A prospective study assessing feasibility of performing percutaneous nephrolithotomy in chronic kidney disease patients - What factors affect the outcome?

ABSTRACT Objectives To primarily evaluate the functional outcomes of PCNL for bilateral renal calculi/calculi in solitary functioning kidney with Chronic Kidney Disease(CKD). To identify factors affecting the renal replacement therapy following PCNL. Materials and Methods Patients with bilateral renal calculi/calculi in solitary kidney and CKD (eGFR<60/s.creatinine>2) and Good Performance Status [Eastern Cooperative Oncology Group (ECOG): 0-2] were included in the study. Results A total of 60 patients with CKD who had bilateral renal calculi/calculi in solitary functioning kidney underwent PCNL. At 6 months, eGFR improved or stabilized in 45 (75%) patients, while in 15 (25%) patients eGFR deteriorated. A total of 5 (14.28%) and 2 (25%) patients of CKD stage 4 and 5 respectively had improvement in eGFR as well as CKD stage. Fourteen (82.35%), 21 (60%), 3 (37.5%) patients of CKD stage 3, 4, 5 had improvement in eGFR but not significant enough to cause stage migration. Again 3 (17.65%) , 9 ( 40%) and 3 (37.5%) patients of CKD stage 3, 4, 5 had reduction in eGFR but not significant enough to cause stage migration. None of the patients had worsening of CKD stage. Preoperative CKD stage and eGFR were compared with measurements made at the final follow up visit (6 months). Conclusion Our results indicate that most patients of renal calculi with CKD show improvement or stabilization of renal function with aggressive stone removal. Improvement is more in patients who have mild to moderate CKD. Aggressive management of comorbidities, peri-operative UTI and complications may delay or avoid progression of CKD status in such patients.

Comparison of third generation ELISA and conventional nested RT-PCR for detection of HCV among hemodialysis patients.

Hepatitis C virus is one of the main cause of chronic hepatitis in developing countries. The current study was done to evaluate the efficacy of the third generation ELISA compared to nested RT- PCR for establishing the diagnosis of hepatitis C virus (HCV) in patients on hemodialysis. This descriptive, cross-sectional study was carried out on 237 Hemodialysis patients in Lucknow, Uttar Pradesh. The retrospective demographic data of the subjects was collected and the patient’s serum samples were analyzed by ELISA & RT-PCR for HCV. In the present study, of total 21 HCV positive either by ELISA or PCR 12 (57.14%) were positive for both RT-nested PCR and ELISA. Total four (19.05%) patients were positive for HCV by RT-nested PCR and negative by ELISA while five (23.81%) patients were negative for RT-nested PCR and positive for ELISA. PCR method is accredited as a specific and reliable method suitable for screening of HCV and is recommended for establishing exact and final diagnosis of these patients. However third generation ELISA assays have many advantages in the diagnostic setting including ease of automation, ease of use, relative cost-effectiveness, and low variability.

Heterotopic bone formation in renal cell carcinoma: a diagnostic challenge.

Formation of bone in cases of renal cell carcinoma is a rare finding and only a couple of case reports from Japan and one from India are mentioned in the literature. Calcification inside renal mass has been reported earlier but the prognostic implications have not been clearly elucidated. We report a case which showed heterotopic bone formation (ossification) inside the renal mass and was managed by radical nephrectomy. The histopathology showed clear cell renal carcinoma with multiple centers of ossification in the region of calcification suggesting bone formation. In this case report we discuss bone morphogenetic proteins which have been implicated as a prognostic and causative factor, highlight the difficulties in distinguishing between calcification and bone formation on the basis of radiological investigations and mention the geographic implications of this rare phenomenon which has not been described earlier.