Impact of acute kidney injury on long-term adverse outcomes in obstructive uropathy

Obstructive uropathy is known to be associated with acute kidney injury (AKI). This study aimed to investigate the etiologies, clinical characteristics, consequences and also assess the impact of AKI on long-term outcomes. This multicenter, retrospective study of 1683 patients with obstructive uropathy who underwent percutaneous nephrostomy (PCN) analyzed clinical characteristics, outcomes including progression to end-stage kidney disease (ESKD), overall mortality, and the impact of AKI on long-term outcomes. Obstructive uropathy in adults was most commonly caused by malignancy, urolithiasis, and other causes. AKI was present in 78% of the patients and was independently associated with preexisting chronic kidney disease (CKD). Short-term recovery was achieved in 56.78% after the relief of obstruction. ESKD progression rate was 4.4% in urolithiasis and 6.8% in other causes and older age, preexisting CKD, and stage 3 AKI were independent factors of progression. The mortality rate (34%) was highly attributed to malignant obstruction (52%) stage 3 AKI was also an independent predictor of mortality in non-malignant obstruction. AKI is a frequent complication of adult obstructive uropathy. AKI negatively affects long-term kidney outcomes and survival in non-malignant obstructions. A better understanding of the epidemiology and prognostic factors is needed for adult obstructive uropathy.

Colonic Stenting Using Side-Viewing Endoscope: A Case Report

Colonic self-expandable metal stents (SEMS) are widely used as palliation for malignant obstruction. The conventional method involves using a forward-viewing endoscope as part of the procedure. Sometimes, however, the sharp angle of the stricture poses difficulty in evaluating the stricture, so a guidewire is placed across the stricture. Here, we present a case where a side-viewing endoscope was employed for colonic stent placement and propose its use in patients with sharp bends to increase success.

297 Risks of Delaying De-Obstruction of an Acutely Infected Obstructed Urinary Tract

Introduction We investigated patients with acute urinary tract obstruction in a DGH to ascertain which factors predispose to CKD and mortality. Method Over five months there were 37 nephrostomy/stent cases, 18 female, 3 mortalities. Median age was 55.5 (18-93). Retrospective data was used in a multiple regression analysis. Input variables included the intervention indication, admission Creatinine, Charlson Co-morbidity Index, and intervention delay. Output variables were length of hospital stay, renal function and 90-day mortality. Results Positive urine cultures (p = 0.035) and co-morbidity (p = 0.018) were associated with CKD. Nephrostomy patients (p = 0.031) were associated with AKI post-procedure. Delay in disobstruction (p < 0.01) and delay-length (p = 0.026) were significantly associated with longer hospital stays. AKI severity on admission (p = 0.047) and intervention delay (p = 0.045) increased risk of 90-day mortality, with positive blood cultures (p = 0.071) trending towards significance. Malignant obstruction neared a significant association with CKD (p = 0.08) and 90-day mortality (p = 0.075). Conclusions The severity of presentation and delay in intervention all contribute to poorer outcomes and a longer admission. Co-morbid patients with malignant obstruction had a higher risk of 90-day mortality. Therefore, in those with poor baseline, are we intervening inappropriately?

Endovascular Stenting for Malignant Obstruction of Superior Vena Cava: A Single-Center Experience Using the Body Floss Technique

Purpose Endovascular stenting is the treatment of choice for malignant obstruction of the superior vena cava (SVC) when rapid symptomatic relief is desired. Body floss technique is not routinely used during SVC stenting but has few advantages over single-access technique. We report our experience with stenting for malignant obstruction of the SVC using the body floss technique. Materials and Methods Between March 2015 and March 2020, 25 patients (20 men, 5 women; median age, 65 years) with malignant SVC obstruction underwent endovascular stenting of the SVC. We retrospectively evaluated these patients for clinical and technical success rates, complications, recurrence-free survival, and overall survival. Results Stent placement was successful in 24/25 patients (technical success: 96%). Clinical success was achieved in 23/25 (92%) patients. A mortality rate of 4% (1/25) was noted due to SVC rupture. Partial stent migration was noted in two patients (8%) and was treated by placing an additional overlapping stent. Incidental early stent thrombosis was seen in two patients within 8 hours of stent placement, but these patients showed symptom relief with anticoagulation. Follow-up imaging confirmed stent patency in all patients. Late stent occlusion due to tumor progression was seen in one patient. The primary patency rate was 88% (22/25). Overall median survival of 133 days was observed (range: 1–847 days). Conclusion Endovascular stenting of the SVC for malignant obstruction using the body floss technique is associated with high technical and clinical success, and low rate of complications.

Extra-Hepatic Biliary Obstruction - A Cross-Sectional Study to Assess the Various Benign and Malignant Causes for Obstructive Jaundice among Patients Attending Trivandrum Medical College

BACKGROUND Extra-hepatic biliary tract obstruction can be due to a number of conditions. Most causes are due to stones in the common biliary duct or due to malignant obstruction. Malignant causes include carcinoma head of pancreas, periampullary carcinoma and cholangiocarcinoma. Besides calculus and malignant obstruction, benign and malignant strictures can also cause obstruction of extra hepatic biliary ducts. The objectives of the study were to describe the clinical profile of patients presenting with extra-hepatic biliary obstruction and to assess the known aetiological factors. METHODS The research was designed as a hospital based cross-sectional study in the general surgery wards of our institution from 2016 to 2017. All individuals who were diagnosed to have extra-hepatic biliary obstruction by imaging were included in the study. RESULTS Among the 66 cases studied, majority were due to malignancies and gall stones. The malignancies included carcinoma head of pancreas, periampullary carcinoma, cholangiocarcinoma and Klatskin’s tumour. Miscellaneous causes were bile duct stricture, cholelithiasis with biliary sludge and annular pancreas. For the malignant cases, Whipple surgery and its pylorus-preserving variant were the most common surgical procedures carried out. Biliary bypass procedures were also carried out in some patients. For patients with common bile duct (CBD) stones, cholecystectomy, choledocholithotomy and choledochojejunostomy were done. CONCLUSIONS Malignant causes of jaundice are more common than benign causes. Secondary stones are the commonest cause of non-malignant biliary obstruction. Jaundice is more severe and associated with pruritis and more intolerable and persistent in malignancy. Surgical bypass procedures give good palliation for obstructive jaundice. KEY WORDS Bile Ducts, Choledocholithiasis, Cholestasis, Extra Hepatic, Pancreatic Cancer, Periampullary Cancer