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Chahine R, Mendiratta-Lala M, Consul N, Wang J, Stein EB, Roseland ME, Aslam A. What can go wrong when doing right? A pictorial review of iatrogenic genitourinary complications. Abdom Radiol (NY) 2024:10.1007/s00261-024-04384-8. [PMID: 38832944 DOI: 10.1007/s00261-024-04384-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 06/06/2024]
Abstract
A growing number of treatments for genitourinary diseases can result in various iatrogenic complications. Multimodality imaging in the post-procedural setting is essential for early and accurate diagnosis to limit morbidity and mortality. We review common and uncommon treatment-induced pathologies affecting the genitourinary system via a case-based approach. We illustrate notable complications affecting the kidneys, ureters, bladder, and urethra induced by percutaneous procedures, external beam radiation, immunotherapy, laparoscopic/robotic pelvic surgery, and intravesicular BCG. Finally, we provide guidance on optimal imaging techniques for diagnosis and highlight the role of image-guided interventions for mitigation of complications.
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Affiliation(s)
- Reve Chahine
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA.
| | - Mishal Mendiratta-Lala
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
| | - Nikita Consul
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
| | - Jeffrey Wang
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
| | - Erica B Stein
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
| | - Molly E Roseland
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
| | - Anum Aslam
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
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2
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Chen KY, Lange MJ, Qiu JX, Lambert D, Mithqal A, Krupski TL, Schenkman NS, Lobo JM. Cost-Effectiveness Analysis of the Clear Cell Likelihood Score Against Renal Mass Biopsy for Evaluating Small Renal Masses. Urology 2024; 188:111-117. [PMID: 38648945 PMCID: PMC11193637 DOI: 10.1016/j.urology.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/21/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To examine the cost-effectiveness of the clear cell likelihood score compared to renal mass biopsy (RMB) alone. METHODS The clear cell likelihood score, a new grading system based on multiparametric magnetic resonance imaging, has been proposed as a possible alternative to percutaneous RMB for identifying clear cell renal carcinoma in small renal masses and expediting treatment of high-risk patients. A decision analysis model was developed to compare a RMB strategy where all patients undergo biopsy and a clear cell likelihood score strategy where only patients that received an indeterminant score of 3 undergo biopsy. Effectiveness was assigned 1 for correct diagnoses and 0 for incorrect or indeterminant diagnoses. Costs were obtained from institutional fees and Medicare reimbursement rates. Probabilities were derived from literature estimates from radiologists trained in the clear cell likelihood score. RESULTS In the base case model, the clear cell likelihood score was both more effective (0.77 vs 0.70) and less expensive than RMB ($1629 vs $1966). Sensitivity analysis found that the nondiagnostic rate of RMB and the sensitivity of the clear cell likelihood score had the greatest impact on the model. In threshold analyses, the clear cell likelihood score was the preferred strategy when its sensitivity was greater than 62.7% and when an MRI cost less than $5332. CONCLUSION The clear cell likelihood score is a more cost-effective option than RMB alone for evaluating small renal masses for clear cell renal carcinoma.
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Affiliation(s)
- Katherina Y Chen
- Department of Urology, University of Virginia, Charlottesville, VA
| | - Moritz J Lange
- University of Virginia School of Medicine, Charlottesville, VA
| | - Jessica X Qiu
- University of Virginia School of Medicine, Charlottesville, VA
| | - Drew Lambert
- Department of Radiology and Medical Imaging, Charlottesville, VA
| | - Ayman Mithqal
- Department of Radiology and Medical Imaging, Charlottesville, VA
| | - Tracey L Krupski
- Department of Urology, University of Virginia, Charlottesville, VA
| | - Noah S Schenkman
- Department of Urology, University of Virginia, Charlottesville, VA
| | - Jennifer M Lobo
- Department of Urology, University of Virginia, Charlottesville, VA; Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA.
