scholarly journals Revascularization of a single-kidney occluded stent for renal salvage complicated by guide wire distal artery perforation and reperfusion injury

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Angeliki Pastroma ◽  
Stavros Spiliopoulos ◽  
Konstantinos Palialexis ◽  
Lazaros Reppas ◽  
Elias Brountzos
Keyword(s):  
Reperfusion Injury ◽  
Guide Wire ◽  
Left Kidney ◽  
Elevated Serum ◽  
Simultaneous Occurrence ◽  
Left Renal Artery ◽  
Refractory Hypertension ◽  
Life Threatening ◽  
Stable Renal Function ◽  
Acute Renal Ischemia

Abstract Background The complexity of the case, including the rarefied simultaneous occurrence of complications—iatrogenic, as well as reperfusion injury, invite reporting and publication. Case presentation A 39-year-old woman with a single-functioning left kidney, previous left renal artery stenting (RAS), and known hypercoagulopathy was hospitalized for flash pulmonary edema, elevated serum creatinine (9.7 mg/dl), and refractory hypertension. She was subsequently referred to our center [2] for endovascular treatment of acute renal ischemia (AKI) due to RAS occlusion. Periprocedural complications of guide-wire arterial perforation and reperfusion injury resulted in life-threatening hemorrhage. Conclusions Following more than 48 h of hypoperfusion of the left kidney, revascularization of the thrombosed RAS was successfully attempted with selective, trans-catheter thrombolysis, and balloon angioplasty. Ultra-selective, nephron-sparing coil embolization was successfully performed. The patient’s creatinine level decreased to 2.8 mg/dl at 12 days and to 1.5 mg/dl at 3 months. After 1 year of follow-up, the stent remains patent, and the patient is asymptomatic with stable renal function.

scholarly journals Total occlusion of the abdominal aorta in a patient with renal failure and refractory hypertension: a case report

2015 ◽  
Vol 76 (1) ◽  
Author(s):  
Cinzia Perrino ◽  
Laura Scudiero ◽  
Maria Piera Petretta ◽  
Gabriele Giacomo Schiattarella ◽  
Mario De Laurentis ◽  
...  
Keyword(s):  
Renal Failure ◽  
Renal Artery ◽  
Abdominal Aorta ◽  
Left Kidney ◽  
Fatal Outcome ◽  
Left Renal Artery ◽  
Refractory Hypertension ◽  
Total Occlusion ◽  
Delay In Diagnosis ◽  
The Right

Total occlusion of the abdominal aorta is unusual, and potentially catastrophic. It occurs in patients with advanced atherosclerotic occlusive disease, and can cause severe ischemic manifestations, depending on the site of obstruction. Prompt and appropriate diagnostic and therapeutic approaches are important whenever this condition is suspected, in order to avoid a fatal outcome. The development of a complex network of collaterals may prevent the manifestation of acute ischemic phenomena, and cause a delay in diagnosis and treatment. Here we report the clinical case of a 59-year-old man who was referred to our Department for evaluation of renal failure and refractory hypertension. Ultrasonography and 99mTc-DTPA scintigraphy showed a shrunken, non-functioning left kidney, while CT angiography and aortography showed the complete occlusion of the aorta from below the right renal artery down to the bifurcation of both common iliac arteries, with a critical stenosis of the origin of the right renal artery, an occlusion of the left renal artery as well as of the origin of the inferior mesenteric artery. The patient was referred to the surgery department for aorto-bifemoral bypass surgery and re-implantation of the right renal artery.

Abstract 388: Postconditioning Beyond The Heart: Postconditioning The Ischemic Kidney Attenuates Renal Reperfusion Injury

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Shady M Eldaif ◽  
Jeremiah Deneve ◽  
Ning Ping Wang ◽  
Mario Mosunjac ◽  
Rong Jiang ◽  
...  
Keyword(s):  
Reperfusion Injury ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Left Kidney ◽  
Arterial Occlusion ◽  
Control Group ◽  
Left Renal Artery ◽  
List Type ◽  
Protective Effects ◽  
Pkc Signaling

