Every nephron deserves a second chance before nephrectomy in obstructed uropathy due to urolithiasis

2021 ◽  
pp. 039156032110190
Author(s):  
Senol Tonyali ◽  
Mazhar Ortac ◽  
Murat Dursun
Keyword(s):  
Left Kidney ◽  
Flank Pain ◽  
Renal Scintigraphy ◽  
Renal Unit ◽  
Intractable Pain ◽  
Urinary Drainage ◽  
Double J Stent ◽  
Appointment List ◽  
Split Function ◽  
Second Chance

Objective: In this case report, we aimed to present our clinical experience in a patient with hydronephrotic and atrophic kidney due to impacted lower ureteral stone. Case description: A 56-year-old male was admitted to our emergency department with flank pain and nausea. A computed tomography scan revealed a 3 cm stone at the distal ureter, causing severe hydroureteronephrosis. Right kidney parenchyma was extremely thin at the medial zone, and some parenchyma was apparent at the upper and lower poles. We planned renal scintigraphy, but it was impossible to perform quickly due to the active appointment list. The patient’s kidney was assumed to be atrophic/non-functioning; however, given the long waiting list for renal scintigraphy and the patient’s intractable pain, we decided to relieve the patient’s pain with urinary drainage. Nephrostomy insertion was denied because of the extra thin parenchyma. About 40 days later, the patient underwent semi-rigid ureterorenoscopy under spinal anesthesia. It was impossible to place a double J stent to the ureter because of the kinked and extremely dilated ureter. So, we decided to place an open-end 6Fr ureter catheter. DMSA renal scintigraphy showed 33% right kidney and 67% left kidney function. Conclusion: Intractable flank pain might be a predictor of functioning renal parenchyma in hydronephrotic/atrophic kidneys. Renal split function lower than 10% on DMSA scintigraphy might not be an absolute indication of nephrectomy, especially in the obstructed renal unit. Evaluation of renal function after eliminating obstruction might be more reliable.

scholarly journals Parenchymal mucinous cystadenoma of the kidney: a case report and literature review

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Mahmoudreza Kalantari ◽  
Shakiba Kalantari ◽  
Mahdi Mottaghi ◽  
Atena Aghaee ◽  
Salman Soltani ◽  
...  
Keyword(s):  
Renal Cyst ◽  
Left Kidney ◽  
Previous History ◽  
Mucinous Cystadenoma ◽  
Single Layer ◽  
Renal Cysts ◽  
Cystic Mass ◽  
Flank Pain ◽  
History Of

Abstract Background Mucinous cystadenoma (MC) of the kidney is exceedingly rare. We found 22 similar cases in the literature. These masses are underdiagnosed due to radiologic similarities with simple renal cysts. Case presentation A 66-year-old man with a previous history of hypertension and anxiety was referred to our tertiary clinic with left flank pain. Ultrasound revealed a 60 mm-sized, complex cystic mass with irregular septa in the lower pole of the left kidney (different from last year's sonographic findings of a simple benign cyst with delicate septa). CT scan showed the same results plus calcification. Due to suspected renal cell carcinoma, a radical nephrectomy was performed. Postoperative histopathologic examination revealed a cyst lined by a single layer of columnar mucin-producing cells with small foci of pseudo-stratification, consistent with the MC’s diagnosis. The first follow-up visit showed normal blood pressure without medication and no flank pain and anxiety after a month. Conclusion It is quite challenging to distinguish the primary MC of the kidney from a simple renal cyst based on clinical and imaging findings. The radiologic features of these entities overlap significantly. Thus, complex renal cyst and renal cysts with mural nodules should be followed closely to detect malignancy earlier.

scholarly journals Laparoscopic transposition for crossing vessels (vascular hitch) in pure extrinsic pelvic-ureteric junction obstruction: a successful case report of a 2-year-old infant with horseshoe kidney

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Satoshi Ieiri ◽  
Kouji Nagata
Keyword(s):  
Laparoscopic Surgery ◽  
Left Kidney ◽  
Horseshoe Kidney ◽  
Renal Scintigraphy ◽  
Multicystic Dysplastic Kidney ◽  
Extrinsic Compression ◽  
Dysplastic Kidney ◽  
Renal Vessels ◽  
The Right ◽  
Crossing Vessels

