scholarly journals Treatment of recurrent renal transplant lithiasis: analysis of our experience and review of the relevant literature

2019 ◽  
Author(s):  
Xiaohang Li ◽  
Baifeng Li ◽  
Yiman Meng ◽  
Lei Yang ◽  
Gang Wu ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Early Stage ◽  
Relevant Literature ◽  
Treatment Method ◽  
Laser Lithotripsy ◽  
Invasive Treatment ◽  
Post Transplantation ◽  
Residual Stone ◽  
Specific Symptom ◽  
Holmium Laser Lithotripsy

Abstract Background:Renal transplant lithiasis is a rather unusual disease, and the recurrence of lithiasis presents a challenging situation. Methods: We retrospectively analyzed medical history of the patient who surferred renal transplant lithiasis for two times, reviewed the relevant literature, and summarized the characteristics of this disease. Results: We retrieved 29 relevant studies with an incidence of 0.34% to 3.26% for renal transplant lithiasis.The summarized incidence is 0.52%, and the recurrent rate is 0.082%. The mean interval after transplantation is 33.43±56.70 m.Most of the patients(28.90%) are asymptomatic.The management included percutaneous nephrolithotripsy(PCNL,22.10%),ureteroscope(URS,22.65%),extracorporeal shockwave lithotripsy(ESWL,18.60%) and conservative treatment(17.13%).In our case the patient suffered from renal transplant lithiasis at 6 years post transplantation, and the lithiasis recurred 16 months later. He presented oliguria,infection or ARF during the two attacks, but without pain. PCNL along with URS and holmium laser lithotripsy were performed.The patient had even recoveries after surgeries,except for a 3mm residual stone in the calyx after the second surgery. He had normal renal function without any symptom,and was allowed to discharge with oral anti-calculus drugs and strict follow-up at clinic.Fortunately, the calculus passed spontaneously about 1 month later. Conclusions: Due to lack of specific symptom in early stage, patients with renal transplant lithiasis may be delayed for diagnosis and present ARF. Minimally invasive treatment method was optimal,and combined usage of two or more procedures are beneficial for patients. After surgery taking anti-calculus drugs, correcting metabolic disorders and avoiding UIT are key measures to prevent the recurrence of lithiasis.

scholarly journals Non-Contrast Computed Tomography and the Impact of Stone Density to Choose Minimal Invasive Treatment

2019 ◽  
Vol 70 (3) ◽  
pp. 946-949
Author(s):  
Ioan Scarneciu ◽  
Alexandru Banuta ◽  
Laurian Maxim ◽  
Salvatore Giordano ◽  
Dragos Radu Marcu ◽  
...  
Keyword(s):  
Treatment Method ◽  
Developed Countries ◽  
Laser Lithotripsy ◽  
Minimal Invasive ◽  
Flexible Ureteroscopy ◽  
Invasive Treatment ◽  
Ureteral Lithiasis ◽  
Wide Range ◽  
Function Impairment ◽  
The Impact

Reno-ureteral lithiasis is a common pathology especially in socio-economically developed countries and may pose serious problems with renal function impairment. Urology is currently one of the surgical branches that benefit from a wide range of therapeutic options in reno-ureteral lithiasis, that revolutionized the criteria and indications of the lithiasis pathology, increasing the success rate and decreasing the number of days of hospitalization but which cannot provide satisfactory results if not complemented by imaging examinations. Non-contrast computer tomography is a key element in determining the best method of treatment by measuring the density of stones and increasing the stone-free rate of patients. Measurement of the stones density is done by Hounsfield units (HU), and patients who have had a [500 HU density have pleaded in over 90% for the uric acid composition. We included in our study a batch of 364 patients with reno-ureteral lithiasis and the treatment method was chosen based on the density of the stones: 64.83% of the patients with a density between 200-700 HU performed semi-rigid ureteroscopy and ballistic lithotripsy, 3.57% of patients with density between 700-1000 HU benefited from flexible ureteroscopy and laser lithotripsy, 17.58% of patients with density between 400-700HU performed ESWL and 13.73% with density]1000 HU have benefited from PCNL.

