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Kikuchi S, Kayama K, Kawada Y, Kitada S, Seo Y. Evaluation of renal circulation in heart failure using superb microvascular imaging, a microvascular flow imaging system. J Med Ultrason (2001) 2024:10.1007/s10396-023-01397-6. [PMID: 38236503 DOI: 10.1007/s10396-023-01397-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/15/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE Renal circulation evaluation is essential in understanding the cardiorenal relationship in heart failure (HF), and there is a growing interest in imaging techniques that visualize renal circulation. This study aimed to assess the effectiveness of superb microvascular imaging (SMI) in evaluating renal circulation in HF patients. METHOD The study included 71 HF patients undergoing cardiac catheterization. Prior to catheterization, renal ultrasound examinations were performed. A control group of 18 subjects without HF was also included. SMI was used to measure the vascular index (VI), which was calculated as the percentage of blood flow signal area in the region of interest. The intrarenal perfusion index (IRPI) was determined as a fluctuation index of VI, reflecting variations in the number of blood cells moving through renal tissue during the cardiac cycle. RESULTS Using the upper 95% confidence interval of IRPI (0.6) from the control group, HF patients were classified into two groups. Patients with IRPI > 0.6 showed a more congestive profile. Right atrial pressure and biphasic or monophasic Doppler intrarenal flow pattern were independent determinants of IRPI > 0.6. In addition, IRPI remained a significant predictor of estimated glomerular filtration rate (eGFR). CONCLUSION The parameter IRPI as variations in SMI signal during the cardiac cycle may be a useful evaluation method for renal perfusion impairment in HF.
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Affiliation(s)
- Shohei Kikuchi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Kiyomi Kayama
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Yu Kawada
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Shuichi Kitada
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
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Bianchi Bosisio NSM, Romero-González G, De Silvestri A, Husain-Syad F, Ferrari F. Doppler-based evaluation of intrarenal venous flow as a new tool to predict acute kidney injury: A systematic review and meta-analysis. Nefrologia 2023; 43 Suppl 2:57-66. [PMID: 38245439 DOI: 10.1016/j.nefroe.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/14/2023] [Indexed: 01/22/2024] Open
Abstract
Congestion is a common complication in the critical care setting, these patients are at increased risk of developing acute kidney injury (AKI). Congestive nephropathy (CN) has recently been described as a mechanism of worsening renal function, and evaluation of renal venous flow by pulsed Doppler (PD) is a useful tool to assess the presence of renal vein congestion. We comprehensively explore the ability of the PD in the evaluation of the intrarenal venous flow (IRVF) to predict the development of AKI in critically ill patients. We searched Pubmed-MEDLINE, Scopus, Embase, and Cochrane Library of Systematic Reviews (to 31th December 2021). We evaluated the association between Doppler-based Intrarenal venous flow demodulation and AKI. CN was defined as the presence of a pulsatile pattern (biphasic or monophasic) in the PD. A total of 4 articles (660 patients) were included in our systematic review, three of these in the metanalysis (413 patients): one study was excluded because its data were inadequate for pooling. Two studies originated in Europe and the other two in the United States. AKI occurrence ranged between 34 and 68%. Patients who developed AKI had a significant difference in PD pattern (continuous vs. pulsatile) in the IRVF (RR=0.46; 95% CI 0.28-0.76). Nevertheless, a large heterogeneity was observed among the studies (I2=68.7%; p=0.04). Albeit preliminary, these findings suggest that the presence of a pulsatile pattern in the PD of the IRVF may be involved in the development of AKI in the critically ill patient. The effect of alterations in the IRVF and renal function warrant further investigation.
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Affiliation(s)
| | - Gregorio Romero-González
- Department of Nephrology, Hospital Germans Trias i Pujol, Badalona, Spain; International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometrics Service, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Faeq Husain-Syad
- Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany; International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Fiorenza Ferrari
- Anaesthesiology and Intensive Care Unit 1, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.
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Chen G, Dai Y, Zhang J. C-Net: Cascaded convolutional neural network with global guidance and refinement residuals for breast ultrasound images segmentation. Comput Methods Programs Biomed 2022; 225:107086. [PMID: 36044802 DOI: 10.1016/j.cmpb.2022.107086] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/05/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Breast lesions segmentation is an important step of computer-aided diagnosis system. However, speckle noise, heterogeneous structure, and similar intensity distributions bring challenges for breast lesion segmentation. METHODS In this paper, we presented a novel cascaded convolutional neural network integrating U-net, bidirectional attention guidance network (BAGNet) and refinement residual network (RFNet) for the lesion segmentation in breast ultrasound images. Specifically, we first use U-net to generate a set of saliency maps containing low-level and high-level image structures. Then, the bidirectional attention guidance network is used to capture the context between global (low-level) and local (high-level) features from the saliency map. The introduction of the global feature map can reduce the interference of surrounding tissue on the lesion regions. Furthermore, we developed a refinement residual network based on the core architecture of U-net to learn the difference between rough saliency feature maps and ground-truth masks. The learning of residuals can assist us to obtain a more complete lesion mask. RESULTS To evaluate the segmentation performance of the network, we compared with several state-of-the-art segmentation methods on the public breast ultrasound dataset (BUSIS) using six commonly used evaluation metrics. Our method achieves the highest scores on six metrics. Furthermore, p-values indicate significant differences between our method and the comparative methods. CONCLUSIONS Experimental results show that our method achieves the most competitive segmentation results. In addition, we apply the network on renal ultrasound images segmentation. In general, our method has good adaptability and robustness on ultrasound image segmentation.
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Affiliation(s)
- Gongping Chen
- College of Artificial Intelligence, Nankai University, Tianjin, China.
| | - Yu Dai
- College of Artificial Intelligence, Nankai University, Tianjin, China.
| | - Jianxun Zhang
- College of Artificial Intelligence, Nankai University, Tianjin, China
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Binder S, Boosz A, Kolioulis I, Baev E, Müller N, Krämer J, Müller A. Detection rate with routine postoperative renal ultrasound to identify urinary tract injury after gynecological surgery. Arch Gynecol Obstet 2022; 306:1617-1621. [PMID: 35916959 DOI: 10.1007/s00404-022-06714-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/17/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE The aim of this study was to establish the rate at which routine postoperative renal ultrasonography is able to detect urinary tract injury following gynecological surgery. METHODS A retrospective analysis was carried out for the study period 2015-2019 of all patients who had undergone subtotal or total hysterectomy, or radical hysterectomy or salpingectomy, salpingo-oophorectomy, or oophorectomy, and subsequently had a urinary tract injury. RESULTS In a total of 2068 patients, 25 urinary tract injuries occurred (1.21%), including 21 urinary bladder lesions (1.02%) and four ureteral injuries (0.19%). The incidence of urinary tract injuries was 3% in oncologic procedures and 0.86% in procedures for benign disease. Nineteen injuries (76%) were diagnosed intraoperatively, and six injuries (24%) were clinically diagnosed after surgery. All of the patients had uneventful postoperative renal ultrasound examinations. CONCLUSION Routine postoperative renal ultrasonography was not capable of diagnosing urinary tract injuries after gynecologic surgery. Routine postoperative renal ultrasound examinations should, therefore, not be performed after gynecologic operations.
