scholarly journals Bilateral Giant Hydronephrosis Secondary to Ureteropelvic Junction Stricture: a Case Report

2021 ◽  
Author(s):  
Samet Senel ◽  
Yalcin Kizilkan ◽  
Serdar Toksoz
Keyword(s):  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Left Kidney ◽  
Current Case ◽  
Giant Hydronephrosis ◽  
Widespread Availability ◽  
The Right ◽  
Time Of Admission

Abstract Introduction: Giant hydronephrosis, which implies a collecting system containing more than one liter of fluid, is becoming increasingly rare with the widespread availability of imaging facilities. We aimed to report a case and management of bilateral giant hydronephrosis due to bilateral ureteropelvis stenosis.Case presentation: A 45-year old male presented at the Emergency Department with the complaint of difficulty passing stools. On computed tomography (CT), bilateral giant hydronephrosis was determined covering the whole abdomen. After bilateral nephrostomy, 8 liters of urine was drained from the right kidney and 10 liters of urine from the left kidney after bilateral nephrostomy in the patient whose serum creatinine level was 1.06 mg/dl at the time of admission. Bilateral pyeloplasty was applied to the patient who was diagnosed with bilateral ureteropelvis stenosis after dynamic renal scintigraphy. After 4 years of follow-up, serum creatinine level was 1.3 mg / dl. Hydronephrosis was still present despite being smaller than its previous condition and the presence of bilateral double J stents.Conclusions: An interesting finding of the current case was that the creatinine level might be normal despite the fact that bilateral giant hydronephrosis. So rather than nephrectomy, pyeloplasty was applied and to date there has been no need for hemodialysis.

scholarly journals Transurethral Resection of Bladder Neck in the Management of Primary Bladder Neck Obstruction in Female: Our Preliminary Experience in Bangladesh

2020 ◽  
Vol 17 (1) ◽  
pp. 23-28
Author(s):  
AHM Manjurul Islam ◽  
Md Shahidul Islam ◽  
Md Anwar Hossain ◽  
Abm Mobasher Alam ◽  
Shahi Farzana Tasmin
Keyword(s):  
Renal Impairment ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Transurethral Resection ◽  
Bladder Neck ◽  
Bladder Neck Obstruction ◽  
Primary Bladder ◽  
Primary Bladder Neck Obstruction

Objectives: To determine the effectiveness of transurethral resection of bladder neck in the management of primary bladder neck obstruction (PBNO) in female Patients and Methods: This prospective study has been done with thirty female patients aged from 27 to 48 years who were presented with difficult micturition or urinary retention. These patients had unremarkable physical findings with normal perianal sensation, anal sphincter tone and lower extremity reflexes. Patients associated with cystocele, meatal stenosis, stricture urethra, urethral caruncle and urethral diverticula that may lead to mechanical bladder outflow obstruction were excluded from the study. Preoperative investigations include uroflowmetry, ultrasonography, serum creatinine, urethrocystoscopy with simultaneous “water flow test” was done. Seven patients presented with obstructed voiding symptom without renal impairment (serum creatinine, mean±SEM 1.24±0.04) and were initially treated with á-blocker (category A). Among the other 23 patients those had renal impairment 18 presented with near retention and these patients were on indwelling catheterization before operation (category B, serum creatinine, mean±SEM 2.72±0.13).Rest of the 5 patients presented with nausea, vomiting, and disorientation in addition to near retention and were put on haemodialysis along with indwelling catheterization to reach near normal creatinine level before operation(category C, serum creatinine, mean±SEM,9.34±0.96 ). PBNO causing voiding difficulty were diagnosed in all the cases and were undergone transurethral bladder neck resection (BNR). Three months after operations, their pre- and post-operative symptoms were analyzed, and serum creatinine levels, ultrasonographic findings (MCC, PVR), uroflowmetric study were compared. Results: Twenty-nine (96.33%) Patients become symptom free. Their average pre- and post-operative values of MCC (Maximum Cystometric Capacity), PVR (Post Voidal Residual urine), Qmax (Peak urinary flow during uroflowmetric study, Serum creatinine level were changed from 679.50 to 482.17ml, from 574.50 to 29.37ml, from 8.43 to 29.37ml/sec, from 3.48 to 1.13 mg/dl respectively. One patient (3.33%) did not continent ever postoperatively. One patient had become dry after using pad for stress incontinent for one month only. Serum creatinine level of category C patient did not reach to the normal level (post operative creatinine level Mean±SEM,2.8±0.15)within this three moths follow up period. Conclusions: Our short term follow-up suggests that judicious Transurethral BNR is effective in relieving voiding difficulty due to primary bladder neck obstruction in female. A thorough gynaecological, neurological and urological examination is essential along with uroflowmetric, ultrasonographic and cystoscopic study to reach a correct diagnosis and making a treatment plan. Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2014 p.23-28