Impact of Pharmacogenetic Determinants of Tacrolimus and Mycophenolate on Adverse Events in Renal Transplant Patients

2021 ◽  
Vol 22 ◽  
Author(s):  
Kalluri Thishya ◽  
Boddupally Sreenu ◽  
Shree Bhushan Raju ◽  
Vijay Kutala
Keyword(s):  
Renal Transplant ◽  
Adverse Events ◽  
Metabolic Pathways ◽  
Early Stage ◽  
Maintenance Phase ◽  
Solid Organ ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplantation ◽  
Increased Risk

Background: Graft acceptance against immunity is one of themajor challenges in solid organ transplant. Immunosuppressive medications have effectively improved the post-transplantation outcome; however it has its own limitations. Genetic polymorphisms in drug-metabolizing enzymes have been identified as the potential targets in developing a pharmacogenetic strategy, to individualize drug dose and also in preventing the adverse events. Objective: The rationale of the study was to explore polymorphisms in tacrolimus and mycophenolate metabolic pathways that influence the adverse clinical outcomes in renal transplant recipients. Methods: A total of 255 renal transplant recipients were analyzed for the pharmacogenetic determinants of tacrolimus (CYP3A5*3, ABCB1 1236 T>C, ABCB1 2677 G>A/T, ABCB1 3435 T>C) and mycophenolate (UGT1A8*3, UGT1A9, IMPDH I, IMPDH II c.787C>T , ABCC2 -24 C>T and c.3972C>T) using Sanger sequencing. Results: Acute rejection (AR) was observed in 5.88% of the transplant recipients, whereas, acute tubular necrosis (ATNs) was observed in 7.45% of the patients, within early stage of the maintenance phase. Infections, such as urinary tract infection (UTI) and cytomegalovirus (CMV) infection were observed in 11.37% and 12.16% of the patients. The AUC of mycophenolate was significantly higher in patients with increased risk for infections. ABCC2 -24 C>T, c.3972C>T polymorphisms and ABCB1 3435 C-allele, were associated with reduced risk for infections. ABCC2 rs3740066 was associated with 2.06-fold all-cause mortality risk. CYP3A5 AG- and UGT1A9-440 CC-genotypes showed increased risk, and ABCC 3972C>T, CC-genotype showed protection against adverse events. Conclusion: Genetic variants in tacrolimus and mycophenolate metabolic pathways were found to influence the morbidity and mortality in renal transplant recipients.

scholarly journals Ex vivo pyelotomy, nephroscopy and holmium laser lithotripsy of a staghorn stone in a donor kidney prior to renal transplant

2015 ◽  
Vol 2 ◽  
pp. 286-289 ◽  
Author(s):  
Dariusz Janczak ◽  
Barbara Bolanowska ◽  
Paweł Jankowski ◽  
Tadeusz Dorobisz ◽  
Karolina Dorobisz ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Ex Vivo ◽  
Laser Lithotripsy ◽  
Holmium Laser ◽  
Donor Kidney ◽  
Holmium Laser Lithotripsy ◽  
Staghorn Stone

Dialysis and Renal Transplant in a Hemophiliac

1981 ◽  
Vol 46 (03) ◽  
pp. 626-628 ◽  
Author(s):  
Edward D Gomperts ◽  
Mohammed H Malekzadeh ◽  
Richard N Fine
Keyword(s):  
Renal Transplant ◽  
Post Transplantation ◽  
Home Hemodialysis ◽  
Post Transplant ◽  
Cadaver Donor

SummaryHemodialysis was initiated in a mild-moderate hemophiliac at 15 years of age. Hematuria had been a frequent and persisting feature from the age of five years without documented cause. Anemia and proteinuria was first detected at 13 years. A cadaver donor renal transplant was carried out after three months of hemodialysis. Massive intravesical bleeding complicated the immediate post-transplantation period. The allograft rejected after three months and the patient was maintained for eight years on home hemodialysis. A second cadaver donor allograft was carried out at 23 years of age. Again, massive intravesical hemorrhage was a problem post-transplant. The allograft is currently functioning 27 months post-transplant. Factor VIIIc activities have fluctuated between 5% and 40% in the absence of factor infusions.

Percutaneous Sacroplasty for Sacral Insufficiency Fractures: Case Series and Review of Presentation, Diagnosis, and Treatment

2019 ◽  
Vol 3 ◽  
pp. 4
Author(s):  
Andrew C. Clark ◽  
Devang Butani
Keyword(s):  
Low Back Pain ◽  
Elderly Population ◽  
Case Series ◽  
The Elderly ◽  
Treatment Method ◽  
Open Reduction Internal Fixation ◽  
Low Back ◽  
Insufficiency Fractures ◽  
Invasive Treatment ◽  
Sacral Insufficiency Fractures

Sacral insufficiency fractures (SIFs) are a cause of debilitating low back pain that is often difficult to diagnosis and manage. The diagnosis of SIF is often delayed due to inaccurately attributing symptoms to spondylosis, which is a commonly present in the elderly population where SIFs are most prevalent. Historically, treatment consisted of medical management and open reduction internal fixation reserved for severe cases. However, percutaneous sacroplasty has emerged as a minimally invasive treatment option which provides early pain relief without significant complications. The objective of this article is to raise awareness of SIFs and percutaneous sacroplasty as an effective and safe treatment method.

Bk Polyoma Virus Nephropathy In An Immunocompromised Host.

