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Serious Deterioration of Renal Function after Percutaneous Nephrolithotomy: A Case Report  [PDF]
Heng Zhang, Houyong Zhou, Bo Song, Zhansong Zhou, Longkun Li
Open Journal of Nephrology (OJNeph) , 2011, DOI: 10.4236/ojneph.2011.12003
Abstract: A 25-year-old man presented with stones in left kidney received the left Percutaneous nephrolithotomy (PCNL) with holmium laser lithotripsy. All the stones were successfully removed, and all the results were normal in the first three months followup. However, a deterioration of renal function was confirmed two years later. No mechanical obstruction was found with ureteroscopy. The deterioration of renal function may be induced by high internal renal pelvis pressure, injury of the laser energy, potential functional obstruction, and/or ischemia-reperfusion injury.
HDR Syndrome (Hypoparathyroidism, Sensorineural Deafness and Renal Disease) Accompanied by Hirschsprung Disease
Mohsen Akhavan Sepahi,Behrouz Baraty,Fatemeh Khalifeh Shooshtary
Iranian Journal of Pediatrics , 2010,
Abstract: Background: HDR syndrome (hypoparathyroidism, sensorineural deafness and renal disease) is an autosomal dominant condition, defined by the triad hypoparathyroidism, renal dysplasia and hearing loss. Hirschsprung (HSCR) disease is a variable congenital absence of ganglion cells of the enteric nervous system resulting in degrees of functional bowel obstruction. Rarer chromosomal anomalies are reported in combination with Hirschsprung disease like DiGeorge syndrome, mosaic trisomy 8, XXY chromosomal constitution, partial duplication of chromosome 2q, tetrasomy 9p, and 20p deletion. Case Presentation: Here, we describe an 8 year-old girl with HDR syndrome accompanied by Hirschsprung disease. Although the association of Hirschsprung disease with chromosomal anomalies has been reported, according to our knowledge, this is the first report of associated HSCR with HDR syndrome.
Level of circulating cytokines and microelements in patients with hemorrhagic fever accompanied by renal syndrome  [PDF]
Khasanova G.M.
Saratov Journal of Medical Scientific Research , 2011,
Abstract: The research goal is to examine the interrelation of cytokines level (INF-y, TNF-a, IL-2, IL-4, IL-10) and concentration of microelements in blood of patients with hemorrhagic fever accompanied by renal syndrome. 292 patients aged 18-59 years have been examined.Enzyme immunodetection has been carried out by using reagents from Vector-Best (Novosibirsk). The content of microelements in blood plasma has been estimated by mass spectrometry with inductively coupled plasma (ICP-MS; Elan-9000, PerkinElmer, USA) and atomic emission spectrometry with inductively coupled plasma (ICP-OES; Optima-2000 DV, PerkinElmer, USA). A direct correlation between zinc, selenium, the level of IL-2 and lead, aluminum, the level of TNF-a has been found out. The negative correlation between aluminum concentration and the level of IF-y has been determined
Effects of Qingshen Granule on serum interleukin-8 and -18 levels in patients with a sharp deterioration of chronic renal failure and dampness-heat syndrome: a randomized controlled trial  [cached]
Fei WANG
Zhong Xi Yi Jie He Xue Bao , 2010,
Abstract: Background: Dampness-heat syndrome is a major syndrome type in patients with a sharp deterioration of chronic renal failure (CRF). Qingshen Decoction, a compound traditional Chinese herbal medicine, could relieve the clinical symptoms of CRF patients, and was considered to have a certain reversal effect on rapid deterioration of renal function.Objective: To observe the changes of serum interleukin-8 (IL-8) and IL-18 levels in CRF patients with a sharp deterioration and dampness-heat syndrome, and to explore the curative efficacy of Qingshen Granule.Design, setting, participants and interventions: Sixty CRF patients with a sharp deterioration and dampness-heat syndrome from Department of Nephrology, the First Affiliated Hospital of Anhui College of Traditional Chinese Medicine, were randomly divided into