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Xing Z, Xu H, Ai K, Deng H, Hong Y, Deng P, Wang J, Xiong W, Li Z, Zhu L, Li Y. Gross Hematuria Does not Affect the Selection of Nephrectomy Types for Clinical Stage 1 Clear Cell Renal Cell Carcinoma: A Multicenter, Retrospective Cohort Study. Ann Surg Oncol 2024; 31:3531-3543. [PMID: 38329657 DOI: 10.1245/s10434-024-14958-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/10/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE This study aimed to discuss the correlation between gross hematuria and postoperative upstaging (from T1 to T3a) in patients with cT1 clear cell renal cell carcinoma (ccRCC) and to compare oncologic outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in patients with gross hematuria. METHODS A total of 2145 patients who met the criteria were enrolled in the study (including 363 patients with gross hematuria). The least absolute selection and shrinkage operator logistic regression was used to evaluate the risk factor of postoperative pathological upstaging. The propensity score matching (PSM) and stable inverse probability of treatment weighting (IPTW) analysis were used to balance the confounding factors. The Kaplan-Meier analysis and multivariate Cox proportional risk regression model were used to assess the prognosis. RESULTS Gross hematuria was a risk factor of postoperative pathological upstaging (odds ratio [OR] = 3.96; 95% confidence interval [CI] 2.44-6.42; P < 0.001). After PSM and stable IPTW adjustment, the characteristics were similar in corresponding patients in the PN and RN groups. In the PSM cohort, PN did not have a statistically significant impact on recurrence-free survival (hazard ratio [HR] = 1.48; 95% CI 0.25-8.88; P = 0.67), metastasis-free survival (HR = 1.24; 95% CI 0.33-4.66; P = 0.75), and overall survival (HR = 1.46; 95% CI 0.31-6.73; P = 0.63) compared with RN. The results were confirmed in sensitivity analyses. CONCLUSIONS Although gross hematuria was associated with postoperative pathological upstaging in patients with cT1 ccRCC, PN should still be the preferred treatment for such patients.
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Affiliation(s)
- Zhuo Xing
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Haozhe Xu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Kai Ai
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Haitao Deng
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yulong Hong
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Piye Deng
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Wang
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Wei Xiong
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhi Li
- Department of Urology, The Affiliated First Hospital of Hunan Traditional Chinese Medical College, Zhuzhou, Hunan, China
| | - Lingfei Zhu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Yuan Li
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Sousa P, Brás C, Menezes C, Vizcaino R, Costa T, Faria MS, Mota C. Percutaneous kidney biopsies in children: a 24-year review in a tertiary center in northern Portugal. J Bras Nefrol 2024; 46:e20230143. [PMID: 38591825 DOI: 10.1590/2175-8239-jbn-2023-0143en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/16/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Percutaneous kidney biopsy (KB) is crucial to the diagnosis and management of several renal pathologies. National data on native KB in pediatric patients are scarce. We aimed to review the demographic and clinical characteristics and histopathological patterns in children who underwent native percutaneous KB over 24 years. METHODS Retrospective observational study of patients undergoing native percutaneous KB in a pediatric nephrology unit between 1998 and 2021, comparing 3 periods: period 1 (1998-2005), period 2 (2006-2013), and period 3 (2014-2021). RESULTS We found that 228 KB were performed, 78 (34.2%) in period 1, 91 (39.9%) in period 2, and 59 (25.9%) in period 3. The median age at KB was 11 (7-14) years. The main indications for KB were nephrotic syndrome (NS) (42.9%), hematuria and/or non-nephrotic proteinuria (35.5%), and acute kidney injury (13.2%). Primary glomerulopathies were more frequent (67.1%), particularly minimal change disease (MCD) (25.4%), IgA nephropathy (12.7%), and mesangioproliferative glomerulonephritis (GN) (8.8%). Of the secondary glomerulopathies, lupus nephritis (LN) was the most prevalent (11.8%). In group 1, hematuria and/or non-nephrotic proteinuria were the main reasons for KB, as opposed to NS in groups 2 and 3 (p < 0.01). LN showed an increasing trend (period 1-3: 2.6%-5.3%) and focal segmental glomerular sclerosis (FSGS) showed a slight decreasing trend (period 1-3: 3.1%-1.8%), without statistical significance. CONCLUSIONS The main indication for KB was NS, which increased over time, justifying the finding of MCD as main histological diagnosis. LN showed an increase in incidence over time, while FSGS cases did not increase.
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Affiliation(s)
- Patrícia Sousa
- Hospital Senhora da Oliveira, Serviço de Pediatria, Guimarães, Portugal
| | - Catarina Brás
- Hospital Professor Doutor Fernando Fonseca, Serviço de Nefrologia, Lisboa, Portugal
| | - Catarina Menezes
- Centro Hospitalar Universitário de Santo António, Centro Materno-Infantil do Norte, Serviço de Pediatria, Porto, Portugal
| | - Ramon Vizcaino
- Centro Hospitalar Universitário de Santo António, Serviço de Anatomia Patológica, Porto, Portugal
| | - Teresa Costa
- Centro Hospitalar Universitário de Santo António, Centro Materno-Infantil do Norte, Unidade de Nefrologia Pediátrica, Serviço de Pediatria, Porto, Portugal
| | - Maria Sameiro Faria
- Centro Hospitalar Universitário de Santo António, Centro Materno-Infantil do Norte, Unidade de Nefrologia Pediátrica, Serviço de Pediatria, Porto, Portugal
- Unidade de Ciências Biomoleculares Aplicadas, Department of Biological Science, Porto, Portugal
| | - Conceição Mota
- Centro Hospitalar Universitário de Santo António, Centro Materno-Infantil do Norte, Unidade de Nefrologia Pediátrica, Serviço de Pediatria, Porto, Portugal
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Li H, Li Z, Wu Z, Wang F, Xing Y, Liu Y, Jia J, Yan T. Clinical and pathological findings of IgA nephropathy following SARS-CoV-2 infection. Clin Exp Med 2024; 24:43. [PMID: 38400937 PMCID: PMC10894116 DOI: 10.1007/s10238-023-01271-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/30/2023] [Indexed: 02/26/2024]
Abstract
The features of IgA nephropathy (IgAN) after SARS-CoV-2 infection have not been well characterized. In this study, we compared the clinical and pathological characteristics of patients with IgAN who had experienced SARS-CoV-2 infection to those who had not. We conducted a retrospective study that enrolled 38 patients with biopsy-proven IgAN following SARS-CoV-2 infection with 4 months (post-SARS-CoV-2 infection group) and 1154 patients with IgAN prior to the pandemic (pre-SARS-CoV-2 infection group). Among the SARS-CoV-2 group cases, 61% were females. The average duration from SARS-CoV-2 infection to renal biopsy was 78.6 days. Prior to SARS-CoV-2 infection, the patients had different presentations of nephropathy. One patient had isolated hematuria, two had isolated proteinuria, twenty presented with both hematuria and proteinuria, and one patient had elevated serum creatinine. Additionally, there were eight cases with uncertain nephropathy history, and six cases did not have a history of nephropathy. Following SARS-CoV-2 infection, five patients experienced gross hematuria, one case exhibited creatinine elevation, and five cases showed an increase in proteinuria. The group of patients infected with SARS-CoV-2 after the COVID-19 pandemic exhibited older age, higher hypertension ratio and lower eGFR values compared to the pre-SARS-CoV-2 infection group. As for pathological parameters, a higher proportion of patients in the post-SARS-CoV-2 infection group exhibited a higher percentage of sclerotic glomeruli and glomerular ischemic sclerosis. There were no significant differences observed between the two groups in terms of therapy involving steroids, immunosuppressants, or RAS inhibitors. IgA nephropathy patients who were infected with SARS-CoV-2 were generally older and experienced more severe kidney damage compared to those without SARS-CoV-2 infection.
