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1.
MR Danzig RA Ghandour P Chang AA Wagner PM Pierorazio ME Allaf JM McKiernan 《Urologic oncology》2017,35(3):116
Purpose
We compared renal function outcomes among patients in the surveillance and intervention arms of the DISSRM registry.Materials and methods
Patients were grouped into chronic kidney disease stages by estimated glomerular filtration rate range. Cases were considered up staged if a more advanced chronic kidney disease stage was entered during followup. Chronic kidney disease up staging-free survival was compared among groups using Kaplan-Meier analysis and paired comparisons log rank tests. Multivariate Cox regression identified independent predictors of chronic kidney disease up staging-free survival.Results
A total of 162 patients met the study inclusion criteria, with 68 in the surveillance arm, 65 undergoing partial nephrectomy, 15 undergoing radical nephrectomy, and 14 undergoing cryoablation. Median tumor size was 2.2 cm. Mean estimated glomerular filtration rate change was significantly larger for radical nephrectomy vs. surveillance (?9.2 vs. ?0.5 ml/min/1.73 m2) and for radical vs. partial nephrectomy (?9.2 vs. ?1.9 ml/min/1.73 m2) (P = 0.001). No other groups differed significantly. On Kaplan-Meier analysis, patients undergoing radical nephrectomy had significantly worse chronic kidney disease up staging-free survival vs. those treated with partial nephrectomy (P = 0.029), surveillance (P = 0.007), and cryoablation (P = 0.019). No other groups differed significantly. On multivariate analysis, radical nephrectomy independently predicted poor chronic kidney disease up staging-free survival (odds ratio vs. surveillance 30.6, P = 0.001). Neither partial nephrectomy (P = 0.985) nor cryoablation (P = 0.976) predicted poor chronic kidney disease up staging-free survival relative to surveillance.Conclusions
Patients in the surveillance arm had superior estimated glomerular filtration rate preservation compared to those in the radical nephrectomy but not the partial nephrectomy arm. In certain patients with small renal masses, surveillance and partial nephrectomy may offer comparable renal functional outcomes. This could be partly attributable to a modest estimated glomerular filtration rate decrease associated with surveillance itself. A thorough understanding of the renal functional impacts of treatment modalities is critical in the management of small renal masses. 相似文献2.
Clotilde Loustau Nicolas Rosine Marine Forien Sébastien Ottaviani Pierre-Antoine Juge Frédéric Lioté Thomas Bardin Pascal Richette Philippe Dieudé Christophe Richez Bernard Bannwarth Thierry Schaeverbeke Hang-Korng Ea Marie-Elise Truchetet 《Joint, bone, spine : revue du rhumatisme》2018,85(6):755-760
Objectives
Interleukin (IL)-1β blocking is effective for the treatment of gout flares and is recommended in patients with contraindications to the standard of care, such as stage 4–5 chronic kidney disease (CKD) patients. However, efficacy and safety data regarding these agents are lacking in this population. We aimed to investigate the efficacy and safety of anakinra for the treatment of gout flares in patients with stage 4–5 CKD or renal transplantation.Methods
This retrospective study encompassing 3 academic centres included consecutive patients with stage 4–5 CKD or kidney transplantation who received anakinra for the treatment of acute gouty arthritis and completed at least one follow-up visit. Efficacy, occurrence of infection, and renal function variations were recorded.Results
Of the 31 included patients (24 men, mean age 72 ± 11 years), 25 were non-transplant subjects with stage 4–5 CKD (mean estimated glomerular filtration rate, MDRD formula (eGFR) 22.7 ± 6.5 mL/min/1.73 m2), and six had undergone kidney transplantation (mean eGFR 41.5 ± 22.8 mL/min/1.73 m2). Median gout duration was 3.5 years, and the mean serum urate (SUA) level was 8.7 mg/dL. Twenty-one (68%) patients had tophi, and 21 had gout arthropathy. Anakinra was efficacious in all patients (final VAS 10 and CRP level 10 mg/L). Ten patients (32%) were anakinra dependent (i.e., required prolonged treatment with anakinra). A serious infection was recorded in only one patient, occurring 3 months after starting anakinra. No significant variation in renal function was observed.Conclusion
Anakinra may be a safe therapeutic option for gout patients with advanced CKD. Further randomized controlled studies are required to confirm our results. 相似文献3.