Abstract Background Pediatric hydronephrosis induced by pelvic-ureteric junction obstruction (PUJO) is treated by dismembered pyeloplasty (DP) via open and laparoscopic surgery. The etiology of PUJO involves both intrinsic stenosis and extrinsic compression of crossing vessels (CVs). PUJO owing to CVs is also treated by DP, as there is no consensus concerning this vascular condition. We encountered a 2-year-old infant with pure extrinsic PUJO combined with horseshoe kidney who successfully underwent laparoscopic transposition for CVs (vascular hitch). Case presentation A 2-year-old boy was prenatally diagnosed with left multicystic dysplastic kidney (MDCK) and right hydronephrosis and received a definitive diagnosis after birth. At 6 months old, renal scintigraphy revealed a non-functioning pattern in the left kidney and an obstructive pattern in the right, showing no response to furosemide loading. The patient also had recurrent urinary tract infection, and his right hydronephrosis gradually worsened. We decided to perform surgery for the right PUJO. Preoperative enhanced computed tomography detected three right renal vessels independently branching from the abdominal aorta. The middle renal vessels were located at the ventral side of the pelvis and coincident with the site of PUJO. These vessels were suspected of being CVs. The patient underwent laparoscopic surgery electively. A 5-mm trocar was inserted at the umbilicus for a 5-mm, 30° rigid scope. Two additional ports were then inserted under laparoscope inspection. The dilated right pelvis and CVs were detected after ascending colon mobilization. To confirm the pathogenesis of PUJO, the CVs were dissected and taped. After taping the CVs, an intraoperative diuretic test was performed using furosemide loading. Peristalsis of the right ureter was recognized, and the extrinsic PUJO owing to the CVs was definitively confirmed. We therefore performed transposition for the CVs (vascular hitch procedure). The CVs were mobilized in the cranial direction and those were wrapped by dilated pelvis. The post-operative course was uneventful. The renal scintigraphy findings improved and showed a favorable response of furosemide loading. Conclusions The laparoscopic vascular hitch procedure is minimally invasive and effective for extrinsic PUJO due to CVs. Anastomotic stricture after Anderson and Hynes DP can be prevented by appropriate patient selection.

Abnormal left kidney in a patient with acute flank pain

JAMA ◽  
1979 ◽  
Vol 242 (1) ◽  
pp. 75-76
Author(s):  
R. L. Dubuisson
Keyword(s):  
Left Kidney ◽  
Flank Pain ◽  
Acute Flank Pain

scholarly journals Renal Parenchyma Perforation and Hematoma Formation following Double-J Stent Insertion in a Solitary Functioning Kidney: An Unusual Complication

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Michael S. Nomikos ◽  
Zacharias Chousianitis ◽  
Christos Georgiou ◽  
Chrysostomos Georgellis ◽  
Panagiotis Rikas ◽  
...  
Keyword(s):  
Left Kidney ◽  
Stent Insertion ◽  
Unusual Complication ◽  
Hematoma Formation ◽  
The Past ◽  
Double J Stent ◽  
Noncontrast Computed Tomography ◽  
Functioning Kidney ◽  
Collecting System

Double-J ureteral stent insertion is a common urological procedure performed for the relief of ureteral obstruction or as a part of other endourological procedures. Several complications have been reported in the past. A case of a 62-year-old woman who was stented due to hydronephrosis of her solitary functioning left kidney and had renal perforation and retroperitoneal hematoma formation is presented. She was managed conservatively with blood transfusion and double-J stent repositioning in the collecting system the fifth postoperative day. Follow-up noncontrast computed tomography (CT) of the abdomen was performed the first and third months after stent placement which showed stabilization of the hematoma.

scholarly journals Salvage ipilimumab associated with a significant response in sarcomatoid renal cell carcinoma

2020 ◽  
Vol 8 (1) ◽  
pp. e000584 ◽  
Author(s):  
Gemlyn George ◽  
Laura Schmidt ◽  
Parag Tolat ◽  
Mathew Riese ◽  
Deepak Kilari
Keyword(s):  
Renal Cell Carcinoma ◽  
Partial Response ◽  
Combination Therapy ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Left Kidney ◽  
Single Agent ◽  
Flank Pain ◽  
Significant Response ◽  
Sarcomatoid Renal Cell Carcinoma

BackgroundMetastatic sarcomatoid renal cell carcinoma (sRCC) is an aggressive variant of RCC with generally poor prognosis. Treatment with vascular endothelial growth factor inhibitors or chemotherapy generates only short-lived responses. Recent research has suggested a role for combination checkpoint inhibition as first line treatment for metastatic sRCC. This therapy consists of induction with cytotoxic T-lymphocyte-associated protein 4 inhibitor, ipilimumab, administered with programmed cell death protein 1 (PD-1) inhibitor, nivolumab. After completion of four cycles of combination therapy, single-agent maintenance nivolumab is recommended until progression. Patients who progress on maintenance nivolumab are switched to alternate therapy. Herein, we present a case of a patient with RCC who progressed on maintenance nivolumab who, on retreatment with ipilimumab, demonstrated a significant response In addition, we summarize important findings to support the role of salvage ipilimumab in patients with sRCC.Case presentationA 46-year-old man presented with flank pain and hematuria, the work up of which noted a left kidney mass for which he underwent nephrectomy and was diagnosed with localized sRCC with 60% sarcomatoid differentiation. Within 3 months of nephrectomy, he presented with recurrent flank pain and was diagnosed with recurrence of disease. He was treated with ipilimumab 1 mg/kg and nivolumab 3 mg/kg for four doses and demonstrated a partial response. He was then transitioned to single agent nivolumab maintenance. After 3 months on maintenance therapy, he was noted to have progression of disease. Given prior response to immune check point combination, it was decided to rechallenge the patient with 1 mg/kg ipilimumab. After two doses of ipilimumab and nivolumab combination therapy, the patient was noted to have a partial response. He maintained a response for an additional 9 months and treatment was eventually discontinued due to grade 3 toxicity and progression.ConclusionsThis case report demonstrates the utility of retreatment with ipilimumab as a salvage option for patients progressing on maintenance PD-1 inhibitors in metastatic RCC. Further studies are needed to identify predictors of response and toxicity to this approach, as well as the optimal scheduling of ipilimumab with maintenance nivolumab.

