Hidronefrosis como causa de poliglobulia secundaria / Hydronephrosis as a cause of secondary polyglobulia

La policitemia primaria es producida por una mutación adquirida o heredada en las células progenitoras de los glóbulos rojos, mientras que la poliglobulia secundaria está relacionada con un aumento de la eritropoyetina sérica como respuesta a la hipoxia tisular o a la producción autónoma tumoral. Hace más de medio siglo que se conoce que la hidronefrosis puede actuar como una rara causa de eritrocitosis debido al aumento de producción de eritropoyetina por un riñón que censa una disminución de oxígeno, mecanismo también observado en la estenosis de la arteria renal y en los quistes renales. Se describe a continuación el caso de un paciente de 38 años con poliglobulia atendido en el Hospital Italiano de San Justo (Argentina), que presenta como hallazgo una hidronefrosis unilateral severa y cuya resolución quirúrgica a través de una nefrectomía revierte el cuadro hematológico de base. (AU)

Primary polycythemia is produced by an acquired or inherited mutation in progenitor cells of red blood cells, while secondary polyglobulia is related to an increase in serum erythropoietin in response to tissue hypoxia or autonomous tumor production. Since the middle of the twentieth century, the hydronephrosis is known to be a rare etiology of secondary polycythemia, with increased erythropoietin production caused by diminished oxygen sensing by the kidney, also seen in renal artery stenosis and kidney cysts. We describe a case of a 38 year old patient with polycythemia studied in the "Hospital Italiano de San Justo" (Argentina) that presented an incidental severe unilateral hydronephrosis, and nephrectomy was carried out as a final resolution of the hematological disorder. (AU)

Dissecção espontânea da artéria renal: relato de caso / Spontaneous dissection of the renal artery: case report

A dissecção espontânea da artéria renal é uma patologia rara que, na maioria dos casos, ocorre de forma idiopática. Em alguns casos, pode estar associada à presença de alterações arteriais prévias. Os sintomas geralmente são discretos e inespecíficos, dificultando o diagnóstico. Os autores relatam o caso de um paciente do sexo masculino, de 40 anos, com quadro de hipertensão arterial não controlada de início recente. Na investigação da etiologia da hipertensão arterial, o eco-Doppler de artérias renais revelou a presença de estenose (> 80%) no terço médio da artéria renal esquerda, e a angiografia evidenciou uma dissecção com dupla luz e redução do calibre do vaso. O paciente foi submetido a tratamento com implante de stent com evolução satisfatória.

Spontaneous renal artery dissection is rare and most cases are considered idiopathic. Previous renal arterial disease may be present in some cases and clinical presentation is often non-specific. Here, the authors present a case of spontaneous renal artery dissection in a 40-year-old male patient with uncontrolled hypertension discovered during investigation of secondary hypertension. Duplex ultrasound initially showed 80% left renal artery stenosis which was shown to be a renal artery dissection during angiography. The patient was successfully managed by percutaneous placement of a renal artery stent.

Collared Pecary (tayassu tajacu) as a new model of renal ischemic injury induced by clamping the renal artery

PURPOSE: The use of the collared peccary as an experimental model for ischemic nephropathy. METHODS: A total of 12 collared peccary (Tayassu tajacu) was used and ischemic nephropathy was induced in six of these animals that constituted the experimental group (G1) while the other six formed the control group (G2). Ischemic nephropathy was induced surgically by partial occlusion of the left renal artery. The disease course was assessed by hematological tests, serum chemistry, urinalysis, ultrasound (US) and doppler ultrasound function of the renal artery before induction, and at five, 10, 15 and 20 days after surgery. Twenty days after the occlusion, unilateral nephrectomy and histopathological examination were performed to assess renal morphology. RESULTS: Statistical analysis by Fischer's test showed a significant difference (p<0.05) between the control group and the experimental group. The histopathological examination showed glomerular, tubular and interstitial lesions. In the experimental group, 83.3% (5 /6) showed moderate renal lesions and only 16.7% (1/6) were classified with no lesions. The ultrasound examination of the right kidney presented statistical difference between day 5 and day 10 post occlusion. CONCLUSION: The collared peccary as a good experimental model for ischemic renal disease, because it could be manipulated during the research time without death, with health conditions that permit any subsequent procedure for disease therapy. .

