فهرست مطالب

  • Volume:3 Issue:4, 2011
  • تاریخ انتشار: 1390/07/23
  • تعداد عناوین: 18
|
  • Cristina Costa Page 237
    Implication for health policy/practice/research/medical education: Cytomegalovirus infection and disaese may represent a serious complication in renal transplant recipients, being potentially involved in the pathogenesis of acute vascular rejection. Evaluation of potential markers of subsequent risk of acute renal allograft vascular rejection, such as cytomegalovirus-induced anti-endothelial cell antibodies, could be useful in the clinical management.
  • Muhammed Mubarak, Javed I. Kazi Page 240
    Collapsing focal segmental glomerulosclerosis (cFSGS) is a distinct clinicopathological variant of focal segmental glomerulosclerosis (FSGS) characterized pathologically by the segmental and/or global collapse of the glomerular capillaries, marked hypertrophy and hyperplasia of visceral epithelial cells (VECs), and severe tubulointerstitial disease. The etiology of this lesion is still elusive, but a growing list of diseases/conditions is associated with this morphologic expression of renal parenchymal injury. The pathogenesis of cFSGS involves VEC injury leading to cell cycle dysregulation and a proliferative podocyte phenotype. Clinically, collapsing glomerulopathy is characterized by black racial predisposition, a high incidence and severity of nephrotic syndrome (NS), poor response to empirical therapy, and rapid progression to end-stage renal disease (ESRD). The lesion has also been reported in transplanted kidneys either as recurrent or de novo disease, often leading to loss of the allograft. Most of the cases have been reported from the western countries, but the lesion is being increasingly recognized in the tropics as well. The optimal treatment for cFSGS is still not known. Empirical therapies include steroids or cyclosporine in addition to aggressive blood pressure control, angiotensin converting enzyme inhibitors (ACEIs) and/or angiotensin II receptor blockers (ARBs), and lipid lowering agents. The role of other immunosuppressive agents such as mycophenolate mofetil in the treatment of cFSGS awaits further studies. Newer insights into the pathogenesis may change this ominous outlook for this therapeutically resistant form of FSGS. There is still lack of awareness among the pathologists and nephrologists in the developing countries about this lesion. There is an urgent need to educate the pathologists and nephrologists from developing countries on this topic. This review describes the historical background, epidemiology, etiology, pathogenesis, pathology, treatment, and prognosis of this disorder, with an emphasis on the pathologic features on renal biopsies to facilitate its accurate diagnosis in developing countries.
  • Katarzyna A. Lisowska, Aleksandra Jasiulewicz, Ewa Bryl, Jacek M. Witkowski Page 247
    Erythropoietin (EPO) is a glycoprotein produced by peritubular capillary epithelial kidney cells in response to hypoxia to control erythropoiesis. It stimulates growth and differentiation of red blood cells progenitors and protects them from apoptosis by binding to receptor (EPO-R) on CFU-E (erythroid colony-forming unit) and BFU-E (erythroid burst-forming unit) colonies. Although it seems that primary role of EPO is the regulation of red cells production, EPO-R has been found in/on other tissues and cells, including human polymorphonuclear leukocytes, monocytes and lymphocytes. Both EPO-R structure and its presence on these cells suggest that beyond erythropoietic function, EPO might possess some immunomodulatory properties. Progress of chronic kidney disease (CKD) gradually leads to kidney failure, uremia, hypertension and anemia resulting from decreased EPO production and presence of uremic toxins and proiflammatory cytokines. At the same time, CKD patients also show signs of the deficiency state in both cell mediated and humoral immunity, which is even deepened by dialysis procedure. High levels of proinflammatory cytokines produced by chronically activated monocytes and decreased IL-2 level reflecting weakened T lymphocytes function are observed. Deficient T lymphocytes responses lead to impaired humoral immunity presented by the decreased immunoglobulin levels in response to hepatitis B vaccination and increased frequency of different infections. Since late 80s recombinant human erythropoietin (rhEPO) is commonly used for treatment of anemia related to chronic kidney disease (CKD). Current review describes immunological aspects of rhEPO therapy in CKD patients. The aim of this work is to pay attention to the fact that observed improvement of the immunological responses described in last 15 years in CKD patients is not only the result of anemia correction during rhEPO treatment. Changes of crucial activation and co-stimulation antigens of T lymphocytes of rhEPO treated CKD patients along with EPO-R presence on human leukocytes indicate that EPO/rhEPO can directly influence immunological responses.