Massimiliano Spaliviero Nicholas E. Power Katie S. Murray Daniel D. Sjoberg Nicole E. Benfante Melanie L. Bernstein James Wren Paul Russo Jonathan A. Coleman 《European urology》2018,73(1):53-59
Background
Mannitol is currently used as a renal protective agent to mitigate the effects of renal ischemia during nephron-sparing surgery (NSS). This routine practice lacks rigorous methodological study.Objective
To assess the effect on renal function outcomes after surgery of mannitol infusion prior to renal ischemia during NSS.Design, setting, participants
This prospective, randomized, placebo-controlled, double-blind trial included 199 patients with a preoperative estimated glomerular filtration rate (eGFR) >45 ml/min/1.73m2 scheduled for NSS; the trial was conducted between July 2012 and July 2015.Intervention
Patients undergoing NSS were randomized to receive mannitol (12.5 g) or placebo intravenously within 30 min prior to renal vascular clamping.Outcome measurements and statistical analysis
The primary outcome was the difference in eGFR (renal function) between the two groups at 6 mo following surgery assessed with an analysis of covariance model using preoperative eGFR, treatment group, and surgical approach as covariates.Results and limitations
At baseline, the median age of the patients was 58 yr, and the median eGFR was 88 ml/min/1.73m2. Comparing placebo with mannitol infusion, the adjusted difference of 0.2 eGFR units at 6 mo was not significant (p = 0.9), with the upper bound of the 95% confidence interval (–3.1 to 3.5) excluding a clinically relevant effect of mannitol. Limitations include evaluation of a single mannitol dose and patients all had excellent preoperative renal function.Conclusions
Intraoperative 12.5 g mannitol infusion during NSS has no demonstrable clinical benefit when compared with standardized fluid hydration in patients with normal preoperative renal function, and its use in this setting is not warranted.Patient summary
In this randomized trial, patients with normal kidney function who received mannitol during surgery to remove part of their kidney had no better kidney function 6 mo after surgery than those who did not receive mannitol. We conclude that this routine practice should be discontinued. 相似文献4.
Peter A. Caputo Homayoun Zargar Daniel Ramirez Hiury S. Andrade Oktay Akca Tianming Gao Jihad H. Kaouk 《European urology》2017,71(1):111-117
Background
The traditional treatment for a cT1b renal tumor has been radical nephrectomy. However, recent guidelines have shifted towards partial nephrectomy (PN) in selected patients with cT1b renal tumors. Furthermore, practitioners have extended the role of cryoablation (CA) to treat cT1b tumors in selected patients.Objective
To evaluate the efficacy of CA compared to PN for cT1b renal tumors.Design, setting, and participants
We performed a retrospective review of patients who underwent either renal CA (laparoscopic or percutaneous) or PN (robot-assisted) for a cT1b renal mass (>4 cm and ≤7 cm) between November 1999 and August 2014. To reduce the inherent biases of a retrospective study, CA and PN groups were matched on the basis of key variables: tumor size, Charlson comorbidity index (CCI), age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, preoperative serum creatinine, preoperative estimated glomerular filtration rate (eGFR), gender, and solitary kidney. The matching algorithm was 1:1 genetic matching with no replacement.Outcome measurements and statistical analysis
Survival analysis was performed only for patients diagnosed with renal cell carcinoma according to histopathologic evaluation of a tumor biopsy or resected tumor specimen. Recurrence-free, overall, and cancer-specific survival were analyzed using Kaplan-Meier survival curves. Survival outcomes were compared between groups using the log-rank test.Results and limitations
A total of 31 patients were treated using CA and 161 using PN during the study period. After matching, there was no significant difference between the PN and CA groups for tumor size (4.6 vs 4.3 cm; p = 0.076), CCI (6 vs 6; p = 0.3), RENAL score (9 vs 8; p = 0.1), age (68 vs 68 yr; p = 0.9), BMI (30 vs 31 kg/m2; p = 0.2), ASA score (3 vs 3; p = 0.3), preoperative creatinine (1.2 vs 1.4 mg/dl; p = 0.2), preoperative eGFR (63 vs 53 ml/min/1.73 m2; p = 0.2), and proportion of patients with a solitary kidney (19% vs 32%; p = 0.4). The total postoperative complication rate was higher for PN than for CA (42% vs 23%; p = 0.10). There was no significant difference in percentage eGFR preservation between PN and CA (89% vs 93%; p = 0.5). The rate of local recurrence was significantly higher for CA than for PN (p = 0.019). There was no significant difference in cancer-specific mortality (p = 0.5) or overall mortality (p = 0.15) between the CA and PN groups.Conclusions
Patients treated with CA for cT1b renal tumors had a significantly higher rate of local cancer recurrence at 1 yr compared to those treated with PN. Until further studies are performed to clearly define the role of CA in cT1b renal tumors, CA should be reserved for patients with imperative indications for nephron-sparing surgery who cannot be subjected to the risks of more invasive PN.Patient summary
We evaluated the efficacy of renal cryoablation compared to partial nephrectomy for clinical T1b renal tumors. The cryoablation and partial nephrectomy groups were matched to provide a better comparison. We concluded that renal cryoablation had a higher rate of local cancer recurrence. 相似文献5.
