosets. There were no significant changes in the mesangial matrix injury score, vimentin and desmin positivity or the number of WT1 positive cells between the control and Nx marmoset groups. On the other hand, in the Nx rats, the blood and urine parameters were elevated; histopathologically, various changes were observed in the glomeruli, and the mesangial matrix injury score, vimentin and desmin positivity were increased, while the number of WT1 positive cells was decreased; these histopathological impacts on the renal glomerulus at 13 weeks after Nx in rats were more severe than that in the Nx marmosets. Because the glomerular basement membrane (GBM) was much thicker in the marmosets than in the rats in electron microscopy, the weaker pathological changes in the Nx marmosets might be due to the GBM thickness. This study showed for the first time glomerular lesions developed in the Nx marmosets, and the possible pathogenesis of the glomerular lesions was discussed.

  8. Multidetector spiral CT renal angiography in the diagnosis of renal artery fibromuscular dysplasia

    Energy Technology Data Exchange (ETDEWEB)

    Sabharwal, Rohan [Department of Radiology, Westmead Hospital, Sydney, NSW (Australia)]. E-mail:; Vladica, Philip [Department of Radiology, Westmead Hospital, Sydney, NSW (Australia); Coleman, Patrick [Department of Renal Medicine, Westmead Hospital, Sydney, NSW (Australia)


    Objective: The aim of this study was to evaluate the role and detection rate of multidetector spiral CT renal angiography (CTA) as compared with conventional angiography (CA), the commonly accepted gold standard, in the diagnosis of renal artery fibromuscular dysplasia (FMD). In addition, the role of CTA reconstructions (multiplanar reformatted images (MPR), maximum intensity projections (MIP) and shaded-surface display (SSD)) in the detection of FMD was also evaluated. Materials and methods: CTA results were retrospectively reviewed in 21 hypertensive patients with CA-proven FMD. Clinical indications for referral included resistant hypertension (requiring greater than three antihypertensive medications), labile hypertension, hypertension in combination with renal impairment and the presence of abdominal bruits in the context of systemic hypertension. In some cases, these clinical indications were supplemented by positive results in other tests, including plasma renin assay, captopril scintigraphy and/or Doppler ultrasound. The findings of CA in these 21 patients were compared to CTA. Results: Mean patient age was 62.33 + 14.32 years (range 24-85 years). CTA identified all 42 main renal arteries (100%) and all 10 accessory renal arteries (100%) visualized on CA. In the diagnosis of FMD, CTA detected all 40 (100%) lesions detected by CA. No single CTA reconstruction technique was able to detect all lesions noted on corresponding CA, however, upon review of all CTA reconstructions (MPR, MIP and SSD) in each case, every lesion was correctly identified by CTA. Conclusion: Our experience suggests that CTA is a non-invasive, reliable and accurate method for the diagnosis of renal artery fibromuscular dysplasia. Moreover, in our experience CTA has many advantages as a diagnostic screening tool over CA, including accessibility, speed, lower complication profile, versatility and cost-effectiveness. CTA shows great potential as a guiding tool for directing subsequent

  9. Kidney (Renal) Failure (United States)

    ... How is kidney failure treated? What is kidney (renal) failure? The kidneys are designed to maintain proper fluid ... marrow and strengthen the bones. The term kidney (renal) failure describes a situation in which the kidneys have ...

  10. Renal arteries (image) (United States)

    A renal angiogram is a test used to examine the blood vessels of the kidneys. The test is performed ... main vessel of the pelvis, up to the renal artery that leads into the kidney. Contrast medium ...

  11. Incidental finding of malignant renal cystic tumour diagnosed sonographically

    Directory of Open Access Journals (Sweden)

    Stojanović Milan


    Full Text Available Introduction Malignant cystic renal tumor is a rare variant of renal malignancy. Cystic neoplasm results from haemorrhage, necrosis and colliquation of a solid tumour or tumour occurring within the wall of a cyst. That pathoanatomic substratum reflects characteristic sonographic features indicating its malignant nature. It is important to distinguish a simple cyst (not requiring surgery from intracystic malignant lesion because it requires surgery. Case Outline The authors present a 59-year-old woman with a sonographic finding of a simple cyst in the upper pole of the right kidney revealed during gynaecological ultrasonography. Immediately afterwards, the radiologist performed renal sonography and its finding was a cystic lesion suggestive of malignancy. Further evaluation by CT scan showed that the lesion was clearly malignant. After surgery, the histological finding verified cystic renal cancer. Conclusion Ultrasonography may reveal a complex cyst and solid mass but requires an experienced sonographer. Contrast CT scan would be performed to examine the "suspicious" lesion because it clearly shows if a cystic lesion is benign or malignant. .

  12. Isolated renal metastasis from squamous cell lung cancer

    Directory of Open Access Journals (Sweden)

    Cai Jun


    Full Text Available Abstract Renal metastasis from non-small cell lung cancer is rather uncommon. The mechanism underlying the occurrence of metastasis in this site is still not well understood. We report a case of a 53-year-old Chinese woman who had moderately differentiated squamous cell carcinoma of the lung. After a ten months post-surgery interval of disease free survival, computed tomography (CT scan found that left renal parenchymal was occupied by a mass, confirmed by kidney biopsy to be a metastasis from squamous cell lung carcinoma. Based on this case, we are warned to be cautious in diagnosis and treatment when renal lesion are detected.

  13. Renal functional reserve and renal recovery after acute kidney injury. (United States)

    Sharma, Aashish; Mucino, Marìa Jimena; Ronco, Claudio


    Renal functional reserve (RFR) represents the capacity of the kidney to increase glomerular filtration rate (GFR) in response to certain physiological or pathological stimuli or conditions. Once baseline GFR is determined, RFR can be assessed clinically after an oral protein load or intravenous amino acid infusion. In clinical practice, baseline GFR displays variable levels due to diet or other factors. RFR is the difference between peak 'stress' GFR induced by the test (p.o. or i.v.) and the baseline GFR. In clinical scenarios where hyperfiltration is present (high baseline GFR due to pregnancy, hypertension or diabetic nephropathy, in solitary kidney or kidney donors), RFR may be fully or partially used to achieve normal or supranormal renal function. Since commonly used renal function markers, such as GFR, may remain within normal ranges until 50% of nephrons are lost or in patients with a single remnant kidney, the RFR test may represent a sensitive and early way to assess the functional decline in the kidney. RFR assessment may become an important tool to evaluate the ability of the kidney to recover completely or partially after a kidney attack. In case of healing with a defect and progressive fibrosis, recovery may appear complete clinically, but a reduced RFR may be a sign of a maladaptive repair or subclinical loss of renal mass. Thus, a reduction in RFR may represent the equivalent of renal frailty or susceptibility to insults. The main aim of this article is to review the concept of RFR, its utility in different clinical scenarios, and future perspective for its use.

  14. Renal disease in pregnancy ambulatory issues. (United States)

    Phelan, Sharon T


    Acute and chronic renal disease will complicate prenatal care. Normal physiological changes during pregnancy make the urinary tract system more vulnerable to infectious complications or worsening of preexisting disease. Much of the focus of prenatal care includes screening for these concerns both at the onset of prenatal care and through the pregnancy and postpartum course. With careful and attentive care, the pregnancy outcome for women with significant renal disease has improved and the occurrence of renal injury or obstetric complications due to infectious insults has decreased. This manuscript reviews the current ambulatory prenatal care as it relates to the urinary tract in pregnancy.

