Épidémiologie de la maladie rénale chronique en République démocratique du Congo : une revue synthétique des études de Kinshasa,la capitale

Chronic kidney disease (CKD) is a worldwide public health problem. Little is known about its burden in Africa. This paper reviews the knowledge of CKD in Kinshasa, summarizing four studies undertaken in the general population and traditional health system of Kinshasa. CKD was defined by either kidney damage (proteinuria ≥ 300 mg/day) or reduced kidney function (eGFR < 60 ml/min/1.73 m²). In the general population, the prevalence of CKD all stage is 12.4 %. Our work shows also the high prevalence of proteinuria among subjects who do not have diabetes or hypertension, the lack of early detection and management of CKD risk factors in the traditional health care system leading to late referral or premature deaths, and the limits of renal replacement treatment. CKD affects young people in the DRC, in contrast to the United States, where CKD is more prevalent in older people. Major determinants of CKD in our studies were hypertension, diabetes, overweight, age, lower socioeconomic status, and Human immunodeficiency virus (HIV) infection. Glomerular nephropathy (mainly focal segmental glomerulosclerosis) remains the leading cause of end stage renal disease. An annual screening of the population for proteinuria and CKD risk factors is feasible and will, it is hoped, provide the basis for building a nationwide prevention strategy.     

A successful live donor kidney transplantation after large angiomyolipoma excision

INTRODUCTIONAngiomyolipoma is the most common benign neoplasm of the kidney. Successful transplantation of an AML affected kidney has been reported. However it is still often seen as a contraindication to transplantation.PRESENTATION OF CASEA 47-year-old female underwent assessment for a direct specified kidney donation to her husband who had end stage renal failure, due to adult polycystic kidney disease. Routine pre-operative CT angiography demonstrated a large 6 cm × 4 cm AML arising from the upper pole of the right kidney. Right-side hand assisted retro-peritoneoscopic live donor nephrectomy with bench tumour excision was subsequently performed. Recipient implantation was unremarkable with no haemorrhage.DISCUSSIONHistology confirmed a 7 cm AML. At 36 months follow up, the recipient's serum creatinine was 158 μmol/l and eGFR 40 ml/min without the need for dialysis at any stage.CONCLUSIONAML should not be a contraindication for specified live kidney donation, despite a size of 7 cm.     

Variables linked to hepatitis B vaccination success in non-dialyzed chronic kidney disease patients: Use of a bayesian model

BackgroundHepatitis B vaccination is recommended for chronic kidney disease (CKD) patients before starting dialysis. We performed an analyis aimed to describe the clinical and biological parameters related to the success of vaccination in CKD patients before starting dialysis.MethodsWe extracted data of 170 non-dialyzed patients who were offered hepatitis B vaccination from a register. They received a first vaccination of 40 μg followed by boosters after one, two and six months. Patients were considered protected if their hepatitis B antibody level was > 10 IU/L, three months apart. A logistic regression and a Bayesian model were used to describe the relationships between variables and the success of vaccination.ResultsVaccination protected 50.6% of the patients. Model adjustment to the data was higher using the Bayesian model compared to the logistic regression (with area under the ROC curve of 0.955 ± 0.007 vs 0.775 ± 0.066 respectively). The Bayesian model's robustness studied using a 10 fold cross validation showed a percentage of misclassified subjects of 12.4 ± 1.8%, a sensitivity of 87.7 ± 0.3%, a specificity of 87.5 ± 0.3%, a positive predictive value of 87.8 ± 0.3% and negative predictive value of 87.4 ± 0.2%. As classified by the Bayesian model, the variables most related to successful vaccination were, in descending order: age, eGFR, protidemia, albuminemia, cause of renal failure, gender, previous vaccination and weight.ConclusionThe Bayesian network confirmed that both kidney function and nutritional status of patients are important factors to explain the success of vaccination against hepatitis B in CKD patients before dialysis. For research purposes, before an external validation, the network can be used online at www.hed.cc/?s=Bhepatitis&n=ReseauhepatiteBsup10.neta.     

