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1.
BMC Pediatr ; 24(1): 385, 2024 Jun 07.
Article in English | MEDLINE | ID: mdl-38849790

ABSTRACT

Inguinal hernia repair is one of the most common surgical procedures in the pediatric population. While a rare complication, bladder injury can impose a significant burden on patients. This study outlined a case of bladder injury following selective inguinal hernia repair and summarized methods to prevent this complication, aiming to emphasize the importance of not underestimating interventions labeled as "routine surgery" in order to avoid avoidable harm to patients.


Subject(s)
Hematuria , Hernia, Inguinal , Herniorrhaphy , Postoperative Complications , Urinary Bladder , Humans , Hernia, Inguinal/surgery , Hematuria/etiology , Herniorrhaphy/adverse effects , Male , Urinary Bladder/injuries , Urinary Bladder/surgery , Postoperative Complications/etiology , Child
2.
Pediatr Int ; 66(1): e15781, 2024.
Article in English | MEDLINE | ID: mdl-38863300

ABSTRACT

BACKGROUND: Immumoglobulin A (IgA) vasculitis (IgAV), formerly known as Henoch-Schönlein purpura (HSP), is a self-limiting systemic vasculitis in children. Kidney involvement is associated with a long-term unfavorable outcome and can lead to significant morbidity. This study was conducted to describe the clinical and laboratory characteristics of childhood IgAV with kidney involvement and to identify risk factors associated with IgAV nephritis (IgAVN). METHODS: This was an ambidirectional descriptive study of 77 children with IgAV. All demographic data, clinical features, and laboratory tests were collected from electronic medical records from January 2010 to December 2022. Risk factors for kidney involvement in IgAV were assessed using multivariate logistic regression. Kaplan-Meier survival analysis was used to calculate the time to commencement of kidney involvement. RESULTS: Twenty-five children (32.4% of the IgAV patients) developed IgAVN. The common findings in IgAV with kidney involvement were microscopic hematuria (100%), nephrotic range proteinuria (44%), and non-nephrotic range proteinuria (40%). Multivariate logistic regression showed that age greater than 10 years (adjusted hazard ratio, AHR 4.66; 95% confidence interval, CI, 1.91-11.41; p = 0.001), obesity (body mass index, BMI, z-score ≥ +2 standard deviations, SDs) (AHR 3.59; 95% CI 1.41-9.17; p = 0.007), and hypertension at onset (AHR 4.78; 95% CI 1.76-12.95; p = 0.002) were associated significantly with kidney involvement. During follow up, most IgAV patients developed nephritis within the first 9 months. CONCLUSION: Age greater than 10 years, obesity, and hypertension at presentation were predictive factors for IgAVN. Our study emphasized that IgAV patients with risk factors should be closely monitored for at least 1 year after the onset of the disease.


Subject(s)
IgA Vasculitis , Humans , Male , Female , Child , Risk Factors , IgA Vasculitis/complications , IgA Vasculitis/epidemiology , IgA Vasculitis/diagnosis , Child, Preschool , Adolescent , Retrospective Studies , Proteinuria/etiology , Proteinuria/epidemiology , Kaplan-Meier Estimate , Hematuria/etiology , Hematuria/epidemiology , Logistic Models , Kidney/pathology , Glomerulonephritis, IGA/complications , Glomerulonephritis, IGA/epidemiology
3.
J Urol ; 212(1): 41-51, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38700731

ABSTRACT

PURPOSE: AUA guidelines for patients with microhematuria (≥3 red blood cells [RBC]/high-power field [hpf]) include cystoscopy for most over age 40 due to risk of urothelial cancer (UC). Cxbladder Triage (CxbT) is a urinary genomic test with UC negative predictive value of 99%. In this prospective randomized controlled trial, we compared cystoscopy use in a standard of care (SOC) arm vs a marker-based approach. MATERIALS AND METHODS: All patients with hematuria provided urine for a CxbT. Those categorized as lower risk (LR), defined as 3 to 29 RBC/hpf and minimal smoking history (<10 pack-years) were randomized between the test group provided with the CxbT result vs the SOC control group. Negative CxbT patients were offered omission of cystoscopy with surveillance. "Not lower risk" (NLR) patients (>30 RBC/hpf or >10 pack-year smoking history) had a CxbT but otherwise SOC. Patient decision and outcomes were recorded. RESULTS: Of 390 eligible patients, 255 were NLR and 135 were LR randomized to CxbT informed decision or SOC. The median age was 62 years (range 18-94) and 54% were male. Overall, 63% of CxbT tests were negative. For NLR patients, 82% had cystoscopy. In the LR control group, cystoscopy was performed in 67% of SOC and 27% in the test group (relative risk 0.41 [95% CI 0.27-0.61]). Compared to cystoscopy, CxbT had 90% sensitivity, 56% specificity, and 99% negative predictive value for UC. CONCLUSIONS: In this prospective randomized controlled trial, use of CxbT in patients with LR hematuria resulted in 59% reduction of cystoscopy use. This clinical utility of CxbT can reduce the burden of unnecessary cystoscopies.