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Affiliation(s)
- Simon Binder
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany. .,Department of Gynecology and Obstetrics, Diakonissenkrankenhaus Karlsruhe, Diakonissenstraße 28, 76199, Karlsruhe, Germany.
| | - Alexander Boosz
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany
| | - Ioannis Kolioulis
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany
| | - Evgeni Baev
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany
| | - Nadine Müller
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany
| | - Janine Krämer
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany
| | - Andreas Müller
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany
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Gigante A, Lai S, Pellicano C, Vezzoli D, Sorato G, Rosato E, Muscaritoli M, Cianci R. Assessment of renal microcirculation in biopsy-proven tubulointerstitial nephritis in patients with and without glomerular disease: the role of resistive index. Microvasc Res 2022; 142:104379. [PMID: 35588888 DOI: 10.1016/j.mvr.2022.104379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/24/2022] [Accepted: 05/11/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Renal resistive index (RRI) measured by Doppler sonography is a marker of microvascular status and it is associated with changes in renal function. Aim of the study was to assess RRI in biopsy-proven tubulointerstitial nephritis (TIN) in patients with and without glomerular disease. METHODS 132 consecutive patients underwent to native renal biopsy with diagnosis of isolated TIN or in association with glomerulonephritis. Estimated glomerular filtration rate (eGFR), 24-hour urinary protein excretion and renal ecocolorDoppler ultrasonography with RRI assessment were performed at time of enrollment. RESULTS Patients with isolated-TIN had significantly higher RRI than both patients with non-immunoglobulin A glomerulonephritis (non-IgA-TIN) [0.73 (0.68-0.77) vs 0.64 (0.60-0.67), p < 0.001] and patients with IgA nephropathy (IgAN) [0.73 (0.68-0.77) vs 0.66 (0.60-0.71), p < 0.01]. Patients with isolated-TIN had mainly RRI ≥ 0.70 (n = 15, 65.2%) with the respect to patients with non-IgA-TIN (n = 7, 12.3%) and patients with IgAN (n = 17, 32.7%). A negative linear correlation was found between RRI and hemoglobin (r = 0.233, p < 0.01) and between RRI and eGFR (r = 0.537, p < 0.001). CONCLUSION Tubulointerstitial damage is the most accurate histological lesion that correlates with eGFR and renal impairment. RRI can be a useful parameter to detect tubulointerstitial lesions.
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Affiliation(s)
- Antonietta Gigante
- Department of Translational and Precision Medicine, "Sapienza", University of Rome, Italy
| | - Silvia Lai
- Department of Translational and Precision Medicine, "Sapienza", University of Rome, Italy
| | - Chiara Pellicano
- Department of Translational and Precision Medicine, "Sapienza", University of Rome, Italy
| | - Debora Vezzoli
- Department of Translational and Precision Medicine, "Sapienza", University of Rome, Italy
| | - Georgia Sorato
- Department of Translational and Precision Medicine, "Sapienza", University of Rome, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, "Sapienza", University of Rome, Italy
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, "Sapienza", University of Rome, Italy
| | - Rosario Cianci
- Department of Translational and Precision Medicine, "Sapienza", University of Rome, Italy.
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Lerchbaumer MH, Fischer T, Uluk D, Friedersdorff F, Hamm B, Spiesecke P. Diagnostic value of contrast-enhanced ultrasound (CEUS) in kidney allografts - 12 years of experience in a tertiary referral center. Clin Hemorheol Microcirc 2022; 82:75-83. [PMID: 35662110 DOI: 10.3233/ch-211357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND B-Mode and Doppler ultrasound are standard diagnostic techniques for early postoperative monitoring and long-term follow-up of kidney transplants. In certain cases, contrast-enhanced ultrasound (CEUS) is used to clarify unclear Doppler findings. OBJECTIVE To investigate the diagnostic performance of CEUS in the workup of renal allograft pathologies. METHODS A systematic search for CEUS examinations of renal transplants conducted in our department between 2008 and 2020 was performed using the following inclusion criteria: i) patient age ≥18 years and ii) confirmation of diagnosis by biopsy and histopathology, imaging follow-up by CEUS, contrast-enhanced computed tomography (ceCT), contrast-enhanced magnetic resonance imaging (ceMRI), or angiography, or intraoperative findings. Exclusion criteria were: i) CEUS performed in the setting of a study and ii) CEUS for other indications than dedicated renal transplant examination. Statistical analysis was performed separately for subgroups with different indications (focal vs non-focal). RESULTS Overall, 78 patients were included in the statistical analysis, which revealed high sensitivity (92.2%, 95% -confidence interval [CI] 81.5-96.9%) and high specificity (88.9%, 95% -CI 71.9-96.1%) of CEUS. CONCLUSIONS The high diagnostic performance demonstrated here and the superficial location of kidney allografts advocate the additional use of CEUS in the follow-up of renal transplant recipients.
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Affiliation(s)
- Markus Herbert Lerchbaumer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Memberof Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thomas Fischer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Memberof Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Deniz Uluk
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Memberof Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Memberof Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Paul Spiesecke
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Memberof Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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McCall NN, Burgner A. Point of Care Ultrasound in Monitoring of Post-Renal Biopsy Bleeding. POCUS J 2022; 7:33-34. [PMID: 36896114 PMCID: PMC9994303 DOI: 10.24908/pocus.v7ikidney.14988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 32-year-old male presented with hypertensive emergency and features of thrombotic microangiopathy. He underwent a kidney biopsy after renal dysfunction persisted despite clinical improvement otherwise. The kidney biopsy was performed with direct ultrasound guidance. The procedure was complicated by hematoma formation and persistent turbulent flow on color Doppler concerning for ongoing bleeding. Serial point of care ultrasounds of the kidney with color flow Doppler were used to monitor the size of the hematoma and determine if there was evidence of ongoing bleeding. These serial ultrasounds showed stable hematoma size, resolution of biopsy-associated Doppler signal and prevented further invasive interventions.