  15. CT and sonography of severe renal and perirenal infections

    Energy Technology Data Exchange (ETDEWEB)

    Hoddick, W. (Univ. of California, San Francisco); Jeffrey, R.B.; Goldberg, H.I.; Federle, M.P.; Laing, F.C.


    Twelve patients with urosepsis and severe renal or perirenal infections were evaluated with both computed tomography (CT) and sonograhy. Six patients had nine proven renal or perirenal abscesses larger than 2 cm in diameter. One patient had multiple microabscesses smaller than 1 cm. Five patients had CT or sonographic evidence of focal or multifocal bacterial nephritis. Computed tomography correctly diagnosed all renal (six) and perirenal (three) abscesses. Sonography was falsely negative in a patient with multiple microabscesses and in another patient with a gas-forming perinephric abscess. In one patient with four bilateral renal abscesses, sonography correctly diagnosed only one of the abscesses. In the five patients with focal or multifocal bacterial nephritis, CT demonstrated poorly defined, poorly enhancing lesions in all cases. Sonography was normal in three of these patients. Although this report is based on a limited experience, computed tomography seems to be the more sensitive method of evaluating severe renal and perirenal infections.

  16. Stents in Renal Artery Bifurcation Stenosis: A Case Report

    Directory of Open Access Journals (Sweden)

    Polytimi Leonardou


    Full Text Available A 39-year-old patient presented with poorly controlled hypertension, and she was referred to renal angiogram and potential renal angioplasty. Renal angiogram showed a bifurcation lesion of the right renal artery. A guide wire was used to cross the upper branch, while the lower branch was protected by another same-type guide wire through the same introducer. Two thin monorail balloons were used to dilate the two branches; however, despite balloon dilatation, the stenosis of the vessels persisted. The “kissing balloon” technique was then attempted by simultaneously inflating both branches using the same balloons, but more than a 70% residual stenosis persisted in each branch. Two stents were finally placed in a “kissing” way through the main renal artery. The imaging and clinical results were good, without any procedure-related complications. Three years clinical followup was also good, without any reason for further interventional approach.

  17. Changes in pathological pattern and treatment regimens based on repeat renal biopsy in lupus nephritis

    Institute of Scientific and Technical Information of China (English)

    WANG Guo-bao; XU Zheng-jin; LIU Hong-fa; ZHOU Qiu-gen; ZHOU Zhan-mei; JIA Nan


    Background Relapses occur frequently in patients with lupus nephritis.Renal biopsy is the gold standard for assessing renal activity and hence guiding the treatment.Whether repeat renal biopsy is helpful during flares of lupus nephritis remains inconclusive.In the present study,we retrospectively reviewed the patients with lupus nephritis who had more than one renal biopsy with the hope to find the clinical value of repeat biopsy.Methods Patients who had a diagnosis of lupus nephritis and two or more renal biopsies were selected from the database of the patient pathology registration at this renal division.Renal biopsy was evaluated according to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification of lupus nephritis.The pathological patterns and treatment regimens were analyzed after a repeat biopsy.Results We identified 44 systemic lupus erythematosus patients with serial renal biopsies.In total,there were 94 renal biopsies.Overall,the pathological transition occurred in 64% instances according to the ISN/RPS class.When the transition was analyzed according to proliferative,membranous or mix lesions,it showed different profile:35% in patients with proliferative lesion,23.5% patients with mix lesions,100% in patients with pure membranous lesion.The pathological transition could not be predicted by any clinical characteristics.After the repeat renal biopsy,34% of patients had a change in their treatment regimens.Conclusions The pathological conversion was very prevalent in patients with lupus nephritis.However,the transitions became less prevalent when they were analyzed according to pure membranous,proliferative,and mix lesion.Repeat biopsy might be helpful to avoid unnecessary increased immunosuppression therapy.

  18. ANCA-Associated Glomerulonephritis: Risk Factors for Renal Relapse (United States)

    Göçeroğlu, Arda; Berden, Annelies E.; Fiocco, Marta; Floßmann, Oliver; Westman, Kerstin W.; Ferrario, Franco; Gaskin, Gill; Pusey, Charles D.; Hagen, E. Christiaan; Noël, Laure-Hélène; Rasmussen, Niels; Waldherr, Rüdiger; Walsh, Michael; Bruijn, Jan A.; Jayne, David R. W.; Bajema, Ingeborg M.


    Relapse in ANCA-associated vasculitis (AAV) has been studied previously, but there are few studies on renal relapse in particular. Identifying patients at high risk of renal relapse may aid in optimizing clinical management. We investigated which clinical and histological parameters are risk factors for renal relapse in ANCA-associated glomerulonephritis (AAGN). Patients (n = 174) were newly diagnosed and had mild–moderate or severe renal involvement. Data were derived from two trials of the European Vasculitis Society: MEPEX and CYCAZAREM. The Cox regression model was used to identify parameters increasing the instantaneous risk (= rate) of renal relapse (useful for instant clinical decisions). For identifying predictors of renal relapse during follow-up, we used Fine & Gray’s regression model. Competing events were end-stage renal failure and death. The cumulative incidence of renal relapse at 5 years was 9.5% (95% CI: 4.8–14.3%). In the Cox model, sclerotic class AAGN increased the instantaneous risk of renal relapse. In Fine & Gray’s model, the absence of interstitial infiltrates at diagnosis was predictive for renal relapse. In this study we used two different models to identify possible relationships between clinical and histopathological parameters at time of diagnosis of AAV with the risk of experiencing renal relapse. Sclerotic class AAGN increased the instantaneous risk of renal relapse. This association is most likely due to the high proportion of sclerosed glomeruli reducing the compensatory capacity. The absence of interstitial infiltrates increased the risk of renal relapse which is a warning sign that patients with a relatively benign onset of disease may also be prone to renal relapse. Renal relapses occurring in patients with sclerotic class AAGN and renal relapses occurring in patients without interstitial infiltrates were mutually exclusive, which may indicate that they are essentially different. PMID:27973575

  19. Computed tomography of renal cell carcinoma in patients with terminal renal impairment

    Energy Technology Data Exchange (ETDEWEB)

    Ferda, Jiri [Department of Radiology, Charles University Hospital Plzen, Alej Svobody 80, CZ-306 40 Plzen (Czech Republic)], E-mail:; Hora, Milan [Department of Urology, Charles University Hospital Plzen, Dr. Edvarda Benese 13, CZ-306 40 Plzen (Czech Republic); Hes, Ondrej [Institut of Pathology, Charles University Hospital Plzen, Alej Svobody 80, CZ-306 40 Plzen (Czech Republic); Reischig, Tomas [Department of Internal Medicine, Nephrology Unit, Charles University Hospital Plzen, Alej Svobody 80, CZ-306 40 Plzen (Czech Republic); Kreuzberg, Boris; Mirka, Hynek; Ferdova, Eva; Ohlidalova, Kristyna; Baxa, Jan [Department of Radiology, Charles University Hospital Plzen, Alej Svobody 80, CZ-306 40 Plzen (Czech Republic); Urge, Tomas [Department of Urology, Charles University Hospital Plzen, Dr. Edvarda Benese 13, CZ-306 40 Plzen (Czech Republic)


    's. Bilateral renal tumors were found in our study in 60% (6/10) confirmed in six cases, one kidney left on follow-up due to the small tumors. Conclusions: With the use of a multi-detector row system, it is possible to detect smaller foci suspected to originate in multiple tumors, especially when up to 3-mm thin multi-planar reconstructions are used. Two cases demonstrated the possibility the development of RCC in impaired kidneys may start before dialysis initiation.

