Living donor nephrectomy : Open vs laparoscopy. Renal function and complications

This study is to compare the short and long-term renal function between adult recipients of living laparoscopic and open donors [LR vs OR] to highlight the effect of the surgical technique on graft function. Moreover, we chose to compare the organic [hypertension, proteinuria, serum creatinine] and psychological [aspect of libido, need for anxiolytics] long-term effect of the surgery between laparoscopic and open donors [LD vs OD]

Methods: After census of adult recipients and living donors between 2003 and 2012, and after application of exclusion criteria and selection of homogeneous groups of donors and recipients, a retrospective cohort study was conducted between October 2008 and January 2012. In recipients, renal function in the short term was reported by the value of serum creatinine at +/- D5 post-op and the long-term values of serum creatinine at 6 and 12 months after surgery. Delayed graft function was defined by a serum creatinine value >/= 2.5 mg/dl on D5 post-op. A questionnaire for donors was established

Results: The two groups OR and LR were homogeneous concerning age, sex and body mass index [BMI]. Different groups OD and LD, chosen according to the variable of interest, were made homogeneous. Despite a different warm ischemia time between the 2 groups [175.54 seconds in LR vs 44.67 seconds in OR, p < 0.001], renal function in the short- and long-term in recipients was not statistically different [At day 5, 1.54 vs 1.50 mg/dl, p = 0.781; at 6 months, 1.37 vs 1.38, p = 0.871; at 12 months, 1.34 vs 1.36, p = 0.569, in OR and LR respectively]. Similarly, there was no significant statistical difference concerning organic and psychological complications between OD and LD except for a shorter period between hospital discharge and return to work in LD

Conclusion: In our center, renal function in the shortand long-term was similar in OR and LR. Apart from the advantages offered by the laparoscopic technique, organic and psychological long-term effects were similar between OD and LD. Nevertheless, laparoscopy seemed to facilitate kidney donation and is requested by almost all living donors independently of their social status

[Study of risk factors of permanent functional limitations on 210 hemodialysed patients]

The aim of the study is to identify risk factors that can worsen the disability in chronic hemodialysis patients. A transversal study was conducted on a total of 210 patients. Data was collected using a 42-item questionnaire, and univariate and multivariate statistical analyses were conducted. Univariate analysis reveals that male sex, advanced age, small stature, low weight, unemployment, lifestyle, lack of sport, hypertension or diabetes, co-morbid conditions, polysulfane filter, time on dialysis, diffuse and chronic pain with high analog visual score are all aggravating disability. Multivariate study confirms advanced age, male sex, hemiplegia, cardiac failure and high analog visual scale as factors aggravating handicap in hemodialysis patients. Modifiable and non modifiable factors can be identified in the disability of dialysis patients. The approach for such patients should be targeted and multifactorial with emphasis on the role of physical rehabilitation and exercises

Thrombotic thrombocytopenic purpura sine purpura occuring simultaneously with systemic lupus erythematosus. A case Report

The association between thrombotic thrombocytopenic purpura and systemic lupus erythematosus has been rarely described, especially when the occurrence of both situations is simultaneous. We report the case of a 21-year-old young woman who presented with this association. The simultaneous diagnosis of these two diseases is difficult because both share similar features. Treatment must be given early. It relies on therapeutic plasma exchange, systemic glucocorticoids or other immunosuppressive agents. The prognosis is very much related to the rapidity of the diagnosis and subsequent treatment

[Erythropoietin: dosage forms and therapeutic indications]

Erythropoietin is a growth factor specific of the erythroid cells. The erythropoietin gene was first cloned in 1985, and very rapidly the first clinical studies started. The drug was first used in France in 1988 for the treatment of the anemia of hemodialysis patients with end-stage renal disease. Then the indication also included the treatment of the anemia in children on hemodialysis, the anemia of the adults on peritoneal dialysis, and the renal anemia of the adults on peritoneal dialysis, and the renal anemia of adults with renal diseases suffering from chronic renal failure. In addition to renal insufficiency, the recombinant human erythropoietin has other indications: -treatment and prevention of anemia in premature babies.- To increase autologous blood donation before elective surgery. - Prevention and treatment of anemia in adult patients with solid tumors treated with chemotherapy

