فهرست مطالب

Nephro-Urology Monthly - Volume:4 Issue:4, 2012
  • Volume:4 Issue:4, 2012
  • تاریخ انتشار: 1391/07/16
  • تعداد عناوین: 17
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  • V., Iacute, Ctor Garcia-Nieto, Franciscop Negrete-Pedraza, Marta L., Oacute, Pez-Garc, Iacutea., Mar, Iacute, A. Isabel Luis-Yanes Pages 596-598
  • Mohammadreza Ardalan Pages 599-602
    Introduction
    Idiopathic Membranous Nephropathy (MN) is a common cause of adult nephrotic syndrome. Recently, M-type phospholipase A2 receptor (PLA2-R) has been discovered as the main podocyte antigen in the pathogenesis of idiopathic MN..
    Materials And Methods
    In this mini review, the author searched English-language MEDLINE for the terms “membranous nephropathy”, “rituximab”, and “phospholipase A2 receptor” up to October 2011..
    Results
    In support of its earlier discovery, reports from China and Europe confirmed the major pathogenic role of non-complement fixing IgG4 antibody against PLA2-R in the pathogenesis of idiopathic MN. Antibodies against aldose reductase (AR) and manganese superoxide dismutase (SOD2), and sub-epithelial deposition of cationic bovine serum albumin (BSA) are also reported in rare occasions. It seems that Rituximab is a good therapeutic choice for those patients who need immunosuppressive therapy..
    Conclusions
    Great discoveries in the diagnosis and treatment of idiopathic MN have been performed but pathogenic mechanism and triggers for anti-PLA2-R production are still unknown..
    Keywords: Glomerulonephritis, Membranous, Phospholipase A2, Rituximab
  • Muhammed Mubarak, Javed I. Kazi Pages 603-608
    IgM nephropathy (IgMN) is an idiopathic immune complex-mediated glomerulopathy that was first described as a distinct disease in a nephropathology literature in 1978. Here,a historical review and the current status of IgMN in the light of world literature and the current experience will be presented. The Pubmed (www.pubmed.gov) search was made for articles on IgMN as the sole subject of the study or where it constituted a significant number of cases in a biopsy series in the world literature written in English. A total of 41 articles were found. A critical review of the literature was made. Soon after 1978, a series of reports were published mostly from the western world, but the interest in the entity did not withstand the test of time. No substantial basic medical research was carried out and the disease was largely ignored by the western researchers. More recently, a flurry of articles have appeared in the literature on the topic, mostly from tropical countries, and have renewed the interest in the entity. However, most of the current literature on IgMN is based on clinical observations, and experimental models and mechanistic studies of IgMN are lacking. There is an urgent need to develop consensus based criteria for the diagnosis of the condition, as well as, to focus the research on mechanistic studies to understand the pathogenesis of the disease better..
    Keywords: Kidney Diseases, Nephrotic Syndrome, Pathology
  • Wenli Lu, Yuehong Tao, Amy B. Wisniewski, Dominic Frimberger, Brad P. Kropp Pages 609-612
    Background and Objects: The patient’s age at the first hypospadias repair may be an important factor for determining postoperative outcomes. Age at the first procedure differs between Western countries and medical centers in China. This review examines the differences between the incidence of surgical complications and surgical age in boys receiving hypospadias repairs in North America, Europe and China..
    Materials And Methods
    Literature reports were reviewed in PubMed and WanFang databases using the key terms and phrases; ‘hypospadias outcomes’, ‘complications of hypospadias repair’ and ‘timing of hypospadias repair’. All peer-reviewed articles published over the past decade (2001-2011) were considered if; a full text was available, the article included age at the first hypospadias procedure and surgical complications..
    Results
    In total, 16 131 patients were reported in 113 papers from North America, Europe and China according to our inclusion criteria. There was a significant difference in age at the first hypospadias surgery (P < 0.0005) and in the incidence of complications (P <0.001) between the different global regions investigated, with the earliest surgeries occurring in North American patients. Urethral fistulas were the most common complication reported in all of the regions included in this study..
    Conclusions
    Fellowship training in pediatric urology could improve surgical outcomes,particularly in young children. Younger children experience fewer complications following hypospadias surgeries, independent of training and access to resources.
