Ischämieprotektion der Nieren bei thorakoabdominalen Aortenrekonstruktionen: leistet Prostaglandin E1 mit Kühlung mehr als die alleinige Kühlung?

Background: Prostaglandin E1 (PGE1) is known to have a positive effect on kidney function after kidney ischaemia due to aortic clamping. Side effects of PGE1 are a decrease of systemic blood pressure and prevention of thrombocyte clotting, both being undesired during repair of thoracoabominal aortic aneurysms (TAA). The aim of this study was to evaluate, whether intraoperative and intraarterial kidney perfusion with 4° Ringer’s lactate plus 1000 IU of heparin/l plus 20 mug PGE1/l is more effective in preventing postischaemic kidney dysfunction than cold perfusion without PGE1. Patients and methods: In the time period from I/1996 until X/1998 58 patients underwent aortic repair for TAA type II, III, or IV (Crawford’s classification). Ten patients fulfilled the criteria for this study: renal artery stenosis or occlusion was excluded by angiography pre- and postoperatively. By means of szintigraphy an at least 30% participation in renal function had to be proven for every kidney. Intraoperatively both kidneys had to be excluded from circulation simultaneously. The left kidney in each patient was perfused with 4° Ringer’s lactate plus 1000 IU of heparin/l plus 20 mug PGE1/l. The right kidney was perfused with a solution of the same temperature plus heparin but without PGE1. Results: There was an intermittent increase of creatinin and/or urea in each patient postoperatively. By renal szintigraphy, which was performed after a mean time of 9 (5–13) days postoperatively, a shift of renal function from one kidney to the other could be excluded. Conclusion: In this experimental setting no additional benefit for kidney function could be detected, when under conditions of ischaemia kidneys were perfused with 4° Ringer’s lactate plus 1000 IU of heparin/l plus 20 mg PGE1/l compared to kidneys perfused with the same solution without PGE

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STUDY OF RADIATION CHARACTERISTICS THE RENAL FUNCTION IN PATIENTS WITH TYPE 2 DIABETES

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2014.2.12 ◽

2014 ◽

pp. 73-77

Author(s):

Van Chuong Nguyen ◽

Thi Kim Anh Nguyen

Keyword(s):

Type 2 Diabetes ◽

Renal Function ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Filtration Rate ◽

Disease Duration ◽

Left Kidney ◽

Cross Sectional ◽

The Right

Background: A Research glomerular filtration rate (GFR) of 61 patients with type 2 diabetes mellitus with renal scanning 99mTc-DTPA glomerular filtration rate at the hospital 175. Objective: (1) To study characteristics of imaging of renal function. (2) Understanding the relationship between GFR with blood sugar, HbA1c, blood pressure and albuminuria in patients with type 2 diabetes. Methods: Descriptive, prospective, cross-sectional study. Clinical examination, Clinical tests and 99mTc-DTPA GFR gamma - camera renography for patients. Result: GFR of the study group was 75,4 ± 22,3 ml/phut/1,73m2, the left kidney was 35,0 ± 13,0 is lower than the right kidney and 39,8 ± 11,9; p <0,01. There is no correlation between GFR with blood glucose and HbA1c, the risk of reduced GFR in hypertensive group associated is OR = 6,5 with p<0,01; albuminuria (+) is OR = 4,2 with p <0,01; and disease duration > 10 years is OR = 3,5 with p <0.01. Conclusion: GFR of the left kidneys is lower than the right kidney; correlation decreased GFR associated with hypertension, albuminuria and disease duration. Keywords: GFR, diabetes, albuminuria

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Case 7.25

Mayo Clinic Body MRI Case Review ◽

10.1093/med/9780199915705.003.0186 ◽

2014 ◽

pp. 353-354

Author(s):

Christine U. Lee ◽

James F. Glockner

Keyword(s):

Renal Function ◽

Soft Tissue ◽

Left Kidney ◽

The Right

30-year-old man with decreased renal function Coronal SSFSE (Figure 7.25.1) and axial fat-suppressed T2-weighted FSE (Figure 7.25.2) images reveal hydronephrosis in the upper pole of the right kidney and an atrophic left kidney with hydronephrosis. Note the rind of hypointense soft tissue surrounding both kidneys. Coronal (...

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Renal scintigraphy as an early and efficient method for detecting loss of renal function in a cat

Journal of Feline Medicine and Surgery Open Reports ◽

10.1177/20551169211062551 ◽

2021 ◽

Vol 7 (2) ◽

pp. 205511692110625

Author(s):

Gabriela C Schaefer ◽

Mariana M Brose ◽

José R Herrera Becerra ◽

Fabíola PS Mello ◽

Inácio B Rovaris ◽

...

