Clinical efficacy of flexible ureteroscopic holmium laser lithotripsy combined with cyst wall incision in the treatment of renal calculi with ipsilateral renal cyst / 现代泌尿外科杂志

【Objective】 To investigate the efficacy of flexible ureteroscopic holmium laser lithotripsy combined with cyst wall incision and drainage in the treatment of renal calculi with ipsilateral renal cyst. 【Methods】 A total of 70 patients with renal calculi complicated with ipsilateral renal cyst (cyst diameter >40 mm, maximum diameter of stone 0.05). 【Conclusion】 Flexible ureteroscopic holmium laser lithotripsy combined with cyst incision and drainage has the advantages of short operation time, small trauma, few adverse reactions, good stone clearance effect and satisfactory efficacy. It can be used as a preferred surgical method for renal calculi complicated with ipsilateral renal cyst.

Glomerulocystic disease, a rare cause of renal cysts in infants: A series of three cases

Glomerulocystic kidney disease (GCKD) is an uncommon type of cystic renal disease affecting children. It has both sporadic and familial occurrence and is characterized by cortical microcysts associated with dilatation of Bowman's spaces. In some instances, GCKD is an early manifestation of autosomal dominant polycystic kidney disease. Here, we present three cases of GCKD, two in infants and one in a perinatal postmortem. The first one is a case of GCKD with unilateral involvement, diagnosed on surgical biopsy. GCKD is a morphological expression of several hereditary and nonhereditary disorders that differ vastly in their management and long-term outcome. Hence, accurate morphological diagnosis of this entity is important for prognostication and genetic counseling.

A renal oncocytoma in a Maltese dog with renal cysts / 대한수의학회지

A renal oncocytoma was diagnosed in an 8-year-old female Maltese dog with a history of renal cysts. Tumor cells were not detected until six months after observation of renal cysts. Nephrectomy was performed to treat the neoplasia. Tumor-like masses with numerous nodules were observed in the inner surface of cysts present in the caudal part of the left kidney. Histologically, the tumor consisted of cells with abundant eosinophilic cytoplasm. The diagnosis was based on histological features, periodic acid-Schiff reaction, and immunohistochemical cytokeratin staining. Based on a literature review, this is the first canine renal oncocytoma case reported in Korea.

Application value of contrast-enhanced ultrasound in differential diagnosis of complex renal cysts and clear renal cell carcinoma with cystic change / 中华超声影像学杂志

Objective@#To investigate the value of contrast-enhanced ultrasound(CEUS) in differential diagnosis of complex renal cysts and clear renal cell carcinoma with cystic change(CRCCC).@*Methods@#The ultrasonographic datas of 82 lesions in 82 patients with complicated renal cysts or CRCCC confirmed by pathology were analyzed. The characteristics of conventional ultrasound and CEUS were observed and evaluated. The lesions were graded according to Bosniak classification criteria.@*Results@#Pathological examination showed that 36 cases were complicated renal cysts and 46 cases were CRCCC. Routine ultrasound showed there were 9 cases (25.0%) with cystic masses and 27 cases (75.0%) with solid and cystic masses in complex renal cysts, of which 14 cases (38.9%) could detect color flow signals. In CRCCC, 2 cases (4.3%) were with cystic masses and 44 cases (95.7%) were with solid and cystic masses, of which 33 cases (75.0%) could detect color flow signals. CEUS showed that only 18 cases (50.0%) of the complex renal cysts showed enhancement of cystic wall or septum, with equal or low enhancement at the peak, 9 cases (50.0%) accompanied by decrease of renal cortex, 35 cases (97.2%) had thin and regular cystic wall, no enhancement of cystic wall in all lesions, and 33 cases (91.7%) had septal thickness less than 1 mm. Forty-five cases (97.8%) of CRCCC showed enhancement of cystic wall or septum, 40 cases (88.9%) showed equal or high enhancement at peak, 30 cases (66.7%) were faster than the decrease of renal cortex, 37 cases (80.4%) showed uneven thickness of cystic wall, 24 cases (52.2%) showed enhancement of cystic wall nodules, and 28 cases (60.9%) showed uneven thickness of septum. After CEUS, 33 cases (91.7%) of complex renal cysts were classified as grade Ⅰ and Ⅱ, while 42 cases (91.3%) of CRCCC were classified as grade Ⅲ and Ⅳ.@*Conclusions@#The CEUS manifestations of complex renal cysts are different from those of CRCCC. The application of Bosniak criteria in CEUS is helpful for the differential diagnosis of complex renal cysts and CRCCC.

