Renal artery aneurysm misdiagnosed as a pelvic stone: A case report.

INTRODUCTION AND IMPORTANCE: Renal artery aneurysm (RAA) is an extremely rare condition that is usually symptomless and may be diagnosed by a chance in imaging. However, misdiagnosis is not out of mind and few cases of misdiagnosis of RAA with renal stone have been reported. Misdiagnosis leads to wrong treatment, so it is very important for the correct diagnosis. CASE PRESENTATION: We reported a similar case in a 57 years old female that referred with right flank pain and ultrasonography and computed tomography (CT) scan reported a calcified mass, resembling renal stone. Through the operation the RAA was diagnosed; however, the mass was damaged and the patient underwent aneurysmectomy. Although she was a single kidney case, collateral circulation saved the kidney. CLINICAL DISCUSSION: The patients may be asymptomatic or may present symptoms like treatment-resistant hypertension, hematuria, thrombosis, renal infarction, abdominal, or flank pain. As literature shows the diagnosis of RAA is challenging and affects patients' timely treatment. Our patient, who was a single kidney person, also survived the condition with no nephrectomy. The case of our study was single kidney and the collateral vessels give a further chance to kidney for survival. Although the affected artery was not further used, the collateral vessels circulation helped the kidney and the patient survived nephrectomy. She was discharged with a normal state and normal urination. CONCLUSION: The timely diagnosis may help the patient with less invasive treatments.

Successful salvage of renal allograft rupture: A case report.

Allograft rupture is a rare complication of renal transplantation. We present a case of renal allograft rupture which did not lead to nephrectomy. A young woman underwent renal transplantation. On day 5 of transplantation, the patient complained of sudden pain over the transplant site and severe hemorrhage. the immediate exploration, shows allograft rupture. The rupture of allograft was repaired. The patient recovered without any complications our study revealed that, repair and salvage of renal allograft were successful and nephrectomy is not mandatory in renal allograft rupture.

Role of Donors and Recipients' Glutathione S-Transferase Gene Polymorphisms in Association of Oxidative Stress With Delayed Graft Function in Kidney Allograft Recipients.

INTRODUCTION: Oxidative stress contributes to delayed graft function (DGF). Glutathione S-transferases (GSTs) are polymorphic genes which produce enzymes with protective effect against oxidative stress. This study aimed to investigate the association between donors' and recipients' GSTM1 and GSTT1 polymorphisms and DGF, creatinine clearance, and oxidative stress parameters in kidney allograft recipients. MATERIALS AND METHODS: One hundred and eighty-two donor-recipient pairs were studied. Lipid peroxidation and total antioxidant capacity were measured in the recipients' plasma as the parameters of oxidative stress. Delayed graft function was determined based on at least 10% increase, no change, or less than 10% decrease in the serum creatinine level in 3 consecutive days during the 1st week after transplantation. RESULTS: Lipid peroxidation was significantly greater in the recipients with DGF (P < .001). The frequency of GSTM1 null was significantly higher in the patients with DGF (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.17 to 0.86; P = .02). There was also a significant association between the donors' GSTM1 polymorphism and DGF (OR, 0.31; 95% CI, 0.14 to 0.68; P = .003). A significant association was detected between combination of recipients and donors' GSTM1 polymorphism and DGF (OR, 0.20; 95% CI, 0.07 to 0.64, P = .006). The recipients' GSTM1 polymorphism, alone and in combination with donors' GSTM1 and GSTT1, significantly affected the creatinine clearance on discharge day. CONCLUSIONS: These results suggest that the donors and recipients' GSTM1 polymorphism may be a major risk factor for oxidative stress and poor kidney allograft transplantation outcomes.

Comparing the length of penile mucosa in men with and without premature ejaculation.

BACKGROUND: Premature ejaculation is one of the prevalent disorders in men; almost one out of three men between 18 and 59 years old have this disorder with its leading sequel such as lack of self-confidence, anxiety, depression and unsatisfactory intercourse in men and their partners. This study aimed to compare the length of penile mucosa in men with and without premature ejaculation. METHOD: Three hundred and eighty patients referring to our hospital from March 2009 to March 2010 were enrolled in the study. First group comprised 190 men with premature ejaculation and second group included 190 men without premature ejaculation as control group that were chosen randomly. A questionnaire was designed to collect data and was completed for both groups. Height, weight, body mass index (BMI), length of penile mucosa, length of penis and intravaginal ejaculation latency time (IELT) were measured. RESULTS: The mean IELT in premature ejaculation group and control group were 47.58 ± 29.55 and 410.38 ± 190.2 s, respectively (p = 0.001). The mean penis length in premature ejaculation group and control group were 127.25 ± 16.23 and 127.03 ± 17.42 mm, respectively (p = 0.901, with nonsignificant difference); the mean penile mucosa in premature ejaculation group was 33.83 ± 11.54 mm and in control group was 31.40 ± 11.97 mm (p = 0.014, with significant difference). CONCLUSION: Longer penile mucosa can be one of the factors in causing premature ejaculation.