Use of Drug-Eluting Stent with Provisional T-Stenting Technique in the Treatment of Renal Artery Bifurcation Stenosis; Long-term Angiographic Follow-up

Atherosclerotic renal artery stenosis (RAS) usually involves the ostium and the proximal one-third of the renal artery main branch. Percutaneous renal artery angioplasty with stent placement is a well recognized treatment for atherosclerotic RAS. Occasionally, atherosclerotic RAS involves renal artery bifurcations. However, stent implantation in atherosclerotic RAS involving bifurcation is not only troublesome, but also challenging because of side branch occlusion and in-stent restenosis (ISR). In the present report, we describe the use of drug-eluting stents (DES) with provisional T-stenting technique for the treatment of renal artery bifurcation lesion. Follow-up angiogram showed no significant ISR 18 months after the procedure. In the treatment of renal bifurcation lesions, a two-stent strategy using DES could be a viable option in selected patients.

Trombólise tardia e espontânea de artéria renal sem comprometimento funcional / Late and spontaneous thrombolysis of renal artery without functional impairtment

A aterosclerose em artérias renais é um importante fator desencadeante de tromboses com subsequente comprometimento da função e da viabilidade renal. A oclusão aguda das artérias renais por trombo ou êmbolo é causa incomum e potencialmente reversível de falência renal. Todavia, a duração e ograu de oclusão arterial compatível com a manutenção da viabilidade do parênquima renal ainda não estão bem estabelecidos, razão pela qual o diagnóstico precoce e a intervenção são importantes. O objetivo deste artigo é descrever um caso de trombose de artéria renal de rim funcional único, com lise espontânea e tardia do trombo seguida de recuperação funcional inesperada.

Atherosclerosis in the renal arteries is an important triggering factor for thrombosis with subsequent impairment of renal function and viability. Acute occlusion of the renal arteries by a thrombus or embolus is unusual and potentially reversible cause of renal failure. However, the duration of arterial occlusion and ograu compatible with maintaining the viability of renal parenchyma are not well established, which is why early diagnosis and intervention are important. The aim of this paper is to describe a case of renal artery thrombosis functional single kidney with spontaneous lysis of thrombus and late functional recovery after unexpected.

O stent descoberto não promove reações em artérias renais e parênquima renal em suínos / Uncovered stent does not provoke reactions in renal arteries and renal parenchyma in swines

OBJETIVO: Avaliar as alterações histológicas da aorta, artéria renal e parênquima renal, em suínos, induzidos pelo stent metálico descoberto implantado em localização transrenal na aorta abdominal. MÉTODOS: Foram utilizados 10 suínos com peso médio de 86,6 quilos e idade média de 6 meses, submetidos a implante de stent metálico posicionado na aorta, no nível das artérias renais, após 100 dias do implante. Os stents foram liberados por auto-expansão com laparotomia. Foram realizadas análises anatômicas e histológicas da aorta abdominal, artérias renais e parênquima renal. Os cortes histológicos foram realizados nos seguintes locais: 1) transição entre a aorta normal e aorta contendo stent; 2) porção contendo os óstios das artérias renais, 3) parênquima renal. As lâminas foram coradas pela técnica da hematoxilina e eosina e analisadas conforme protocolo de análise histológica aplicada na prática clínica dos laboratórios de patologia. RESULTADOS: Os achados macroscópicos revelaram espessamento da parede aórtica; artérias renais pérvias; estrutura anatômica renal normal. Análises microscópicas, próximas aos stents, evidenciaram espessamento da parede vascular, artérias renais sem alterações e parênquima renal preservado. CONCLUSÃO: O stent de aço inoxidável descoberto produziu importante reação inflamatória com espessamento da parede da aorta. No entanto, as artérias renais permaneceram pérvias e o parênquima renal sem alterações isquêmicas ou embólicas.

OBJECTIVE: To assess the histological changes of the aorta, the renal arteries and the renal parenchyma in swine, induced by a metalic uncovered stent implanted in transrenal position in the abdominal aorta. METHODS: Ten pigs with a mean weight of 86.6 kg and mean age of 6 months underwent implantation of metal stent graft placed in the aorta at the level of the renal arteries after 100 days of implantation. The self-expanding stents were released by laparotomy. Anatomic and histological analyses of the abdominal aorta, the renal arteries and the renal parenchyma were performed. Histological slices were performed in the following sites: 1) transitional zone between the aorta with and without stent graft; 2) portion of the renal arteries ostia; 3) renal parenchyma. The slices were stained through the hematoxylin and eosin stain technique and analyzed according the protocol of histological analyses applied in the clinical practice of pathology labs. RESULTS: The macroscopic findings showed thickening of the aortic wall; patent renal arteries; and normal anatomic renal structures. Microscopic analyses, close to the stents, showed thickening of the vascular wall, renal arteries without changes, and preserved renal parenchyma. CONCLUSION: The uncovered stainless steel stent caused a significant inflammatory reaction with thickening of the aortic wall. However, the renal arteries remained patent and the renal parenchyma did not present embolic or ischemic changes.

