Isolated renal hydatid cyst; A rarer infectious disease

Hydatid cyst disease caused by Echinococcus granulosus is commonly seen in the liver but rarely seen in the kidneys, in addition, the isolated renal occurrence is estimated to be about as low as 2–4% of all cases. A 38-year-old male presented with ambiguous left flank pain to the urology clinic. After examination and imaging, he was diagnosed with suspected renal cell carcinoma in the left kidney. Nephrectomy was done and ELISA suggested strongly positive for Hydatid cyst which was later confirmed by histopathological examination. Isolated renal hydatid cyst is an exceedingly rare condition and could possibly be misdiagnosed with other renal masses. The clinical history, laboratory tests, and thorough radiologic imaging are crucial, for accurate preoperative diagnosis as the disease may have no symptoms for years.

Primary renal lymphoma: a rare cause of renal mass in pediatric age group: case report and review of literature

The secondary renal involvement of non-Hodgkin lymphoma is frequently encountered but primary renal lymphoma is extremely rare in children. We hereby present a rare case of primary renal diffuse lymphoma in a 3-year-old girl child who presented with bilateral renal masses.  The tumour was initially diagnosed as bilateral Wilms’ tumour but on biopsy, it turned out to be non-Hodgkin's lymphoma. Primary renal lymphoma is an aggressive tumour with guarded prognosis. There are a variety of diseases which present as renal masses in children amongst which primary renal lymphoma is extremely rare. This article describes the clinical features and diagnostic features of primary renal lymphoma. Our report highlights the importance of keeping this neoplastic condition under consideration while evaluating children with renal mass .In order to distinguish primary renal lymphoma from other renal tumours, the authors have also described the clinical, imaging and pathological features of various other renal tumours prevalent in children.

Compromiso vesical en paciente pediátrico con poliarteritis nodosa: primera descripción / Bladder involvement in a paediatric patient with polyarteritis nodosa: First description

RESUMEN La poliarteritis nudosa (PAN) es una vasculitis necrosante, rara en la infancia, caracterizada por el compromiso de vasos pequeños/medianos y de múltiples órganos. Presentamos a una paciente que inició a los 4 arios con síndrome febril prolongado, dolor abdominal crónico, mialgias incapacitantes y compromiso en la piel, quien luego de 2 años de cuadro clínico completa criterios clínicos para PAN. Recibió tratamiento con corticoide sistêmico por vía oral e intravenosa, 6 meses de ciclofosfamida por vía intravenosa y manejo de mantenimiento con inmunosupresores convencionales sin respuesta adecuada, logrando control de la enfermedad únicamente con ciclofosfamida por vía oral y corticoide a largo plazo. Luego de 5 años y de recibir una dosis alta acumulada de ciclofosfamida, inicia con cuadros de hematuria macroscópica. Se evaluaron, entre otras causas, la toxicidad por ciclofosfamida y la actividad de la enfermedad. El estudio incluyó biopsia vesical, con hallazgo de vas-culitis necrosante de paredes vesicales. La vasculitis vesical es raramente reportada en la literatura (3-5 casos en adultos) y en lo consultado no hay reportes en niños. Se describe, en nuestro conocimiento, el primer caso de compromiso vesical asociado a vasculitis sistêmica reportado en la edad pediátrica.

A B S T R A C T Polyarteritis nodosa (PAN) is a necrotising vasculitis, rare in childhood, and characterized by the inflammation of small and medium vessels and multiple organ involvement. The case is presented of a 4 year old girl with prolonged febrile syndrome, chronic abdominal pain, disabling myalgia, and skin involvement. After 2years of symptoms, she met clinical criteria for PAN. She received treatment with oral and intravenous systemic corticosteroids, 6 months of intravenous cyclophosphamide and maintenance with conventional immuno-suppressants without an adequate response. However, she showed clinical improvement with oral cyclophosphamide and long-term corticosteroids. She had several relapses during follow-up visits due to irregular treatment requiring a high cumulative dose of cyclophosphamide. Five years later she presented with macroscopic haematuria, and was assessed for, among other causes, cyclophosphamide toxicity and disease activity. The workup included cystoscopy and bladder biopsy with findingof necrotising vasculitis of bladder wall. Bladder vasculitis is rarely reported in the literature (3-5 cases in adults) and in that consulted there are no reports in children. To our knowledge, this is the first case of bladder involvement associated with systemic vasculitis reported in the paediatric age.