  • Benjamin T. Ristau, Timothy D. Averch, Jeffrey J. Tomaszewski Page 252
    Background
    Percutaneous nephrolithotomy (PCNL) is the preferred treatment for renal calculi greater than 2cm in diameter. In both the United States and United Kingdom, interventional radiologists often perform percutaneous access rather than urologists obtaining their own access.
    Objectives
    We present a local cohort of urologist versus radiologist obtained percutaneous access and a relevant literature review. In addition, access techniques and the role of training urologists to obtain percutaneous access are reviewed.
    Materials And Methods
    The records of 233 patients undergoing PCNL at the University of Pittsburgh Medical Center (UPMC) between 2000 and 2008 were retrospectively reviewed. Patients were stratified according to percutaneous access by urologists (group 1) or a group of interventional radiologists (group 2) in 195 and 38 patients, respectively. Radiologist-acquired access was performed for collecting system decompression in 33.3% of patients in group 2. A predicted access difficulty score was calculated using demographic, stone, and operative variables. Percutaneous access complications and stone-free rates were compared between groups.A Medline search of pertinent articles was conducted. Additional sources were identified from the reference sections of relevant manuscripts.
    Results
    Rates of stone clearance are superior with urologist-obtained renal access as compared to radiologist-obtained access when there is no preoperative communication between groups. Complication rates are similar between groups. Among urologists, the learning curve for PCNL is 60 cases for competence and 100-115 cases for excellence. Several models for virtual training in percutaneous renal access are available. The use of retrograde endoscopy can reduce the number of tracts required for access, thereby reducing perioperative blood loss. Ultrasound has been used as an adjunct imaging modality for PCNL and reduces the risk of radiation to patients and staff.
    Conclusion
    Urologists can safely obtain percutaneous renal access. Further training during and after residency is necessary to increase the number of urologists capable of obtaining access for PCNL. A number of virtual models are available to facilitate training. Endoscopic-assisted percutaneous renal access may decrease the steep learning curve associated with obtaining percutaneous access. Efforts should be made to decrease the use of ionizing radiation during PCNL.
  • Chong Xie, Jianming Guo, Guomin Wang, Hang Wang Page 258
    Background
    Ureteropelvic junction obstruction (UPJO) is mostly a benign, congenital condition that remains an enigma in terms of diagnosis. Despite several advances in morphological and functional imaging of UPJO, controversies still remain about the optimal imaging method to diagnose UPJO. Intravenous urography (IVU) has been standardized and is a familiar technique to urologists, however, its diagnostic efficacy is not high and thus another examination is usually needed.
    Objectives
    The aim of this study was to compare CTU and IVU in the assessment of patients with UPJO.Patients and
    Methods
    Sixty-one patients with final diagnosis of UPJO received both IVU and CTU before operation. The CTU examination included three phase axial scan: noncontrast (phase I), nephrographic phase (phase II), excretory phase (phase III) and CTU images were obtained by coronal reconstruction of phase I and III. Two radiologists who were unaware of the findings independently interpreted these examinations. The diagnosis of both imaging studies were compared with the final diagnosis and the two examinations were compared by the results of diagnostic accuracy for different causes of disease.
    Results
    In our study, the cause of UPJO were mainly crossing vessel, stone disease, carcinoma, fiber cord compression, congenital distorted uretero-pelvic junction, inflammatory stenosis, high ureteropelvic junction, ureteral valves and renal duplication combined with obstruction. The diagnostic accuracy is 85.2% in CTU and 49.2% in IVU. Although suspicious abnormal findings in IVU were recognized in many patients (23/61), they were usually inadequate for making accurate diagnosis and further examinations were thus acquired. As compared with IVU, the operative procedure of CTU was simpler and the examination time was shorter, however, the cost and the radiation exposure was larger.
    Conclusions
    CTU has higher diagnostic efficacy as compared with IVU and could be the one-stop examination for patient with UPJO. It should be under consideration to have CTU as the first line diagnostic tool, although more delicate cost-effectiveness evaluation is needed for conclusion.
  • Anubha Singh Yadav, Santosh Kr. Singh, Devendra Singh Pawar, Sachit Sharma, Tapan Aggarwal, Asha Kumari Page 264
    Background
    Prostatic abscess is an uncommon condition and is most often associated with prostatitis. The incidence of prostatic abscess has declined markedly with the widespread use of antibiotics and decreasing incidence of gonococcal urethritis. The management of prostatic abscess consists of antibiotic therapy and aspiration/drainage by transperineal, transrectal and transurethral route.
