Hyaline‐vascular type Castleman’s disease of the pararenal retroperitoneum: Multidetector CT findings

We describe the case of a 40‐year‐old woman who presented with a pararenal hyaline‐vascular type Castleman’s disease that had an arterial supply from the renal artery and a draining vein as showed by multidetector CT. Identification of the renal artery relationship to the feeding vessel of the mass is critical to prevent potential surgical complications.     

原发性肝癌自发性破裂出血26例临床分析

目的探讨总结肝癌自发性破裂出血的诊治经验。方法回顾性分析海口市人民医院自1992年1月～2004年5月收治26例原发性肝癌破裂出血的临床资料。结果该组原发性肝癌自发性破裂出血病例中，行肝癌切除术者，生存时间长。结论原发性肝癌破裂出血行肝叶切除和肝局部切除不但可以彻底有效地止血，而且可以达到切除肿瘤的目的，是首选的方法，是一种安全、可行的方法．如果病人情况不允许，可先行保守治疗或介入治疗（TAE），争取行Ⅱ期或延期肝切除术。而肝动脉结扎加胃网膜右静脉插管化疗，注入无水酒精等癌灶综合治疗为一种有效的辅助措施。     

Failure of intravenous fluid therapies to decrease serum sodium levels in elderly hospitalized patients

Elderly patients may have a tendency to develop hyponatremia due to sensitivity to stimuli that release ADH as well as an impaired ability to excrete a water load. We evaluated changes in serum sodium in elderly hospitalized patients who received various forms of intravenous fluid therapies. All patients were required to have a baseline serum sodium of 136–145 meq/L. Fourteen patients were enrolled in the study. The mean age was 82.9 ± 6.8 years (mean ± SEM). Thirty-six % were nursing home residents. Seventy-nine % were females. Seventy-two % received half normal saline and the remainder received normal saline as intravenous fluid therapy. The patients received a mean of 1098 ± 145 mL of intravenous fluid per day, in addition to oral fluids. Mean follow up period was 5.9 days (3–10 days). Mean baseline serum sodium was 140.2 ± 0.7 meq/L and mean follow up serum sodium was 141.4 ± 0.9 meq/L. The mean baseline BUN was 25 ± 3.6 mg/dL and mean follow u BUN was 19.6 ± 3.4 mg/dL. The mean baseline serum creatinine was 0.9 ± 0.1 mg/dL and mean follow up creatinine was 0.9 ± 0.1 mg/dL. The postintravenous fluid therapy serum sodium in the group receiving half normal saline was 141.7 ± 0.7 meq/L and 140.8 ± 3 meq/L in the normal saline group. No significant difference was observed between the pre and post fluid therapy for any of these paramenters (p > 0.05). Mean baseline plasma renin activity was 1.6 ± 0.7 ng/ml/hour and fifty-seven % had PRA of less than 1 ng/ml/hour. Mean plasma aldosterone was 8.5 ± 1.8 ng/mL and forty-two % were less than 5.5 ng/mL. Plasma ADH and ANP was 5.7 ± 3.4 pg/mL and 83.6 ± 26.9 pg/mL, respectively. Mean serum and urine osmolalities were 290 ± 3.1 mOsm/kg and 471 ± 57.7 mOsm/kg, respectively. No patient developed hyponatremia and 7 of the 14 patients experienced an increase in serum sodium during the follow up period. We conclude that many elderly patients hospitalized for acute medical illnesses either maintain a stable serum sodium or experience an increase in serum sodium. This occurs because total fluids administered to these patients are generally insufficient.     

Increasing incidence of focal segmental glomerulosclerosis and an examination of demographic patterns

BACKGROUND: Idiopathic focal segmental glomerulosclerosis (FSGS) is one of the leading causes of the nephrotic syndrome in adults and an important cause of end-stage renal disease. Its incidence has dramatically increased in the last two decades and it is especially prevalent among black patients. The trend of FSGS incidence has not been reported beyond 1997. METHODS: We retrospectively reviewed all renal biopsies performed at our institution between 1986 and 2002 and identified patients with diagnoses consistent with primary glomerulopathy (PG), which included: minimal-change disease (MCD), idiopathic focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MGN), IgA nephropathy (IgA), membrano-proliferative glomerulonephritis (MPGN) and mesangioproliferative glomerulonephritis. Patients with possible secondary causes for their renal disease were excluded. Clinical data at the time of biopsy and follow-up data were collected and analyzed. RESULTS: During the period from January 1986-December 2002, 299 renal biopsies were performed and 132 patients were diagnosed with PG. FSGS was the most common form of PG representing 37.8% of all PG followed by IgA 27.3%, MGN 16.6% and MCD 9.1%. Among FSGS patients 59% were females, 64% had nephrotic range proteinuria and 54% had the nephrotic syndrome. Mean serum creatinine was 2.0 +/- 0.2 mg/dl and mean protein excretion was 6.1 +/- 1.0 g/day. The incidence of FSGS increased from 19.3% (1986-1991) and 16.6% (1992-1997) to 58.5% in the period from 2002. The increase occurred among black and Hispanic patients (33.3-79.2%) as well as white patients (12.5-51.5%). Black and Hispanic patients with PG presented for renal biopsy at a significantly younger age than white patients (p = 0.003), with mean age 37.5 +/- 2.0 years vs. 50.3 +/- 1.8 years. White FSGS patients were significantly older than white non-FSGS patients (mean age 56.4 +/- 3.2 years vs. 48.0 +/- 2.0 years, p = 0.03). Black and Hispanic FSGS patients were also older when compared to their non-FSGS counter-parts (mean age 40.6 +/- 2.8 years vs. 32.1 +/- 2.0 years, p = 0.04). When patients were stratified by age (< 45 years and > or = 45 years), FSGS was the most common diagnosis in both age groups among black and Hispanic patients (55.1% and 88.8%) but only among older white patients (36.2%). CONCLUSIONS: The incidence of FSGS as a proportion of PG in our population has increased markedly in the most recent time period analyzed (1998-2002). The increase has occurred among both white and black and Hispanic patients. We also found that FSGS was most prevalent in patients > or = 45 years.     

Message from the New President of the International Society for Geriatric Nephrology and Urology

International Urology and Nephrology -     

Anion excretion pattern following infusion of hyperoncotic human serum albumin into dogs.

The effects of hyperoncotic human serum albumin on the excretion rates of several electrolytes and cyclic-AMP were measured in mongrel dogs and the results were compared with those obtained after the infusion of saline. Hyperoncotic albumin increased the excretion rates of sodium, potassium, bicarbonate, and phosphate. There was a small increase in chloride excretion after albumin, while there was a significant decrease in the rate of excretion of cyclic-AMP. Saline, on the other hand, caused a marked increase in the rate of of excretion of all the measured ions. Like albumin, saline was associated with a decrease in the rate of excretion of cyclic-AMP. The marked increase in bicarbonate and phosphate excretion suggests that the response to albumin which includes decreased isotonic reabsorption in the proximal tubule and increased urinary sodium excretion could result from decreased reabsorption in the proximal tubule accompanied by distal sodium and chloride reabsorption. Saline, on the other hand, caused a greater increase in sodium excretion and, although phosphate and bicarbonate excretion also increased, a much greater effect on the excretion of chloride was observed, suggesting that saline may also decrease sodium and chloride reabsorption in the distal nephron.