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Affiliation(s)
- Natalie N McCall
- Division of Nephrology, Vanderbilt University Medical Center Nashville, TN
| | - Anna Burgner
- Division of Nephrology, Vanderbilt University Medical Center Nashville, TN
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Jiang JX, Guo LH, Cai CZ, Luo Q. [The value of renal color Doppler ultrasound in evaluating the severity and prognosis of patients with acute organophosphorus pesticide poisoning complicated by acute kidney injury]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2021; 39:862-865. [PMID: 34886650 DOI: 10.3760/cma.j.cn121094-20201021-00593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objective: To analyze the value of renal color Doppler ultrasound examination and clinical indicators in evaluating the severity and prognosis of acute organophosphorus pesticide poisoning (AOPP) complicated by acute kidney injury (AKI) . Methods: In November 2019, 86 AOPP patients complicated by AKI who were admitted from May 2018 to May 2019 were selected as the observation group, and they were divided into AKI stage 1 group (n=37) , AKI stage 2 group (n=32) and AKI stage 3 group (n=17) . 40 healthy people were selected as the control group. The differences in power Doppler ultrasound (PDU) score, renal interlobular artery resistance index (RI) value and related clinical indicators of each group were measured and analyzed, and the correlations between the indicators were analyzed. At the same time, binary logistic regression was used to analyze the risk factors of death in AOPP patients complicated by AKI. Results: There were statistically significant differences in Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱscore, mean arterial pressure (MAP) , serum creatinine (SCr) and the length of continuous renal replacement therapy (CRRT) between different groups (P<0.05) . Compared with the control group, the APACHE Ⅱscores and SCr of patients in the AKI stage 2 and resistance index AKI stage 3 groups increased, while the MAP decreased (P<0.05) . Compared with the control group, AKI stage 1 group and AKI stage 2 group, the PDU score of patients in the AKI stage 3 group was significantly decreased, and the renal interlobular artery RI value was significantly increased (P<0.05) . SCr was positively correlated with the RI value of renal interlobular arteries and CRRT days (r=0.435, 0.713, P<0.05) , and was negatively correlated with renal PDU score (r=-0.643, P<0.05) . The renal PDU score was negatively correlated with the RI value of renal interlobular arteries and CRRT days (r=-0.350, -0.556, P<0.01) . Binary logistic regression analysis showed that SCr (OR=1.017, 95%CI: 1.004-1.041) and APACHE Ⅱ score (OR=1.289, 95%CI: 1.019-1.827) were risk factors for death in patients with AOPP complicated by AKI (P<0.05) . Conclusion: Both PDU score and the RI value of renal interlobular artery can reflect the severity and stage of patients with AOPP complicated by AKI to a certain extent, but neither of them is a key factor affecting the death of patients.
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Affiliation(s)
- J X Jiang
- Guangzhou 12th People's Hospital (Guangzhou Occupational Disease Prevention and Control Hospital) , Guangzhou 510620, China
| | - L H Guo
- Guangzhou 12th People's Hospital (Guangzhou Occupational Disease Prevention and Control Hospital) , Guangzhou 510620, China
| | - C Z Cai
- Guangzhou 12th People's Hospital (Guangzhou Occupational Disease Prevention and Control Hospital) , Guangzhou 510620, China
| | - Q Luo
- Guangzhou 12th People's Hospital (Guangzhou Occupational Disease Prevention and Control Hospital) , Guangzhou 510620, China
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Hai J, Qiao K, Chen J, Liang N, Zhang L, Yan B. Multi-view features integrated 2D\3D Net for glomerulopathy histologic types classification using ultrasound images. Comput Methods Programs Biomed 2021; 212:106439. [PMID: 34695734 DOI: 10.1016/j.cmpb.2021.106439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/18/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Early diagnoses and rational therapeutics of glomerulopathy can control progression and improve prognosis. The gold standard for the diagnosis of glomerulopathy is pathology by renal biopsy, which is invasive and has many contraindications. We aim to use renal ultrasonography for histologic classification of glomerulopathy. METHODS Ultrasonography can present multi-view sections of kidney, thus we proposed a multi-view and cross-domain integration strategy (CD-ConcatNet) to obtain more effective features and improve diagnosis accuracy. We creatively apply 2D group convolution and 3D convolution to process multiple 2D ultrasound images and extract multi-view features of renal ultrasound images. Cross-domain concatenation in each spatial resolution of feature maps is applied for more informative feature learning. RESULTS A total of 76 adult patients were collected and divided into training dataset (56 cases with 515 images) and validation dataset (20 cases with 180 images). We obtained the best mean accuracy of 0.83 and AUC of 0.8667 in the validation dataset. CONCLUSION Comparison experiments demonstrate that our designed CD-ConcatNet achieves the best classification performance and has great superiority on histologic types diagnosis. Results also prove that the integration of multi-view ultrasound images is beneficial for histologic classification and ultrasound images can indeed provide discriminating information for histologic diagnosis.
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Affiliation(s)
- Jinjin Hai
- Henan Key Laboratory of Imaging and Intelligent Processing, PLA Strategy Support Force Information Engineering University, China
| | - Kai Qiao
- Henan Key Laboratory of Imaging and Intelligent Processing, PLA Strategy Support Force Information Engineering University, China
| | - Jian Chen
- Henan Key Laboratory of Imaging and Intelligent Processing, PLA Strategy Support Force Information Engineering University, China
| | - Ningning Liang
- Henan Key Laboratory of Imaging and Intelligent Processing, PLA Strategy Support Force Information Engineering University, China
| | - Lijie Zhang
- Department of Nephrology in First Affiliated Hospital of Zhengzhou University, China
| | - Bin Yan
- Henan Key Laboratory of Imaging and Intelligent Processing, PLA Strategy Support Force Information Engineering University, China.
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Wilson RD, Nelson G. Evaluation of the Fetal Therapy Evidence in Lower Urinary Tract Obstruction: Would an ERAS Guideline Improve Outcomes? Fetal Diagn Ther 2021; 48:504-516. [PMID: 34350862 DOI: 10.1159/000517624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/03/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pregnancies that are prenatally identified to have fetal anomalies are complex and require expert multidisciplinary care. As many conditions can impact the fetus prenatally and require intervention, an enhanced recovery after surgery (ERAS) for lower urinary tract obstruction (LUTO) is being evaluated to determine the level of evidenced-based data available. PROBLEM The percutaneous ultrasound-guided fetal surgery procedure for bladder neck obstruction is the focus for elements of preoperative counseling, intraoperative procedure/risk complications, and postoperative management. METHODS A quality improvement review Squire 2.0 (2000-2020) was undertaken for the percutaneous LUTO fetal surgery shunting (lower urinary tract obstruction), process and procedure which require 2 process pathways, one to evaluate the fetal candidate and a second to treat. This structured review is focused on identifying the process elements to allow the determination of the number of evidenced-based elements that would allow for audit and measurement of the clinical element variance for comparative feedback to the individual surgical provider or surgery center. INTERVENTIONS Titles and abstracts were screened to identify potentially relevant articles with priority given to meta-analyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series. RESULTS A series of potential clinical elements for the diagnostic fetal evaluation and for the 3 protocol areas of surgical care for the procedures (pre-, intra-, and postoperative care) are identified using an ERAS-like process. CONCLUSIONS The identified clinical elements have the potential for ERAS-LUTO fetal therapy guideline. Multidisciplinary collaboration (surgeon, anesthesia, nursing, imaging, and laboratory) is required for ERAS quality improvement in the pre-, intra-, and postoperative processes. Process elements in each of the operative areas can be audited, evaluated, compared, and modified/improved.