2020 ◽  
Vol 01 ◽  
Author(s):  
Faraz Khan ◽  
Maroun El Khoury ◽  
Fahad Kouli ◽  
Aaron Han
Keyword(s):  
Renal Transplant ◽  
Graft Failure ◽  
Renal Transplant Patient ◽  
Relevant Literature ◽  
Late Complication ◽  
Solid Organ Transplantation ◽  
Immunocompromised Host ◽  
Polyoma Virus ◽  
Solid Organ ◽  
Early Graft

Background: Post-transplant Lymphopoliferative disorders(PTLD) are a well known late complication after solid organ transplantation including renal transplant. Among others, graft failure due to reactivation of BK polyoma virus in the grafted kidney is also a well recognized complication but tends to present early in the first several months after transplant. Case: Here we present the case of PTLD Burkitt's lymphoma(BL-PTLD) in a renal transplant patient who was successfully treated with multiagent chemo-immunotherapy but later developed BK polyoma virus nephropathy(BKVN) with graft failure only after completion of her systemic therapy for lymphoma and 7 years after transplant. Relevant literature is reviewed. Conclusion: In this case, reactivation and progression of BKVN was most likely associated with immunosuppression from chemoimmunotherapy for her BL–PTLD unlike early graft failures associated with BKVN.

scholarly journals Effects of irrigation fluid temperature during flexible ureteroscopic holmium laser lithotripsy on postoperative fever and shivering: a randomized controlled trial

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yue He ◽  
You-Gang Feng ◽  
Jun He ◽  
Bo Liang ◽  
Ming-Dong Jiang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Laser Lithotripsy ◽  
Holmium Laser ◽  
Fluid Temperature ◽  
Postoperative Fever ◽  
Irrigation Fluid ◽  
Suspected Infection ◽  
Randomized Controlled ◽  
Holmium Laser Lithotripsy

Abstract Background Flexible ureteroscopic holmium laser lithotripsy is used to treat urinary tract calculi, but postoperative complications include shivering, fever and infection. To investigate the effects of irrigation fluid temperature on postoperative complications. Methods This randomized controlled trial included 120 consecutive patients undergoing flexible ureteroscopic holmium laser lithotripsy at the Urology Department, Suining Central Hospital, Sichuan, China between January 2017 and July 2019. Patients were randomized 1:1:1 into three groups (17 °C, 27 °C or 37 °C). Primary outcome was fever incidence (body temperature > 37.5 °C) within 48 h after surgery. Secondary outcomes included shivering incidence during recovery from anesthesia, white blood cell count (WBC), serum procalcitonin (PCT) and incidence of suspected infection (temperature > 38.5 °C and PCT > 0.5 µg/L). Results There were 108 patients, (17 °C group, n = 36; 27 °C group, n = 35; 37 °C group, n = 37), received flexible ureteroscopic holmium laser lithotripsy and analyzed. Age, gender distribution, body mass index, ASA grade, stone burden, preoperative creatinine, preoperative core temperature and irrigation fluid volume did not differ significantly between groups. 17 °C, 27 °C and 37 °C groups exhibited significant differences in the incidences of postoperative fever (38.9% vs. 17.1% vs. 13.5%) and shivering (22.2% vs. 5.7% vs. 2.7%) (p < 0.05 for all pairwise comparisons). There was no significant difference of WBC, PCT and incidence of suspected infection in 37 °C or 27 °C group compared with 17 °C group. One case each of flash pulmonary edema and bleeding occurred in 37 °C group. Conclusion Warming the irrigation fluid can reduce the incidence of postoperative fever and shivering, but further studies are needed to determine the optimal temperature. Trial registration The trial was registered at the Chinese Clinical Trials Registry and allocated as ChiCTR2000031683. The trial was registered on 07/04/2020 and this was a retrospective registration.

scholarly journals Minimally invasive treatment options to borderline ovarian tumors

2016 ◽  
Author(s):  
Punita Bhardwaj ◽  
T. K. Das ◽  
S. Batra ◽  
Keyword(s):  
Early Stage ◽  
Treatment Options ◽  
Malignant Potential ◽  
Ovarian Tumors ◽  
Conservative Approach ◽  
Uncertain Malignant Potential ◽  
Invasive Treatment ◽  
Younger Women ◽  
Borderline Ovarian Tumors

Borderline Ovarian tumors are tumors of uncertain malignant potential. They have favour able prognosis. They occur in younger women and present at an early stage. They are difficult to diagnose preoperatively as macroscopic picture is a combination of benign and invasive ovarian tumors. Over the years surgical treatment has changed from radical to conservative approach without overlooking oncologic safety. Follows up is essential. Prolonged follow up (>10 yrs) is required because of later recurrences. Special attention is to be paid to the conserved ovary in follow up.

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