Nephro-Urology Monthly
Volume:7 Issue: 3, May 2015

Anderson-Hynes dismembered pyeloplasty is the gold standard therapeutic approach to ureteropelvic junction obstruction (UPJO). Use of a drainage method to protect the suture line from leakage is a matter of controversy.. We have compared the surgical outcome of Anderson-Hynes dismembered pyeloplasty for UPJO repair, with or without internal stenting..Patients and Eighty-two patients with UPJO were evaluated from 1996 to 2002. Complicated or emergent cases were excluded. Classic standard dismembered pyeloplasty was performed. Internal drainage, with a double j catheter, was performed in several patients, randomly. Another drain was also placed in the retroperitoneal space. The follow-up of patients was planned weekly, with patient visits and urine analysis and intravenous pyelography (IVP) and diethylene-triamine-pentaacetate (DTPA) scan after one month.. The study group consisted of 51 male and 31 female patients, who were mostly in the age range of 20 - 40 years. Comparing the two techniques of pyeloplasty with or without internal drainage, there was no significant difference between groups regarding extravasation and anastomosis complications, such as leakage, stenosis, urinoma formation or evidence of obstruction on postoperative IVP or DTPA scan. However, a higher incidence of catheter related urinary symptoms and flank pain was reported among those with internal stent.. Pyeloplasty, with adequate spatulation, hemostasis and a watertight anastomosis, represents the mainstay of successful pyeloplasty and there may be no significant benefit for urethral stenting, especially in non-complicated cases..

Malnutrition, inflammation and poor quality of life are prevalent among hemodialysis (HD) patients. Health-related quality of life is an important determinant of hospitalization and mortality in HD patients.. The aim of this study was to assess the correlation between quality of life and malnutrition-inflammation status according to subjective global assessment (SGA) and malnutrition-inflammation scores (MIS) in HD patients..Patients and We randomly selected 87 of 180 stable HD patients from two HD centers. Those on hemodialysis for at least three months and with malnutrition according to the SGA scores were included in this study. They were divided into two groups of mild to moderate malnutrition (n = 39) and severe malnutrition (n = 49) based on the SGA scores. Serum levels of transferrin, albumin, blood urea nitrogen, creatinine, kt/v, body mass index and malnutrition-inflammation scores were measured in all patients. Health-related quality of life was assessed by validated short form-12 (SF-12) questionnaire for each patient. These values were compared between the two groups of patients by independent sample t-test and Mann-Whitney U test. The correlations of nutritional variables with SGA and MIS scores were determined by Pearson and Spearman correlation tests.. There were no differences in measured parameters between the two groups except for MIS scores. Those with severe malnutrition showed higher MIS scores. All quality of life aspects and total scores (PCS, MCS) (rather than social functioning (SF) aspect) were significantly different between the two groups, which showed lower physical and mental scores in severely-malnourished patients. Physical functioning (PF), role limitations due to physical heath (RP), general health (GH), mental health (MH), SF, role limitation due to emotional health (RE), vitality (VT) aspects and total scores (PCS and MCS) had negative significant correlations with MIS and SGA scores (All P values < 0.05). No correlation was found between MIS and SGA scores and other measured variables.. This study focused on important effects of malnutrition and inflammation on health-related quality of life aspects, both physically and mentally in HD patients. SGA and MIS are highly correlated with quality of life in HD patients..

Antibody mediated rejection (AMR) and thrombotic microangiopathy (TMA) after kidney transplantation are difficult to differentiate most of the times and both play important roles in kidney allograft loss. Common treatment strategies of these two conditions include plasmapheresis, intravenous immunoglobulin (IVIG) and rituximab.. This study was designed to assess the efficacy of routine treatment of AMR/TMA in Iranian kidney transplant recipients, which comprises of plasmapheresis and IVIG..Patients and This one-year cross-sectional study was performed in the Kidney Transplantation Ward of Imam-Khomeini Hospital Complex, Tehran, Iran. All kidney transplant recipients who were administered plasmapheresis and IVIG to treat definite or suggested AMR or TMA were assessed clinically and also evaluated on laboratory data.. During 2014, we encountered five patients with suspicious AMR or TMA at our kidney transplant center. Renal biopsy was performed for two of them, suggesting AMR for one patient and TMA for another patient. All patients were treated with plasmapheresis plus IVIG. In this center, as a routine practice, the cumulative dose of 2 g/kg of IVIG was divided to 300 - 400 mg/kg after each plasmapheresis. Only one out of the five patients showed response, albeit not completely.. Due to daily plasmapheresis within the first several days after AMR or TMA, administering high amounts of the cumulative dose of IVIG after plasmapheresis may result in high amounts of IVIG withdrawal by plasmapheresis and response failure. Our suggestion is to reduce the IVIG dose after each plasmapheresis to 100 mg/kg (i.e. replacement dose) to reach a cumulative dose of 2 g/Kg. If plasmapheresis treatment is initiated sooner than the completion of the IVIG cumulative dose of 2 g/kg, the remaining dose can be administered during one injection..

