Micropercutaneous Laser Lithotripsy: How to Improve Stone Free Rate

Introduction: Micropercutaneous Nephrolithotomy is a novel technique with the creation of a 4.85-8F working channel. The advantage of micro-PCNL is the possibility of kidney puncture under direct endoscopic control. Materials and Methods: 99 patients aged 47,3 ± 16.9 years were included in the study. 78 patients had isolated kidney stones (78.8%). The stone size ranged from 8 to 38 mm (13.9 ± 5.4 mm). Group A included stones smaller than 15 mm (57 patients, 57,6%) and Group B included stones larger than 15 mm (42 patients, 42,4%). A 4.85 F percutaneous sheath was used in 38 (38,4%) patients, 8 F sheath was used in 61 (61,6%) patients. A holmium laser for lithotripsy was used in 46.5% cases, the thulium fiber laser in 53.5%. Results: The average surgery time was 39,9 ± 13.7 min (from 13 to 75 min). A stone-free rate (SFR) for patients of both groups was 88.8%. A Double-J stent was placed in 39 (39.4%) patients. In one case conversion to the mini-PCNL was done. In four cases (4%) retrograde stone manipulations were performed through ureteral access sheath. 5 (5.1%) patients required the second micro-PCNL tract. 3 (3%) patients required stenting postoperatively. In 7.1% of cases the episode of acute pyelonephritis developed. In 7 cases (7,1%), Extracorporeal Shock Wave Lithotripsy was required due to residual stones. Conclusions: We recommend using the laser micro-PCNL for the category of patients with severe comorbidities, including coagulopathy. The micro-PCNL could be safely performed in patients with kidney stones larger than 1.5 cm.

The Safe Use of Rituximab In The Management of ANCA-Associated Vasculitis In A Patient With Suspicious Renal Cyst – A Case Report

ANCA- Associated Vasculitis (AAV) is a multi-system immune small vessel vasculitis. The use of traditional immunosuppressive agents in the management of ANCA vasculitis is known to increase baseline susceptibility to malignancy [1]. Renal cyst is a commonly encountered incidental finding in clinical practice. Although most cysts found are benign, the identification of complex cysts warrants further diagnostic investigation to exclude a neoplastic process. To shed light on this complex area, the Bosniak system has provided a framework for the classification of cystic renal lesions. The system defines five categories of renal lesions based on radiological features seen on CT or MRI, to stratify the lesions associated risk of malignancy [2].

The Prevalence of Grade III Varicocele and Undescended Testis in Turkish Adolescent Males

Objective: To determine the grade III varicocele and undescended testis (UDT) prevalence, testicular atrophy rate, and treatment rate in adolescent boys aged 13-15 in the Turkish population. Methods: Healthy boys who were candidates for military high schools were evaluated between June and July 2015. Patients with undescended testis or grade III varicocele were recorded. Also, the presence of testicular atrophy and history of previous surgeries were recorded. The prevalence of grade III varicocele and UDT, testicular atrophy rate and treatment data were assessed. Results: Grade III varicocele was detected in 627 (6.48%) of 9669 boys. Testicular atrophy due to grade III varicocele was detected in 213 (33.97%) of the cases. Patients who did not undergo varicocelectomy are more likely to have testicular atrophy than patients who underwent varicocelectomy (35.37% vs 19.64%, p=0.018). The UDT was detected in 96 (0.99%) candidates. Of those, 76 (79.16%) candidates had unilateral, and 20 (20.83%) candidates had bilateral UDT. 84 (87.50%) candidates underwent at least one surgery for the management of UDT and 12.5% of the candidates (n=12) were not aware of their diseases. Conclusion: This study shows us the prevalence of grade III varicocele in our population. Varicocele is a progressive disease that can cause fertility and testicular atrophy increases with the puberty.