Kristina H. Berg Lene Ryom Daniel Faurholt-Jepsen Tania Pressler Terese L. Katzenstein 《Journal of cystic fibrosis》2018,17(4):478-483
Background
With improved prognosis of CF, comorbidities including chronic kidney disease (CKD) are becoming increasingly important. Identification of those at highest CKD risk is hence a priority.Methods
In this cross-sectional study, adults with CF attending the Copenhagen CF Centre at Rigshospitalet with ≥ 2 measurements of serum creatinine from 2013 to 2015 were included. Data was obtained from an electronic CF database, which contains anonymised clinical and laboratory data on all individuals attending the clinic. CKD was defined as a confirmed (≥ 3 months apart) estimated glomerular filtration rate ≤ 60 mL/min/1.73m2.Results
Of 181 individuals, the CKD prevalence was 2.7% and increased to 11% after inclusion of lung transplanted patients. Individuals with CKD were generally older (median 39 (IQR, 36–45) vs. 31 (IQR, 24–39) years; p < 0.001), diabetic (86% vs. 41%, p < 0.001), with longer median duration of chronic pulmonary infection (28.3 (20.0–35.8) vs. 20.0 (9.9–34.7) years; p = 0.008) and with longer intravenous aminoglycosides use (606 (IQR, 455–917) vs. 273 (IQR, 91–826) days, p = 0.005).Conclusions
The CKD prevalence is high and related to age, diabetes, chronic infection, transplantation and aminoglycosides use. These observations call for longitudinal studies investigating CKD predictors in adults with CF. 相似文献6.
Alexander M. Helfand Rebekah Beach Miriam Hadj-Moussa Naveen Krishnan Chang He Jeffrey S. Montgomery Todd M. Morgan Alon Z. Weizer Khaled Hafez Cheryl T. Lee John T. Stoffel Ted A. Skolarus 《Urologic oncology》2017,35(1):33.e1-33.e9
Objective
To examine whether long-term renal function and overall survival outcomes vary according to management approach for ureteral anastomotic stricture (UAS) after cystectomy and urinary diversion.Methods
We conducted a retrospective cohort study of patients with benign UAS following cystectomy and urinary diversion using our institutional database. We compared time to stricture, renal function, rates of renal loss, and overall survival between patients undergoing ureteral reimplantation vs. those undergoing nonoperative management (nephrostomy tube or ureteral stent). A multivariable Cox proportional hazard model was used to determine whether reimplantation was independently associated with overall survival.Results
We identified 87 UAS in 69 patients. Reimplantation was performed in 26 patients (37.7%), and 43 patients (62.3%) were managed nonoperatively. The interval between cystectomy and stricture diagnosis was similar in the reimplanted and nonoperative groups (3.06 vs. 4.34 mo, P = 0.42). The differences between baseline and follow-up creatinine levels (+0.40 vs.+0.40 mg/dl, P = 0.72) and estimated glomerular filtration rate (?25.0 vs.?18.9 ml/min/1.73 m2, P = 0.66) were similar between groups, as were rates of renal loss (34.6% vs. 39.5%, P = 0.68); however, mortality was significantly higher in the nonoperative group. After multivariable adjustment, overall survival remained significantly higher among UAS patients who underwent reimplantation (adjusted hazard ratio [aHR] for risk of death = 0.32, 95% CI: 0.13–0.80).Conclusion
Reimplantation was associated with improved overall survival but not with improved long-term renal functional outcomes compared with nonoperative management. Nonrenal complications of nonoperative UAS management may play an important role in reducing longevity. 相似文献7.