Ring sign over left kidney in 99mTc DTPA renal scintigraphy

2010 ◽  
Vol 29 (3) ◽  
pp. 140-141
Author(s):  
E. Ceylan Gunay ◽  
A. Erdogan
Keyword(s):  
Left Kidney ◽  
Renal Scintigraphy

scholarly journals Symptomatic Infundibulopelvic Dysgenesis in an Adolescent

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Daniel Pitts ◽  
David Chalmers ◽  
Brian Jumper
Keyword(s):  
Complete Resolution ◽  
Left Kidney ◽  
Rare Condition ◽  
Renal Calculi ◽  
Flank Pain ◽  
Pelvicalyceal System ◽  
Retrograde Pyelogram ◽  
History Of ◽  
The Right ◽  
Collecting System

Infundibulopelvic dysgenesis is a rare condition characterized by congenital malformation of the pelvicalyceal system. We present the case of an 18-year-old boy with chronic intermittent right flank pain and cystic dilation with parenchymal thinning on ultrasonography. The left kidney was normal. The patient denied dysuria, constipation, and history of UTIs or renal calculi. Cystoscopy with retrograde pyelogram showed marked stenosis of the right pelvicalyceal system and anatomy unfavorable to stenting. The patient’s symptoms were unresponsive to conservative management. Reconstruction of the right collecting system was unsuccessful and a simple nephrectomy was performed, which led to complete resolution of his symptoms.

What Resulted in the Radioactivity Superior to the Left Kidney on Renal Scintigraphy?

2007 ◽  
Vol 32 (4) ◽  
pp. 325-327 ◽  
Author(s):  
Hongming Zhuang ◽  
Jian Q. Yu ◽  
Hua Yang ◽  
Lisa J. States
Keyword(s):  
Left Kidney ◽  
Renal Scintigraphy

scholarly journals Late-Onset Kidney Biopsy-Associated Retroperitoneal Hemorrhage in Lupus Nephritis: A Case Report of Pseudoaneurysm and Microaneurysm Formations

2021 ◽  
pp. 55-62
Author(s):  
Panupong Hansrivijit ◽  
Kinjal P. Gadhiya ◽  
Sandra D. Zelonis ◽  
John T. Cinicola
Keyword(s):  
High Risk ◽  
Lupus Nephritis ◽  
Kidney Biopsy ◽  
Late Onset ◽  
Left Kidney ◽  
Flank Pain ◽  
Unusual Complication ◽  
Lower Pole ◽  
Retroperitoneal Hemorrhage ◽  
Ct Guided

Late-onset retroperitoneal hemorrhage from renal intraparenchymal pseudoaneurysm (RIP) following a kidney biopsy is an extremely rare complication but should not be ignored, especially in high-risk populations. Here, we introduce a 32-year-old Caucasian female who presented with sudden-onset left-sided flank pain. She had recently been diagnosed with systemic lupus erythematosus (SLE) and had undergone a computed tomography (CT)-guided core needle biopsy of the left kidney 9 days earlier. The results were consistent with lupus nephritis class III or IV. Initial vitals were within normal limits. She appeared pale and her left flank was tender to palpation without discoloration or abdominal distention. Laboratory investigations showed a hemoglobin level of 7.1 g/dL. The CT scan of the abdomen and pelvis revealed a large hyperdense left perinephric collection consistent with perinephric hematoma with a moderate amount of retroperitoneal stranding most prominent on the left side extending across the midline to the right side. Contrast extravasation was suspected in the lower pole of the left kidney consistent with active bleeding site. Emergent renal angiography revealed a 2 × 1 cm intraparenchymal pseudoaneurysm in the lower pole of the left kidney along with a few small microaneurysms. Coil embolization of the pseudoaneurysm was successfully performed without any complications. In conclusion, SLE or lupus nephritis in this patient may be the predisposing factors for microaneurysm and RIP formations. RIP is an unusual complication after percutaneous kidney biopsy that carries a significant mortality rate if ruptured, causing retroperitoneal hemorrhage. Clinicians should be vigilant when encountering high-risk patients with persistent hematuria, flank pain, or abdominal pain within four weeks after a kidney biopsy.

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