treatment group (30 cases) and control group (30 cases), with another 20 healthy individuals as normal control. The patients in the treatment and control groups were all treated with Jiedu Xiezhuo Ⅱ, a compound traditional Chinese herbal medicine, given as retention enema. Qingshen Granule was additionally administered to the patients in the treatment group with 1 dosage each time and 3 times a day. The treatment course was one month.Main outcome measures: The levels of serum IL-8 and IL-18 in the normal individuals and before and after treatment in the treatment and control groups were detected.Results: The total response rates of treatment group in clinical efficacy assessment and assessment of syndrome of traditional Chinese medicine (86.67% and 86.67%) were higher than those of the control group (56.67% and 60%), and there were significant differences between the two groups (P<0.05). The levels of serum IL-8 and IL-18 in CRF patients before treatment were obviously higher than those in the healthy individuals (P<0.01), and there were no differences in the levels of IL-8 and IL-18 before treatment between the treatment group and control group (P>0.05). After one-month treatment, the levels of serum IL-8 and IL-18 were markedly decreased in the two groups (P<0.01), and the levels of serum IL-8 and IL-18 in the treatment group were markedly lower than those in the control group (P<0.05). There were differences in decreased degrees of IL-8 and IL-18 levels between the two groups (P<0.05).Conclusion: CRF patients with a sharp deterioration and dampness-heat syndrome have high serum IL-8 and IL-18 levels. Qingshen Granule can reduce the levels of serum IL-8 and IL-18, and improve the renal function and ameliorate the clinical symptoms.
Segmental arterial mediolysis accompanied by renal infarction and pancreatic enlargement: a case report
Ito Nobuhisa,Kuwahara Go,Sukehiro Yuta,Teratani Hiromitsu
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-307
Abstract: Introduction Due to recent advances in imaging diagnostic techniques, there are an increasing number of case reports of segmental arterial mediolysis. However, there are only a limited number of reports on segmental arterial mediolysis-related abnormalities of abdominal organs other than the intestine. This report describes a case of segmental arterial mediolysis accompanied by abnormalities of abdominal organs without clinical symptoms. Case presentation A 52-year-old Japanese man with hematuria and no prior medical history was referred to a urologist and was diagnosed as having urinary bladder cancer. He underwent trans-urethral resection of the bladder tumor and intra-vesical instillation therapy, which was followed by observation. During follow-up, although no abdominal symptoms were observed, an abdominal computed tomography scan revealed a dissection of the superior mesenteric artery. A false lumen partially occluded by a thrombus was located distal to this occlusion. The lumen was irregularly shaped with narrow and wide sections. Similar irregularities were also observed in the wall of the inferior mesenteric artery. Arterial dissection with thromboembolism in the left renal artery and renal infarction was also observed. Follow-up computed tomography after two months revealed an enlargement of the pancreatic tail adjacent to the splenic artery. Follow-up three-dimensional computed tomography showed gradual re-expansion of the true lumen of the superior mesenteric artery, improvement in arterial wall irregularities, and a reduction in the pancreas enlargement and renal infarction. Over the following 15 months, these changes gradually normalized. On the basis of the vascular changes in multiple arterial systems that resolved spontaneously, we considered that the lesions were associated with segmental arterial mediolysis. Conclusions We present a rare case of segmental arterial mediolysis accompanied by abnormalities of abdominal organs without clinical symptoms. Three-dimensional computed tomography was useful for follow-up evaluation in our patient.