Evaluating International Prostate Symptom Score (IPSS) in Accuracy for Predicting Post-Operative Urinary Retention After Elective Cataract Surgery: A Prospective Study.

BACKGROUND: Postoperative urinary retention-a common and important complication of surgical procedures, can occur after any form of surgical intervention, in both sexes and all ages regardless of patients' previous history of urinary problems. The importance of post operative urinary tract retention is due to its effect on development of post operative urinary infection, patient anxiety and discomfort, prolongation of hospital stay and increase in hospital costs and morbidity. The International Prostate Symptom Score (IPSS) is an easy method for quantifying and estimating the association between pre-operative bladder-outflow problems and post-operative urinary retention. The aim of present study was to investigate whether the IPSS could predict the likelihood of patients developing urinary retention after elective cataract surgery. METHODS: One hundred and fourteen male patients older than fifty years old, who were candidate for elective cataract surgery, were enrolled in this study. All patients completed an IPSS questionnaire form before operation, and classified into three groups regarding their score (0-7: mild, 8-19: moderate, 20- 35: severe). RESULTS: Totally 8 patients (7%) developed post-operative urinary retention during first 24 hours after operation. Of the 8 urinary retention patients, 2 had moderate symptoms and 6had severe symptoms. There was a significant difference in developing postoperative urinary retention between patients having mild symptoms and patients having severe symptoms (P-value: 0.025). CONCLUSION: It is concluded that while some litterateurs definitely support the idea that IPSS may be useful for predicting post operative urinary retention, there are still some controversies. Considering our results, it seems that IPSS score is not useful in the accurate prediction of those patients who are likely to develop postoperative retention after surgical procedures other than arthroplasty, and more precise studies are need to be conducted about urinary retention occurring postoperatively in different type surgeries, different methods of anesthesia considering age and gender of patients.

Investigation of association between donors' and recipients' NADPH oxidase p22(phox) C242T polymorphism and acute rejection, delayed graft function and blood pressure in renal allograft recipients.

BACKGROUND: Production of reactive oxygen species (ROS) and thereby induction of oxidative stress seem to be one of the major mediators of inflammatory adverse outcomes after renal transplantation. p22(phox) is a polymorphic subunit of NAD(P)H-oxidase that is critical for activation and stabilization of the enzyme. This enzyme is involved in the production of superoxide that triggers inflammatory injuries to the kidney. So in this study, the association between donors and recipients' C242T polymorphism of p22(phox) and acute rejection (AR), delayed graft function (DGF), creatinine clearance (CrCl), and blood pressure in renal-allograft recipients was studied. METHODS: One hundred ninety six donor-recipient pairs were studied. The C242T polymorphism of p22(phox) was determined using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). According to p22 genotype, the subjects were divided in wild-type (CC) and T allele carriers (CT+TT). Transplantation outcomes were determined using acute rejection and delayed graft function criteria. The mean arterial pressure was also measured monthly after transplantation. RESULTS: There was a significant association between the recipients' p22(phox) polymorphism and DGF occurrence (OR=2.5, CI: 1.2-4.9, p=0.0009). No significant association was detected between donors' p22(phox) polymorphism and AR and DGF events. CrCl during the six months follow-up after transplantation was lower in the patients who received allograft from donors carrying 242T allele (B=-12.8, CI: -22.9-12.8 (-22.9 to -2.6)). Changes in the blood pressure were not different among the patients having different genotypes of p22(phox). CONCLUSION: These results suggest that the recipients' p22(phox) C242T polymorphism may be a major risk factor for DGF in renal transplantation. Moreover, the donors' 242T allele seems to affect the rate of CrCl in the renal allograft recipients.

Patient Survival in Renal Allograft Failure: A Time-dependent Analysis.

