scholarly journals Non-surgical management of vesicoureteral junction obstruction: a case report

2021 ◽  
Author(s):  
Thais Yuki Kimura ◽  
Pedro Alves Soares Vaz de Castro ◽  
Thiago Vasconcelos Silva ◽  
Jordana Almeida Mesquita ◽  
Ana Cristina Simões e Silva
Keyword(s):  
Antibiotic Prophylaxis ◽  
Kidney Function ◽  
Kidney Development ◽  
Renal Ultrasound ◽  
Transverse Diameter ◽  
Inherited Disorders ◽  
Imaging Evaluation ◽  
Bilateral Hydronephrosis ◽  
History Of ◽  
Age Appropriate

Abstract Objective: To report the case of a pediatric patient with bilateral hydronephrosis due to vesicoureteral junction obstruction (VUJO) that was treated non-surgically and to discuss the approach of this anomaly. Case Description: A 25-month-old boy was referred without complaints for consultation due to prenatal ultrasound showing kidneys with cysts. He was under antibiotic prophylaxis. No family history of kidney disease and/or inherited disorders was reported. Renal ultrasound (RUS) at 2 days of life showed bilateral hydronephrosis, thus ruling out the possibility of kidney cystic disease. Dynamic renal scintigraphy (DTPA) showed marked retention of the marker in the pyelocaliceal system bilaterally, with little response to diuretic drug. He was maintained under antibiotic prophylaxis, when a new RUS showed bilateral ureteral dilatation, abrupt stenosis in the ureterovesical transition region (0.2 cm caliber), moderate bilateral hydronephrosis, and slight renal cortical thickness, confirming the diagnosis of VUJO. At 2 years and 10 months of age, DTPA showed hydronephrosis and ureteral stasis in both kidneys secondary to stenosis at the vesicoureteral junction (VUJ) level, with preservation of kidney function and slow degree of emptying. We opted for a non-surgical approach. RUS at 10 years of age showed significant improvement of all parameters, with ureteral transverse diameter of 9 mm, preserved VUJ, and age-appropriate bilateral kidney development. Comments: VUJO is a major cause of prenatal hydronephrosis and can trigger a deterioration of kidney function. Its treatment is still controversial but should take into account the importance of clinical follow-up and serial imaging evaluation.

MO238CHALLENGING BEVACIZUMAB RELATED KIDNEY DAMAGE: A SUCCESSFUL STRATEGY BY THE NEPHROLOGIST

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Roberta Ranieri ◽  
Angela Cervesato ◽  
Sofia Giuliana ◽  
Carolina Ruosi ◽  
Giovambattista Capasso ◽  
...  
Keyword(s):  
Case Report ◽  
Kidney Function ◽  
Renal Damage ◽  
Kidney Damage ◽  
Renal Ultrasound ◽  
Anti Vegf ◽  
Renal Complications ◽  
Significant Survival ◽  
Oncologic Patients ◽  
History Of

