The pulsatility index and the resistive index in renal arteries in patients with hypertension and chronic renal failure

BACKGROUND.: The pulsatility index (PI) and the resistive index (RI) areused as pulsed-wave Doppler measurement of downstream renalartery resistance. Little information is available on theirvalue in chronic renal failure and their correlation to parametersof renal function and haemodynamics. The aim was to comparePI and RI of renal arteries in healthy volunteers and in patientswith hypertension and chronic renal failure, and furthermoreto study the correlation of these indices to measurements ofrenal haemodynamics and function by standard methods in patientswith renal failure and hypertension. METHODS.: Twenty-five hypertensive patients (10 females, 15 males, meanage 52 years (24–74) with a glomerular filtration rate(GFR) less than 50 ml/min and an arterial blood pressure above140 mmHg systolic and 95 mmHg diastolic were included in thestudy. Ten healthy, normotensive volunteers (4 females and 6males, mean age 43 years (30–62)) served as controls inthe Doppler examinations. Doppler examinations were performedin segmental arteries by an Acuson 128. The PI and the RI wascalculated from the blood flow velocities. RESULTS.: Both the PI and the RI were significantly higher in the patientgroup (P) than in the control group (C) (PI, P 1.65 (1.31–1.86),C 1.19 (0.93–1.25), P=0.003; RI, P 0.76 (0.69–0.81),C 0.67 (0.64–0.70), P=0.003). Both PI and RI correlated significantly with effective renalplasma flow (PI: r= –0.5, P=0.02; RI: r=–0.5, P=0.006),renal vascular resistance (PI: r=0.4, P= 0.05; RI: r=0.5, P=0.02),filtration fraction (PI: r=0.6, P=0.005; RI: r=0.5, P=0.01)and clearance of creatinine (PI: r=–0.6, P=0.008; RI:r=–;0.6, P= 0.006). Only RI correlated significantly toGFR (r=–0.5, P=0.02). The indices did not correlate toserum creatinine, or mean arterial blood pressure. CONCLUSION.: PI and RI seems to be closely related to parameters of renalhaemodynamics and clearance of creatinine in patients with chronicrenal failure and hypertension.     

Indirect computed tomography sign of renal artery injury: Retrograde filling of the renal vein

Computed tomography is a very useful diagnostic tool in children's trauma. In the present case report, retrograde filling of the renal vein during computerized tomographic examination of a patient with renal trauma is presented. This is an indirect sign of traumatic renal artery injury. This finding might assist in the early diagnosis of severe renovascular trauma.     

Differences in new-onset IgA nephropathy between young adults and the elderly

Background: The goal of this study was to define the clinical and histological differences in new-onset IgA nephropathy between young adults and the elderly. Methods: We retrospectively examined renal biopsy findings, clinical features at presentation and outcomes in 82 young adults (mean age 30.3 ± 10.2 years) and 17 elderly patients (mean age 71.9 ± 4.5 years) with IgA nephropathy whose renal biopsies were taken within 1 year from the onset of renal manifestations. Results: The elderly group more frequently had hypertension (p < 0.001), acute renal failure (p < 0.001), and nephrotic range proteinuria (p = 0.001) at presentation than the young adults group. On histology, a higher percentage of globally sclerotic glomeruli (p < 0.001) was present in the elderly group. In patients presenting with acute renal failure, the elderly group more frequently had an intercurrent disease (p = 0.02), mostly infection, and a higher mortality rate (p = 0.033). On histology, the young adults group had a higher percentage of glomeruli affected by crescents (p = 0.027); in contrast, the elderly group more commonly had acute tubular injury (p = 0.02). Conclusions: The elderly patients affected by IgA nephropathy had more severe renal manifestations at presentation (acute renal failure in 52.9% and nephrotic syndrome in 41.2% of patients). In cases of acute renal failure, the elderly patients had more predominant tubular rather than glomerular injury. Moreover, the considerable mortality rate (44.4%) might be associated with the intercurrent disease, mostly infection, which was more commonly present in the elderly patients.     