Bimal Bhindi Ross J. Mason Mustafa M. Haddad Stephen A. Boorjian Bradley C. Leibovich Thomas D. Atwell Adam J. Weisbrod Grant D. Schmit R. Houston Thompson 《European urology》2018,73(2):254-259
Background
While partial nephrectomy (PN) is considered the standard approach for a tumor in a solitary kidney, percutaneous cryoablation (PCA) is emerging as an alternative nephron-sparing option.Objective
To compare outcomes between PCA and PN for tumors in a solitary kidney.Design, setting, and participants
Patients who underwent PCA or PN between 2005 and 2015 for a single primary renal tumor in a solitary kidney were identified using Mayo Clinic Registries. Exclusion criteria were inherited tumor syndromes and salvage procedures.Intervention
PCA and PN.Outcome measurements and statistical analysis
To achieve balance in baseline characteristics, we used inverse probability of treatment weighting (IPTW) based on propensity to receive treatment. The risk of having a post-treatment complication and percent drop in estimated glomerular filtration rate (eGFR), as well as the risks of local/ipsilateral recurrence, distant metastasis, and cancer-specific mortality, were compared between groups using logistic, linear, and Fine-and-Gray competing risk regression models.Results and limitations
The cohort included 118 patients (PCA: 54; PN: 64) with a median follow-up of 47 mo (interquartile range 18, 74). In unadjusted analyses, PCA was associated with a lower risk of complications (15% vs 31%; odds ratio [OR] = 0.38; 95% confidence interval [CI] 0.15, 0.96; p = 0.04). However, upon accounting for baseline differences with IPTW adjustment, there was no longer a significant difference in the risk of complications (28% vs 29%; OR = 0.95; 95% CI 0.53, 1.69; p = 0.9). There were no significant differences between PCA and PN in percentage drop in eGFR at discharge (mean: 11% vs 16%; β = –5%; 95% CI –13, 3; p = 0.2) or at 3 mo (12% vs 9%; β = 3%; 95% CI –3, 10; p = 0.3). Likewise, no significant differences were noted in local recurrence (HR = 0.87; 95% CI 0.38, 1.98; p = 0.7), distant metastases (HR = 0.60; 95% CI 0.30, 1.20; p = 0.2), or cancer-specific mortality (HR = 1.13; 95% CI 0.32, 3.98; p = 0.8). Limitations include the sample size, given the relative rarity of renal masses in solitary kidneys.Conclusions
Our study found no significant difference in complications, renal function outcomes, and oncologic outcomes between PN and PCA for patients with a tumor in a solitary kidney. Validation in a larger multi-institutional analysis may be warranted.Patient summary
Partial nephrectomy (surgery) and percutaneous cryoablation are both options for treating a kidney tumor while preserving the normal portion of the kidney. In patients with a tumor in their only kidney, we found no difference in the risk of complications, kidney function outcomes, or cancer control outcomes between these two approaches. 相似文献8.
Fiona Mei Wen Wu Fiona Burkhard Filippo Turri Marc Furrer Lukas Loeffel George Thalmann Patrick Wuethrich 《Urologic oncology》2017,35(10):602.e11-602.e17
Objective
To determine whether a restrictive perioperative fluid management in the context of an enhanced recovery after surgery program for radical cystectomy and urinary diversion affects renal function, as fluid restriction and the use of vasopressors have been linked to impaired tissue perfusion, potentially resulting in renal dysfunction.Methods
We followed 166 patients initially included in a randomized clinical trial and equally allocated to receive a continuous norepinephrine administration combined with 1 ml/kg/h initially, and after cystectomy 3 ml/kg/h crystalloid infusion (intervention group, n = 83), or a standard crystalloid infusion of 6 ml/kg/h throughout surgery (control group, n = 83). All patients followed our institutional enhanced recovery after surgery program. We prospectively assessed renal function (plasma creatinine values and estimated glomerular filtration rate Chronic Kidney Disease Epidemiology Collaboration equation) postoperatively. Decreased renal function was defined as a decrease in glomerular filtration rate is greater than 20% compared to preoperative values.Results
There was no significant difference in renal function between the groups postoperatively at any time point after discharge: diabetes mellitus (HR = 2.81 [95% CI: 1.48–5.36]; P = 0.002), preoperative estimated glomerular filtration rate (HR = 1.02 [95% CI: 1.00–1.03]; P = 0.007), and age (OR = 1.03 [95% CI: 11.00–1.06]; P = 0.038) were negative predictors for renal deterioration.Conclusion
Postoperative renal function evolution was similar in patients receiving restrictive hydration with norepinephrine administration when compared to liberal hydration intraoperatively, suggesting that there is no influence of fluid management and administration of vasopressors on mid-term renal function. 相似文献9.
