Evaluation of Inflammatory Parameters Following Extracorporeal Shock Wave Lithotripsy (ESWL) and Ureteroscopy for the Treatment of Proximal Ureteral Stones.

Introduction Inflammation can arise as a consequence of both extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) treatments. Alterations in inflammatory parameters may serve as indicators of kidney injuries and the ensuing inflammation. This study aims to investigate the effects of ESWL and URS procedures on inflammatory parameters for proximal ureteral stone treatment. Materials and methods A prospective interventional study comprised 120 patients with confirmed stones measuring less than 10 mm in the upper half of the proximal ureter. These patients were randomly assigned to either the ESWL or URS treatment groups. Laboratory analyses encompassed interleukin-6 (IL-6), leukocyte count, fibrinogen levels, and erythrocyte sedimentation rate (ESR), which were assessed prior to the intervention, on the first postoperative day, and six months later. IL-6 levels in the serum were determined using a chemiluminescence immunoassay (CLIA). Results There was no significant difference in IL-6 levels between pre-intervention and the first post-intervention day in patients treated with ESWL (1.8 (1.4-2.59) pg/mL vs. 2.33 (1.22-3.19) pg/mL). However, for patients treated with URS, the pre-intervention IL-6 value was 2.9 (1.9-3.34) pg/mL, and it increased significantly to 7.1 (3.85-28.07) pg/mL on the first post-intervention day (p<0.001). On the first post-intervention day, levels of IL-6, CRP, leukocyte count, and ESR were significantly higher in patients treated with URS compared to ESWL (p<0.001; p<0.001; p=0.03; p=0.03, respectively). Conclusion Our research findings suggest that monitoring IL-6 levels can offer valuable insights into the degree of inflammation and tissue damage during and following observed procedures, particularly among patients undergoing URS, even within the initial days post-procedure.

Relationship between ultrasound criteria and voiding ultrasonography (VUS) in the evaluation of vesicoureteral reflux (VUR).

AIM: To analyze the usefulness of five ultrasound parameters (ureteral dilatation, renal pelvis dilatation, renal parenchyma width reduction, calyceal dilatation, and urothelial reaction) in detecting vesicoureteral reflux (VUR). METHODS: The study included 101 patients with diagnosed and therapeutically treated urinary infection. The ultrasound examination and voiding urosonography (VUS) were carried out according to a standard protocol. In the group of patients with proven VUR the presence of the indirect ecomorphological signs of VUR was evaluated. RESULTS: The referral diagnosis urinary tract infection was present at the admission in 53 patients, while the remaining 48 patients were admitted with the diagnosis of infectio tractus urinarii recidivans. Pathological VUS was found in 53 patients. The ultrasound parameter with the highest sensitivity, specificity, and negative predictive value (77.4%, 79.2%, and 76.0%, respectively) in detection of VUR was urethral dilatation, while the parameter with the highest positive predictive value (62.5%) in detection of VUR was urothelial reaction. CONCLUSION: In case of ultrasound verification of ureteral dilatation or urothelial reaction, especially in if the urinary infection has proved, it is necessary to exclude the existence of VUR.

Posterior reversible encephalopathy syndrome (PRES).

Posterior reversible encephalopathy syndrome (PRES) is described neurological condition identifiable by clinical and radiological presentation. It occurs due to elevated blood pressure which exceeds auto-regulatory capacity of brain vasculature. PRES is characterized by headache, confusion, seizures, and altered mental function. In this report we describe a case of eleven-year-old boy who was hospitalized, because of nausea, vomiting, intermittent fever, headache, confusion and distress. Because of suspicion of encephalitis CT and MRI examinations were performed immediately where was established diagnose of PRES syndrome.

[Asymptomatic isolated microhaematuria--a reason for concern?]. / Asimptomatska izolovana mikrohematurija--razlog za brigu?

Nephrologists and urologists are frequently faced with patients with asymptomatic isolated microhaematuria (AIMH). This entity is defined as the presence of more than 5 red cells/uL in the sediment of first morning urine, in the absence of symptoms by the urinary tract and in the absence of proteinuria. From 201 children who were referred on the clinical examinations on the Pediatric Clinic in Sarajevo under the diagnosis haematuria in period from 01/01/1997 until 31/08/2002, 87 had AIMH. Age of life was from 0 to 16 years (mean 8 years). Fourteen children (16.1%) had a hypercalciuria, 10 (11.5%) had a state after purpura Henoch-Schonlein nad scarlatine, while 6 (6.9%) had glomerulopathy. Five children (5.7%) had anomalies of urinary system, 5 (5.7%) had evidence of nephrolithiasis, while 4 (4.6%) had asymptomatic urinary tract infection. Cause out of urinary system was found in 29 children (33.3%) and for 14 children (16.1%) etiology remained unknown. Transient microhaematuria was noted in 43 children (49.4%), recurrent in 37 (42.5%) and persistent in 7 (8.1%). Renal biopsy was performed in 5 children (5.7%) because of indications of glomerular disease and all of them had glomerular lesions. Sixty nine children of these 87 were followed up from 2 to 11 years (mean period of 3 years) and none of them developed hypertension or renal impairment. Most patients who have AIMH do not have clinically significant glomerular pathology and they don't need renal biopsy, but only periodic follow up. Any degree of proteinuria accompanying haematuria should be fully investigated, as proteinuria is often a sign of serious renal disease.

[Urinary tract infections and vesicoureteral reflux as a cause of renal parenchymal damage]. / Infekcija urinarnog trakta i vezikoureteralni refluks kao uzrok renalnog parenhimnog ostecenja.

GOAL: Infection of the urinary tract is a risk for the damage of parenchyma and kidney function. Dimercaptosuccinil acid (DMSA) scan was used based on the relation between vesicoureteral reflux (VUR), infection of the urinary tract (UTI) and parenchymal kidney damage. METHODOLOGY: The number of observed children was 79, 58 (73.41%) girls and 21 (26.58%) boys: following the first UTIs, recidiv infect and with positive VUR contrast voiding cistourethrography (VCUG) and ultrasound tests were compelted following the treatment of infect within 6 weeks and DMSA within 4 months. The classification of VUR was done of I to V degrees. The damage to the renal parenchyma after DMSA was defined as inhomogen distribution, reduced bonding with radio-farmake as well as portion of the kidney in the overall renal function smaller than 45%. RESULTS: Among 45.56% (36/79) patients VUR was registered. Reflux over III/V was registered among 27.84 (22/79) among whom 24.05% (19/79) were younger than 5 years of age. DMSA scan showed reduced kidney function bellow 45%, in one direction 33.33% (12/36) and 25.00% (9/36) in both directions. The correlation between clinically proved acute pielonephrities and damage to the parenchyma was not proven. It was proven in 30.37% (24/79) reoccurring urinal infection. CONCLUSION: DMSA is a sensitive method that should not be routinely used on every child with urinary infection. It should be left to assess the renal damage in cases of high degree reflux and reoccurring urinary infection.