肾肿瘤剜除术治疗肾细胞癌、肾血管平滑肌脂肪瘤

目的探讨肾肿瘤剜除术治疗肾细胞癌及肾血管平滑肌脂肪瘤的疗效。方法回顾分析15例在我院进行肾肿瘤剜除术的肾细胞癌及肾血管平滑肌脂肪瘤患者的临床及病理资料。结果全部肾肿瘤均成功剜除,平均热缺血时间为15min,术中肿瘤剜除面平均出血25ml,术后无继发出血,无急性肾小管坏死、慢性肾功能不全及尿瘘等并发症发生。术后平均随访时间为2．5年,均未见肿瘤复发或转移。依据2003AJCC肾癌分期方法,所有肾癌患者均为Tla期,组织学形态为透明细胞癌。病理分级按Fuhrman标准为G1。结论肾肿瘤剜除术对有假性包膜的Tla肾细胞癌和肾血管平滑肌脂肪瘤是有效和安全的,术后并发症少,可以最大程度地保留肾脏功能。     

磁共振弥散加权成像在肾脏常见占位性病变中的诊断价值

目的探讨磁共振弥散加权成像在肾脏常见占位性病变中的诊断价值。方法对30例健康志愿者及80例肾脏占位性疾病患者（包括40例肾癌、20例肾错构瘤27个病灶、肾囊肿20例31个病灶）进行常规肾脏磁共振检查及弥散加权成像检查,并在ADC图上直接测量不同b值正常肾脏及病变的平均ADC值。结果 40例肾癌在DWI上表现肿瘤的实质部分表现为高信号,坏死部分呈低信号;20例肾错构瘤DWI表现为境界清楚的混杂信号影,脂肪成分呈低信号;20例肾囊肿DWI上表现为均匀的稍低信号。在b值为500、800、1000s/mm2时,同一b值下正常肾脏、肾癌、肾错构瘤、肾囊肿ADC值存在统计学差异。结论通过DWI及ADC值研究,可以更早更多地了解肿瘤内部结构,有助于肾脏良恶性疾病的诊断与鉴别诊断。     

Acute pain over the kidney graft and Duplex-sonographic findings mimicking complete renal transplant vein thrombosis.

A 33-year-old male ESRD patient received a cadaveric left kidneyallograft in May 2001. The vascular anatomy of the kidney wasnormal but the renal vein was quite long. On the first postoperativeday, Duplex-ultrasound showed a well perfused graft, but thepatient required further dialysis. On the fourth postoperativeday the patient complained about tenderness and pain over thegraft.     

肾巨大鹿角形结石25例手术方式探讨

目的：探索巨大鹿角形肾结石新的手术方法。方法：根据巨大鹿角形肾结石的临床特点，25例病人采用经薄弱的肾皮质切开肾盏颈部，解除嵌顿，取净结石。结果：不损伤肾内主要血管，术中出血少。结论：该术式是治疗有积水的巨大鹿角形肾结石较理想的手术方式。     

MR在肾肿瘤诊断中的应用

目的探讨MR在肾肿瘤临床诊断中的价值。方法回顾分析24例经病理证实的肾肿瘤患者临床资料,病理类型包括透明细胞性肾癌20例、乳头状肾细胞癌2例及血管平滑肌瘤2例。所有患者均行T1wI、T2WI、STIR序列检查,同时做MR动态增强扫描。结果透明细胞癌20例,T1wI均匀等信号7例,混杂信号10例,均匀低信号3例;T2WI均匀略高信号9例,明显高信号1例,混杂信号10例;显示假包膜者10例;肾窦侵犯3例,肾周侵犯4例,下腔静脉癌栓1例,腹膜后或肾门淋巴结肿大3例,腰大肌转移1例。注入造影剂后,7例病灶均匀强化,13例不均匀强化。乳头状肾细胞癌2例,T2wI低信号,增强后表现为持续轻度强化。血管平滑肌瘤2例,T1wI上的明显的高信号,T2WI为中等信号,无假包膜,脂肪可被明显抑制,无明显强化。结论MR对于肾肿瘤的术前检出、诊断有较高的准确率,具有重要的临床应用价值。     

Experimental investigation of the relationship between operative technique and renal parenchymal injury

Summary Subject: Experiments have been done in rats to discover whether kidney surgery in situ is preferable to complete exposure with its risks of decapsulation and more vigorous traction on the renal pedicle.Methods: Kidneys exposed in situ were either decapsulated or subjected to intermittent traction before slices were taken for measurement of metabolic activity in a Warburg apparatus.Results: Neither procedure caused any significant change from normal values.Conclusions: The advantages of complete exposure of the kidney, thus making its free rotation possible, need not be foregone because of the theoretically greater risk of producing renal damage.     

Baseline renal function,ischaemia time and blood loss predict the rate of renal failure after partial nephrectomy

OBJECTIVE

To identify independent predictors of renal failure after partial nephrectomy (PN) in patients with renal cell carcinoma (RCC).