Louis de Laforcade Mickaël Bobot Marie-France Bellin Olivier Clément Steven Grangé Nicolas Grenier Alain Wynckel Dominique Guerrot 《Diagnostic and interventional imaging》2021,102(3):131-139
Contrast medium administration is classically considered to cause or worsen kidney failure, but recent data may moderate this assertion. The European Society of Urogenital Radiology recently published guidelines re-evaluating the precautions before administering contrast media. Kidney injury does not constitute a contra-indication to the administration of iodinated contrast medium, as long as the benefit–risk ratio justifies it. Intravenous hydration with 0.9% NaCl or 1.4% sodium bicarbonate is the only validated measure for the prevention of post-iodine contrast nephropathy. This is necessary for intravenous or intra-arterial administration of iodinated contrast agent without first renal pass when the glomerular filtration rate is less than 30 mL/min/1.73 m2, for intra-arterial administration of iodinated contrast agent with first renal passage when the glomerular filtration rate is less than 45 mL/min/1.73 m2, or in patients with acute renal failure. The use of iodinated contrast medium should allow the carrying out of relevant examinations based on an analysis of the benefit–risk ratio and the implementation of measures to prevent toxicity when necessary. 相似文献
10.
H.H. Lee W.K. Han S.K. Kang K.H. Huh M.S. Kim S.I. Kim Y.S. Kim Y.E. Yoon 《Transplantation proceedings》2017,49(5):1023-1026
Background
Diethylenetriamine pentaacetic acid (DTPA) and multi-detector computed tomography (MDCT) can predict postoperative estimated glomerular filtration rate (eGFR) in a live kidney donor. Accordingly, we compared predicted eGFR measured by use of DTPA and MDCT.Methods
From January 2013 to May 2015, 264 live kidney donors were enrolled. All donors underwent preoperative DTPA and MDCT, and bilateral renal cortex volume was measured by use of MDCT. We estimated DTPA-eGFR [remaining split renal function (%) × preoperative eGFR] and Vol-eGFR [remaining renal volume/total renal volume (%) × preoperative eGFR] and analyzed DTPA-eGFR, Vol-eGFR, and Modification of Diet in Renal Disease (MDRD)-eGFR during week 1 and in months 1, 3, and 6. Additionally, we compared DTPA-eGFR and Vol-eGFR by use of the formula ΔeGFR (maximum eGFR minus minimum eGFR during 6 months).Results
The mean DTPA-eGFR and Vol-eGFR values (mL/min/1.73 m2) were 52.97 ± 10.32 and 51.26 ± 10.26, respectively. Predictions of the dominant side did not agree in 113 of 303 (37.3%) cases. Postoperative MDRD-eGFR exhibited a statistically significant correlation with total renal volume, DTPA-eGFR, and Vol-eGFR (P < .0001). A significant correlation was found between ΔeGFR and total renal volume, DTPA-eGFR, and Vol-eGFR (P < .0001). Receiver operating characteristic curves were generated to predict the possibility of eGFR <60 mL/min/1.73 m2 at 6 months, using DTPA-eGFR and Vol-eGFR, which indicated that DTPA-eGFR (area under the curve = 0.858; P < .0001) and Vol-eGFR (area under the curve = 0.878; P < .0001) could predict chronic kidney disease class III at 6 months.Conclusions
MDRD-eGFR, Vol-eGFR, and DTPA-eGFR were significantly correlated. Moreover, Vol-eGFR and DTPA-eGFR exhibited high predictive value for chronic kidney disease class III at 6 months, whereas Vol-eGFR was a good predictor of renal function recovery. 相似文献11.
Context
Renal colic is a common, acute presentation of urolithiasis that requires immediate pain relief. European Association of Urology guidelines recommend nonsteroidal anti-inflammatory drugs (NSAIDs) as the preferred analgesia. However, the fear of NSAID adverse effects and the uncertainty about superior analgesic effect have maintained the practice of advocating intravenous opioids as the initial analgesia.Objective
The objective of this systematic review and meta-analysis was to compare the safety and efficacy of NSAIDs with opioids and paracetamol (acetaminophen) for the management of acute renal colic.Evidence acquisition
Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, World Health Organization International Clinical Trials Registry Platform, Google Scholar, and the reference list of retrieved articles were searched up to December 2016 without language restrictions. Two reviewers independently assessed eligible studies using the Cochrane Collaboration tool for assessing and reporting the risk of bias and abstracted data using predefined data fields.Evidence synthesis
From 468 potentially relevant studies, 36 randomized controlled trials (RCTs) including 4887 patients, published between 1982 and 2016, were included in this systematic review. The treatment effect observed indicated marginal benefit of NSAIDs over opioids in initial pain reduction at 30 min (11 RCTs, n = 1985, mean difference [MD] –5.58, 95% confidence interval [CI] –10.22 to –0.95; heterogeneity I2 = 81%). In the subgroup analyses by the route of administration, NSAIDs required fewer rescue treatments (seven RCTs, n = 541, number needed to treat [NNT] 11, 95% CI 6–75) and had lower vomiting rates compared with opioids (five RCTs, n = 531, NNT 5, 95% CI 4–8). Comparisons of NSAIDs with paracetamol showed no difference for both drugs at 30 min (four RCTs, n = 1325, MD –5.67, 95% CI –17.52 to 6.18, p = 0.35; I2 = 89%). Patients treated with NSAIDs required fewer rescue treatments (two trials, n = 1145, risk ratio 0.56, 95% CI 0.42–0.74, p < 0.001; I2 = 0%).Conclusions
NSAIDs were equivalent to opioids or paracetamol in the relief of acute renal colic pain at 30 min. There was less vomiting and fewer requirements for rescue analgesia with NSAIDs compared with opioids. Patients treated with NSAIDs required less rescue analgesia compared with paracetamol. Despite observed heterogeneity among the included studies and the overall quality of evidence, the findings of a lower need for rescue analgesia and fewer adverse events, in conjunction with the practical advantages of ease of delivery, suggest that NSAIDs should be the preferred analgesic option for patients presenting to the emergency department with renal colic.Patient summary
In kidney stone–related acute pain episodes in patients with adequate renal function, treatment with nonsteroidal anti-inflammatory drugs offers effective and most sustained pain relief, with fewer side effects, when compared with opioids or paracetamol. 相似文献12.