Adrenal cystic lymphangioma is a rare benign tumor, which is nearly always asymptomatic and incidentally discovered during routine imaging work-ups or investigating other pathologies..Case Report: A 43-year-old female presented hypertension, which during routine work-up of her newly diagnosed hypertension an adrenal mass was discovered and after operation the pathologic diagnosis was lymphangioma of adrenal.. In evaluation of adrenal masses cystic lymphangioma should be considered as a differential diagnosis..

Context: In human beings, uric acid is the poorly soluble circulating end product of the purine nucleotide metabolism. A reduction in the glomerular filtration rate (GFR) contributes to hyperuricemia, which is frequently observed in patients with chronic kidney disease (CKD)..Evidence Acquisition: Hyperuricemia is defined as a serum uric acid level > 7.0 mg/dL in males and > 6.0 mg/dL in females, while CKD is defined as kidney damage or a GFR < 60 mL/min/1.73 m2 for 3 months or more, irrespective of the cause. Hyperuricemia is common in CKD and may occur because of decreased excretion, increased production, or a combination of both mechanisms.. The causes for hyperuricemia in overproducers may be either exogenous or endogenous. CKD has become a global public health problem because of its high prevalence and the accompanying increase in the risk of end-stage renal disease, cardiovascular disease, and premature death. The most common risk factors for CKD are obesity and the metabolic syndrome, which is strongly associated with hyperuricemia probably as a consequence of insulin resistance and the effects of insulin to reduce the urinary urate excretion. For recurring bouts of hyperuricemia or gout, patients should have a blood test and joint fluid test to determine whether the medication taken is effective. Interventional studies are a useful clinical research tool in clarifying the role of hyperuricemia in CKD.. Although many evidence-based studies have suggested that uric acid itself may harm patients with CKD by increasing inflammation and CKD progression, the issue is still a matter of controversy. Special attention should be paid to specific contraindications to certain drugs and the possibility of infectious arthritis..

Metabolic Syndrome (MS) has become a global public health and has been suggested to be a risk factor for Lower Urinary Tract Symptoms (LUTS). Studies evaluating the association between the rate of the MS and LUTS often showed controversial results.. The purpose of this study was to reveal the relevance of MS and its components on the frequency and severity of the LUTS that were seen with Benign Prostate Hyperplasia (BPH) in Turkish men or not..Patients and In this study, 237 patients referred to urology policlinic with BPH were retrospectively scanned between April 2009 and April 2013. Patients with normal digital rectal examination and the Prostate Specific Antigen (PSA) level of ≤ 4 ng/mL were evaluated using the International Prostate Symptom Score (IPSS) and all the data of the patients'' body, including Body Mass Index (BMI), lipid parameters, preprandial blood glucose, and waist circumference. Seventy-four patients (31.3%) with mild IPSS (0-7) was group 1; 97 patients (40.9%) with moderate IPSS (8 - 19) group 2 and 66 patients (27.8%) with severe IPSS (20-35) were defined as group 3. group 4 consisted of 117 healthy controls. Three groups and controls were compared about MS and its components. The diagnosis criteria of The Society of Endocrinology and Metabolism of Turkey were used in MS diagnosis. Also, BMI, lipid parameters, preprandial blood glucose, waist circumference, and blood pressure were used as MS parameters.. The average age of patients in group 1 was 69.8 ± 7.2; in group 2, 69.1 ± 7.4; 68.3 ± 7.1 in group 3 and 70.2 ± 7.2 in the control group. Metabolic syndrome was determined at 37 patients (50%) in group 1, 45 patients (46.5%) in group 2, 32 patients (48%) in group 3 and 52 patients (44.4%) in controls and no statistically significant correlation was detected between LUTS and MS in BPH (P = 0.113). In the comparison of the four groups in the point of MS parameters, no significant correlation was detected in the levels of total cholesterol (P = 0.337), fasting glucose (P = 0.291), BMI (P = 0.452), Low Density Lipoprotein (LDL, P = 0.069) and triglyceride (P = 0.307).. In our study, the evidence is not enough to support the hypothesis of the relevance between MS and LUTS. Wide-ranging, prospective and multicentric studies are needed to research the relevance between MS and LUTS in BPH..

Crossed renal ectopia is a rare anomaly and ninety percent of crossed ectopic kidneys are fused to their ipsilateral mate. Based on autopsy findings, the incidence has been estimated to be one in 2000 individuals.. We hereby report on a 53-year-old woman with two episodes of painless gross hematuria. Imaging revealed left side fused crossed renal ectopia and filling defect within the pyelocaliceal of crossed kidney.. The patient underwent surgery applying a midline incision. The left kidney showed a lump pattern embedded in lower pole of the right kidney. Left sided nephrectomy was performed while temporary right renal artery was clamped temporarily. Histopathological evaluation revealed clear cell carcinoma with severe nuclear atypia (Fuhrman grade 4/4). However, local recurrence was not detected during the 18-month follow up after surgery..