Urinary and Plasma Levels of Vasohibin-1 Can Predict Renal Functional Deterioration in Patients with Renal Disorders  [PDF]
Norikazu Hinamoto, Yohei Maeshima, Daisuke Saito, Hiroko Yamasaki, Katsuyuki Tanabe, Tatsuyo Nasu, Hiroyuki Watatani, Haruyo Ujike, Masaru Kinomura, Hitoshi Sugiyama, Hikaru Sonoda, Yasufumi Sato, Hirofumi Makino
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0096932
Abstract: Vasohibin-1 (VASH-1) is a negative feedback regulator of angiogenesis, and a small vasohibin-binding protein (SVBP) serves as its secretory chaperone and contributes to its antiangiogenic effects. In the present study, we aimed to define the clinical significance of VASH-1 and SVBP in patients with chronic kidney disease (CKD). We recruited 67 Japanese hospitalized patients with renal disorders with (n = 45) or without (n = 22) renal biopsy samples and 10 Japanese healthy controls. We evaluated the correlations between the plasma and urinary levels of VASH-1/VASH-1-SVBP complex/SVBP and the clinicopathological parameters. The plasma levels of VASH-1 were inversely correlated with age and systolic and diastolic blood pressure and positively correlated with crescent formation. Increased plasma and urinary levels of VASH-1 and VASH-1-SVBP complex were significantly correlated with worse renal outcomes. These results demonstrate an association between elevated urinary and plasma levels of VASH-1 and progressive decline of the renal function, thus suggesting a potential role for VASH-1 in predicting a worse renal prognosis in patients with renal disease, including CKD.
Chronic asymptomatic pyuria precedes overt urinary tract infection and deterioration of renal function in autosomal dominant polycystic kidney disease  [cached]
Hwang Jin Ho,Park Hayne Cho,Jeong Jong Cheol,ha Baek Seon
BMC Nephrology , 2013, DOI: 10.1186/1471-2369-14-1
Abstract: Background Urinary tract infection (UTI) occurs in 30%-50% of individuals with autosomal dominant polycystic kidney disease (ADPKD). However, the clinical relevance of asymptomatic pyuria in ADPKD patients remains unknown. Methods We retrospectively reviewed medical records of 256 ADPKD patients who registered to the ADPKD clinic at Seoul National University Hospital from Aug 1999 to Aug 2010. We defined the asymptomatic pyuria as more than 5-9 white blood cells in high-power field with no related symptoms or signs of overt UTI. Patients were categorized into 2 groups depending on its duration and frequency: Group A included non-pyuria and transient pyuria patients; Group B included recurrent and persistent pyuria patients. The association between asymptomatic pyuria and both the development of overt UTI and the deterioration of renal function were examined. Results With a mean follow-up duration of 65.3 months, 176 (68.8%) out of 256 patients experienced 681 episodes of asymptomatic pyuria and 50 episodes of UTI. The annual incidence of asymptomatic pyuria was 0.492 episodes/patient/year. The patients in group B showed female predominance (58.5% vs. 42.0%, P=0.01) and experienced an upper UTI more frequently (hazard ratio: 4.612, 95% confidence interval: 1.735-12.258; P=0.002, adjusted for gender and hypertension). The annual change in estimated glomerular filtration rate (ΔeGFR) was significantly larger in magnitude in group B than in group A (-2.7±4.56 vs. -1.17±5.8, respectively; P=0.01). Age and Group B found to be the independent variables for ΔeGFR and developing end-stage renal disease (16.0% vs. 4.3%, respectively; P=0.001). Conclusions Chronic asymptomatic pyuria may increase the risk of developing overt UTI and may contribute to declining renal function in ADPKD.