Post operative complications of double-J ureteral stenting: a prospective study

Background: Placement of indwelling ureteral stents has become routine in the management of variety of urinary tract infections. Despite the advances and technology, the ideal stent is not available yet. A double-J stent is never without potential complications which may be minor in form of hematuria, dysuria, frequency, flank and suprapubic pain to major complications such as vesicoureteric reflux, migration, malposition, encrustation, stent fracture etc.Methods: One hundred urological patients who had undergone double-J ureteral stenting attending surgery department were taken. Patients were subjected to detailed history and clinical examination and other routine investigations and symptoms of any complications were recorded starting at the time of placement of double-J ureteral stent till its removal.Results: Majority of the patients in our study had only minor complications related to double-J ureteral stenting like flank or suprapubic pain, dysuria, hematuria and urgency which were managed conservatively. Major complication like stent migration was seen only in 1 patient which was managed with removal of stent.Conclusions: At the end of study, we concluded that double-J stents have become an essential part of many endourological and open urological procedures and their use cannot be completely avoided.

Tubeless PCNL in Macrotract for Multiple and Staghorn Calculus with More Than One Tract- A Single Centre Experience and Literature Review..

Percutaneous nephrolithotomy (PCNL) has gradually become a preferred method of treatment modality for kidney stones in adults as well as in paediatric patients. The primary objective of this study was to evaluate the outcomes and complications in patients having multiple and staghorn calculi and of different sizes, who underwent tubeless PCNL at a single, tertiary care hospital.METHODSA retrospective study was conducted at IGIMS, Patna from January 2017 to February 2018. Patients who underwent conventional PCNL with one or two access for single, multiple or staghorn calculus without nephrostomy tube were included in the study. Patients having solitary kidney with stones are excluded from this study. The primary outcomes of the study were haemoglobin, pain score, and duration of hospital stay.RESULTSA total of 96 patients underwent conventional PCNL with a mean age of 34 years and male:female ratio of 1.3:1. Majority of the patients had a single stone (n=54) followed by 28 patients with multiple stones. Medical comorbidities including hypertension, diabetes mellitus and chronic obstructive pulmonary disease were observed in patients of single (n=8), multiple (n=3) and staghorn (n=2) groups, respectively. Postoperative complications such as haematuria and pleural effusion were developed by the patients. Seventy-six patients were treated with single-tract and 20 by double tract PCNL.CONCLUSIONSPCNL is safe and efficient with limited post-operative complications. The number of residual stones were nil in single stone group while in multiple and staghorn groups insignificant number of renal stones was seen.

Five-year girl with advanced lupus nephritis and insulin dependent diabetes mellitus

Systemic Lupus Erythematosus (SLE) and Insulin Dependent Diabetes Mellitus (IDDM) are two common auto immune disorder occurring in children which can involve the renal system. The condition when occurs simultaneously in a child and its effects and follow up on the kidneys and its management have been mentioned here. A five-year-old girl was presented with low grade fever, dryness of mouth and bilateral pain over knee joints over four months. She had facial puffiness, mild bilateral pedal edema, and ascites on admission. She was treated immunosuppressive medications following a renal biopsy and insulin for IDDM

Síndrome del cascanueces / Nutcracker syndrome

El síndrome del cascanueces es una anomalía vascular en la que se comprime la vena renal izquierda a su paso entre la unión de la aorta y la arteria mesentérica superior, debido a un ángulo muy cerrado entre ambas arterias. Clínicamente puede presentarse como hematuria macro o microscópica, dolor episódico en flanco izquierdo, dolor pélvico, várices gonadales o simplemente cursar de forma asintomática. Presentamos dos casos clínicos, uno de ellos con dolor abdominal tipo cólico nefrítico y hematuria macroscópica y otro estudiado por hipertensión pero con antecedentes de embolización de la vena renal izquierda por varicocele izquierdo. Discutimos los aspectos clínicos, diagnósticos y terapéuticos de este síndrome.