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Affiliation(s)
- R Douglas Wilson
- Department of Obstetrics and Gynecology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Gregg Nelson
- Department of Obstetrics and Gynecology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Vergura M, Pellegrino AM, Piemontese M, Grifa R, Borelli C, Aucella F. Ghosts in the renal pelvises: what are they? J Nephrol 2021; 35:1041-1042. [PMID: 34057675 DOI: 10.1007/s40620-021-01074-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/18/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Michele Vergura
- Division of Nephrology and Dialysis, Department of Medical Sciences, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale Cappuccini snc, San Giovanni Rotondo, Italy
| | - Angela Maria Pellegrino
- Division of Nephrology and Dialysis, Department of Medical Sciences, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale Cappuccini snc, San Giovanni Rotondo, Italy.
| | - Matteo Piemontese
- Division of Nephrology and Dialysis, Department of Medical Sciences, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale Cappuccini snc, San Giovanni Rotondo, Italy
| | - Rachele Grifa
- Division of Nephrology and Dialysis, Department of Medical Sciences, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale Cappuccini snc, San Giovanni Rotondo, Italy
| | - Cristina Borelli
- Division of Radiology, Department of Radiological Sciences, Fondazione IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Filippo Aucella
- Division of Nephrology and Dialysis, Department of Medical Sciences, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale Cappuccini snc, San Giovanni Rotondo, Italy
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12
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Cianci R, Gigante A, Bagordo D, Pintus G, Giovannetti A, Lai S, Mazzaferro S, Rosato E. Renal resistive index in IgA nephropathy and renal scleroderma vasculopathy. Microvasc Res 2020; 133:104095. [PMID: 33035555 DOI: 10.1016/j.mvr.2020.104095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Renal Ultra-Sound (US) and Doppler US provide measurements which reflect changes in renal and systemic haemodynamic. The renal resistive index (RRI), obtained through the Doppler spectrum analysis of renal small arteries, is altered in several pathologic conditions. Glomerulonephritis cause minor RRI changes, while renal scleroderma vasculopathy (RSV) leads to significant RRI modifications. The aim of our study was to assess RRI in IgA nephropathy (IgAN) and RSV in a retrospective observational study and to investigate determinants of the RRI in these groups of patients. METHODS We enrolled 61 IgAN patients [23 female, median age 41 (33-58) years] and 80 SSc patients [71 female, median age 52 (43-60) years]. RRI was evaluated in all patients at the time of enrolment. Laboratory tests and clinical assessment were evaluated in all patients. RESULTS IgAN patients showed lower RRI values than RSV patients [0.70 (0.65-0.73) vs 0.66 (0.62-0.72), p < 0.01], while no significant difference in longitudinal length was observed. Median age was significantly lower in IgAN patients than in RSV patients [41 (33-58) vs 52 (43-60), p < 0.05] while IgAN patients showed a higher prevalence of high blood pressure than RSV patients (39.3% vs 13.8%, p < 0.01). The multiple regression analysis, weighted for age, showed that RRI inversely correlates with estimated glomerular filtration rate (β coefficient = -0.524, p < 0.0001). CONCLUSION Higher RRI were found in RSV patients than IgAN patients. IgAN is characterized mainly by glomerular injury, not leading to major RRI changes.
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Affiliation(s)
- Rosario Cianci
- Department of Translational and Precision Medicine, "Sapienza", University of Rome, Italy
| | - Antonietta Gigante
- Department of Translational and Precision Medicine, "Sapienza", University of Rome, Italy
| | - Domenico Bagordo
- Department of Translational and Precision Medicine, "Sapienza", University of Rome, Italy
| | - Giovanni Pintus
- Department of Translational and Precision Medicine, "Sapienza", University of Rome, Italy
| | - Antonello Giovannetti
- Department of Translational and Precision Medicine, "Sapienza", University of Rome, Italy
| | - Silvia Lai
- Department of Translational and Precision Medicine, "Sapienza", University of Rome, Italy
| | - Sandro Mazzaferro
- Department of Translational and Precision Medicine, "Sapienza", University of Rome, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, "Sapienza", University of Rome, Italy.
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Edwards A, Hammer M, Artunduaga M, Peters C, Jacobs M, Schlomer B. Renal ultrasound to evaluate for blunt renal trauma in children: A retrospective comparison to contrast enhanced CT imaging. J Pediatr Urol 2020; 16:557.e1-557.e7. [PMID: 32446678 DOI: 10.1016/j.jpurol.2020.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/13/2020] [Accepted: 04/18/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The standard imaging modality for hemodynamically stable blunt abdominal trauma patients is a contrast enhanced CT scan, which is reflected in the current AUA urotrauma guidelines. This comes, however, with radiation exposure and the potential sequalae of IV contrast administration in the pediatric patient. OBJECTIVE We hypothesize that ultrasound imaging would be able to diagnose and rule out clinically significant renal injuries when compared to the gold standard of CT scan in the setting of pediatric blunt abdominal trauma. STUDY DESIGN All children <18 years of age who were evaluated for blunt abdominal trauma who had a CT scan and ultrasound imaging of kidneys were identified. The ultrasound images were reviewed by four reviewers who were blinded to CT results and all clinical information. The ability of ultrasound to diagnose and rule out clinically significant renal injury was evaluated by diagnostic test performance characteristics including sensitivity, specificity, negative predictive value and positive predictive value. RESULTS There were 76 patients identified, 24 of which had a renal injury (1 bilateral) diagnosed by CT scan for a total of 25 injuries in 152 renal units. There were six grade I-II injuries and 19 grade III-V injuries. The sensitivity of the four blinded reviewers by ultrasound alone to detect the 19 grade III-V injuries ranged from 79 to 100% with NPV between 97 and 100%. Three of the four reviewers identified all 19 grade III-V injuries by ultrasound. When combined with significant hematuria, all 19 grade III-IV injuries were identified. Of note, all patients with a grade III-V injury of the kidney had significant hematuria. Of the grade I-II renal injuries, all reviewers identified 1/5 or 2/5 by ultrasound alone. DISCUSSION The limitations of this study include: its retrospective nature, limited number of patients and reviewers, quality of the ultrasound machine. and experience of technologist, radiologist and urologist. A major limitation is the inability to assess other solid organ injuries during this initial study. CONCLUSIONS When compared to a CT scan as the gold standard, kidney ultrasound images had a sensitivity of 79-100% to detect grade III-V injuries and NPV of 97-100% by four blinded reviewers. All grade III-V injuries had either an episode of gross hematuria or microscopic hematuria >50 RBC/hpf. A prospective study that includes full abdominal imaging is needed to confirm that ultrasound can safely be used in place of CT scan for evaluation of hemodynamically stable blunt trauma patients.
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Affiliation(s)
| | - Matthew Hammer
- University of Texas Southwestern Department of Radiology, USA
| | | | - Craig Peters
- University of Texas Southwestern Department of Urology, USA
| | - Micah Jacobs
- University of Texas Southwestern Department of Urology, USA
| | - Bruce Schlomer
- University of Texas Southwestern Department of Urology, USA.
