Nephro-Urology Monthly
Volume:6 Issue: 5, Sep 2014

Bladder reconstruction in the pediatric population is challenging for many reasons, including perioperative complications and readmissions. On a national scale, determine readmission rates at 30, 60 and 90 days after bladder reconstruction in a pediatric population over a 7-year period, evaluating the influence of hospital and patient-specific variables.Patients and Using the Pediatric Health Information System database, we identified patients 0-17 years of age, from 2004-2010, undergoing bladder reconstruction using ICD-9 procedure codes. Descriptive statistics characterized demographics, prevalence of surgeries, and readmission rates. Surgery prevalence over time was examined using linear regression. Readmission rates were compared using the Chi2 test. Regression was used to evaluate the influence of variables on readmission risk. We identified 1,985 patients for inclusion, of which 52.7% were female. Median age was 9 years. There has been no change in the prevalence of bladder reconstruction surgeries (P = 0.327). There was no change in 30-day (P = 0.272), 60-day (P = 0.788) or 90-day readmission rates (P = 0.924). Despite surgical volume adjustment, 90-day readmission rates did not significantly vary among the majority of hospitals. Initial LOS > 7 days (P < 0.001) and complex chronic condition males (P < 0.001) were significantly associated with 90-day readmission. No improvement in readmission rates after pediatric bladder reconstruction was observed during the study period. Nearly all centers have a similar readmission rate despite volume adjustment.

Chronic kidney disease (CKD) is an emerging worldwide epidemic but littledata concerning African populations are available. We aimed to assess prevalence of CKD in adult populations of Saint-Louis, northern Senegal.Patients and In a population-based survey between January and May 2012, we included 1037 adults ≥ 18 years of age who resided in Saint-Louis. Socio-demographic, clinical, and biologic data were collected during household visits. Serum creatinine was measured by Jaffé method. We estimated glomerular filtration rate (eGFR) using the four-variable Modification of Diet in Renal Disease (MDRD) equation and CKD was defined by eGFR< 60 mL/min/1.73 m2 and/or albuminuria > 1 g/L. A multivariate logistic regression was performed to identify factors associated with CKD. The mean of participants’ age was 47.9 ± 16.9 years (range, 18-87) and sex ratio (male to female) was 0.52. Majority of participants lived in urban areas (55.3%) and had school education (65.6%). Hypertension, diabetes, and obesity were present respectively in 39.1%, 12.7%, and 23.4% of participants. Overall CKD prevalence was 4.9% (95% CI, 3.5-6.2) with eGFR< 30 mL/min/1.73 m2 in 0.9%. Albuminuria > 1 g/L was found in 3.5% of patients. CKD was significantly more frequent among hypertensive patients in comparison with normotensive ones. Risk factors associated with CKD were hypertension (12% of risk excess) and age (3% of risk excess). CKD is frequent in adult population living in Northern Senegal. Main associated factors are hypertension and age. Prevention strategies are urgently needed to raise public awareness and promote early CKD detection and treatment in both urban and rural areas.

Percutaneous nephrolithotomy (PCNL) is a standard, safe, and efficient method for removing large renal calculi. Despite development of endourologic equipment, complications of the PCNL are still prevalent. Even though therapeutic modalities such as mini-micro PCNL have been developed in recent years, the complications are a serious concern yet. The most important complication is hemorrhage. The hemorrhage may be either arterial or venous. Venous hemorrhage is usually treated conservatively whereas the arterial one might require transarterial embolization (TAE). Arterial hemorrhage may cause serious problems, especially in the patients with solitary kidney. In the presented patient, serious retroperitoneal hemorrhage and hypotension in the preoperative and postoperative periods resulted in acute renal failure (ARF). It was first report of selective TAE in a patient with ARF due to post-PCNL pseudoaneurysm in solitary kidney. Super-selective segmental embolization was performed successfully in this case and was shown to be a reliable and efficient procedure.