    Objectives
    The purpose of the study was to present and discuss the clinical presentation, etiologies, diagnosis and treatment outcome of prostatic abscess at our institute in last 8 years.Patients and
    Methods
    A retrospective study was carried out on 12 patients diagnosed with prostatic abscess during 2002-2010 at our institute. Age of patients ranged from 17-76 years. The data analyses regarding age, presenting complaint, digital rectal examination, diagnostic imaging, bacteriological profile, treatment modalities and outcome. The collected data was compared with the available latest literature.
    Results
    10 patients presented with lower urinary tract symptoms, 5 patients were diabetics, 3 patients presented with retention urine and 3 had fever. Two patients had pyrexia of unknown etiology without any LUTS. Urine culture was sterile in 7 patients. On digital rectal examination fluctuation was present in only 5 patients. Pus culture showed Escherichia coli in 5 patients, Staphylococcus aureus in 3 patients, Pseudomonas aeruginosa and Klebsiella sp. in one patient each. 9 patients were cured by TRUS guided aspiration; only 2 patients underwent transurethral drainage and 1 with concomitant BPH underwent TURP. One patient had retrograde ejaculation after TUR deroofing of abscess.
    Conclusions
    TRUS guided aspiration of prostatic abscess may be the first line treatment of prostatic abscess. TRUS is also helpful in the diagnosis of prostatic abscess and follow up of patients who are treated conservatively. Other modalities should be reserved for failed treatment.
  • Omer Bayrak, Ilker Seckiner, Mehmet Sakip Erturhan, Ahmet Erbagci, Faruk Yagci Page 268
    Objective
    It was aimed that the comparison between the urodynamic parameters and The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) scores in patients with stress urinary incontinence.
    Material And Methods
    In this study, the ICIQ-SF was filled and urodynamics were done the 40 patients who have got stress urinary incontinence. After the biofeedback therapy, ICIQ-SF was filled and urodynamics were done again.
    Results
    In this study it was seen that there was a great benefit from the scores of ICIQ-SF (9.95 ± 4.39) after the biofeedback therapy to the scores of ICIQ-SF (18.07 ± 2.4) which were done before the biofeedback therapy. However, it was observed that there was not any statistical difference between the urodynamics parameters which were before the therapy and the urodynamics parameters which were after the therapy.
    Conclusions
    Considering the results of this study, the patients started getting well with the help of the biofeedback therapy and the ICIQ-SF scores decreased. That's why the biofeedback is a good alternative according to the surgery therapy if surgery is indicated. The reason why urodynamics is needless on the stress urinary incontinence that are planned to biofeedback therapy, because it doesnt illustrate any difference on the urodynamics parameters.
  • Ali Momeni, Shiva Seirafian Page 272
    Background
    Leptin is produced by fat cells and is secreted into the blood stream. Leptin is freely filtered into the renal tubules but its concentration in the urine is very low. Serum leptin level is higher in continuous ambulatory peritoneal dialysis (CAPD) patients, compared to the healthy individuals. Serum leptin level may have correlation with inflammatory markers and peritonitis.
    Objectives
    The aim of this study was to evaluate relationship of serum leptin level with peritonitis, the major complication of CAPD, in these patients.Patients and
    Methods
    In a cross sectional study, 75 CAPD patients in Al-Zahra Hospital in Isfahan were enrolled from October 2007 to February 2008. Serum levels of leptin, Kt/V, demographic findings, total numbers of peritonitis and presence of peritonitis in last year, were recorded in all patients, based on history, physical exam and patients’ files.
    Results
    Mean age of the patients was 53 ± 15 years. Mean serum leptin level in females and males were 27 ± 23µg/l and 16 ± 13µg/l respectively. At univariate general linear model (GLM), there was a significant correlation between serum leptin level with body mass index (BMI) (p < 0.001, β = 2.7) and duration of renal failure (p = 0.01). No correlation was seen between serum leptin level and total number of peritonitis in the past. However, there was negative relationship between serum leptin level and presence of peritonitis in the last year (p = 0.004, β = 6).
    Conclusions
    Presumably, we could not use serum leptin level as a marker of infection in long term; however, serum leptin level may be used as an index of peritonitis and morbidity in short time.