A Retrospective Study of Intravascular Ultrasound use in Patients Undergoing Endovascular Aneurysm Repair: Its Usefulness and a Description of the Procedure

ObjectivesTo verify the usefulness and limitation of intravascular ultrasound (IVUS) in endovascular aneurysm repair (EVAR).MethodsA total of 112 consecutive patients, who underwent EVAR to treat abdominal aortic aneurysms, were examined retrospectively. Of these, 33 patients were assigned to the IVUS group because of renal failure, a suspected allergy to contrast agents or anatomical difficulties; the remaining 79 patients were assigned to the non-IVUS group.ResultsPatients in the IVUS group required fewer intra-arterial contrast agents (IACAs) than those in the non-IVUS group (67 ± 34 ml vs. 123 ± 50 ml; p < 0.01). Blood loss and operation time were comparable between the two groups. No patients died within 30 days of the operation. Three major renal complications occurred in the non-IVUS group. Renal deterioration evaluated by chronic kidney disease (CKD) stage was found to a greater extent in the non-IVUS group.ConclusionsIVUS is a powerful auxiliary method in EVAR for reducing the required volume of contrast agents. The combination of IVUS and IACA usage showed good overall performance; thus, we propose the routine use of IVUS in EVAR procedures.     

Chronic kidney disease consecutive to chemotherapy for chondroblastic osteosarcoma: A report on 6 pediatric cases

BackgroundThe management of osteosarcoma in children and adolescents is based on poly-chemotherapy including several nephrotoxic drugs (e.g. ifosfamide, methotrexate, and cisplatinum). Chronic renal toxicity is a frequent complication but stage 5 chronic kidney disease requiring dialysis is rare. We report here a series of six pediatric patients with osteosarcoma displaying chronic kidney disease after chemotherapy.Case-diagnosis/treatmentWe retrospectively reviewed the medical charts, mainly for clinical history, timing between chemotherapy and development of tubulopathy and CKD, type of therapies and global evolution (chronic dialysis and further renal transplantation, n = 2; death, n = 1). Notably, all patients suffered from chondroblastic osteosarcoma.ConclusionsAdvanced chronic kidney disease can be a complication of osteosarcoma management that could more frequently lead to dialysis and further transplantation. It would be interesting to identify specific risk factors of such renal toxicity. The chondroblastic sub-type may be associated with such susceptibility, but this needs to be confirmed.     

The natural history of renal functional decline in patients undergoing surveillance in the DISSRM registry

ObjectiveTo describe the natural history of renal function in patients on active surveillance (AS) for small renal masses (SRM) in the Delayed Intervention and Surveillance for Small Renal Masses Registry.MethodsDelayed Intervention and Surveillance for Small Renal Masses is a prospective, multi-institutional registry of patients with SRM (≤4 cm) who choose intervention or AS. Of these, 64 patients on AS had longitudinal serum creatinine (sCr) values and underwent analysis of estimated glomerular filtration rate (eGFR). eGFR was calculated using the Modification of Diet in Renal Disease formula. The Kidney Disease Outcomes Quality Initiative chronic kidney disease (CKD) classification was used to categorize patients’ eGFR values.ResultsMedian age was 74 (range: 34–88) years at onset of AS. Overall, 9% (6/64) of patients had CKD at baseline. Median initial tumor size was 2.1 cm (range: 0.8–4.0). Median Charlson comorbidity index score was 4 (range: 0–8). Median baseline sCr was 1.0 mg/dl (range: 0.4–2.1) and median baseline eGFR was 70.25 (range: 24.07–165.52). After a median follow-up of 17 (range: 2–46) months, 64% of patients experienced a decrease in eGFR, with average yearly decrease in eGFR of 1.82 ml/min/1.73 m² (P = 0.092) and average yearly increase in sCr of 0.046 (P = 0.012). A total of 15 (24%) patients experienced an upstaging in classification of CKD.DiscussionNearly two-thirds of patients on AS experienced a decrease in eGFR and nearly one-fourth had upstaging of CKD classification. The annual eGFR decline experienced by patients on AS minimally exceeded the annual decline of 1.49±0.3 ml/min/1.73 m² that an individual who was 70 to 79 years of age can expect from aging alone. Further follow-up is necessary to assess this in a more definitive manner, but this trend should be considered when evaluating AS as an alternative to interventional therapies for SRM.     