Experimental model for the study of chronic renal ischemia in rats: morphologic, histological and ultra-structural analysis

PURPOSE: To evaluate a model of chronic renal ischemia in rats and to characterize the effects on renal tissue. METHODS: 168 Wistar rats were divided into two equal groups, control (GC) and ischemia (GI). The animals of the GI (n=84) were submitted to partial ligation of the left renal artery, and the animals of GC (n=84) stayed with the renal artery intact. In seven successive and identical periods of time, in weekly intervals, 12 animals of each group were submitted to nephrectomy, with morphometric determinations and histological and ultra-structural analysis. RESULTS: The GI presented progressive reduction in renal weight, volume and cortical thickness observed from the 7th day of the experiment, reaching maximum degree in the 49th day (p < 0.05). The proximal tubular atrophy in the GI was observed in 75/84 analysis (89,2 percent), with highly significant difference among the groups starting from the 7th day (p=0 .0009) and in the other periods of the experiment (p=0 .00001). The most prevalent interstitial alteration was the infiltrate, present in 98,8 percent of the GI, with highly significant difference among the groups in the whole experiment (p=0 .00001). Ultra-structural analysis didn't demonstrate glomerular lesions, evidencing that the glomerule preserves its intact architecture during chronic ischemia. CONCLUSION: The model showed that chronic renal ischemia in rats provokes progressive renal atrophy, with preservation of glomerular structure.

OBJETIVO: Avaliar um modelo de isquemia renal crônica em ratos e caracterizar os efeitos no tecido renal. MÉTODOS: Utilizaram-se 168 ratos Wistar divididos em dois grupos iguais, controle (GC) e isquemia (GI). Os animais do GI (n=84) foram submetidos à ligadura parcial da artéria renal esquerda, e os animais do GC (n=84) permaneceram com a artéria renal intacta. Em sete períodos de tempo sucessivos e iguais, em intervalos semanais, 12 animais de cada grupo foram submetidos à nefrectomia, com determinações morfométricas e análises histológica e ultra-estrutural. RESULTADOS: O GI apresentou redução progressiva no peso, volume e espessura cortical renal a partir do 7° dia do experimento, atingindo grau máximo no 49° dia (p < 0.05). A atrofia tubular proximal no GI ocorreu em 75/84 análises (89,2 por cento), com diferença altamente significativa entre os dois grupos a partir do 7° dia (p=0.0009) e nos demais períodos do experimento (p=0.00001). A alteração intersticial mais comum no GI foi o infiltrado, presente em 98,8 por cento, com diferença altamente significativa entre os dois grupos (p=0.00001). A análise ultra-estrutural não demonstrou lesões glomerulares, evidenciando que os glomérulos preservam sua arquitetura intacta durante a isquemia crônica. CONCLUSÃO: O modelo mostrou que a isquemia renal crônica em ratos provoca atrofia renal progressiva, com preservação da estrutura glomerular.

Síndrome de leriche: a propósito de un caso / Syndrome of leriche: a purpose of a case

EL SINDROME DE LERICHE o Síndrome de Obliteración Aorto Iliaca, es un síndrome causado por la obstrucción de la Aorta Terminal¹. Es un disturbio que afecta generalmente a varones jóvenes, entre los 30 y 40 años de edad². La enfermedad arteriosclerótica oclusiva crónica suele afectar a la Aorta abdominal distal, por debajo de las arterias renales. El síndrome se caracteriza por la triada de: disminución o ausencia de pulsos femorales, claudicación o dolor en los glúteos y las piernas al caminar y la impotencia para la erección del pene. Se presenta caso de paciente masculino de 73 años de edad con enfermedad actual de cinco meses de evolución, el cual fue ingresado al servicio de Medicina Interna del Hospital Central de San Cristóbal en el mes de abril de 2005 con el diagnóstico de Enfermedad Arterial Periférica (Síndrome de Leriche) al cual se le realizó arteriografía que revelo obstrucción total de la aorta abdominal por debajo del origen de las arterias renales, confirmado mediante laparotomía exploradora, presentando posteriormente las complicaciones clásicas principales de las arteriopatías obstructivas de las extremidades inferiores.