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Yoon H, Lee YS, Lim BJ, Han K, Shin HJ, Kim MJ, Lee MJ. Renal elasticity and perfusion changes associated with fibrosis on ultrasonography in a rabbit model of obstructive uropathy. Eur Radiol 2019; 30:1986-1996. [PMID: 31858205 DOI: 10.1007/s00330-019-06547-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/24/2019] [Accepted: 10/24/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate elasticity and perfusion change associated with fibrosis in a rabbit model of unilateral ureter obstruction using shear wave elastography (SWE) and contrast-enhanced ultrasonography (CEUS). METHODS Complete unilateral ureter obstruction by ligation was performed in the left kidney of 15 rabbits. Renal elasticity on SWE and perfusion change on CEUS at the renal cortex were measured before and after the operation. Histopathological renal fibrosis was quantified by the stained area ratio with Masson trichrome and Picrosirius red using ImageJ analysis. Renal elasticity and perfusion values were compared by the Mann-Whitney U test and Proc Mixed as a function of time. Spearman's correlation was used to analyze differences between imaging values and fibrosis. RESULTS The duration of imaging follow-up was up to 49 days, with interval imaging performed 1-3 times. Renal elasticity values were higher in obstructed kidneys compared to contralateral kidneys (31.0 kPa vs 16.4 kPa, p < 0.001) and increased according to postoperative time (0.46 kPa/day). With respect to renal fibrosis, SWE values were positively correlated with Masson trichrome (ρ = 0.651, p < 0.001) and Picrosirius red (ρ = 0.514, p = 0.007). Among CEUS parameters, mean transit time was negatively correlated with renal fibrosis by Masson trichrome (ρ = - 0.639, p = 0.001) and Picrosirius red (ρ = - 0.625, p = 0.001). Rise time and time to peak were positively correlated with renal fibrosis. CONCLUSION Obstructive uropathy resulted in changes to both renal elasticity and perfusion. Renal fibrosis was moderately associated with increased renal cortical stiffness and both delayed and decreased cortical perfusion. KEY POINTS • Obstructive uropathy causes changes in elasticity and perfusion in a rabbit model. • Renal fibrosis from obstructive uropathy increases renal cortical stiffness, and both delay and decrease cortical perfusion.
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Affiliation(s)
- Haesung Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Yong Seung Lee
- Department of Pediatric Urology, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Beom Jin Lim
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyunghwa Han
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Hyun Joo Shin
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Myung-Joon Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Mi-Jung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Denault A, Canty D, Azzam M, Amir A, Gebhard CE. Whole body ultrasound in the operating room and intensive care unit. Korean J Anesthesiol 2019; 72:413-428. [PMID: 31159535 PMCID: PMC6781205 DOI: 10.4097/kja.19186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/23/2019] [Indexed: 12/14/2022] Open
Abstract
Whole body ultrasound can be used to improve the speed and accuracy of evaluation of an increasing number of organ systems in the critically ill. Cardiac and abdominal ultrasound can be used to identify the mechanisms and etiology of hemodynamic instability. In hypoxemia or hypercarbia, lung ultrasound can rapidly identify the etiology of the condition with an accuracy that is equivalent to that of computed tomography. For encephalopathy, ocular ultrasound and transcranial Doppler can identify elevated intracranial pressure and midline shift. Renal and bladder ultrasound can identify the mechanisms and etiology of renal failure. Ultrasound can also improve the accuracy and safety of percutaneous procedures and should be currently used routinely for central vein catheterization and percutaneous tracheostomy.
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Affiliation(s)
- André Denault
- Department of Anesthesiology and Critical Care Medicine, Faculté de Médecine, Université de Montréal, Institut de Cardiologie de Montréal, and Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - David Canty
- Department of Surgery, University of Melbourne, Australia.,Department of Medicine, Monash Medical Centre, Monash University, Clayton, Melbourne, and Department of Anesthesia, Monash Medical Centre and Royal Melbourne Hospital, Victoria, Australia
| | - Milène Azzam
- Department of Anesthesiology, Jewish General Hospital, McGill University Faculty of Medicine, Montreal, QC, Canada
| | - Alexander Amir
- Department of Anesthesiology, Montreal General Hospital, McGill University Faculty of Medicine, Montreal, QC, Canada
| | - Caroline E Gebhard
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
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Carrie C, Lannou A, Rubin S, De Courson H, Petit L, Biais M. Augmented renal clearance in critically ill trauma patients: A pathophysiologic approach using renal vascular index. Anaesth Crit Care Pain Med 2019; 38:371-5. [PMID: 30579942 DOI: 10.1016/j.accpm.2018.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The aim of the present study was to explore the relationship between creatinine clearance (ClCr), cardiac index (CI) and renal vascular index (RVI) in order to assess the potential mechanisms driving ARC in critically ill trauma patient. The secondary objective was to assess the performance of RVI for prediction of ARC. METHODS Every trauma patient who underwent cardiac and renal ultrasound measurements during their initial ICU management was retrospectively reviewed over a 3-month period. ARC was defined by a 24-hr measured ClCr ≥ 130 mL/min/1.73m2. A mixed effect model was constructed to explore covariates associated with ClCr over time. The performance of RVI for prediction of ARC was assessed by receiver operating characteristic (ROC) curve and compared to the ARCTIC (ARC in trauma intensive care) predictive scoring model. RESULTS Thirty patients, contributing for 121 coupled physiologic data, were retrospectively analysed. There was a significant correlation between ClCr values and RVI (r = -0.495; P = 0.005) but not between ClCr and CI values (r = 0.023; P = 0.967) at day 1. Using a mixed effect model, only age remained associated with ClCr variations over time. The area under the ROC curve of RVI for predicting ARC was 0.742 (95% CI: 0.649-0.834; P < 0.0001), with statistical difference when compared to the ROC curve of ARCTIC [0.842 (0.771-0.913); P < 0.0001]. CONCLUSION Ultrasonic evaluation of CI and RVI did not allow approaching the haemodynamic mechanisms responsible for ARC in patients. RVI was inaccurate and not better than clinical score for predicting ARC.