BACKGROUND: To improve patient survival after a renal transplant, it is important to detect which variables affect it. OBJECTIVES: This study aimed to assess the effect of renal allograft failure on patient survival. PATIENTS AND METHODS: This retrospective cohort study included 405 renal transplant patients from Kerman University of Medical Sciences hospital, Kerman, Iran from 2004 to 2010. Kaplan-Meier method was used to estimate survival rates of patients, and time-dependent Cox regression was used to examine the effect of allograft failure on patient survival. RESULTS: During 4.06 years (median) of follow-up 28 (6.9%) patients died and 20 (71.4%) of dead patients had allograft failure. Survival rate of patients with allograft failure at 1-, 3-, 5-, and 7-year were 0.98, 0.8, 0.53, and 0.53, respectively; in patients with allograft function these values were 0.99, 0.98, 0.97, and 0.96, respectively. The unadjusted death rate was 0.5 per 100 patient years for the maintained allograft function, which increased to 9 per 100 patient years for patients following allograft failure. In fully adjusted model the risk of death increased in patients with allograft failure (HR = 2.09; 95% CI: 1.56-2.81), pretransplant diabetes (HR = 2.81; 95% CI: 1.2-6.7), patients with BMI ≥ 25 (vs. 18.5 ≤ BMI < 25) (HR = 3.56; 95% CI: 1.09-11.6). With an increase in recipient age this risk increased (HR = 1.04 per year increase; 95% CI: 1.01-6.7). Receiving a living kidney transplant decreased this risk (HR = 0.52; 95% CI: 0.39-0.69). CONCLUSIONS: An increase in recipient age and BMI, affliction with diabetes, allograft failure, and receiving deceased kidney transplant increased the risk of death.

Multi-state survival analysis in renal transplantation recipients.

BACKGROUND: Renal transplantation is a therapy for end-stage renal disease. During the study of recipients' survival after renal transplantation, there are some events as intermediate events that not only affect the recipients' survival but also events which are affected by various factors. The aim of this study was to handle these intermediate events in order to identify factors that affect recipients' survival by using multi-state models. METHODS: This retrospective cohort study included 405 renal transplant patients from Afzalipour Hospital, Kerman, Iran, from 2004 to 2010. The survival time of these recipients was determined after transplantation and the effect of various factors on the death hazard with and without renal allograft failure and hazard of renal allograft failure was studied by using multi-state models. RESULTS: During 4.06 years (median) of follow-up; 28 (6.9%) recipients died and allograft failure occurred in 51 (12.6%) recipients. Based on the results of multi-state model, receiving a living kidney transplantation decreased the hazard of renal allograft failure (HR=0.38; 95% CI: 0.17- 0.87), pre-transplant hypertension (HR=2.94; 95% CI: 1.54- 5.63) and serum creatinine levels >1.6 upon discharge from the hospital (HR=7.38; 95% CI: 3.87- 7.08) increased the hazard of renal allograft failure. Receiving living kidney transplantation decreased the hazard of death directly (HR=0.18; 95% CI: 0.04- 0.93). CONCLUSION: It was concluded that the effect of donor type, pre-transplant hypertension and having serum creatinine >1.6 upon discharge from the hospital was significant on hazard of renal allograft failure. The only variable that had a direct significant effect on hazard of death was donor type.

Combination of a low dose of daclizumab and standard regimen for prevention of rejection in men and women receiving a kidney transplant.

INTRODUCTION: This study aimed to investigate the effectiveness of low-dose daclizumab for prevention of acute kidney allograft rejection and to evaluate differences between men and women receiving living donor transplants. MATERIALS AND METHODS: This randomized controlled trial was performed on 120 living donor kidney transplant recipients. Participants in the case group received a low dose of daclizumab (1 mg/kg) before and 14 days after transplantation in addition to their standard immunosuppressant regimen. Participants in the control group received the standard treatment protocol only. Acute rejection episodes and graft survival were compared between the two groups. Additionally, graft survival of women and men was compared separately between the two groups. RESULTS: Acute rejection was significantly less frequent in the daclizumab group than in the controls (6.7% versus 18.3%; P = .048). The 6-month survival rates were 95% (95% CI, 92% to 98%) in the daclizumab group and 85% (95% CI, 81% to 89%) in the control group (P = .03). The 6-month graft survival rates of the women were 97% (95% CI, 95% to 99%) in the daclizumab group and 74% (95% CI, 65% to 83%) in the control group (P = .02). However, the difference in graft survival rates was not significant among the men. CONCLUSIONS: The use of induction therapy with two doses of daclizumab reduces the incidence of acute rejection and improves graft survival of living donor kidney transplant recipients. This study shows that these effects are prominent among the female recipients.