Subject(s)
Cystoscopy , Hematuria , Triage , Urinary Bladder Neoplasms , Humans , Cystoscopy/adverse effects , Male , Hematuria/diagnosis , Hematuria/etiology , Female , Middle Aged , Prospective Studies , Aged , Urinary Bladder Neoplasms/diagnosis , Triage/methods , Risk Assessment/methods , Adult , Asymptomatic Diseases
4.
Hematology ; 29(1): 2356307, 2024 Dec.
Article in English | MEDLINE | ID: mdl-38776234

ABSTRACT

OBJECTIVE: This study aims to investigate the efficacy and safety of hyperbaric oxygen therapy (HBOT) in the treatment of late-onset hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation. METHODS: This retrospective analysis included 16 patients with late-onset hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation between 2016 and 2022. Among them, 8 patients received HBOT in addition to conventional treatment, while the other 8 received only conventional treatment. The clinical efficacy and safety of HBOT were evaluated by comparing the Numeric Rating Scale pain scores and clinical grades of hematuria before and after treatment, reflecting the patients' urinary pain and hematuria status. RESULTS: The patients were divided into two groups based on whether they received HBOT. The group that received HBOT (n = 8) had a shorter duration of illness compared to the non-HBOT group (n = 8) (p < 0.05). The time for the NRS to decrease to below 2 was also shorter in the HBOT group. Furthermore, the patients who received HBOT did not experience any significant adverse reactions. CONCLUSION: The combination of conventional treatment and hyperbaric oxygen therapy (HBOT) has been shown to improve symptoms such as urinary pain, frequency, urgency, and hematuria in patients with late-onset hemorrhagic cystitis after transplantation. This approach has been proven to be safe and effective.


Subject(s)
Cystitis , Hematopoietic Stem Cell Transplantation , Hemorrhage , Hyperbaric Oxygenation , Humans , Hematopoietic Stem Cell Transplantation/adverse effects , Cystitis/therapy , Cystitis/etiology , Male , Female , Adult , Middle Aged , Retrospective Studies , Hemorrhage/etiology , Hemorrhage/therapy , Transplantation, Homologous , Young Adult , Hematuria/etiology , Hematuria/therapy , Treatment Outcome , Cystitis, Hemorrhagic
5.
Medicine (Baltimore) ; 103(20): e38228, 2024 May 17.
Article in English | MEDLINE | ID: mdl-38758868

ABSTRACT

Hematuria is the most common symptom of bladder cancer (BCa). It is well-known that the frequency of hematuria increases with the use of antithrombotic drugs (ATDs). We designed our study with the hypothesis that patients using antithrombotic drugs who present with the complaint of hematuria and are subsequently diagnosed with BCa may receive an earlier diagnosis, leading to lower tumor grades and stages. Data of 441 consecutive patients who presented to our urology outpatient clinic with macroscopic hematuria between 2020 and 2023 were retrospectively evaluated. A total of 88 patients (21.4%) with a primary diagnosis of BCa were included in our study. Patients were divided into 2 groups: those using ATDs during the episode of macroscopic hematuria (group 1) and those not using ATDs (group 2). Univariate and multivariate binary logistic regression analysis was performed to identify risk factors that could predict tumor grade. The incidence of multiple tumors (>1) was significantly lower in patients using ATDs (P = .033). The number of patients with tumor size larger than 3 cm was significantly higher in the group not using ATDs (P = .005). The rates of pathological T1 stage in the group using ATDs were significantly lower than those in the nonuser group (P = .038). According to the results of the multivariate model, the effect of pathology stage and ATD use on predicting tumor grade was significant (P = .002 and P < .001, respectively). The probability of having a high-grade tumor in patients with pathology stage T1 was 5.32 times higher than in patients with pathology stage TA. The probability of having a high-grade tumor in patients not using ATDs was 7.73 times higher than in those using ATDs. The effect of pathology stage and ATD use on predicting tumor grade was found to be significant. The probability of having a high-grade tumor was higher in patients not using ATDs compared to those using ATDs. In light of these results, we can state that the use of ATDs is a positive predictive factor in the early diagnosis of BCa, bringing along the chance of early diagnosis and treatment.