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Affiliation(s)
- Hongfen Li
- Department of Nephrology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, People's Republic of China
| | - Zhao Li
- Department of Clinical Discipline of Chinese and Western Integrative Medicine, Shuanghuan Cun Street Community Health Services Center, Tianjin, People's Republic of China
| | - Zhanfei Wu
- Department of Nephrology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, People's Republic of China
| | - Fanghao Wang
- Department of Nephrology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, People's Republic of China
| | - Yue Xing
- Department of Nephrology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, People's Republic of China
| | - Youxia Liu
- Department of Nephrology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, People's Republic of China.
| | - Junya Jia
- Department of Nephrology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, People's Republic of China.
| | - Tiekun Yan
- Department of Nephrology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, People's Republic of China
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Garaz R, Stühler V, Stenzl A, Rottscholl R, Amend B. Hemangioma of the Urinary Bladder: A Brief Narrative Review of Their Diagnosis, Histology, and Treatment Options. Urol Int 2024; 108:83-88. [PMID: 38228116 DOI: 10.1159/000536057] [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: 09/19/2023] [Accepted: 12/28/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Hemangioma of the urinary bladder is a rare benign tumor. Although benign, their presenting symptoms are alarming for both patients and doctors, and their rarity makes them challenging to correctly diagnosis and treat. This review paper summarizes current knowledge about hemangioma of the urinary bladder, treatment options, and follow-up modalities. SUMMARY After the kidney, the bladder is the second most common location of hemangiomas in the urinary tract. There is painless gross hematuria on clinical presentation once the lesion has eroded the urothelium. Magnetic resonance imaging (MRI) has been reported to be valuable in diagnosing soft-tissue hemangiomas. Cystoscopic findings of a sessile, blue, multilocular mass suggest hemangioma. Most tumors are solitary, smaller than 3 cm, and have smooth or irregular surfaces. Histologically, lesions comprise numerous proliferative capillaries with thin-walled, dilated, blood-filled vessels lined with flattened endothelium. The treatment of patients with hemangioma has been controversial. It depends on the tumor size and the degree of penetration. The prognosis of these tumors is excellent. KEY MESSAGES Despite the widespread use of MRI, CT, and endoscopy in evaluating hematuria, hemangioma remains one of the rarest bladder tumors. Moreover, only a histological examination can confirm the diagnosis. Transurethral resection, fulguration, and YAG laser ablation are standard treatments for small tumors. In terms of follow-up, cystoscopy after 6 months of treatment helps assess recurrence. In addition, MRI is a practical, noninvasive technique for follow-up of small hemangiomas.
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Affiliation(s)
- Radion Garaz
- Department of Urology, University Hospital of Tübingen, Tübingen, Germany
| | - Viktoria Stühler
- Department of Urology, University Hospital of Tübingen, Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital of Tübingen, Tübingen, Germany
| | - Robert Rottscholl
- Department of Pathology, University Hospital Tübingen, Tübingen, Germany
| | - Bastian Amend
- Department of Urology, University Hospital of Tübingen, Tübingen, Germany
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Matsuzaki K, Suzuki H, Kikuchi M, Koike K, Komatsu H, Takahashi K, Narita I, Okada H. Current treatment status of IgA nephropathy in Japan: a questionnaire survey. Clin Exp Nephrol 2023; 27:1032-1041. [PMID: 37646957 PMCID: PMC10654181 DOI: 10.1007/s10157-023-02396-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND In 2020, the Committee of Clinical Practical Guideline for IgA Nephropathy (IgAN) revised the clinical practice guidelines. Herein, we conducted a questionnaire survey to assess the potential discrepancies between clinical practice guidelines and real-world practice in Japan. METHODS A web-based survey of members of the Japanese Society of Nephrology was conducted between November 15 and December 28, 2021. RESULTS A total of 217 members (internal physicians: 203, pediatricians: 14) responded to the questionnaire. Of these respondents, 94.0% answered that the clinical practice guidelines were referred to "always" or "often." Approximately 66.4% respondents answered that histological grade (H-Grade) derived from the "Clinical Guidelines for IgA nephropathy in Japan, 3rd version" and the "Oxford classification" were used for pathological classification. Moreover, 73.7% respondents answered that the risk grade (R-grade) derived from the "Clinical Guidelines for IgA nephropathy in Japan, 3rd version" was referred to for risk stratification. The prescription rate of renin-angiotensin system blockers increased based on urinary protein levels (> 1.0 g/day: 88.6%, 0.5-1.0 g/day: 71.0%, < 0.5 g/day: 25.0%). Similarly, the prescription rate of corticosteroids increased according to proteinuria levels (> 1.0 g/day: 77.8%, 0.5-1.0 g/day: 52.8%, < 0.5 g/day: 11.9%). The respondents emphasized on hematuria when using corticosteroids. In cases of hematuria, the indication rate for corticosteroids was higher than in those without hematuria, even if the urinary protein level was 1 g/gCr or less. Few severe infectious diseases or serious deterioration in glycemic control were reported during corticosteroid use. CONCLUSION Our questionnaire survey revealed real-world aspects of IgAN treatment in Japan.