En bloc kidney transplant from an 18-month-old donor to an adult recipient: Case report and literature review

INTRODUCTIONThere is an ever-increasing need for organ donations globally. Paediatric kidney transplantation into adult recipients is a well-recognised technique to expand the donor pool. The transplantation can be done either via en bloc kidney transplant (EBKT) or as single kidney transplantation (SKT).PRESENTATION OF CASEAn EKBT from a 18-month-old (15 kg) male patient was transplanted in a 35-year old, 85 kg male with end stage renal failure (ESRF), secondary to Focal Segmental Glomerulosclerosis (FSGS) on haemodialysis. Post-operative recovery was uneventful. Immuno-suppressant drugs used were tacrolimus, basiliximab and prednisolone. Doppler ultrasound scans performed post-operatively showed normal renal resistive indices in both kidneys. Serum creatinine decreased from 1200 to 170 μmol/L 57 with eGFR improving from 4 to 38 mL/min/1.73 m² at four weeks post-transplant.DISCUSSIONGiven the low incidence of paediatric donors, EBKTs are relatively uncommon and subsequently published series tend to be centre specific with small numbers. The graft survival rates tell us that paediatric kidney donors should not be considered as marginal transplants. The difficulty is in determining when it is more appropriate to perform a paediatric EBKT as opposed to splitting and performing two SKT. Unfortunately there are no widely accepted guidelines to direct clinicians.CONCLUSIONThis case report highlights the first EKBT performed at our institution. The current literature demonstrates that paediatric donors are excellent resources that should be procured whenever available.     

Nefrectomía parcial robótica con compresión selectiva del parénquima (pinza de Simon)

ObjectiveTo present our initial experience using selective renal parenchymal ischemia, without hilar clamping, in robotic-assisted partial nephrectomy.Material and methodsIn four patients with T1a renal tumor we performed robotic-assisted partial nephrectomy, using the Simon's clamp (Aesculap®). It provides selective parenchymal compression without the need of vascular clamping. All patients had exofitic renal tumors in polar location. Renal parenchymal reconstruction was done as the standard technique.ResultsThe median age was 49.6 years (42-59), 3 male and 1 female patient. Median operative time was 71,6 minutes (40-120). Mean stimated bleeding was 250 ml (50-400). Average tumor size was 3,25 cm (1,5-5,3). There were no complications and the average hospital stay was 3,5 days (1-7). The pathology was informed as renal cell carcinoma in three patients and one hemorrhagic cyst. The surgical margins were negative.ConclusionOur preliminary results shows that selective renal parenchymal compression, with the Simon's clamp, provides an alternative to vascular control in selected patients with polar renal tumors.     

Myoglobin clearance by continuous venous-venous haemofiltration in rhabdomyolysis with acute kidney injury: A case series

BackgroundClearance of circulating myoglobin is a critical measure to prevent further damage in patients with rhabdomyolysis (RM) and acute kidney injury (AKI). Continuous venous-venous haemofiltration has emerged to be a novel approach for this purpose. The objective of present study is to evaluate the efficacy and safety of CVVH in myoglobin clearance for patients with RM complicated with AKI.MethodWe prospectively analysed 15 patients with acute RM and AKI due to crush syndrome (n = 7), bee stings (n = 5), polymyositis (n = 2) and heroin poisoning (n = 1). All of them presented oliguria with high serum myoglobin and creatine kinase concentration. They were treated by CVVH for at least 48 h until the conditions turned to be stable, then replaced by intermittent renal replacement therapy (intermittent haemofiltration or haemodialysis). Meanwhile intravascular volume expansion, urinary alkalinisation, and forced diuresis were administered. During the procedure, serum and effluent concentrations of myoglobin and creatinine were measured simultaneously at 2, 6, 12 and 24 h.ResultThe mean sieving coefficients for myoglobin were 0.28 ± 0.06, 0.21 ± 0.06, 0.15 ± 0.02 and 0.11 ± 0.02 during 2, 6, 12 and 24 h of CVVH intervention, whilst mean clearance of myoglobin was 14.3 ± 3.1 ml/min during 2 h and reduced to 11.5 ± 3.2, 7.5 ± 0.9, 5.6 ± 1.0 ml/min during 6, 12 and 24 h. In contrast to myoglobin, the sieving coefficient for creatinine remained stable at 0.95 ± 0.25, 1.02 ± 0.12, 0.89 ± 0.32, 0.98 ± 0.27 during 24 h of CVVH. In all of the 15 patients, serum myoglobin and creatine kinase were dramatically decreased in 24 h (?56.2 and ?32.1%), 3 days (?72.9 and ?50.3%) and in 7 days (?97.6 and ?96.7%). Seven patients (46.7%) complicated with hypophosphatemia during CVVH intervention improved in natural course after the cessation of CVVH. After 16 ± 12 days, all of 15 patients came to polyuria stage and finally, discharged with normal renal function after 31 ± 15 days.ConclusionOur study showed CVVH can be employed to clear myoglobin effectively in patients with RM and AKI and presented oliguria. This indicate that CVVH would be better than other modes of renal replement treatment in acute RM with AKI because of the additional benefit of myoglobin removal, but large sample randomised controlled trials are still required to confirm it.     

