Functional outcome after neonatal pyeloplasty in antenatally diagnosed uretero-pelvic junction obstruction

Background With routine antenatal ultrasonography, fetal hydronephrosis is commonly diagnosed. This leads to early detection of postnatal uretero-pelvic junction obstruction which may require surgical intervention. But, there is no clear consensus in the benefits of operating these patients in the neonatal age. Methods Aim—To study the functional outcome after pyeloplasty in neonates with antenatally diagnosed unilateral uretero-pelvic junction obstruction (UPJO). Records of all neonates (N = 48) who presented between 2016 and 2018 with prenatal diagnosis of unilateral UPJO and underwent a Anderson-Hyne’s Pyeloplasty were retrospectively analyzed. Indications for surgery were SFU grade 3 or 4, a split renal function (SRF) < 40% on a diuretic renal scan and antero-posterior renal pelvic diameter (APD) > 2.5 cm with parenchymal thinning. Parenchymal thickness (PT) and APD measured by ultrasonography, and SRF measured by 99 m Tc-EC renal scan were compared before and after surgery. Results Our study comprised of 48 patients with 79.2% males (n = 38). UPJO affected the left side more (n = 30, 62.5%). The mean age at pyeloplasty was 28 days (range 26–30). The outcome was considered successful in 46 (95.84%) patients. The APD decreased from a mean of 3.5 cm APD preoperatively to 1.38 cm 1 year later which was statistically significant (p < 0.001). The PT increased from 3.95 to 7.1 mm 1 year postoperatively which was significant (p < 0.001). The drainage pattern and SRF improved in 46 (95.84%) patients. The SRF improved from a mean of 35.48–44.7% 1 year postoperatively which was significant (p < 0.001). Conclusion Pyeloplasty done in the neonatal age for prenatally diagnosed UPJO, having SFU grade 3–4 UPJO, leads to significant improvement of SRF and PT with minimal complications. Neonatal Pyeloplasty for significant UPJO is a safe procedure which provides the kidney maximum opportunity to improve function.

Selection of the optimal type of the stapler cassette for distal pancreas resection

Aim of study. Investigation of risk factors in development of postoperative pancreatic fi stula (POPF) in patients aft er distal pancreatectomy (DP) involving application of a cutting stapler device (CS) as well as determination of the criteria for selection of the optimal cassette type for such devices making it possible to reduce the POPF development frequency. Material and methods. A two-centre retrospective/prospective controlled study was performed. A total of 46 patients (19 (41.3 %) male and 27 (58.7 %) female) were enrolled. All patients included in the study underwent DP surgery using CS for excision of the pancreas with closure of its stump. In all cases, measurement of the pancreas thickness in the resection area based on the data of preoperative computed tomography and calculation of the difference between the pancreatic parenchymal thickness in the resection area and the staple closure height (SCH). Th e patients were distributed between two groups: 1) without POPF of with biochemical leakage (BL); 2) with clinically relevant POPF (CR-POPF). Results. CR-POPF developed in 15 (32.6 %) cases (type-B POPF: 14 (93.3 %) cases, type-С: 1 (6.7 %) case). Statistically signifi cant diff erence in mean pancreatic parenchymal thickness in the resection area as well as mean SCH between the group without POPF or with BL and the group with CR-POPF (15.4±4.3mm versus 12.3±3.5mm, р=0.01 and 12.8±2.3mm versus 16.4±3.1mm, р<0.01, respectively). Th e frequency of CR-POPF development was reliably lower at the SCH varying from 8 to 14mm (9.5 %) as compared to cases with SCH below 8mm (55.6 %, p<0.01) and above 14mm (50.0 %, p<0.01). Conclusion. Upon analysis of risk factors in POPF development aft er DP, it has been established that a greater pancreatic parenchymal thickness in the resection area as well as SCH are statistically significant risk factors for this complication. Th e optimal SCH making it possible to achieve the minimal frequency of POPF aft er pancreatic stump closure using a CS is within the range of 8-14mm.

Dynamics of renal parenchymal thickness in hydronephrosis patients before and after surgery

Aim of study. To reveal changes in renal parenchymal thickness in hydronephrosis patients before and after surgery depending on the patient’s age. Materials and methods. Archived medical histories of 350 patients after surgery for congenital hydronephrosis within 1990-2020 were studied. The age of patients at the moment of surgery varied from one month to 18 years. The dynamics of change in the parenchymal layer thickness of the impaired kidney was evaluated based on ultrasound protocols of kidney scanning before and after the surgery. Results. The maximum decrease in renal parenchyma before surgery was noted in the group of patients aged 15-18 years: 46.00% and 59.68% on the poles and in the lower third, respectively. The minimum decrease was registered in patients aged 0-3 months: 24.43% on the poles and 49.06% in the middle third of the kidney. The best renal parenchyma restoration after surgery was registered in group 1: 94.04% on the poles and 87.74% in the middle third. Low percentages of parenchymal regeneration were observed in the 7th age group: 69.11% and 61.52%, respectively. The values of loss and restoration of parenchyma in each age group were statistically reliable at p≤0.001. Conclusion. Patients operated at the age before 3 months were observed to have the minimum decrease in the thickness of the renal parenchymal layer before surgery with maximum values associated with restoration of renal parenchyma after surgical correction. The probability of complete equivalence of parenchymal thickness of the operated kidney to the healthy one reliably declines with increasing age at the moment of operation.

