Kidney biopsy in pregnancy: evidence for counselling? A systematic narrative review.

BACKGROUND: Kidney diseases, which have a prevalence of 3% in women of childbearing age, are increasingly encountered in pregnancy. Glomerulonephritis may develop or flare up in pregnancy, and a differential diagnosis with pre-eclampsia may be impossible on clinical grounds. Use of kidney biopsy is controversial, but a systematic review has not been carried out to date. OBJECTIVES: To review the literature on kidney biopsy in pregnancy, with a focus on indications, risks and timing. SEARCH STRATEGY: Medline, Embase, CHINAL and the Cochrane Library were searched in September 2012, with 'pregnancy' and 'kidney biopsy' used as MESH and free terms, for the period 1980-2012. Results were filtered for 'human' if this option was available. SELECTION CRITERIA: Biopsies during pregnancy and within 2 months after delivery. Case reports (fewer than five cases) and kidney grafts were excluded. Paper selection was performed in duplicate. DATA COLLECTION AND ANALYSIS: Data were extracted in duplicate. The high heterogeneity in study design necessitated that the review be narrative, except for data on adverse events, which were analysed with regard to the timing of kidney biopsy. MAIN RESULTS: Of 949 references, 39 were selected, providing data on 243 biopsies in pregnancy and 1236 after delivery (timing was unclear in 106 women). The main aims of the studies were to define morphology in pre-eclampsia (23 studies), to carry out a risk-benefit analysis of kidney biopsy (11 studies), and to investigate pregnancy-related acute kidney injury (five studies). Four cases of major bleeding complications occurred at 23-26 weeks of gestation. Relevant complications were observed in 7% of women during pregnancy and 1% after delivery (P = 0.001). Kidney biopsy performed for the diagnosis of glomerulonephritis or pre-eclampsia led to therapeutic changes in 66% of cases. AUTHORS' CONCLUSIONS: The evidence on kidney biopsy in pregnancy is heterogeneous, but a significantly higher risk of complications (relative to postpartum biopsy) was found, with a possible peak at around 25 gestational weeks.

Girdlestone arthroplasty for loosening of the total hip prosthesis: evaluation and results.

A total of 72 patients (73 hips) who had been submitted to Girdlestone arthroplasty to treat aseptic (63%) and septic (37%) loosening of total hip replacement, and who had been followed-up after an average of 6.8 years, were reviewed. Good pain control was obtained in nearly 60% of the patients. Functional results were poor, but 52% of the patients said that they were satisfied. Mean score based on the Harris Hip Score was 54. Infection was dominated in 92.6% of the cases. The best results were obtained in younger patients, while we did not observe any differences based on the cause of loosening (aseptic or septic). Despite the limits of the method, Girdlestone arthroplasty continues to constitute an effective indication for the treatment of loosening in total hip replacement, when the choice of reimplantation exposes the patient to a high risk of further failure.

[Current status of diagnostic imaging]. / Attualità della diagnostica per immagini.

The authors overview the diagnostic progresses as based on the state of art of imaging which evolves at an electrifying and committing pace towards of a broader horizon of medical fields. They aim at creating centralized integrated diagnostic units in hospitals and at promoting physicians, and technicians skills.

Transport and metabolism of palmitate in the rat liver. Net flux and unidirectional fluxes across the cell membrane.

The unidirectional fluxes of palmitate across the liver cell membrane and metabolic uptake rates were measured employing the multiple-indicator dilution technique. The following results were obtained: (1) Influx and net uptake rates do not vary proportionally to each other when albumin and palmitate concentrations are varied. (2) Efflux is significant for albumin concentrations in the range between 1.5 and 500 microM. (3) At 150 microM albumin net uptake rates are proportional to the total (bound plus free) extracellular palmitate concentration in the range from 10 to 600 microM; the dependence of influx rates on the palmitate concentration is rather concave up. (4) When albumin and palmitate are both varied at an equimolar ratio, pseudo-saturation appears in the net uptake rates; the influx rates also show pseudo-saturation, but with a declining tendency at the higher concentrations. (5) The intracellular palmitate concentration is strongly influenced by albumin. At very low concentrations of the protein (1.5 microM) the intracellular concentration is practically equal to the extracellular one; at physiological albumin concentrations, however, the intracellular palmitate concentration is less than 2% of the extracellular one. (6) Saturation of net uptake with respect to the intracellular palmitate concentration was not observed with concentrations up to 46 microM.

The influence of albumin on palmitate transport in the isolated perfused rat liver.

Unidirectional fluxes (influx and efflux) and the net flux of palmitate across the hepatocyte membrane were measured in the intact rat liver employing the multiple indicator dilution technique. At albumin concentrations in the range between 0.1 and 0.5 mM the influx rate was 2.3 times greater than that of the net flux. The rate of efflux was somewhat higher than the net flux, indicating that palmitate undergoes an exchange process across the liver cell membranes with efflux to the extracellular albumin site being significant. At lower albumin concentrations, however, the influx/net flux ratio approached unity, implying that transport becomes a rate-limiting factor for metabolism.

Octanoate transport in the isolated, perfused rat liver.

The multiple indicator dilution technique was used to investigate octanoate transport in the isolated, perfused rat liver. The form of the octanoate outflow profiles depends on albumin concentration. The steady-state intracellular octanoate concentration and the rate of uptake increase when the albumin concentration is decreased. At physiological albumin concentrations, the intracellular concentration of octanoate is only 7% of the extracellular concentration. Exchange between the intra- and extracellular space, however, is very rapid, irrespective of the albumin concentration and consequently exchange is not rate limiting for metabolism.

The influence of albumin on palmitate transport in the isolated perfused rat liver

Unidirectional fluxes (influx and efflux) and the net flux of palmitate across the hepatocyte membrane were measured in the intact rat liver employing the multiple indicator dilution technique. At albumin concentrations in the range between 0.1 and 0.5 mM the influx rate was 2.3 times greater than that of the net flux. The rate of efflux was somewhat higher than the net flux, indicating that palmitate undergoes an exchange process across the liver cell membranes with efflux to the extracellular albumin site being significant. At. lower albumin concentrations, hower, the influx/net flux approached unit, implying that transport becomes a rate-limiting factor for metabolism

Octanoate transport in the isolated, perfused rat liver

The multiple indicator dilution technique was used to investigate octanoate transport in the isolated, perfused rat liver. The form of the octanoate outflow profiles depends on albumin concentration. The steady-state intracellular octanoate concentration and the rate of uptake increase when the albumin concentration is decreased. At physiological albumin concentrations, the intracellular concentration of octanoate is only 7% of the extracellular concentration. Exchange between the intra-and extracellular space, however, is very rapid, irrespective of the albumin concentration and consequently exchange is not rate limiting for metabolism