Résumé
Background: Nephrectomies whether partial, total or radical are common surgical procedures these days with trauma being the most common cause of an emergency nephrectomy. The indications of elective nephrectomies vary with different age groups- malignancies being common in the elderly age group and non-neoplastic indications of nephrectomy may present in any age group. The present study was undertaken in view of the increasing elective nephrectomies in our area thus analyzing the common causes requiring nephrectomy as a treatment. The present study also aimed at determining the age and sex distribution of various renal lesions requiring a nephrectomy. Methods: It was a prospective study for a period of 2 years - January 2013 to December 2014. A total of 45 nephrectomies were included in the study. Detailed clinical, biochemical and imaging findings were taken into consideration before analyzing each case. Results: There was a male predominance(64.4%) and 26.6% of the cases were in the age group of 40-50 years. 95.5% of the nephrectomies were performed for a non-neoplastic indication. Involvement of the right and left kidney was almost equal in the study. Chronic pyelonephritis was the most common histopathological diagnosis(68.8%). Conclusion: Inflammatory causes more commonly required a nephrectomy in the study population. Chronic calculous pyelonephritis was the most common underlying pathophysiology leading to a nonfunctioning kidney thus highlighting the early treatment of renal calculi.
Résumé
Background: The functional reserve of the kidney being large, serum biochemical parameters do not show abnormality until late. The need to recognize minimal damage in the kidneys is hence valuable. Urine sediment examination is cost effective, time saving and is called “liquid renal biopsy”. The present study was aimed to evaluate the role of urine sediment examination in predicting the severity of renal damage and compare the results with serum biochemical parameters, 24 hour urine protein values and renal biopsy findings. Methods: A total of 149 patients presenting with symptoms pertaining to renal disease were included in the study. Clinical information and serum biochemical parameters were obtained. Urine examination was done and renal biopsy performed in all the cases. 2 scoring systems were adopted to grade the urine sediment findings and renal biopsy grading devised by A. Z. Gyory et al. was used to grade the renal injury. 24 hour urine protein was estimated by Esbach’s method. Urine sediment scores, serum biochemical parameters, 24 hour urine protein values were compared with the grades of renal injury on renal biopsies and statistical significance calculated. Results: 32.8% of patients with renal disease were in the age group of 31-40 years. Nephrotic syndrome was the most common clinical presentation (33.5%) followed by nephritic syndrome (21.4%). The most common histopathological diagnosis was post infectious glomerulonephritis (n = 26) followed by acute interstitial nephritis (n = 17). 14 cases of lupus nephritis were diagnosed all of which were confirmed by “full house” pattern of immunofluorescence. Both the urine sediment scores had high specificity and positive predictive values in predicting the severity of renal injury. 24 hour urine protein had high positive predictive value in predicting the severity of renal injury. Serum biochemical parameters were insignificant in predicting the severity of renal injury. Conclusion: Urine sediment examination can be used as an effective diagnostic test for predicting the severity of renal injury. The decision of further investigations and follow-up can be certainly decided by taking urine microscopy findings and 24 hour urine protein values into consideration.