Incidence and risk factors of acute kidney injury in the Japanese trauma population: A prospective cohort study

IntroductionPrevious studies have reported the prevalence and risk factors of acute kidney injury (AKI) in relatively young trauma patients. The aims of this study were to identify the prevalence and risk factors of AKI among older Japanese trauma patients.MethodsWe conducted a prospective observational study in the 8-bed intensive care unit (ICU) of a Japanese tertiary-care hospital. Participants comprised trauma patients aged 18 years or older admitted to the ICU. Our primary outcome was the incidence of AKI within 10 days of admission, according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria.ResultsAmong 333 patients, 66 (19.8%) developed AKI (Stage 1, n = 54; Stages 2, n = 5; and Stage 3, n = 7). Multivariate logistic regression analysis revealed that the incidence of AKI was associated with increased age (odds ratio (OR), 1.38; 95% confidence interval (CI), 1.15–1.65), male sex (OR, 2.06; 95%CI, 1.04–4.07), greater amount of red blood cell transfusions (OR, 1.61; 95%CI, 1.04–1.17), and presence of underlying chronic kidney disease (CKD) (OR, 3.97; 95%CI, 1.78-8.83). Length of stay in the ICU was significantly longer in patients with AKI (6 days) than in those without (3 days; p < 0.001). Patients ≥65 years old were more likely to develop AKI (26.2% vs 11.6%; p < 0.001). No significant differences in ICU stay (median, 4 vs 4 days; p = 0.70), hospital stay (median, 24 vs 21 days; p = 0.45), or 28-day mortality (2.1% vs 1.4%; p = 0.19) were evident between age groups.ConclusionsApproximately 20% of trauma patients developed AKI, and the elderly were more likely to develop AKI. Older age, male, greater units of red blood cell transfusions, and underlying CKD were associated with incidence of AKI.     

Association between the CX3CR1 gene V249I polymorphism and delayed kidney allograft function

BackgroundFractalkine is a member of the chemokine family that acts as an adhesion molecule and as an extracellular chemoattractant promoting cellular migration. In this study, we analysed the association between the CX3CR1 gene V249I (rs3732379) SNP and renal allograft function.MethodsThe study enrolled 270 Caucasian kidney allograft recipients. The following parameters were recorded in each case: the recipient's age and gender, delayed graft function (DGF) defined as the need for dialysis in the first 7 days after transplantation, occurrence and number of episodes of acute rejection (AR), and chronic allograft dysfunction (CAD).ResultsDelayed graft function was diagnosed in 39.2% of individuals with the CC genotype, 22.7% with CT and 23.5% of those with the TT genotype. The differences were statistically significant (CC vs. TT + CT: OR = 2.17; 95% CI = 1.28–3.70, p = 0.0042). In multivariate analysis the CC genotype was an independent and significant predictor of higher risk of DGF. The distribution of genotypes and alleles of the CX3CR1 gene polymorphism among patients with and without AR as well as CAD did not differ significantly.ConclusionsThe results of this study suggest that the CX3CR1 gene V249I (rs3732379) SNP CC genotype is associated with increased risk of DGF.     

