Short- and mid- term impact of tobacco smoking on donor renal function following living kidney donation at a tertiary referral hospital

Background: The negative impact of tobacco smoking on renal function has been widely studied. However, there is limited knowledge about the effect of smoking on pre-operative and post-operative renal function in living kidney donors. Objective: The objective of the study was to evaluate the short- and mid-term impact of smoking on donor renal function. Methods: This is a retrospective study of 308 patients who underwent living donor nephrectomy (LDN) at a tertiary referral hospital. We compared baseline characteristics as well as functional outcomes following LDN according to history of tobacco smoking. Estimated glomerular filtration rate (eGFR) was calculated with the modification of diet in renal disease equation in 6 time periods: pre-operative, 1 week, 1 month, 6 months, 12 months, and 24 months after surgery. We performed a Kaplan-Meier analysis for chronic kidney disease (CKD) outcome and binary logistic regression analysis to identify risk factors associated with CKD at 24 months of follow-up. Results: Among donors, 106 (34.4%) reported a smoking history before nephrectomy. Smoking donors had worse pre-operative eGFR than non-smokers (90 ± 26.3 mL/min/1.73m2 vs. 96 ± 27 mL/min/1.73 m2, respectively; p = 0.02) and lower eGFR at 1 week (p = 0.01), 1 month (p ≤ 0.01), 6 months (p = 0.01), and 12 months (p = 0.01) after LDN. Tobacco smoking (OR 3.35, p ≤ 0.01) and age ≥ 40 years at donation (OR 6.59, p ≤ 0.01) were associated with post-operative development of CKD at 24 months after LDN. Conclusions: Living kidney donors with a tobacco smoking history had an increased risk of developing chronic kidney disease following nephrectomy. Smoking-cessation strategies should be implemented.

Endometriosis en colon sigmoides asociada a hematoquecia en una paciente histerectomizada / Endometriosis within the sigmoid colon associated with hematochezia in a hysterectomized woman

La endometriosis es la existencia e implantación de estroma y glándulas endometriales funcionales fuera del útero, pero con funcionalidad similar al tejido endometrial dentro de la cavidad uterina. Tiene una presentación clínica variable, ya que depende del sitio de implantación. Se ha determinado que es la tercera causa de hospitalización en los Estados Unidos. Se presenta el caso de una paciente de 44 años de edad con hematoquecia causada por endometriosis profunda infiltrante en colon sigmoides, después de once años de haberse realizado la histerectomía. La paciente fue tratada mediante resección quirúrgica debido a que se sospechaba de un carcinoma.

Endometriosis is the presence of functional ectopic endometrial tissue outside the uterine cavity. The clinical presentation is variable and depends on the location. It is considered the third leading cause of hospitalization in the United States. In this case, we report a 44-year-old woman with hematochezia caused by deep infiltrating endometriosis within the sigmoid colon, after having undergone a hysterectomy 11 years ago. The patient received surgical resection due to suspicion of carcinoma.