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Affiliation(s)
- K Matsuzaki
- Department of Public Health, Kitasato University School of Medicine, Kanagawa, Japan
| | - H Suzuki
- Department of Nephrology, Juntendo University Urayasu Hospital, Chiba, Japan.
| | - M Kikuchi
- Department of Nephrology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - K Koike
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - H Komatsu
- Center for Medical Education and Career Development, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - K Takahashi
- Department of Biomedical Molecular Sciences, Fujita Health University School of Medicine, Aichi, Japan
| | - I Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - H Okada
- Department of Nephrology, Saitama Medical University, Saitama, Japan
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Di H, Wang Q, Liang D, Zhang J, Gao E, Zheng C, Yu X, Liu Z. Genetic features and kidney morphological changes in women with X-linked Alport syndrome. J Med Genet 2023; 60:1169-1176. [PMID: 37225412 DOI: 10.1136/jmg-2023-109221] [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: 02/15/2023] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND X-linked Alport syndrome (XLAS) caused by COL4A5 pathogenic variants usually has heterogeneous phenotypes in female patients. The genetic characteristics and glomerular basement membrane (GBM) morphological changes in women with XLAS need to been further investigated. METHODS A total of 83 women and 187 men with causative COL4A5 variants were enrolled for comparative analysis. RESULTS Women were more frequently carrying de novo COL4A5 variants compared with men (47% vs 8%, p=0.001). The clinical manifestations in women were variable, and no genotype-phenotype correlation was observed. Coinherited podocyte-related genes, including TRPC6, TBC1D8B, INF2 and MYH9, were identified in two women and five men, and the modifying effects of coinherited genes contributed to the heterogeneous phenotypes in these patients. X-chromosome inactivation (XCI) analysis of 16 women showed that 25% were skewed XCI. One patient preferentially expressing the mutant COL4A5 gene developed moderate proteinuria, and two patients preferentially expressing the wild-type COL4A5 gene presented with haematuria only. GBM ultrastructural evaluation demonstrated that the degree of GBM lesions was associated with the decline in kidney function for both genders, but more severe GBM changes were found in men compared with women. CONCLUSIONS The high frequency of de novo variants carried by women indicates that the lack of family history tends to make them susceptible to be underdiagnosed. Coinherited podocyte-related genes are potential contributors to the heterogeneous phenotype of some women. Furthermore, the association between the degree of GBM lesions and decline in kidney function is valuable in evaluating the prognosis for patients with XLAS.
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Affiliation(s)
- Hongling Di
- National Clinical Research Center of Kidney Diseases, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Qing Wang
- National Clinical Research Center of Kidney Diseases, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
- Department of Nephrology, General Hospital of Eastern Theater Command, Naval Medical University, Shanghai, Shanghai, China
| | - Dandan Liang
- National Clinical Research Center of Kidney Diseases, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Jiahui Zhang
- The Key Laboratory of Biosystems Homeostasis & Protection of Ministry of Education, Life Sciences Institute, Zhejiang University, Hangzhou, Zhejiang, China
| | - Erzhi Gao
- National Clinical Research Center of Kidney Diseases, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Chunxia Zheng
- National Clinical Research Center of Kidney Diseases, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Xiaomin Yu
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, Zhejiang, China
| | - Zhihong Liu
- National Clinical Research Center of Kidney Diseases, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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Pichard D, Kurtz M, Reyes-Gomez E, Manassero M, Maurey C. A Case of Urinary Bladder Malakoplakia in a Young French Bulldog: Diagnostic and Therapeutic Issues. Top Companion Anim Med 2023; 56-57:100804. [PMID: 37597743 DOI: 10.1016/j.tcam.2023.100804] [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: 08/28/2022] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/21/2023]
Abstract
A 3-month-old female French Bulldog presented with hematuria, severe pollakiuria, and urinary incontinence lasting for 1.5 months. Broad-spectrum empirical antibiotic therapy and nonsteroidal anti-inflammatory drugs were initiated by the referring veterinarian. Due to a lack of improvement, the dog was referred. At referral examination, urinary clinical signs persisted (hematuria, severe pollakiuria) and a firm bladder was noted. Abdominal ultrasonography revealed severe, diffuse bladder wall thickening with a significant reduction in the bladder lumen. Urinary tract endoscopy showed whitish exophytic proliferations throughout the entire bladder wall. Histological bladder wall analysis led to a diagnosis of bladder malakoplakia. Prolonged antibiotic therapy with fluoroquinolones was prescribed and resulted in clinical remission despite persistent bacteria in the bladder wall. This report describes a case of successfully medically managed bladder malakoplakia, a very rare condition in veterinary medicine, well documented in humans.
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Affiliation(s)
- Diane Pichard
- Internal Medicine Department, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France.
| | - Maxime Kurtz
- Internal Medicine Department, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Edouard Reyes-Gomez
- Anatomical Pathology Department, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Mathieu Manassero
- Surgery Department, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Christelle Maurey
- Internal Medicine Department, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
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Darraj M. Urinary Bladder Schistosomiasis Mimicking Neoplasm: A Case Report. Medicina (B Aires) 2022; 58:medicina58081001. [PMID: 36013468 PMCID: PMC9414605 DOI: 10.3390/medicina58081001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
Schistosomiasis is a neglected disease that is prevalent in tropical and subtropical areas. A 20-year-old woman presented to the emergency room with a history of right flank pain and lower abdominal discomfort for one day, which coincided with the onset of menses. The patient did not provide any history of premenstrual hematuria. The physical examination revealed right costovertebral angle tenderness and was otherwise unremarkable. The urinalysis demonstrated a mild increase in red and white blood cells and no ova or parasite. The blood test was normal, except for eosinophilia. A right pedunculated intraluminal urinary bladder mass was detected by the computerized axial tomographic scan and ultrasonography, and after the transurethral resection of the mass, the patient was diagnosed with urinary schistosomiasis. The patient received two doses of oral praziquantel of 1200 mg every 12 h for one day. The cure was confirmed with a one-month post-treatment follow-up that revealed a normal urine microscope and eosinophil count. The S. haematobium infection should be evaluated as a possible cause of urinary bladder lesion in those who have travelled or lived in endemic areas.
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Affiliation(s)
- Majid Darraj
- Department of Medicine, College of Medicine, Jazan University, Jazan 45142, Saudi Arabia
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Saranti G, Zolota V, Kalogeropoulou C, Papathanasiou N, Katsila T, Kitsou K, Haliassos I, Kardamakis D. Diagnostic and Therapeutic Challenges in a Patient with Ureteral Metastases from a Triple Negative Breast Cancer. Curr Oncol 2022; 29:4791-4798. [PMID: 35877240 PMCID: PMC9323522 DOI: 10.3390/curroncol29070380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/01/2022] [Accepted: 07/03/2022] [Indexed: 11/27/2022] Open
Abstract
Metastatic ureteral tumors arising from a primary breast carcinoma are extremely rare. They present with hematuria and radiological findings compatible with obstructive ureteral phenomena. We present a case of an 87-year-old woman with a history of lymphoma and triple negative breast cancer (TNBC), during an emergency admission for peptic ulcer, developed macroscopic hematuria. Radiologic and endoscopic investigations revealed a remarkable stenosis at the lower segment of the right ureter, attributed to metastases from her breast carcinoma. We report this case with the aim to make both oncologists and urologists aware of this rare condition.