Application value of contrast-enhanced ultrasound in differential diagnosis of complex renal cysts and clear renal cell carcinoma with cystic change / 中华超声影像学杂志

Objective To investigate the value of contrast-enhanced ultrasound(CEUS)in differential diagnosis of complex renal cysts and clear renal cell carcinoma with cystic change(CRCCC).Methods The ultrasonographic datas of 82 lesions in 82 patients with complicated renal cysts or CRCCC confirmed by pathology were analyzed.The characteristics of conventional ultrasound and CEUS were observed and evaluated.The lesions were graded according to Bosniak classification criteria.Results Pathological examination showed that 36 cases were complicated renal cysts and 46 cases were CRCCC. Routine ultrasound showed there were 9 cases (25.0％) with cystic masses and 27 cases (75.0％) with solid and cystic masses in complex renal cysts,of which 14 cases (38.9％) could detect color flow signals.In CRCCC,2 cases(4.3％)were with cystic masses and 44 cases(95.7％)were with solid and cystic masses, of which 33 cases(75.0％)could detect color flow signals.CEUS showed that only 18 cases(50.0％)of the complex renal cysts showed enhancement of cystic wall or septum,with equal or low enhancement at the peak,9 cases(50.0％) accompanied by decrease of renal cortex,35 cases (97.2％) had thin and regular cystic wall,no enhancement of cystic wall in all lesions,and 33 cases(91.7％)had septal thickness less than 1 mm.Forty-five cases (97.8％) of CRCCC showed enhancement of cystic wall or septum,40 cases(88.9％)showed equal or high enhancement at peak,30 cases(66.7％)were faster than the decrease of renal cortex,37 cases (80.4％) showed uneven thickness of cystic wall,24 cases (52.2％) showed enhancement of cystic wall nodules,and 28 cases (60.9％) showed uneven thickness of septum.After CEUS,33 cases(91.7％)of complex renal cysts were classified as grade Ⅰ and Ⅱ,while 42 cases(91.3％) of CRCCC were classified as grade Ⅲ and Ⅳ.Conclusions The CEUS manifestations of complex renal cysts are different from those of CRCCC.The application of Bosniak criteria in CEUS is helpful for the differential diagnosis of complex renal cysts and CRCCC.

Detección de mutaciones del gen de HNF1B en niños con malformaciones congénitas renales y del tracto urinario / Detection of mutations of the HNF1B gene in children with congenital anomalies of the kidney and urinary tract

Resumen: Introducción: Las anomalías congénitas del riñón y del tracto urinario se originan de alteraciones genéticas, en su mayoría desconocidas. Las mutaciones en el gen que codifica para el factor hepatocitario nuclear 1B (HNF1B), son la causa monogénica más frecuentemente descrita. Se desconocen datos en Chile y Latinoamérica. Objetivo: Determinar la presencia de variantes del gen HNF1B en niños chilenos con anomalías congénitas del riñón y/o tracto urinario y sus características clínicas. Pacientes y Mé todo: Estudio descriptivo con pacientes entre 10 meses y 17 años, consultantes en Unidad de Nefrología Hospital Luis Calvo Mackenna, período abril - diciembre 2016, portadores de displasia renal quística, displasia/hipoplasia renal no quística y/o riñón en herradura. Se determinaron variantes de HNF1B mediante secuenciación de exones 1, 2, 3 y 4; previa extracción y amplificación de DNA. Se utilizaron enzimas de restricción para definir si variantes eran homo o heterocigotas. Familiares di rectos de casos índices se estudiaron con secuenciación del exón afectado. Resultados: Se incluyeron 32 pacientes, 43,75% varones, mediana edad 11 años. El 65,6% displasia/hipoplasia renal no quística, 31,25% displasia renal quística y 3,15% riñón en herradura. En 2 pacientes (6,25%) se detectó una misma variante genética heterocigota en exón 4, posición 1027 (C1027T), no descrita anteriormente. El estudio de familiares determinó la variante en 3 de 5 individuos, todos sin anomalías nefrouro- lógicas congénitas. Conclusiones: Confirmamos la presencia de una variante genética heterocigota del gen HNF1B, no descrita previamente, dando inicio a la búsqueda de este tipo de mutaciones en nuestro medio, lo cual nos permite aproximarnos al conocimiento de causalidad, determinación de compromiso extrarrenal y consejo genético.

