RESUMO
PURPOSE: The aim of this study was to evaluate the performance of the new classification of urinary tract dilatation (UTD) to predict long-term clinical outcomes in infants with isolated antenatal hydronephrosis (ANH). MATERIALS AND METHODS: Between 1989 and 2019, 447 infants diagnosed with isolated severe ANH and were prospectively followed. The main predictive variable for the analysis was the new UTD classification system. The events of interest were surgical interventions, urinary tract infections, chronic kidney disease stage II or higher, hypertension and proteinuria. The primary end-point was time until the occurrence of a composite event of renal injury, including proteinuria, hypertension and chronic kidney disease. RESULTS: Among 447 infants with ANH included in the analysis, 255 (57%) had UTD P1, 93 (20.8%) UTD P2 and 99 (22.2%) UTD P3. Median followup time was 9 years (IQR 7-12 years). Of 447 patients included in the analysis, 11 (2.5%) had hypertension, 13 (2.9%) exhibited persistent mild proteinuria, 14 (3%) developed chronic kidney disease Stage 2 and 26 (5.8%) had the composite outcome of renal injury. By survival analysis, the UTD system predicted accurately all events of interest. According to the Kaplan-Meier survival analysis, the probability of renal injury at 20 years of age was estimated at about 0%, 14% and 56% for patients assigned to UTD P1, UTD P2 and UTD P3, respectively (p <0.001). CONCLUSIONS: Our findings provide insights that the new UTD classification has a good performance for discriminating not only mid-term, but also long-term clinical outcomes, including renal injury.
Assuntos
Dilatação Patológica/classificação , Hidronefrose/classificação , Estudos de Coortes , Dilatação Patológica/complicações , Dilatação Patológica/diagnóstico por imagem , Humanos , Hidronefrose/complicações , Hidronefrose/diagnóstico por imagem , Lactente , Recém-Nascido , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Resultado do Tratamento , Ultrassonografia Pré-Natal , Sistema Urinário/diagnóstico por imagemRESUMO
La policitemia primaria es producida por una mutación adquirida o heredada en las células progenitoras de los glóbulos rojos, mientras que la poliglobulia secundaria está relacionada con un aumento de la eritropoyetina sérica como respuesta a la hipoxia tisular o a la producción autónoma tumoral. Hace más de medio siglo que se conoce que la hidronefrosis puede actuar como una rara causa de eritrocitosis debido al aumento de producción de eritropoyetina por un riñón que censa una disminución de oxígeno, mecanismo también observado en la estenosis de la arteria renal y en los quistes renales. Se describe a continuación el caso de un paciente de 38 años con poliglobulia atendido en el Hospital Italiano de San Justo (Argentina), que presenta como hallazgo una hidronefrosis unilateral severa y cuya resolución quirúrgica a través de una nefrectomía revierte el cuadro hematológico de base. (AU)
Primary polycythemia is produced by an acquired or inherited mutation in progenitor cells of red blood cells, while secondary polyglobulia is related to an increase in serum erythropoietin in response to tissue hypoxia or autonomous tumor production. Since the middle of the twentieth century, the hydronephrosis is known to be a rare etiology of secondary polycythemia, with increased erythropoietin production caused by diminished oxygen sensing by the kidney, also seen in renal artery stenosis and kidney cysts. We describe a case of a 38 year old patient with polycythemia studied in the "Hospital Italiano de San Justo" (Argentina) that presented an incidental severe unilateral hydronephrosis, and nephrectomy was carried out as a final resolution of the hematological disorder. (AU)
Assuntos
Humanos , Animais , Masculino , Adulto , Pessoa de Meia-Idade , Policitemia/diagnóstico , Pielonefrite/diagnóstico , Infecções Urinárias/complicações , Eritropoetina/sangue , Hidronefrose/diagnóstico , Nefrectomia/tendências , Policitemia/complicações , Policitemia/etiologia , Pielonefrite/sangue , Obstrução da Artéria Renal/patologia , Dor Lombar , Hipóxia-Isquemia Encefálica/patologia , Eritrócitos/fisiologia , Doenças Renais Císticas/patologia , Disuria , Febre , Hidronefrose/cirurgia , Hidronefrose/complicações , Anemia , Nefrectomia/métodosRESUMO
The objective of this study was to report a case of a hydronephrotic patient with Strongyloides stercoralis infection, with discharge of rhabditoid larvae exclusively in urine. In 2013, a 72-yr-old male patient, hypertensive, obese, and diagnosed with hydronephrosis secondary to renal calculi, reported lumbar pain, polyuria, polaciuria, and dysuria, as well as frequent urinary tract infections. The microscopic analysis of urine sediment showed the presence of S. stercoralis rabditoid larvae. However, parasitological examinations by Baermann-Moraes, agar plate culture, and spontaneous sedimentation performed with 3 fecal samples on alternate days had negative results. The patient was treated with albendazole and to date has shown negative results in both parasitological and urine tests. This report deals with the unusual finding of S. stercoralis in a urine sample of an immunocompetent individual and absence of disseminated infection, but with hydronephrosis. Patients with nephropathies from S. stercoralis-endemic areas should be monitored periodically, as early detection may prevent the worsening of symptoms and renal failure.