  • Malleshappa Pavan, Ravi Ranganath, Anup P. Chaudhari, Meenakshi Shetty Page 276
    Background
    Obesity is one of the important risk factors for coronary heart disease (CHD), hypertension, diabetes and dyslipidemia. This constellation of risk factors is also associated with end-stage renal disease (ESRD), the prevalence of which has increased despite the availability of interventions to control blood sugar and blood pressure and because albuminuria appears early in the natural history of kidney disease, it’s a potential target of primary prevention
    Objectives
    Obesity is common in adults and likely has a causal role for Kidney disease incidence and progression. The aim of this study was to evaluate the association of obesity defined as per Asia-Pacific guidelines with microalbuminuria which is an early marker of kidney disease in adults.Patients and
    Methods
    Observational study based on 120 obese and 120 healthy individuals between 30-70 years of age. Urine albumin-to-creatinine ratio and body mass index (kg/m2) were measured among healthy and obese individuals at Kasturba Medical College, Mangalore, India.
    Results
    There was a strong association between obesity and microalbuminuria. Microalbuminuria was highly prevalent among obese subjects compared to the controls (OR = 15.33, 95% CI: 5.83 to 40.32, P < 0.001).
    Conclusions
    This study supports a significant association between obesity and the presence of microalbuminuria in adults. Given the increasing prevalence of obesity, this association is particularly alarming. A prospective study of the relationship between obesity and early markers of kidney damage in adults is warranted.
  • Uz E., Uz B., Kaya A., Akdeniz D., Ruzgaresen Nb, Uz E., Turgut Fh, Bayrak R., Akcay A Page 280
    Background
    Cyclosporine (CsA) is a clinically used immunosuppressive agent; but nephrotoxicity is a serious side effect of this drug. Some antioxidants may be used to diminish oxidative stress related to cyclosporine.
    Objectives
    The aim of this study was to determine the protective effect of erdosteine on CsA induced chronic nephrotoxicity.
    Materials And Methods
    We assessed oxidative stress enzymes (SOD, CAT, GSHPx, MDA, NO and PC levels) and light microscopic changes before and after erdosteine treatment in damaged kidney. The rats were assigned randomly to one to four groups. These were: control group (n = 8), CsA group (15 mg/kg day, n = 8), erdosteine treated group (10 mg/kg day orally, n = 8) and CsA + erdosteine group (n = 8). CsA nephrotoxicity was induced by administrating oral dose of 15 mg/kg CsA daily for 21 days.
    Results
    We observed that the activities of glutathione peroxidase (GSHPx) were higher and MDA, NO activities were lower in CsA plus erdosteine group than in CsA group. Histological parameters significantly improved after erdosteine treatment.
    Conclusions
    Erdosteine does seem to have a protective effect on CsA nephrotoxicity by reducing oxidative stress.
  • Mohammadreza Ardalan, Jalal Etemadi, Kamyar Ghabili, Mortaza Ghojazadeh, Ali Ghafari, Hamid Tayebi Khosroshahi Page 285
    Background
    Peritoneal dialysis (PD) and Hemodialysis (HD) have been considered as two standard treatment methods in patients with end stage renal disease. It has been proposed that PD patients have a more protected volume status leading to a better renal transplantation outcome and lower incidence of post-transplant (DGF) delayed graft function, while HD exacerbates the immune disturbance by recurrent activation of inflammatory response, oxidative stress and free radical production that can contribute to DGF.
    Objectives
    In this retrospective study, we analyzed the effect of peritoneal dialysis (PD) or Hemodialysis (HD) on patients’ survival, graft survival, delayed graft function (DGF), acute rejection and early and late complication after living-donor renal transplantation.Patients and
    Methods
    We retrospectively analyzed the data of patients who received their first living renal transplantation between December 2002 and Aril 2010. We entered only those patients who were on PD or HD for at least three months. We excluded patients who experienced DGF because of surgical complications. We allocated one or two aged and sex matched HD patients for one patient in PD group. All patients in each group were operated in a single transplant center.
    Results
    Of 143 patients who had their first living kidney transplant in, 69 patients (M/F 48/21 mean age: 35.3 ± 15.9 years) were in PD group and 74 patients (M/F 38/36 mean age: 40.7 ± 13.3 years) were in HD group. Mean age of donor in PD and HD group were 28.4 ± 4.4 and 29.7 ± 5.6 years. The number of diabetic patient in PD and HD groups were 11/69 (13.6%) and 16/74 (16.2%) (P: 0.4). The rate of delayed graft function, early acute rejection in PD and HD groups was as the followings: 3/69(4.3%) versus 3/74(4.1%) and 3/69(4.3%) versus 2/74 (2.7%). Comparison of overall five years patient and graft survival between the PD and HD patients showed no significant difference by log-rank test (P = 0.13 for patients survival), (P = 0.26 for grafts survival).