Abstract Background Renal complications in cancer patients are frequently associated with chemotherapy, immunotherapy and targeted drugs. Inhibitors of vascular endothelial growth factor(anti-VEGF) advent has permitted a significant survival improvement in metastatic patients, promising less renal complications than conventional chemotherapy .Indeed, direct nephrotoxicity is not typical, but immune-mediated glomerular damage is increasingly reported as a common complication of anti-VEGFs.The blockade of VEGF in podocytes mightimpair the filtration barrierintegrity leading to proteinuria appearance.In addition, anti-VEGFs activate NFkb triggering pro-inflammatory cytokines. The lack of integrity of the filtration membrane and the inflammatory milieu could probably lead to the exposure of normally unexposed antigens and consequently predispose, by a mimicry mechanism, to autoantibodies and immunocomplex formation/deposition and renal damage occurrence. Case report We report the case of a 59-year-old male with a history of adenocarcinoma of sigma-rectumand peritoneal carcinosis, who underwent several cycles of chemotherapy. In 2015, the patient presented with gastro-intestinal obstruction. A laparoscopic rectal resection was first performed, followed by colostomy and two cycles of the FOL-FOX protocol. Between 2016 and 2019, due to disease progression, the patient received FOLFIRI protocol and, subsequently, the anti-VEGF Bevacizumab. During the treatment course, laboratory tests documented moderate proteinuria (1 g/day approximately) and normal kidney function. End of 2019,due to a creatinine rise to 1.6 mg/dl, Bevacizumab was suspended. However, in the next three months the kidney function continued to worsen and reached a level of 3.2 mg/dl. The patient was referred to our Nephrology Unit and admitted to the ward showing an increase of 24 h proteinuria to 2 g/day with stable high creatinine and normal renal ultrasound parameters. In the suspect of a dehydration, patient was infused with saline solution without any significant GFR improvement. Suspecting an anti-VEGF mediated glomerulopathy, we checked the patient for an autoimmunity panel and found a positivity for ANA anti- Ro, anti Mi-2 and ASMA. A renal biopsy was not performed because the patient did not release the consent and a 2-month course of prednisone 25 mg/day was introduced and successively tapered to a maintenance dose of 5 mg/day. A prompt improvement of the kidney function (creatinine decreased to 1.5 mg/dl) and proteinuria (240 mg/24h)was observed and allowed a new oncological evaluation in order to start a new cycle of targeted-therapy. Conclusion Our case report suggests the need for an accurate investigation of the pathophysiological mechanisms of kidney damage linked to anti-VEGF agents. Moreover, based on our clinical experience, it appears that the multidisciplinary approach, with a key role of the nephrologist, to oncologic patients on anti-VEGF agents complicated with renal damage, is fundamental for achieving a double goal: oncologic therapy maintenance and renal function preservation.

The Triumph of Olemaun: Survivance, Empathic Unsettlement, and Restorying the History of Canadian Residential Schools

2018 ◽  
Vol 11 (2) ◽  
pp. 132-146
Author(s):  
Anah-Jayne Markland
Keyword(s):  
Residential Schools ◽  
Truth And Reconciliation Commission ◽  
Aboriginal Peoples ◽  
Close Reading ◽  
Reconciliation Commission ◽  
Mandatory Education ◽  
Truth And Reconciliation ◽  
Young Readers ◽  
History Of ◽  
Age Appropriate

The ignorance of many Canadians regarding residential schools and their traumatic legacy is emphasised in the reports of the Truth and Reconciliation Commission (TRC) as a foundational obstacle to achieving reconciliation. Many of the TRC's calls to action involve education that dispels and corrects this ignorance, and the commission demands ‘age-appropriate curriculum on residential schools, Treaties, and Aboriginal peoples' historical and contemporary contributions to Canada’ to be made ‘a mandatory education requirement for Kindergarten to Grade Twelve students’ (Calls to Action 62.i). How to incorporate the history of residential schools in kindergarten and early elementary curricula has been much discussed, and one tool gaining traction is Indigenous-authored picturebooks about Canadian residential schools. This article conducts a close reading of Margaret Pokiak-Fenton and Christy Jordan-Fenton's picturebook When I Was Eight (2013). The picturebook gathers Indigenous and settler children together to contest master settler narratives regarding the history of residential schools. Using Gerald Vizenor's concept of ‘survivance’ and Dominick LaCapra's notion of ‘empathic unsettlement’, the article argues that picturebooks work to unsettle young readers empathetically as part of restorying settler myths about residential schools and implicating young readers in the work of reconciliation.

scholarly journals Acute Hematogenous Infection of Revision Total Hip Arthroplasty by Oral Bacteria in a Patient without a History of Dental Procedures: Case Report

2014 ◽  
Vol 8 (1) ◽  
pp. 56-59 ◽  
Author(s):  
Motoki Sonohata ◽  
Masaru Kitajima ◽  
Syunsuke Kawano ◽  
Masaaki Mawatari
Keyword(s):  
Total Hip Arthroplasty ◽  
Antibiotic Prophylaxis ◽  
Hip Arthroplasty ◽  
Oral Bacteria ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Metastatic Infection ◽  
Dental Procedures ◽  
History Of ◽  
Joint Prostheses