Assuntos
Hidronefrose/complicações , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/parasitologia , Infecções Urinárias/parasitologia , Urina/parasitologia , Idoso , Albendazol/uso terapêutico , Animais , Antinematódeos/uso terapêutico , Fezes/parasitologia , Humanos , Hidronefrose/etiologia , Cálculos Renais/complicações , Masculino , Estrongiloidíase/tratamento farmacológico , Urina/citologia , Urina/microbiologiaAssuntos
Expressão Facial , Convulsões/fisiopatologia , Sorriso , Adolescente , Paralisia Facial , Glucuronidase/genética , Humanos , Hidronefrose/complicações , Hidronefrose/diagnóstico por imagem , Hidronefrose/fisiopatologia , Nefropatias , Imageamento por Ressonância Magnética , Masculino , Mutação , Convulsões/complicações , Transtornos Urinários/complicaçõesRESUMO
ABSTRACT Objectives To investigate a possible causal relationship for stone formation in pelviureteric junction obstruction and to outline management options. Materials and Methods A literature search and evidence synthesis was conducted via electronic databases in the English language using the key words pelviureteric junction obstruction; urolithiasis; hyperoxaluria; laparoscopic pyeloplasty; flexible nephroscopy; percutaneous nephrolithotomy, alone or in combination. Relevant articles were analysed to extract conclusions. Results Concomitant pelviureteric junction obstruction (PUJO) and renal lithiasis has been reported only scarcely in the literature. Although PUJO has been extensively studied throughout the years, the presence of calculi in such a patient has not received equal attention and there is still doubt surrounding the pathophysiology and global management. Conclusions Metabolic risk factors appear to play an important role, enough to justify metabolic evaluation in these patients. Urinary stasis and infection are well known factors predisposing to lithiasis and contribute to some extent. The choice for treatment is not always straightforward. Management should be tailored according to degree of obstruction, renal function, patient symptoms and stone size. Simultaneous treatment is feasible with the aid of minimally invasive operative techniques and laparoscopy in particular.
Assuntos
Humanos , Obstrução Ureteral/cirurgia , Obstrução Ureteral/complicações , Rim Displásico Multicístico/cirurgia , Rim Displásico Multicístico/complicações , Urolitíase/cirurgia , Urolitíase/complicações , Hidronefrose/congênito , Doenças Metabólicas/complicações , Obstrução Ureteral/metabolismo , Nefrostomia Percutânea/métodos , Fatores de Risco , Laparoscopia/métodos , Rim Displásico Multicístico/metabolismo , Urolitíase/metabolismo , Hidronefrose/cirurgia , Hidronefrose/complicações , Hidronefrose/metabolismo , Pelve Renal/cirurgiaRESUMO
OBJECTIVES: To investigate a possible causal relationship for stone formation in pelviureteric junction obstruction and to outline management options. MATERIALS AND METHODS: A literature search and evidence synthesis was conducted via electronic databases in the English language using the key words pelviureteric junction obstruction; urolithiasis; hyperoxaluria; laparoscopic pyeloplasty; flexible nephroscopy; percutaneous nephrolithotomy, alone or in combination. Relevant articles were analysed to extract conclusions. RESULTS: Concomitant pelviureteric junction obstruction (PUJO) and renal lithiasis has been reported only scarcely in the literature. Although PUJO has been extensively studied throughout the years, the presence of calculi in such a patient has not received equal attention and there is still doubt surrounding the pathophysiology and global management. CONCLUSIONS: Metabolic risk factors appear to play an important role, enough to justify metabolic evaluation in these patients. Urinary stasis and infection are well known factors predisposing to lithiasis and contribute to some extent. The choice for treatment is not always straightforward. Management should be tailored according to degree of obstruction, renal function, patient symptoms and stone size. Simultaneous treatment is feasible with the aid of minimally invasive operative techniques and laparoscopy in particular.