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3
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Lester W, Bent C, Alikhan R, Roberts L, Gordon-Walker T, Trenfield S, White R, Forde C, Arachchillage DJ. A British Society for Haematology guideline on the assessment and management of bleeding risk prior to invasive procedures. Br J Haematol 2024; 204:1697-1713. [PMID: 38517351 DOI: 10.1111/bjh.19360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Will Lester
- Department of Haematology, University Hospitals Birmingham, Birmingham, UK
| | - Clare Bent
- Department of Radiology, University Hospitals Dorset, Dorset, UK
| | - Raza Alikhan
- Department of Haematology, University Hospitals of Cardiff, Cardiff, UK
| | - Lara Roberts
- Department of Haematology, King College London, London, UK
| | - Tim Gordon-Walker
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Sarah Trenfield
- Department of Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK
| | - Richard White
- Department of Radiology, Cardiff and Vale UHB, Cardiff, UK
| | - Colm Forde
- Department of Radiology, University Hospitals Birmingham, Birmingham, UK
| | - Deepa J Arachchillage
- Department of Immunology and Inflammation, Centre for Haematology, Imperial College London, London, UK
- Department of Haematology, Imperial College Healthcare NHS Trust, London, UK
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4
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Fateri C, Roth B, Rao S, Peta A, Limfueco L, Bui TL, Kar N, Glavis-Bloom J, Cumpanas A, Landman J, Houshyar R. Utilization of Re-VASC, the Novel Retroperitoneal Neovascularity Scoring System, for Characterization of T1a Small Renal Masses. J Endourol 2024; 38:301-305. [PMID: 38149604 DOI: 10.1089/end.2023.0421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
Purpose: Early characterization of small (T1a, <4 cm) renal masses is imperative for patient care and treatment planning. Renal biopsy is a sensitive and specific procedure that can accurately differentiate small renal masses as malignant or benign. However, it is an invasive procedure with a nonnegligible complication rate and is not performed routinely at most institutions. In this study, we sought to apply the Retroperitoneal Vascularity Assessment and Scoring in Carcinoma (Re-VASC) scoring system to T1a renal masses and analyzed whether it could differentiate these masses as benign or malignant. Methods: We obtained Institutional Review Board approval to retrospectively examine the records of all patients who presented to our single, urban academic referral center for surgical treatment of renal cell carcinoma (RCC). For the malignant group, patients with a diagnosis of T1a RCC from pathologic evaluation were included. Additionally, patients with a histopathological diagnosis of a T1a nonmalignant renal mass (fat poor-angiomyolipoma or oncocytoma) were included in our benign group. Results: This study includes 57 benign and 69 malignant T1a renal tumors. Average size for benign and malignant masses were 2.47 and 2.63, respectively (p = 0.267). Analysis demonstrated no significant difference between both groups in terms of sex, laterality, or size. The average Re-VASC score of benign and malignant masses was 0.175 and malignant masses was 0.784, respectively (p < 0.001). Additionally, the Re-VASC score was independently associated with malignancy with an odds ratio of 2.223 (p = 0.0109). Conclusion: The Re-VASC scoring system exhibits significantly greater values for malignant T1a renal masses when compared to benign masses. As a result, it shows promise as an adjunctive tool to renal biopsy for clinical decision-making. Further assessment of Re-VASC's true efficacy as a diagnostic marker will include prospective evaluation of a larger multicenter population.
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Affiliation(s)
- Cameron Fateri
- Department of Radiology and University of California, Irvine, Orange, California, USA
| | - Bradley Roth
- Department of Radiology and University of California, Irvine, Orange, California, USA
| | - Sriram Rao
- Department of Radiology and University of California, Irvine, Orange, California, USA
| | - Akhil Peta
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Luke Limfueco
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Thanh-Lan Bui
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Nina Kar
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Justin Glavis-Bloom
- Department of Radiology and University of California, Irvine, Orange, California, USA
| | - Andrei Cumpanas
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Jaime Landman
- Department of Radiology and University of California, Irvine, Orange, California, USA
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Roozbeh Houshyar
- Department of Radiology and University of California, Irvine, Orange, California, USA
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5
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Carraro A, De Gaspari P, Antoniello B, Marzenta D, Vianello E, Bussolati B, Tritta S, Collino F, Bertoldi L, Benvenuto G, Vedovelli L, Benetti E, Negrisolo S. New Insights into Pediatric Kidney Transplant Rejection Biomarkers: Tissue, Plasma and Urine MicroRNAs Compared to Protocol Biopsy Histology. Int J Mol Sci 2024; 25:1911. [PMID: 38339187 PMCID: PMC10856071 DOI: 10.3390/ijms25031911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
The early identification of a subclinical rejection (SCR) can improve the long-term outcome of the transplanted kidney through intensified immunosuppression. However, the only approved diagnostic method is the protocol biopsy, which remains an invasive method and not without minor and/or major complications. The protocol biopsy is defined as the sampling of allograft tissue at pre-established times even in the absence of an impaired renal function; however, it does not avoid histological damage. Therefore, the discovery of new possible biomarkers useful in the prevention of SCR has gained great interest. Among all the possible candidates, there are microRNAs (miRNAs), which are short, noncoding RNA sequences, that are involved in mediating numerous post-transcriptional pathways. They can be found not only in tissues, but also in different biological fluids, both as free particles and contained in extracellular vesicles (EVs) released by different cell types. In this study, we firstly performed a retrospective miRNA screening analysis on biopsies and serum EV samples of 20 pediatric transplanted patients, followed by a second screening on another 10 pediatric transplanted patients' urine samples at one year post-transplant. In both cohorts, we divided the patients into two groups: patients with histological SCR and patients without histological SCR at one year post-transplantation. The isolated miRNAs were analyzed in an NGS platform to identify different expressions in the two allograft states. Although no statistical data were found in sera, in the tissue and urinary EVs, we highlighted signatures of miRNAs associated with the histological SCR state.