The risk of periprosthetic joint infection from hematogenous bacterial seeding is increased in patients undergoing dental procedures that facilitate the development of bacteremia. We herein report the case of a patient without a history of dental procedures who suffered from an acute metastatic infection of a hip prosthesis by the oral bacterium Streptococcus mutans 18 months after undergoing revision total hip arthroplasty. The patient was successfully treated by two-stage revision surgery. It is important to realize that the efficacy of antibiotic prophylaxis against joint infections has not yet been convincingly proven. As a result, optimal dental hygiene and regular dental visits may be more important than antibiotic prophylaxis for maintaining joint health. Therefore, orthopedic surgeons should educate patients with joint prostheses about good oral health.

scholarly journals Extramedular plasmacytoma in the urinary bladder: Unusual localization

2006 ◽  
Vol 63 (11) ◽  
pp. 975-978 ◽  
Author(s):  
Violeta Rabrenovic ◽  
Zoran Kovacevic ◽  
Dragan Jovanovic ◽  
Milorad Rabrenovic ◽  
Novak Milovic ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Renal Failure ◽  
Urinary Bladder ◽  
Cell Clone ◽  
Obstructive Uropathy ◽  
Bilateral Hydronephrosis ◽  
Rare Case Report ◽  
Atypical Cells ◽  
History Of ◽  
Bladder Mass

Background. Multiple myeloma is a plasmaproliferative disease characterized by the uncontrolled proliferation of a pathogenic plasma cell clone engaged in the production of monoclonal immunoglobulin. This condition affects the bone marrow, but it can be manifested in any other organ or tissue. The urinary bladder involvement is extremely rare. Case report. We reported a 70-year-old male with the history of multiple myeloma, receiving chemotherapy containing melphalan and prednisone (MP). Two years after the treatment, there was a renal failure associated with oligoanuria, hematuria and bilateral hydronephrosis. The urine cytology tests revealed the atypical cells, so was suspected obstructive uropathy to be caused by urothelium cancer. However, only upon the cystoscopy and biopsy performed on the urinary bladder mass, plasmacytoid infiltration diagnosis was confirmed. This extremely rare variant was presented throughout the illness period and proved to be resistant to the administered chemotherapy. Conclusion. When renal failure associated with hematuria and bilateral hydronephrosis is presented in a patient with multiple myeloma, this unusual and rare extramedular localization should be also considered.

scholarly journals 1000 Genomes-based meta-analysis identifies 10 novel loci for kidney function

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Mathias Gorski ◽  
Peter J. van der Most ◽  
Alexander Teumer ◽  
Audrey Y. Chu ◽  
Man Li ◽  
...  
Keyword(s):  
Kidney Function ◽  
Kidney Development ◽  
Association Studies ◽  
Meta Analysis ◽  
European Ancestry ◽  
P Value ◽  
Genome Wide Association Studies ◽  
1000 Genomes ◽  
Gene Sets ◽  
Project Promise

Abstract HapMap imputed genome-wide association studies (GWAS) have revealed >50 loci at which common variants with minor allele frequency >5% are associated with kidney function. GWAS using more complete reference sets for imputation, such as those from The 1000 Genomes project, promise to identify novel loci that have been missed by previous efforts. To investigate the value of such a more complete variant catalog, we conducted a GWAS meta-analysis of kidney function based on the estimated glomerular filtration rate (eGFR) in 110,517 European ancestry participants using 1000 Genomes imputed data. We identified 10 novel loci with p-value < 5 × 10−8 previously missed by HapMap-based GWAS. Six of these loci (HOXD8, ARL15, PIK3R1, EYA4, ASTN2, and EPB41L3) are tagged by common SNPs unique to the 1000 Genomes reference panel. Using pathway analysis, we identified 39 significant (FDR < 0.05) genes and 127 significantly (FDR < 0.05) enriched gene sets, which were missed by our previous analyses. Among those, the 10 identified novel genes are part of pathways of kidney development, carbohydrate metabolism, cardiac septum development and glucose metabolism. These results highlight the utility of re-imputing from denser reference panels, until whole-genome sequencing becomes feasible in large samples.