Wan Song Hyun Hwan Sung Deok Hyun Han Byong Chang Jeong Seong Il Seo Seong Soo Jeon Hyun Moo Lee Han Yong Choi Hwang Gyun Jeon 《Urologic oncology》2017,35(3):114.e1-114.e7
Purpose
We investigated the effect of preoperative contralateral kidney (CK) volume on renal function after radical nephroureterectomy (RNU).Methods
We reviewed 630 patients who underwent RNU between September 1994 and December 2013. Of these 630 patients, 135 patients with advanced upper tract urothelial cancer were ultimately included. Preoperative CK volume was measured from computed tomography images of the venous phase using a specialized volumetric program. Glomerular filtration rate (GFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations and checked preoperatively, 7 days, 1, 3, and 12 months postoperatively.Results
The mean age at surgery was 62.1 (10.1) years and the mean CKD-EPI GFR was 73.8 (75.5) ml/min/1.73 m2. After RNU, new-onset CKD was identified in 69 (51.1%) patients. On multivariate logistic regression analysis, high body mass index (95% CI: 1.08–1.51, P = 0.005), low preoperative CKD-EPI GFR (95% CI: 0.92–0.98, P = 0.037), and low CK volume (95% CI: 0.96–0.99, P<0.001) were associated with new-onset CKD at 1 month after RNU. There was a positive correlation between CK volume and CKD-EPI GFR at 1 month after RNU (Spearman ρ = 0.495, P<0.001). When stratified according to CK volume, CK volume less than 150 ml was significantly associated with new-onset CKD after RNU (95% CI: 2.49–26.29, P = 0.001).Conclusions
High body mass index, low preoperative CKD-EPI GFR, and low CK volume are significantly associated with new-onset CKD. Therefore, they could be used to identify patients eligible for neoadjuvant chemotherapy in upper tract urothelial cancer. 相似文献13.
Kai-wei Yang Geng-yan Xiong Xue-song Li Yuan Tang Qi Tang Cui-jian Zhang Zhi-song He Li-qun Zhou 《World journal of urology》2014,32(4):1027-1031
Purpose
To evaluate the prevalence of baseline chronic kidney disease (CKD) in a large cohort of patients with renal masses in a single Chinese institution. Estimated glomerular filtration rate (eGFR) and CKD stage are more clinically relevant to predict the risk of morbidity and mortality in patients after nephrectomy. But, sCr reflects renal function poorly.Methods
We retrospectively identified patients undergoing kidney surgery between January 2002 and June 2012. eGFR was calculated using the modification of diet in renal disease formulas modified based on Chinese people. CKD stages I–V were defined using the National Kidney Foundation definitions.Results
A total of 2769 patients had adequate data available to calculate a preoperative eGFR (mL/min/1.73m2) with renal cancer confirmed by pathology. Of all patients, 97.7 % awaiting surgery at our institution had a “normal” baseline sCr (≤1.4 mg/dL), and 3.2 % of patients had CKD stage III or worse. Of the 401 patients ≥70 years old, 16.7 % (67/401) had CKD stage III.Conclusion
Many patients with a seemingly normal sCr have CKD stage III or worse, especially in patients over 70 years old. Given the high prevalence of baseline CKD in patients with renal cancer, it is important to preserve renal parenchyma when treating them surgically. 相似文献14.
15.