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Affiliation(s)
- Georgia Saranti
- Department of Radiation Oncology, University Hospital of Patras, University Campus, 26504 Patras, Greece; (G.S.); (I.H.)
| | - Vasiliki Zolota
- Department of Histopathology, University Hospital of Patras, University Campus, 26504 Patras, Greece;
| | - Christina Kalogeropoulou
- Department of Radiology, University Hospital of Patras, University Campus, 26504 Patras, Greece;
| | - Nikolaos Papathanasiou
- Department of Nuclear Medicine, University Hospital of Patras, University Campus, 26504 Patras, Greece;
| | - Theodora Katsila
- Institute of Chemical Biology, National Hellenic Research Foundation, 11635 Athens, Greece;
| | - Konstantina Kitsou
- Department of Hygiene and Epidemiology, University of Patras Medical School, 26504 Patras, Greece;
| | - Ilias Haliassos
- Department of Radiation Oncology, University Hospital of Patras, University Campus, 26504 Patras, Greece; (G.S.); (I.H.)
| | - Dimitrios Kardamakis
- Department of Radiation Oncology, University Hospital of Patras, University Campus, 26504 Patras, Greece; (G.S.); (I.H.)
- Correspondence: ; Tel.: +30-6999-424273
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Abstract
BACKGROUND Kidney biopsy is important to guide the management of allograft dysfunction but has a risk of complications. This review aimed to determine the incidence and risk factors of complications after kidney allograft biopsy. METHODS This is a systematic review and meta-analysis of randomized controlled trials, cohort studies, or case-control studies indexed on PubMed, Embase, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry, and ClinicalTrials.gov, limited to the English language, from January 2000 to December 2020, including adult and pediatric kidney allograft biopsies. Primary outcomes were gross hematuria, bleeding requiring transfusion, and major complications (requiring interventions such as blood transfusion or surgical or radiological interventions). RESULTS The review included 72 studies (40 082 biopsies). The quality of included studies was suboptimal. Pooled rates of gross hematuria, bleeding requiring transfusion, and major complications were 3.18% [95% confidence interval (95% CI), 2.31-4.19], 0.31% (95% CI, 0.15-0.52) and 0.89% (95% CI, 0.61-1.22), respectively. Gross hematuria rates were lower in high-income compared with middle-income countries (2.59% versus 6.44%, P < 0.01) and biopsies performed by radiology as compared with nephrology departments (1.25% versus 3.71%, P < 0.01). Blood transfusion rates were lower in pediatrics than adults (0.0% versus 0.65%, P < 0.01). Major complications were lower in biopsies performed by specialists as compared with trainees (0.02% versus 3.64%, P < 0.01). Graft loss and mortality were extremely rare. Limitations included missing data, few randomized controlled trials, and possible publication bias. CONCLUSIONS The risk of complications after kidney allograft biopsy was low. Given the low quality of included studies, risk factors for complications should be further examined in future studies.
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Affiliation(s)
- Quan Yao Ho
- Department of Renal Medicine, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Transplant Centre, Singapore
| | | | - Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | | | - Terence Kee
- Department of Renal Medicine, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Transplant Centre, Singapore
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
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Emelianova D, Prikis M, Morris CS, Gibson PC, Solomon R, Scriver G, Smith ZT, Bhave A, Shields J, DeSarno M, Kumar A. The evolution of performing a kidney biopsy: a single center experience comparing native and transplant kidney biopsies performed by interventional radiologists and nephrologists. BMC Nephrol 2022; 23:226. [PMID: 35752759 PMCID: PMC9233823 DOI: 10.1186/s12882-022-02860-1] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kidney biopsy is the most vital tool guiding a nephrologist in diagnosis and treatment of kidney disease. Over the last few years, we have seen an increasing number of kidney biopsies being performed by interventional radiologists. The goal of our study was to compare the adequacy and complication rates between kidney biopsies performed by interventional radiology versus nephrology. METHODS : We performed a single center retrospective analysis of a total of all kidney biopsies performed at our Institution between 2015 and 2021. All biopsies were performed using real-time ultrasound. Patients were monitored for four hours post biopsy and repeat ultrasound or hemoglobin checks were done if clinically indicated. The entire cohort was divided into two groups (Interventional radiology (IR) vs nephrology) based on who performed the biopsy. Baseline characteristics, comorbidities, blood counts, blood pressure, adequacy of the biopsy specimen and complication rates were recorded. Multivariable logistic regression was used to compare complication rates (microscopic hematuria, gross hematuria and need for blood transfusion combined) between these two groups, controlling for covariates of interest. ANCOVA (analysis of variance, controlling for covariates) was used to compare differences in biopsy adequacy (number of glomeruli per biopsy procedure) between the groups. RESULTS 446 kidney biopsies were performed in the study period (229 native and 147 transplant kidney biopsies) of which 324 were performed by IR and 122 by nephrologist. There was a significantly greater number of core samples obtained by IR (mean = 3.59, std.dev. = 1.49) compared to nephrology (mean = 2.47, std.dev = 0.79), p < 0.0001. IR used 18-gauge biopsy needles while nephrologist exclusively used 16-gauge needles. IR used moderate sedation (95.99%) or general anesthesia (1.85%) for the procedures more often than nephrology, which used them only in 0.82% and 0.82% of cases respectively (p < 0.0001). Trainees (residents or fellows) participated in the biopsy procedures more often in nephrology compared to IR (97.4% versus 69.04%, p < 0.0001). The most frequent complication identified was microscopic hematuria which occurred in 6.8% of biopsies. For native biopsies only, there was no significant difference in likelihood of complication between groups, after adjustment for covariates of interest (OR = 1.01, C.I. = (0.42, 2.41), p = 0.99). For native biopsies only, there was no significant difference in mean number of glomeruli obtained per biopsy procedure between groups, after adjustment for covariates of interest (F(1,251) = 0.40, p = 0.53). CONCLUSION Our results suggest that there is no significant difference in the adequacy or complication rates between kidney biopsies performed by IR or nephrology. This conclusion may indicate that kidney biopsies can be performed safely with adequate results either by IR or nephrologists depending on each institution's resources and expertise.
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Affiliation(s)
- Daria Emelianova
- Department of Radiology, Robert Larner MD College of Medicine, Burlington, VT, USA.
