Supervivencia a mediano plazo de pacientes críticamente enfermos con función renal normal, lesión renal aguda y enfermedad renal crónica / Medium-term survival of critically ill patients with normal renal function, acute kidney injury and chronic kidney disease / Sobrevivência a médio prazo de pacientes criticamente doentes com função renal normal, lesão renal aguda e doença renal crônica

Resumen: Introducción: La falla renal es la tercera disfunción orgánica más frecuente en pacientes ingresados al hospital y la Unidad de Cuidados Intensivos; la supervivencia de pacientes críticamente enfermos con lesión renal aguda es aproximadamente 70%, pero los datos en pacientes críticamente enfermos con enfermedad renal crónica son escasos. Objetivo: Contrastar la supervivencia a mediano plazo de pacientes críticamente enfermos con función renal normal, lesión renal aguda y enfermedad renal crónica. Material y métodos: Se eligieron todos los pacientes ingresados de forma consecutiva a la Unidad de Cuidados Intensivos de enero 01 a diciembre 31 de 2018, se diagnosticó la función renal al ingreso, fueron seguidos a 90 días y se contrastó la supervivencia entre los tres grupos. Resultados: De los 355 pacientes para el análisis final, a 184 (51.8%) se les diagnosticó función renal normal, 96 (27.1%) lesión renal aguda y 75 (21.1%) enfermedad renal crónica al ingreso a la Unidad de Cuidados Intensivos. La edad fue mayor en los grupos de lesión renal aguda y enfermedad renal crónica que en el grupo de función renal normal (64.0 ± 17.6 y 67.8 ± 16.3 vs 56.7 ± 18.5 años, p = 0.000), el porcentaje de mujeres fue menor en el grupo de lesión renal aguda y enfermedad renal crónica que en el grupo de función renal normal (46/96 [47.9%] y 25/75 [47.6% vs 122//184 [63.3%], p = 0.001). La supervivencia fue menor en los grupos de lesión renal aguda y enfermedad renal crónica contrastada con el grupo de función renal normal (66/96 [68.75%] y 49/75 [65.33%] vs 150/184 [81.5%], Logrank test = 0.007). Conclusiones: La supervivencia a mediano plazo de pacientes críticamente enfermos con lesión renal aguda y enfermedad renal crónica al ingreso a la Unidad de Cuidados Intensivos es baja contrastada con el grupo de función renal normal.

Abstract: Introduction: Renal failure is the third most frequent organ dysfunction in patients admitted to the hospital and Intensive Care Unit; survival of critically ill patients with acute kidney injury is approximately 70%, but data in critically ill patients with chronic kidney disease are scarce. Objective: To contrast the medium-term survival of critically ill patients with normal renal function, acute kidney injury and chronic kidney disease. Material and methods: All patients consecutively admitted to the Intensive Care Unit from January 01 to December 31, 2018, were chosen, renal function was diagnosed on admission, they were followed up for 90 days and survival between the three groups was contrasted. Results: Of the 355 patients for the final analysis, 184 (51.8%) were diagnosed with normal renal function, 96 (27.1%) acute kidney injury, and 75 (21.1%) chronic kidney disease on admission to the Intensive Care Unit. Age was higher in the acute kidney injury and chronic kidney disease groups than in the normal renal function group (64.0 ± 17.6 and 67.8 ± 16.3 vs 56.7 ± 18.5 years, p = 0.000), the percentage of women was lower in the group acute kidney injury and chronic kidney disease than in the normal renal function group (46/96 [47.9%] y 25/75 [47.6% vs 122//184 [63.3%], p = 0.001). Survival was lower in the acute kidney injury and chronic kidney disease groups compared to the normal kidney function group (66/96 [68.75%] and 49/75 [65.33%] vs 150/184 [81.5%], Logrank test = 0.007). Conclusions: The medium-term survival of critically ill patients with acute kidney injury and chronic kidney disease on admission to the intensive care unit is low compared to the group with normal kidney function.

Resumo: Introdução: A insuficiência renal é a terceira disfunção orgânica mais frequente em pacientes internados no hospital e na Unidade de Terapia Intensiva; a sobrevivência de pacientes críticos com lesão renal aguda é de aproximadamente 70%, mas os dados em pacientes críticos com doença renal crônica são escassos. Objetivo: Compare a sobrevivência a médio prazo de pacientes críticos com função renal normal, lesão renal aguda e doença renal crônica. Material e métodos: Todos os pacientes admitidos consecutivamente na Unidade de Cuidados Intensivos de 1º de Janeiro a 31 de Dezembro de 2018 foram escolhidos, a função renal foi diagnosticada na admissão, foram acompanhados por 90 dias e a sobrevivência entre os 3 grupos foi contrastada. Resultados: Dos 355 pacientes para a análise final, 184 (51.8%) foram diagnosticados com função renal normal, 96 (27.1%) lesão renal aguda e 75 (21.1%) doença renal crônica na admissão na unidade de terapia intensiva. A idade foi maior nos grupos lesão renal aguda e doença renal crônica do que no grupo função renal normal (64.0 ± 17.6 e 67.8 ± 16.3 vs 56.7 ± 18.5 anos, p = 0.000), o percentual de mulheres foi menor no grupo agudo lesão renal e doença renal crônica do que no grupo com função renal normal (46/96 [47.9%] y 25/75 [47.6% vs 122//184 [63.3%], p = 0.001). A sobrevivência foi menor nos grupos de lesão renal aguda e doença renal crônica em comparação com o grupo de função renal normal (66/96 [68.75%] e 49/75 [65.33%] vs 150/184 [81.5%], teste Logrank = 0.007). Conclusões: A sobrevivência em médio prazo de pacientes críticos com lesão renal aguda e doença renal crônica na admissão na unidade de terapia intensiva é baixa em comparação com o grupo com função renal normal.