Handicap et reeducation fonctionnelle chez les hemodialyses hospitalises: Etude descriptive a propos de 20 patients

Twenty hemodialyzed patients, received rehabilitation while they were hospitalized. They were all handicapped in the beginning; when they left the hospital, 10 patients were completely independent, six needed help at home and 4 were completely dependent. The authors search, from their own practice, the etiologies of handicap with hemodialyzed patients and how to prevent this handicap, with the target of giving to their patients the best quality of life. The rehabilitation is very important in the strategies of global care of these patients

Current therapeutic indications for ciclosporin

Ciclosporine was launched in therapeutic use in 1978. It marked the transplantation era due to the success of organ transplantation. Ciclosporine is actually used in bone marrow transplantation and in the transplantation of solid organs such as kidney, liver, heart, lungs, lung-heart, pancreas and bowel. It was proven also efficient in the treatment of auto-immune diseases especially in the treatment of psoriasis and nephrotic syndrome. Pharmacokinetic and drug interactions of ciclosporine have to be taken in consideration in order to allow an optimal use of the medication. However, the drug presents a long list of side effects: hypertension, increased level of serum creatinine, hypomagnesemia, severe gingivitis, maxillary modification, which can restrict the therapeutic use of the drug

Quelle attitude pratique face a une hematurie microscopique isolee?

The finding of isolated asymptomatic microhcmaturia usually raises questions about the need to perform further invasive investigations. Phase contrast microscopy of the urine sediment is a sensitive, non invasive method that provides information on the glomerular or non glomerular origin of hematuria, as well as on its grade. This analysis, however, must be performed by an experienced technician under standard conditions. The presence of dysmorphic [i.e. glomerular] erythrocytes indicates a glomerular disease if the count is higher than 10 erythrocytes per micro-liter and is considered physiological if the count is below this number. In these two cases, no further investigation will be undertaken if all criteria for isolated microhematuria are verified. Conversely, isomorphic erythrocytes reveal a non glomerular origin of hematuria, which may indicate a serious urological disease. In this case, further investigations [e.g. ultrasound, urine cytology] are recommended, taking into account the age of the patient

Tertiary hyperparathyroidism in patients on hemodialysis for chronic renal failure: subtotal parathyroidectomy or conservative treatment?

To report our experience in novel surgical strategy in the treatment of tertiary hayperparathyroidism in hemodialysis patients for chronic renal failure and to assess the impact of this type of surgery on postoperative clinical and laboratory variables in this population. methods: Fifteen hemodialysis [12 female and 3 male] patients with chronic renal failure were operated on for tertiary hyperparathyroidism. Cervical ultrasound was performed in all patients [n = 15]. Preoperative cervical ultrasound showed one enlarged parathyroid gland [n = 4] or few enlarged parathyroid glands [n = 11]. Group I consisted of four patients with single parathyroid gland enlargement on ultrasound. These patients underwent resection of only the enlarged gland; three by unilateral approach under local anesthesia and one by cervicotomy under general anesthesia. Group II consisted of 11 patients with enlargement of all parathyroid glands on ultrasound. These patients were assumed to have hyperplasia and underwent subtotal parathyroidectomy [3.5 glands] and thymectomy by cervicotomy under general anesthesia. Postoperatively, patients in group I were normocalcemic [n = 4] and patients in group II were normocalcemic [n = 4] or had transient hypocalcemia [n = 7]. The pathology showed an adenoma in patient of group I [n = 4] and hyperplasia in patients of group II [n = 11]. postoperatively, both patients in Group I and II had a similar resolution of their symptoms. Tertiary hyperparathyroidism secondary to chronic renal failure may be treated by parathyroidectomy of one or few enlarged parathyroid gland[s]. Parathyroidectomy by unilateral approach under local anesthesia may be of value when preoperative localization studies show a single parathyroid gland enlargement