S.L. Heltshe U. Khan V. Beckett A. Baines J. Emerson D.B. Sanders R.L. Gibson W. Morgan M. Rosenfeld 《Journal of cystic fibrosis》2018,17(3):341-347
Background
While the emergence of chronic and mucoid Pseudomonas aeruginosa (Pa) infection are both associated with poorer outcomes among CF patients, their relationship is poorly understood. We examined the longitudinal relationship of incident, chronic and mucoid Pa in a contemporary, young CF cohort in the current era of Pa eradication therapy.Methods
This retrospective cohort was comprised of patients in the U.S. CF Foundation Patient Registry born 2006–2015, diagnosed before age 2, and with at least 3 respiratory cultures annually. Incidence and age-specific prevalence of Pa infection stages (initial and chronic [≥ 3 Pa + cultures in prior year]) and of mucoid Pa were summarized. Transition times and the interaction between Pa stage and acquisition of mucoid Pa were examined via Cox models.Results
Among the 5592 CF patients in the cohort followed to a mean age of 5.5 years, 64% (n = 3580) acquired Pa. Of those, 13% (n = 455) developed chronic Pa and 17% (n = 594) cultured mucoid Pa. Among those with mucoid Pa, 36% (211/594) had it on their first recorded Pa + culture, while mucoid Pa emerged at or after entering the chronic stage in 12% (73/594). Mucoidy was associated with significantly increased risk of transition to chronic Pa infection (HR = 2.59, 95% CI 2.11, 3.19).Conclusions
Two-thirds of early-diagnosed young children with CF acquired Pa during a median 5.6 years of follow up, among whom 13% developed chronic Pa and 17% acquired mucoid Pa. Contrary to our hypothesis, 87% of young children who developed mucoid Pa did so before becoming chronically infected. 相似文献16.
Yogavijayan Kandasamy Roger Smith Ian M. R. Wright Eugenie R. Lumbers 《Pediatric nephrology (Berlin, Germany)》2013,28(9):1791-1796
Background
Nephron number in humans is determined during fetal life. The objective of this study was to investigate the effects of preterm birth on nephron number using renal volume as a surrogate for nephron number.Methods
This observational study was conducted over 12 months in a tertiary perinatal center. Preterm babies less than 32 weeks of gestation were recruited and followed until discharge. Term infants were recruited for comparison. The babies underwent renal sonography and renal function measurements at 32 and 38 weeks corrected age. The primary outcome measurement was total kidney volume at 38 weeks and the secondary outcome was estimated glomerular filtration rate (eGFR).Results
Forty-four preterm infants and 24 term infants were recruited. At 38 weeks corrected age, premature infants had lower total kidney volume than term infants (21.6?±?5.7 vs. 25.2?±?5.7 ml; p?=?0.02) and a significantly lower eGFR (73.6 [IQR 68.1–77.6] vs. 79.3 [IQR 72.5–86.6] ml·min?1·1.73 m?2; p?=?0.03). There was a significant correlation between total kidney volume and eGFR in premature and term babies.Conclusions
Premature infants have smaller kidney volume and likely decreased nephron number and lower estimated glomerulofiltration rate relative to infants born at term. 相似文献17.
Introduction
Percutaneous nephrolithotomy (PCNL) could be mentioned as the most important treatment of choice for kidney staghorn stones. Previous publications reported that the novel biomarker urinary neutrophil gelatinase-associated lipocalin (NGAL) activity significantly increases in acute kidney injury (AKI) but there is not many published articles related to increase of NGAL after PCNL procedure.Objective
This study aimed to investigate AKI by urinary measurement of NGAL after PCNL procedure.Subjects and methods
Based on a cross-sectional design, 41 patients with staghorn renal stones were nominated. All patients have been informed and signed the consent form. NGAL levels were measured by urinary sampling at 2 h before and 12 h after the procedure. Serum creatinines (Cr) were measured 12 h before and 48 h after the surgery. Demographic and clinical data including surgical procedure were recorded in Excel and analyzed by SPSS (SPSS Inc., Chicago, IL) for windows.Results
With a minimum of 20 and a maximum of 70, the mean age of patients was 47 years old. 71% of patients studied were males. There was a significant change in mean serum Cr (1.06 versus 1.12 mg/dL; p < 0.01) before and after the procedure respectively. Glomerular filtration rate (GFR) with a mean of 81.93 umol/L before the procedure was decreased (p < 0.02) to 77.46 umol/L after the procedure. The changes in urine level of NGAL were significant (p < 0.02), associated to an increase in mean value of 20.63 ng/mL (two hours before) versus 56.28 ng/mL (twelve hours after)the PCNL procedure.Conclusions
Within different extents after PCNL procedure there was a significant increase in the biomarker of NGAL levels.In order to reduce AKI and other post-operative complications, further studies in a large population of patients seem to be advantageous. 相似文献18.