Subject(s)
Early Detection of Cancer , Fibrinolytic Agents , Hematuria , Urinary Bladder Neoplasms , Humans , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/diagnosis , Male , Female , Retrospective Studies , Aged , Middle Aged , Early Detection of Cancer/methods , Hematuria/etiology , Fibrinolytic Agents/therapeutic use , Risk Factors , Neoplasm Staging , Neoplasm Grading
6.
Scand J Urol ; 59: 90-97, 2024 May 02.
Article in English | MEDLINE | ID: mdl-38698545

ABSTRACT

OBJECTIVE: To evaluate whether artificial intelligence (AI) based automatic image analysis utilising convolutional neural networks (CNNs) can be used to evaluate computed tomography urography (CTU) for the presence of urinary bladder cancer (UBC) in patients with macroscopic hematuria. METHODS: Our study included patients who had undergone evaluation for macroscopic hematuria. A CNN-based AI model was trained and validated on the CTUs included in the study on a dedicated research platform (Recomia.org). Sensitivity and specificity were calculated to assess the performance of the AI model. Cystoscopy findings were used as the reference method. RESULTS: The training cohort comprised a total of 530 patients. Following the optimisation process, we developed the last version of our AI model. Subsequently, we utilised the model in the validation cohort which included an additional 400 patients (including 239 patients with UBC). The AI model had a sensitivity of 0.83 (95% confidence intervals [CI], 0.76-0.89), specificity of 0.76 (95% CI 0.67-0.84), and a negative predictive value (NPV) of 0.97 (95% CI 0.95-0.98). The majority of tumours in the false negative group (n = 24) were solitary (67%) and smaller than 1 cm (50%), with the majority of patients having cTaG1-2 (71%). CONCLUSIONS: We developed and tested an AI model for automatic image analysis of CTUs to detect UBC in patients with macroscopic hematuria. This model showed promising results with a high detection rate and excessive NPV. Further developments could lead to a decreased need for invasive investigations and prioritising patients with serious tumours.


Subject(s)
Artificial Intelligence , Hematuria , Tomography, X-Ray Computed , Urinary Bladder Neoplasms , Urography , Humans , Hematuria/etiology , Hematuria/diagnostic imaging , Urinary Bladder Neoplasms/diagnostic imaging , Urinary Bladder Neoplasms/complications , Male , Aged , Female , Tomography, X-Ray Computed/methods , Urography/methods , Middle Aged , Neural Networks, Computer , Sensitivity and Specificity , Aged, 80 and over , Retrospective Studies , Adult
7.
Medicine (Baltimore) ; 103(18): e36130, 2024 May 03.
Article in English | MEDLINE | ID: mdl-38701280

ABSTRACT

RATIONALE: Spontaneous renal rupture is an uncommon disease, it usually occurs after upper urinary calculi-related operation treatment or renal tumor. This disease caused by factor VII deficiency has rarely reported. PATIENT CONCERNS: A 49-year-old woman came to our hospital with on the left flank pain and gross hematuria that had persisted for 10 days. The patient had no recent history of waist and abdominal trauma or surgical history recently. DIAGNOSES: An outside computed tomography (CT) examination revealed left renal rupture before arriving at our hospital, but she was not treated. Further laboratory examination revealed that the patient condition was turned out to be hemophilia caused by factor VII deficiency. INTERVENTION: We have used both internal and external drainage methods, and supplemented with coagulation factor. OUTCOME: After 9 months of follow-up, it was observed that the left renal hematoma and urinary extravasation was completely absorbed. LESSONS: Spontaneous renal rupture for hemophilia is a clinical emergency. When spontaneous renal rupture is associated with abnormal coagulation function, and the coagulation function cannot be corrected by conventional treatment, the possibility of hemophilia needs to be considered, and the type of hemophilia needs to be further defined. This case indicates a successful resolution of spontaneous renal rupture, it can provide guiding value for our clinical practice.


Subject(s)
Factor VII Deficiency , Kidney Diseases , Humans , Female , Middle Aged , Rupture, Spontaneous/etiology , Factor VII Deficiency/complications , Kidney Diseases/etiology , Tomography, X-Ray Computed , Drainage/methods , Hematuria/etiology
8.
Open Vet J ; 14(4): 1059-1071, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38808288