  20. [Renal leiomyoma. Case report]. (United States)

    Joual, A; Guessous, H; Rabii, R; Benjelloun, M; Benlemlih, A; Skali, K; el Mrini, M; Benjelloun, S


    The authors report a case of renal leiomyoma observed in a 56-year-old man. This cyst presented in the from of loin pain. Computed tomography revealed a homogeneous renal tumor. Treatment consisted of radical nephrectomy. Histological examination of the specimen showed benign renal leiomyoma.

  1. Renal inflammatory myofibroblastic tumor

    DEFF Research Database (Denmark)

    Heerwagen, S T; Jensen, C; Bagi, P


    Renal inflammatory myofibroblastic tumor (IMT) is a rare soft-tissue tumor of controversial etiology with a potential for local recurrence after incomplete surgical resection. The radiological findings in renal IMT are not well described. We report two cases in adults with a renal mass treated...

  2. Fibromuscular dysplasia in living renal donors: Still a challenge to computed tomographic angiography

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    Blondin, D., E-mail: blondin@med.uni-duesseldorf.d [Institute of Radiology, University Hospital Duesseldorf, Moorenstr. 5, D-40225 Duesseldorf (Germany); Lanzman, R.; Schellhammer, F. [Institute of Radiology, University Hospital Duesseldorf, Moorenstr. 5, D-40225 Duesseldorf (Germany); Oels, M. [Department of Nephrology (Germany); Grotemeyer, D. [Department of Vascular Surgery and Renal Transplantation (Germany); Baldus, S.E. [Institute of Pathology (Germany); Rump, L.C. [Department of Nephrology (Germany); Sandmann, W. [Department of Vascular Surgery and Renal Transplantation (Germany); Voiculescu, A. [Department of Nephrology (Germany)


    Background: Computed tomographic angiography has become the standard evaluating method of potential living renal donors in most centers. Although incidence of fibromuscular dysplasia is low (3.5-6%), this pathology may be relevant for success of renal transplantation. The incidence of FMD in our population of LRD and reliability of CTA for detecting vascular pathology were the aims of this study. Materials and methods: 101 living renal donors, examined between 7/2004 and 9/2008 by CTA, were included in a retrospective evaluation. The examinations were carried out using a 64 Multi-detector CT (Siemens Medical Solutions, Erlangen). The presence or absence of the characteristic signs of fibromuscular dysplasia, as 'string-of-beads' appearance, focal stenosis or aneurysms, were assessed and graded from mild (=1) to severe (=3). Furthermore, vascular anatomy and arterial stenosis were investigated in this study. Retrospective analysis of CTA and ultrasound were compared with operative and histological reports. Results: Four cases of fibromuscular dysplasia (incidence 3.9%) in 101 renal donors were diagnosed by transplanting surgeons and histopathology, respectively. Three cases could be detected by CTA. In one donor even retrospective analysis of CTA was negative. Ten accessory arteries, 14 venous anomalies and 12 renal arteries stenosis due to atherosclerosis were diagnosed by CTA and could be confirmed by the operative report. Conclusion: CTA is sufficient for detection of hemodynamic relevant stenosis and vascular anatomy. Only one patient with a mild form of FMD was under estimated. Therefore, if the CTA shows slightest irregularities which are not typical for atherosclerotic lesions, further diagnostic work up by DSA might still be necessary.

  3. Metastatic Renal Cell Carcinoma: The Importance of Immunohistochemistry in Differential Diagnosis

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    Sandra Custódio


    Full Text Available Introduction: Clear cell carcinoma accounts for 75% of all types of renal neoplasms. Approximately one third presents with metastatic disease at diagnosis. Immunohistochemical studies play a significant diagnostic role. Case Report: We report the case of a 48-year-old heavy smoker who presented with productive cough and progressive dyspnea. The study revealed a renal mass and lung alterations compatible with primary tumor of the lung. The patient underwent a right complete nephrectomy. The anatomopathological exam showed clear cell renal carcinoma (pT1bN0Mx. After transthoracic needle aspiration biopsy, the clinical diagnosis was stage IV adenocarcinoma of the lung. Initially, the patient received one cycle of chemotherapy (cisplatin/pemetrexed. Two weeks later, the immunohistochemistry tests revealed a secondary lesion with probable renal origin. Chemotherapy was stopped and the patient was started on sunitinib treatment. After two cycles the disease progressed. A second-line treatment with everolimus was proposed; however, the patient died 2 weeks later due to terminal respiratory insufficiency. Discussion: Clear cell renal cell carcinoma remains one of the great mimickers in pathology. Immunohistochemistry is a valuable tool in the differential diagnosis of lung carcinomas. With the help of thyroid transcription factor 1, it is possible to distinguish a primary lung tumor from a metastasis with a reasonable degree of certainty. The present case report illustrates the challenge of making a definitive and adequate diagnosis. The immunohistochemistry added information that changed the whole treatment strategy. For the best treatment approach, it is fundamental that clinicians await all possible test results, before establishing a treatment plan.

  4. Reversible renal failure after treatment with omeprazole. (United States)

    Post, A T; Voorhorst, G; Zanen, A L


    Omeprazole is a proton pump inhibitor widely used in the treatment of gastro-esophageal reflux disease and peptic ulcer disease. In a 73-year-old man we describe renal failure due to acute interstitial nephritis after use of omeprazol during 4 months. Unexpected renal failure without signs of hydronephrosis should always provoke awareness of drug reaction, omeprazole being one of the possible drugs.

  5. Safety and efficacy of coronary drug eluting stent for atherosclerotic stenosis of the small renal artery

    Institute of Scientific and Technical Information of China (English)

    LI Chun-jie; WU Zheng; YAN Hong-bing; WANG Jian; ZHAO Han-jun


    @@ Small diameter renal artery refers to the renal artery with the cross-section diameter less than 5 mm, the incidence of which is approximately 8%.1 Small diameter renal artery is common in patients with congenital multi-branch renal arteries, diabetes and multi-coronary artery lesions. Renal artery bare-mental stent (BMS) implantation is the standard treatment for ostial renal artery stenosis.2,3 However, the restenosis rate4-6 is too high and becomes one of the relative contraindications for small diameter renal artery stent implantation. Clinical trials (e.g. RAVEL,7,8 SIRIUS9 and TAXUS-IV10) have proved that drug eluting stent (DES), compared with BMS, can reduce the restenosis rate after the percutanous coronary intervention (PCI). And Huda et al11 claimed that DES had the better results than BMS in the treatment of obstructive superficial femoral artery disease. However,there are few studies involved restenosis after the renal artery intervention. We hypothesized that coronary DES applied in renal artery stenosis might inhibit intimal proliferation effectively as in coronary artery disease;therefore we evaluated the results of 25 patients with atherosclerotic renal artery stenosis treated using coronary DES to assess the safety and efficacy of coronary DES in patients with small renal artery stenotic lesions.

