Renin-angiotensin system dysregulation in fetuses with hydronephrosis.

OBJECTIVES: To evaluate if fetal hydronephrosis is associated with dysregulation of the renin-angiotensin system (RAS), and if it could represent an early predictor of future renal damage or arterial hypertension. STUDY DESIGN: The study consisted of 26 pregnant women and their fetuses. Ultrasound scans were performed to evaluate the renal pelvis in fetuses. Four fetuses with hydronephrosis were included in the study, while the rest were found to have normal renal pelvis. Active and inactive renin was calculated by IRMA method in fetal and maternal blood, during the second trimester of pregnancy. RESULTS: A comparison of plasma active and inactive renin levels was made between pregnant women and their fetuses, as well as between fetuses with and without hydronephrosis. Active and inactive renin levels obtained from fetuses with hydronephrosis were significantly higher compared to those obtained from fetuses with normal kidneys. CONCLUSIONS: Dilatation of renal pelvis in the second trimester of pregnancy seems to up-regulate the renin and prorenin system in fetal blood. Both factors are indicative of possible future renal pathology.

Management of ovarian cysts with aspiration and methotrexate injection.

PURPOSE: To evaluate prospectively ultrasonography (US)-guided cyst aspiration and methotrexate injection in the management of simple and endometriotic ovarian cysts in selected patients. MATERIALS AND METHODS: Authors obtained informed patient consent and approval from hospital ethics committee. Study included 162 female patients (aged 15-77 years) with simple or endometriotic ovarian cysts (3.0-10.6 cm) at a tertiary hospital. Criteria for inclusion in the study were (a) persistence of the cyst for at least 6 months, (b) benign appearance of the cyst at US, and (c) normal serum CA-125 level measurement before the procedure. Authors performed transabdominal aspiration of the cysts with direct US guidance and injection of methotrexate (30 mg). Cytologic examination was performed in all cases. Follow-up US was performed at 1, 3, and 6 months. If the cyst persisted, the procedure could be repeated. Main outcome measure was resolution or persistence of cysts. chi(2) Test or Mantel-Haentszel chi(2) tests for univariate analysis and multiple logistic regression were used for multivariate statistical analysis. RESULTS: Of 162 patients, 148 were available for follow-up. Malignant cells were not found in any of the cases at cytologic examination. At follow-up US, cysts had disappeared in 124 patients (83.8%) and persisted in 24 (16.2%). Cyst diameter proved to be a significant prognostic factor for cyst resolution (P = .01). No major complications were observed. Patients received neither analgesia nor antibiotics. CONCLUSION: US-guided transabdominal aspiration of cyst fluid and subsequent methotrexate injection appears to be an alternative treatment for both simple and endometriotic ovarian cysts in selected cases.