PATIENTS AND METHODS

Data were available for 166 patients with pathological T1‐3 N0M0 RCC treated with PN. Renal failure after PN was defined as a decrease in glomerular filtration rate (GFR) of >25% (RIFLE criteria). The GFR before and after PN was estimated using the Modification of Diet in Renal Disease study group equation. Univariable and multivariable logistic regression models were used to assess a decrease of >25% in GFR from the preoperative level. Candidate predictor variables were age, gender, PN indication (absolute vs relative), preoperative GFR, tumour size, perioperative blood loss, surgery duration and clamping time.

RESULTS

After PN, 22 (13.3%) patients had a decrease in GFR of >25%. The perioperative blood loss (P = 0.02), clamping time (P = 0.04) and preoperative GFR (P = 0.002) were independent predictors of a decrease in GFR of >25%.

CONCLUSIONS

We identified two important potentially modifiable variables that should be considered in the planning of PN, i.e. the clamping time and blood loss. It is possible that selective referral to experienced surgeons who can perform PN within short surgical and clamping times, and with minimal blood loss, could minimize the rate of renal failure, especially in patients with an underlying renal function impairment.     

Renal Vein Thrombosis Misdiagnosed as a Renal Cell Carcinoma with a Tumor Thrombus in the Inferior Vena Cava

A 69-year-old man was diagnosed with a right renal carcinoma with a tumor thrombus in the inferior vena cava, and underwent a radical nephrectomy. The entire specimen was examined by step-wise sectioning and found to be a thrombus with extensive hemosiderin deposits and recánalization which contained no malignant cells.     

Increased prevalence of dialysis-dependent renal failure in ethnic minorities in the West Midlands

A total of 1038 adult patients with dialysis-dependent renalfailure were treated at this centre between 1981 and 1991. Dataon racial origin and primary renal diagnosis have been analysedin order to determine the prevalence of end-stage renal failure(ESRF) and its causes. Compared with Caucasians there was a greater proportion of Asians(P < 0.001) and Blacks (P < 0.001) with ESRF. The relativerisk of ESRF in Asians compared with Caucasians was 1.76 (95%CI 1.46–2.10) and for Blacks 1.76 (95% CI 1.39–2.2).Hypertension/renal vascular disease and systemic lupus erythematosuswere more frequent causes of ESRF in Blacks than in Caucasians(P < 0.005). Hypertension/vascular disease and tuberculosiswere more frequent causes of ESRF in Asians than Caucasians(P < 0.005) respectively. Diabetes mellitus appeared to bemore common as a cause of ESRF in Blacks than Asians or Caucasians(0.1 >P>0.05). Adult polycystic disease was significantlyless common in Asians compared to Caucasians and Blacks (P<0.05). The prevalence of ESRF in Asians and Blacks in the West Midlandsappears to be greater than that of Caucasians, mostly as a consequenceof hypertension/vascular disease and to a lesser extent of systemiclupus erythematosus in Blacks and of tuberculosis in Asians.If these data are confirmed by prospective study then they haveimplications for service provision.     

经皮肾镜取石术治疗鹿角形肾结石通道建立技巧的探讨

目的：探讨经皮肾镜取石术（PCNL）治疗鹿角形肾结石术中穿刺点、穿刺径路的合理选择及扩张、通道建立的技巧。方法：总结在X线定位下PCNL治疗36例鹿角形肾结石患者的经皮肾通道建立与治疗效果。结果：Ⅰ期手术穿刺、通道建立、成功碎石率100％;Ⅰ～Ⅲ期结石完全清除率83．33％;单通道26例（72．22％）,双通道7例（19．44％）,三通道3例（8．33％）;无大出血、感染休克等严重并发症发生。结论：PCNL治疗鹿角形肾结石的第一个穿刺点首选中后组盏,径路应与目标盏长径相吻合;带鞘扩张时扩张器应进入集合系统内约2cm,退出扩张器直接完成通道建立;Ⅰ期建立单通道处理。肾盂、中组肾盏结石为主,Ⅱ期先经Ⅰ期通道处理上下盏残留结石,慎重建立第二、三条经皮肾通道。     

ESRD in Guatemala and a Model for Preventive Strategies: Outlook of the Guatemalan Foundation for Children with Kidney Diseases

The rapidly growing burden of chronic renal failure (CRF) is a major public health problem that will stretch the health care system of all countries, especially those that are not yet industrialized. It is estimated that only 35% of Guatemalan patients with end stage renal disease (ESRD) would be diagnosed and treated, and unlike many developed countries, the age of presentation in 60% of the patients is before the forth decade. Therefore, the cost of death and disability due to a CRF in this young population is particularly profound, resulting in reduced productivity and economic growth of the country. It is also estimated that 400 pediatric cases develop progressive kidney disorder (neurogenic bladder, reflux nephropathy, chronic glomerulonephritis) annually, which, if left untreated, could result in ESRD in adulthood. This reality justifies initiatives such as FUNDANIER (Foundation for Children with Kidney Diseases), whose mission is to offer comprehensive nephrological treatment to children and adolescents and enable health care providers to prevent ESRD by early identification, diagnosis, and timely referral of children with risk factors. Efforts should be taken to better involve pediatricians and pediatric nephrologists in the fight against the burden of CRF.     