Nutcracker syndrome is a vascular anomaly consisting in the compression of the left renal vein between the superior mesenteric artery and the aorta. Clinical features in nutcracker syndrome include pelvic pain, flank pain, haematuria, gonadal varices or simply asymptomatic. We are presenting two cases, one of them with macroscopic haematuria and flank pain and the other was studied for hypertension but with previous antecedents of left renal vein embolization in the setting of varicocele. We discuss the clinical presentation as well as diagnostic and therapeutic aspects related to this syndrome.

Analysis of the clinical features of isolated hematuria Henoch-Schonlein purpura nephritis of chil-dren in 135 cases / 新乡医学院学报

Objective To analyze the clinical features of isolated hematuria Henoch-Schonlein purpura nephritis (HSPN). Methods The clinical data of children with isolated hematuria HSPN diagnosed in the First Affiliated Hospital of Henan University of Chinese Medicine from November 2003 to December 2014 was analyzed retrospectively. Results One hundred and thirty-five isolated hematuria HSPN patients were rolled in the study. Eighty cases were male and fifty-five cases were female. Male to female was 1. 45:1,average age was(9. 24 ± 5. 32)years old. Thirty one cases had pure skin purpura, thirty three cases had purpura accompany with abdominal pain,twenty eight cases had purpura accompany with arthralgia,forty three purpura accompany with abdominal pain and arthralgia. The pathogenesis was (8. 62 ± 7. 28)months. Seven cases were given nephridial tissue biopsy. In the 135 cases,there were 31 cases accepted general therapy,and 104 cases accepted the ther-apy of immunodepressant. In the patients with general therapy,there were 19 cases with recovery,8 cases with isolated hematu-ria,3 cases with mild proteinuria,1 case with moderate proteinuria. In the patients with therapy of immunodepressant,there were 72 cases with recovery,23 cases with isolated hematuria,7 cases with mild proteinuria,one case with moderate proteinuria,one case severe proteinuria. There was no significant difference in the prognosis between the general therapy patients and immu-nodepressant therapy patients(z = 0. 65,P = 0. 516). Conclusion The prognosis of the HSPN in children accompany with iso-lated haematuria is favourable,but a few patients may progress to moderate and severe proteinuria.

El análisis de orina como herramienta diagnóstica en casos de malaria grave / Urinalysis as a diagnostic tool in severe malaria

Resumen La malaria produce complicaciones y muerte especialmente en poblaciones con acceso limitado a la atención en salud. La malaria grave puede reconocerse tempranamente mediante la detección en la orina de hallazgos como la hematuria, la coluria y la proteinuria. Se hizo una revisión narrativa basada en estudios sobre malaria grave y el empleo del análisis de orina mediante la consulta de 91 publicaciones. Mediante el análisis de la orina, se pueden detectar alteraciones metabólicas y lesiones en distintos órganos. En estudios recientes en Colombia se ha confirmado su utilidad como apoyo en el diagnóstico de la disfunción renal, la disfunción hepática y la anemia asociada con hemólisis, las cuales son complicaciones frecuentes en la malaria. El examen constituye una herramienta de fácil aplicación en la consulta ambulatoria y en pacientes hospitalizados para reconocer tempranamente casos complicados, y permite la detección oportuna de diferentes lesiones en el paciente con malaria, contribuyendo así a la reducción de la morbilidad grave y la mortalidad.