Context: Restless legs syndrome (RLS) is an irresistible urge to move legs that usually occur during inactivity and at night. This neurologic condition is associated with increased risk of nocturnal hypertension as well as cardiovascular events and affects patient’s sleep, which leads to anxiety, depression, and decreases quality of life. Presence of RLS in patients on hemodialysis is associated with higher mortality rate. Most of the times, patients have indescribable symptoms. The aim of this review was to provide physicians with information to be aware and turn their attention to the patient’s symptoms, which are the most important clue to diagnosis of RLS.Evidence Acquisition: For data extraction, we reviewed PubMed, Scopus, Google scholar, the Cochrane collaboration, and Up to Date databases with the keywords of restless legs syndrome, sleep disorders, and end-stage renal disease (ESRD). The most recent review articles, clinical trials, and cross-sectional studies with large sample sizes that had used International RLS Study Group criteria (IRLSSG) and had focused on demographic characteristics and renal function were included. This situation has described in primary and secondary forms. The former usually occurs in younger patients and seems to have genetic tendencies and the latter is due to the iron deficiency state, pregnancy, and ESRD. Two major theories are developed regarding the pathophysiology of RLS. The first one concerns central nervous system dopamine imbalance and the second one concerns intracellular iron dysregulation. The most common used pharmacologic agents in treatment of RLS are dopamine agonists. Other used therapeutic agents include levodopa, Alpha-2-delta calcium channel ligands, opioids, anticonvulsants, benzodiazepines, clonidine, iron therapy in low levels of serum ferritin, and nonpharmacologic therapies. The most important factor in diagnosis is physician’s attention and clinical experience with this condition and using IRLSSG.

Renal injury is the main side effect of cisplatin (CP), an anticancer drug. It has been shown that pretreatment with single-dose oxygen (0.5 to six hours) could reduce CP-induced renal toxicity in rats. The present study aimed to compare the effects of pretreatment with single-dose and intermittent O2 on CP-induced nephrotoxicity. Adult male rats were allocated to seven groups (eight rats in each group). The rats were kept in normal air or hyperoxic environment (O2, 80%) for either a single six-hour period or intermittent six hours per day for seven days and then were subjected to intraperitoneal injection of saline or CP (5 mg/kg) at 48 hours, 72 hours, or seven days after exposure to O2. Three days after CP (or Saline) injection, renal function tests, renal tissue injury scores, and cleaved Caspase-3 and Bax/Bcl-2 genes expression (as markers of renal cell apoptosis) were assessed. Treatment with the 6-hour single-dose O2 reduced renal injury significantly when CP was administrated 48 hours after O2 pretreatment. Pretreatment with intermittent seven days of six hours per day had no protective effects and even relatively worsened renal injury when CP was injected 48 hours or 72 hours after the last session of O2 pretreatment. The beneficial effects of pretreatment with O2 on renal structure and function were seen if CP was administrates seven days after pretreatment with intermittent O2. The pattern of pretreatment with O2 could change this potential and highly protective strategy against CP-induced nephropathy to an ineffective or even mildly deteriorating one. Therefore, O2 administration before CP injection to patients with cancer, for therapeutic purposes or as a preconditioning approach, should be performed and investigated with caution until exact effects of different protocols has been determined in human.

Percutaneous nephrolithotomy is generally considered a safe option for the management of large complex or infectious upper urinary tract calculi. Biliary tract injury is a rare and potentially serious complication of percutaneous nephrolithotomy that can even lead to mortality, especially in cases where biliary peritonitis develops. All reported cases of biliary tract injury have been managed by either open or laparoscopic cholecystectomy. Herein for the first time, we report a 39-year old woman with biliary tract injury following percutaneous nephrolithotomy who was managed less invasively by insertion of a percutaneous cholecystostomy tube. The patient was discharged home shortly thereafter, and the tube was later removed at a follow up visit after a normal cholangiogram. Biliary tract injury is a rare and potentially serious complication of percutaneous nephrolithotomy that can even lead to mortality. If a biliary tract injury is suspected during percutaneous renal procedures, diverting the bile away from the leak may resolve the problem without the need for a cholecystectomy. Ideally this can be done with ERCP and a stent, but in cases where this is not technically feasible; a percutaneous cholecystostomy can be successful at accomplishing the same result.

Oxidative stress is thought to be involved in the pathogenesis of diabetic nephropathy. Selenium (Se), and antioxidant enzymes such as glutathione peroxidase (GPx) play an important protective role in diabetes complications. This study aimed to evaluate the association between plasma Se and GPx levels with severity of diabetic nephropathy.Patients and In a case-control study, we measured plasma Se and GPx concentrations in patients with type two diabetes without microalbuminuria (group 1), with microalbuminuria (group 2), with macroalbuminuria (group 3), and healthy control subjects (group 4). We also assessed plasma glucose, urea, creatinine, and glycated hemoglobin levels in all study patients. Plasma Se and GPx concentrations were significantly lower in diabetic patients with macroalbuminuria than other study groups (P < 0.001). Albuminuria (Alb/Cr in random urine sample) had a negative correlation with plasma Se (r = -0.40, P = 0.01), and GPx (r = -0.23, P = 0.03) concentrations. Plasma Se and GPx levels were lower in type two diabetic patients with macroalbuminuria and related to the stage of diabetic nephropathy.