Tubular Necrosis, Acid-Base and Electrolyte Abnormalities Associated with Gasoline Vapour-induced Nephrotoxicity

Introduction: This study aimed to assess the effect of exposure to gasoline vapor (GV) on the histomorphology and biochemical markers of renal function in rats. Methods: Twenty-four mature Wistar Albino rats weighing 180–200 g were randomly divided into two groups (n = 12 per group). Animals in group 1 (G1) served as unexposed controls, while animals in group 2 (G2) were exposed to GV for 35 days. At the end of the exposure, the animals were sacrificed, and blood samples were collected for biochemical analysis while the kidneys were removed and processed for histopathological evaluation. Results: Serum biochemical markers of renal function in the exposed group differed significantly (p< 0.05) from the unexposed group in urea (45.16 ± 1.00mg/dl versus(vs) 13.20 ± 0.69 mg/dl), creatinine (1.16 ± 0.27mg/dl vs 0.38 ± 0.10mg/dl), uric acid (3.66 ± 0.82mmol/L vs 1.96 ± 0.08mmol/L), potassium (6.90 ± 0.27mmol/L vs 3.57 ± 0.26mmol/L), sodium (182.60 ± 3.21mmol/L vs 141.33 ± 10.46mmol/L), chloride (119.00 ± 1.58mmol/L vs 103.33 ± 2.07mmol/L), pH (6.82 ± 0.22 vs 7.38 ± 0.25), bicarbonate (16.60 ± 5.03mmol/L vs 26.50 ± 3.45mmol/L), and glucose (125.60 ± 16.23mg/ dl vs 83.33 ± 4.46mg/dl). Histopathological examination of kidney sections revealed areas of degenerative and necrotic changes in the glomerulus, tubules, and renal vasculature, particularly in the cortical portion of the kidney. Conclusion: Chronic exposure to gasoline compounds may be associated with significant structural and biochemical derangements in kidney function.

APOL 1 and kidney disease

APOL1 gene variants have been described to offer higher risk to develop hypertension, collapsing nephropthy and end stage kidney disease. The prevalence of mutations of the APOL1 gene among afro-descendant patients with chronic kidney disease for the G1 and the G2 variants can be of 20–22% and 13–15%, respectively [1]. Moreover this can be a greater problem in afrodescendante based populations, for instance, in Colombia, the genetic background of the populations was shaped by different levels of admixture between Natives, European, and Africans. Approximately 35.363 patients have diagnosed chronic kidney disease and according to population studies, 10.4% of these patients are Afro-descendant, and these frecuency can be as high as 90% in some áreas of this country. Given the importance that accounts on this area in the last years, the purpose of this review is to highlight the majors improvements in the understanding on the biology, pathophysiology and kidney disease development on patients affected with this genetic high risk variants.

Prevalence and Predictors of Malnutrition among patients on Maintenance Haemodialysis in a Tertiary Care Centre, Sri Lanka

Chronic kidney disease (CKD) is a mammoth public health issue, the tide of which continues to rise continuously [1]. Approximately 2.5 million receive renal replacement therapy in the world and it is projected to double to 5.4 million by 2030 [1].

Decaffeinated Coffee Consumption and Renal Function Impairment in Health and Diabetes: A Paradigm-Shift

Aim: The belief that decaffeinated coffee (DCAF) does not contain a physiologically relevant concentration of caffeine and therefore has no significant adverse effect on renal endpoints makes patients who are vulnerable to renal dysfunction, renal compromised state, medical conditions that contraindicate caffeine intake or those already on prescription medications known to adversely affect the kidney to sometimes substitute DCAF for caffeinated coffee even as the credibility of this paradigm remains disputable. Therefore, the present study aimed to assess the effect of DCAF consumption on markers of renal function and carbohydrate metabolism in health and diabetes. Materials and Methods: Sixty Wistar Albino rats were divided into 12 groups (6pairs) (n=5per group) for male and female animals. Animals in group 1 served as normal control (NCTRL) and were given standard feed and water only. Animals in group 2 received standard feed plus DCAF. Group 3 was the diabetic (DIA) only group while groups 4, 5, and 6 were DIA plus DCAF treatment groups. After 4weeks of treatment, animals were sacrificed and blood obtained and analyzed for the biochemical indices of renal function and carbohydrate metabolism using standard methods. Results: Serum creatinine (SCr) levels increased significantly in all DCAF treated groups compared with the NCTRL group in male and female animals. Serum electrolytes did not show any significant change across groups. Serum Urea (SUr) increased and decreased in DIA alone group and DIA plus DCAF groups respectively. Serum glucose, insulin, and HOMA-IR increased and decreased significantly in DIA alone group and DIA plus DCAF treated groups respectively compared with NCTRL and DCAF control groups. Conclusion: The consumption of DCAF may adversely affect renal endpoints in health and diabetes but improves markers of carbohydrate metabolism in diabetes likely due to the re-enforcement effect of its caffeine and other bioactive constituents.