Endovascular abdominal aortic stenosis treatment alleviates renal failure after kidney transplantation

2021 ◽  
Vol 14 (5) ◽  
pp. e238233
Author(s):  
Shigeyasu Tsuda
Keyword(s):  
Renal Failure ◽  
Kidney Transplantation ◽  
Aortic Stenosis ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Ankle Brachial Index ◽  
Stenotic Lesion ◽  
Abdominal Aortic ◽  
The Right

A 79-year-old man developed bilateral intermittent claudication. Peritoneal dialysis had been initiated at 55 years of age to manage chronic renal failure. In addition, he underwent kidney transplantation at 61 years of age. His Ankle-Brachial Index (ABI) was 0.82 and 0.71 for the right leg and left leg, respectively. Furthermore, his serum creatinine level had increased from 0.98 mg/dL to 2.38 mg/dL over the past 2 years. CT angiography revealed focal calcified stenosis in the terminal abdominal aorta. However, ultrasound revealed no significant stenotic lesion in the supplied artery bound to the transplanted kidney from the right external iliac artery. We performed endovascular therapy for abdominal aortic stenosis using the pressure gradient. Following the procedure, the patient’s symptoms disappeared and the ABI increased to 1.25 and 1.14 in the right leg and left leg, respectively. Furthermore, the serum creatinine level improved to 0.96 mg/dL.

MO318END-STAGE RENAL DISEASE RELATED FACTORS IN ANCA-ASSOCIATED VASCULITIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Guillermo Ferrer García ◽  
Esperanza Moral Berrio ◽  
Maria Paz Castro Fernández ◽  
Luis Guillermo Piccone Saponara ◽  
Agustín Carreño Parrilla ◽  
...  
Keyword(s):  
Renal Disease ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Categorical Variables ◽  
Induction Treatment ◽  
Free Survival ◽  
Anca Associated Vasculitis ◽  
Stage Renal Disease