| | - Marios Prikis
- Division of Nephrology and Transplantation, Department of Medicine, Robert Larner MD College of Medicine, Burlington, VT, USA
| | - Christopher S Morris
- Department of Radiology, Robert Larner MD College of Medicine, Burlington, VT, USA
| | - Pamela C Gibson
- Department of Pathology, Robert Larner MD College of Medicine, Burlington, VT, USA
| | - Richard Solomon
- Department of Medicine, Robert Larner MD College of Medicine, Burlington, VT, USA
| | - Geoffrey Scriver
- Department of Radiology, Robert Larner MD College of Medicine, Burlington, VT, USA
| | - Zachary T Smith
- Department of Radiology, Robert Larner MD College of Medicine, Burlington, VT, USA
| | - Anant Bhave
- Department of Radiology, Robert Larner MD College of Medicine, Burlington, VT, USA
| | - Joseph Shields
- Department of Radiology, Robert Larner MD College of Medicine, Burlington, VT, USA
| | - Michael DeSarno
- Department of Medical Biostatistics, Robert Larner MD College of Medicine, Burlington, VT, USA
| | - Abhishek Kumar
- Yale School of Medicine, Section of Nephrology, New Haven, CT, USA
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12
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Grosch S, Erpicum P, Bouquegneau A, Jouret F, Bovy C. [The glomerulus in all its states]. Rev Med Liege 2022; 77:330-337. [PMID: 35657191] [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: 06/15/2023]
Abstract
Glomerulonephritis are the result of an inflammatory hit to the glomerulus. They are rare and heterogeneous renal diseases. Each glomerular compartment can be affected. The clinical manifestations present with hematuria, proteinuria and/or impaired renal function, either isolated or combined. Two main clinico-biological syndromes are described: nephrotic syndrome and nephritic syndrome. The latter can present in a more severe form i.e. rapidly progressive glomerulonephritis with the worst prognosis. These different clinical pictures are related to specific glomerular lesions. Thus, podocytic damage is mainly responsible for nephrotic syndromes, mesangial damage is responsible for proteinuria and hematuria and, finally, endothelial damage is responsible for nephritic syndrome and rapidly progressive glomerulonephritis. Therapeutic approaches include non-specific measures, combining both life-style and pharmacological interventions with the aim to reduce risk factors, and specific measures with the use of different immunosuppressive agents.
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Affiliation(s)
- S Grosch
- Service de Néphrologie, Dialyse et Transplantation CHU Liège, Belgique
| | - P Erpicum
- Service de Néphrologie, Dialyse et Transplantation CHU Liège, Belgique
- Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Unité de Recherche Cardio-Vasculaire, ULiège, Belgique
| | - A Bouquegneau
- Service de Néphrologie, Dialyse et Transplantation CHU Liège, Belgique
| | - F Jouret
- Service de Néphrologie, Dialyse et Transplantation CHU Liège, Belgique
- Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Unité de Recherche Cardio-Vasculaire, ULiège, Belgique
| | - C Bovy
- Service de Néphrologie, Dialyse et Transplantation CHU Liège, Belgique
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13
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Aronowitz J, Ding L, Yates J, Zong Y, Zheng L, Jiang Z, Yancey J, Mittal K, Fitzgerald TJ. Stereotactic Body Radiotherapy for Palliation of Hematuria Arising From Urothelial Carcinoma of the Kidney in Unfavorable Surgical Candidates. Am J Clin Oncol 2021; 44:175-180. [PMID: 33710134 DOI: 10.1097/coc.0000000000000801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Hematuria can be a distressing and debilitating complication of urothelial carcinoma (UC) of the kidney for patients who are not candidates for surgery or ureteroscopic ablation. We retrospectively assessed the efficacy, tolerability, and safety of stereotactic body radiotherapy (SBRT) for controlling gross hematuria in this patient population. MATERIALS AND METHODS Institutional Review Board (IRB)-approved review of the records, laboratory values, pathology, and imaging of 8 consecutive patients treated with SBRT over a 5-year period for uncontrolled gross hematuria caused by UC of the renal pelvis or calyces. RESULTS Therapy was delivered in 3 to 5 treatments over 1 to weeks. Individual treatments lasted an average of 17.2 minutes. No patient experienced treatment-related pain, vomiting, or diarrhea. All enjoyed cessation of bleeding within a week of completing therapy. Hematuria recurred in 2 patients in 4 and 22 months. Of the patients who have not re-bled, 3 expired of metastatic disease or co-morbidities, and 3 remain alive up to 6 years posttreatment. Of patients who have survived longer than a year, creatinine has changed by -0.05 to +0.35, and estimated glomerular filtration rate has fallen by an average of 22%. No patient has required dialysis. CONCLUSIONS SBRT appears to be an effective and well-tolerated means of palliating gross hematuria secondary to UC of the renal pelvis or calyces in patients who are unfavorable candidates for nephrectomy or ureteroscopic ablation. Treatment was associated with a moderate decline in renal function.
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Affiliation(s)
| | | | | | | | | | | | - Jessica Yancey
- Department of Radiation Oncology, Tufts University Medical School, Boston, MA
| | - Kriti Mittal
- Medicine, Division of Medical Oncology, University of Massachusetts Medical School, Worcester
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14
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Chemouny JM, Bobot M, Sannier A, Maisons V, Jourde-Chiche N, Ferriere E, Joly D, Vigneau C, Rioux-Leclercq N, Barba C, Daniel L, Halimi JM, Vrtovsnik F. Kidney Biopsy in Type 2 Diabetes: A Multicenter Cross-Sectional Study. Am J Nephrol 2021; 52:131-140. [PMID: 33780924 DOI: 10.1159/000514259] [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: 10/31/2020] [Accepted: 12/28/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Kidney biopsies (KBs) are performed in patients with type 2 diabetes (T2D) to diagnose non-diabetic or hypertensive kidney disease (NDHKD) potentially requiring specific management compared to diabetic and or hypertensive nephropathy (absence of NDHKD). Indications for KB are based on the presence of atypical features compared to the typical course of diabetic nephropathy. In this study, we assessed the association of different patterns of atypical features, or KB indications, with NDHKD. METHODS Native KBs performed in patients with T2D were analyzed. Data were collected from the patients' records. KB indications were determined according to the presence of different atypical features considered sequentially: (1) presence of any feature suggesting NDHKD which is not among the following ones, (2) recent onset of nephrotic syndrome, (3) low or rapidly declining estimated glomerular filtration rate (eGFR), (4) rapid increase in proteinuria, (5) short duration of diabetes, (6) presence of hematuria, or (7) normal retinal examination. RESULTS Among the 463 KBs analyzed, NDHKD was diagnosed in 40% of the total population and 54, 40, 24, and 7% of the KBs performed for indications 1-4 respectively. Conversely, no patient who underwent KB for indications 5-7 displayed NDHKD. Logistic regression analyses identified eGFRCKD-EPI >15 mL/min/1.73 m2, urinary protein-to-Cr ratio <0.3 g/mmol, hematuria, HbA1c <7%, and diabetes duration <5 years as predictors of NDHKD, independently from the indication group. CONCLUSION NDHKD is frequent in T2D. Despite the association of hematuria with NDHKD, our results suggest that presence of hematuria and absence of DR are insufficient to indicate KB in the absence of concurrent atypical features. Conversely, rapid progression of proteinuria and rapid deterioration of eGFR are major signals of NDHKD.