    Keywords: Hypospadias, General Surgery, Outcomes Assessment
  • Sidy Mohamed Seck, Mohamed Dahaba, Elhadj Fary Ka, Mouhamadou Moustapha Cisse, Seigne Gueye, Ahmet Ould Lemrabott Pages 613-616
    Background
    Chronic kidney disease related mineral and bone disease (CKD-MBD) is a worldwide challenge in hemodialysis patients. In Senegal, number of dialysis patients is growing but few data are available about their bone disorders..
    Objectives
    To describe patterns of CKD-MBD in Senegalese dialysis patients..Patients and
    Methods
    We performed a cross-sectional study including patients from three dialysis centres in Senegal. Diagnosis of different types of CKD-MBD relied on clinical, biological and radiological data collected from medical records in dialysis..
    Results
    We included 118 patients and 79 of them presented CKD-BMD (prevalence of was 66.9 %). Mean age of CKD-MBD patients was 47.8 ± 15.7 years (16-81 years) and sex-ratio (Male/Female) was 1.15. Secondary hyperparathyroidism was the most frequent disorder (57 patients) followed by adynamic bone disease (21 patients) and osteomalacia (1 patients). The main clinical manifestations were bone pain (17.5% of cases), pruritus (36.8% of cases) and pathological fractures (2.5% of cases). Bone biopsy was not available. Valvular and peripheral vascular calcification were present in 24.5% and 21.2% of patients respectively. Management of CKD-MBD included optimization of dialysis, calcium bicarbonate, sevelamer, vitamin D analogues and calcimimetics. The NKF/DOQI recommended levels of serum calcium, phosphate and parathormone PTH were not achieved in one third of patients. Six patients presented major cardiovascular events during their dialysis period..
    Conclusions
    CKD-MBD are frequent in Senegalese hemodialysis patients and they are dominated by high turn-over disease. Clinical and biological manifestations are unspecific and accurate diagnoses are often difficult in absence of histomorphometry. Treatment is suboptimal for many patients in a context of limited resources.
    Keywords: Renal Osteodystrophy, Hemodialysis, Senegal
  • Ali Tayyebi, Afsaneh Raiesifar, Soheil Najafi Mehri, Abbas Ebadi, Behzad Einolahi, Shadi Pashandi Pages 617-621
    Background
    Different measuring tools have been used to understand the outcomes of renal replacement therapies. The goal of renal transplantation is both to ensure survival, and to promote quality of life in the patients. One of the widely used disease-specific instruments to measure the quality of life is the Kidney Transplant Questionnaire (KTQ-25)..
    Objectives
    The current study aimed to perform a cross-cultural adaptation and assess the psychometric properties of the KTQ-25 to Persian..
    Materials And Methods
    The KTQ-25 was trasnlated according to International Quality of Life Assessment (IQOLA) translation methodology. Cronbach’s alpha coefficient, and test-re-test were used to determine internal consistency, and reliability respectively..
    Results
    In the test–re-test reliability of all questionnaire items, Pearson correlation was r = 0.96 (P < 0.001). Cronbach’s alpha coefficient estimated the internal consistency for each scale andalpha equal or more than 0.73 was considered satisfactory. Criterion-related validity, measured by the correlation coefficients between the KTQ-25 and the SF-36 Health Survey, was r = 0.63 (P < 0.001)..
    Conclusions
    The psychometric properties of the Kidney Transplant Questionnaire (KTQ-25) in Persian have proven to be satisfactory, therefore the application of this questionnaire in clinical practice can be recommended.
    Keywords: Quality of Life, Kidney Transplantation, Questionnaires, Psychometrics
  • Hosein Khoshrang, Siavash Falahatkar, Sara Ilat, Manzar Hossein Akbar, Maryam Shakiba, Alireza Farzan, Nadia Rastjou Herfeh, Aliakbar Allahkhah Pages 622-628
    Background
    Nowadays Percutaneous Nephrolithotomy (PCNL) is performed in prone and supine positions. Physiologic solutions should be used to irrigate during PCNL. Irrigation can cause hemodynamic, electrolyte and acid-base changes during PCNL..