ABSTRACT

Background: Bloody urine is classified in farm animals as hematuria, hemoglobinuria, and myoglobinuria. In small ruminants, discolored urine is reported due to several etiologies which is sometimes fatal. Of these causes are babesiosis, bacillary hemoglobinuria, copper toxicity, and hypophosphatemia. Aim: This study was designed to investigate the clinical, etiological, hematobiochemical, ultrasonographic, and pathological findings in rams and bucks with red urine syndrome. Methods: Eighteen male animals (nine rams and nine bucks) of 6 months to 3 years were examined. Parallel, 10 healthy controls were used. They were admitted due to red urine, voiding of only urine drops, straining during the act of urination, grunting during urination, ventral abdominal edema, and abdominal distension. The duration of the disease ranged from 2 to 30 days. A history of chronic copper toxicosis was informed in two bucks and a ram. Two blood samples were collected from diseased as well as from controls in EDTA tubes (for complete blood count testing) and in plain tubes (for serum collection). Results: Hematuria was found in 11 animals (seven bucks and four rams) while hemoglobinuria was detected in seven animals (five bucks and two rams). Sonographic findings in diseased animals included ruptured urinary bladder in 3, ruptured urethra in 5, penile calculi, uroperitoneum in 6, distended urinary bladder in 7, hydronephrosis in 5, echogenic deposits in the bladder in 3, and ventral urine accumulation in four animals. Laboratory evaluation of a Geimsa-stained blood smear confirmed the infection with Babesia in three bucks and a ram. Hemolytic anemia was marked in two bucks and a ram due to chronic copper toxicity. Biochemical abnormalities included hypoalbuminemia, hyperglobulinemia, increased blood urea nitrogen and creatinine concentration, and hyperglycemia. Postmortem examination was carried out on six animals (four rams and two bucks). Conclusion: Discolored urine in rams and bucks in this study resulted from hematuria due to urinary calculi and pelvic abscessation or from hemoglobinuria due to Babesia infection or due to copper toxicity. Hemolytic anemia was the outstanding hematological finding and hypoalbuminemia, hyperglobulinemia, increased blood urea nitrogen (BUN) and creatinine, and hyperglycemia were the characteristic biochemical findings. Sonography of the urinary tract was very helpful in assessing the renal parenchyma, urinary bladder, and abdominal cavity for the verification of urolithiasis, hydronephrosis, intact or ruptured urinary bladder, uroperitoneum, and perforated urethra.


Subject(s)
Goat Diseases , Goats , Sheep Diseases , Animals , Male , Goat Diseases/parasitology , Goat Diseases/pathology , Goat Diseases/etiology , Sheep Diseases/pathology , Sheep Diseases/parasitology , Sheep , Ultrasonography/veterinary , Hematuria/veterinary , Hematuria/etiology , Hemoglobinuria/veterinary , Hemoglobinuria/etiology
9.
Urologie ; 63(6): 578-584, 2024 Jun.
Article in German | MEDLINE | ID: mdl-38639783

ABSTRACT

BACKGROUND: Urinary bladder tamponade is a urological emergency that is part of the clinical routine of every urologist and requires immediate and adequate diagnosis and therapy. OBJECTIVES: Presentation of the clinical picture of urinary bladder tamponade including etiology, diagnostics, and therapy as well as formulation of recommendations for action for clinical routine. MATERIALS AND METHODS: Structured presentation of the diagnosis and therapy of urinary bladder tamponade with practical recommendations for action based on a current literature search and a clinical case study. RESULTS: Urinary bladder tamponade is a usually painful filling of the urinary bladder with blood clots as part of gross hematuria. The central pillars of diagnostics are anamnesis, targeted physical examination, and sonography. Therapy involves the rapid insertion of a flushing catheter with manual evacuation of the tamponade. A flushing catheter with at least 20 French should be used here. CONCLUSION: Timely diagnosis and prompt treatment are crucial. This usually includes transurethral catheter insertion with manual evacuation. If the tamponade is unsuccessfully removed, further measures such as endoscopic evacuation or, as a last resort, sectio alta or radical cystectomy are available.


Subject(s)
Urinary Catheterization , Aged, 80 and over , Humans , Male , Emergencies , Hematuria/etiology , Hematuria/therapy , Hematuria/diagnosis , Urinary Bladder Diseases/therapy , Urinary Bladder Diseases/diagnosis , Urinary Catheterization/methods
10.
BMJ Case Rep ; 17(4)2024 Apr 29.
Article in English | MEDLINE | ID: mdl-38684348

ABSTRACT

Bladder paragangliomas (bPGLs) account for only 0.06% of all bladder tumours, most commonly presenting with post-micturition syncope and hypertensive crisis. Silent paragangliomas are very rare, and failure to recognise them in the perioperative setting can precipitate a hypertensive crisis in the absence of sufficient alpha-blockade. Here, we describe a case of unrecognised bPGL in a woman with pre-existing hypertension and a single prior episode of haematuria thought to be related to urothelial carcinoma. She was found to have a low-grade non-invasive papillary urothelial carcinoma (potentially the cause of her haematuria) and an unrelated vascular-appearing tumour causing hypertensive crisis and broad complex tachycardia on resection. This was confirmed to be a bPGL on histology for which she underwent definitive management with a partial cystectomy following blood pressure management.