Objective : Postconditioning (Poc), defined as brief cycles of arterial occlusion and reflow applied at the onset of reperfusion (R), has proven to reduce multiple consequences of myocardial ischemia-reperfusion injury (I/R). The protective effects of Poc in the kidney I/R are not known. Therefore, we tested the hypothesis that Poc attenuates renal I/R injury via adenosine receptor (AR) activation and protein kinase C (PKC) signaling. Methods : The in vivo single kidney rat model was used. Rats underwent right nephrectomy and were randomized to 5 groups. A sham group (n=8) underwent the surgical and perfusion protocol without other interventions. In all remaining groups, the left renal artery is occluded for 45min and the left kidney was reperfused for 24 hours. Control group (n=8) received no intervention at R; Poc (n=8) underwent 4 cycles of 45 seconds R and 45 seconds of reocclusion at the onset of R. PC + ARi (n=6): the AR inhibitor 8-SPT (10mg/kg) was administered i.v. 5 minutes before Poc; Poc + PKCi: the PKC inhibitor, chelerytherine (5mg/kg), was administered i.v. 5 min before R. After 24 hours, renal function was assessed by plasma blood urea nitrogen (BUN) and creatinine (Cr), and the kidneys were harvested; apoptotic cells were quantified by TUNEL stain and morphological injury by H&E staining. Results: Compared to sham, BUN and Cr were greater in control I/R group, which was significantly reduced in Poc (table ). Inhibition of AR or PKC stimulation reversed the reductions in BUN and Cr achieved by Poc. In addition, renal I/R increased the percentage of TUNEL positive cells in ten high powered fields vs Sham, which was reduced by Poc. Blockade of AR and PKC reversed the apoptosis reduction achieved by Poc. Conclusion: Postconditioning attenuates renal dysfunction and apoptosis induced by R injury and involves AR and PKC signaling. Poc suggests that R injury is triggered in early moments of reflow.

Effects of renovascular hypertension on rat adrenal zona glomerulosa

1978 ◽  
Vol 36 (2) ◽  
pp. 582-583
Author(s):  
G. Mazzocchi ◽  
P. Rebuffat ◽  
C. Robba ◽  
P. Vassanelli ◽  
G. G. Nussdorfer
Keyword(s):  
Renovascular Hypertension ◽  
Left Kidney ◽  
Renin Angiotensin System ◽  
Plasma Renin ◽  
Zona Glomerulosa ◽  
Ultrastructural Changes ◽  
Albino Rats ◽  
Left Renal Artery ◽  
Angiotensin System ◽  
And Control

It is well known that the rat adrenal zona glomerulosa steroidogenic activity is controlled by the renin-angiotensin system. The ultrastructural changes in the rat zona glomerulosa cells induced by renovascular hypertension were described previously, but as far as we are aware no correlated biochemical and morphometric investigations were performed.Twenty adult male albino rats were divided into 2 experimental groups. One group was subjected to restriction of blood flow to the left kidney by the application of a silver clip about the left renal artery. The other group was sham-operated and served as a control. Renovascular hypertension developed in about 10 days: sistolic blood pressure averaged 165 ± 6. 4 mmHg, whereas it was about 110 ± 3. 8 mmHg in the control animals. The hypertensive and control rats were sacrificed 20 days after the operation. The blood was collected and plasma renin activity was determined by radioimmunological methods. The aldosterone concentration was radioimmunologically assayed both in the plasma and in the homogenate of the left capsular adrenal gland.

Treatment of Malignant Esophageal Fistulas: Fluoroscopic Placement of Esophageal SEMS, Endoscopically-assisted through Surgical Gastrostomy. A Case Report

2016 ◽  
Vol 25 (2) ◽  
pp. 249-252 ◽  
Author(s):  
Gabriel Constantinescu ◽  
Vasile Şandru ◽  
Mădălina Ilie ◽  
Cristian Nedelcu ◽  
Radu Tincu ◽  
...  
Keyword(s):  
Esophageal Carcinoma ◽  
Guide Wire ◽  
Subsequent Development ◽  
Covered Stent ◽  
Metallic Stents ◽  
Fistula Formation ◽  
Life Threatening ◽  
Endoscopic Placement ◽  
Surgical Gastrostomy ◽  
Methods Of Treatment