Intravoxel incoherent motion diffusion weighted imaging of normal adult kidney / 实用放射学杂志

Objective To analyze quantitatively intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI)of normal adult kidney and to evaluate the effects of the location of the kidney,gender and age on IVIM-DWI parameters.Methods Thirty healthy adult volunteers were recruited to undergo IVIM-DWI examination.Two radiologists measured the D ,D? and f values of renal parenchyma in both the upper pole,middle part and lower pole of the kidneys separately.Results The D ,D? and f values of the middle part of kidneys in healthy adult were(1.61±0.1 6)×10 -3 mm2/s,(1 7.45 ±3.78)×10 -3 mm2/s and (26.88 ±5.1 9)%, respectively.The D values of right kidney were higher than that of left kidney (P 50 years group were lower than that of ≤50 years group (t = 3.548,P=0.001).D value of the kidney and age was negatively correlated (r=-0.406).Intraclass correlation coefficient of D,D? and f values between two observers were 0.881,0.56 and 0.741,respectively.The consistency of two observers in measurement of IVIM-DWI parameters in the middle part of kidneys was higher than that of the upper pole and lower pole of the kidneys.Conclusion The IVIM-DWI parameters of adult normal kidneys are influenced by different parts of the kidney,gender and age.

Nephrogenic systemic fibrosis following acute kidney injury and exposure to gadolinium.

Nephrogenic systemic fibrosis (NSF) is a scleroderma-like systemic fibrosing condition of unknown etiology described in patients with renal insufficiency. Gadolinium exposure has been strongly associated with the development of NSF though the mechanism of such injury is not known. There are only few reported cases of NSF in the setting of acute renal failure and fewer reported cases where skin lesions developed after kidney function had returned to normal. We report a case of NSF in a young Hispanic woman with lupus nephritis but normal creatinine, who received gadolinium during a brief episode of prerenal acute kidney injury not requiring dialysis, secondary to sepsis.

Selective Cytotoxicity of Novel Platinum (II) Coordination Complexes on Human Bladder Cancer Cell-Lines and Normal Kidney Cells

Cisplatin is often effective in cancer treatment, but its clinical use is limited because of its nephrotoxicity. We have synthesized new platinum (II) coordination complexes (PC-1 & PC-2) containing trans-l and cis-1, 2-diaminocyclohexane (DACH) as carrier ligands and L-3 -phenyllactic acid (PLA) as a leaving group with the aim of reducing nephrotoxicity but maintaining its anticancer activity. In this study, new platinum (II) complex compounds were evaluated for selective cytotoxicity on cancer cell-lines and normal kidney cells. The new platinum complexes have demonstrated high efficacy in the cytotoxicity against human bladder carcinoma cell-lines (T-24/HT-1376). The cytotoxicity of these compounds against rabbit proximal renal tubular cells and human renal cortical tissues, was determined by MTT assay, the [3H]-thymidine uptake and glucose consumption test, and found to be quite less than those of cisplatin. Based on our results, these novel platinum compounds appear to be valuable lead compounds with high efficacy and low nephrotoxicity.

The Pre-operative Clinical Predictors for Renal Insufficiency Developing after Radical Nephrectomy in the Patients with Contralateral Normal Kidney / 대한비뇨기과학회지

PURPOSE: In order to help selecting candidates for nephron-sparing surgery, the pre-operative clinical parameters that can predict a renal insufficiency developing after a radical nephrectomy even in patients with contralateral normal kidney were identified. MATERIALS AND METHODS: Of 551 patients who underwent a radical nephrectomy to treat a renal cell carcinoma, 213 patients with a pre-operative serum creatinine >2.0mg/dl or with synchronous bilateral or metastatic tumors were excluded. In 338 patients (male 227, female 111), the incidence of post-operative renal insufficiency was evaluated. Using Kaplan-Meier's method, the clinical parameters including age, sex, pre-operative serum creatinine level, hypertension and diabetes mellitus were evaluated to determine if they could be used to predict a post-nephrectomy creatinine failure, which was defined as a serum creatinine >2.0mg/dl. RESULTS: Of the 338 patients, creatinine failure had developed in 25 (6.1%) at post-operative 8 months (1-72 months). The mean pre-operative serum creatinine level of these patients was 1.35mg/dl. Six patients were older than 60, 16 patients had hypertensive and 8 patients were diabetic. In 2 patients, hemodialysis was required due to a progressive post-operative deterioration in the renal function. Multivariate analysis revealed that all the pre-operative clinical parameters such as old age (>60 years), male sexuality, hypertension, diabetes mellitus and an elevated serum creatinine level (>1.4mg/dl) were significant independent predictors of a post-nephrectomy renal insufficiency (p< 0.05). CONCLUSIONS: Patients with clinical factors including old age, male sexuality, hypertension, diabetes mellitus and an elevated creatinine value have an increased risk of a renal insufficiency after a radical nephrectomy even though the contralateral kidney is normal. Therefore, in these patients nephron-sparing surgery is strongly recommended.