Subject(s)
Cystectomy , Hypertension , Paraganglioma , Urinary Bladder Neoplasms , Humans , Female , Urinary Bladder Neoplasms/complications , Paraganglioma/complications , Paraganglioma/surgery , Hypertension/etiology , Hypertension/complications , Hematuria/etiology , Middle Aged , Hypertensive Crisis
11.
J Urol ; 211(6): 765-774, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38573938

ABSTRACT

PURPOSE: Our purpose was to determine changes in patient-reported hematuria and urinary symptoms after hyperbaric oxygen (HBO2) treatment for radiation cystitis (RC). MATERIALS AND METHODS: We analyzed prospectively collected data from the Multicenter Registry for Hyperbaric Oxygen Therapy Consortium accumulated within a week of beginning and ending HBO2. Measures included the modified Radiation Therapy Oncology Group (RTOG) Hematuria Scale, Urinary Distress Inventory Short Form, and EuroQol Five Dimension Five Level instrument. RTOG hematuria and Urinary Distress Inventory Short Form scores were compared using the sign test. Logistic regression was used to evaluate characteristics associated with hematuria improvement. RESULTS: A total of 470 registry patients had RC. The median age, number of HBO2 sessions, and years after radiation were 73 (IQR 12) years, 39 (IQR 10) sessions, and 5 (IQR 8) years, respectively. Eighty-four percent of patients (393/470) had prostate cancer‒related radiation. EuroQol Five Dimension Five Level scores improved from 0.83 (IQR 0.14) to 0.85 (IQR 0.22; P < .001. Three hundred seventy patients had complete RTOG hematuria scores that improved from 2 (IQR 2) to 0 (IQR 2; P < .001. Two hundred forty-six patients had complete Urinary Distress Inventory Short Form ratings that decreased from 33.3 (IQR 44) to 22.2 (IQR 33; P < .001). Regression analysis of those with visible hematuria before HBO2 showed lower improvement odds associated with higher HBO2 hematuria scores (odds ratio [OR] 0.44, 95% CI 0.26-0.73; P < .01), a smoking history (OR 0.44, 95% CI 0.21-0.92; P = .03), or a nonprostate cancer history (OR 0.32, 95% CI 0.10-0.99; P = .05). CONCLUSIONS: HBO2 for RC improved reported hematuria, urinary function, and quality of life. Higher baseline hematuria scores, smoking, and nonprostate cancer history were associated with lower odds of hematuria improvement.


Subject(s)
Cystitis , Hematuria , Hyperbaric Oxygenation , Patient Reported Outcome Measures , Radiation Injuries , Registries , Humans , Cystitis/therapy , Cystitis/etiology , Male , Aged , Radiation Injuries/therapy , Hematuria/etiology , Hematuria/therapy , Female , Middle Aged , Prospective Studies , Prostatic Neoplasms/radiotherapy , Prostatic Neoplasms/therapy , Prostatic Neoplasms/complications , Quality of Life , Aged, 80 and over , Treatment Outcome
12.
Am J Case Rep ; 25: e942746, 2024 Apr 03.
Article in English | MEDLINE | ID: mdl-38566390

ABSTRACT

BACKGROUND RARP is an established procedure in treatment of localized prostate cancer. Hemorrhagic complications in the postoperative period are rare, but sometimes life-threatening. Adequate monitoring and prompt intervention in these unusual scenarios rely on clinical judgement and blood and imaging studies. Prostatic fossa pseudoaneurysm formation after RARP is very rare and its etiology is not well known; it may be related to small vessel trauma. It becomes apparent with the development of hematuria 1-6 weeks after surgery. CASE REPORT A 58-year-old man underwent RARP with extended lymph node dissection for intermediate-risk prostate cancer, with bilateral preservation of neurovascular bundles and puboprostatic ligaments. He was discharged on day 2 without complications. In the following 4 weeks he came to the Emergency Department 3 times with hematuria and acute urinary retention. Four weeks after surgery, a pelvic CT angiogram showed a 20-mm pseudoaneurysm in the prostatic fossa, which was embolized by percutaneous angiography, with resolution of symptoms. He was discharged soon thereafter. CONCLUSIONS This case study describes a patient with prostatic fossa pseudoaneurysm after RARP. It was diagnosed 1 month after surgery and effectively managed by percutaneous embolization. Despite being a very rare condition, it must be kept in mind, especially when postoperative hematuria develops 1-6 weeks after surgery. Use of a management algorithm including serial blood tests, CT angiogram, and percutaneous angiography can lead to early detection and avoid life-threatening hemorrhage and overall postoperative morbidity.