Analysis of risk factors for progression of diabetic nephropathy in patients with type 2 diabetes

Introduction/Objective. The aim of the study was to examine the progression of diabetic nephropathy (DN) in a prospective three-year period as well as to establish the risk factors for DN progression. Methods. The study involved 45 patients with type 2 diabetes and DN (26 males, aged 18-62 years) followed for three years. All patients underwent physical examination and laboratory analysis at each visit. Laboratory analyses included complete blood count, serum glucose, urea, creatinine, protein, lipid concentration, glycosylated hemoglobin (HbA1c) and urine protein, albumin and creatinine concentration. Glomerular filtration rate (GFR) was calculated using Modification of Diet in Renal Disease formula. Kidney length and parenchymal thickness were measured by ultrasound. Results. Fasting serum glucose concentration (12.0 ? 2.79 vs. 9.50 ? 2.22, p < 0.001) and HbA1c (7.99 ? 1.43 vs. 7.49 ? 1.29, p < 0.031) were decreased over the three years. Albuminuria increased (43.75 ? 10.83 vs. 144.44 ? 52.70 mg/l, p < 0.001) and GFR (63 vs. 58.3 ml/min/1,73m2) decreased significantly during the study, but serum lipid concentration remained unchanged. Mean kidney length and parenchymal thickness decreased during the three years. Linear regression analysis found systolic blood pressure, fasting glycemia, HbA1c as positive and kidney length and parenchymal thickness as negative predictors of proteinuria increase, but proteinuria as negative and serum iron and albumin concentrations as positive predictors of annual change in GFR. Conclusion. High blood pressure and high HbA1c are selected as significant risk factors for increasing of proteinuria which is a significant predictor of GFR decreasing in patients with DN.

Correlation of Ultrasonographic Parameters with Serum Creatinine and Estimated Glomerular Filtration Rate in Patients with Echogenic Kidneys

Background: Ultrasonography is widely used to evaluate the kidney status. Serum creatinine and glomerular filtration rate assess the functional status of the kidney. This study tried to find the association between renal parameters in ultrasonography, serum creatinine and estimated glomerular filtration rate in patients with echogenic kidneys. Methods: Study was done in 61 patients. Four sonographic renal parameters (renal echogenicity grade, renal length, cortical thickness, parenchymal thickness) were obtained from patients showing echogenic kidneys irrespective of cause during ultrasonography of abdomen. Glomerular filtration rate was calculated using Modified Diet in Renal Disease formula after obtaining patient’s serum creatinine level. Sonographic renal parameters were compared with serum creatinine and estimated glomerular filtration rate using Pearson’s correlation coefficient and one-way ANOVA tests. Results: The study showed significant correlation of only renal echogenicity grade and parenchymal thickness with eGFR. However, all four sonographic renal parameters showed significant correlation with serum creatinine level. Renal echogenicity grading had strongest correlation with both serum creatinine (r=0.571, p=0.000) and estimated glomerular filtration rate (r= -0.349, p=0.006). Mean serum creatinine (in mg/dL) ± standard deviation was 1.9(±1.5), 4.0(±3.7), 5.8(±3.7), and 15.4(±5.3) for grade I, II, III, and IV echogenic kidneys respectively. Similarly, mean eGFR (in ml/min/1.73m2) ± standard deviation was 50.2(±22.9), 35.9(±40), 15.7(±13.4), and 3.4(±1.1) for Grade I, II, III, and IV echogenic kidneys respectively. Conclusions: Renal echogenicity is a better sonographic parameter that correlated well with both eGFR and serum creatinine. Renal ultrasound should be routinely used for early diagnosis, grading and monitoring of kidney disease. Keywords: Correlation; estimated glomerular filtration rate; renal echogenicity; serum creatinine; ultrasound

CT findings after left renal vein division during abdominal aortic surgery

Background The rationale behind left renal vein division (LRVD) is the assumption that adequate collateral draining channels will develop. Purpose To describe computed tomography (CT) findings after LRVD during aortic surgery. Material and Methods Among 61 consecutive patients who underwent LRVD during aneurysm repair or revascularization for aortic occlusive disease between January 2003 and December 2017, 51 patients (40 men, mean age 71.4 ± 8.4 years) were enrolled. Contrast-enhanced CT images were analyzed to evaluate collateral drainage, patency, left renal vein diameter, and left renal parenchymal thickness. A total of 115 radiologic reports were reviewed to check whether these findings were accurately mentioned. Results The median time period of the first postoperative follow-up CT was 36 days (range 7–1351 days). The gonadal vein (n = 47) was the most common collateral draining channel, followed by the retroperitoneal veins (n = 42) and adrenal vein (n = 33). Thrombosis occurred in five patients between postoperative days 7 and 17 in the remnant renal vein (n = 3), remnant renal vein plus gonadal and adrenal veins (n = 1), and gonadal vein (n = 1). There was a significant decrease in renal vein diameter (–0.48 ± 2.12 mm, P = 0.006). There was no significant difference in parenchymal thickness (−0.25 ± 1.27 mm, P = 0.193). Neither LRVD nor any associated findings were correctly stated on radiologic reports. Conclusion Postoperative contrast-enhanced CT can delineate collateral draining channels and complications following LRVD. However, these findings tend to be either missed or misinterpreted.

Ultrasonographyical Study of Kidneys Length Correlation in Various Clinical Stages of Chronic Type II Diabetes

The aim of the study was to use ultrasound imaging technique to differentiate between acute and chronic kidney diseases in type 2 diabetes. The renal length of left and right kidneys was compared and a detailed documentation was made. The study was carried out in Sree Balaji Medical College and Hospital, Chennai, Tamilnadu, India. Our study included adult male and female population who were known case of Diabetes Mellitus, above 18 years of age and biochemically diagnosed for nephropathy. All patients were subjected to ultrasonography evaluation of the renal parenchymal thickness and the findings were documented.