Keyword(s):

Renal Function ◽

Complete Blood Count ◽

Left Kidney ◽

Health Assessment ◽

Serum Biochemistry ◽

Reference Intervals ◽

Renal Scintigraphy ◽

Abdominal Ultrasonography ◽

Mild Reduction ◽

The Right

Case summary A 6-year-old mixed-breed male cat was evaluated for a routine annual health assessment. No alterations on physical examination were observed other than mild pain on palpation of the right kidney. Complete blood count, serum biochemistry (including symmetric dimethylarginine), urinalysis and urine protein:creatinine ratio were within the reference intervals for the species. Abdominal ultrasonography showed the presence of asymmetric kidneys, decreased corticomedullary definition, presence of a cyst on the left kidney and moderate renal pelvis dilatation on the right kidney. Dynamic renal scintigraphy (technetium [99mTc]-diethylenetriamine pentaacetic acid) revealed a single functioning kidney on the left. Static renal scintigraphy (99mTc-dimercaptosuccinic acid) exhibited renal activity practically restricted to the left kidney (relative uptake was 99% for the left kidney and 1% for the right kidney). Results of renal scintigraphy showed that the left kidney was compensating for the lack of function of the right one. GFR was 2.17 ml/min/kg, which is considered subclinical renal insufficiency and is in accordance with the case, as the cat was asymptomatic and did not present alterations in laboratory parameters. Relevance and novel information Renal scintigraphy was an important tool to determine the loss of renal function in one of the kidneys and mild reduction of global GFR. In this case report, renal scintigraphy proved to be more sensitive in the assessment of renal function than other tests routinely performed.

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Measurements of renal shear wave velocities in chronic kidney disease patients

Acta Radiologica ◽

10.1177/0284185117734417 ◽

2017 ◽

Vol 59 (7) ◽

pp. 884-890 ◽

Cited By ~ 2

Author(s):

Yutaka Sasaki ◽

Yoshiki Hirooka ◽

Hiroki Kawashima ◽

Takuya Ishikawa ◽

Kyosuke Takeshita ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Disease ◽

Shear Wave ◽

Interstitial Fibrosis ◽

Left Kidney ◽

Shear Wave Elastography ◽

University Hospital ◽

Success Rates ◽

The Right

Background Chronic kidney disease (CKD) patients have advanced glomerulosclerosis and renal interstitial fibrosis. Shear wave elastography (SWE) is useful to diagnose liver fibrosis. However, there are few data available regarding evaluation of kidney function on the use of SWE. Purpose To assess the utility of SWE by evaluating the correlation between renal function and renal elasticity using SWE. Material and Methods A total of 187 participants who had available serum creatinine levels and also underwent SWE of the kidney using a transabdominal ultrasonography were recruited at Nagoya University Hospital. We measured the depth of the shear wave (SW) in the right and left kidneys and calculated the measurement success rates. The glomerular filtration rate (GFR) classification and shear wave value (SWV) were compared. Results The success rates of the right and left kidneys were 93.6% and 71.6%, respectively. Based on these results, the correlation between GFR classification and SWV were analyzed in only the right kidneys because the success rates and the number of enrolled patients were low for the left kidney. There were significant differences found between G1 and G3a, G2 and G3a, G3a and G3b, G3a and G4, and G3a and G5. SWV significantly negatively and positively correlated with the G2–G3a and G3a–G3b classifications. Conclusion There is no correlation between renal function and SW. However, we can diagnose the progression to the CKD stages G3a and G3b by observing the changes over time using the SWV.

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Tubulointerstitial injury and impaired renal function after recovery from acute puromycin nephrosis

AJP Renal Physiology ◽

10.1152/ajprenal.1995.269.3.f331 ◽

1995 ◽

Vol 269 (3) ◽

pp. F331-F338 ◽

Cited By ~ 1

Author(s):

K. Baboolal ◽

T. W. Meyer

Keyword(s):