Abstract Background and Aims Management of ANCA-Associated Vasculitis (AAV) is in constant update. The aim of the study is to describe our experience as a territorial reference center with this systemic disease and to analyze which factors have a significant influence on the development of end-stage renal disease (ESRD). Method Retrospective observational study. All the patients who developed AAV in our center between 2010 and 2019 were included. Demographic variables (age, sex), renal function, other vasculitis related symptoms, induction and maintenance therapy, response degree and follow-up were collected. Categorical variables are expressed as percentages and compared using Chi2 test. Quantitative variables are expressed as mean ± standard deviation and compared using Mann-Whitney U test. Cox regression was performed to determine independent predictors of ESRD. Kaplan-Meier was used to estimate ESRD-free survival. Statistical significance for a value of p< 0,05. Statistical analysis was performed with SPSS 25.0. Results 45 patients were analyzed, with an average age of 70 ± 11 years. 62.2% were men. Mean time of follow-up 36 ± 31.6 months. 37.8% presented c-ANCA autoantibodies and 57.8% p-ANCA. Mean baseline serum creatinine level was 5.51 ± 3.65 mg/dl and proteinuria 2.82 ± 2.48 g/24h. 77.8% received cyclophosphamide as induction immunosuppressive treatment whereas 13.3% rituximab. 50% received azathioprine, 36.1% mycophenolate and 13.9% rituximab as maintenance treatment. 37.8% patients underwent plasma exchange therapy and 44.4% hemodialysis. Complete remission was achieved by 13.3% of patients, while 57.8% partial remission. 28.9% had absence of remission. 28.9% achieved ESRD. ESRD was associated with undergoing hemodialysis (69.2% vs 30.8% p=0.033), to the type of response (complete 7.7% vs partial 23.1% vs no response 69.2%), baseline creatinine level (8.36 ± 5.44 vs 4.35 ± 1.64 mg/dl p=0.011), creatinine 6 months after induction treatment (4.3 ± 2.05 vs 2.04 ± 0.77 mg/dl p=0.001) and at the end of follow-up (6.33 ± 2.47 mg/dl vs 2.2 ± 1.29 mg/dl p=0.001) and also to baseline proteinuria (4.21 ± 3.12 vs 2.25 ± 1.96 p=0.003), proteinuria 6 months after induction treatment (1.4 ± 1.46 vs 0.58 ± 0.73 g/24h p=0.014) and at the end of follow-up (2.48 ± 1.9 vs 1.12 ± 1.64 p=0.001). Logistic regression only showed end of follow up serum creatinine level as an independent risk factor of ESRD (OR3.74 IC 95% 1.01-13.75 p=0.047). ESRD-free survival chance after 5 of follow-up was 67%. Conclusion Only serum creatinine level at the end of follow-up could be found as an associated factor with ESRD. Greater number of patients would be needed in order to obtain other factors leading to ESRD in patients with AAV.

scholarly journals GIANT HYDRONEPHROSIS

2012 ◽  
Vol 19 (04) ◽  
pp. 546-548
Author(s):  
NISAR AHMED SHAIKH ◽  
GHULAM SHABIR SHEIKH ◽  
SHABIR AHMED LARIK ◽  
Muhammad Iqbal ◽  
MALIK Hussain
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Clinical Presentation ◽  
Renal Stones ◽  
Elevated Blood ◽  
Early Referral ◽  
Giant Hydronephrosis ◽  
Definitive Surgery

Objective: To study the clinical presentation and management of giant hydronephrosis. Setting: Civil Hospital Dadu andUrology Department SMBBMU Larkana. Period: March 2004 to march 2011. Patients and methods: 28 Patient with giant hydronephrosistreated. 18(64.3%) patients had unilateral and 2(7.1%)had bilateral pelvi ureteric junction obstruction, 4(14.3%) had ureteric stones andremaining 4(14.3%) had multiple renal stones. All patients were treated with definitive surgery ie pyeloplasty, nephroplication, ureterolithotomy,extended pyelolithotomy and nephrectomy. Six (21.4%) patients had elevated blood urea and serum creatinine level so initially treated bypercutaneous nephrostomy and ureteric cathetrization. Result: 10 out of 28 cases of giant hydronephrosis showed improvement in the functionand drainage as well as pelvi-calyceal system dilatation while 18 patients going for nephrectomy. Conclusions: Early referral and interventionis necessary for giant hydronephrosis to prevent infection and deterioration of renal function.

MO1002EFFICACY OF PLASMAPHERESIS IN KIDNEY TRANSPLANT PATIENTS WITH FOCAL SEGMENTAL GLOMERULOSCLEROSIS : A SINGLE CENTER EXPERIENCE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Imen El Meknassi ◽  
Zellema Dorsaf ◽  
Azzabi Awatef ◽  
Sahtout Wissal ◽  
Ben Aicha Narjes ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Kidney Transplant ◽  
Creatinine Level ◽  
Focal Segmental Glomerulosclerosis ◽  
Renal Diseases ◽  
Baseline Serum ◽  
Segmental Glomerulosclerosis ◽  
The Mean