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Koenig JL, Amoils M, Grade MM, Chang KW, Truong MT. Renal ultrasound abnormalities in children with syndromic and non-syndromic microtia. Int J Pediatr Otorhinolaryngol 2018; 113:173-6. [PMID: 30173979 DOI: 10.1016/j.ijporl.2018.07.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/12/2018] [Accepted: 07/17/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Renal abnormalities are commonly considered in the work up of pediatric patients with external ear malformations. However, there is little consensus regarding an appropriate renal screening protocol for patients with microtia. We sought to characterize renal abnormalities detected on ultrasonography in pediatric patients with microtia. METHODS We conducted a retrospective cohort study of pediatric patients diagnosed with microtia who underwent renal ultrasound from 1991 to 2014 at a single tertiary academic institution. Renal ultrasound reports and medical records were reviewed to assess for renal abnormalities and to determine whether patients required specialist follow-up or interventions. Audiograms and otolaryngology notes were used to determine patterns of hearing loss. The following additional information was recorded from the electronic medical records: patient sex, microtia grade (I-IV), microtia laterality, and known associated syndromes. Characteristics were compared between those who did and did not have renal ultrasound findings using Fisher's exact test. Univariate logistic regression analysis was performed to determine factors associated with renal ultrasound findings. RESULTS The majority of patients in this cohort were syndromic (n = 51, 64%) with grade III microtia (n = 46, 58%) and conductive hearing loss (n = 58, 72%). Syndromic children with microtia demonstrated a higher crude rate of renal ultrasound abnormalities (22%) than children with isolated microtia (7%). Of these patients, 69% required specialist follow-up. Univariate logistic regression analysis did not identify predictors that were significantly associated with renal ultrasound findings. CONCLUSION Fairly high rates of abnormalities in syndromic and non-syndromic patients may warrant screening renal ultrasound in all patients with microtia, especially given the high percentage of findings requiring renal follow-up. A prospective study to formally evaluate screening efficacy is needed.
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Faura Morros A, Cuaresma González A, Hernández-Bou S, Trenchs Sainz de la Maza V, Camacho Diaz JA, Luaces Cubells C. [Diagnostic efficiency of renal ultrasound after the first urine infection in infants]. An Pediatr (Barc) 2018; 90:232-236. [PMID: 30017745 DOI: 10.1016/j.anpedi.2018.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 06/06/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Several authors question the performance of systematic renal ultrasound after first urinary tract infection (UTI) in young children, given the high sensitivity of prenatal ultrasounds to detect major malformations and the low prevalence of clinical relevant findings. The aims of this study are to evaluate the yield of renal ultrasound performed after the first UTI in patients aged less than 2 years and to analyse potential risk factors (RF) of altered renal ultrasound. PATIENTS AND METHODS Retrospective study, including patients aged less than 2 years diagnosed with UTI in the Emergency Department between July 2013 and December 2014. Patients with an underlying nephro-urological pathology, previous UTIs and those without prenatal or post-infection renal ultrasound were excluded. Altered renal ultrasound was defined as the presence of dilated urinary tract or structural abnormalities. Potential RF analysed were: male, age less than 3 months, presence of fever and microorganism other than Escherichia coli. Univariate and multivariate logistic regression were performed. RESULTS A total of 306 patients were included. Altered renal ultrasound was found in 35 cases (11.4%; 95% CI 8.3-15.5): 24 (68.6%) urinary tract dilation, and 11 (31%) structural abnormalities. Among the cases with altered ultrasound, 68.6% were male, 51.4% were younger than 3 months, 74.3% were febrile, and 31.4% were caused by microorganisms other than E. coli, compared to 45% (P=.009), 31.7% (P=.021), 78.2% (P=.597) and 10% (P=.001) of cases with normal ultrasound. In the multivariate analysis, age less than 3 months (OR 2.1; 95% CI 1.0-4.3, P=.05) and microorganism other than E. coli (OR 3.8; 95% CI 1.7-8.7, P=.002) remained as RF. CONCLUSIONS The yield of renal ultrasound after the first UTI is low. Its indication should be individualised according to the presence of RF: age less than 3 months and microorganism other than E. coli.
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Affiliation(s)
- Anna Faura Morros
- Servicio de Urgencias de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Adriana Cuaresma González
- Servicio de Urgencias de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España.
| | - Susanna Hernández-Bou
- Servicio de Urgencias de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Victoria Trenchs Sainz de la Maza
- Servicio de Urgencias de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España; Influencia del entorno en el bienestar del niño y del adolescente, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | | | - Carles Luaces Cubells
- Servicio de Urgencias de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España; Influencia del entorno en el bienestar del niño y del adolescente, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
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Hamadah HK, Hijazi O, Faraji MA, Kabbani MS. Bedside ultrasonography screening for congenital renal anomalies in children with congenital heart diseases undergoing cardiac repair. J Saudi Heart Assoc 2018; 30:95-101. [PMID: 29910579 PMCID: PMC6000884 DOI: 10.1016/j.jsha.2017.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/30/2017] [Accepted: 09/10/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Ultrasound (US) assessment of renal anomalies in children requiring pediatric cardiac surgery is not a standard practice. This study is highlighting the role of bedside US performed by intensivist to detect occult renal anomalies associated with congenital heart disease (CHD). Methods A cross sectional study for 100 consecutive children with CHD admitted to Pediatric Cardiac Intensive Care Unit (PCICU) in 2015. US of kidneys screening was performed by trained pediatric cardiac intensivists to ascertain the presence of both kidneys in renal fossae without gross anomalies and to investigate if early detection of occult kidney anomaly would have any impact on outcome. Results After screening of 100 consecutive children with CHD with renal US, we identified in 94 cases (94%) normal right and left kidney in the standard sonographer shape within the renal fossae. In 6 cases further investigation revealed ectopic kidney in 3 patients (50%), solitary functional kidney in 2 patients (33%) and bilateral grade IV hydronephrosis in one patient (17%). Urinary tract infection developed peri-operatively in 66% of the cases with kidney anomalies with statistical significance compared to patients with normal renal US (P: 0.0011). No significant renal impairment was noted in these patients post-surgery. We observed no specific association between the type of renal anomaly and specific CHD. Conclusion Routine renal US in children with CHD demonstrated prevalence of associated congenital renal anomalies in 6% of children undergoing cardiac surgery. The presence of occult renal anomalies was associated with higher UTI risk. Performing routine renal US as a standard practice in children with CHD is justifiable.
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Affiliation(s)
- Hussam K. Hamadah
- Section of Pediatric Cardiac ICU, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Riyadh, Saudi ArabiaaSaudi Arabia
- Corresponding author at: Section of Pediatric Cardiac ICU, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Mail Code: 1423, P.O. Box 22490, Riyadh 11426, Saudi Arabia. Fax: +966 118011111x16773.