Deterioro agudo de la función renal en una Unidad Coronaria en Espa a Acute renal function deterioration in a Coronary Unit in Spain
D. Martí,C. Escobar,N. Dedieu,F. Lia?o
Medicina Intensiva , 2008,
Abstract: Objetivo. Valorar la incidencia y el valor pronóstico del deterioro agudo de la función renal (DAFR) en pacientes cardiológicos agudos. ámbito. Unidad Coronaria de un hospital universitario terciario. Dise o. Estudio retrospectivo. Pacientes. Cien pacientes consecutivos ingresados durante 2004. Intervenciones. No hubo intervenciones aleatorizadas. Los procedimientos diagnósticos y terapéuticos se realizaron de acuerdo con protocolos locales y las Guías de Práctica Clínica en uso. Variables principales. El objetivo primario del estudio fue analizar la incidencia de DAFR y su relación con la mortalidad por cualquier causa durante el ingreso. Se definió DAFR como el aumento de la creatinina sérica respecto a la basal mayor de 0,5 mg/dl y/o mayor del 50%. Resultados. La incidencia de DAFR fue del 26%, con un incremento medio de la creatinina sérica de 1,5 ± 0,9 mg/dl. El DAFR se asoció de forma significativa con la edad y los antecedentes de hipertensión e insuficiencia renal crónica. Los pacientes con DAFR tuvieron un curso más complicado, mayores estancias hospitalarias y recibieron menos cateterismos. El empeoramiento agudo de la función renal se asoció con mayor mortalidad hospitalaria (33% frente a 6%, p = 0,002). Conclusiones. El DAFR es frecuente en el paciente cardiópata agudo y su presencia se asocia con alta mortalidad. Objective. To assess the incidence and prognostic value of acute renal function deterioration (ARFD) in patients with acute heart disease. Setting. Coronary Care Unit in a tertiary university hospital. Design. Retrospective study. Participants. One hundred consecutive patients admitted during 2004. Interventions. No randomized interventions were done. Diagnostic and therapeutic procedures were performed according to local protocols and current Clinical Practice Guidelines. Primary variables. The primary aim of the study was to analyze the incidence of acute renal function deterioration and its effect in mortality during hospitalization. ARFD was defined as the increase of serum creatinine by 0.5 mg/dl and/or by 50% over baseline. Results. Incidence of ARFD was 26%, with a mean increase of serum creatinine of 1.5 ± 0.9 mg/dl. ARFD was significantly associated with age, background of hypertension and chronic kidney disease. Patients with ARFD had a more complicated course, longer hospitalizations, and received fewer catheterisms. Acute renal function deterioration was associated with higher mortality during hospitalization (33% versus 6%, p = 0.002). Conclusions. Acute renal function deterioration is frequent in patients with acute h
Reversal of end-stage renal disease after aortic dissection using renal artery stent: a case report
Andrew S Weiss, Michael Ludkowski, Chirag R Parikh
BMC Nephrology , 2004, DOI: 10.1186/1471-2369-5-7
Abstract: A 69 y/o male with a Type B aortic dissection diagnosed two months earlier was found to have a serum creatinine of 15.2 mg/dL (1343.7 μmol/L) on routine visit to his primary care physician. An MRA demonstrated a rightward spiraling aortic dissection flap involving the origins of the celiac artery, superior mesenteric artery, and both renal arteries. The right renal artery arose from the false lumen with lack of blood flow to the right kidney. The left renal artery arose from the true lumen, but an intimal dissection flap appeared to be causing an intermittent stenosis of the left renal artery with compromised blood flow to the left kidney. Endovascular reconstruction with of the left renal artery with stent placement was performed. Hemodialysis was successfully discontinued six weeks after stent placement.Percutaneous intervention provides a promising alternative for patients with Type B aortic dissections when medical treatment will not improve the likelihood of meaningful recovery and surgery entails too great a risk. Nephrologists should therefore be aggressive in the workup of ischemic renal failure associated with aortic dissection as percutaneous intervention may reverse the effects of renal failure in this population.Medical management is the conventional treatment for most Stanford Type B aortic dissections. Surgical intervention is warranted when the dissection is thought to be rapidly expanding with impending rupture, or when there is impairment of blood flow to organs or limbs [1]. Renal ischemia is a major complication of aortic dissection occurring anywhere from 8% to 60% of presentations [2,3]. One study revealed that operative risk increased from 23% to 80% when renal or visceral ischemia was present [4]. Another study looking at operative risk for aortic dissection presenting with peripheral vascular complications revealed that impaired renal function was the only complication that was a significant independent predictor of increased operative mortal
Late de novo minimal change disease in a renal allograft  [cached]
Madhan Krishan,Temple-Camp Cynric
Saudi Journal of Kidney Diseases and Transplantation , 2009,
Abstract: Among the causes of the nephrotic syndrome in renal allografts, minimal change disease is a rarity with only few cases described in the medical literature. Most cases described have occurred early in the post-transplant course. There is no established treatment for the condition but prognosis is favorable. We describe a case of minimal change disease that developed 8 years after a successful transplantation of a renal allograft in a middle-aged woman. The nephrotic syndrome was accompanied by deterioration of allograft function. Treatment with mycophenolate mofetil was successful in inducing remission and stabilizing allograft function.
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