Xanthogranulomatous Pyelonephritis Caused by Stenotrophomonas maltophilia—The First Case Report and Brief Review

Xanthogranulomatous pyelonephritis (XGP) represents a rare and severe pathology secondary to chronic urinary obstruction and recurrent infections. Commonly, this condition leads to loss of kidney function, and frequently, surgical approach is the only optional treatment. Proteus mirabilis and Escherichia coli are the most frequent pathogens associated with XGP. The actual changes in the pathogen’s characteristics increased the risk of newly acquired infections once considered opportunistic. Stenotrophomonas malthophilia is one of those agents more related to immunocompromised patients, presenting an increased incidence and modified antibiotic resistance profile in the modern era. This case report presents a healthy female patient with an underlying renal stone pathology diagnosed with XGP related to S. maltophilia urinary infection. After a complete biological and imagistic evaluation, the case was treated as pyonephrosis. Empirical antibiotic administration and a surgical approach were considered. A total nephrectomy was performed, but the patient’s condition did not improve. The patient’s status improved when specific antibiotics were administered based on the bacterial identification and antibiotic susceptibility pattern of drained perinephric fluid. Levofloxacin and Vancomycin were considered the optimal combination in this case. The histopathological examination revealed XGP secondary to chronic renal stone. The present study describes the first case of XGP related to an aerobic Gram-negative pathogen such as S. maltophilia, once considered opportunistic, in an apparently healthy female adult.

THE PROTECTIVE AND THERAPEUTIC EFFECT OF CORN SILK EXTRACT ON UROLITHIATIC AND HYPERTENSIVE RATS INDUCED BY ETHYLENE GLYCOL

Renal stone is one of the most problems worldwide. They are affected by different factors such as environmental effectors such as nutrient as well as family history. Corn silk (CS) used as antiurolythiasis. This study investigated the impact of corn silk extract as the management of renal stone formation, hypertension, and hepatoprotective. This work has been carried out on rats at Faculty of science Sana’a University, University of Science, and Technology Laboratories. Twenty-four male albino rats with weighing range between (200 g to 250g) were taken. They were divided in four groups (each group consists of 6animals). The first group of rats took normal diet and named as negative control (Co) whereas, the second group took normal diet with ethylene glycol (EG) (0.75%) and 1% ammonium chloride (AC) for 28 days and serve as positive control (Po). The third and fourth groups took the same substances as inPo group with 200 mg/kg and 400 mg/kg of corn silk (CS) for 28 days respectively.Blood samples were collected from rats on last day of the experiment. All the tested samples showed a significant antioxidant DPPH radical scavenging activity and a notifiable decrease in serum aldosterone hormone, angiotensin comforting enzyme urea and creatinine levels comparedto positive control. Shown to significantly increased AST, ALT, and LDH in comparison to the urolithiatic group and near of normal group.In conclusion, the present study emphasizes the safe herbal remedies of CS as anti-hypertensive and antioxidants, as well as antiurolithiatic and hepatoprotective.

Double obstruction of upper and lower urinary tract in a child due to renal stone disease: Endoscopic treatment

Incidence of renal stone disease/urolithiasis has increased significantly in children due to multifactorial causes. Stones secondary to metabolic abnormalities are treatable if it is identified at the early stage. Surgical intervention may be needed depending on the site, size of the stone, and the clinical presentation. We report a 12-year-old adolescent boy with multiple calculi at various sites who needed medical as well as surgical intervention.

Contrast Agent Mimicking Calculi in Entrapped Calyx. A Report of a Case

Urolithiasis is a common condition, and it represents a large number of hospital visits. Under the term infundibulopelvic dysgenesis, many conditions amongst a spectrum of congenital disorders of the pelvicalyceal system are described. Retrograde intrarenal surgery (RIRS) is an effective and safe treatment modality in the management of urinary system stone disease. Fluoroscopic imaging is a cornerstone in endourology. Herein, we present a case where we diagnosed an obstructed calyx during RIRS for renal calculi and operated on it. In this extraordinary case, contrast agent was trapped in the calyx mimicking a renal stone and that was the reason that we discovered the infundibular stenosis. The patient, 24 h after the operation, left the hospital without any complications reported.