Assuntos
Hidronefrose/congênito , Doenças Metabólicas/complicações , Rim Displásico Multicístico/complicações , Rim Displásico Multicístico/cirurgia , Obstrução Ureteral/complicações , Obstrução Ureteral/cirurgia , Urolitíase/complicações , Urolitíase/cirurgia , Humanos , Hidronefrose/complicações , Hidronefrose/metabolismo , Hidronefrose/cirurgia , Pelve Renal/cirurgia , Laparoscopia/métodos , Rim Displásico Multicístico/metabolismo , Nefrostomia Percutânea/métodos , Fatores de Risco , Obstrução Ureteral/metabolismo , Urolitíase/metabolismoRESUMO
BACKGROUND: An alternative treatment for obstructive and refluxing obstructive megaureter with ureterovesical junction maintenance through laparoscopy is proposed. MATERIAL AND METHODS: The series consists of 8 cases, all of them studied because of prenatal hydronephrosis or febrile urinary tract infection. Seven were diagnosed with obstructive megaureter and one with obstructive refluxing megaureter. The procedure consisted in incising the stenotic portion of the ureter longitudinally and maintaining its posterior wall attached to the bladder, the anterior wall of the ureter was anastomosed transversally to the bladder mucosa in order to liberate the obstruction. RESULTS: Two of the 8 cases were women and 6 were male. They were aged between 5 months and 11 years (average age of 2.9 years). The surgical time varied between 90 and 120min, with a 48h hospital stay. The permanence of the vesical catheter and the double J stent was of 48h and 6 weeks, respectively. A female patient developed febrile urinary tract infection one week after the surgical procedure. The rest of the patients remained asymptomatic, with normal urinalysis and quarterly urine culture results. Six months after the procedure, the ultrasound showed improvement of the ureteral diameter and of the pyelocaliceal ectasia. The average follow-up was of 2 years. DISCUSSION: The handling of stenosis with longitudinal incision of the ureter and transverse anastomosis to the bladder mucosa, seems promising. The laparoscopic approach allows to identify clearly the longitude of the stenotic segment and join with relative precision such opening with the one of the vesical mucosa.
Assuntos
Laparoscopia/métodos , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Bexiga Urinária/cirurgia , Refluxo Vesicoureteral/complicações , Anastomose Cirúrgica/métodos , Criança , Pré-Escolar , Dilatação Patológica/complicações , Dilatação Patológica/cirurgia , Feminino , Seguimentos , Humanos , Hidronefrose/complicações , Hidronefrose/embriologia , Lactente , Masculino , Stents , Técnicas de Sutura , Ureter/anormalidades , Obstrução Ureteral/etiologia , Cateterismo Urinário , Infecções Urinárias/complicaçõesRESUMO
Abstract Nephrectomies are usually performed under general anesthesia alone or in combination with regional anesthesia and rarely under regional anesthesia alone. We report the management of a patient with chronic obstructive pulmonary disease with a history of recurrent spontaneous pneumothorax undergoing nephrectomy under regional anesthesia alone.
Resumo Geralmente, as nefrectomias são feitas sob anestesia geral, isoladamente ou em combinação com anestesia regional, e raramente sob anestesia regional sozinha. Relatamos o tratamento de um paciente com doença pulmonar obstrutiva crônica e história de pneumotórax espontâneo recorrente submetido à nefrectomia sob anestesia regional isolada.