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Affiliation(s)
- Andrea Carraro
- Laboratory of Immunopathology and Molecular Biology of the Kidney, Department of Women’s and Children’s Health, University of Padova, 35127 Padua, Italy
| | - Piera De Gaspari
- Laboratory of Immunopathology and Molecular Biology of the Kidney, Department of Women’s and Children’s Health, University of Padova, 35127 Padua, Italy
- Laboratory Reference, Euroimmun Italy, 35127 Padua, Italy
| | - Benedetta Antoniello
- Laboratory of Immunopathology and Molecular Biology of the Kidney, Department of Women’s and Children’s Health, University of Padova, 35127 Padua, Italy
| | - Diana Marzenta
- Laboratory of Immunopathology and Molecular Biology of the Kidney, Department of Women’s and Children’s Health, University of Padova, 35127 Padua, Italy
- Pediatric Nephrology, Department of Women’s and Children’s Health, Padua University Hospital, 35128 Padua, Italy
| | - Emanuele Vianello
- Pediatric Nephrology, Department of Women’s and Children’s Health, Padua University Hospital, 35128 Padua, Italy
| | - Benedetta Bussolati
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10124 Torino, Italy
| | - Stefania Tritta
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10124 Torino, Italy
| | - Federica Collino
- Department of Clinical Sciences and Community Health, University of Milano, 20126 Milan, Italy
- Paediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | | | | | - Luca Vedovelli
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Elisa Benetti
- Laboratory of Immunopathology and Molecular Biology of the Kidney, Department of Women’s and Children’s Health, University of Padova, 35127 Padua, Italy
- Pediatric Nephrology, Department of Women’s and Children’s Health, Padua University Hospital, 35128 Padua, Italy
- Pediatric Research Institute “IRP Città della Speranza”, 35127 Padua, Italy
| | - Susanna Negrisolo
- Laboratory of Immunopathology and Molecular Biology of the Kidney, Department of Women’s and Children’s Health, University of Padova, 35127 Padua, Italy
- Pediatric Research Institute “IRP Città della Speranza”, 35127 Padua, Italy
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Giordano F, Mitrotti A, Losurdo A, Esposito F, Granata A, Pesino A, Rossini M, Natale P, Dileo V, Fiorentino M, Gesualdo L. Effect of music therapy intervention on anxiety and pain during percutaneous renal biopsy: a randomized controlled trial. Clin Kidney J 2023; 16:2721-2727. [PMID: 38046004 PMCID: PMC10689136 DOI: 10.1093/ckj/sfad246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Indexed: 12/05/2023] Open
Abstract
Background Percutaneous renal biopsy (PRB) may subject patients to emotional distress and pain before and during the biopsy. The aim of this study was to evaluate the effects of complementary/non-pharmacological interventions such as music therapy (MT) on anxiety, pain and satisfaction in renal patients undergoing PRB. Methods A prospective, single-centre, single-blind, randomized controlled two-arm trial was conducted. Patients ≥18 years of age, hospitalized at the Nephrology, Dialysis and Transplantation Unit (Bari, Italy) and scheduled for PRB were screened. Participants were assigned to standard treatment (CG) or to the music therapy (MT) intervention group. Participants in the MT group received standard care and an MT intervention by a certified music therapist qualified in guided imagery and music. The CG patients received the standard of care. MT and CG patients were subjected to identical measurements (pre/post) of the parameters in the State Trait Anxiety Inventory Y1 (STAI-Y1), visual analogue scale for pain (VAS-P) and satisfaction (VAS-S) and heart rate variability. Results A statistically significant difference in the anxiety scores after PRB between MT and CG patients (STAI-Y1 35.4 ± 6.2 versus 42.9 ± 9.0) was observed. MT also had strong and significant effects on VAS-P compared with CG (5.0 ± 1.4 versus 6.3 ± 1.3, respectively; P < .001) and VAS-S (7.8 ± 1.0 versus 6.0 ± 0.9, respectively; P < .001). Decreased activity of the sympathetic nervous system and increased activity of the parasympathetic nervous system was observed after PRB in the MT group. Conclusion Our study supports the use of MT to mitigate the psychological anxiety, pain and sympathetic activation associated with PRB.
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Affiliation(s)
- Filippo Giordano
- Nephrology, Dialysis and Transplantation, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Adele Mitrotti
- Nephrology, Dialysis and Transplantation, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Antonia Losurdo
- Nephrology, Dialysis and Transplantation, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | | | - Antonio Granata
- Nephrology and Dialysis Unit, “Cannizzaro” Emergency Hospital, Catania, Italy
| | - Alessandra Pesino
- Nephrology, Dialysis and Transplantation, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Michele Rossini
- Nephrology, Dialysis and Transplantation, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Patrizia Natale
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Vincenzo Dileo
- Nephrology, Dialysis and Transplantation, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Marco Fiorentino
- Nephrology, Dialysis and Transplantation, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
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7
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Madhvapathy SR, Wang JJ, Wang H, Patel M, Chang A, Zheng X, Huang Y, Zhang ZJ, Gallon L, Rogers JA. Implantable bioelectronic systems for early detection of kidney transplant rejection. Science 2023; 381:1105-1112. [PMID: 37676965 DOI: 10.1126/science.adh7726] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/19/2023] [Indexed: 09/09/2023]
Abstract
Early-stage organ transplant rejection can be difficult to detect. Percutaneous biopsies occur infrequently and are risky, and measuring biomarker levels in blood can lead to false-negative and -positive outcomes. We developed an implantable bioelectronic system capable of continuous, real-time, long-term monitoring of the local temperature and thermal conductivity of a kidney for detecting inflammatory processes associated with graft rejection, as demonstrated in rat models. The system detects ultradian rhythms, disruption of the circadian cycle, and/or a rise in kidney temperature. These provide warning signs of acute kidney transplant rejection that precede changes in blood serum creatinine/urea nitrogen by 2 to 3 weeks and approximately 3 days for cases of discontinued and absent administration of immunosuppressive therapy, respectively.