Compensatory structural and functional adaptation after radical nephrectomy for renal cell carcinoma according to preoperative stage of chronic kidney disease. Choi DK,Jung SB,Park BH,Jeong BC,Seo SI,Jeon SS,Lee HM,Choi HY,Jeon HG.J Urol. 2015 Oct;194(4):910-5. [Epub 2015 Apr 28]. doi: 10.1016/j.juro.2015.04.093.

Purpose

We investigated structural hypertrophy and functional hyperfiltration as compensatory adaptations after radical nephrectomy in patients with renal cell carcinoma according to the preoperative chronic kidney disease stage.

Control de la hemostasia durante la nefrectomía parcial laparoscópica sin renorrafia parenquimatosa: la experiencia Vivostat®

ObjectiveTo present our experience using an autologous fibrin sealant prepared with the Vivostat system^® to control haemostasis without any renal parenchymal reconstruction.Material and methodsWe performed 45 laparoscopic partial nephrectomies using this haemostatic agent. The surgical steps were: colon mobilization, identification of ureter, renal vessels and renal tumor, renal artery control with Rummel tourniquet, tumor excision with harmonic scalpel, application of fibrin glue to the resection bed twice (before and after kidney reperfusion). Patients were evaluated for acute or delayed bleeding.ResultsMean age was 63.9 years (33-80); mean tumor size was 2.5 cm (1.5-4); mean operative time was 136.1 min (90-180). Mean warm ischemia time was 19.2 min (10-30). Mean blood loss was 97 ml (50-300). Individual haemostatic stitches were performed before application of the sealant if acute bleeding was observed (14 cases). We did not achieve any case of postoperative bleeding from resection bed or renal failure. 1 patient required transfusion due to an abdominal wall haematoma. 65% were clear cell carcinoma, 10% were papillary carcinoma, 20% were oncocitoma. Free margin rate was 100%. Mean hospital stay was 4 days (2-6). Mean follow-up was 14 months (5-45).ConclusionsExcluding renorrhaphy during laparoscopic partial nephrectomy is feasible and safe. Our initial experience with the vivostat system in laparoscopic partial nephrectomy has been encouraging, but longer follow-up is needed to determine the real benefit of this surgical technique in laparoscopic partial nephrectomy     

Épidémiologie de l’hypertension artérielle non contrôlée au cours des maladies rénales chroniques chez des patients admis dans une unité de néphrologie d’Afrique noire : une étude rétrospective de 479 patients

The incidence of uncontrolled hypertension (HTN+) in CKD in nephrology could reflect the quality of the management of the patients in a primary care setting. The aim of the present study was to identify factors associated with HTN+ in CKD in order to elaborate a prevention strategy for the health professionals. A retrospective analysis of 479 incidents patients has been performed from 2012/1st to 2012/12th. Sixty-two percent had CKD HTN+. Eighty percent were at stages 4 and 5. Mean value of SBP was 166.5 ± 32 mmHg and 96 ± 27.3 mmHg for DBP. Mean age was 48.2 ± 14.6 years. Mean GFR was 17.4 ± 17.1 mL/min and no difference found between groups (17.4 ± 17.6 mL/min in CKD HTN+ versus 17.5 ± 16.3 mL/min in CKD HTN–, P < 0.9). Alcohol consumption was more in CKD HTN+ as compared to CKD HTN–, but not different between groups (37.2% in CKD HTN+ versus 27.6% in CKD HTN–; P < 0.09). Patients who were taking antihypertensive drugs were significantly more in the CKD HTN– than CKD HTN+ (22% in CKD HT+ versus 41.1% in CKD HTN–; P < 0.0001). Factors associated with HTN+ in CKD were antihypertensive therapy (OR = 0.39; CI 0.20–0.75; P < 0.005); alcohol (OR = 2.19; CI 1.09–4.37; P < 0.02). BP was similar in HN and non-HN patients (173.0 ± 26.9 mmHg versus 174.7 ± 33.7 mmHg; P = 0.75). But kidney function was a little better in HN (16.9 ± 17.7 mL/min and 20.95 ± 18.5 mL/min; P < 0.1). Factors associated positively with HN/HTN+ were: history of HTN and age. Factors associated negatively with HN/HTN+ were: history of diabetes and CKD stage.     

