COVID-19 in Single Kidney Patient

The COVID-19 pandemic has affected all people in the world, especially those at risk of kidney disorders. Early kidney damage in patients born with unilateral renal agenesis (URA) or solitary kidney can happen. These patients are at risk of chronic kidney disease (CKD), high blood pressure, and developing proteinuria. Unilateral renal agenesis is a cause of CKD. Therefore, it is very interesting that observe a unilateral renal Patient that Suffers from COVID-19. Hence, the management of these patients with COVID‐19 is an area of interest, and a unique approach is warranted. A 43-year-old male patient with unilateral renal presented to our hospital for corona disease. The case was discussed between the nephrologists, Infectious disease specialists, and nursing head nurses for a care plan daily. The patient had unilateral renal disease, and COVID-19 could have a detrimental effect on the renal, but renal tests were normal, and the patient recovered without acute renal complications. The treatment of such patients is the need for teamwork contain nephrologists, critical care nurses, and specialists in infectious and tropical diseases. This was a new experience in Iran.

Comorbid patient with arterial hypertension: difficulties in diagnosis and treatment

The problem of comorbidity becomes especially relevant in the conditions of demographic aging of the population. In recent years the number of studies devoted to diagnostic and treatment features of comorbidities, especially in elderly and senile patients, has increased. In spite of this fact, until now there are no clear recommendations for the management of comorbidities in the therapeutic practice.The article is devoted to the presentation and discussion of a clinical case of a comorbid patient with arterial hypertension. The stages of the performed diagnostic search with verification of the clinical diagnosis and the tactics of the prescribed pharmacotherapy are presented. On the basis of the presented data it is shown that exacerbation of one of the chronic diseases of the patient’s general comorbid background may significantly increase the severity of the general pathology and in its turn will determine the prognosis and influence the treatment tactics. The complexity of this case is that the patient has chronic single kidney disease in the stage of chronic renal failure. In analysing this case, it is also important to note the difficulties in the choice of drug therapy, as this situation poses significant limitations in the use of many drugs. This is a challenge that every clinician faces on a daily basis, regardless of clinical experience and medical knowledge. Only a multilevel approach will enable comprehensive medical and social care to be organised for patients with co-morbidities with chronic diseases, provide follow-up not only during exacerbations but also during remissions, contribute to the prevention of exacerbations and complications, which will consequently improve prognosis and quality of life.

Postrenal Azotemia in a Gastric Cancer Patient Revealed the Coincidence of Ureteral Metastasis and Contralateral Ureteral Stone: A Case Report

Metastatic ureteral masses are not rare, but isolated ureteral metastasis from the origin of gastric cancer is rare. Ureteral metastasis is usually unilateral and does not lead to postrenal azotemia unless in single kidney patients. Herein, we describe an 80-year-old man with a history of nonmetastatic gastric cancer who presented with postrenal azotemia due to the coincidence of right distal ureteral metastasis and left distal ureteral stone.

First experience of superselective embolization of renal arteries supplying the tumor with subsequent laparoscopic kidney resection

Background. Patients with signs of tumor lesions in a single kidney or in the only one functioning kidney, with bilateral renal tumors are at high risk of functional failure or insufficiency of the kidney after surgery. Joint discussions with specialists in X-ray endovascular surgeries resulted in the development of a treatment algorithm for patients with localized kidney cancer who require organ-sparing surgery without ischemic kidney resection.Objective: to evaluation of the immediate results of two-stage surgical treatment of localized kidney cancer in patients with signs of tumor lesions in a single kidney or in the only one functioning kidney, with bilateral renal tumors, including superselective embolization of the artery supplying the tumor at the first stage, and laparoscopic kidney resection without renal ischemia parenchyma at the second stage.Materials and methods. This study included 5 patients with localized kidney cancer, who underwent two-stage treatment at Moscow Regional Oncology Dispensary between 24.03.2021 and 19.04.2021. The first stage included superselective embolization of the artery supplying the tumor; the second stage implied laparoscopic kidney resection 6-7 days following the first stage.Results. The median age of the patients was 62 years (range: 42-73 years). Four patients (80%) had unilateral kidney lesions, while 1 patient (20 %) had bilateral (synchronous) kidney cancer. The mean RENAL score was 8 (range: 6-10); patients were distributed as follows: score 4-6 in 40 %, score 7-9 in 40 %, and score >10 in 20 % of patients. At the first stage, patients underwent endovascular embolization of the branches of the renal artery. Patients had superselective embolization of either middle (n = 3; 60 %), upper (n = 1; 20 %), or lower (n = 1; 20 %) segmental arteries supplying the tumor. In one of them (20 %), we identified 3 large arterial branches; in another one (20 %), we identified 2 large arterial branches.At the second stage, we performed laparoscopic kidney resection. None of the patients required renal artery clamping, because there was an excellent visualization of the demarcation zone and no significant blood loss. The resection area was sutured in 1 case (20 %). In 2 individuals (40 %), a hemostatic sponge was installed in the removed tumor bed. In the remaining 2 cases (40 %), hemostasis was ensured by coagulation. The median blood loss was 100 mL (range: 50-200 mL). The postoperative period was uneventful in all patients. None of the patients developed symptoms of acute renal failure.Conclusion. Thus, superselective embolization of arteries supplying a kidney tumor has undeniable advantages in organ-sparing surgeries for patients with localized kidney cancer and some additional kidney problems, when organ preservation is crucial for patient's life.