  6. Association of systemic hypertension with renal injury in dogs with induced renal failure. (United States)

    Finco, Delmar R


    Systemic hypertension is hypothesized to cause renal injury to dogs. This study was performed on dogs with surgically induced renal failure to determine whether hypertension was associated with altered renal function or morphology. Mean arterial pressure (MAP), heart rate (HR), systolic arterial pressure (SAP), and diastolic arterial pressure (DAP) were measured before and after surgery. Glomerular filtration rate (GFR) and urine protein:creatinine ratios (UPC) were measured at 1, 12, 24, 36, and 56-69 weeks after surgery, and renal histology was evaluated terminally. The mean of weekly MAP, SAP, and DAP measurements for each dog over the 1st 26 weeks was used to rank dogs on the basis of MAP, SAP, or DAP values. A statistically significant association was found between systemic arterial pressure ranking and ranked measures of adverse renal responses. When dogs were divided into higher pressure and lower pressure groups on the basis of SAP, group 1 (higher pressure, n = 9) compared with group 2 (lower pressure, n = 10) had significantly lower GFR values at 36 and 56-69 weeks; higher UPC values at 12 and 56-69 weeks; and higher kidney lesion scores for mesangial matrix, tubule damage, and fibrosis. When dogs were divided on MAP and DAP values, group 1 compared with group 2 had significantly lower GFR values at 12, 24, 36, and 56-69 weeks; higher UPC values at 12 and 56-69 weeks; and higher kidney lesion scores for mesangial matrix, tubule damage, fibrosis, and cell infiltrate. These results demonstrate an association between increased systemic arterial pressure and renal injury. Results from this study might apply to dogs with some types of naturally occurring renal failure.

  7. Isolated plexiform neurofibroma mimicking a vascular lesion* (United States)

    Stefano, Paola Cecilia; Apa, Sebastian Nicolas; Lanoël, Agustina Maria; María, Josefina Sala; Sierre, Sergio; Pierini, Adrián Martin


    Plexiform neurofibromas are benign tumors originating from peripheral nerve sheaths, generally associated with Neurofibromatosis Type 1 (NF1). They are diffuse, painful and sometimes locally invasive, generating cosmetic problems. This report discusses an adolescent patient who presented with an isolated, giant plexiform neurofibroma on her leg that was confused with a vascular lesion due to its clinical aspects. Once the diagnosis was confirmed by surgical biopsy, excision of the lesion was performed with improvement of the symptoms. PMID:27192529

  8. SLAP lesions in the overhead athlete. (United States)

    Rokito, Steven E; Myers, Kevin R; Ryu, Richard K N


    The diagnosis and management of SLAP lesions in the overhead athlete remains a challenge for the sports medicine specialist due to variable anatomy, changes with aging, concomitant pathology, lack of dependable physical findings on examination, and lack of sensitivity and specificity with imaging studies. This article presents a comprehensive review of the epidemiology, relevant anatomy, proposed pathogenesis, diagnostic approach, and outcomes of nonoperative and operative management of SLAP lesions in the overhead athlete.

  9. Tuberous sclerosis with bilateral renal cell carcinoma in a child: A case report


    Sanjay Choudhuri; Jeevanjyoti Mishra; Gyan Prakash Singh; Datteswar Hota


    Tuberous sclerosis complex (TCS) is an autosomal dominant disease which comes under a group of diseases known as neurocutaneous syndrome. Incidence of TCS is around 1 in 6000. The clinical triad of papular facial nevus, seizures and mental retardation is found in less than 50% of the patients. Renal lesions in TCS commonly consist of simple renal cyst and angiomyolipomas. Renal cell carcinoma though rarely associated with tuberous sclerosis may be its significant manifestations. We report a c...

  10. Differentiation of Renal Oncocytoma and Renal Clear Cell Carcinoma Using Relative CT Enhancement Ratio

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    An Ren


    Full Text Available Background: The difference between renal oncocytomas (RO and renal clear cell carcinomas (RCCs presents the greatest diagnostic challenge. The aim of this study was to retrospectively determine if RO and RCCs could be differentiated on computed tomography (CT images on the basis of their enhancement patterns with a new enhancement correcting method. Methods: Forty-six patients with a solitary renal mass who underwent total or partial nephrectomy were included in this study. Fourteen of those were RO and 32 were RCCs. All patients were examined with contrast-enhanced CT. The pattern and degree of enhancement were evaluated. We selected the area that demonstrated the greatest degree of enhancement of the renal lesion in the corticomedullary nephrographic and excretory phase images. Regions of interest (ROI were also placed in adjacent normal renal cortex for normalization. We used the values of the normal renal cortex that were measured at the same time as divisors. The ratios of lesion-to-renal cortex enhancement were calculated for all three phases. The Student′s t-test and Pearson′s Chi-square test were used for statistical analyses. Results: All RCCs masses showed contrast that appeared to be better enhanced than RO on all contrast-enhanced phases of CT imaging, but there was no significant difference in absolute attenuation values between these two diseases (P > 0.05. The ratio of lesion-to-cortex attenuation in the corticomedullary phase showed significantly different values between RO and RCCs. The degree of contrast enhancement in RCCs was equal to or greater than that of the normal renal cortex, but it was less than that of the normal cortex in RO in the corticomedullary phase. The ratio of lesion-to-cortex attenuation in the corticomedullary phase was higher than the cut off value of 1.0 in most RCCs (84%, 27/32 and lower than 1.0 in most RO (93%, 13/14 (P < 0.05. In the nephrographic phase, the ratio of lesion-to-cortex attenuation

  11. Congenital hypopituitarism and renal failure

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    Gaurav Atreja


    Full Text Available Congenital hypopituitarism is potentially fatal in the newborn period but treatable if the diagnosis is made early. We report a neonate who presented with hypothermia and severe hypoglycemia. He also had undescended testis and micropenis. Initial screening revealed panhypopituitarism, which was corrected promptly. He developed renal failure due to initial cardiovascular compromise related to hypotension but recovered quickly with standard management. Magnetic resonance imaging revealed absent stalk of anterior pituitary.

  12. Diffusion-weighted MRI in assessment of renal dysfunction

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    Ankur Goyal


    Full Text Available Background: Diffusion-weighted magnetic resonance imaging (DW-MRI in renal diseases is an evolving field and its potential is yet to be fully realized. Purpose: To study the relationship between apparent diffusion coefficient (ADC values of renal parenchyma and serum markers of renal function and stage of chronic kidney disease (CKD. Materials and Methods: A retrospective review was performed of all adult patients who underwent DW-MRI (at b-values of 0 and 500 s/mm 2 for renal lesions from January 2009 to September 2010 and revealed 88 patients, of which 22 patients had renal dysfunction and 66 had normal renal function. Of these 22, 15 patients were known cases of CKD and were staged depending on disease severity. ADC values were determined for renal parenchyma and compared. Receiver operating characteristic (ROC curves were drawn to establish cut-off ADC values. Pearson′s correlation coefficient (R was calculated between ADC and renal function parameters. Results: ADC values in patients with renal dysfunction were significantly lower than in patients with normal renal function (2.1133 ± 0.2851 vs. 2.3198 ± 0.1246 (×10 -3 mm 2 /s. ADC values lower than 2.0354 (×10 -3 mm 2 /s were seen only with renal dysfunction and higher than 2.4516 (×10 -3 mm 2 /s were seen only with normal function. There was significant inverse correlation between ADC and serum creatinine ( R = -0.530, blood urea (R= -0.502, and significant linear correlation ( R = 0.784 with estimated glomerular filtration rate (eGFR. ADC values showed a statistically significant decreasing trend with increasing stage of CKD. Conclusion: ADC values may serve as an additional marker for the presence and degree of renal dysfunction.

  13. Postpartum renal vein thrombosis. (United States)

    Rubens, D; Sterns, R H; Segal, A J


    Renal vein thrombosis in adults is usually a complication of the nephrotic syndrome. Rarely, it has been reported in nonnephrotic women postpartum. The thrombosis may be a complication of the hypercoagulable state associated with both the nephrotic syndrome and pregnancy. Two postpartum patients with renal vein thrombosis and no prior history of renal disease are reported here. Neither patient had heavy proteinuria. In both cases, pyelonephritis was suspected clinically and the diagnosis of renal vein thrombosis was first suggested and confirmed by radiologic examination. Renal vein thrombosis should be considered in women presenting postpartum with flank pain.