In the past few decades, Chronic Kidney Disease (CKD) - a disease with progressive decline in renal function - has become an important problem of global public health, not only in developed countries, but also in developing countries with less economic power. In this study, CKD progression to death or End Stage Renal Disease (ESRD) in elderly Iranian patients was compared with younger counterparts.Patients and This retrospective cohort study was conducted on CKD patients with estimated Glomerular Filtration Rate (eGFR) < 60 mL/min, in a nephrology clinic in Tehran from December of 2006 until December of 2012. eGFR trend, death and need to renal replacement therapy (RRT) were evaluated as outcomes and compared between patients younger and older than 60 years. Data were analyzed using SPSS version 13. Five-hundred and two patients were enrolled and followed up for an average of 37.6 months. Two thirds of the patients were older than 60 years. The incidence density of ESRD in patients younger and older than 60 years were 6.3 and 3.6 for 100 persons per year, respectively. Younger ones showed more rapid decline in their eGFR, while older patients had more stable renal function. It seems necessary to conduct more researches in order to redefine CKD and identify its prognostic markers in elderly population.

Extramedullary hematopoiesis in the kidney and adrenal are rarely reported in medical literature and are usually found as incidentaloma. It usually occurs in patients with hematologic disorder such as thalassemia. The patient was a 23-year-old Iranian man with beta thalassemia who was admitted with a suprarenal mass. Adrenal mass was detected by ultrasonography and computed tomography. Results of biochemical evaluations were insignificant. The patient underwent right adrenalectomy. Gross and microscopic histopathologic examination demonstrated extramedullary hematopoiesis without any adrenal tissue. To the best of our knowledge, we document the first reported case of adrenal extramedullary hematopoiesis in Iran, which seems to be rare and remarkable.

The healthcare organizations need to develop and implement quality improvement plans for their survival and success. Measuring quality in the healthcare competitive environment is an undeniable necessity for these organizations and will lead to improved patient satisfaction. This study aimed to measure the quality of provided services for patients with chronic kidney disease in Kerman in 2014.Patients and This cross-sectional, descriptive-analytic study was performed from 23 January 2014 to 14 February 2014 in four hemodialysis centers in Kerman. All of the patients on chronic hemodialysis (n = 195) who were referred to these four centers were selected and studied using census method. The required data were collected using the SERVQUAL questionnaire, consisting of two parts: questions related to the patient's demographic characteristics, and 28 items to measure the patient's expectations and perceptions of the five dimensions of service quality, including tangibility, reliability, responsiveness, assurance, and empathy. The collected data were analyzed using SPSS 21.0 through some statistical tests, including independent-samples t test, one-way ANOVA, and paired-samples t test. The results showed that the means of patient's expectations were more than their perceptions of the quality of provided services in all dimensions, which indicated that there were gaps in all dimensions. The highest and lowest means of negative gaps were related to empathy (-0.52 ± 0.48) and tangibility (-0.29 ± 0.51). In addition, among the studied patient's demographic characteristics and the five dimensions of service quality, only the difference between the patient's income levels and the gap in assurance were statistically significant (P < 0.001). Overall, the results of the present study showed that the expectations of patients on hemodialysis were more than their perceptions of provided services. The healthcare providers and employees should pay more attention to the patient's opinions and comments and use their feedback to solve the workplace problems and improve the quality of provided services. In addition, training the health staff to meet the patient's emotional needs and expectations is suggested.

Cisplatin (CP) is an important antitumor drug with serious side effects such as nephrotoxicity. Estrogens can affect CP-induced nephrotoxicity; however, the role of testosterone (TS), the main male sex hormone, is not clear. This study aimed to investigate the effect of TS on CP-induced nephrotoxicity in castrated male rats. A total of 54 male Wistar rats were castrated and allocated into eight groups. Groups 1 through 3 respectively received 10, 50, and 100 mg/kg/wk of TS and group 4 received sesame oil for four weeks; then all four groups received 2.5 mg/kg/d CP for one week. Groups 5 through 8 received the same treatment regimen as groups 1 through 4 during first four weeks but instead of CP, they received saline for one week. Then the animals were sacrificed for biochemical and histopathologic studies. CP increased the serum levels of blood urea nitrogen (BUN), creatinine (Cr), and malondialdehyde (SMDA) as well as kidney weight (KW), bodyweight (BW) loss, and kidney tissue damage score (KTDS). It significantly decreased the serum and kidney levels of nitrite and serum level of TS in comparison with the control group (P < 0.05). However, coadministration of CP and low dose of TS significantly decreased the serum levels of BUN as well as Cr and KTDS (P < 0.05). Administration of high-dose TS alone increased the SMDA level, KTDS, and KW while decreased the BW significantly (P < 0.05). It seems that testosterone in low dose, i.e. physiologic dose, protects kidneys against CP-induced nephrotoxicity; however, special care is needed in CP therapy of patients with high levels of TS.