Abstract Malaria accounts for a significant morbidity and mortality rate around the world, especially in communities with limited access to healthcare. Some clinical signs in urine, like haematuria, coluria and proteinuria, help for the early diagnosis of severe malaria cases. A narrative review was conducted by analyzing 91 publications on studies about severe malaria cases and the use of urinalysis. A urinalysis can detect metabolic disturbances and organ injury. Its diagnostic utility for frequent complications caused by malaria, such as hepatic injury, kidney dysfunction and hemolysis, has been confirmed by recent Colombian studies. This test is an easy-to-use tool in outpatient clinics and with hospitalized patients to promptly recognize complicated cases, allowing the timely identification of different lesions in patients with malaria, thus contributing to the reduction of severe morbidity and mortality.

Loin Pain Haematuria Syndrome - A Narrative Review of Pain Management Strategies

Loin pain haematuria syndrome (LPHS) is an uncommon clinical entity that has divided renal physicians, pain practitioners, and even psychiatrists since its initial description. A relative paucity of data exists regarding the condition, with best practice guidelines lacking amid the existing threads of anecdotal experiences and variable follow-up observations. The aim of this article was to review the cumulative published experience of pain relief strategies for LPHS.

Renal biopsy findings in Jamaican children / Hallazgos en las biopsias renales en niños jamaicanos

OBJECTIVE: To document the histological findings in Jamaican children undergoing renal biopsy in order to determine the relative prevalence of varying types of glomerular disease in the island. METHODS: This study analyses retrospectively the renal histology in all Jamaican children less than age 12 years undergoing their first adequate renal biopsy between January 1985 and December 2008. Clinicopathological data were obtained solely from the histology reports from the University Hospital of the West Indies where all paediatric renal biopsies are processed. RESULTS: Of the 270 children, aged 1 month to 11 years (mean 7.58 years), 147 [58.1%] were males. The commonest indications for renal biopsy were nephrotic syndrome (57.4%) and glomerulonephritis (30%). Most biopsied children (260/270) had glomerular disease. The predominant glomerulonephritides were diffuse proliferative glomerulonephritis (DPGN) (27.7%) and mesangialproliferative glomerulonephritis (MesGN) (25.5%). Glomerular disease was idiopathic in 136/260 (53%) but was infection-associated in 32.3% (84 cases) of which Poststreptococcal glomerulonephritis (PSGN) was the commonest (75%) -predominantly DPGN (74.6%). Hepatitis B followed at 15.5% (13/84) manifested as membranous nephropathy in 83.3% (10/12). In patients with SS disease, DPGN was the commonest histology (47.4%). Systemic lupus erythematosus accounted for 5% ofall renal biopsies. Over time, PSGNoccurred less frequently, with a parallel reduction in DPGN and MesGN. CONCLUSION: In Jamaican children, DPGN is the commonest nephritis. Membranous nephropathy is primarily due to Hepatitis B. The commonest histology in SS disease is DPGN. The role ofinfection in the pathogenesis ofrenal disease in Jamaican children is probably underestimated.