Renal artery rupture secondary to pretransplantation Candida contamination of the graft in two different recipients

Infected graft transplantation is an unwelcome complication that may lead to serious consequences in the immunosuppressed host. It can be caused by infection of the donor or by contamination of the organ during harvest, preservation and handling, or at transplantation. With current donor evaluation protocols, the risk of transmitting infections by exogenous contaminated grafts seems to be more frequent than true donor-transmitted infections. Nevertheless, although rare and usually free of clinically significant sequelae, if contamination is by some virulent organisms such as Staphylococcus aureus, gram-negative bacilli, or fungi, severe complications may occur. We report the clinical outcome of liver, heart, and kidney recipients from a single donor. Both renal allografts had to be removed because of renal artery rupture secondary to Candida albicans infection. Careful donor evaluation before transplantation, unusually early presentation of mycosis leading to anastomotic renal artery disruption, the histopathologic findings of the grafts, and the absence of Candida infection in the liver and heart recipients make us believe that exogenous contamination of the grafts occurred during donor procedure, kidney processing, or at transplantation. In summary, because infected grafts can lead to serious complications, besides careful donor screening, it is important to achieve early recognition of contaminated organs by culturing the perfusate to start specific antiobiotic or antifungal therapy after transplantation if necessary and avoid the rare but, in this case, fatal consequences of these infections.     

The use of the hypogastric artery in the anastomosis of multiple renal arteries in the transplant patient

Abstract. Alternative techniques for handling multiple renal vessels in living related kidney transplants by use of the hypogastric artery are presented. This vessel can be used either as a tubular vascular graft or as a Carrel patch graft. Details of these techniques are discussed.     

Renal tumors: The good, the bad, and the ugly

Renal cancers comprise a wide variety of neoplasms with quite different genetic and molecular characteristics and clinical behaviors. Several issues of significant note have arisen in association with our increased understanding of these tumors, including questions regarding early diagnosis, the evaluation of cystic lesions, the behavior of tumors occurring in young patients, and insights regarding the prognosis and best follow-up strategies for these tumors.     

Isolated hydatid disease of the native kidney in a renal transplant recipient.

A 43-year-old male renal allograft recipient was admitted tothe hospital for annual check-up. He received a cadaveric renaltransplant 2 years previously. On admission his physical examinationdid not show any abnormalities. Abdominal ultrasonography ofthe patient revealed     

The Spectrum of Adult Postinfectious Glomerulonephritis in the New Millennium

Background. Postinfectious glomerulonephritis is rare in adults. The characteristics of the disease now differ from what were described decades ago. The goal of this study is to illustrate the clinicopathological spectrum of the disease in the modern era. Methods. Between July 2000 and June 2008, 20 adult cases of postinfectious glomerulonephritis were identified at a medical center in Taiwan. The patients' records were retrospectively reviewed with respect to clinical presentation, microbiology, serology, morphology of renal biopsy, and clinical course. Results. There were 14 males and 6 females. The mean age was 61 years. All patients developed acute renal failure, and the majority (65%) required dialysis support during the disease course. Hypocomplementemia was present in 60% of patients. The most frequently identified infectious agent was Staphylococcus (60%). Histological characteristics showed two distinct patterns of glomerulonephritis: diffuse endocapillary proliferative glomerulonephritis (65%) and focal mesangial proliferative glomerulonephritis (35%). There were no significant differences in the clinical presentation and outcome between the two groups. However, glomerular neutrophil infiltration was more commonly present in diffuse endocapillary proliferative pattern (p = 0.017). The percentage of patients with focal mesangial proliferative pattern significantly increased over time (p < 0.001). At the last follow-up, 6 patients (30%) had died, 6 (30%) were in complete remission, 4 (20%) had partial remission with renal insufficiency, and 4 (20%) were on chronic dialysis. Conclusions. Our data suggested that Staphylococcus had become the leading pathogen in adult postinfectious glomerulonephritis over the past 10 years. Furthermore, atypical histological feature with focal mesangial proliferative pattern was increasingly identified over time. The prognosis was still guarded, carrying a considerable mortality rate and risk for developing chronic renal failure.