Application of B-ultrasound information image in Renal Puncture Biopsy treatment and Nursing

Objectives: This study was to explore the application value of B-ultrasound in guiding puncture biopsy of chronic kidney disease (CKD) and the clinical nursing effects under the guidance of B-ultrasound. Methods: Pathological examination of kidney biopsy was performed on 94 patients with CKD under the guidance of ultrasound from August 2020 to December 2020.; patients were observed for symptoms such as low back pain, backache, hematuria, and subcapsular hematoma. Color Doppler ultrasonography was performed on the punctured patients on day 1, 2, and 3 to observe whether there was subrental hematoma. The pathological results were analyzed and the success rate of percutaneous renal biopsy under ultrasound guidance was analyzed. Before the patient was discharged, investigate the satisfaction with the nursing work. Results: (1) After the puncture, 45 patients developed low back pain and low back pain symptoms, 12 cases developed subcapsular hematoma; 8 cases showed gross hematuria, 62 cases showed microscopic hematuria, and the rest had no obvious symptoms; (2) the nursing satisfaction rate of 94 cases was as high as 95.7%. Conclusion: US-PRB is a safe and effective auxiliary examination method, which can improve the success rate of puncture and reduce postoperative complications. Effective nursing can reduce the incidence of postoperative complications and improve patient satisfaction. doi: https://doi.org/10.12669/pjms.37.6-WIT.4831 How to cite this:Dong L, Li J, Zhao M, Ren J. Application of B-ultrasound information image in Renal Puncture Biopsy treatment and Nursing. Pak J Med Sci. 2021;37(6):1564-1568. doi: https://doi.org/10.12669/pjms.37.6-WIT.4831 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Page Kidney: A Secondary Cause of Hypertension

Page kidney is a rare cause of secondary hypertension in adults that occurs due to extrinsic compression of the kidney due to a subcapsular collection, such as a hematoma or urinoma. Usually these subcapsular formations are a result of trauma to the kidney such as from a biopsy or motor vehicle accident. Here we present a case of a 61-year old African American male who presented to the hospital with worsening shortness of breath for 2 days, a blood pressure of 203/156, and a BNP of 206. He was admitted and treatment was begun for diastolic congestive heart failure and hypertensive emergency. Clinically, he was improving but his systolic blood pressure continued to be in the 150’s despite multiple blood pressure medications. Due to this difficulty in controlling blood pressure and a negative renal ultrasound, an abdominal CT scan with contrast was ordered and revealed a subcapsular fluid collection indenting the lateral margin of the left kidney measuring approximately 7.1 x 5.4 x 2.3 cm that was suggestive of a Page kidney per radiology. Upon further history taking it was found that the patient has had received extracorporeal shock wave lithotripsy for nephrolithiasis in past several months which is a known risk factor for subcapsular hematoma formation. Ultimately it was determined that this subcapsular hematoma was resolving on its own and no intervention was needed other than follow-up as an outpatient. We feel this case is noteworthy for not only being a presentation of a Page kidney, but also demonstrates the importance of considering a secondary cause to hypertension in patients with difficult to control hypertension.

Page kidney post ureteroscopy: a case report

Renal injury after surgical intervention is not uncommon in current urological practice with most complication would be anticipated in high risk patient. Subcapsular renal hematoma is not known complication post some urological interventions such as extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and trauma. Few cases of subcapsular hematomas are reported as a complication post ureteroscopy in the literature. Clinical spectrum varies from spontaneous resolution through acute renal failure secondary to Page kidney. Page kidney is the external compression of a kidney usually caused by a subcapsular hematoma associated with high blood pressure and occasional renal failure. It is named after Dr. Irvin Page who first demonstrated in 1939 that applying external compression on the renal parenchyma could cause hypertension. Various management options are mentioned in literature and depend upon the severity and presentation. Percutaneous drainage is an option for the management of subcapsular hematoma in hemodynamically stable patient.

SUBCAPSULAR LIVER HEMATOMA – A COMPLICATION AFTER LAPAROSCOPIC CHOLECISTECTOMY

Subcapsular liver haematoma is among the most severe complications after laparoscopic cholecistectomy, but occurs rarely. The hematoma is usually located around the right lobe of the liver (in 75% of patients). We report the case of a 71 year old patient who underwent laparoscopic cholecistectomy for acute colecistitis. Initial postoperative evolution was favorable. On postoperative day 3 patient presents intense abdominal pain and decreased hemoglobin. The CT shows subcapsular hepatic hematoma. Emergency surgery is performed for signs of hemorragic shock with evacuation of the hematoma and hemostasis. Postoperative evolution is good. There are several theories proposed for the occurance of a subcapsular hematoma of the liver after laparoscopic cholecistectomy. Among these, the presence of a hemangioma, the use of NSAIDs or low molecular weight heparin. No clear mecanism is known and the only clinical sign can be abdominal pain. This case reminds us that we must take abdominal pain seriously after cholecystectomy in order to identify severe complications that can occur, such as hepatic subcapsular hematoma.