OBJETIVO: Documentar los hallazgos histológicos en niños jamaicanos a los que se les ha realizado biopsias renales para determinar la prevalencia relativa de los diversos tipos de enfermedad glomerular en la isla. MÉTODOS: Este estudio analiza retrospectivamente la histología renal en todos los niños jamaicanos menores de 12 años sometidos a su primera biopsia renal adecuada entre enero de 1985 y diciembre de 2008. Los datos clinicopatológicos fueron obtenidos exclusivamente de los reportes de histología del Hospital Universitario de West Indies, dónde se procesan todas las biopsias renales. RESULTADOS: De 270 niños, cuyas edades fluctuaban de 1 mes a 11 años (media 7.58 años), 147 [58.1%] eran varones. Las indicaciones más comunes para la biopsia renal fueron el síndrome nefrótico (57.4%) y la glomerulonefritis (30%). La mayoría de los niños sometidos a biopsia (260/270) tenían la enfermedad del glomerular. Las glomerulonefritis predominantes fueron la glomerulonefritis proliferativa difusa (GNPD) (27.7%) y glomerulonefritis proliferativa mesangial (GNMes) (25.5%). La enfermedad glomerular fue idiomática en 136/260 (53%) pero estuvo asociada con infecciones en 32.3% (84 casos) en los cuales la glomerulonefritis poststreptocóccica (GNPS) fue la más común (75%) - predominantemente GNDP (74.6%). La hepatitis B siguió con 15.5% (13/84), manifestada como nefropatía membranosa en 83.3% (10/12). En los pacientes con la enfermedad de la hemoglobina SS, la GNDP fue la histología más común (47.4%). El lupus eritematoso sistémico representó el 5% de todas las biopsias renales. Al pasar el tiempo, la GNPS ocurrió menos frecuentemente, con una reducción paralela en GNPD y GNMes. CONCLUSIÓN: En los niños jamaicanos, la GNPD es la nefritis más común. La nefropatía membranosa se debe principalmente a la Hepatitis B. La histología más común en el caso de la enfermedad de hemoglobina SS es la GNPD. Probablemente se subestima el papel que las infecciones desempeñan en la patogénesis de la enfermedad renal en los niños jamaicanos.

Sarcoma vesical: presentación de un caso / Bladder Sarcoma: case presentation

Paciente femenina de 50 años de edad, quien presenta hematuria y pérdida de peso. Se le realizaron varios exámenes, incluyendo ultrasonido abdominal, donde se observa masa tumoral en región vesical. No se pudo intervenir, posteriormente, por la evolución tórpida con deceso, que presentara la misma. Se toma muestra para biopsia y se envía el especimen quirúrgico a Anatomía Patológica; resultó un tumor vesical infrecuente con poca incidencia en la literatura. Lo fundamental es señalar la importancia de poner en práctica y descubrir, a tiempo, las herramientas necesarias para evidenciar y diagnosticar estos tipos de tumores(AU)

50 years old female who suffrered haematuria and lost weight is presented. Several tests are perfomed including abdominal ultrasonographic test in which a tumoral mass in vesical region are noted. The patient was not surgered due to bad evolution and fast death. Surgical specimen for biopsy was sent to Anatomy pathology deparment. The diagnosis was an infrecuent vesical tumor as well as the lower incidence in the literature. I think that the most important goal is finding as soon as possible the necessary tools that just may us to diagnose them at time(AU)

Alum Irrigation for the Treatment of Intractable Haematuria

Managing intractable haematuria is a daunting task. One cause of this condition is radiationinduced haemorrhagic cystitis. Several treatments for the condition have been proposed and one non-invasive option is alum irrigation. Here, we report on a 65-year-old woman with intractable haematuria secondary to radiation cystitis who was successfully treated with alum irrigation. Alum irrigation is safe, well tolerated and relatively cheap. A review of the literature and a comprehensive discussion on alum irrigation as treatment for haematuria is discussed here to create an awareness regarding this treatment option.

Urothelial carcinoma in patients with chronic aristolochic acid nephropathy / 中华肾脏病杂志

Objective To investigate the urothelial carcinoma in patients with chronic aristolochic acid nephropathy(CAAN). Methods The clinical data of urothelial carcinoma were analyzed in 4 cases among 102 patients with CAAN. Results (1)Chronic renal insufficiency caused by CAAN was diagnosed in 4 patients after intermittently taking the medicine containing aristolochic acid(AA) for a long time (from 3 years to 24 years). (2) Urinary examination of these 4 cases showed the red cells with uniformed shape. Two of them experienced an episode of macroscopic haematuria. (3) Three of them had papillary transitional cell carcinomas on the bladder wall by the cystoscopy and pathological examination. The other one had carcinoma of the left renal pelvis by the retrograde urography and pathological examination after surgical operation. Conclusion CAAN is associated with the developing urothelial tumours when a patient with CAAN has an episode of macroscopic or obvious microscopic hematuria with red cells of uniformed shape.