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Affiliation(s)
- Surabhi R Madhvapathy
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA 60208
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA 60208
| | - Jiao-Jing Wang
- Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA 60611
| | - Heling Wang
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA 60208
- Department of Civil Engineering, Northwestern University, Evanston, IL, USA 60208
- Laboratory of Flexible Electronics Technology, Tsinghua University, Beijing, 100085 China
| | - Manish Patel
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA 60208
- Department of Intervention Radiology, University of Illinois at Chicago, Chicago, IL, USA 60612
| | - Anthony Chang
- Department of Pathology, University of Chicago, Chicago, IL USA 60637
| | - Xin Zheng
- Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA 60611
| | - Yonggang Huang
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA 60208
- Department of Civil Engineering, Northwestern University, Evanston, IL, USA 60208
| | - Zheng J Zhang
- Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA 60611
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA 60611
- Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, IL, USA 60611
| | - Lorenzo Gallon
- Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA 60611
- Department of Nephrology, Northwestern University, Chicago, IL, USA 60611
| | - John A Rogers
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA 60208
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA 60208
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA 60208
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA 60611
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8
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Møller M, Borg R, Bressendorff I, Fink LN, Gravesen E, Jensen KH, Hansen T, Krustrup D, Persson F, Rossing P, Sembach FE, Thuesen ACB, Hansen D. Rationale and design of a prospective, clinical study of kidney biopsies in people with type 2 diabetes and severely increased albuminuria (the PRIMETIME 2 study). BMJ Open 2023; 13:e072216. [PMID: 37280026 PMCID: PMC10254618 DOI: 10.1136/bmjopen-2023-072216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/14/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Diabetic kidney disease is a severe complication of diabetes. The diagnosis is based on clinical characteristics such as persistently elevated albuminuria, hypertension and decline in kidney function, although this definition is not specific to kidney disease caused by diabetes. The only way to establish an accurate diagnosis-diabetic nephropathy-is by performing a kidney biopsy. The histological presentation of diabetic nephropathy can be associated with a heterogeneous range of histological features with many pathophysiological factors involved demonstrating the complexity of the condition. Current treatment strategies aim to slow disease progression and are not specific to the underlying pathological processes.This study will investigate the prevalence of diabetic nephropathy in individuals with type 2 diabetes (T2D) and severely elevated albuminuria. The deep molecular characterisation of the kidney biopsy and biological specimens may pave the way for improved diagnostic accuracy and a better understanding of the pathological processes involved and may also reveal new targets for individualised treatment. METHODS AND ANALYSIS In the PRecIsion MEdicine based on kidney TIssue Molecular interrogation in diabetic nEphropathy 2 study, research kidney biopsies will be performed in 300 participants with T2D, urine albumin/creatinine ratio ≥700 mg/g and estimated glomerular filtration ratio >30 mL/min/1.73 m2. Cutting-edge molecular technologies will be applied to the kidney, blood, urine, faeces and saliva samples for comprehensive multi-omics profiling. The associated disease course and clinical outcomes will be assessed by annual follow-up for 20 years. ETHICS AND DISSEMINATION The Danish Regional Committee on Health Research Ethics and the Knowledge Center on Data Protection (in the Capital Region of Denmark) have granted approval for the study. The results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04916132.
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Affiliation(s)
- Marie Møller
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Rikke Borg
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Iain Bressendorff
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | | | - Eva Gravesen
- Department of Pathology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Karina Haar Jensen
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dorrit Krustrup
- Department of Pathology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | | | - Peter Rossing
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | - Anne C B Thuesen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Hansen
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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9
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Choudhuri S, Rainone F. Assessment of current clinical practice throughout the UK for the diagnosis and management of monoclonal gammopathy of renal significance. EJHAEM 2023; 4:410-418. [PMID: 37206284 PMCID: PMC10188446 DOI: 10.1002/jha2.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/31/2023] [Indexed: 05/21/2023]
Abstract
Since the inception of the term monoclonal gammopathy of renal significance (MGRS) in 2012 by the International Kidney and Monoclonal Gammopathy Research Group, there have been no consensus guidelines specifically pertaining to the UK regarding to patient management. We aimed to identify both regional and cross-discipline variation in current clinical practice, to provide insight and rationale for a potential standardised pathway in the future. A national survey of 88 consultants from the disciplines of haematology and nephrology was conducted between June 2020 and July 2021. Agreement was evident for aspects of the diagnostic pathway, including presenting features likely to raise suspicion of MGRS and the most pertinent confounding factors to consider before renal biopsy. However, significant variability was identified in both the cohort of diagnostic tests used, as well as urinary work-up for patients with suspected MGRS. Treatment and monitoring frequency was also an aspect of management identified as variable. Despite differences in clinical practice across the UK, MGRS diagnosis was widely regarded to be the joint responsibility of both disciplines. The results provide an indication of inter-regional and interdisciplinary differences in practice, highlighting the need for improved awareness and standardised protocol for management of MGRS that applies to the UK population.