Abstract Introduction: Congenital anomalies of the kidney and urinary tract are caused by genetic alterations mostly unknown. Mutations in the gene that codes for hepatocyte nuclear factor 1B (HNF1B) are the most frequently described monogenic causes. Data are unknown in Chile and Latin America. Objective: To determine the presence of variants of the HNF1B gene in Chilean children with conge nital anomalies of the kidney and/or the urinary tract and their clinical characteristics. Patients and Method: Descriptive study with children aged 10 months to 17 years, patients of the Calvo Mackenna Hospital Nephrology Unit, with cystic renal dysplasia, non cystic renal dysplasia/hypoplasia, horses hoe kidney between April and December 2016. HNF1B variants were determined by sequencing of exons 1, 2, 3 and 4 after DNA extraction and amplification. Restriction enzymes were used to define if the variants were homo or heterozygous. Direct family members of index cases were studied with sequencing of the affected exon. Results: 32 patients were included, 43.75% males, median age 11 years. 65.6% of them had non-cystic renal dysplasia, 31.25% cystic renal dysplasia, and 3.15% hor seshoe kidney. In two patients (6.25%) the same heterozygous genetic variant was detected in exon 4, position 1027 (C1027T), not previously described. The study of relatives found the same variant in three out of five individuals, all without congenital nephro-urological anomalies. Conclusions: We confirmed the presence of a not previously described heterozygous genetic variant of the HNF1B gene. This work initiates the search for this type of mutations in our region which allows us to ap proach the knowledge of causality, determination of extrarenal involvement, and genetic counseling.

The use of tetracycline as sclerosing agent in renal cyst aspiration: A systematic review

OBJECTIVE@#Percutaneous aspiration sclerotherapy is indicated for treatment of symptomatic renalcysts. The efficacy and safety of the different sclerosing agents have been sources of debate anddisagreement. The purpose of this study was to assess the efficacy and safety of using tetracyclineaspiration sclerotherapy in a systematic review of the literature.@*MATERIALS AND METHODS@#A systematic search was conducted on the following electronic databases:Cochrane Central Register of Controlled Trials, EMBASE, PubMed and HERDIN (until November2017). Studies of cyst volume reduction after tetracycline aspiration sclerotherapy were included forfull text evaluation. The quality of the studies and the risk of bias were assessed independently by theauthors, based on the Cochrane Handbook for Systematic Reviews of Interventions.@*RESULTS@#Three studies were included for full-text assessment. They included 87 patients. Overall, riskof bias was high. Complete renal cyst disappearance ranged between 29%-100% after a follow-upperiod of 3-36 months. Partial success/>50% renal cyst reduction ranged between 85.7%-100%.Complications were minor and self-limited, postoperative procedural pain occurred most frequently.@*CONCLUSION@#The authors found good results with respect to efficacy and safety after tetracyclineaspiration sclerotherapy of renal cysts. However, due to high risk of bias in the included studies,definite conclusions regarding efficacy could not be drawn.

Carcinomas renales múltiples como manifestación inicial del Síndrome de Von Hippel Lindau. Presentación de caso / Multiple renal carcinoma as a clinical manifestation of Von Hippel Lindau Syndrome. Case presentation

Introducción: El Síndrome de Von Hippel Lindau es una afección neoplásica multisistémica, heredada de manera autosómica dominante y con alta penetrancia. Su expresividad clínica es muy diversa,oscilando la incidencia entre 1/35000 y 1/36000 nacidos vivos. Esta enfermedad usualmente se diagnostica entre los 20 y 30 años, pero los síntomas pueden aparecer en la infancia. La lesión clínica inicial más común y precoz es el hemangioblastoma de la retina y/o del sistema nervioso central. Objetivo: Presentar un caso de un paciente con carcinomas renales múltiples como manifestación inicial de un Síndrome de Von Hippel Lindau. Presentación del Caso: Paciente masculino de 59 años, con antecedentes de salud, quien acude a urgencias por cuadro febril de 3 días de evolución, que fue interpretado como Dengue; se le realizó, dentro de los complementarios, ultrasonido abdominal, donde se descubrió masa sólida a nivel del polo superior del riñón derecho, asociado a existencia de otra en polo inferior de este mismo riñón, así como de 2 más en el contralateral. Además, se encontraron varios quistes pancreáticos y 2 renales izquierdos corticales. El paciente fue intervenido quirúrgicamente; se corroboró el diagnóstico de carcinomas renales de células claras. El examen oftalmológico reveló la presencia de un hemangioblastoma retiniano derecho; en tanto la tomografía computarizada simple de cráneo y la resonancia magnética espinal no mostraron alteraciones. Conclusiones: Este síndrome es una rara, pero grave afección genética, caracterizada por un alto riesgo de desarrollar enfermedades neoplásicas, lo que hace que sea aún más importante conocerlo, para poder identificar y tratar a tiempo sus temidas complicaciones(AU)