Cirugía robótica multicuadrante concomitante para prostatectomía radical y nefrectomía parcial izquierda. Dos procedimientos mediante un solo abordaje

IntroductionTo present the first case of a concomitant robotic radical prostatectomy and a left robotic partial nephrectomy performed by a single-port approach using the SP® da Vinci surgical system (Intuitive Surgical, Sunnyvale CA, EE.UU.).Patient and methodsA 66-year-old male diagnosed with localized prostate cancer and a left kidney renal mass incidentally found on computed tomography (CT) scan during prostate cancer evaluation. Procedures were performed using a single supra-umbilical 3 cm incision, plus one additional laparoscopic port, utilizing a standard Gelpoint® (Applied Medical, Rancho Santa Margarita, CA, EE.UU.) and replicating the technique previously described for single-port transperitoneal radical prostatectomy and partial nephrectomy with the use of the SP® robotic platform.ResultsTotal operative time was 256 minutes (min) with a console time of 108 min for radical prostatectomy, and 101 min for the partial nephrectomy respectively, including a warm ischemia time of 26 min. Estimated blood loss was 250 cc. Blood transfusion was not needed. Final pathology for prostate was adenocarcinoma Gleason 7 (4 + 3) and for the kidney lesion was renal cell carcinoma. After two months of follow-up, PSA was undetectable and no complications or recurrence were detected.ConclusionsThe single-port approach has advantages as easier surgical planning and transition for combined and multi-quadrants surgeries: faster recovery, minimal postoperative pain and need for opioids, and excellent cosmetic outcome. We suggest that combined procedures should be performed only in high volume institutions by surgeons with vast experience in robotic surgery in selected patients.     

Increased hip fracture and mortality in chronic kidney disease individuals: The importance of competing risks

BackgroundMany studies have shown a correlation between chronic kidney disease (CKD) and fracture. However, increased mortality in CKD patients is a competing risk scenario not accounted for in previous studies. Our aim was to investigate the true impact of CKD on hip fracture after accounting for a competing risk with death.MethodsWe conducted a population-based cohort study to determine the impact of CKD on hip fractures in individuals aged ≥ 50 years old registered in the SIDIAP^Q database (representative of 1.9 million people in Catalonia, Spain). Cox regression was used to estimate hazard ratio (HR) for death and hip fracture according to CKD status. A competing risk (Fine and Gray) model was fitted to estimate sub-HR for hip fracture in CKD or CKD-free patients accounting for differential mortality.ResultsA total of 873,073 (32,934 (3.8%) CKD) patients were observed for 3 years. During follow-up, 4,823 (14.6%) CKD and 36,328 (4.3%) CKD-free participants died (HR, 1.83 [95% CI, 1.78–1.89]), whilst 522 (1.59%) and 6,292 (0.75%) sustained hip fractures, respectively. Adjusted Cox models showed a significantly increased risk of hip fractures for the CKD group (HR, 1.16 [1.06–1.27]), but this association was attenuated in competing risk models accounting for mortality (SHR, 1.14 [1.03–1.27]).ConclusionsBoth death and hip fracture rates are increased (by 83% and 16%, respectively) in CKD patients. However, the association between CKD and hip fractures is attenuated when an excess of mortality is taken into account. A competing risk with death must be considered in future analyses of association between CKD and any health outcomes.     

Predictors of 30-day acute kidney injury following radical and partial nephrectomy for renal cell carcinoma