| | - Omar Hijazi
- Section of Pediatric Cardiac ICU, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Riyadh, Saudi ArabiaaSaudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiacSaudi Arabia
| | - Mohammad A. Faraji
- Section of Pediatric Radiology, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Riyadh, Saudi ArabiabSaudi Arabia
| | - Mohamed S. Kabbani
- Section of Pediatric Cardiac ICU, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Riyadh, Saudi ArabiaaSaudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiacSaudi Arabia
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Sosa-Barrios RH, Burguera V, Rodriguez-Mendiola N, Galeano C, Elias S, Ruiz-Roso G, Jimenez-Alvaro S, Liaño F, Rivera-Gorrin M. Arteriovenous fistulae after renal biopsy: diagnosis and outcomes using Doppler ultrasound assessment. BMC Nephrol 2017; 18:365. [PMID: 29262805 PMCID: PMC5738109 DOI: 10.1186/s12882-017-0786-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 12/11/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Percutaneous renal biopsy (PRB) is an important technique providing relevant information to guide diagnosis and treatment in renal disease. As an invasive procedure it has complications. Most studies up to date have analysed complications related to bleeding. We report the largest single-center experience on routine Doppler ultrasound (US) assessment post PRB, showing incidence and natural history of arteriovenous fistulae (AVF) post PRB. METHODS We retrospectively analysed 327 consecutive adult PRB performed at Ramon Cajal University Hospital between January 2011 and December 2014. All biopsies were done under real-time US guidance by a trained nephrologist. Routine Doppler mapping and kidney US was done within 24 h post biopsy regardless of symptoms. Comorbidities, full blood count, clotting, bleeding time and blood pressure were recorded at the time of biopsy. Post biopsy protocol included vitals and urine void checked visually for haematuria. Logistic regression was used to investigate links between AVF, needle size, correcting for potential confounding variables. RESULTS 46,5% were kidney transplants and 53,5% were native biopsies. Diagnostic material was obtained in 90,5% (142 grafts and 154 native). Forty-seven AVF's (14.37%) were identified with routine kidney Doppler mapping, 95% asymptomatic (n = 45), 28 in grafts (18.4%) and 17 natives (9.7%) (p-value 0.7). Both groups were comparable in terms of comorbidities, passes, cylinders or biopsy yield (p-value NS). 80% were <1 cm in size and 46.6% closed spontaneously in less than 30 days (range 3-151). Larger AVF's (1-2 cm) took a mean of 52 days to closure (range 13-151). Needle size was not statistically significant factor for AVF (p-value 0.71). CONCLUSIONS Contrary to historical data published, AVF's are a common complication post PRB that can be easily missed. Routine US Doppler mapping performed by trained staff is a cost-effective, non-invasive tool to diagnose and follow up AVF's, helping to assess management.
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Affiliation(s)
- R. Haridian Sosa-Barrios
- Nephrology Department. Ramon y Cajal University Hospital, Madrid, Spain
- Spanish Group of Diagnostic and Interventional Nephrology, Spanish Society of Nephrology, Madrid, Spain
| | - Victor Burguera
- Nephrology Department. Ramon y Cajal University Hospital, Madrid, Spain
- Spanish Group of Diagnostic and Interventional Nephrology, Spanish Society of Nephrology, Madrid, Spain
| | | | - Cristina Galeano
- Nephrology Department. Ramon y Cajal University Hospital, Madrid, Spain
| | - Sandra Elias
- Nephrology Department. Ramon y Cajal University Hospital, Madrid, Spain
| | - Gloria Ruiz-Roso
- Nephrology Department. Ramon y Cajal University Hospital, Madrid, Spain
| | | | - Fernando Liaño
- Nephrology Department. Ramon y Cajal University Hospital, Madrid, Spain
- Red de investigacion renal (REDinREN), ISCIII (ERC 10 RD12/0021/0020) Nephrology, Madrid, Spain
- Instituto Ramon y Cajal de Investigacion Sanitaria (IRYCIS), Madrid, Spain
| | - Maite Rivera-Gorrin
- Nephrology Department. Ramon y Cajal University Hospital, Madrid, Spain
- Alcala University, Madrid, Spain
- Spanish Group of Diagnostic and Interventional Nephrology, Spanish Society of Nephrology, Madrid, Spain
- Red de investigacion renal (REDinREN), ISCIII (ERC 10 RD12/0021/0020) Nephrology, Madrid, Spain
- Instituto Ramon y Cajal de Investigacion Sanitaria (IRYCIS), Madrid, Spain
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Catena C, Colussi G, Brosolo G, Verheyen N, Novello M, Bertin N, Cavarape A, Sechi LA. Long-Term Renal and Cardiac Outcomes after Stenting in Patients with Resistant Hypertension and Atherosclerotic Renal Artery Stenosis. Kidney Blood Press Res 2017; 42:774-783. [PMID: 29161704 DOI: 10.1159/000484299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 09/01/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Atherosclerotic renal artery stenosis (ARAS) is frequently detected in patients with resistant hypertension (RHTN), but the evidence supporting the utility of renal revascularization in these patients is limited. This prospective, observational study investigates the outcomes of renal stenting in patients with RHTN and hemodynamically significant ARAS. METHODS Fifty-four patients with RHTN were selected because of angiographic evidence of ARAS >70% and were followed for 4 years after renal stenting. Renal function and echocardiographic variables were assessed at baseline and during follow-up. RESULTS Blood pressure decreased rapidly after renal stenting and was normalized in 67% of patients at six months, with significant reduction in the number of antihypertensive drugs. Creatinine clearance increased in 39% of patients, decreased in 52%, and remained stable in the remaining 9%, with an average value that had a nonsignificant decrease during follow-up. Urinary albumin excretion did not change throughout the study. After 4 years, left ventricular (LV) wall thickness and concentric geometry decreased significantly and variables of LV diastolic function improved. CONCLUSION In patients with RHTN, stenting of hemodynamically significant ARAS decreases blood pressure, preserves renal function in a substantial proportion of patients, and improves LV structure and function, suggesting the opportunity for timely identification of ARAS in these patients.
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Affiliation(s)
- Cristiana Catena
- Hypertension Unit, Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
| | - GianLuca Colussi
- Hypertension Unit, Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
| | - Gabriele Brosolo
- Hypertension Unit, Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
| | - Nicolas Verheyen
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Marileda Novello
- Hypertension Unit, Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
| | - Nicole Bertin
- Hypertension Unit, Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
| | - Alessandro Cavarape
- Hypertension Unit, Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
| | - Leonardo A Sechi
- Hypertension Unit, Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
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Keenswijk W, Walle JV. Another atypical case of acute kidney injury-or not? Questions. Pediatr Nephrol 2017; 32:1879-1880. [PMID: 27913874 DOI: 10.1007/s00467-016-3550-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Werner Keenswijk
- Department of Pediatrics, Pediatric Nephrology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium.