Introduction: Von Hippel Lindau Syndrome is a multisystem neoplastic affection, which is inherited as an autosomal dominant trait, with high penetrance. Its clinical expressivity is very diverse, ranging its incidence between 1/35000 and 1/36000 born alive. This disease is usually diagnosed between the 20 and 30 years of age, but its symptoms can appear in childhood. The most common and early initial clinical lesion is the hemangioblastoma of the retina and/or central nervous system. Objective:To present a case of a patient with multiple renal carcinoma as initial manifestation of Von Hippel Lindau Syndrome. Case presentation: 59 years old male patient with a history of good health who comes to the Emergency Room because of febrile clinical state of 3 days´ evolution, that was interpreted as dengue. Abdominal ultrasound was included in the complementary studies, in which a solid mass at level of upper pole of right kidney was observed, associated with the existence of another one in lower pole of the same kidney, as well as two others in contralateral. Also, multiple pancreatic cysts and two left cortical renal ones were found. The patient underwent surgery, and the diagnosis of clear cells renal carcinoma was corroborated. The ophthalmological exam revealed the presence of a right retinal hemangioblastoma whereas the plain skull CT-scan, and the magnetic resonance imaging of the lumbar spine did not show any alterations. Conclusions:This syndrome is a rare, but a serious genetic affection, characterized by a high risk to develop neoplastic diseases; that´s one reason why it is very important to know about it in order to identify, and treat its feared complications in time(AU)

Classification, clinic and hereditary of renal medullary cystic diseases / 中华实用儿科临床杂志

Renal medullary cystic diseases are a large class of heterogeneous diseases,and they are common in clinic,most of them often progress to end-stage renal disease.With recent advances in genetics,increasing number of genes and genetic mutations has been identified with the etiology of renal medullary cystic diseases.Although genetic testing can provide mass data for diagnosis,clinical manifestation are even more important for clinical diagnosis,differentiation and genetic counseling for the patients.In this review,the classification,renal presentations,extra-renal presentations,and genetic analysis of renal medullary cystic diseases will be discussed.

The safety and efficacy for percutaneous ureteroscopic laser deroofing in the management of renal cysts / 中华泌尿外科杂志

Objective To assess the safety and efficacy of a novel technology referred to as percutaneous ureteroscopic laser deroofing in the management of renal cysts.Methods From November 2014 to August 2016,59 patients having surgical indications with renal cysts were enrolled and evaluated by ultrasound and CT scan.Of all the 59 patients,36 were males and 23 were females.Their mean age was 46 years (ranging 35-64 years).41 patients complained about the reported flank and abdominal pain.18 patients were found by imaging examination.Their mean diameter of cyst was 6.3cm(ranging 4.9-9.1cm).In regards to the 59 patients,include 6 patients suffered with parapelvic cysts and 4 patients suffered with renal cyst complicated with ipsilateral renal calculi.Their mean stone surface area was 5.7 cm2 (ranging 3.4-9.8 cm2).All of the patients received combined spinal and epidural analgesia or paravertebral nerve block anesthesia.Patients were placed in the prone position for percutaneous puncture and tract dilation.Under ultrasound guidance,an eighteen gauge needle was placed inside the cyst cavity percutaneously,a metal guidewire was introduced followed by sequential dilation up to F26-28.9.8F rigid ureteroscope was inserted through the Amplazt access sheath and advanced into the cyst cavity.Then sheath and ureteroscope both returned to the exterior cyst together.Cyst wall was dissociated from perirenal adipose tissue by used ureteroscope.A majority of the collapsed cyst wall was grasped and gently pulled towards the Amplazt sheath interior using grasping forceps and incised using either Thulium (Power 40 ～50W) or Holmium laser(Power 60 ～70W) and was taken for pathological examination.Nephrostomy tube was left in place for 2-3 days and removed before discharge.For parapelvic cysts patients,ureter stent was inserted into the renal pelvis i n the dorsal lithotomy position firstly.Patients were then placed in the prone position for percutaneous puncture and tract dilation.Laser was used to incise cyst wall towards identified pelvis to create a permanent communication between the cyst and adjacent renal collecting system.F6 double-J stent was inserted into the cyst cavity at the end to prevent auto-closure for at most two months.F22 nephrostomy tube was left in renal pelvis for two weeks.For renal cyst complicated with ipsilateral renal calculi patients,a puncture was created targeting the stone through the cyst,after fragmenting and extracting the stone,the same laser was used to deroof the cyst.More than 50％ reduction in cyst volume was considered a success.The perioperative complications,hospitalization days and the effective rate of surgery were evaluated.Results All operations were conducted without intraoperative complications such as bleeding,urinary leakage or injury of the renal parenchyma and the adjacent organs.The hospital stay after the surgery was 2-4 days (mean 2.5 days).After 3-12 months follow-up (mean 8.1 months),patients underwent imaging examinations.42 out of 59 cases were completely resolved,15 were reduced to less than 50％,the total effective rate for the operation is 96.6％ (57/59).4 patients with ipsilateral renal calculi were completely clear.However,two cases failed probably due to incomplete resection and follow treated with laparoscopic renal cyst deroofing.Conclusions Percutaneous ureteroscopy renal cyst laser deroofing is a safe,effective,less invasive,which can be performed in any endourological center without the need of special instruments and training.