Surgical Complications RevealingNephrotic Syndrome Of Children At ’’Hopital Saint Jean De Dieu De Tanguieta’’ (Benin)

Background:Thromboembolic and infectious complications of nephrotic syndrome are powerfuland canbefunctional or life threatening. Surgical complications are rare, hence the interest of our work which aimed to study the therapeutic and evolutionary clinical aspects of the surgical complications of the children’s nephrotic syndrome at ’’Hopital Saint Jean De Dieu De Tanguieta’’ (Benin). Methods: This was a prospective case study of children with complicatednephrotic syndrome followed at ‘’Hopital Saint Jean De Dieu De Tanguieta’’ (Benin) fromOctober 2016 to December 2018. Results: We reported two cases, all male. Before surgical complications the symptoms were dominated by an oedema syndrome lasting for each of them on averageeightmonths. Surgical complications thatrevealednephrotic syndrome were a spontaneous amputation of the right foot due to arterialthrombosis in a seven-year-old boy and a necrotizingfasciitis of the left foot in a 10-year-old child.The nephrotic syndrome wasidiopathic and the cares werebothsurgical and medical. Nephrotic syndrome wascorticosensitivewith a goodevolution in five months. Conclusion: These two cases teach that any childhoodoedema syndrome must bequicklyexplored for appropriated management to avoidtheseserious complications and aftereffects.

Using Time-Series and Forecasting to Manage Type 2 Diabetes Conditions (GH-Method: Math-Physical Medicine)

This paper describes the author’s application of Time-Series Analysis and forecasting to manage type 2 diabetes (T2D) conditions. The dataset is provided by the author, who uses his own T2D metabolic conditions control, as a case study via the “math-physical medicine” approach of a non-traditional methodology in medical research. Math-physical medicine (MPM) starts with the observation of the human body’s physical phenomena (not biological or chemical characteristics), collecting elements of the disease related data (preferring big data), utilizing applicable engineering modeling techniques, developing appropriate mathematical equations (not just statistical analysis), and finally predicting the direction of the development and control mechanism of the disease.

Haemangioma of the Penis: A Review and Update of the Literature

Haemangioma of the penis (HOP) is a rare benign vascular lesion which can affect the penis of males including infants, children, and adults of up to the over 80 year-olds. HOP does manifest as: asymptomatic lump or lesion on the penis; localised pain or tenderness anywhere within the penis; a tumoral mass anywhere on the penis; pain in the penis on erection; curvature of penis on erection; bright red compressible papule or papules on penis; nodules on penis; plaques on penis; ulceration on penis; haemorrhage on penis. HOP may be associated erectile dysfunction in some cases and could affect voiding if it is associated with the urethral meatus. HOP which tends to be solitary in most cases may mimic other diseases of the penis as well as may be associated with haemangioma in the scrotum and perineal region occasionally. Diagnosis can be established by the clinical features and this can be reaffirmed by radiology imaging features with the use of Doppler ultrasound scan, CT scan and MRI scan which show low-flow within the lesion. Majority of the lesions tend to be superficial and not associated with the corpora cavernosa and spongiosum. There is no consensus opinion on the best treatment options hence various treatment options for HOP have been successfully utilized including: complete surgical excision, sclerotherapy, laser treatment, cryotherapy, and other therapies. Most cases of HOP do not recur but following sclerotherapy and laser treatment of large HOPs repeat procedures tend to be required and there may be residual / recurrent lesion that may need to be treated again. Deep and large HOPs may require complete excision with insertion of tunica graft. Very large HOPs could be more effectively treated by one stage complete surgical excision but the choice of the patient is important. The diagnosis of the lesion can be confirmed by the histopathology features of the lesion and positive immunohistochemistry staining for CD31 (strong), Factor VIII, and HHF35 (myopericytes) and minimal staining for CD34. HOP needs to be carefully differentiated from epithelioid angiosarcoma of the penis and epithelioid haemangioendothelioma. A multi-centre trial of various treatment options for HOP would be required to provide treatment guidelines for HOP taking into consideration the size of the lesion and availability of the various treatment options.