    Conclusions
    We found that the choice of dialysis modality does not influence the overall patient and graft survival and the rate of specific complications in living-donor renal transplantation.
  • Behzad Einollahi, Fatemeh Heidary, Hoda Einollahi, Zohreh Rostami Page 291
    Background
    Diabetic patients are increasing rapidly worldwide and kidney transplantation is generally accepted as a treatment of choice in these patients with end stage kidney disease.
    Objectives
    We made a plan to evaluate the 5-year outcome of kidney transplantation in patients with and without DM.Patients and
    Methods
    Two groups of adult kidney recipients including 117 with history of DM mellitus (DM) and 135 non- DM mellitus between March 2006 and September 2009, enrolled in this study. The clinical information was retrieved from both paper records and electronic databases and additional details were obtained from phone call.
    Results
    From total of 252 recipients, 182 received kidney from living donors (11% living related and 89% living unrelated) and 70 from deceased donors. Renal function was preserved among the diabetic patients as same as the non-diabetic cases (median serum creatinine 1.35 mg/ dL versus 1.30 mg/ dL, P = 0.8). Triglyceride (P = 0.000), cholesterol (P = 0.000) and uric acid levels (P = 0.004) were significantly higher in patients with DM. In addition, no significant differences were seen between two groups in terms of graft survivals at univariate and multivariate analyses. There was no significant difference in patient survival between recipients with and without DM (log-rank, P = 0.2). Multivariate analysis by Cox regression showed that age and gender of recipient, donor source and DM had no adverse effect on mid-term outcome among our patients.
    Conclusions
    Diabetic and non-diabetic kidney transplant recipients had similar short- and mid-term graft and patient survivals.
  • Fatemeh Beiraghdar, Zohreh Rostami, Behzad Einollahi Page 296
    Background
    Cyclosporine (CsA) is one of the most frequently used anti-rejection drugs in organ transplant. Pediatric patients have different CsA pharmacokinetics than adults.
    Objectives
    The aim of this retrospective study was to evaluate the CsA blood levels monitoring in pediatric renal transplant recipients in a single-center setting, after the first year of transplantation.Patients and
    Methods
    We reviewed 236 pediatric kidney recipients (aged ≤ 18) years old who received a kidney for the first time with at least a minimum time of 1 year after transplantation between April 2008 and June 2010. Mean follow-up was at least 6 months.
    Results
    The male to female ratio was 1.3/1.0. Mean age of patients’ were 14 ± 3 years. A negative relation was found between CsA levels (C0 and C2) with serum creatinine (r = -0.1, P = 0.001 and r = -0.1, P = 0.01, respectively). A significant correlation was found between C0 level and liver enzymes. Although increase in the donor age had a negative effect on C0 as well as C2 levels, significant value was only shown in C2 level (r = -0.5, P = 0.1 vs. r = -0.15, P = 0.000). C0 level was higher in male than female gender (P = 0.000) as well as in deceased donor source (P = 0.000). Serum creatinine level, serum alkaline phosphatase, liver enzymes affected C0 blood level; whereas, donor age and serum creatinine were the confounding variables on C2 level.
    Conclusions
    We conclude that C0 was affected by serum creatinine level, serum alkaline phosphates, liver enzymes; whereas, C2 level was influenced by donor age and serum creatinine.
  • Mary Eng, Suzanne Schiffman, Kadiyala Ravindra Page 301
    Allograft hydroureteronephrosis caused by ipsilateral inguinal hernia occurs rarely. Its close proximity to the spermatic cord structures places the ureter at risk for herniation into the internal inguinal ring. Likewise, the ureter is also at risk for injury during inguinal herniorrhaphy. We present two cases where such events occurred in two separate patients. In both cases, the patients were managed with percutaneous nephrostomy tube decompression followed by definitive surgical repair.
  • Osama Gheith, Ehab Wafa, Ayman Refaie, Nabil Hassan, Amani Mostafa, Hussein Sheashaa, Ahmaed Shokeir, Mohamed Kamal, Mohamed A. Ghoneim Page 306
  • Francine D. Salinitri, Lama Hsaiky, Nicole R. Pinelli Page 308
  • Mitra Mahdavi-Mazdeh Page 311