Progressive esophageal carcinoma can infiltrate the surrounding tissues with subsequent development of a fistula, most commonly between the esophagus and the respiratory tract. The endoscopic placement of covered self-expanding metallic stents (SEMS) is the treatment of choice for malignant esophageal fistulas and should be performed immediately, as a fistula formation represents a potential life-threatening complication. We report the case of a 64-year-old male diagnosed with esophageal carcinoma, who had a 20Fr surgical gastrostomy tube inserted before chemo- and radiotherapy and was referred to our department for complete dysphagia, cough after swallowing and fever. The attempt to insert a SEMS using the classic endoscopic procedure failed. Then, a fully covered stent was inserted, as the 0.035” guide wire was passed through stenosis retrogradely by using an Olympus Exera II GIF-N180 (4.9 mm in diameter endoscope) via surgical gastrostomy, with a good outcome for the patient. The retrograde approach via gastrostomy under endoscopic/fluoroscopic guidance with the placement of a fully covered SEMS proved to be the technique of choice, in a patient with malignant esophageal fistula in whom other methods of treatment were not feasible. Abbreviations: ERCP: endoscopic retrograde cholangio-pancreatography; GI: gastrointestinal; SEMS: self-expandable metallic stents.

MO650EMPHYSEMATOUS PYELONEPHRITIS IN TYPE 2 DIABETES – CLINICAL PROFILE AND MANAGEMENT

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Dr Sanjay Bhat ◽  
Anupma Kaul ◽  
Priyanka Rai ◽  
Rohit Srivastav
Keyword(s):  
Glycosylated Hemoglobin ◽  
Left Kidney ◽  
Diabetic Patients ◽  
Emphysematous Pyelonephritis ◽  
Medical College ◽  
Poor Outcome ◽  
Microbial Profile ◽  
Disturbance Of Consciousness ◽  
Life Threatening ◽  
High Index Of Suspicion

Abstract Background and Aims Emphysematous pyelonephritis (EPN) is a rare but life-threatening acute suppurative infection of the kidney among diabetics. There is no current consensus on management of EPN. Method A prospective observational study was conducted at Department of General Surgery at RML institute of Medical sciences , Lucknow as well as at Eras Lucknow medical college, Lucknow from 2015-2018 to look for clinical, microbial profile and treatment outcome of diabetic patients with emphysematous pyelonephritis. Results A total of 76 Diabetic patients diagnosed with pyelonephritis were identified, of which 15 patients were diagnosed with EPN (26.3%). The mean age of the patients was 58.4±6.5 years. Mean duration of diabetes was 5.3 ± 3.3 years. 12 (82%) of the 15 patients with DM had a glycosylated hemoglobin A1C level higher than 7.5. Renal dysfunction at presentation was seen in 11 (73.3%) patients. Among the unilateral involvement, left kidney was more affected. Escherichia coli in 11 (73.3%), Klebsiella sp. in 1 (6.6%), Pseudomonas in 1 (6.6%), and 1 each with polymicrobial and fungal UTI respectively. Of 15 EPN patients, 13 (86.6 %) survived and 1 (6.6 %) expired. 2 of them underwent nephrectomy both survived. All patients with Stage I, II and IIIa EPN (n = 12) were managed with antibiotics with or without PCD. In EPN Stage IIIb/IV (n = 3), all the 3 (20 %) patients were managed with antibiotics and PCD and later 2 (13.3%) needed nephrectomy. Only time to diagnosis, altered sensorium, shock at presentation and thrombocytopenia were associated with poor outcome in EPN patients (P < 0.05) Multiple logistic regression tests showed shock (P = .04) and and disturbance of consciousness (P = .05) on hospital admission as being the independent factors for poor outcome. Conclusion EPN in diabetics needs high index of suspicion, timely diagnosis and good multidisciplinary approach with adequate antibiotics and surgical management for better patient outcomes.

scholarly journals Severe hypertriglycerdemia in pregnancy

2021 ◽  
Vol 4 (1) ◽  
pp. 019-019
Author(s):  
Muralidhara Krithika ◽  
Dhareshwar Shashank
Keyword(s):  
Low Density Lipoprotein ◽  
Elevated Serum ◽  
Density Lipoprotein ◽  
Good Health ◽  
Glycerol Phosphate ◽  
Serum Triglycerides ◽  
Serum Lipase ◽  
Threatening Condition ◽  
Life Threatening ◽  
Membrane Plasma Separation