Multiple bilateral renal abscesses in a previously healthy young patient

The incidence of renal abscesses is not common. Patients usually have risk factors like diabetes mellitus or an underlying condition which predisposes to urinary tract infections. We report a case of a previously healthy young girl with multiple bilateral renal abscesses. Ultrasonography revealed multiple renal abscesses with a possible differential diagnosis of polycystic kidney disease with infected cysts. No renal calculi were seen. CT-scan of kidneys confirmed the diagnosis. Blood and urine cultures were repeatedly negative. She was treated with two weeks of intravenous antibiotics followed by another four weeks of oral Ciprofloxacin. No surgical intervention was carried out. Repeated ultrasound at six months showed complete resolution of all the renal abscesses.

Safety and feasibility of radiofrequency ablation for treatment of Bosniak IV renal cysts

ABSTRACT Purpose To describe our initial experience with radiofrequency ablation (RFA) of Bosniak IV renal cysts. Materials and Methods From 2010 to 2014, 154 renal tumor cases were treated with percutaneous thermal ablation, of which 10 cases (6.4%) from nine patients were complex renal cysts and were treated with radiofrequency ablation. Results All complex cysts were classified as Bosniak IV (four women and five men; mean age: 63.6 yrs, range: 33–83 years). One patient had a single kidney. Lesion size ranged from 1.5 to 4.1cm (mean: 2.5cm) and biopsy was performed on four cysts immediately before the procedure, all of which were malignant (two clear cell and two papillary carcinoma). Mean volume reduction of complex cysts was 25% (range: 10–40%). No patients required retreatment with RFA and no immediate or late complications were observed. The follow-up of Bosniak IV cysts had a median of 27 months (interquartile range [IQR], 23 to 38) and no recurrence or significant loss of renal function were observed. Conclusions Mid-term follow-up of the cases in our database suggests that image-guided percutaneous RFA can treat Bosniak IV cysts with very low complication rates and satisfactorily maintain renal function.

Radioterapia de intensidade modulada (IMRT) para pacientes do SUS: análise de 508 tratamentos em dois anos de instalação da técnica / Intensity modulated radiotherapy (IMRT) for patients of the Brazilian unified health system (SUS): an analysis of 508 treatments two years after the technique implementation

Objetivo: A oferta de radioterapia de alta tecnologia para população atendida pelo Sistema Único de Saúde (SUS) é limitada, por não pertencer ao rol de procedimentos e, muitas vezes, pela capacidade instalada frente à demanda e dificuldade de retenção de recursos humanos especializados. Dessa forma, o acesso à radioterapia de intensidade modulada (IMRT) é restrito a poucos serviços no Brasil. Pretendemos apresentar as características dos primeiros 508 tratamentos de IMRT durante os primeiros anos de instalação da técnica em um hospital universitário. Materiais e Métodos: Foram analisados 508 tratamentos de IMRT, de maio de 2011 a setembro de 2013, que completaram a radioterapia. A técnica empregada foi multilâminas estático. Resultados: De um total de 4.233 pacientes tratados no período, 12,5% realizaram IMRT. As principais indicações foram para crânio, cabeça e pescoço, e próstata. Aproximadamente 30% das radioterapias de crânio e 50% das de próstata foram por IMRT. A toxicidade total foi 4%. Conclusão: Em razão das restrições de acesso à radioterapia e da não cobertura deste procedimento, as indicações de IMRT para pacientes do SUS devem ser apoiadas nos protocolos clínicos das instituições em acordo com sua realidade, com especial atenção à redução da toxicidade. .

The Bosniak classification for renal cysts was developed in the late 1980s in an attempt to standardize the description and management of complex cystic renal lesions. Alterations were made to such a classification in the 1990s and, the last one, in 2005. Currently, five categories of cystic renal lesions are defined - namely, I, II, II-F, III and IV –, according to their degree of complexity and likelihood of malignancy. Despite being initially described for computed tomography, this classification has been also utilized with some advantages also for magnetic resonance imaging. The present article reviews the different phases of this classification, its diagnostic efficacy and the most controversial features of its use.

Classificação de Bosniak para cistos renais complexos: histórico e análise crítica / Bosniak classification for complex renal cysts: history and critical analysis

A classificação de Bosniak para cistos renais surgiu na década de 1980 para tentar padronizar a descrição e condutas em relação às lesões renais císticas complexas. Esta classificação sofreu alterações na década de 1990 e, a última, em 2005. Atualmente, são definidas cinco categorias de lesões císticas renais – I, II, II-F, III e IV –, de acordo com o grau de complexidade e maior probabilidade de malignidade. Apesar de inicialmente ter sido descrita para a tomografia computadorizada, esta classificação é utilizada, com algumas vantagens, também na ressonância magnética. O presente artigo revisa as diferentes fases desta classificação, sua eficácia diagnóstica e os aspectos mais controversos de sua utilização.