    Objectives
    The current study aimed to compare the electrolyte, hemodynamic and metabolic changes of prone and complete supine PCNL..Patients and
    Methods
    It was a randomized clinical trial study on 40 ASA class I and II patients. Twenty of patients underwent prone PCNL (Group A) and the other twenty underwent complete supine PCNL (Group B). The two groups received the same premedication and induction of anesthesia. Blood pressure (systolic, diastolic and mean) and pulse rate were recorded before, during and after anesthesia and Hb, Hct, BUN, Cr, Na, and K were also measured before and after operation in the two groups. The volume of irrigation fluid, total effluent fluid (the fluid in the bucket and the gazes) and volume of absorbed fluid were measured..
    Results
    There were no significant differences in Na, K, BUN, Cr, Hb and Hct between the two groups. Absorption volume was significantly different between the two groups (335 ± 121.28 mL in group A and 159.45 ± 73.81 mL in group B, respectively) (P = 0.0001). The mean anesthesia time was significantly different between the two groups (P = 0.012). There was a significant difference in bleeding volume between supine and prone PCNL (270.4 ± 229.14 in group A and 594.2 ± 290 in group B, respectively) (P = 0.0001). Mean systolic blood pressure during operation and recovery was 120.2 ± 10.9 and 140.7 ± 25.1 in group B, and 113.4 ± 6.4 and 126.2 ± 12.7 in group A, respectively. Systolic blood pressure between the two groups during operation and recovery was significantly different (P = 0.027 and P = 0.022, respectively). Mean diastolic blood pressure in supine group during operation and recovery was 80.53 ± 7.57 and 95.75 ± 17.48, and 73.95 ± 3.94 and 83.4 ± 12.54 in prone group, respectively. Diastolic blood pressure was significantly different between the two groups. It was 80.55 ± 7.57 and 95.75 ± 17.48, respectively during operation and recoveryin the supine group and 73.95 ± 3.94 and 83.4 ± 12.54 in the prone group, respectively (P = 0.001 and P = 0.014, respectively), but there was no significant difference between the pulse rate mean value of the two groups..
    Conclusions
    The electrolyte and metabolic changes were not significantly different between the two groups, and although fluid absorption in prone group was more than that of the complete supine group, there was no significant difference between the two groups. Considering advantages of complete supine PCNL such as less hemodynamic changes (less hypotension, less fluid absorption and less duration of operation) this kind of PCNL was recommended.
    Keywords: Electrolyte, Prone Position, Supine Posion, Percutaneous Nephrolithotomy
  • Hossein Keyhan, Alireza Dadvar, Mohammad Ansari, Kheirollah Rafiee Pages 629-632
    Background
    Since nitric oxide (NO) has an oxidant activity, lower levels following a varicocelectomy may result in better functioning sperm, improved semen quality and consequently higher fertility rates. However, this procedure should be examined in more detail..
    Objectives
    Accordingly, this study was performed to compare the before and after varicocelectomy levels of NO in the seminal fluid of infertile men..Patients and
    Methods
    In this before and after comparative study, 20 consecutive patients attending a training hospital in Tehran, Iran were recruited. All of these men had primary or secondary infertility accompanied with a varicocele. A semen sample was collected from the men in two phases, first before their varicocelectomy and two months after their operation..
    Results
    NO levels differed significantly across the study and the mean (± standard deviation) levels of NO in the patients were 30.59 ± 10.35 µM/L and 21.48 ± 32.14 µM/L in the before and after phases of the study, respectively (P = 0.009)..
    Conclusions
    According to the results obtained in this study, it may be concluded that in future, levels of NO should be taken into consideration together with other parameters for the evaluation of patients who are affected by varicoceles, to determine probable therapeutic responses.
    Keywords: Varicocele, Nitric Oxide, Infertility, Semen
  • Seyed Mohammadreza Rabani Pages 633-635
    Background
    Ureteral stents are widely used in many urologic practices. However, stents can cause significant complications including migration, fragmentation, and encrustation and it may possibly be forgotten. Successful management of a retained, encrusted stent requires combined endourological approaches..