  14. Renal infarction resulting from traumatic renal artery dissection. (United States)

    Kang, Kyung Pyo; Lee, Sik; Kim, Won; Jin, Gong Yong; Na, Ki Ryang; Yun, Il Yong; Park, Sung Kwang


    Renal artery dissection may be caused by iatrogenic injury, trauma, underlying arterial diseases such as fibromuscular disease, atherosclerotic disease, or connective tissue disease. Radiological imaging may be helpful in detecting renal artery pathology, such as renal artery dissection. For patients with acute, isolated renal artery dissection, surgical treatment, endovascular management, or medical treatment have been considered effective measures to preserve renal function. We report a case of renal infarction that came about as a consequence of renal artery dissection.

  15. Intraosseous osteolytic lesions

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    Adler, C.P.; Wenz, W.


    Any pathological damage occurring in a bone will produce either an osteolytic or osteosclerotic lesion which can be seen in the macroscopic specimen as well as in the roentgenogram. Various bone lesions may lead to local destructions of the bone. An osteoma or osteoplastic osteosarcoma produces an osteosclerotic lesion showing a dense mass in the roentgenogram; a chondroblastoma or an osteoclastoma, on the other hand, induces an osteolytic focal lesion. This paper presents examples of different osteolytic lesions of the humerus. An osteolytic lesion seen in the roentgenogram may be either produced by an underlying non-ossifying fibroma of the bone, by fibrous dysplasia, osteomyelitis or Ewing's sarcoma. Differential diagnostic considerations based on the radiological picture include eosinophilic bone granuloma, juvenile or aneurysmal bone cyst, multiple myeloma or bone metastases. Serious differential diagnostic problems may be involved in case of osteolytic lesions occurring in the humerus. Cases of this type involving complications have been reported and include the presence of an teleangiectatic osteosarcoma as well as that of a hemangiosarcoma of the bone.

  16. Implications of Von Hippel-Lindau Syndrome and Renal Cell Carcinoma (United States)

    Ashouri, Kenan; Mohseni, Sophia; Tourtelot, John; Sharma, Pranav


    Von Hippel-Lindau syndrome (VHLS) is a rare hereditary neoplastic disorder caused by mutations in the vhl gene leading to the development of tumors in several organs including the central nervous system, pancreas, kidneys, and reproductive organs. Manifestations of VHLS can present at different ages based on the affected organ and subclass of disease. In the subclasses of VHLS that cause renal disease, renal involvement typically begins closer to the end of the second decade of life and can present in different ways ranging from simple cystic lesions to solid tumors. Mutations in vhl are most often associated with clear cell renal carcinoma, the most common type of renal cancer, and also play a major role in sporadic cases of clear cell renal carcinoma. The recurrent, multifocal nature of this disease presents difficult challenges in the long-term management of patients with VHLS. Optimization of renal function warrants the use of several different approaches common to the management of renal carcinoma such as nephron sparing surgery, enucleation, ablation, and targeted therapies. In VHLS, renal lesions of 3 cm or bigger are considered to have metastatic potential and even small lesions often harbor malignancy. Many of the aspects of management revolve around optimizing both oncologic outcome and long-term renal function. As new surgical strategies and targeted therapies develop, the management of this complex disease evolves. This review will discuss the key aspects of the current management of VHLS.

  17. Implications of Von Hippel-Lindau Syndrome and Renal Cell Carcinoma

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    Kenan Ashouri


    Full Text Available Von Hippel-Lindau syndrome (VHLS is a rare hereditary neoplastic disorder caused by mutations in the vhl gene leading to the development of tumors in several organs including the central nervous system, pancreas, kidneys, and reproductive organs. Manifestations of VHLS can present at different ages based on the affected organ and subclass of disease. In the subclasses of VHLS that cause renal disease, renal involvement typically begins closer to the end of the second decade of life and can present in different ways ranging from simple cystic lesions to solid tumors. Mutations in vhl are most often associated with clear cell renal carcinoma, the most common type of renal cancer, and also play a major role in sporadic cases of clear cell renal carcinoma. The recurrent, multifocal nature of this disease presents difficult challenges in the long-term management of patients with VHLS. Optimization of renal function warrants the use of several different approaches common to the management of renal carcinoma such as nephron sparing surgery, enucleation, ablation, and targeted therapies. In VHLS, renal lesions of 3 cm or bigger are considered to have metastatic potential and even small lesions often harbor malignancy. Many of the aspects of management revolve around optimizing both oncologic outcome and long-term renal function. As new surgical strategies and targeted therapies develop, the management of this complex disease evolves.  This review will discuss the key aspects of the current management of VHLS.

  18. Cryoablation of small peripheral renal masses: a retrospective analysis. (United States)

    Schwartz, Bradley F; Rewcastle, John C; Powell, Timothy; Whelan, Christopher; Manny, Ted; Vestal, J Clifton


    Renal cryoablation is a minimally invasive, nephron-sparing option that has shown promise in the treatment of patients with solitary small renal lesions suspicious for malignancy. Few large clinical studies have used this promising technology, although intermediate-term data are encouraging. We present a retrospective review and report the outcomes of a large cohort of patients who underwent renal cryotherapy. Patients who were candidates for partial nephrectomy with peripheral lesions chart review was performed only in cases of missing data. From February 2001 to March 2005, 85 consecutive patients with an average age of 67 years and a mean tumor size of 2.6 cm (range, 1.2-4.7 cm; median, 2.5 cm), underwent renal cryoablation; 70 procedures were performed laparoscopically. Mean estimated blood loss was 58 mL, with 2 patients requiring transfusion. Mean hospital stay was 3.0 days (range, 0-14 days; median, 2 days) for the entire cohort and 2.2 days (range, 0-7 days; median, 2 days) for the laparoscopic group. A total of 7 laparoscopic cases were converted to an open approach early in the experience, 2 of which were considered technical failures. Mean follow-up was 10 months (range, 3-36 months). Abnormal postoperative enhancement occurred in 2 patients at 3 months and 12 months. Radical nephrectomy in the first revealed no viable tumor; needle biopsy in the second revealed renal cell carcinoma, which prompted nephrectomy. Intraoperative needle biopsy yielded a 59% malignancy rate. We conclude that renal cryotherapy is a viable option for nephron-sparing surgery in small, peripheral renal lesions. The procedure is well tolerated, may be considered in patients who are not good candidates for open surgical approaches, results in minimal morbidity, and has shown encouraging treatment results. Close posttreatment surveillance is essential. Longer-term follow-up data will be necessary if the long-term durability of renal cryotherapy is to be established.

  19. [Takayasu arteritis associated with heart valve diseases (pulmonary and aortic) and arteritis (coronary and renal)]. (United States)

    Rangel-Abundis, A; Fraga, A; Badui, E; Guijosa, N; Navarro, J


    The most severe arteritis due to Takayasu's disease are those related to renal and coronary arteries. The first one because it produces severe arterial hypertension and the second one because it puts the patient in high risk of suffering either myocardial ischemia or infarction. These situations worsen when this entity is associated to valvular heart lesions. The authors present the clinical cases of two female patients with Takayasu's disease. One of them in acute phase of the illness, where coronary arteritis, mild coarctation of the aorta, right pulmonary artery stenosis, and pulmonary valve stenosis were present. The second patient was seen during the remission phase of the disease with obstruction of the left subclavicular artery, renal arteritis, severe arterial hypertension and aortic valve insufficiency. The authors discuss the prognosis of patients with Takayasu's disease associated to valvular heart disease and its role in the etiology of pulmonary valvular stenosis. Finally, the authors point out the importance of recognizing the active and non active phases of the Takayasu's disease in relation of the adequate stage for surgical treatment of the lesions caused by this disease.