MO292MALIGNANT DISEASE IS MORE COMMON WITH DETERIORATING KIDNEY FUNCTION IN PATIENTS WITH MEMBRANOUS NEPHROPATHY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ivana Vukovic Brinar ◽  
Karlo Kurtov ◽  
Mario Laganovic ◽  
Zivka Dika ◽  
Marijana Ćorić ◽  
...  
Keyword(s):  
Kidney Function ◽  
Membranous Nephropathy ◽  
Malignant Disease ◽  
Initial Therapy ◽  
University Hospital ◽  
Long Term Follow Up ◽  
History Of ◽  
Kdigo Guidelines ◽  
Informatic System

Abstract Background and Aims Membranous nephropathy (MN) can be associated with tumor and present a paraneoplastic condition. Recently, development of tumors during the course of follow up is more in focus. It is especially interested whether patient with MN are prone to tumors, or tumors are condition indipendent of membranous nephropathy or consequence of imunosupressive therapy (IS). Method Retrospective data of all adult patients diagnosed with MN from 1987 to 2017 at the Department of Nephrology of University Hospital Centre Zagreb were analysed. Medical data regarding antropometric measeures and preexsisting comorbid disease at presentation and during follow up were derived from medical records and hospital informatic system. Furthermore, data regarding kidney function were used, namely serum creatinine (SCr), proteinuria. Renal function was assessed using CKD-EPI equation. CKD stages, partial and complete remission were defined according to KDIGO guidelines. Results From 1987 till 2017 a total of 122 patients were diagnosed with MN. Eighty nine (72.9%) were treated with imunosupressive therapy. Most commonly prescribed initial therapy was combination of corticosteroids and cyclophosphamide (N=66; 74%). Three (0,02%) patients had history of tumor with median of 3y (min – max 1-4 y) before glomerular disease presentation, two solid tumor, adenocarcinoma pulmonum and carcinoma prostatae, and one condition after allogenic haematopoetic transplantation due to acute myeloid leukemia. There was no difference in clinical presentation between those with positive history of malignant disease and others (proteinura 11.7 g/du (25-75C 3.4-15.7) vs. 5.8 g/dU (25-75C 3.4 – 8.5); p=0.232 and eGFR 57 ml/min/1,73m2 (25C-75C 14 – 59) vs. 81 ml/min/1.73m2 (25-75C 54 – 100); p=0.066). During follow up 11 (9%) patients developed tumor, median age of pts 67 y (min – max 59 – 71); nine solid tumors most comonly of gastrointestinal origin (pancreas, colon N=5 (45%)), then pulmonum (N=2(18%)) and urogenithal origin (ca renis and prostate N=2 18%). Also two hematological malignancies (B-ALL, B-NHL) occurred. Median time till confirmed malignant disease was 9 y (min – max 5 -24). At the time of detecting the tumor six (54%) patients were in complete and partial remission (4 and 2) and 2 (18%) patients had nephrotic syndrome. No difference was observed in proteinuria between those with malignant condition and other MN patients (1,4 g/dU (25 – 75C 0.2 – 5.6) vs. 0,29 g/dU (25 – 75C 0.13 – 0.74); P=0.154). MN patients with malignant disease during follow up had lower estimated glomerular filtration rate (eGFR 45 ml/min/1,73m2 (25 – 75C 22 – 70) vs. 77 (25 – 75C 58 – 92); p=0.010). There was no difference in cummulative dose of cyclophosphamide between those who developed tumor with others (24 g(25 – 75C13.5 – 30) vs. 27 g(25 – 75C 15 – 38)p=0.592). Conclusion Our data emphasize the need for long term follow up of patients with membranous nephropathy despite accomplishing remission of MN and period screening for malignant disease, especially in those with deteriorating kidney function.

scholarly journals Natural History of Atherosclerosis and Abdominal Aortic Intima-Media Thickness: Rationale, Evidence, and Best Practice for Detection of Atherosclerosis in the Young