31 year old female presented with abdominal pain and respiratory distress in the third trimester of her second pregnancy. Her blood workup revealed a lipemic sample (Figure 1) due to markedly elevated serum triglycerides of 8178 mg/dl (Glycerol Phosphate Oxidase method). Total cholesterol and Low Density Lipoprotein were elevated at 1701 mg/dl and 788 mg/dl respectively. There was no family history of lipid disorders. Diagnosis was consistent with gestational hypertriglyceridemia with acute pancreatitis (Serum Amylase-50 U/L, Serum Lipase- 96 U/L), though genetic tests to rule out pre-existing primary hypertriglyceridemia was not feasible. In view of the life threatening condition, she was initiated on Insulin-Dextrose infusion and offered one session of Plasma Exchange. Figures 2,3 depict membrane plasma separation with the obtained effluent as lipemic plasma. Her serum triglycerides showed a declining trend and was discharged in good health (serum triglycerides at discharge-651 mg/dl).

scholarly journals Sickle cell anaemia in vaso-occlusive crisis and acute fatty liver of pregnancy: a case report

2020 ◽  
Vol 54 (3) ◽  
pp. 201-203
Author(s):  
Michael Ezeanochie ◽  
Oghenefegor Olokor ◽  
Ofure Yamah
Keyword(s):  
Case Report ◽  
Fatty Liver ◽  
Sickle Cell ◽  
Sickle Cell Anaemia ◽  
Elevated Serum ◽  
Simultaneous Occurrence ◽  
Published Data ◽  
Care Providers ◽  
Delay In Diagnosis ◽  
Acute Fatty Liver

Acute fatty liver of pregnancy (AFLP) is an uncommon condition that manifests in the third trimester of pregnancy.Its association with vaso-occlusive crisis from Sickle Cell Anaemia is not common. Published data on the simultaneous occurrence of these two conditions is rare, hence this case report. A 32-year-old gravida 3 para 1+1 lady, with Sickle Cell Anaemia, had a vaso-occlusive crisis in association with AFLP at 32 weeks’ gestation, and the outcome of her management was successful. AFLP is a rare late-gestational event affecting about 1 in 10,000 to 15,000 pregnancies. The exact aetiology is not known. Profound hypoglycaemia and jaundice with elevated serum transaminases are recognized features of AFLP.These features may also be seen in haemoglobinopathies. The simultaneous occurrence of AFLP and Sickle Cell Anaemia may result in overlap of symptoms and delay in diagnosis and treatment. Therefore, maintaining a high index of suspicion is key. The cornerstone for treatment remains prompt delivery and supportive care. AFLP can coexist with Sickle cell crises. It is important that care providers, especially in populations with high burden of Sickle Cell Anaemia, consider this as a differential diagnosis, especially when the jaundice is associated with profound or recurring episodes of hypoglycaemia. Prompt diagnosis and delivery in a multidisciplinary approach is important to avoid adverse maternal and foetal outcomes.Keywords: Vaso-occlusive crises, acute fatty liver of pregnancy, hypoglycaemia, Sickle-cell anaemiaFunding: No funding sources

scholarly journals Mesenchymal Stromal Cells Derived Extracellular Vesicles Ameliorate Acute Renal Ischemia Reperfusion Injury by Inhibition of Mitochondrial Fission through miR-30

2016 ◽  
Vol 2016 ◽  
pp. 1-12 ◽  
Author(s):  
Di Gu ◽  
Xiangyu Zou ◽  
Guanqun Ju ◽  
Guangyuan Zhang ◽  
Erdun Bao ◽  
...  
Keyword(s):  
Reperfusion Injury ◽  
Extracellular Vesicles ◽  
Mesenchymal Stromal Cells ◽  
Stromal Cells ◽  
Ischemia Reperfusion Injury ◽  
Mitochondrial Dynamics ◽  
Ischemia Reperfusion ◽  
Mitochondrial Fission ◽  
Apoptosis Pathway ◽  
Acute Renal Ischemia