Subject(s)
Aneurysm, False , Prostatic Neoplasms , Robotics , Male , Humans , Middle Aged , Hematuria/etiology , Hematuria/surgery , Aneurysm, False/diagnostic imaging , Aneurysm, False/etiology , Aneurysm, False/therapy , Prostatectomy/adverse effects , Prostatectomy/methods , Prostatic Neoplasms/surgery , Prostatic Neoplasms/pathology , Treatment Outcome
13.
Reumatol Clin (Engl Ed) ; 20(4): 199-203, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38644031

ABSTRACT

INTRODUCTION AND OBJECTIVES: Henoch Schönlein purpura (HSP) and Kawasaki disease (KD) are two main inflammatory diseases among childhood vasculitis. Considering the anti-inflammatory effects of 25-hydroxyvitamin D3, we decided to investigate the association of serum 25-hydroxy vitamin D3 level with the type and severity of these conditions. MATERIALS AND METHODS: The present study was performed as a historical cohort of 254 affected children with KD and HSP vasculitis. The required data were extracted, using a researcher-made questionnaire from patients' electronic file, and then they were analyzed after collecting information of the patients. RESULTS: In HSP group, 54% of participants were boys. Similarly, in KD group, boys were more affected than girls. The comparative 25-hydroxyvitamin vitamin D3 level in HSP patients with and without renal involvement (P=0.02), hematuria (P=0.14), and in two groups with and without heart disease, and also with and without coronary artery dilatation in KD patients (P<0.001) were significant. DISCUSSION AND CONCLUSIONS: The findings showed that insufficient level of vitamin D3 were significantly associated with the exacerbation of complications of both diseases, and therefore it seems that vitamin D deficiency can be an effective predictive factor of severity in HSP and KD patients.


Subject(s)
IgA Vasculitis , Mucocutaneous Lymph Node Syndrome , Humans , IgA Vasculitis/blood , IgA Vasculitis/complications , Male , Female , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/blood , Child , Child, Preschool , Vitamin D Deficiency/complications , Vitamin D Deficiency/blood , Calcifediol/blood , Retrospective Studies , Hematuria/etiology , Adolescent , Infant , Vitamin D/blood , Vitamin D/analogs & derivatives , Vitamin D/therapeutic use , Severity of Illness Index
14.
J Bras Nefrol ; 46(3): e20230143, 2024.
Article in English, Portuguese | MEDLINE | ID: mdl-38591825

ABSTRACT

INTRODUCTION: Percutaneous kidney biopsy (KB) is crucial to the diagnosis and management of several renal pathologies. National data on native KB in pediatric patients are scarce. We aimed to review the demographic and clinical characteristics and histopathological patterns in children who underwent native percutaneous KB over 24 years. METHODS: Retrospective observational study of patients undergoing native percutaneous KB in a pediatric nephrology unit between 1998 and 2021, comparing 3 periods: period 1 (1998-2005), period 2 (2006-2013), and period 3 (2014-2021). RESULTS: We found that 228 KB were performed, 78 (34.2%) in period 1, 91 (39.9%) in period 2, and 59 (25.9%) in period 3. The median age at KB was 11 (7-14) years. The main indications for KB were nephrotic syndrome (NS) (42.9%), hematuria and/or non-nephrotic proteinuria (35.5%), and acute kidney injury (13.2%). Primary glomerulopathies were more frequent (67.1%), particularly minimal change disease (MCD) (25.4%), IgA nephropathy (12.7%), and mesangioproliferative glomerulonephritis (GN) (8.8%). Of the secondary glomerulopathies, lupus nephritis (LN) was the most prevalent (11.8%). In group 1, hematuria and/or non-nephrotic proteinuria were the main reasons for KB, as opposed to NS in groups 2 and 3 (p < 0.01). LN showed an increasing trend (period 1-3: 2.6%-5.3%) and focal segmental glomerular sclerosis (FSGS) showed a slight decreasing trend (period 1-3: 3.1%-1.8%), without statistical significance. CONCLUSIONS: The main indication for KB was NS, which increased over time, justifying the finding of MCD as main histological diagnosis. LN showed an increase in incidence over time, while FSGS cases did not increase.


Subject(s)
Glomerulonephritis, IGA , Glomerulosclerosis, Focal Segmental , Kidney Diseases , Lupus Nephritis , Nephrosis, Lipoid , Nephrotic Syndrome , Child , Humans , Adolescent , Glomerulosclerosis, Focal Segmental/pathology , Hematuria/epidemiology , Hematuria/etiology , Hematuria/pathology , Portugal/epidemiology , Kidney/pathology , Kidney Diseases/epidemiology , Kidney Diseases/pathology , Nephrotic Syndrome/diagnosis , Lupus Nephritis/pathology , Glomerulonephritis, IGA/pathology , Proteinuria , Retrospective Studies , Biopsy
15.
J Med Case Rep ; 18(1): 191, 2024 Apr 19.
Article in English | MEDLINE | ID: mdl-38637904