2019 ◽  
Vol 8 (8) ◽  
pp. 1201 ◽  
Author(s):  
Michael R. Skilton ◽  
David S. Celermajer ◽  
Erich Cosmi ◽  
Fatima Crispi ◽  
Samuel S. Gidding ◽  
...  
Keyword(s):  
Natural History ◽  
Best Practice ◽  
Intima Media Thickness ◽  
Media Thickness ◽  
Abdominal Aortic ◽  
History Of ◽  
Age Appropriate ◽  
Practice Methods ◽  
Timing Of Onset ◽  
Aortic Intima

Atherosclerosis underlies most myocardial infarctions and ischemic strokes. The timing of onset and the rate of progression of atherosclerosis differ between individuals and among arterial sites. Physical manifestations of atherosclerosis may begin in early life, particularly in the abdominal aorta. Measurement of the abdominal aortic intima-media thickness by external ultrasound is a non-invasive methodology for quantifying the extent and severity of early atherosclerosis in children, adolescents, and young adults. This review provides an evidence-based rationale for the assessment of abdominal aortic intima-media thickness—particularly as an age-appropriate methodology for studying the natural history of atherosclerosis in the young in comparison to other methodologies—establishes best practice methods for assessing abdominal aortic intima-media thickness, and identifies key gaps in the literature, including those that will identify the clinical relevance of this measure.

Is baseline routine renal ultrasound indicated for all MS patients?

2019 ◽  
Vol 96 (1134) ◽  
pp. 194-196
Author(s):  
Igor B Títoff ◽  
Victoria Titoff ◽  
Thomas F Scott
Keyword(s):  
Urinary Tract ◽  
Upper Urinary Tract ◽  
Renal Ultrasound ◽  
Red Flags ◽  
Inclusion Criteria ◽  
Detrusor Sphincter Dyssynergia ◽  
History Of ◽  
Bladder Symptoms ◽  
Tract Infections

BackgroundMost patients with multiple sclerosis (MS) develop multiple urological complaints due to hyperactive or hypoactive bladder, and may have detrusor-sphincter dyssynergia. Routine renal ultrasound (RUS) screening has been recommended for both symptomatic and asymptomatic MS patients; however, there is little data to support this practice.MethodsProspectively screened consecutive MS clinic patients in 2016–2017 with functional systems scores (FSS) indicating moderate to severe neurogenic bladder symptoms (FSS bladder ≥2) were sent for RUS. We also screened for history of urinary tract infections.Results872 patients were screened between 3 September 2016 and 13 April 2017. 58 patients met inclusion criteria for RUS. 6 were excluded due to non-compliance with testing or unavailability of results; 52 patients were imaged. Only 3/52 patients were found to have renal pathology requiring follow-up. Of those three, one had known symptomatic nephrolithiasis, and one had subsequently normal findings, leaving one patient newly found to have valid abnormal upper urinary tract (UUT) findings. Multiple incidental findings were also discovered.ConclusionThe minimal yield for significant UUT pathology found in this enriched group of symptomatic MS patients indicates that RUS screening for asymptomatic MS patients without clear risk factors is not indicated. Red flags for high risk of UUT complications should be used as triggers for baseline RUS screening in MS patients.

scholarly journals Ascites, a New Cause for Bilateral Hydronephrosis: Case Report

2009 ◽  
Vol 9 ◽  
pp. 1035-1039 ◽  
Author(s):  
Deepika Jain ◽  
Smrita Dorairajan ◽  
Madhukar Misra
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Liver Cirrhosis ◽  
Case Report ◽  
Abdominal Ultrasound ◽  
Back Pressure ◽  
Alcoholic Liver Cirrhosis ◽  
Bilateral Hydronephrosis ◽  
History Of

Bilateral hydronephrosis secondary to urinary obstruction leads to a buildup of back pressure in the urinary tract and may lead to impairment of renal function. We present a case of a 57-year-old male with a history of alcoholic liver cirrhosis, who presented with tense ascites and acute renal failure. Bilateral hydronephrosis was seen on abdominal ultrasound. Multiple large-volume paracenteses resulted in resolution of hydronephrosis and prompt improvement in renal function.

Sign in / Sign up

Export Citation Format

Share Document