Does COVID-19 infection change the need for future surgical interventions? An exploratory analysis.

Background: It is unknown whether recovery from coronavirus disease 2019 (COVID-19) infection leads to an increased need for common surgical procedures. Our objective was to conduct an exploratory analysis of surgical procedures performed after a documented COVID-19 infection. Methods: We conducted a retrospective cohort study using routinely collected data from the province of Ontario, Canada. We identified individuals with a positive COVID-19 test between February 1 2020 and May 31 2020, and matched them 1:2 with individuals who had a negative COVID-19 test during the same period. We used physician billing codes to identify the ten most frequent surgical procedures in the COVID-19 cohort. An at-risk period 30 days after the first positive COVID-19 swab (or matched index date in the control group) until November 30 2020 was used. Cox proportional hazard models (adjusted for important baseline differences) are reported with hazard ratios (HR) and 95% confidence intervals. Results: After exclusions and matching, we had 19,143 people in the COVID-19 cohort, and 38,286 people in the control cohort. The top ten surgical procedures were hand/wrist fracture fixation, cesarean-section, ureteral stent placement, cholecystectomy, treatment of an upper tract urinary stone, hysterectomy, femur fracture repair, hip replacement, transurethral prostatectomy, and appendectomy. There was a significantly reduced hazard of requiring upper tract renal stone surgery (adjusted hazard ratio [aHR] 0.50, 95% confidence interval [CI] 0.29-0.87) or ureteral stent placement (aHR 0.54, 95%CI 0.36-0.82), or undergoing a cholecystectomy (aHR 0.43, 95%CI 0.26-0.71) among those with a prior positive COVID-19 test. Conclusions: After a COVID-19 infection there is not an increased risk of needing several common surgical procedures. There appears to be a reduced risk of renal stone disease treatment and ureteral stent placement, and a reduced risk of cholecystectomy, however understanding the reasons for this will require further study.

Short-Chain Fatty Acids Reduced Renal Calcium Oxalate Stones by Regulating the Expression of Intestinal Oxalate Transporter SLC26A6

Some studies found that the relative abundances of short-chain-fatty-acid (SCFA)-producing bacteria were lower in the gut microbiota of renal stone patients than healthy controls. Our previous study demonstrated that SCFAs could reduce the formation of renal calcium oxalate (CaOx) stones, but the mechanism is still unknown.

Minimising Radiation Dose in Computerised Tomography in the Investigation of Renal Stone Disease: A Teaching Hospital Audit

Background: CTKUB is a commonly performed scan as the gold standard investigation for renal stone disease. However, CT exposes a patient to ionising radiation. The radiation delivered to the patient increases in importance given the young demographic and often need for interval imaging. To minimise exposure, low dose scanning techniques are employed, and image field is reduced to only scan relevant anatomy. A common starting point for CT KUB is often the T10 vertebra however many scans are performed starting at higher levels exposing the patient to unnecessary radiation. Methods: A list of 100 patients who underwent CTKUB for renal stone disease at a teaching hospital was created. Following exclusion of duplicates and application of exclusion criteria 51 scans were included. Each scan was individually analysed to assess vertebral level of upper limit of kidney and vertebral level at which the CTKUB scan was started. Percentage overshoot was calculated as number of axial slices cranial to the upper aspect of the kidneys. Results: 22% of scans included in the study were started proximal to T10, these scans had a mean percentage overshoot of 19.6% exposing the patient to excess radiation. Of the CT KUB scans started at T10 or below mean percentage overshoot was improved to 8.6%. At the level of T10 all analysed scans would avoid undershooting. Conclusions: Implementation of a CTKUB imaging protocol which starts at T10 will minimise ionising radiation exposure whilst allowing visualisation of the complete renal tract. Keywords: CT KUB, Radiation safety, Minimise radiation