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10
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Luo C, Liu H, Shao L, Tang J, He Q, Jin J. The role of small extracellular vesicle non-coding RNAs in kidney diseases. Front Genet 2022; 13:1013637. [PMID: 36303545 PMCID: PMC9593037 DOI: 10.3389/fgene.2022.1013637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/27/2022] [Indexed: 12/02/2022] Open
Abstract
Kidney diseases have become an increasingly common public health concern worldwide. The discovery of specific biomarkers is of substantial clinical significance in kidney disease diagnosis, therapy and prognosis. The small extracellular vesicle (sEV) can be secreted by several cell types, like renal tubular epithelial cells, podocytes, collecting duct cells and leap cells, and functions as a communication medium between cells by delivering signaling molecules, including proteins, lipids and nucleic acids. There has been growing evidence that kidney diseases are associated with aberrant expression of sEV-derived non-coding RNAs (sEV-ncRNAs). As a result, sEV-ncRNAs may provide valuable information about kidney diseases. In this paper, a systematic review is presented of what has been done in recent years regarding sEV-ncRNAs in kidney disease diagnosis, treatment and prognosis.
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Affiliation(s)
- Chuxuan Luo
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- Division of Health Sciences, Hangzhou Normal University, Hangzhou, China
| | - Haojie Liu
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- The 2nd Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lina Shao
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Jiyu Tang
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- The 2nd Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Qiang He
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
- *Correspondence: Juan Jin, ; Qiang He,
| | - Juan Jin
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- *Correspondence: Juan Jin, ; Qiang He,
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Niroshan V, Balagobi B, Brammah T, Weerasinghe N, Gowribahan T. Surgically managed acute Page kidney following renal biopsy-A case report. Int J Surg Case Rep 2022; 99:107641. [PMID: 36122422 PMCID: PMC9568784 DOI: 10.1016/j.ijscr.2022.107641] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction and importance Case presentation Clinical discussion Conclusion
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Affiliation(s)
- V Niroshan
- University Surgical Unit, Teaching Hospital of Jaffna, Sri Lanka
| | - B Balagobi
- University Surgical Unit, Teaching Hospital of Jaffna, Sri Lanka.
| | - T Brammah
- University Medical Unit, Teaching Hospital of Jaffna, Sri Lanka
| | - N Weerasinghe
- Urology Unit, Teaching Hospital of Jaffna, Sri Lanka
| | - T Gowribahan
- Urology Unit, Teaching Hospital of Jaffna, Sri Lanka
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Comparative Analysis for the Distinction of Chromophobe Renal Cell Carcinoma from Renal Oncocytoma in Computed Tomography Imaging Using Machine Learning Radiomics Analysis. Cancers (Basel) 2022; 14:cancers14153609. [PMID: 35892868 PMCID: PMC9332006 DOI: 10.3390/cancers14153609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/13/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023] Open
Abstract
Background: ChRCC and RO are two types of rarely occurring renal tumors that are difficult to distinguish from one another based on morphological features alone. They differ in prognosis, with ChRCC capable of progressing and metastasizing, but RO is benign. This means discrimination of the two tumors is of crucial importance. Objectives: The purpose of this research was to develop and comprehensively evaluate predictive models that can discriminate between ChRCC and RO tumors using Computed Tomography (CT) scans and ML-Radiomics texture analysis methods. Methods: Data were obtained from 78 pathologically confirmed renal masses, scanned at two institutions. Data from the two institutions were combined to form a third set resulting in three data cohorts, i.e., cohort 1, 2 and combined. Contrast-enhanced scans were used and the axial cross-sectional slices of each tumor were extracted from the 3D data using a semi-automatic segmentation technique for both 2D and 3D scans. Radiomics features were extracted before and after applying filters and the dimensions of the radiomic features reduced using the least absolute shrinkage and selection operator (LASSO) method. Synthetic minority oversampling technique (SMOTE) was applied to avoid class imbalance. Five ML algorithms were used to train models for predictive classification and evaluated using 5-fold cross-validation. Results: The number of selected features with good model performance was 20, 40 and 6 for cohorts 1, 2 and combined, respectively. The best model performance in cohorts 1, 2 and combined had an excellent Area Under the Curve (AUC) of 1.00 ± 0.000, 1.00 ± 0.000 and 0.87 ± 0.073, respectively. Conclusions: ML-based radiomics signatures are potentially useful for distinguishing ChRCC and RO tumors, with a reliable level of performance for both 2D and 3D scanning.
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Yang Y, Zeng C, Yang K, Xu S, Zhang Z, Cai Q, He C, Zhang W, Liu SM. Genome-wide Analysis Reflects Novel 5-Hydroxymethylcytosines Implicated in Diabetic Nephropathy and the Biomarker Potential. EXTRACELLULAR VESICLES AND CIRCULATING NUCLEIC ACIDS 2022; 3:49-60. [PMID: 35342902 PMCID: PMC8950161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIM Diabetic nephropathy (DN) has become the most common cause of end-stage renal disease (ESRD) in most countries. Elucidating novel epigenetic contributors to DN can not only enhance our understanding of this complex disorder, but also lay the foundation for developing more effective monitoring tools and preventive interventions in the future, thus contributing to our ultimate goal of improving patient care. METHODS The 5hmC-Seal, a highly selective, chemical labeling technique, was used to profile genome-wide 5-hydroxymethylcytosines (5hmC), a stable cytosine modification type marking gene activation, in circulating cell-free DNA (cfDNA) samples from a cohort of patients recruited at Zhongnan Hospital, including T2D patients with nephropathy (DN, n = 12), T2D patients with non-DN vascular complications (non-DN, n = 29), and T2D patients without any complication (controls, n = 14). Differentially analysis was performed to find DN-associated 5hmC features, followed by the exploration of biomarker potential of 5hmC in cfDNA for DN using a machine learning approach. RESULTS Genome-wide analyses of 5hmC in cfDNA detected 427 and 336 differential 5hmC modifications associated with DN, compared with non-DN individuals and controls, and suggested relevant pathways such as NOD-like receptor signaling pathway and tyrosine metabolism. Our exploration using a machine learning approach revealed an exploratory model comprised of ten 5hmC genes showing the possibility to distinguish DN from non-DN individuals or controls. CONCLUSION Genome-wide analysis suggests the possibility of exploiting novel 5hmC in patient-derived cfDNA as a non-invasive tool for monitoring DN in high risk T2D patients in the future.