Renal Function ◽

Sodium Excretion ◽

Structural Changes ◽

Left Kidney ◽

Left Renal Artery ◽

Angiotensin Ii Receptor ◽

Tubulointerstitial Injury ◽

Albumin Excretion ◽

Angiotensin Ii Receptor Blockade ◽

The Right

Renal function was assessed at 2 and 8 wk after infusion of puromycin into the left renal artery of Munich Wistar rats. At 2 wk, albumin excretion averaged 90 +/- 12 micrograms/min in the left kidney and 4 +/- 1 microgram/min in the right kidney. Unilateral nephrosis was accompanied by reduction in the glomerular filtration rate (GFR) (left, 0.71 +/- 0.04; right, 1.31 +/- 0.02 ml/min) and by impaired excretion of sodium (FENa; left, 0.025 +/- 0.004; right, 0.064 +/- 0.006%). Reductions in GFR and FENa in the nephrotic kidney were not reversed by acute angiotensin II receptor blockade with losartan. At 8 wk, albumin excretion averaged 6 +/- 1 in the left kidney and 8 +/- 1 microgram/min in the right kidney. Recovery from nephrosis was accompanied by persistent reduction in GFR (left, 1.05 +/- 0.05; right, 1.41 +/- 0.05 ml/min) and impairment of sodium excretion in the previously nephrotic left kidney (left, 0.031 +/- 0.004; right, 0.051 +/- 0.004%). Losartan again did not return GFR and FENa toward normal. The reductions in GFR and FENa in the previously nephrotic left kidney were associated with structural changes, including intratubular casts, an increased fractional volume of the interstitium (left, 25 +/- 1; right, 15 +/- 1%), decreased fractional volume of tubules (left, 66 +/- 2; right, 77 +/- 1%), and glomerular collapse (left, 15 +/- 2; right, 1 +/- 1%). These findings suggest that tubulointerstitial injury can cause persistent reduction in GFR and impairment of sodium excretion after recovery from acute nephrosis.

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Efficacy of long-term low-dose sulodexide in diabetic and non-diabetic nephropathies

Romanian Journal Of Internal Medicine ◽

10.1515/rjim-2015-0022 ◽

2015 ◽

Vol 53 (2) ◽

pp. 161-169 ◽

Cited By ~ 1

Author(s):

Diana-Silvia Zilişteanu ◽

Teodora Atasie ◽

M. Voiculescu

Keyword(s):

Renal Function ◽

Low Dose ◽

Concomitant Administration ◽

Multivariate Regression Analysis ◽

Mean Value ◽

Hypertensive Nephropathy ◽

Time Period ◽

Baseline Response ◽

Mean Time

Abstract Background and Aims. Sulodexide has been reported to have antiproteinuric and nephroprotective properties. We investigated the effects of long-term low-dose Sulodexide on proteinuria and renal function in patients with chronic kidney disease (CKD) caused by diabetic nephropathy (DN), hypertensive nephropathy (HN) and primary glomerulonephritis (GN). Material and Methods. 100 patients with CKD received low-dose Sulodexide 50 mg/day for 12 months. Treatment efficacy was evaluated as proteinuria reduction compared to baseline; response was defined as a decline in proteinuria below 0.3 g/d. Renal function evolution was assessed by eGFR variation from baseline. Results. All patients presented reduction of proteinuria, with global mean value of proteinuria decrease of 0.85 ± 1.34 g/d (p<0.0001). Patients with HN had the highest mean percentage of proteinuria reduction (73±29%) and the lowest mean time period to achieve responder status (6.6±2.4 months), compared to patients with DN (57±29%, 8±2.9 months) and GN (63±24%, 10.7±1.2 months). Renal function as mean eGFR remained stable or improved during the study; significant increase was found only in HN group (3.41 ± 6.38 ml/min/1.73m2, p=0.043). Multivariate regression analysis identified that responder status was significantly associated with gender, baseline eGFR, baseline proteinuria and etiology of CKD. Concomitant administration of ACEIs or/and ARBs did not influence the response to Sulodexide therapy. Conclusions. Independently of ACEIs or/and ARBs therapy, long-term low-dose Sulodexide is efficient as antiproteinuric and renoprotective therapy in patients with CKD caused by DN, GN and HN. Better response is achieved in patients with lower degree of renal dysfunction.

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DMSA-scintigraphy in paediatrics: Is the evaluation of the geometric mean necessary for the calculation of the differential renal function?

Nuklearmedizin ◽

10.1055/s-0038-1625921 ◽

2001 ◽

Vol 40 (04) ◽

pp. 107-110 ◽

Cited By ~ 1

Author(s):

B. Roßmüller ◽

S. Alalp ◽

S. Fischer ◽

S. Dresel ◽

K. Hahn ◽

...