    Objectives
    To present our experience with the approaches for treating forgotten ureteral stents associated with giant stone formation..Patients and
    Methods
    Seventy four patients with forgotten ureteral stents were managed by different open (nephrolithotomy and/or cystolithotomy), or endoscopic procedures in our center. Among these, 11 patients had severe encrustation (stones larger than 35 mm within the bladder or kidney) and seven patients of this group, presented at our department between July 2007 and December 2010. Combined endourological procedures percutaneous nephrolithotripsy (PCNL), cystolithotripsy (CLT), transurethral lithotripsy (TUL) were performed in one or 2 separate sessions. In these 7 patients the whole of the stents, especially both ends were encrusted. Initially, cystolithotripsy, retrograde ureteroscopy and TUL were performed in the dorsal lithotomy position. Following this, agentle attempt was made to retrieve the stent with the help of an ureteroscopic grasper.In some cases the stent was grasped by a hemostat clamp out of the urethral meatus with a gentle traction to facilitate lithotripsy in the ureter and even in the kidney. Finally, aureteric catheter was placed adjacent to the stent for injection of radio-contrast material to delineate the renal pelvis and the calyces. Then in the same session or later in another session the patient was placed in the prone position and PCNL of the upper coil of the encrusted stent along with calculus was done and the stent was removed..
    Results
    In 5 out of seven patients, the initial indication for stent placement was for urinary stone disease after open nephrolithotomy and pyeloplasty in other centers and in two patients after TUL. All patients underwent the procedure (s) under spinal anesthesia and all received antibiotics in preoperative period. The only available source of energy in our center was pneumatic lithotripsy..
    Conclusions
    Multiple endourological approaches or even open surgery are needed because of encrustations and the associated stone burden that may involve bladder, ureter and kidney. This may require single or multiple endourological sessions or rarely open surgical removal of the encrusted stents. Although, endourological management of these stents achieves success in majority of the cases with minimal complications, the best treatment that remains is prevention of this complication and to achieve this important point designing a recall system is suggested.
    Keywords: Ureter, Stents, Encrustation, Nephrostomy, Percutaneous
  • Hakki Uzun, Orhan Unal Zorba, Yakup Tomak, Habip Bostan, Mehmet Kalkan Pages 636-639
    Background
    Urethral stricture is a common condition, and direct vision internal urethrotomy is prefered as the first treatment option by many urologists, for strictures shorter than 2 cm. This procedure is generally performed under general or spinal anaesthesia..
    Objectives
    To investigate the feasibility of adding local urethral anaesthesia to intravenous sedation and analgesia (sedoanalgesia) methods in patients undergoing internal urethrotomy..Patients and
    Methods
    A total of 21 and 15 patients with anterior urethral strictures underwent internal urethrotomy under local urethral anaesthesia, with or without sedoanalgesia, respectively. Patient discomfort and pain levels were evaluated using the visual analog scale (VAS). Statistical analyses were calculated with a Mann-Whitney U test to compare difference in VAS scores between the subjects in both groups..
    Results
    Two of the 15 (13%) patients operated under local urethral anaesthesia without sedoanalgesia were converted to general anaesthesia due to patient intolerability. Mean pain VAS scores for patients operated under 2% lidocain urethral gel anaesthesia with or without sedoanalgesia were 2.86 cm and 4.5 cm, respectively (P = 0.001). In addition, a VAS score over 3 cm was found in 3 of the 21 (14%) patients with, and 13 of the 15 (86%) patients without sedoanalgesia (P = 0.001)..
    Conclusions
    The addition of intravenous sedoanalgesia improved the VAS scores of pain and discomfort, compared to patients operated under only local urethral anaesthesia. This may offer patients safer anaesthesia and shorter operative times with equilavent results in selected patients..
    Keywords: Urethral Stricture, Internal Urethrotomy, Anaesthesia
  • Shishir Devaraju, Rajendra B. Nerli, Murigendra B. Hiremath Pages 640-643
    Symptomatic Mullerian duct cysts are uncommon. A young adult male presented to us with a palpable supra-pubic mass, pain and lower urinary tract symptoms. Initial imaging modalities showed a large cystic lesion in the pelvis with a non-visualized right kidney. A short, blind ending right ureter on retrograde pyelography added to the confusion. On exploration, the lesion was noted to be separate from the seminal vesicles, bladder and posterior urethra. The right kidney was absent. The cystic lesion was excised completely preserving the vas and seminal vesicles. A high index of suspicion is needed for identification of this rare condition. Use of MRI (magnetic resonance imaging) can help improve the diagnostic accuracy. Many a times though, the diagnosis is evident only on exploration..
    Keywords: Mullerian Ducts, Cysts, Hereditary Renal Agenesis, Urography
  • Somsri Wiwanitkit, Viroj Wiwanitkit Pages 652-652