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Affiliation(s)
- Ying Yang
- Department of Clinical Laboratory, Center for Gene Diagnosis & Program of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Chang Zeng
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kun Yang
- Department of Clinical Laboratory, Center for Gene Diagnosis & Program of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Shaohua Xu
- Department of Clinical Laboratory, Center for Gene Diagnosis & Program of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Zhou Zhang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Qinyun Cai
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Chuan He
- Department of Chemistry and the Howard Hughes Medical Institute, The University of Chicago, Chicago, Illinois, USA
| | - Wei Zhang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Song-Mei Liu
- Department of Clinical Laboratory, Center for Gene Diagnosis & Program of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
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Liu W, Jin C, Lian Q, Xu L, Lin Z, Lu J, Gong X. Ultrasound-Guided Lauromacrogol Injection for the Treatment of Active Bleeding After Renal Biopsy. Front Pharmacol 2022; 12:723634. [PMID: 35002689 PMCID: PMC8733379 DOI: 10.3389/fphar.2021.723634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study aimed to describe the technique and outcomes of hemostasis for ultrasound-guided lauromacrogol injection for active bleeding after renal biopsy. Methods: Data from patients with active bleeding after renal biopsy between January 2018 and December 2020 were retrospectively collected. Patients who still had active bleeding after 30 min of compression were then injected with lauromacrogol under ultrasound guidance. The patient's symptoms before and after operation were collected to assess whether they had severe complications. Changes in hemoglobin and serum creatinine values were collected. Results: Data from a total of 15 patients with active bleeding after renal biopsy were collected, including data of 6 men and 9 women. After the operation, there were 11 cases of mild back pain; 1 case of chills, cold sweats, and back pain; 1 case of cold sweats and blood pressure reduction, and 2 cases with no obvious symptoms. No severe complications occurred in this study, and active bleeding was stopped in all patients. After the operation, compared with before the operation, there was no statistically significant difference in the hemoglobin value and serum creatinine value (p = 0.10 > 0.05, p = 0.78 > 0.05). Conclusion: Ultrasound-guided lauromacrogol injection is a relatively simple, safe and feasible method, which could be helpful in treating active bleeding in the immediate post-procedure period after renal biopsy.
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Affiliation(s)
- Weizong Liu
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Chunchun Jin
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Qingshu Lian
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Lifeng Xu
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Zhanye Lin
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jianghao Lu
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xuehao Gong
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
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15
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Kim SY, Kim H, Lee J, Jung SI, Moon MH, Joo KW, Cho JY. Quantitative magnetic resonance imaging of chronic kidney disease: an experimental in vivo study using rat chronic kidney disease models. Acta Radiol 2021; 64:404-414. [PMID: 34928730 DOI: 10.1177/02841851211065143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent advances in magnetic resonance imaging (MRI) may allow it to be an alternative emerging tool for the non-invasive evaluation of renal parenchymal disease. PURPOSE To validate the usefulness of quantitative multiparametric MRI protocols and suggest the suitable quantitative MR sequence protocol to evaluate parenchymal fibrosis using an animal model of chronic kidney disease (CKD) by long-term adenine intake. MATERIAL AND METHODS In this prospective animal study, 16 male Wistar rats were analyzed and categorized into three groups. Rats in the CKD groups underwent 0.25% adenine administration for three or six weeks. Quantitative MRI protocols, including diffusion-weighted imaging (DWI), T1ρ (T1 rho), and T2* mapping were performed using a 9.4-T animal MR scanner. A semi-quantitative histopathologic analysis for renal fibrosis was conducted. Quantitative MR values measured from anatomic regions of kidneys underwent intergroup comparative analyses. RESULTS The apparent diffusion coefficient (ADC) and T1 (T1 rho) values were significantly increased in all CKD groups. Values measured from the cortex and outer medulla showed significant intergroup differences. Total ADC values tended to increase according to periods, and T1ρ values increased in three weeks and decreased in six weeks. CONCLUSION Quantitative MRI protocols could be a non-invasive assessment modality in the diagnosis and evaluation of CKD. Particularly, T1ρ may be a suitable MR sequence to quantitatively assess renal parenchymal fibrosis.