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Affiliation(s)
- Jonathan M Chemouny
- CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en santé, Environnement et Travail) - UMR_S 1085, CIC-P 1414 (Centre d'Investigation Clinique), Univ Rennes, Rennes, France
| | - Mickaël Bobot
- Aix-Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
- AP-HM, Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Marseille, France
| | - Aurélie Sannier
- Laboratoire d'Anatomie et Cytologie Pathologiques, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
- Université de Paris, Paris, France
| | - Valentin Maisons
- CHU Tours, Service de Néphrologie et d'Immunologie Clinique, Tours, France
| | - Noémie Jourde-Chiche
- Aix-Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
- AP-HM, Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Marseille, France
| | - Elsa Ferriere
- Service de Néphrologie, Faculté de Médecine, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris-Descartes, Paris, France
| | - Dominique Joly
- Service de Néphrologie, Faculté de Médecine, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris-Descartes, Paris, France
| | - Cécile Vigneau
- CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en santé, Environnement et Travail) - UMR_S 1085, Univ Rennes, Rennes, France
| | - Nathalie Rioux-Leclercq
- CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en santé, Environnement et Travail) - UMR_S 1085, Univ Rennes, Rennes, France
| | - Christophe Barba
- Service de Néphrologie, Hôpital Bichat-Claude Bernard, AP-HP, DHU Fire, Paris, France
| | - Laurent Daniel
- Aix-Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
- AP-HM, Laboratoire d'Anatomopathologie, Hôpital de la Timone, Marseille, France
| | - Jean-Michel Halimi
- CHU Tours, Service de Néphrologie et d'Immunologie Clinique, Tours, France
- Université de Tours, INI-CRCT, Tours, France
| | - Francois Vrtovsnik
- Université de Paris, Paris, France
- Service de Néphrologie, Hôpital Bichat-Claude Bernard, AP-HP, DHU Fire, Paris, France
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15
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Tadros NN, Conlin MJ. Ureteroscopic evaluation and treatment of benign essential hematuria: a systematic review. Can J Urol 2021; 28:10510-10515. [PMID: 33625340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
UNLABELLED INTRODUCTION The advent of ureteroscopy has revolutionized the treatment many urologic diseases, including benign essential hematuria. This systematic review examines the treatment of benign essential hematuria (BEH) with ureteroscopic interventions. MATERIALS AND METHODS We performed a systematic review of the literature from 1977 to May 2020. We included studies that evaluated the use of ureteroscopy to diagnose or treat BEH. Demographics, follow up, findings, treatment method and success rate were extracted from each identified paper. Quality analysis was performed independently by both authors. RESULTS Our search resulted in 587 articles. Fifteen of these studies met inclusion criteria and were included in the final analysis. No randomized controlled trials were found. All 15 studies were case series. Nine studies were graded as good, five as fair, and one as poor. Follow up ranged from 2 to 108 months. A total of 307 patients underwent ureteroscopy for suspected BEH; 223 (73%) were diagnosed with a discrete lesion, 33 (11%) with a diffuse lesion, and 44 (14%) had no lesions seen on ureteroscopy. Of those diagnosed with discrete lesions, the most common was minute venous ruptures (35%), followed by hemangiomas (26%). Ureteroscopic treatment successfully relieved the hematuria and symptoms in most patients, and was more successful in those treated for discrete lesion (115/120, 96%) than diffuse (10/19, 53%). CONCLUSIONS Ureteroscopic treatment of BEH yields excellent outcomes. In this systematic review, 96% of patients with discrete lesions and 53% of patients with diffuse lesions had resolution of their hematuria after ureteroscopic interventions.
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Affiliation(s)
- Nicholas N Tadros
- Division of Urology, Southern Illinois University, Springfield, Illinois, USA
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16
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Wu Y, Zhang J, Wang Y, Wang T, Han Q, Guo R, Zhang R, Ren H, Zhu Y, Xu H, Li L, Tong N, Liu F. The association of hematuria on kidney clinicopathologic features and renal outcome in patients with diabetic nephropathy: a biopsy-based study. J Endocrinol Invest 2020; 43:1213-1220. [PMID: 32147762 DOI: 10.1007/s40618-020-01207-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 07/21/2019] [Accepted: 02/27/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the relationships between hematuria, clinicopathological features and renal outcomes in patients with biopsy-proven diabetic nephropathy (DN). METHODS This cohort study included 261 patients with DN. Participants were divided into two groups according to number of red blood cells per high-power field (RBC/hpf) in urine sediment: the hematuria (-) group (≤ 3 RBC/hpf) and the hematuria (+) group (> 3 RBC/hpf). Basic clinical parameters were measured at the time of renal biopsy; relationships between hematuria and clinicopathological features and renal outcomes were analyzed. RESULTS Patients in the hematuria (+) group often had overt proteinuria. Interstitial inflammation was more severe in the hematuria (+) group than in the hematuria (-) group. Glomerular arteriolar hyalinosis, interstitial fibrosis and tubular atrophy were comparable between groups. For patients with early DN (eGFR ≥ 60 ml/min/1.73 m2), urinary RBC/hpf at baseline was positively correlated with glomerular classification, interstitial fibrosis/tubular atrophy scores and interstitial inflammation scores. In prognostic analysis, hematuria was associated with a higher risk of progression to end-stage renal disease. Hematuria remained an independent predictor after adjustment for confounding factors such as sex, age, duration of diabetes, serum glucose level, hypertension, cholesterol, eGFR and urine protein excretion, especially in patients with early DN and in male patients. CONCLUSION In this study, hematuria was associated with more severe renal pathologic lesions in patients with DN. The presence of hematuria could be an independent predictor of renal outcome in patients with early DN.
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Affiliation(s)
- Y Wu
- Division of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - J Zhang
- Division of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Y Wang
- Division of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - T Wang
- Division of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Q Han
- Division of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - R Guo
- Division of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - R Zhang
- Division of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - H Ren
- Division of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Y Zhu
- Division of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - H Xu
- Division of Pathology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - L Li
- Division of Pathology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - N Tong
- Division of Endocrinology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - F Liu
- Division of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
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17
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Kolovou K, Laskari K, Roumelioti M, Tektonidou MG, Panayiotidis P, Boletis JN, Marinaki S, Sfikakis PP. B-cell oligoclonal expansions in renal tissue of patients with immune-mediated glomerular disease. Clin Immunol 2020; 217:108488. [PMID: 32479988 DOI: 10.1016/j.clim.2020.108488] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 12/15/2022]
Abstract
B-cell clonal expansion has been sporadically described in the blood and/or renal tissue of patients with glomerulonephritides, albeit with unclear pathogenetic role. Herein, using spectratyping analysis, we observed oligoclonal intrarenal B-cell populations in 59% of glomerulonephritis patients with podocyte injury (6/7 with focal segmental glomerulosclerosis, 1/3 minimal change disease, 1/3 idiopathic membranous nephropathy, 3/4 IgA nephropathy, 2/5 membranous lupus nephritis), 20% of glomerulonephritis patients without podocyte involvement (4/13 with mesangial or proliferative lupus nephritis, 0/3 idiopathic membranoproliferative glomerulonephritis, 0/4 pauci-immune vasculitis) and 17% of control patients with renal cancer. In multivariate analysis, oligoclonal B-cells were associated with podocyte injury and the grade of glomerulosclerosis (both p = .009). B-cell oligoclonal expansions were not found in the paired peripheral blood samples. We postulate that B-cell expansion in the kidney results from local stimuli, including antigens expressed on podocytes. Further studies to unravel the role of oligoclonal B-cells in (auto)immune-mediated kidney disease are warranted.