Abstract Background and Aims Plasmapheresis (PP) have been used in kidney transplant (KT) patients for multiple immunological renal diseases. Focal segmental glomerulosclerosis (FSGS) is one of the most prevalent indication for PP. It can be used either for curative or preventive treatment of its recurrence. The aim of our study was to assess the outcomes of PP among KT patients with FSGS. Method We performed a retrospective study including all KT patients with FSGS who underwent PP during the period from December 2007 to December 2018. PP was performed using a filtration technique by a Prismaflex machine. Results Among 275 KT patients, we have identified 5 patients with FSGS who underwent PP either before or after transplantation. The mean age was 26.4 years. All patients but one received a living-donor kidney with number of mismatches between 3 and 5. All patients were under corticosteroids, mycophenolate mofetil and cyclosporine. Two patients presented recurrent FSGS within 3 days following the transplantation. Mean serum creatinine level and proteinuria before PP were 517 ±191 µmol/l and 17.7 ±7.5 g/day respectively. The PP was used basing on Canaud protocol combined to rituximab. The mean number of PP sessions was 29. Only one patient required hemodialysis. None of the patients had lost his graft. The mean serum creatinine level was 172±55 µmol/l. One patient died of septic shock. PP was used in two other patients before transplantation in order to prevent the recurrence of FSGS. They have preserved a normal kidney function after a period of follow-up (37 months and 7 years). No rejection or recurrence of FSGS was noted during the follow-up period. Another patient aged 20, underwent 5 sessions of PP on alternate days immediately after transplantation to prevent the recurrence of FSGS. His baseline serum creatinine level was at 136 µmol/l. The recurrence of his initial renal disease occurred after 21 months requiring other sessions of PP. Rituximab was tried but stopped in front of allergy reaction. His renal function remained stable. Overall, PP was well tolerated in all patients with no incident. Conclusion Recurrence of the FSGS after transplantation is a concern for nephrologists due to the difficulty of treatment. Our study shows the efficacy of plasmapheresis before kidney transplantation to prevent recurrence of FSGS.

Residential cardiac rehabilitation (rCR) derived survival predictors in patients after transcatheter aortic valve replacement (TAVR): a retrospective multicenter study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Tarro Genta ◽  
L Dalla Vecchia ◽  
S Scalvini ◽  
S Sarzi Braga ◽  
G.L Iannuzzi ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Barthel Index ◽  
Training Session ◽  
Test Analysis ◽  
Transcatheter Aortic Valve ◽  
Test Distance ◽  
Mortality Table

Abstract Purpose To evaluate exercise-based rCR derived outcome predictors in patients referred after TAVR. Methods Data of 434 patients (aged 81±6 years) admitted to an average 3-week rCR program after TAVR (walking, up to 30 minutes of cycling or treadmill session twice daily, respiratory and calistenic training) from January 2009 to December 2017 and home discharged, were retrospectively collected at 10 Italian rCR Division of Istituti Clinici Maugeri SpA. Comorbidity (cumulative illness rated state-comorbidity index) (CIRS-CI) score, echocardiography on admission, Disability (Barthel Index) (BI) score, Morse Fall Scale score (MFS), six minutes walking test distance (6MWT) on admission and discharge and maximal training session intensity (MTSI expressed in METs per minutes) were collected. The mortality was assessed up to 3 years after rCR discharge. Results During a 3-years follow up there were 120 (28%) deaths. At t-test analysis non survivors compared to survivors had significantly higher CIRS CI (p=0.000), MFS score on admission (p=0.008) and discharge (p=0.017), serum creatinine level on admission (p=0.000) and discharge (p=0.000); moreover they had significantly lower BI score on admission (p=0.000) and discharge (P=0.000), left ventricle ejection fraction (p=0.008),6MWT on admission (p=0.001) and discharge (p=0.000) and MTSI (p=0.022) in comparison to survivors. At multivariate logistic stepwise analysis, BI score on admission and serum creatinine level at discharge were the only independent predictors of mortality (Table 1); the AUC of the final logistic model was 0.72. Conclusions Patients attending rCR after TAVR seem to be very old; overall mortality at 3 years follow up in patients discharged home after rCR is substantial. Disability profile on admission (measured by Barthel Index) and impaired renal function on discharge (measured by creatinine levels) are independently correlated to death at long term follow up. Funding Acknowledgement Type of funding source: None

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