Zhangqun Ye Guohua Zeng Huan Yang Kun Tang Xiaochun Zhang Hong Li Weibing Li Zhong Wu Lingwu Chen Xingfa Chen Xiankui Liu Yaoliang Deng Tiejun Pan Jinchun Xing Shusheng Wang Yue Cheng Xiaojian Gu Wenxi Gao Hua Xu 《European urology》2018,73(3):385-391
Background
Recent large high-quality trials have questioned the clinical effectiveness of medical expulsive therapy using tamsulosin for ureteral stones.Objective
To evaluate the efficacy and safety of tamsulosin for distal ureteral stones compared with placebo.Design, setting, and participants
We conducted a double-blind, placebo-controlled study of 3296 patients with distal ureteral stones, across 30 centers, to evaluate the efficacy and safety of tamsulosin.Intervention
Participants were randomly assigned (1:1) into tamsulosin (0.4 mg) or placebo groups for 4 wk.Outcome measurements and statistical analysis
The primary end point of analysis was the overall stone expulsion rate, defined as stone expulsion, confirmed by negative findings on computed tomography, over a 28-d surveillance period. Secondary end points included time to stone expulsion, use of analgesics, and incidence of adverse events.Results and limitations
Among 3450 patients randomized between September 1, 2011, and August 31, 2013, 3296 (96%) were included in the primary analysis. Tamsulosin benefits from a higher stone expulsion rate than the placebo (86% vs 79%; p < 0.001) for distal ureteral stones. Subgroup analysis identified a specific benefit of tamsulosin for the treatment of large distal ureteral stones (>5 mm). Considering the secondary end points, tamsulosin-treated patients reported a shorter time to expulsion (p < 0.001), required lower use of analgesics compared with placebo (p < 0.001), and significantly relieved renal colic (p < 0.001). No differences in the incidence of adverse events were identified between the two groups.Conclusions
Our data suggest that tamsulosin use benefits distal ureteral stones in facilitating stone passage and relieving renal colic. Subgroup analyses find that tamsulosin provides a superior expulsion rate for stones >5 mm, but no effect for stones ≤5 mm.Patient summary
In this report, we looked at the efficacy and safety of tamsulosin for the treatment of distal ureteral stones. We find that tamsulosin significantly facilitates the passage of distal ureteral stones and relieves renal colic. 相似文献19.
L. Garcia-Covarrubias D.R. Valdéz L.A. Bermudez R. Córdoba F.J. Avelar R.M. Villanueva D. Ortuño J.C. Hernández A. García I. Castro 《Transplantation proceedings》2018,50(2):428-432
Introduction
As a pretransplantation evaluation, renal function is determined by the glomerular filtration rate (GFR) with the use of renal scintigraphy (RS) and the estimated glomerular filtration rate (eGFR). To date, there are few studies that correlate renal cortex volume with eGFR determined with renal gammagram (GR) and eGFR by equations (Cockroft-Gault, Modification of Diet in Renal Disease, and Chronic Kidney Disease Epidemiology Collaboration equation) in Latin American living donors.Aim
This study sought to determine whether there is correlation of the volume of the renal cortex by Herts equation with the GFR determined with renal gammagram (GFR-GR).Patients and Methods
This was an analytical, observational, and cross-sectional study. A review of the donor charts from January 1, 2014, to December 1, 2014, with a complete clinical file, kidney measurements, predonation tomography volume, and eGFR by different formulas and by renal scintigraphy.Results
Thirty-three donors were included, 51.5% male and 48.5% female. The mean age was 38.58 ± 10 years, with an average volume of 127.83 ± 28.30 mL, with diethylenetriamine-pentaacetate (DTPA) of 54.80 ± 7.13 mL/min/1.73 m2 in the donated kidney. Spearman correlation showed the best association with the Herts equation (r = 0.346) reaching significance (P = .049) when comparing the different equations against the GFR with DTPA. Using the Bland-Altman method, the lowest variability and best significance was verified with the same equation compared to the other formulas (P = .0002).Conclusions
There is no consensus regarding which is the best formula for calculating the GFR of both kidneys. Of the different formulas, the one that best correlated with the GFR was the Herts method, which uses the volume of the kidney. 相似文献20.
Silvia Ceccanti Francesco Cozzi Alice Cervellone Augusto Zani Denis A. Cozzi 《Journal of pediatric surgery》2019,54(2):326-330