The Pre-operative Clinical Predictors for Renal Insufficiency Developing after Radical Nephrectomy in the Patients with Contralateral Normal Kidney / 대한비뇨기과학회지

PURPOSE: In order to help selecting candidates for nephron-sparing surgery, the pre-operative clinical parameters that can predict a renal insufficiency developing after a radical nephrectomy even in patients with contralateral normal kidney were identified. MATERIALS AND METHODS: Of 551 patients who underwent a radical nephrectomy to treat a renal cell carcinoma, 213 patients with a pre-operative serum creatinine >2.0mg/dl or with synchronous bilateral or metastatic tumors were excluded. In 338 patients (male 227, female 111), the incidence of post-operative renal insufficiency was evaluated. Using Kaplan-Meier's method, the clinical parameters including age, sex, pre-operative serum creatinine level, hypertension and diabetes mellitus were evaluated to determine if they could be used to predict a post-nephrectomy creatinine failure, which was defined as a serum creatinine >2.0mg/dl. RESULTS: Of the 338 patients, creatinine failure had developed in 25 (6.1%) at post-operative 8 months (1-72 months). The mean pre-operative serum creatinine level of these patients was 1.35mg/dl. Six patients were older than 60, 16 patients had hypertensive and 8 patients were diabetic. In 2 patients, hemodialysis was required due to a progressive post-operative deterioration in the renal function. Multivariate analysis revealed that all the pre-operative clinical parameters such as old age (>60 years), male sexuality, hypertension, diabetes mellitus and an elevated serum creatinine level (>1.4mg/dl) were significant independent predictors of a post-nephrectomy renal insufficiency (p< 0.05). CONCLUSIONS: Patients with clinical factors including old age, male sexuality, hypertension, diabetes mellitus and an elevated creatinine value have an increased risk of a renal insufficiency after a radical nephrectomy even though the contralateral kidney is normal. Therefore, in these patients nephron-sparing surgery is strongly recommended.

A Statistical Observation on the Morphology of the Normal X-ray Findings of the Kidney in Korean Young Men / 대한비뇨기과학회지

A statistical observation on the morphology of the normal I.V.P. of 500 cases in Korean young men was followed; 1. Age distribution was from 20 to 40 years old. The majority was 325 cases (65%) between 20 and 25 years of age. 2. Upper poles of the both kidneys were located at the T12 level and lower poles located at the L3 Level in supine position. 3. The average angle of every kidney to vertebral column in supine position was 18.3 degrees +/- 5.06 in right and 10.0 degrees +/- 5.01 in left side. 4. The average length of every kidney in supine position was 12.12+/-O.70l cm. in right side and 12.44 +/- 0. 664 cm. in left side. 5. The average width of every kidney in supine position was 6.37 +/- O.539 cm. in right side and 6.75 +/- 0.447 cm. in left side.

A Clinical Observation on the Normal and Movable Kidney of Korean / 대한비뇨기과학회지

The clinical and intravenous pyelographic studies on 513 cases of Korean with normal or movable kidneys at St. Mary's Hospital, Catholic Medical College, during the period from January 1965 through September 1969 were performed Of 513 cases, 215 cases, normal kidneys and others, movable kidneys. The results were summarized as follows; 1. The center of the right renal pelvis in the supine position was at the level of the upper part of the second lumbar vertebra, and that of the left was located at the L1-L2 level in normal kidney 2. The angle between the long axis of normal kidney and the vertebral column was 6 degrees - 20 degrees, and no differences were noticed between the right and left side. 3. The range of the angular change obtained by the postural change from the supine to the erect was 1'-10' in normal kidney. 4. The ratio of the movable kidney of the male and female was 1:1.6, and that of the right and left was 20:1. The incidence of the movable kidney was the highest in the age of 31 to 40, and majority of the movable kidney (80.5%) was lied between the age of 20 and 50. 5. The most common clinical findings of the movable kidney wag flank pain (40.6%) and other findings were recorded in the order of hematuria, frequency of urination, palpable mass on the renal region, pyuria and indigestion. 6. Among 52 cases of microscopic hematuria, grade 1 showed 30 cases (57.7%). 7. 104 cases (35.0%) of the movable kidney showed no subjective symptoms. 8. 139 cases (46.6%) of the movable kidney showed poor drainage of contrast media during I.V.P. taken in erect position. 9. Only 25 cases (8.3%) of the movable kidney were treated by operation.