| | - Johan Vande Walle
- Department of Pediatrics, Pediatric Nephrology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium
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Starzec K, Klimek M, Grudzień A, Jagła M, Kwinta P. Longitudinal assessment of renal size and function in extremely low birth weight children at 7 and 11 years of age. Pediatr Nephrol 2016; 31:2119-26. [PMID: 27234909 PMCID: PMC5039221 DOI: 10.1007/s00467-016-3413-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are a lack of studies describing a longitudinal association between preterm delivery and renal complications later in life. We assessed renal size and function in preterm infants born with extremely low birth weight (ELBW) during 4 years of follow-up, comparing these parameters to age-matched children born full term (term controls). METHODS The results of selected renal laboratory tests [levels of cystatin C, creatinine, blood urea nitrogen (BUN)] and of renal ultrasound evaluations were compared between the ELBW group and the term control group at age 7 and 11 years. RESULTS The study population consisted of 64 children born with ELBW (ELBW children) who had been recruited at birth and 36 children born at term (term children) who took part in both follow-up assessments. Renal ultrasound examination revealed a significantly smaller renal volume in the 7- and 11-year-old ELBW children compared to the term controls [right kidney volume: 50.8 vs. 61.2 ml/m(2), respectively, at 7 years (p <0.01) and 51.4 vs. 58.2 ml/m(2), respectively, at 11 years (p <0.01); left kidney volume: 51.4 vs. 60.3 ml/m(2), respectively, at 7 years (p <0.01) and 55.2 vs. 60.7 ml/m(2), respectively, at 11 years (p = 0.02)]. Renal function in ELBW children was also affected. Serum cystatin C levels were significantly higher in ELBW children than in the controls at 7 years of age, and this difference remained statistically significant at 11 years of age [0.63 vs. 0.59 mg/l, respectively, at 7 years (p = 0.02) and 0.72 vs. 0.61 mg/l, respectively, at 11 years (p = 0.01)]. Six ELBW children also had elevated cystatin C levels (0.97-1.11 mg/l) at 11 years of age. Cystatin C levels were within normal range in the ELBW children at age 7 years and in term children in both follow-up studies. BUN levels were higher in ELBW children at the age of 11 years (4.49 vs. 4.15 mmol/l; p = 0.028). CONCLUSION Continued follow-up of these patients will reveal whether the observed worsening in renal function will persist into adulthood.
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Affiliation(s)
- Katarzyna Starzec
- Department of Pediatrics, Jagiellonian University Medical College, Wielicka Street 265, Cracow, 30-663, Poland.
| | - Małgorzata Klimek
- Department of Pediatrics, Jagiellonian University Medical College, Wielicka Street 265, Cracow, 30-663 Poland
| | - Andrzej Grudzień
- Department of Pediatrics, Jagiellonian University Medical College, Wielicka Street 265, Cracow, 30-663 Poland
| | - Mateusz Jagła
- Department of Pediatrics, Jagiellonian University Medical College, Wielicka Street 265, Cracow, 30-663 Poland
| | - Przemko Kwinta
- Department of Pediatrics, Jagiellonian University Medical College, Wielicka Street 265, Cracow, 30-663 Poland
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Dubov T, Toledano-Alhadef H, Chernin G, Constantini S, Cleper R, Ben-Shachar S. High prevalence of elevated blood pressure among children with neurofibromatosis type 1. Pediatr Nephrol 2016; 31:131-6. [PMID: 26314566 DOI: 10.1007/s00467-015-3191-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 08/05/2015] [Accepted: 08/05/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is a common neurocutaneous disease characterized by café-au-lait spots, axillary and inguinal freckling, neurofibromas, and optic gliomas. Increased rates of hypertension (HTN) were reported among NF1 patients, however, the prevalence of HTN and pre-HTN in pediatric NF1 patients has not been clarified. METHODS Blood pressure (BP) measurements, weight, and renal ultrasound were assessed in 224 NF1 pediatric patients followed in a specialized NF1 clinic. RESULTS The cohort's mean age was 9.1 ± 4.1 years. Overweight and obesity were found in 12.9 and 10.3 % of them, respectively. BP was measured averagely 2.9 times per patient on different occasions. Blood pressure was in the pre-HTN and HTN ranges in 14.9 and 16.9 % of measurements, respectively. BP >95th was detected in 20.5 % at the first measurement. Of 114 children with at least three BP measurements, 18.4 % had two values in the HTN range and 6.14 % had at least three. Overweight was not associated with HTN among children with NF1. Urinary tract ultrasonographic abnormalities were detected in 6.8 % (11/161) of cases. CONCLUSIONS The prevalence of increased BP in pediatric NF1 is much higher than in the general pediatric population. BP has to be regularly assessed and managed in this high-risk population.
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Affiliation(s)
- Tom Dubov
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Gilbert Israeli Neurofibromatosis Center, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Hagit Toledano-Alhadef
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Gilbert Israeli Neurofibromatosis Center, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Gil Chernin
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Nephrology Department, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Shlomi Constantini
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Gilbert Israeli Neurofibromatosis Center, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Roxana Cleper
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Nephrology Service, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Shay Ben-Shachar
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- The Gilbert Israeli Neurofibromatosis Center, Tel-Aviv Medical Center, Tel-Aviv, Israel.
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Ezekiel A, Agrawal V, Romero E, Smith-Harrison LI. Benign Fibroepithelial Polyps: A Rare Cause of Ureteropelvic Junction Obstruction in Children. Urol Case Rep 2015; 3:111-3. [PMID: 26793521 DOI: 10.1016/j.eucr.2015.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 03/25/2015] [Accepted: 03/26/2015] [Indexed: 11/22/2022] Open
Abstract
FEPs are rare, benign mucosal growths that may cause urinary tract obstruction in both adults and children. We present the case of a ten year old Hispanic male with recurring urinary tract infections and hydronephrosis diagnosed with fibroepithelial polyps (FEPs). Despite multiple radiographic procedures, we were unable to accurately preoperatively diagnose FEPs. Here we demonstrate the difficulties in preoperative diagnosis and suggest that perhaps a combination of US and MRI in the setting of persistent urinary tract infections and flank pain may be the best approach for early diagnosis and conservative management, including less invasive treatment protocols.
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Shapiro E. Best of the 2014 Pediatric Urology Fall Congress: Highlights From the 2014 Pediatric Urology Fall Congress, October 24-26, 2014, Miami, FL. Rev Urol 2015; 17:35-37. [PMID: 26029001 PMCID: PMC4444774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Ellen Shapiro
- Department of Urology, NYU Langone Medical Center, New York, NY
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Whittam BM, Calaway A, Szymanski KM, Carroll AE, Misseri R, Kaefer M, Rink RC, Karmazyn B, Cain MP. Ultrasound diagnosis of multicystic dysplastic kidney: is a confirmatory nuclear medicine scan necessary? J Pediatr Urol 2014; 10:1059-62. [PMID: 24909606 DOI: 10.1016/j.jpurol.2014.03.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/27/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE It is critical to differentiate between a multicystic dysplastic kidney (MCDK) and a kidney with severe hydronephrosis as the treatment varies significantly. We designed a study to compare renal ultrasound (RUS) to nuclear medicine (NM) scan in the diagnosis of MCDK, in order to determine if RUS can be used for the definitive diagnosis of MCKD without use of NM scan. MATERIALS AND METHODS We performed a retrospective review of children with MCDK, who underwent both a RUS and Tc-99m MAG3 or DMSA scan. We planned to calculate the positive predictive value of an RUS diagnosis of MCDK, using NM scan diagnosis of a nonfunctioning kidney as the gold standard. RESULTS The diagnosis of MCDK was made by RUS in 91 patients, 84 of whom had a normal bladder US. NM confirmed the diagnosis of MCDK in all 84 of these patients (100%). CONCLUSION We have demonstrated a high predictive value for RUS in the diagnosis of MCDK. Our data support that in healthy infants with RUS diagnosis of unilateral MCDK and normal bladder US, NM scan may be unnecessary to confirm the diagnosis.
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