IntroductionPatients with renal cell carcinoma who were treated with radical nephrectomy (RN) or partial nephrectomy (PN) are at risk of postoperative acute kidney injury (AKI), and in consequence, short- and long-term adverse outcomes. We sought to identify independent predictors of 30-day AKI in patients undergoing RN or PN.Materials and methodsBetween 2005 and 2011, patients who underwent RN or PN for renal cell carcinoma within the National Surgical Quality Improvement Program data set were identified. Patients with preexisting severe renal failure, defined as a preoperative estimated glomerular filtration rate<30 ml/min/1.73 m², were excluded from the analyses. AKI was defined as an elevation of serum creatinine>2 mg/dl above baseline or the need for dialysis within 30 days of surgery. Univariable and multivariable logistic regression analyses were used to examine the association between preoperative factors and the risk of postoperative AKI.ResultsOverall, 1,944 (58.6%) and 1,376 (41.4%) patients underwent RN and PN, respectively. Overall, 1.8% of the patients included in the study experienced AKI within an average of 5.4 days after RN or PN. Independent predictors for AKI included obesity (odds ratio [OR] = 2.24, P = 0.04), history of neurovascular disease (OR = 5.29, P<0.001), and a preoperative chronic kidney disease stage II (OR = 10.00, P = 0.03) or stage III (OR = 26.49, P = 0.02). Furthermore, RN (OR = 2.87, P = 0.02) or the open approach (OR = 2.18, P = 0.04) was significantly associated with postoperative AKI. AKI was significantly associated with adverse postoperative outcomes, such as prolonged length of stay, occurrence of any complication, and mortality (all P <0.001).ConclusionsThe assessment of preoperative kidney function and comorbidity status is essential to identify patients at risk of postoperative AKI. In addition to preoperative chronic kidney disease stages II and III, neurovascular disease, obesity, and surgical approach (RN or open) represent predictors of 30-day AKI. Careful patient selection as well as preoperative planning may help reduce this unfavorable postoperative outcome.     

Ultrasonographic renal volume measurements in early autosomal dominant polycystic disease: Comparison with CT-scan renal volume calculations

PurposeTo investigate the correlation and concordance between the ellipsoid volume calculated by ultrasonography measurements (Vol3DUS) and the reference kidney volume measured by CT (VolTDM) in early autosomal dominant polycystic kidney disease (ADPKD).Materials and methodsProspective study of the correlation and concordance of renal volumes in 24 patients with early ADPKD (48 kidneys analysed separately), with calculation of Vol3DUS using the formula for an ellipsoid in three different manners and VolTDM measurement by manual contouring. Calculations of correlation coefficients (r) and coefficients of intra-class correlation (ICC) with confidence intervals at 95%.ResultsThe US volume was strongly correlated with the CT volume by using the maximum width in a transverse section (r = 0.83) with a mean Vol3DUS = 692 ± 348 ml [180; 2069]. The most reproducible ultrasonography measurement was the height. When the kidney volume exceeded 800 ml, US underestimated the volume. However, the median error was −57.5 ml [−1090; 183] and 85% of the Vol3DUS calculated differed by more than 5% from the reference measurement.ConclusionThe correlation between the US calculated volumes and the CT volumes was strong. However, the median error with ellipsoid US volume was too high to detect a small renal variation in early ADPKD.     

Factors influencing cesarean delivery operative times: a prospective observational cohort study

BackgroundThis study aimed to determine the distribution of operative delivery times for uncomplicated parturients undergoing elective cesarean delivery with neuraxial anesthesia. A secondary aim was to explore patient and surgical factors associated with longer cesarean delivery times.MethodsA prospective observational study of 331 parturients undergoing elective cesarean delivery with neuraxial anesthesia was conducted. Factors examined included age, body mass index, ethnicity, number of previous cesarean deliveries, stretch mark and scar severity and surgical experience.ResultsOperative times ranged from 13 to 108 min with a mean (SD) of 43.4 (±15.7) min. Only 6 (1.8%) parturients had operative times >90 min and none were converted to general anesthesia. As the number of previous cesarean deliveries increased, the mean operative time increased linearly from 39.5 (±13.0) min in subjects with no previous cesarean deliveries to 52.8 (±18.1) min in subjects with 3 or 4 previous cesarean deliveries (P < 0.0005). For parturients with previous cesarean deliveries, operative times were longer for those with scar scores ?5 than for those with scores <5 (P < 0.01). Stretch mark scores were not associated with operative times. Tubal ligation prolonged the total operative time by a mean of 7 min (P < 0.0005), and attending staff required a mean of 6 more min than residents or fellows (P < 0.01). There was no correlation between operative times, age and body mass index and little variation with ethnicity.ConclusionsThese findings identify previous cesarean deliveries, increased scar intensity, tubal ligation and surgical experience as factors that increase operative times for cesarean delivery. The data also suggest that neuraxial anesthesia lasting 90 min should provide adequate analgesia for most uncomplicated parturients undergoing elective cesarean delivery.