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Affiliation(s)
- Sang Youn Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine and Kidney Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Hyeonjin Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine and Kidney Research Institute, Seoul National University, Seoul, Republic of Korea
- Department of Biomedical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Joongyub Lee
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Min Hoan Moon
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine and Kidney Research Institute, Seoul National University, Seoul, Republic of Korea
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Taniguchi T, Tomita M, Ikeda H, Kamimatsuse R, Yamamoto K, Shimizu A, Yanai Y, Kamata T, Iehara N. Acute Brachial Arterial Embolic Occlusion Following Anticoagulant Discontinuation in a Renal Biopsy of a Nephrotic Syndrome Patient. Intern Med 2021; 60:3453-3458. [PMID: 34024856 PMCID: PMC8627826 DOI: 10.2169/internalmedicine.7269-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/24/2021] [Indexed: 12/02/2022] Open
Abstract
A 73-year-old woman with atrial fibrillation treated with rivaroxaban was hospitalized for nephrotic syndrome. After discontinuation of rivaroxaban to lower the risk of hemorrhagic events, a renal biopsy was performed. Rivaroxaban was scheduled to resume a week after the biopsy to prevent renal hemorrhaging. However, she developed acute brachial arterial embolic occlusion and mural thrombosis in the abdominal aorta before resuming rivaroxaban. If immune-mediated renal diseases are suspected in anticoagulated patients at a risk of thrombotic events, physicians should consider initiating glucocorticoid therapy without a renal biopsy in order to avoid hemorrhagic and thrombotic events.
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Affiliation(s)
| | - Mayumi Tomita
- Department of Nephrology, Kyoto City Hospital, Japan
| | | | | | | | - Ai Shimizu
- Department of Nephrology, Kyoto City Hospital, Japan
| | - Yuko Yanai
- Department of Nephrology, Kyoto City Hospital, Japan
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Peters B, Afghahi H, Maitlo S, Hadimeri H. Risk factors for biopsy complications in initial versus subsequent biopsies in native and transplant kidneys. Acta Radiol 2021; 62:1426-1432. [PMID: 33095648 DOI: 10.1177/0284185120966687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Few studies exist about risk factors for complications in subsequent biopsies. PURPOSE To explore risk factors for complications in initial versus subsequent biopsies in native and transplant kidneys, which may predict biopsy complications. MATERIAL AND METHODS In a multicenter study, 2830 native kidney biopsies (4.3% subsequent) were analyzed for major complications (1251 of these were also analyzed for minor) and 667 transplant kidney biopsies (29% subsequent) were analyzed for major and minor complications. No death or nephrectomy were described. Fisher's exact test, Student's t-test, chi-square analyses, and univariate and multiple binary logistic regression analyses were employed; P < 0.05 was considered significant. RESULTS In initial native kidney biopsies, the frequency of major complications was higher in women compared to men (odds ratio 1.6, 95% confidence interval 1.1-2.2), in younger patients (50 vs. 54 years, P = 0.007), and in patients with lower weight (78 vs. 82 kg, P = 0.005). In subsequent native kidney biopsies, patients with major complications had a higher systolic blood pressure (145 vs. 132 mmHg, P = 0.03). In initial transplant kidney biopsies, biopsies with major complications had less glomeruli in the biopsy (17 vs. 24, P = 0.046). In subsequent transplant kidney biopsies, patients with major complications had a higher mean arterial pressure (112 vs. 98 mmHg, P = 0.002). In subsequent native kidney biopsies, there was a higher number of SLE-nephritis (12% vs. 4.6%, P = 0.001) compared to initial biopsies. CONCLUSION The different types of risk factors for complications in initial versus subsequent renal biopsies could be important for the clinicians to improve patients' safety.
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Affiliation(s)
- Björn Peters
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Henri Afghahi
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
| | - Salar Maitlo
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
| | - Henrik Hadimeri
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
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18
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Intrarenal vascular malformation in a hemodialysis patient. Clin Exp Nephrol 2021; 26:95-96. [PMID: 34409548 DOI: 10.1007/s10157-021-02125-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
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Oliveira MC, Flores FDS, Barbosa FM, Fujii CDC, Rabelo-Silva ER, Lucena ADF. Evaluation of percutaneous renal biopsy complications based on outcomes and indicators of the Nursing Outcomes Classification. Rev Lat Am Enfermagem 2021; 29:e3415. [PMID: 34231785 PMCID: PMC8253370 DOI: 10.1590/1518-8345.3759.3415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 08/19/2020] [Indexed: 11/22/2022] Open
Abstract
Objective: to evaluate the complications of percutaneous renal biopsy based on outcomes
and clinical indicators of the Nursing Outcomes Classification. Method: a prospective longitudinal study. The sample consisted of 13 patients
submitted to percutaneous renal biopsy, with 65 evaluations. The patients
were evaluated in five moments in the 24 hours after the procedure, using an
instrument developed by the researchers based on five outcomes (Blood
coagulation, Circulation status, Blood loss severity, Pain level, Comfort
status: Physical) and 11 indicators. The Generalized Estimation Equation
Test was used to compare the scores of the indicators. The project was
approved by the institutional ethics committee. Results: in the 65 evaluations, a statistically significant difference was identified
in the reduction of the scores of the following nursing outcomes: Blood
coagulation, “hematuria” indicator; Circulation status, in the “systolic
blood pressure and diastolic blood pressure” indicators and Comfort status:
physical, in the “physical well-being” indicator. Conclusion: the evaluated patients did not show major complications. The clinical
indicators signaled changes in circulation status, with reduced blood
pressure, as well as in blood clotting observed by hematuria, but without
hemodynamic instability. The comfort status was affected by the rest time
after the procedure.