ABSTRACT

BACKGROUND: Renal artery pseudoaneurysm following partial nephrectomy is a rare entity, the incidence of this entity is more common following penetrating abdominal injuries, percutaneous renal interventions such as percutaneous nephrostomy(PCN) or Percutaneous nephrolithotomy (PCNL). Although rare, renal artery pseudoaneurysm can be life threatening if not managed timely, they usually present within two weeks postoperatively with usual presenting complains being gross haematuria, flank pain and/or anaemia. CASE PRESENTATION: We report case of two female patients 34 and 57 year old respectively of South Asian ethnicity, presenting with renal artery pseudoaneurysm following left sided robot assisted nephron sparing surgery for interpolar masses presenting clinically with total, painless, gross haematuria with clots within fifteen days postoperatively and their successful treatment by digital subtraction angiography and coil embolization. CONCLUSION: Renal artery aneurysm is a rare fatal complication of minimally invasive nephron sparing surgery however considering the preoperative and intraoperative risk factors for its development and prompt suspicion at the outset can be life saving with coil embolization of the bleeding arterial aneurysm.


Subject(s)
Aneurysm, False , Aneurysm , Embolization, Therapeutic , Robotics , Humans , Female , Adult , Middle Aged , Renal Artery/diagnostic imaging , Hematuria/etiology , Aneurysm, False/diagnostic imaging , Aneurysm, False/etiology , Aneurysm, False/therapy , Nephrectomy/adverse effects , Embolization, Therapeutic/adverse effects , Nephrons , Aneurysm/complications , Aneurysm/surgery
16.
Clin Nucl Med ; 49(6): 557-558, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38598452

ABSTRACT

ABSTRACT: We report the successful application of radioembolization (SIRT) in a 77-year-old man with end-stage renal disease on hemodialysis and repeated episodes of macroscopic hematuria due to a large renal cell carcinoma of the right kidney extending to liver segment VI. A compassionate SIRT therapy was performed with resin microspheres through the upper pole renal artery and the feeding segmental artery of liver segment VI. Hematuria was resolved after treatment, and 4 months later, a follow-up CT scan revealed tumor size reduction and complete tumor necrosis (Response Evaluation Criteria in Solid Tumors criteria). Ablative SIRT therapy could be a safe and efficient option in a large inoperable RCC.


Subject(s)
Carcinoma, Renal Cell , Embolization, Therapeutic , Hematuria , Kidney Neoplasms , Humans , Male , Aged , Carcinoma, Renal Cell/diagnostic imaging , Carcinoma, Renal Cell/radiotherapy , Carcinoma, Renal Cell/complications , Carcinoma, Renal Cell/pathology , Hematuria/etiology , Kidney Neoplasms/diagnostic imaging , Kidney Neoplasms/pathology , Kidney Neoplasms/radiotherapy , Kidney Neoplasms/complications , Necrosis , Liver Neoplasms/radiotherapy , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/complications , Neoplasm Invasiveness , Liver/diagnostic imaging , Liver/pathology , Tomography, X-Ray Computed
17.
Am J Case Rep ; 25: e942770, 2024 Apr 25.
Article in English | MEDLINE | ID: mdl-38662643

ABSTRACT

BACKGROUND Collagen type III glomerulopathy (CG) is a rare disease with poorly understood pathogenesis, usually identified by abnormal collagen type III accumulation in glomeruli and manifesting as progressive deterioration of kidney function with nephrotic-range proteinuria. Immunoglobulin A nephropathy (IgAN) is the most prevalent glomerulopathy worldwide and is a leading cause of end-stage renal disease as a result of progressive fibrotic changes. Fibrosis is primarily caused by collagen type III deposition, which may explain the simultaneous occurrence of IgAN and CG. CASE REPORT A young man presented with clinical and laboratory evidence of chronic kidney injury, including long-term nephrotic-range proteinuria and microscopic hematuria. Partial improvement in proteinuria was achieved with steroid therapy and conservative management. As the non-invasive workup was inconclusive, and a complete recovery of kidney function was not achieved, a kidney biopsy was done. Histopathological microscopic examination revealed advanced IgA nephropathy, Oxford classification M0E1S1T2C0, with features highly suggestive of type III collagen glomerulopathy. CONCLUSIONS We described a case of collagen type III glomerulopathy, also known as collagenofibrotic glomerulopathy, and its association with concurrent immunoglobulin A nephropathy in a healthy man presenting with chronic proteinuria and microscopic hematuria. As the number of reported cases in the Middle East is rising, we present this report to improve understanding and greater recognition of such cases.