Background. The immoderation of mitochondrial fission is one of the main contributors in ischemia reperfusion injury (IRI) and mesenchymal stromal cells (MSCs) derived extracellular vesicles have been regarded as a potential therapy method. Here, we hypothesized that extracellular vesicles (EVs) derived from human Wharton Jelly mesenchymal stromal cells (hWJMSCs) ameliorate acute renal IRI by inhibiting mitochondrial fission through miR-30b/c/d.Methods. EVs isolated from the condition medium of MCS were injected intravenously in rats immediately after monolateral nephrectomy and renal pedicle occlusion for 45 minutes. Animals were sacrificed at 24 h after reperfusion and samples were collected. MitoTracker Red staining was used to see the morphology of the mitochondria. The expression of DRP1 was measured by western blot. miR-30 in EVs and rat tubular epithelial cells was assessed by qRT-PCR. Apoptosis pathway was identified by immunostaining.Results. We found that the expression of miR-30 in injured kidney tissues was declined and mitochondrial dynamics turned to fission. But they were both restored in EVs group in parallel with reduced cell apoptosis. What is more, when the miR-30 antagomirs were used to reduce the miRNA levels, all the related effects of EVs reduced remarkably.Conclusion. A single administration of hWJMSC-EVs could protect the kidney from IRI by inhibition of mitochondrial fission via miR-30.

scholarly journals An unusual experience with endoscopic retrograde cholangiopancreatography

2013 ◽  
Vol 04 (04) ◽  
pp. 114-116 ◽  
Author(s):  
Mallikarjun Patil ◽  
Keyur A. Sheth ◽  
C. K. Adarsh ◽  
B. Girisha
Keyword(s):  
Gastrointestinal Tract ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Guide Wire ◽  
Rare Complication ◽  
Endoscopic Retrograde ◽  
Endoscopic Procedures ◽  
Hepatic Hematoma ◽  
Hemorrhagic Complications ◽  
Life Threatening ◽  
Therapeutic Utility

AbstractThe endoscopic retrograde cholangiopancreatography (ERCP) is known for its varied diagnostic and therapeutic utility for a variety of disorders. However it has greater likelihood of procedure related complications among the endoscopic procedures of gastrointestinal tract. The extraluminal hemorrhagic complications following ERCP are potentially life threatening though relatively rare. We present a 50 year patient with choledocholithiasis and cholelithiasis developing rare complication of subcapsular hepatic hematoma, following ERCP due to guide wire injury.

Results of a three-year follow-up after endovascular therapy with multilayer flow modulator in complex thoracoabdominal aortic aneurysm: A case report

Vascular ◽  
2020 ◽  
pp. 170853812093351
Author(s):  
Nazım Kankılıç ◽  
Mehmet S Aydın
Keyword(s):  
Case Report ◽  
Aortic Aneurysm ◽  
Renal Artery ◽  
Medical Center ◽  
Left Kidney ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Aortic Aneurysms ◽  
Left Renal Artery

Objectives Studies on the short-, medium and long-term effects of flow guiding stents are still limited. In this case report, we present three-year follow-up of the multilayer flow modulator stent in a 55-year-old patient with Crawford Type 2 thoracoabdominal aortic aneurysm. Methods A 55-year-old male patient with Crawford Type 2 thoracoabdominal aortic aneurysm had applied to our medical center. The aneurysm involved coeliac truncus and superior mesenteric artery and extended to the renal artery ostia. Multilayer flow modulator stent was successfully placed, and follow-up CT (Computed tomography) angiographic examination images recorded intermittently (36 months). Results After three years, it was observed that the left renal artery was thrombosed and the left kidney went to atrophy. Other major vascular branches were observed to be open. During this time, the aneurysm was completely closed with thrombus, but the diameter of the aneurysm continued to increase. Conclusions Multilayer flow modulator stents are safe in complex aortic aneurysms. The device increases the thrombus load in the aortic aneurysm and maintains the flow of the main vascular branches. But re-interventions, dilatation of the aneurysm sac and visceral branch obstructions are still challenging for multilayer flow modulator stents.

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