  20. Metachronous adrenal metastasis from operated contralateral renal cell carcinoma with adrenalectomy and iatrogenic Addison's disease. (United States)

    Ozturk, Hakan; Karaaslan, Serap


    Metachronous adrenal metastasis from contralateral renal cell carcinoma (RCC) surgery is an extremely rare condition. Iatrogenic Addison's disease occurring after metastasectomy (adrenalectomy) is an even rarer clinical entity. We present a case of a 68-year-old male with hematuria and left flank pain 9 years prior. The patient underwent left transperitoneal radical nephrectomy involving the ipsilateral adrenal glands due to a centrally-located, 75-mm in diameter solid mass lesion in the upper pole of the left kidney. The tumour lesion was confined within the renal capsule, and the histo-pathological examination revealed a Fuhrman nuclear grade II clear cell carcinoma. The patient underwent transperitoneal right adrenalectomy. The histopathological examination revealed metastasis of clear cell carcinoma. The patient was diagnosed with iatrogenic Addison's disease based on the measurement of serum cortisol levels and the adrenocorticotropic hormone (ACTH) stimulation test, after which glucocorticoid and mineralocorticoid replacement was initiated. The patient did not have local recurrence or new metastasis in the first year of the follow-up. The decision to perform ipsilateral adrenalectomy during radical nephrectomy constitutes a challenge, and the operating surgeon must consider all these rare factors.

  1. Management of obstructive renal failure caused by bilateral renal aspergilloma in an immunocompetent newborn. (United States)

    Martinez-Pajares, J D; Martinez-Ferriz, M C; Moreno-Perez, D; Garcia-Ramirez, M; Martin-Carballido, S; Blanch-Iribarne, P


    Fungal infection of the kidneys is a rare condition that has been reported in premature babies and in diabetic or immunocompromised adult patients. Candida spp. is the most frequent micro-organism involved. This paper reports a case of an immunocompetent newborn with a bladder exstrophy who suffered from an acute renal failure caused by bilateral renal aspergilloma (Aspergillus flavus). The newborn was treated with amphotericin B urinary tract irrigation through bilateral nephrostomy catheters, combined with liposomal amphotericin B and voriconazole therapy, which improved his renal function. However, due to persistent fungal colonization, a long antifungal treatment and permanent ureterostomies were necessary to deal with new episodes of ureterorenal obstruction. As of November 2009, despite the renal injuries, renal function had been conserved. The management of the mechanical obstruction and the choice of antifungal drugs are discussed in this unusual case.

  2. Percutaneous Cryoablation for Renal Cell Carcinoma

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    Tsitskari Maria


    Full Text Available Renal cell carcinoma (RCC is the most common type of kidney cancer in adults. Nephron sparing resection (partial nephrectomy has been the “gold standard” for the treatment of resectable disease. With the widespread use of cross sectional imaging techniques, more cases of renal cell cancers are detected at an early stage, i.e. stage 1A or 1B.  This has provided an impetus for expanding the nephron sparing options and especially, percutaneous ablative techniques.  Percutaneous ablation for RCC is now performed as a standard therapeutic nephron-sparing option in patients who are poor candidates for resection or when there is a need to preserve renal function due to comorbid conditions, multiple renal cell carcinomas, and/or heritable renal cancer syndromes. During the last few years, percutaneous cryoablation has been gaining acceptance as a curative treatment option for small renal cancers. Clinical studies to date indicate that cryoablation is a safe and effective therapeutic method with acceptable short and long term outcomes and with a low risk, in the appropriate setting.  In addition it seems to offer some advantages over radio frequency ablation (RFA and other thermal ablation techniques for renal masses.

  3. Renal disorders in children: a Nigerian study. (United States)

    Eke, F U; Eke, N N


    A 5-year prospective study of 699 children with various renal disorders from around the Rivers State, which is in the eastern part of Nigeria, was carried out to investigate the prevalence and significance of renal disorders in a third world country with no facilities for paediatric dialysis and transplantation. Renal disorders accounted for 1.1% of the total outpatients and hospital admissions. The commonest renal disorders were urinary tract infection (UTI, 68.9%); nephrotic syndrome (NS 14.6%) and acute post streptococcal glomerulonephritis (11.4%). Patients with UTI had no vesico-ureteric reflux (VUR); 22.5% of NS patients were steroid sensitive. Wilms' tumour (1.6%) was the second commonest childhood malignant tumour; 8 of 17 cases of obstructive uropathy were secondary to meatal stenosis following circumcision. Fifteen children developed end-stage renal failure (ESRF), mainly due to chronic glomerulonephritis, giving a prevalence rate of 7.5 children per year per million childhood population. Hence, renal disorders are common in Nigeria and although VUR is rare, ESRF may approximate figures seen in the western world. This highlights the need to improve the country's socioeconomic conditions, make medical facilities more available to children and prevent renal diseases that may lead to ESRF.

  4. Aneurisma da Artéria Renal: caso clínico Renal Artery Aneurysm

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    Joana Moreira


    Full Text Available Apresenta-se o caso clínico de um doente com volumoso aneurisma da artéria renal esquerda. Do sexo masculino, de 22 anos de idade, com lombalgia à esquerda com algumas semanas de evolução. Recorreu ao médico assistente que solicitou estudo imagiológico por ecografia abdominal. Detectada imagem sugestiva de aneurisma da aorta abdominal. Este achado motivou a transferência para o nosso Hospital onde foi admitido consciente e orientado, hemodinamicamente estável, apresentando uma massa pulsátil epigástrica, com frémito e sopro sistólico à auscultação. Angio-TC revelou um aneurisma da artéria renal esquerda com 16 cm de diâmetro. Dada a estabilidade clínica e topografia lesional optou-se por tentar embolizar, sem sucesso, o tronco da artéria renal esquerda antes da abordagem cirúrgica. O doente foi então submetido a Nefrectomia total esquerda por via toraco-abdominal. Pós-operatório sem complicações, locais ou sistémicas. Alta ao 8ºdia, mantendo boa função renal e com níveis normais de hemoglobina. Diagnóstico de aneurisma da artéria renal confirmado por estudo anátomo-patológico da peça operatória.One case of a large left renal artery aneurysm in a young patient 22 years old is presented. He appealed to his assistant physician a few weeks after development of left back pain. Abdominal ultrasound imaging study has been requested. Suggestive abdominal aortic aneurysm was detected. This finding led to the transfer to our hospital where he was admitted conscious and hemodynamically stable. A pulsatile epigastric mass with a systolic murmur on auscultation and thrill were detected. Angio-CT scan revealed a left renal artery aneurysm, 16 cm in diameter. Given the clinical stability and lesional topography we decide a previous embolization of left renal artery, unsuccessfully. The patient underwent then left total nephrectomy, through thoraco-abdominal incision. No local or systemic complications in the postoperative

  5. Glomerular lesions in HIV-infected patients: a Yale University Department of Medicine Residency Peer-Teaching Conference.



    HIV-associated nephropathy (HIVAN) is a clinicopathologic entity characterized by heavy proteinuria, absence of edema and an irreversible decline in renal function. Findings on renal biopsy include: collapsed glomerular capillaries; visceral glomerular epitheliosis; microcystic tubules; mesangial prominence; and endothelial tubuloreticular inclusions. Early in the AIDS epidemic, HIVAN was the predominant glomerular lesion observed in HIV-infected patients. It is being increasingly recognized,...