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Affiliation(s)
- Kyriaki Kolovou
- Department of Nephrology and Renal Transplantation, National and Kapodistrian University of Athens Medical School, Laiko Hospital, Athens, Greece
| | - Katerina Laskari
- Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Laiko Hospital, Athens, Greece
| | - Maria Roumelioti
- Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Laiko Hospital, Athens, Greece
| | - Maria G Tektonidou
- Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Laiko Hospital, Athens, Greece
| | - Panayiotis Panayiotidis
- Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Laiko Hospital, Athens, Greece
| | - John N Boletis
- Department of Nephrology and Renal Transplantation, National and Kapodistrian University of Athens Medical School, Laiko Hospital, Athens, Greece
| | - Smaragdi Marinaki
- Department of Nephrology and Renal Transplantation, National and Kapodistrian University of Athens Medical School, Laiko Hospital, Athens, Greece
| | - Petros P Sfikakis
- Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Laiko Hospital, Athens, Greece.
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18
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Rodriguez Peña M, Ovando E. [Klippel-Trenaunay-Weber syndrome with vesical and uterine involvement treated by endoscopic and endovascular routes]. Medicina (B Aires) 2020; 80:84-86. [PMID: 32044745] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Klippel-Trenaunay-Weber syndrome (KTWS) is a rare venous malformation that generally affects the lower limbs and, more infrequently, the upper limbs. It is characterized by cutaneous angiomatous formations, varicose veins and hypertrophy of the affected limb. The involvement of the genitourinary tract is extremely infrequent. We expose the case of a 14 years old female patient who was admitted for macroscopic hematuria of 48 hours of evolution and metrorrhagia with severe hemodynamic decompensation. The patient was under study for presenting a hemangioma in the lower left limb that extended to the pelvic region. Urethrocystofibroscopy showed the presence of multiple wide-spread angiomatous lesions in the bladder, some of them with active bleeding. The angio-resonance showed a voluminous hypervascular formation in contact with the bladder wall showing several arteriovenous fistulas at the pelvic level and in the left lower limb confirming the etiological diagnosis. A selective arterial embolization of the internal and external iliac territories was performed and then, a laser endocoagulation of the bleeding angiomatous foci was carried out. The hematuria completely stopped within 24 hours later of the procedure. The metrorrhagia associated with KTWS was controlled by the use of LHRH analogs and progestogens.
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Affiliation(s)
| | - Elizabeth Ovando
- Servicio de Ginecología, Hospital Militar Central, Buenos Aires, Argentina
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19
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Colavita L, Salpietro C, Cuppari C, Sallemi A, Di Benedetto V, Concolino D, Marseglia L, D'Angelo G, Gitto E, Betta P, Fede C, Conti G, Chimenz R. Nephrotic syndrome: immunological mechanisms. J BIOL REG HOMEOS AG 2019; 33:13-18. Special Issue: Focus on Pediatric Nephrology. [PMID: 31630708] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Nephrotic Syndrome (NS) is a rare diseases (around 2-7 cases per 100.000 children per year) characterized by proteinuria ≥50 mg/kg/day (or ≥40 mg/m2/h) or a proteinuria/creatininuria ratio >2 (mg/mg); hypoalbuminaemia less than 25 g/l and edema. The protein leakage, with the consequent hypoalbunaemia and edema, due to podocyte alterations may be caused by genetic diseases, immunological mechanisms, infections, toxins or malignancy. However, most commonly the exact etiology is unknow. The idiopathic NS may be classified based on response to corticosteroid therapy or the hytological appearance. The first classification identifies steroid-resistant NS (no response after 4 weeks of steroid therapy); frequently relapsing NS (≥ 2 relapses in first 6 months or ≥4 relapses in 1-year); steroid dependent NS (relapses during steroid decalage or within 2 weeks from steroid therapy interruption). The hystological classification is based on light and electron microscopy after renal biopsy, which is indicated in case of onset disease before 1 year or after 12 years of age. Macroscopic hematuria: persistent hypertension and/or microscopic hematuria and/or low plasma C3 renal failure not related to hypovolemia; steroid resistence: secondary or relatedsyndromes NS. Minimal change disease (MCD) is the most common form of idiopahtic NS in children, with good response to steroid treatment, and it is characterized by normal glomerular appearance on light microscopy and evidence of podocyte foot alterations on electron microscopy, due to immunological related damage. Focal segmental glomerulosclerosis (FSGS) is described inidiopahtic NS, particularly in steroiddependent or steroid-resistant forms, and is characterized by evidence of focal glomerular damage with secondary sclerosis and adhesion with Bowman's capsule; the electron appearance is the same of MCD one. Recent authors hypotizethat the FSGS is an evolution of MCD. These 2 idiopathic NS forms may be expression of the same immunological disease, with 2 different severity grades; so they may be considered different moments of the same disease spectrum. Less common idiopathic NS forms are membrano proliferative glomerulonephritis; membranous nephropathy; IgM-nephropathy; C1q nephropathy and thin basement membrane disease (1, 2, 3).