Keyword(s):

Renal Function ◽

Geometric Mean ◽

Region Of Interest ◽

Posterior View ◽

Renal Abnormality ◽

Anterior View ◽

Differential Renal Function ◽

The Mean ◽

The Right ◽

To Receive

SummaryFor assessment of differential renal function (PF) by means of static renal scintigraphy with Tc-99m-dimer-captosuccinic acid (DMSA) the calculation of the geometric mean of counts from the anterior and posterior view is recommended. Aim of this retrospective study was to find out, if the anterior view is necessary to receive an accurate differential renal function by calculating the geometric mean compared to calculating PF using the counts of the posterior view only. Methods: 164 DMSA-scans of 151 children (86 f, 65 m) aged 16 d to 16 a (4.7 ± 3.9 a) were reviewed. The scans were performed using a dual head gamma camera (Picker Prism 2000 XP, low energy ultra high resolution collimator, matrix 256 x 256,300 kcts/view, Zoom: 1.6-2.0). Background corrected values from both kidneys anterior and posterior were obtained. Using region of interest technique PF was calculated using the counts of the dorsal view and compared with the calculated geometric mean [SQR(Ctsdors x Ctsventr]. Results: The differential function of the right kidney was significantly less when compared to the calculation of the geometric mean (p<0.01). The mean difference between the PFgeom and the PFdors was 1.5 ± 1.4%. A difference > 5% (5.0-9.5%) was obtained in only 6/164 scans (3.7%). Three of 6 patients presented with an underestimated PFdors due to dystopic kidneys on the left side in 2 patients and on the right side in one patient. The other 3 patients with a difference >5% did not show any renal abnormality. Conclusion: The calculation of the PF from the posterior view only will give an underestimated value of the right kidney compared to the calculation of the geometric mean. This effect is not relevant for the calculation of the differntial renal function in orthotopic kidneys, so that in these cases the anterior view is not necesssary. However, geometric mean calculation to obtain reliable values for differential renal function should be applied in cases with an obvious anatomical abnormality.

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Early Coaching to Increase Water Intake in CKD

Annals of Nutrition and Metabolism ◽

10.1159/000515276 ◽

2021 ◽

Author(s):

Mariia D. Ivanova ◽

Anatoliy I. Gozhenko ◽

Tommy Crestanello ◽

Dmytro D. Ivanov

Keyword(s):

Renal Function ◽

Randomized Trial ◽

Kidney Function ◽

Water Intake ◽

Urine Volume ◽

Oral Solution ◽

Increase Water Intake ◽

Group Randomized Trial ◽

Ckd Stage ◽

Patient Reported

Introduction: In observational studies, increased water intake improves kidney function but not in adults with CKD stage 3 and more. CKD WIT trial has shown a nonsignificant gradual decline in kidney function after 1 year of coaching to increase water intake (CIWI) [<xref ref-type="bibr" rid="ref1">1</xref>]. We propose that CIWI may benefit in CKD stage 1–2 (G1 and G2) and depends on functional renal functional reserve (RFR) [<xref ref-type="bibr" rid="ref2">2</xref>, <xref ref-type="bibr" rid="ref3">3</xref>]. Objective: Parallel-group randomized trial was aimed to determinate the effectiveness of CIWI dependence of estimated glomerular filtration rate (eGFR) stage and RFR in adults with CKD 1–2 stages. Methods: CKD WIT trial was taken as the basis for prospective multicenter randomized trial named “Early Coaching to Increase Water Intake in CKD (ECIWIC).” The primary outcome was the change in kidney function by eGFR from baseline to 12 months. Secondary outcomes included 1-year change in urine albumin/Cr ratio, and patient-reported overall quality of health (QH) ranged from 0 (worst possible) to 10 (best possible). CIWI aimed to have the diuresis being 1.7–2 L. There were 4 groups with nondiet sodium restriction which consisted of 31 patients each: 2 groups with CKD G1 and CKD G2, undergoing CIWI and 2 others with CKD G1 and CKD G2 without CIWI (Fig. 1a). Overall checks were made at 0, 6, and 12 months. RFR evaluation was performed using 0.45% sodium chloride oral solution. Results: Of our randomized 124 patients (mean age 53.2 years; men 83 [67%], 0 died), mean change in 24-h urine volume was 0.6 L per day in G1 with CIWI group and 0.5 L in G2. No statistically significant data on eGFR depending CIWI were obtained (Fig. <xref ref-type="fig" rid="f01">1</xref>b). However, the trend suggests that CIWI improves eGFR in CKD G1 (from 95 to 96 mL/min/1.73 m2) and preserves eGFR decline in CKD G2 (78–78). The QH values were also preserved (from 7 to 7 in G1 and G2 groups). Although coaching to maintain the same water intake did not preserve physiological and pathological eGFR decreasing in CKD G1-2 (G1 from 96 to 93, G2 from 76 to 73; t = 0.6, p = 0.29, and p ≤ 0.05 in all groups) and the QH was declined (from 7 to 6 in both groups). An individual analysis of the RFR has shown that patients with RFR more than 50% (G1 19 patients, 61%, and G2 13 patients, 42%) had reliable preservation of eGFR with its increase of 1.5 mL/min on CIWI, while patients with low functional renal reserve had a drop of eGFR at 1.1 mL/min/m2 within 12 months. Patients with low normal serum sodium levels have shown worse results on CIWI. Conclusions: With CKD G1, the CIWI leads to the preservation of the renal function with its increase of GFR per 1 mL/min/m2/per year in comparison with the same water intake. In CKD G2, the CIWI prevents physiological and pathological loss of renal function, and RFR above 50% aids restoration of eGFR both in CKD G1-2. ECIWIC trial demonstrates benefit of CIWI in patients with CKD 1–2 and preserved RFR.