  6. Radiofrequency Ablation of Renal Tumors: Four-Year Follow-Up Results in 47 Patients

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    Kim, Soo Dong; Yoon, Seong Guk; Sung, Gyung Tak [Dong-A University College of Medicine, Busan (Korea, Republic of)


    To retrospectively evaluate the intermediate results of radiofrequency ablation (RFA) of small renal masses (SRMs). Percutaneous or laparoscopic RFA was performed on 48 renal tumors in 47 patients. The follow-up studies included a physical examination, chest radiography, creatinine level, and contrast-enhanced CT or MRI. To confirm the pathologic criteria of complete ablation, 35 patients underwent a follow-up biopsy. Recurrence was defined as contrast enhancement on imaging studies after 3 months, lesion growth at subsequent imaging, or viable cancer cells on follow-up biopsy. Technical success was achieved in 43 (89.6%) of 48 renal tumors. The mean tumor size was 2.3 cm and the mean follow-up period was 49.6 months. Repeated RFA was necessary in 5 tumors due to incomplete ablation. The overall complication rate was 35.8%, of which 96.2% were mild complications. Serum creatinine levels at 12 months after RFA did not differ from those before RFA (1.28 vs. 1.36 mg/dL). Four patients were found to have recurrence at various follow-up intervals, and distant metastasis was not found in any cases. RFA appears to be a useful treatment for selected patients with SRMs. Our 4-year follow-up results disclose an excellent therapeutic outcome with RFA, while achieving effective local tumor control.

  7. Hypodipsic hypernatremia leading to reversible renal failure following surgery for craniopharyngioma. (United States)

    Kwon, Ah Reum; Ann, Jung-Min; Shin, Jae Il; Chae, Hyun Wook; Kim, Ho-Seong


    Thirst is stimulated by increases in effective plasma osmolality that are detected by cerebral osmoreceptors located in the vascular organ of the lamina terminalis. However, surgical destruction or organic lesions of the lamina terminalis decrease the sensation of thirst in response to increased plasma osmolality. A 17-year-old boy who was diagnosed with craniopharyngioma at the age of 10 years and underwent tumor resection and gamma knife surgery was admitted for non-symptomatic severe hypernatremia. Although the sodium level was 173 mmol/L and serum osmolality was also high (371 mOsm/kg), the patient did not report increased thirst. Laboratory analysis revealed hypertonic dehydration and acute non-oliguric renal failure due to dehydration. Treatment was based on correction of hypernatremia with hydration and education about regular, periodic water ingestion. The patient's hypernatremia and acute non-oliguric renal failure resolved with controlled daily fluid intake. To our knowledge, this is the first report of decreased thirst sensation secondary to craniopharyngioma and tumor resection leading to severe hypernatremia and non-oliguric renal failure in an adolescent.

  8. The radiologist's role in the management of papillary renal cell carcinoma. (United States)

    Corral de la Calle, M Á; Encinas de la Iglesia, J; Martín López, M R; Fernández Pérez, G C; Águeda Del Bas, D S

    Papillary carcinoma is the second most common renal cell carcinoma. It has a better prognosis than the more frequent clear cell carcinoma, although this does not hold true for advanced cases, because no specific treatment exists. It presents as a circumscribed peripheral tumor (small and homogeneously solid or larger and cystic/hemorrhagic) or as an infiltrating lesion that invades the veins, which has a worse prognosis. Due to their low vascular density, papillary renal cell carcinomas enhance less than other renal tumors, and this facilitates their characterization. On computed tomography, they might not enhance conclusively, and in these cases they are impossible to distinguish from hyperattenuating cysts. Contrast-enhanced ultrasonography and magnetic resonance imaging are more sensitive for detecting vascularization. Other characteristics include a specific vascular pattern, hypointensity on T2-weighted images, restricted water diffusion, and increased signal intensity in opposed phase images. We discuss the genetic, histologic, clinical, and radiological aspects of these tumors in which radiologists play a fundamental role in management. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Clinical spectrum of cutaneous manifestations in renal and renopancreatic recipients in two centers in Uruguay. (United States)

    Dufrechou, L; Nin, M; Curi, L; Larre Borges, P; Martínez Asuaga, M; Noboa, O; Orihuela, S; González-Martínez, F; Larre Borges, A


    Uruguay, with a total population of 3,345,000 inhabitants, is the Latin American country with the second highest number of renal replacement therapies. Long-term immunosuppressant therapy is essential for graft survival but results in reduced immunosurveillance, leading to an increased risk of complications. A variety of dermatological manifestations and a large increase in nonmelanoma skin cancers have been reported in this population. The purpose of this study was to evaluate the frequency and clinical spectrum of cutaneous manifestations in renal and renopancreatic recipients in 2 reference centers in Uruguay. Two hundred and six renal or renopancreatic recipients between 21 and 77 years old were evaluated between September 2009 and September 2011. A total of 206 dermatoses were observed; 60% of the patients had at least 1 cutaneous manifestation. The most frequent dermatoses were cutaneous side effects due to immunosuppressive treatment (40.6%), followed by infections (26.1%), miscellaneous causes (18.9%), and malignant and premalignant lesions (14.4%). Transplant recipients represent a high-risk dermatological population. Physicians in transplant units should be aware of the importance of dermatological screening in order to promote early detection of skin cancer.

  10. Primary focal segmental glomerulosclerosis recurring rapidly as collapsing glomerulopathy in a renal allograft recipient

    Directory of Open Access Journals (Sweden)

    Vinita Agrawal


    Full Text Available Recurrent focal segmental glomerulosclerosis (FSGS develops in about 30%-40% of patients of FSGS undergoing renal transplantation. We report a patient who received a live- related renal transplant for end-stage renal disease due to a primary FSGS (not otherwise specified in the native kidney and presented with graft dysfunction in the immediate posttransplant period. The first and the second biopsy showed no evidence of rejection or glomerular lesion. A repeat biopsy done on the 30th day revealed recurrent FSGS morphologically presenting as collapsing variant. The patient was found to have massive proteinuria. Electron microscopy done retrospectively showed glomerular foot process effacement even in the first biopsy. This case highlights the presence of an early minimal change disease-like phase in recurrent FSGS and the necessity of evaluation for proteinuria even in immediate and early posttransplant period. It also shows that different variants of FSGS may represent a spectrum of the same disease and suggests a likely role of a pathogenic circulating factor even in collapsing FSGS requiring further evaluation.

  11. Common conjunctival lesions

    African Journals Online (AJOL)

    ocular appearance. is discussion does not attempt to classify lesions, but only highlights ... magnifying glass. Examine what you can see and evert the upper ... look at the cornea and feel for pre-auricular and submandibular lymph nodes.

  12. Oropharynx lesion biopsy (United States)

    ... page: // Oropharynx lesion biopsy To use the sharing features on this ... Department of Otolaryngology - Head and Neck Surgery, The University of Texas Medical School at Houston, Houston, TX. ...

  13. Managing Carious Lesions

    DEFF Research Database (Denmark)

    Schwendicke, F; Frencken, J E; Bjørndal, L


    caries and control activity of existing cavitated lesions to preserve hard tissues and retain teeth long-term. Entering the restorative cycle should be avoided as far as possible. Controlling the disease in cavitated carious lesions should be attempted using methods which are aimed at biofilm removal...... or control first. Only when cavitated carious lesions either are noncleansable or can no longer be sealed are restorative interventions indicated. When a restoration is indicated, the priorities are as follows: preserving healthy and remineralizable tissue, achieving a restorative seal, maintaining pulpal...... health, and maximizing restoration success. Carious tissue is removed purely to create conditions for long-lasting restorations. Bacterially contaminated or demineralized tissues close to the pulp do not need to be removed. In deeper lesions in teeth with sensible (vital) pulps, preserving pulpal health...

