Exclusión renal por endometriosis profunda ureteral: a propósito de un caso / Renal exclusion due to deep infiltrating ureteral endometriosis: a case report

INTRODUCCIÓN: La endometriosis ureteral es una afección rara que afecta al 0.01-1,7% de las mujeres con endometriosis. Hasta un 30% cursa de forma asintomática y un 11,5-14,7% pueden evolucionar con falla renal. La falta de diagnóstico de la enfermedad puede terminar en una uropatía obstructiva y falla renal irreversible. Se presenta el caso de una paciente con afectación grave de la función renal secundaria a endometriosis profunda con compromiso ureteral. CASO CLÍNICO: Mujer de 35 años con endometriosis que consultó por exacerbación de los síntomas. En su estudio destaca, en la resonancia magnética, el hallazgo de endometriosis pélvica profunda y compromiso endometriósico intrínseco del uréter distal derecho, provocando una acentuada hidroureteronefrosis. El cintigrama renal demuestra acentuado compromiso de la función renal derecha, con una función relativa del 7%. Se realizaron nefrectomía total derecha y resección de enfermedad pélvica profunda laparoscópica, sin incidentes. CONCLUSIONES: La endometriosis ureteral representa un desafío diagnóstico y terapéutico. El manejo multidisciplinario entre radiólogos, ginecólogos y urólogos, mediante el diseño de una estrategia quirúrgica individualizada, es imprescindible para definir el tratamiento óptimo de estas pacientes.

INTRODUCTION: Ureteral endometriosis is a rare entity that affects 0.01-1,7% of women with endometriosis. Up to 30% of the patients are asymptomatic and 11.5-14.7% will develop renal failure. Misdiagnosis can lead to obstructive uropathy and permanent renal failure. We present the case of a patient with severe compromise of renal function secondary to deep infiltrating endometriosis with ureteral involvement. CASE REPORT: A 35-year-old woman with endometriosis presented with exacerbation of symptoms. Magnetic resonance showed deep pelvic endometriosis and intrinsic endometriotic involvement of the right distal ureter, causing a marked hydroureteronephrosis. Renal scintigram showed a severe compromise of the right renal function, with a relative function of 7%. Through laparoscopy a total right nephrectomy and resection of deep infiltrating endometriosis was performed. The patient had a satisfactory recovery in the postoperative period. CONCLUSIONS: Ureteral endometriosis presents a diagnostic and therapeutical challenge. Joint multidisciplinary management between radiologists, gynecologists and urologists through the design of an individualized surgical strategy is essential to define the optimal treatment for these patients.

Easy resolution of severe obstructive kidney injury

SUMMARY Chronic constipation is a common diagnosis with a high prevalence in the elderly. Constipation affects the quality of life of sick individuals, bringing several clinical complications.

RESUMO A obstipação crônica é um diagnóstico com alta prevalência comum em idosos. A constipação afeta a qualidade de vida das pessoas doentes, carregando muitas complicações clínicas.

An atypical presentation of a severe and massive atheroembolic disease / Uma apresentação atípica de doença ateroembólica grave

ABSTRACT Atheroembolic renal disease (AERD) is a kidney manifestation of atherosclerosis as a systemic disease. AERD is defined as a renal impairment secondary to embolization of cholesterol crystals with consequent occlusion of renal vascularization. The current case report describes one patient with multiple risk factors but without any inciting event history who presents a very atypical clinical course of a severe and massive atheroembolic disease that developed spontaneously and silently.

RESUMO A doença renal ateroembólica (DRAE) é uma manifestação renal da aterosclerose enquanto patologia sistêmica. A DRAE é definida como uma disfunção renal secundária à embolização de cristais de colesterol seguida da oclusão da vascularização renal. O presente relato descreve o caso de um paciente com vários fatores de risco, porém sem um evento precipitante, que se apresentou com um curso clínico bastante atípico de doença ateroembólica grave de evolução espontânea e silenciosa.

Renal dysfunction in liver cirrhosis: renal duplex doppler us vs. scintigraphy for early identification

Renal arteries of 43 patients with cirrhosis and normal renal function tests were compared with 15 age and gender matched normal subjects as a control group using color Doppler sonography and Tc- 99m DTPA scintigraphy. The patients were categorized into three groups: A [14], B [14] and C [15] according to a modified Child's classification that assesses the severity of liver cirrhosis. Doppler sonography can detect an increase in renal vascular resistance in patients with moderately severe cirrhosis [Child B] when renography was normal. It was concluded that Doppler sonography can be used for earlier identification of cirrhotic patients with a higher risk of impeding renal failure earlier than renography and may also be used to guide therapeutic approaches

Comparison of the accuracy of interventional radiology, diuretic ultrasonography and radionucleids studies in prediction of the prognosis of radiologically non functioning obstructed kidney

Twenty eight patients of unilateral radiologically non functioning obstructed kidneys were studied before treatment, and, after relieve of obstruction, by different radiological and imaging methods i.e. ultrasonography with diuretic ultrasound, radionucleides study, antegrade urography, retrogrode urography and laboratory investigations [Osmolality of urine, urinary ph, and split renal clearance]. The patients examined by I.V.U. after relieve of obstruction by 2 months and 4 months. Eight patients performed nephrectomy because of pyonephrosis and advanced back pressure noted by ultrasonography. The remaining 20 patients showed. after treatment good function in 10/20 [50%] patients, moderate function in 6/20 [30%] patients and non function in 4/ 20 [20%]. It was noted that the split clearance is the most accurate method with 100% accuracy. The renography and diuretic renography shows 100% accuracy in cases of dilated non obstructed and non perfused kidneys. The accuracy of ultrasonography and diuretic ultrasonography was 100% in mild hydronephrosis and when the change in pelvic surface area was from 60-80% after diuretic by 15 minutes