Chemokine receptor 2-V64I and chemokine receptor 5-Delta32 polymorphisms and clinical risk factors of delayed graft function and acute rejection in kidney transplantation.

INTRODUCTION: Chemokines and chemokine receptors have a pivotal role in immunity and inflammation. We aimed to evaluate their role in kidney transplant rejection. MATERIALS AND METHODS: The association of chemokine (C-C motif) receptor 2 (CCR2)-V64I and CCR5-Delta32 gene polymorphisms with acute rejection (AR) and delayed graft function (DGF) were examined in 100 donor-recipient pairs. The CCR2-V64I and CCR5-Delta32 alleles were determined using polymerase chain reaction and polymerase chain reaction-restriction fragment length polymorphism, respectively. RESULTS: No associations were found between donors or recipients' CCR2-V64I and CCR5-Delta32 gene polymorphisms and AR or DGF. Of the characteristics of the donors, recipients, and transplantation, glomerulonephritis as a cause of kidney failure in the recipients was weakly associated with AR (relative risk, 6.1; 95% confidence interval, 0.8 to 46.0; P = .07). Transplantation of kidney from females to males was weakly associated with DGF (relative risk, 5.5; 95% confidence interval, 0.9 to 33.0; P = .06). There was a significant association between AR, but not DGF, and graft loss in the patients (relative risk, 28.6; 95% confidence interval, 1.7 to 487.0; P = .03). CONCLUSIONS: Our study failed to suggest CCR2-V64I or CCR5-Delta32 gene polymorphisms as risk factors for AR and DGF in kidney transplantation. Sex-matching between donors and recipients should be considered for living donor kidney transplantation.

Which Life Style Anthropometric Index is a Better Predictor of Renal Function?

BACKGROUND: Obesity is a risk factor that has been associated scientifically with hypertension, diabetes, hyperlipidemia, cancer and other life threatening diseases. The results of some studies have also shown that obesity is an independent risk factor for the development and progression of renal damage. OBJECTIVES: The aim of the current study is to define which general and central obesity anthropometric indices are better predictors for ceratinine clearance (CC) in healthy, normal and obese Iranian women. PATIENTS AND METHODS: In this case-controlled study, a total of 62 healthy, normal and obese women from 18 to 30 years of age in Zahedan City, the Islamic Republic of Iran, were studied. The subjects were classified into two groups; case group (31 subjects) of healthy obese women (30 ≤ BMI ≤ 39.9 kg/m(2)) and control group (31 subjects) of healthy normal women (18.5 ≤ BMI ≤ 24.9 kg/m(2)). An assessment of body mass index (BMI) was considered as a general obesity index and an assessment of waist circumference (WC) and waist to hip ratio (WHR) were considered as central obesity indices. A measurement of CC was considered for renal function. RESULTS: The means of CC in subjects with increased BMI, WC, and WHR were significantly higher than those in subjects with normal BMI, WC, and WHR. Pearson correlation coefficient revealed that there was a stronger correlation between CC with WC than with WHR and BMI (r = 0.4, P = 0.009; r = 0.4, P = 0.01 in the case and control groups, respectively). CONCLUSIONS: It is suggested that in clinical practice, WC can be used as a better predictor of CC than WHR and BMI in both normal and obese, healthy women.

Isolated hydatid cyst of kidney.

OBJECTIVES: Hydatid cyst of the kidney is a very rare condition caused by the larval stage of Echinococcus granulosus. We report a case of isolated hydatid cyst of the kidney. METHODS: A 32-year-old male patient presented with vague pain in the left lumbar region of 3 months' duration. Abdominal examination demonstrated a palpable mass in the left flank. The routine laboratory findings were normal. Radiologic studies showed a soft-tissue mass in the mid-portion of the left kidney measuring 115 x 130 mm. RESULTS: We performed kidney-sparing pericystectomy, and the cyst was removed intact. The histopathologic findings confirmed the diagnosis. CONCLUSIONS: In general, surgery is the treatment of choice for a hydatid cyst of the kidney, and kidney-sparing surgery is the most appropriate treatment whenever possible.