Clinical significance of renal cortical thickness in patients with chronic kidney disease

PURPOSE: The aim of this study was to evaluate the correlations between laboratory findings and ultrasonographic measurements of renal length and cortical thickness in patients receiving follow-up for chronic kidney disease (CKD). METHODS: A total of 41 CKD patients (18 males and 23 females; mean age, 65.2 years; range, 42 to 85 years) with a low glomerular filtration rate who did not require renal replacement therapy were included in this prospective study. Patients were followed up with laboratory assays at bimonthly intervals and with ultrasonography performed twice a year. Renal cortical thickness, renal length, and estimated glomerular filtration rate (eGFR) values were compared using the paired-samples t test. Additionally, Pearson correlation analysis was conducted between renal length and cortical thickness measurements and eGFR values to assess kidney function. RESULTS: At the beginning of the study and after 24 months, mean eGFR values of the 41 patients were 35.92 mL/min and 28.38 mL/min, respectively. The mean renal length was 91.29 mm at the beginning of the study and 90.24 mm at the end of the study. The mean cortical thickness was 5.76±2.05 mm at the beginning of the study and 5.28±1.99 mm at the end of the study. A statistically significant positive association was found between eGFR and mean renal length (r=0.66, P < 0.01) and between eGFR and mean cortical thickness (r=0.85, P < 0.01), with the latter being more prominent. CONCLUSION: Our study suggests that ultrasonographic cortical thickness measurements may be an important imaging technique in the follow-up care of patients with CKD.

Flexible ureteroscopy versus laparoscopy for the treatment of patients who initially presented with obstructive pyelonephritis

Objective: To compare the safety and effectiveness of flexible ureteroscopy [F-URS] with transperitoneal laparoscopic ureterolithotomy [TPLU] in cases of obstructive pyelonephritis secondary to large proximal ureteral stones

Methods: A series of 42 patients presenting with obstructive pyelonephritis due to proximal ureteral stones larger than 1.5 cm were included from April 2006 to February 2015 in this comparative study. After drainage of pyonephrosis and resolution of sepsis, 22 patients treated with TPLU [Group I], and 20 patients were treated with F-URS [Group II]. Preoperative patient and stone characteristics, procedure-related parameters and clinical outcomes were assessed for each group

Results: It was seen that both methods were effective in the treatment of large proximal ureteral stones. However TPLU provided a higher stone-free rate [100% vs 80%. p=0.043] and lower retreatment rate. There was no difference between the groups for the operative time and complication rate. On the other hand, patients treated with F-URS had less postoperative pain [p=0.008], a shorter hospital stay [p<0.001] and a faster return to daily activities [p<0.001]

Conclusions: The results of our study show that both F-URS and TPLU are safe and effective surgical procedures for treatment of large proximal ureteral stones after controlling obstructive pyelonephritis. However, TPLU has a higher stone-free rate with comparable operating time and complication rate as compared to F-URS. On the other hand F-URS has the advantages of less postoperative pain, shorter hospital stay and faster return to daily activities

Predictive role of hematologic parameters in testicular torsion

PURPOSE: To evaluate the predictive role of the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV), and platelet count (PLT) in the diagnosis of testicular torsion (TT) and testicular viability following TT. MATERIALS AND METHODS: We analyzed two study groups in this retrospective study: 75 patients with a diagnosis of TT (group 1) and 56 age-matched healthy subjects (group 2). We performed a complete blood count as a part of the diagnostic procedure, and NLR, PLR, MPV, and PLT values were recorded. We compared the patient and control groups in terms of these parameters. Then, TT patients were divided into two subgroups according to the time elapsed since the onset of symptoms. Subsequently, we evaluated the relationship between the duration of symptoms and these parameters. RESULTS: There were significant differences between groups 1 and 2 in NLR, PLR, and PLT (p<0.001 for all). There was no predictive role of MPV in the diagnosis of TT (p=0.328). We determined significantly high sensitivity and specificity levels for NLR in the prediction of TT diagnosis (84% and 92%, respectively). Furthermore, NLR was significantly related to the duration of symptoms in TT patients (p=0.01). CONCLUSIONS: NLR may be a useful parameter in the diagnosis of TT. Furthermore, NLR may be used as a predictive factor for testicular viability following TT.