The Bosniak classification for renal cysts was developed in the late 1980s in an attempt to standardize the description and management of complex cystic renal lesions. Alterations were made to such a classification in the 1990s and, the last one, in 2005. Currently, five categories of cystic renal lesions are defined - namely, I, II, II-F, III and IV –, according to their degree of complexity and likelihood of malignancy. Despite being initially described for computed tomography, this classification has been also utilized with some advantages also for magnetic resonance imaging. The present article reviews the different phases of this classification, its diagnostic efficacy and the most controversial features of its use.

Enfermedad renal quística adquirida y su relación con variables clínicas, demográficas y antropométricas en pacientes dialíticos / Acquired renal cystic disease and its relationship to clinical, demographic and anthropometric variables in patients on hemodialysis

Introducción: la enfermedad renal crónica (ERC) se asocia frecuentemente con enfermedad renal quística adquirida (ERQA). En el orden clínico, esta última suele ser asintomática, pero puede complicarse con carcinoma renal. Objetivo: identificar la frecuencia de presentación de ERQA y la posible relación de la longitud renal, el número y tamaño de los quistes, con características de pacientes en hemodiálisis. Métodos: se realizó un estudio analítico, transversal, en el cual se incluyó a todos los pacientes del Servicio de Hemodiálisis del Instituto de Nefrología, en tratamiento en junio de 2012. Fueron excluidos los que tenían enfermedad quística como causa de ERC, los nefrectomizados y aquellos con mala ventana ecográfica. La ecografía renal se realizó con equipo Toshiba Nemio XG de alta resolución y transductor convexo de 3,5 MHz. La información fue procesada de forma automatizada mediante el paquete estadístico SPSS, versión 15.0. Para identificar las posibles relaciones entre las variables fueron utilizados los test de Wilcoxon-Mann-Whitney y de Kruskal-Wallis. También se empleó el coeficiente de correlación lineal de Pearson (r). Resultados: el 38,4 por ciento de los pacientes presentó ERQA. Se encontró asociación del número de quistes con el tiempo en hemodiálisis, la dosis de eritropoyetina utilizada y las cifras de hemoglobina (p< 0,05 en los 3 casos). Entre tiempo en hemodiálisis y número de quistes, la relación fue directa y moderada (r= 0,60). Conclusiones: la frecuencia de ERQA es elevada en pacientes en hemodiálisis. El número de quistes aumenta con el tiempo en tratamiento y los pacientes con mayor número de quistes poseen valores más elevados de hemoglobina y requieren de dosis más bajas de eritropoyetina...

Introduction: chronic kidney disease (CKD) is frequently associated with acquired renal cystic disease (ARCD). The latter condition is usually clinically asymptomatic, but it may complicate with renal carcinoma. Objective: identify the frequency of presentation of ARCD and the possible relationship of renal length and the number and size of cysts, to characteristics of patients on hemodialysis. Methods: an analytical cross-sectional study was conducted of all the patients on hemodialysis at the Institute of Nephrology in June 2012. Patients with cystic disease as the cause of CKD, nephrectomized patients and those with a poor echographic window were not included. Renal echography was performed with high resolution Toshiba Nemio XG equipment and a 3.5 MHz convex transducer. Data was processed with the statistical software SPSS version 15.0. The Wilcoxon-Mann-Whitney and Kruskal-Wallis tests were used for identification of the possible relationships between variables. The Pearson linear correlation coefficient (r) was also used. Results: 38.4 percent of the patients had ARCD. An association was found between the number of cysts and the time on hemodialysis, the doses of erythropoietin used, and hemoglobin values (p< 0.05 in the three cases). The relationship between time on hemodialysis and number of cysts was direct and moderate (r= 0.60). Conclusions: the frequency of ARCD was high among patients on hemodialysis. The number of cysts increased with treatment time. Patients with a greater number of cysts have higher hemoglobin values and require smaller doses of erythropoietin...

Bosniak classification of renal cystic lesions according to multidetector computed tomography findings / Classificação de Bosniak das lesões císticas renais segundo achados na tomografia computadorizada multidetectores

Renal cystic lesions are usually diagnosed in the radiologists' practice and therefore their characterization is crucial to determine the clinical approach to be adopted and prognosis. The Bosniak classification based on computed tomography findings has allowed for standardization and categorization of lesions in increasing order of malignancy (I, II, IIF, III and IV) in a simple and accurate way. The present iconographic essay developed with multidetector computed tomography images of selected cases from the archives of the authors' institution, is aimed at describing imaging findings that can help in the diagnosis of renal cysts.