Estimating Nephron Number from Biopsies: Impact on Clinical Studies

Background: Accumulating evidence supports an association between nephron number and susceptibility to kidney disease. However, it is not currently possible to directly measure nephron number in a clinical setting. Recent clinical studies have used glomerular density from a single biopsy and whole kidney cortical volume from imaging to estimate both nephron number and single nephron glomerular filtration rate. However, the accuracy of these estimates from individual subjects is unknown. Furthermore, it is not clear how sample size or biopsy location may influence these estimates. These questions are critical to study design and to the potential translation of these tools to estimate nephron number in individual subjects. Methods: We measured the variability in estimated nephron number derived from needle or virtual biopsies and cortical volume in human kidneys declined for transplantation. We performed multiple needle biopsies in the same kidney, and examined the three-dimensional spatial distribution of nephron density by magnetic resonance imaging. We determined the accuracy of a single kidney biopsy to predict the mean nephron number estimated from multiple biopsies from the same kidney. Results: A single needle biopsy had a 15% chance and virtual biopsy had a 60% chance of being within 20% of whole kidney nephron number. Single needle biopsies could be used to detect differences in nephron number between large cohorts of several hundred subjects. Conclusions: The number of subjects required to accurately detect differences in nephron number between populations can be predicted based on natural intra-kidney variability in glomerular density. A single biopsy is insufficient to accurately predict nephron number in individual subjects.

Critical timing of ACEi initiation prevents compensatory glomerular hypertrophy in the remaining single kidney

Increasing evidence suggests that single in kidney states (e.g., kidney transplantation and living donation) progressive glomerulosclerosis limits kidney lifespan. Modeling shows that post-nephrectomy compensatory glomerular volume (GV) increase drives podocyte depletion and hypertrophic stress resulting in proteinuria and glomerulosclerosis, implying that GV increase could serve as a therapeutic target to prevent progression. In this report we examine how Angiotensin Converting Enzyme inhibition (ACEi), started before uninephrectomy can reduce compensatory GV increase in wild-type Fischer344 rats. An unbiased computer-assisted method was used for morphometric analysis. Urine Insulin-like growth factor-1 (IGF-1), the major diver of body and kidney growth, was used as a readout. In long-term (40-week) studies of uni-nephrectomized versus sham-nephrectomized rats a 2.2-fold increase in GV was associated with reduced podocyte density, increased proteinuria and glomerulosclerosis. Compensatory GV increase was largely prevented by ACEi started a week before but not after uni-nephrectomy with no measurable impact on long-term eGFR. Similarly, in short-term (14-day) studies, ACEi started a week before uni-nephrectomy reduced both GV increase and urine IGF-1 excretion. Thus, timing of ACEi in relation to uni-nephrectomy had significant impact on post-nephrectomy “compensatory” glomerular growth and outcomes that could potentially be used to improve kidney transplantation and live kidney donation outcomes.

Buccal ureteroplasty in a patient with an extended stricture of the proximal ureter of a solitary kidney

Buccal ureteroplasty is considered a rare operation in urology and the indications for its implementation are still not clearly defined. We have described a clinical case of successful replacement of a part of the proximal ureter with a buccal graft in a patient with a single kidney, which was drained for a long time with a nitinol stent, which was subsequently incrustated, which led to the installation of a permanent nephrostomy drainage. The patient had no postoperative complications, the patency of the urinary tract was fully restored.

Survival of patients with bilateral renal cell cancer after nephro-preserving surgery

This article presents a systematic literature review to assess the survival outcomes of patients with bilateral renal cell carcinoma who underwent nephro-preserving surgery. Patients with bilateral renal neoplastic lesions represent a rare subpopulation, numbering, according to different authors, from 2 to 6 % of the total RCC group. Despite the increase in the number of cases of bilateral RCC, the number of works devoted to the study of the features of surgical intervention, prognosis factors, treatment outcomes and survival of this cohort of patients is limited, and a number of important questions regarding this problem remain unresolved. Currently, the only effective method of treating bilateral renal cancer is nephro-preserving surgery in the volume of bilateral renal resection / nephrectomy with resection of the contralateral kidney in case of synchronous lesion or resection of a single kidney in case of metachronous lesion. This strategy avoids or reduces the risk of developing renal failure and its consequences after surgery. Conclusion. Nephro-preserving surgery for bilateral renal cell carcinoma is the only effective method to achieve satisfactory oncological results with a low incidence of complications.