  14. Evaluation of Renal Histopathological Changes, as a Predictor of Recoverability of Renal Function Following Pyeloplasty for Ureteropelvic Junction Obstruction

    Directory of Open Access Journals (Sweden)



    Full Text Available Background Pyeloplasty is a widely accepted treatment for ureteropelvic junction obstruction (UPJO. However, the renal function recoverability after pyeloplasty is still a matter of debate. Different parameters have been used to predict renal functional recoverability after corrective surgery, with conflicting results. Objectives In this study, renal biopsy was carried on a series of cases of UPJO, during pyeloplasty, to study the extent of histological alterations in renal parenchyma, as a result of obstruction, and its predictive value in renal function recoverability after pyeloplasty. Patients and Methods We retrospectively analyzed the renal biopsy obtained during pyeloplasty in 53 adult patients. Histopathological changes were graded on a scale of 1 to 3, according to their severity, and compared with the differential renal function (DRF revealed on the preoperative and postoperative follow up diethylene triamine pentaacetic acid (DTPA renal scan. A Fischer’s t test was used to evaluate statistical differences between values. Results This study showed a linear relationship between the severity of histological changes and renal function recovery, after pyeloplasty. Out of 24 obstructed renal units (ORU, with minimal histopathological changes (grade I, 21 ORU (87.5%, with > 35% DRF preoperatively, showed significant improvement in renal function after 12 months of pyeloplasty (P 0.05. Renal function deterioration after pyeloplasty was not observed in any of the cases. Conclusions The severity of pathological changes in renal parenchyma, due to UPJO, is a good predictor of renal function recoverability, after pyeloplasty. The ORUs, with DRF > 35%, usually have normal (grade I renal biopsy and might be expected to present better functional recoverability after pyeloplasty.

  15. Unusual benign breast lesions

    Energy Technology Data Exchange (ETDEWEB)

    Porter, G.J.R. [Nottingham Breast Institute, City Hospital, Hucknall Rd, Nottingham NG5 1PB (United Kingdom)]. E-mail:; Evans, A.J. [Nottingham Breast Institute, City Hospital, Hucknall Rd, Nottingham NG5 1PB (United Kingdom); Lee, A.H.S. [Nottingham Breast Institute, City Hospital, Hucknall Rd, Nottingham NG5 1PB (United Kingdom); Hamilton, L.J. [Nottingham Breast Institute, City Hospital, Hucknall Rd, Nottingham NG5 1PB (United Kingdom); James, J.J. [Nottingham Breast Institute, City Hospital, Hucknall Rd, Nottingham NG5 1PB (United Kingdom)


    The purpose of this article is to show examples of the radiological (mammography and/or ultrasound) and pathological appearances of unusual benign breast lesions. The conditions covered are granular cell tumours, fibromatosis, nodular fasciitis, myofibroblastomas, haemangiomas, neurofibromas, and leiomyomas. The article includes the first published description of the ultrasound appearance of a myofibroblastoma. Knowledge of these appearances may help confirm or refute radiological-pathological concordance of percutaneous biopsy results during multidisciplinary assessment of these lesions and aid patient management.

  16. Refractory anemia leading to renal hemosiderosis and renal failure


    Sujatha Siddappa; K M Mythri; Kowsalya, R.; Ashish Parekh


    Renal hemosiderosis is a rare cause of renal failure and, as a result, may not be diagnosed unless a detailed history, careful interpretation of blood parameters and renal biopsy with special staining is done. Here, we present a rare case of renal hemosiderosis presenting with renal failure.

  17. Refractory anemia leading to renal hemosiderosis and renal failure

    Directory of Open Access Journals (Sweden)

    Sujatha Siddappa


    Full Text Available Renal hemosiderosis is a rare cause of renal failure and, as a result, may not be diagnosed unless a detailed history, careful interpretation of blood parameters and renal biopsy with special staining is done. Here, we present a rare case of renal hemosiderosis presenting with renal failure.

  18. Andersson Lesion in Ankylosing Spondylitis

    Directory of Open Access Journals (Sweden)

    Manimegalai N, KrishnanKutty K, Panchapakesa Rajendran C, Rukmangatharajan S, Rajeswari S


    Full Text Available Andersson lesions are destructive foci that appear at the discovertebral junction in ankylosingspondylitis. We report three cases of ankylosing spondylitis with such lesions. These lesions simulatean infection and in our country, mimic spinal tuberculosis.

  19. Percutaneous Nephrolithotripsy for Renal Transplant Lithiasis : A Case Report


    種田, 建史; 金光, 俊行; 林, 哲也; 藤本, 宜正; 小出, 卓生


    A 54-year-old man was introduced to our hospital for follow-up examinations after renal transplantation. At the initial visit, a 25 mm renal transplant stone was noted, which had enlarged to 32 mm at an examination 1 year later. We first attempted transurethral lithotripsy (TUL), but failed due to ureteral stricture. However, we could completely remove the stone in 2 sessions of percutaneous nephrolithotripsy (PNL). The incidence of urinary lithiasis after renal transplantation ranges from 0....

  20. Avaliação dos resultados da artroplastia parcial de ombro para tratamento da artropatia por lesão do manguito rotador Evaluating the results of partial shoulder arthroplasty for the treatment of arthropathy due to rotator cuff lesion

    Directory of Open Access Journals (Sweden)

    Sérgio Luiz Checchia


    Full Text Available OBJETIVO: Avaliar os resultados obtidos com a artroplastia parcial de ombro para o tratamento da artropatia por lesão do manguito rotador. MÉTODOS: No período de junho de 1989 a março de 2004, 11 ombros de 11 pacientes foram submetidos a artroplastia parcial de ombro para o tratamento de artropatia por LMR. O tempo de seguimento variou de 27 a 183 meses, com média de 69 meses. A idade média foi de 69,1 anos, variando de 44 a 78 anos. Houve predomínio do sexo feminino em 90,9% dos casos (10 pacientes. O membro dominante foi acometido em 10 pacientes. Os métodos escolhidos para avaliação dos pacientes, no seguimento pós-operatório, basearam-se nos critérios da UCLA; no índice de satisfação dos pacientes em relação ao alívio da dor; e no método de avaliação de objetivos limitados, proposto por Neer et al. RESULTADOS: O índice de satisfação dos pacientes em relação ao alívio da dor foi de 81,8%. Com o método de avaliação da UCLA, observamos média de 22,7 pontos. Por meio do método de avaliação de objetivos limitados, proposto por Neer et al, obtivemos seis pacientes com resultados satisfatórios e cinco insatisfatórios. CONCLUSÃO: A artroplastia parcial de ombro para o tratamento da artropatia por lesão do manguito rotador promove alívio do quadro doloroso e permite alguma melhora na função do membro para realização das atividades diárias; entretanto, é uma técnica que leva a altos índices de resultados insatisfatórios.OBJECTIVE: To evaluate the results achieved with partial arthroplasty of the shoulder to treat arthropathy due to rotator cuff lesion. METHODS: From June 1989 to March 2004, 11 shoulders of 11 patients were submitted to partial arthroplasty of the shoulder to treat an arthropathy due to rotator cuff lesion. Follow-up time varied from 27 to 182 months, with a mean of 69 months. Mean age was 69.1 years, ranging from 44 to 78 years. There was a predominance of the female gender, in 90.9% of