ABSTRACT
Chronic intrarenal hypoxia has been regarded as a pathogenic factor of progressive renal damage. However, the lack of available human data has impeded the progress in this field. In this work, blood oxygen level-dependent magnetic resonance imaging was used to determine intrarenal oxygen status pre- and post-angiotensin receptor blockade (olmesartan) treatment in normal subjects, diabetic chronic kidney disease (CKD) patients and non-diabetic CKD patients. The mean R2*, which represents intrarenal oxygenation, was significantly lower in the control group than in the CKD group (12.42 ± 0.53 /s vs 18.89 ± 3.15 /s, P < 0.01), indicating the presence of intrarenal hypoxia in the CKD patients. The olmesartan treatment induced a 16.2 ± 7.7% decrement of the mean R2* in CKD patients, suggesting that this drug had an intrarenal hypoxia ameliorating effect.
Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Diabetic Nephropathies/metabolism , Hypoxia/metabolism , Imidazoles/therapeutic use , Kidney/blood supply , Oxygen/blood , Renal Insufficiency, Chronic/metabolism , Tetrazoles/therapeutic use , Adult , Angiotensin Receptor Antagonists/pharmacology , Diabetic Nephropathies/drug therapy , Female , Humans , Hypoxia/drug therapy , Imidazoles/pharmacology , Kidney/drug effects , Magnetic Resonance Imaging , Male , Middle Aged , Renal Insufficiency, Chronic/drug therapy , Tetrazoles/pharmacology , Young AdultABSTRACT
Recto-urinary fistula results as a complication following trauma to the perinium and pelvis. These fistulas are difficult to treat and have a high recurrence rate due to the difficult surgical approach in repairing them. Both the transabdominal or transperineal approaches used in repairing these fistulas are difficult and provide only limited exposure to the fistula being repaired. In the case report, we present a patient with complex recto-urinary fistula due to trauma to the pelvis 20 years previously. In this patient we used the transphincteric York Mason approach to directly approach the fistula, followed by construction of a tube flap connecting the bladder and the urethra. The technique is simple, easy and the outcome has been excellent after 4 years of follow-up.