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109 Game Changing Magnetic Experience in Rural and Urban Wirral Peninsula - Our Experience with Magseed Localisation of Impalpable Breast Tumours and Axillary Nodes

British Journal of Surgery ◽

10.1093/bjs/znab134.368 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

T Arif ◽

R Vinayagam ◽

J M Lund ◽

S Poonawala

Keyword(s):

Incidental Finding ◽

Breast Tumour ◽

Axillary Node ◽

Reliable Technique ◽

Breast Tumours ◽

Rural And Urban ◽

Mean Size ◽

The Right ◽

A Prospective Study ◽

Mean Time

Abstract Introduction Magseed is a novel localization technology in which a tiny seed is inserted to accurately mark the site of breast tumour. These can be detected intra-operatively by sentimag localization system. It aids localization of impalpable breast lesions improving margin clearance rates. Method A prospective study of first fifty Magseed localised breast tumour and axillary node excisions in Clatterbridge General Hospital. Results A total of 50 patients had 52 Magseed inserted. n = 14 was symptomatic, n = 35 was screen detected and n = 1 was an incidental finding on surveillance mammogram for a B3 lesion. 30 seeds were inserted on the right and 22 were inserted on the left (two were bilateral). 44 seeds were inserted under ultrasound guidance and the rest were targeted under stereo guidance (n = 8). Deployment of two resulted in malposition requiring wire localization. Mean age of subjects was 59.76 (range 31-81) years. Mean time to surgery after magseed insertion was 8.04 (range 1-27) days. Mean weight of the specimen was 48.57(range 10-264) gm. Mean size of the lesions was 20.32 (range 8-65) mm. Redo surgery for margin clearance was performed bringing the re-excision rate to 15.38% (n = 8). Conclusions We conclude that Magseed localization of breast tumours is a safe and reliable technique

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1003 A Case of Tunnel-Vision in Upper Renal Tract Imaging: The Invisible Gorilla

British Journal of Surgery ◽

10.1093/bjs/znab134.345 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

M Swamad ◽

M K Quraishi ◽

S Ahmed

Keyword(s):

Renal Mass ◽

Left Kidney ◽

Interesting Case ◽

Ct Scans ◽

Renal Ultrasound ◽

Ultrasound Scan ◽

Surgical Team ◽

Tunnel Vision ◽

Impact Patient Care ◽

The Right

Abstract We present an interesting case of a 70-year-old female who presented with haematuria on the suspected cancer pathway. Renal ultrasound showed a vascular renal mass on her right kidney measuring 8x7cm with an unremarkable left kidney. She underwent a laparoscopic radical nephrectomy following confirmation of an 8cm renal mass in the right kidney on the contrasted staging CT scan with a repeat review at the multidisciplinary meeting. Post-operatively a subsequent review of the pre-operative CT and ultrasound scan, showed an incidental large left(contralateral) upper quadrant retroperitoneal fatty mass sized 15x10cm, displacing the stomach and spleen. Further investigation in the form of an MRI Abdomen excluded features of a liposarcoma, resulting in the diagnosis of a large retroperitoneal lipoma. This case highlights the significance of selective attention in imaging interpretation. We believe this to be a prime example of the level of meticulousness required as fat-rich tissues have low attenuation on CT-scans, which can be easily missed out. A cautious multi-clinician interpretation of scans should be performed to avoid missing potentially sinister pathology which would impact patient care dramatically. This case has led to more thorough review of future pre-operative imaging by the operating surgical team.

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