As lesões renais císticas são diagnósticos frequentes na prática do médico radiologista, sendo sua caracterização fundamental na determinação da conduta e prognóstico. A classificação de Bosniak permitiu, por meio de tomografia computadorizada, uniformizar e categorizar tais lesões em ordem crescente de malignidade (I, II, IIF, III e IV), sendo esta avaliação realizada de maneira simples e precisa. Este ensaio iconográfico realizado com tomografia computadorizada multidetectores, de casos selecionados dos arquivos do nosso serviço, tem como objetivo demonstrar achados de imagem que possam auxiliar no reconhecimento dos principais aspectos diagnósticos dos cistos renais.

Diagnostic value of separated cystic lesion ultrasound and con-trast-enhanced ultrasound for multi-locular cystic renal cell carci-noma and cysts / 中国肿瘤临床

Objective: To investigate the diagnostic values of separated renal multi-locular cystic lesions color Doppler ultra-sound and contrast-enhanced ultrasound performance in multi-locular cystic renal cell carcinoma and cysts. Methods:A total of 53 pa-tients (54 lesions) with multi-locular cystic renal cell carcinoma and cysts were included in the study. The presence of carcinoma and cysts was confirmed via histopathology and tested using ultrasound. Contrast-enhanced ultrasound was applied in 24 (24 lesions) of the total number of patients, and the receiver operating characteristic (ROC) curve was used to analyze the numbers of separation, thick-ness, and type of blood flow patterns of the lesions. The contrast-enhanced ultrasound characteristics were also analyzed. We analyzed the diagnostic value of the color Doppler ultrasound in the separated renal multilocular cystic lesions and the contrast-enhanced ultra-sound performance in multi-locular cystic renal cell carcinoma and cysts. Results:Based on the analysis of the ROC curves of the sepa-ration number, thickness, and type of the blood flow of the lesions in 53 patients (54 lesions), the diagnostic specificity was relatively higher in the lesions where the separation number was≥5 strips (86%), the thicknesses were>3 and≤4 mm (95%), and blood flow was band-like (86%). The areas under the curve of the three indexes were 0.7621, 0.8331, and 0.7962, respectively, which indicate high diagnostic values. The separation number of 4 strips, the thicknesses of>2 and≤3 mm, and the point-like blood flow could be used as critical values for the diagnosis. The contrast enhancement, enhancement peak, and disappearance were (11.2 ± 3.4), (21.7 ± 3.8), and (32.1±4.0) s in 14 patients with multi-locular cystic renal cell carcinoma and (18.4±4.5), (37.8±8.0), and (51.3±9.0) s in 10 patients with multi-locular renal cysts, with statistically significant differences (t=4.47, t'=5.90, t'=6.31, respectively;P<0.05). Conclusion:The sepa-ration number, thickness, and type of blood flow of lesions have relatively higher specificity in multi-locular renal cysts than in multi-locular cystic renal cell carcinoma. The ROC curves show a high diagnostic value. Contrast-enhanced ultrasound of the lesions helped in the differential diagnosis of multi-locular cystic renal cell carcinoma and renal cysts.

Quiste renal gigante. Presentación de un caso / Giant renal cyst. Presentation of a case

En el riñón frecuentemente se desarrollan quistes. Dentro de la diversidad de quistes renales, el simple puede presentarse dentro del riñón o en la superficie de este pudiendo, ser único o múltiple, unilateral o bilateral y más frecuente en el izquierdo. Generalmente se manifiestan asintomático y pueden alcanzar gran tamaño, denominándose quistes gigantes. Se presenta un paciente de 66 años que ingresa por dolor lumbar hace un año, que empeora a pesar del tratamiento médico para una presunta sacrolumbalgia. En el abdomen se aprecia marcado aumento de volumen, sobre todo hacia el hemiabdomen superior y se palpa gran masa tumoral que ocupa la totalidad del hemiabdomen superior, renitente y no dolorosa. Se realizó tomografía axial computarizada de abdomen, apreciándose imagen hipodensa multitabicada que ocupa todo el hemiabdomen izquierdo con desplazamiento de asas, riñón izquierdo y músculo psoas. Se concluye como quiste gigante multitabicado de riñón izquierdo. Se realizó laparotomía paramediana izquierda supra e infraumbilical y se detecta gran quiste renal del polo superior del riñón izquierdo que sobrepasa la línea media desplazando la arteria aorta a la derecha de la columna vertebral. Se realizó nefrectomía izquierda. Es raro, que un quiste renal simple gigante, sobrepase la línea media y tenga compresión de tantos órganos intraabdominales; este es un hecho poco descrito en la literatura médica. El examen físico superficial y limitado al órgano que produce los síntomas que motivan la consulta, limita el diagnóstico precoz de muchas enfermedades como se demuestra en este paciente. Este es uno de los errores más frecuentes que se aprecian al aplicar el método clínico.