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Affiliation(s)
- Magáli Costa Oliveira
- Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil
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Castillo JJ, Callander NS, Baljevic M, Sborov DW, Kumar S. The evaluation and management of monoclonal gammopathy of renal significance and monoclonal gammopathy of neurological significance. Am J Hematol 2021; 96:846-853. [PMID: 33709474 PMCID: PMC8252623 DOI: 10.1002/ajh.26155] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/07/2021] [Indexed: 12/24/2022]
Abstract
Despite the benign nature of monoclonal gammopathy of undetermined significance (MGUS), mounting data are associating MGUS with the development of organ dysfunction, specifically monoclonal gammopathy of renal significance (MGRS) and monoclonal gammopathy of neurological significance (MGNS), which could be associated with substantial morbidity. Emerging evidence suggests that patients with MGRS and MGNS could benefit from treatments used for myeloma, Waldenström macroglobulinemia, or chronic lymphocytic leukemia, depending on the underlying pathology. However, the treatment of MGRS and MGNS is not standardized, and potentially effective therapies might not be reimbursed because these conditions do not formally meet the criteria for malignant processes. The present review aims at establishing standards for the evaluation and management of MGRS and MGNS, which can facilitate the diagnosis of and provide therapeutic options for treating practitioners and patients affected by these conditions. The careful design and execution of clinical trials for patients with MGRS and MGNS are positively encouraged.
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Affiliation(s)
- Jorge J. Castillo
- Dana‐Farber Cancer Institute Harvard Medical School Boston Massachusetts
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Xu J, Wu X, Xu Y, Ren H, Wang W, Chen W, Shen P, Li X, Shi H, Xie J, Chen X, Zhang W, Pan X. Acute Kidney Disease Increases the Risk of Post-Kidney Biopsy Bleeding Complications. Kidney Blood Press Res 2020; 45:873-882. [PMID: 33105145 DOI: 10.1159/000509443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Kidney biopsy, providing the insightful information for most kidney diseases, is an invasive diagnostic tool with certain risks ranging from the least severe macroscopic hematuria to the most severe life-threatening bleeding necessitating renal artery embolization. We aimed to compare the postbiopsy bleeding complications between 2 common methods and to further explore the risk factors of bleeding complications in patients using the negative pressure suction puncture (NPS) method. METHODS We retrospectively collected the data from percutaneous native kidney biopsies in 2016. The clinical, laboratory tests, pathological findings, and the occurrence of bleeding complications following kidney biopsy were analyzed. The kidney biopsy was performed in our center by experienced nephrologists with 2 different methods, namely, NPS method and real-time ultrasound-guided needle (RTU) method. We compared rates of complications between 2 methods and evaluated univariate and multivariate association of risk factors with bleeding complications in the NPS group. RESULTS 626 kidney biopsies were performed between January 2016 and December 2016. There were 83.2% (521/626) participants in the NPS group and 16.8% (105/626) in the RTU group. There were more participants in the RTU group needing >1 needle pass during biopsy than those in the NPS group (61.0 vs. 14.7%, p < 0.001). Acute kidney disease (AKD) occurred before the procedure of kidney biopsy accounted for 13.8% (72/521) in the NPS group and 1.9% (2/105) in the RTU group. The renal pathological findings revealed higher number of glomeruli in the NPS group than in the RTU group (26.8 ± 13.0 vs. 17.2 ± 8.6, p < 0.001). The incidence of bleeding complications in the NPS group was lower than that in the RTU group (9.2 vs. 21.9%, p < 0.01). Logistic multivariate regression showed that AKD was independently associated with bleeding complications after kidney biopsy in the NPS group. CONCLUSION Regarding the bleeding risk, there was noninferiority of NPS over RTU. AKD contributes to higher risks of bleeding complications after kidney biopsy.
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Affiliation(s)
- Jing Xu
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiaojing Wu
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yaowen Xu
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Hong Ren
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Weiming Wang
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Weihong Chen
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Pingyan Shen
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiao Li
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Hao Shi
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jingyuan Xie
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiaonong Chen
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Wen Zhang
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiaoxia Pan
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China,
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Onuigbo MAC, Sharma V, Balogun OO, Ghimire A. Post-Renal Biopsy Acute Kidney Injury and Page Kidney from Intra-Renal Hematoma Aggravated by Reversible Contrast-Induced Nephropathy Following Renal Arterial Embolization. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e919701. [PMID: 31964858 PMCID: PMC6998796 DOI: 10.12659/ajcr.919701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Patient: Male, 73-year-old Final Diagnosis: Page kidney from intra-renal hematoma aggravated by reversible contrast-induced nephropathy following renal arterial embolization Symptoms: Flank pain • nausea • vomiting Medication: Apixaban Clinical Procedure: Kidney biopsy and subsequent renal arterial embolization Specialty: Nephrology
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Affiliation(s)
- Macaulay A Chukwukadibia Onuigbo
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Vivek Sharma
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Omotola O Balogun
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Allina Ghimire
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
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