Subject(s)
Collagen Type III , Glomerulonephritis, IGA , Humans , Male , Glomerulonephritis, IGA/complications , Adult , Hematuria/etiology , Kidney Glomerulus/pathology
18.
Int Angiol ; 43(2): 247-254, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38619204

ABSTRACT

INTRODUCTION: Inferior vena cava (IVC) filters act in preventing pulmonary embolisms (PE). Various complications have been reported with their use. However, a credible urological complication rate, filter characteristics, and clinical presentation has yet to be summarized. Thus, we reported these complications in the form of a systematic review. EVIDENCE ACQUISITION: A search strategy was designed using PubMed, MEDLINE, and EMBASE on February 10th, 2022. The design of this search strategy did not include any language restrictions. The key words (and wildcard terms) used in the search strategy were urolog*, ureter*, bladder, kidney coupled with filter, inferior vena cava, and cava*. Inclusion criteria were: patients older than 18, with previous IVC filter placement, and urologic complication reported. Exclusion criteria were: patients younger than 18, no IVC filter placement, and no urologic complication reported. Other case series and reviews were excluded to avoid patient duplication. EVIDENCE SYNTHESIS: Thirty-five articles were selected for full-text screening. Thirty-seven patient cases were reviewed, and the median age was 53 (range: 21-92 years old). Abdominal and or flank pain was reported in 16 (43%) patients, hematuria was seen in eight (22%) and two (5%) patients died due to acute renal failure resulting from the urologic complications of the IVC filter. Indications for IVC filter placement were recurrent pulmonary embolism (PE), contraindication to or noncompliance with anticoagulant therapy. The IVC filters were infrarenal in 29 (78.4%) patients, suprarenal in five (13.5%) patients, not reported in two patients, and misplaced into the right ovarian vein in one patient. Three or more imaging modalities were obtained in 19 patients (51%) for planning. IVC filter removal was not performed in 17 (45.9%) patients, endovascular retrieval occurred in nine (24.3%) patients, and open removal was performed in seven (18.9%) patients, and tissue interposition was performed in two (5.4%) patients. One patient did not have the management reported. CONCLUSIONS: Urological complications caused by IVC filters although rare, are likely underreported, require extensive workup, and pose surgical challenges. Due to their complex management, filter retrieval should be planned for as soon as feasible, and plans should be made as early as during the IVC filter implant. For those that do develop complications, clinical judgement must be exercised in management, and open surgical, endovascular or even conservative management strategies can be viable options and should be discussed in a multidisciplinary setting.


Subject(s)
Pulmonary Embolism , Vena Cava Filters , Vena Cava Filters/adverse effects , Humans , Aged , Female , Pulmonary Embolism/etiology , Pulmonary Embolism/prevention & control , Middle Aged , Adult , Aged, 80 and over , Male , Hematuria/etiology , Young Adult , Device Removal , Risk Factors , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/surgery , Urologic Diseases/etiology , Urologic Diseases/therapy
19.
J Gastrointest Surg ; 28(6): 903-909, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38555016

ABSTRACT

BACKGROUND: The benefits of prophylactic ureteral stent placement during colorectal surgery remain controversial. This study aimed to determine the incidence of ureteral injury in colorectal operations, assess the complications associated with stent usage, and determine whether their use leads to earlier identification and treatment of injury. METHODS: This was a retrospective study of patients undergoing colorectal abdominal operations between 2015 and 2021. Variables were examined for possible association with ureteral stent placement. The primary study endpoint was ureteral injury identified within 30 days postoperatively. RESULTS: Of 6481 patients who underwent colorectal surgery, 970 (15%) underwent preoperative ureteral stent placement. The use of stents was significantly associated with a higher American Society of Anesthesiologists classification, wound classification, and longer duration of surgery. A ureteral injury was identified in 28 patients (0.4%). Of these patients, 13 had no stent, and 15 had preoperative stents placed. After propensity matching, stent use was associated with an increased risk of hematuria and urinary tract infection. Ureteral injury was identified intraoperatively in 14 of 28 patients (50.0%) and was not associated with ureteral stent use (P = .45). CONCLUSION: Iatrogenic ureteral injury was uncommon, whereas preoperative stent placement was relatively frequent. Earlier recognition of iatrogenic ureteral injury is not an expected advantage of preoperative ureteral stent placement.


Subject(s)
Iatrogenic Disease , Intraoperative Complications , Stents , Ureter , Humans , Stents/adverse effects , Ureter/injuries , Ureter/surgery , Retrospective Studies , Female , Male , Iatrogenic Disease/epidemiology , Middle Aged , Aged , Intraoperative Complications/etiology , Intraoperative Complications/epidemiology , Preoperative Care/methods , Hematuria/etiology , Urinary Tract Infections/etiology , Urinary Tract Infections/epidemiology , Operative Time
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