Frequently, cysts develop in the kidney. Among the diversity of renal cysts, the simple one could be located inside the kidney or in its surface and may be single or multiple, unilateral or bilateral, and more frequent in the left kidney. Generally they are asymptomatic and can reach a great size, called giant cysts. We present a patient aged 66 years, entering the hospital with lumbar pain of one year that gets worse despite the medical treatment for a presumed sacrolumbal pain. It was found a remarked increase of the abdomen volume, mainly in the direction of the upper hemiabdomen and it feels a big tumoral mass filling the totality of the upper abdomen, renitent and no painful. An abdominal computer tomography was carried out, finding a multi partitioned hypodense image filling all the left hemiabdomen with displacement of loops, left kidney and psoas muscle. We arrived to the conclusion that it was a giant multi partitioned cyst of the left kidney. A left paramedian supra and infra umbilical laparotomy was carried out finding a renal cyst of the upper pole of the left kidney surpassing media line and displacing aortal artery to the right of the spinal column. A left nephrectomy was carried out. It is rare a simple renal giant cyst surpassing the media line and compressing so many intra abdominal organs; this is a fact scarcely described in the medical literature. The surface physical examination restricted to the organ producing the symptoms that motivate the consultation, interferes the precocious diagnosis of many diseases as it is shown in this patient. This is one of the most frequent mistakes committed when applying the clinical method.

Causes analysis of 652 hospital stays in patients with autosomal dominant polycystic kidney disease / 中华肾脏病杂志

Objective To analyze the causes of 652 hospitalizations in the patients with autosomal dominant polycystic kidney disease (ADPKD).Methods The medical records of all ADPKD inpatients in our hospital from January 1,1990 to December 31,2010 were collected.The differences of hospitalization causes in different age,gender and period were analyzed.Results (1)In 652 hospitalizations,the most common cause was lumbar pain (15.2％),followed by cystic bleeding (14.6％),aggravating renal failure (10.1％),dialysis-related problems (9.4％),renal transplant related issues (8.3％),renal replacement therapy for ESRD (8.0％),urinary tract infection (6.4％),end stage renal failure (5.8％),hypertension (4.1％),renal cyst volume enlargement (3.7％),finding polycystic kidney disease (2.1％),urinary lithiasis (1.8％) and others (10.4％).(2)Younger patients were admitted into hospital because of polycystic kidney bleeding and finding PKD.With the increase of patients age,hospitalization due to dialysis-related problems increased,while many middle-aged patients were hospitalized because of back pain.(3)Male patients were admitted into hospital for aggravating renal failure,ESRD,kidney transplantation-related problems and urinary lithiasis,while female patients mainly for lumbar pain,dialysis-related problems and urinary tract infection.(4)The proportion was significantly reduced with time of finding PKD,renal failure and polycystic kidney bleeding,the proportion of renal cysts increasing and aggravating renal failure increased,there was a significant increase in the proportion of patients with hypertension,while a significant decrease in the proportion of patients with uncontrolled hypertension,and the average SBP was also significantly reduced.Conclusions The highest rate of hospitalization of ADPKD patients is in 40 to 60 age group.Cause of admission varies with age and gender,and changes with the change of time.Over the past decade,the proportion of hospitalization due to renal cysts enlargement and renal failure aggravation increased significantly.The incidence of hypertension is higher than that in the first 10 years,but hypertension control rate increases compared with the previous.Prevention should focus on finding the suppression measures of renal cysts enlargement.

The Renal Cysts and Diabetes (RCAD) Syndrome in a Child with Deletion of the Hepatocyte Nuclear Factor-1β Gene.

The authors describe a 14-yr-old boy who presented with non-ketotic hyperglycemia, elevated serum creatinine levels and deranged liver function. There was no microalbuminuria or proteinuria. He also had mild mental retardation with learning difficulties. Ultrasonography of the abdomen revealed multiple renal cysts of varying sizes in both the kidneys. Dosage analysis of the hepatocyte nuclear factor (HNF)-1β gene by multiplex ligation-dependent probe amplification (MLPA) detected a heterozygous whole gene deletion (p.Met1_Trp557del). This finding is consistent with the diagnosis of renal cysts and diabetes (RCAD) syndrome. This is the first case of the RCAD syndrome reported in an Indian patient. Pediatricians need to be aware of this entity whenever renal disease is seen in a diabetic child in the absence of microalbuminuria or proteinuria.