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Affiliation(s)
- L Colavita
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Unit of Emergency Pediatrics, University of Messina, Policlinico "G. Martino" Messina, Italy
| | - C Salpietro
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Unit of Emergency Pediatrics, University of Messina, Policlinico "G. Martino" Messina, Italy
| | - C Cuppari
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Unit of Emergency Pediatrics, University of Messina, Policlinico "G. Martino" Messina, Italy
| | - A Sallemi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Unit of Emergency Pediatrics, University of Messina, Policlinico "G. Martino" Messina, Italy
| | - V Di Benedetto
- Department of Pediatric Surgery "Policlinico-Vittorio Emanuele" of Catania, Italy
| | - D Concolino
- Department of Medical and Surgical Sciences, Pediatric Unit, "Magna Graecia" University, Catanzaro, Italy
| | - L Marseglia
- Neonatal Intensive Care Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Italy
| | - G D'Angelo
- Neonatal Intensive Care Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Italy
| | - E Gitto
- Neonatal Intensive Care Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Italy
| | - P Betta
- Neonatal Intensive Care Unit, Policlinico-Vittorio Emanuele" of Catania, Italy
| | - C Fede
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Unit of Pediatric Nephrology and Rheumatology with Dialysis, University of Messina, Policlinico "G. Martino"Messina, Italy
| | - G Conti
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Unit of Pediatric Nephrology and Rheumatology with Dialysis, University of Messina, Policlinico "G. Martino"Messina, Italy
| | - R Chimenz
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Unit of Pediatric Nephrology and Rheumatology with Dialysis, University of Messina, Policlinico "G. Martino" Messina, Italy
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Tan WS, Sarpong R, Khetrapal P, Rodney S, Mostafid H, Cresswell J, Watson D, Rane A, Hicks J, Hellawell G, Davies M, Srirangam SJ, Dawson L, Payne D, Williams N, Brew‐Graves C, Feber A, Kelly JD. Does urinary cytology have a role in haematuria investigations? BJU Int 2019; 123:74-81. [PMID: 30003675 PMCID: PMC6334509 DOI: 10.1111/bju.14459] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the diagnostic accuracy of urinary cytology to diagnose bladder cancer and upper tract urothelial cancer (UTUC) as well as the outcome of patients with a positive urine cytology and normal haematuria investigations in patients in a multicentre prospective observational study of patients investigated for haematuria. PATIENT AND METHODS The DETECT I study (clinicaltrials.gov NCT02676180) recruited patients presenting with haematuria following referral to secondary case at 40 hospitals. All patients had a cystoscopy and upper tract imaging (renal bladder ultrasound [RBUS] and/ or CT urogram [CTU]). Patients, where urine cytology were performed, were sub-analysed. The reference standard for the diagnosis of bladder cancer and UTUC was histological confirmation of cancer. A positive urine cytology was defined as a urine cytology suspicious for neoplastic cells or atypical cells. RESULTS Of the 3 556 patients recruited, urine cytology was performed in 567 (15.9%) patients from nine hospitals. Median time between positive urine cytology and endoscopic tumour resection was 27 (IQR: 21.3-33.8) days. Bladder cancer was diagnosed in 39 (6.9%) patients and UTUC in 8 (1.4%) patients. The accuracy of urinary cytology for the diagnosis of bladder cancer and UTUC was: sensitivity 43.5%, specificity 95.7%, positive predictive value (PPV) 47.6% and negative predictive value (NPV) 94.9%. A total of 21 bladder cancers and 5 UTUC were missed. Bladder cancers missed according to grade and stage were as follows: 4 (19%) were ≥ pT2, 2 (9.5%) were G3 pT1, 10 (47.6%) were G3/2 pTa and 5 (23.8%) were G1 pTa. High-risk cancer was confirmed in 8 (38%) patients. There was a marginal improvement in sensitivity (57.7%) for high-risk cancers. When urine cytology was combined with imaging, the diagnostic performance improved with CTU (sensitivity 90.2%, specificity 94.9%) superior to RBUS (sensitivity 66.7%, specificity 96.7%). False positive cytology results were confirmed in 22 patients, of which 12 (54.5%) had further invasive tests and 5 (22.7%) had a repeat cytology. No cancer was identified in these patients during follow-up. CONCLUSIONS Urine cytology will miss a significant number of muscle-invasive bladder cancer and high-risk disease. Our results suggest that urine cytology should not be routinely performed as part of haematuria investigations. The role of urine cytology in select cases should be considered in the context of the impact of a false positive result leading to further potentially invasive tests conducted under general anaesthesia.
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Affiliation(s)
- Wei Shen Tan
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of UrologyUniversity College London HospitalLondonUK
| | - Rachael Sarpong
- Surgical and Interventional Trials UnitUniversity College LondonLondonUK
| | - Pramit Khetrapal
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of UrologyUniversity College London HospitalLondonUK
| | - Simon Rodney
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- UCL Cancer InstituteLondonUK
| | - Hugh Mostafid
- Department of UrologyRoyal Surrey County HospitalGuildfordUK
| | - Joanne Cresswell
- Department of UrologyJames Cook University HospitalMiddlesbroughUK
| | - Dawn Watson
- Department of UrologyJames Cook University HospitalMiddlesbroughUK
| | - Abhay Rane
- Department of UrologyEast Surrey HospitalRedhillUK
| | - James Hicks
- Department of UrologyWorthing HospitalWorthingUK
| | | | - Melissa Davies
- Department of UrologySalisbury District HospitalSalisburyUK
| | | | | | - David Payne
- Department of UrologyKettering General HospitalKetteringUK
| | - Norman Williams
- Surgical and Interventional Trials UnitUniversity College LondonLondonUK
| | - Chris Brew‐Graves
- Surgical and Interventional Trials UnitUniversity College LondonLondonUK
| | - Andrew Feber
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- UCL Cancer InstituteLondonUK
| | - John D. Kelly
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of UrologyUniversity College London HospitalLondonUK
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Jiang S, Wang Y, Zhang Z, Dai P, Yang Y, Li W. Accuracy of hematuria for predicting non-diabetic renal disease in patients with diabetes and kidney disease: A systematic review and meta-analysis. Diabetes Res Clin Pract 2018; 143:288-300. [PMID: 30059756 DOI: 10.1016/j.diabres.2018.07.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 02/27/2018] [Revised: 06/24/2018] [Accepted: 07/23/2018] [Indexed: 11/18/2022]
Abstract
AIMS To clarify the predictive value of hematuria in patients with diabetes and non-diabetic renal disease (NDRD). METHODS The databases of Medline, Embase and the Cochrane Library were searched up to November 22, 2017. The pooled sensitivity, specificity, positive and negative likelihood ratio (PLR, NLR), diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic (SROC) curve (AUC) were calculated using a bivariate mixed-effects regression model. RESULTS Thirty-eight articles were eligible, of which 35 articles with 4005 patients investigated hematuria. The pooled sensitivity and specificity of hematuria to predict NDRD were 0.42 (95% CI 0.35-0.49) and 0.72 (95% CI 0.64-0.79), respectively. The pooled PLR and NLR were 1.49 (95% CI 1.28-1.75) and 0.81 (95% CI 0.75-0.87), respectively. The DOR was 1.85 (95% CI 1.49-2.30). The pooled AUC was 0.59 (95% CI 0.54-0.63). For dysmorphic erythrocytes, the pooled sensitivity was 0.27 (95% CI 0.23-0.32), while the specificity was 0.94 (95% CI 0.91-0.97). There was heterogeneity among studies (p < 0.001), and no publication bias was identified. CONCLUSIONS Type 2 diabetes patients presenting with hematuria are slightly more likely to develop NDRD. Dysmorphic erythrocytes may be more useful than microhematuria in diagnosing for NDRD in type 2 diabetes with proteinuria.
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Affiliation(s)
- Shimin Jiang
- China-Japan Friendship Institute of Clinical Medicine, Graduate School of Peking Union Medical College, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yining Wang
- Department of Clinical Medicine, Peking University Health Science Center, Beijing 100191, China
| | - Zheng Zhang
- China-Japan Friendship Institute of Clinical Medicine, Graduate School of Peking Union Medical College, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Peilin Dai
- Department of Clinical Medicine, Peking University Health Science Center, Beijing 100191, China
| | - Yue Yang
- Department of Nephrology, China-Japan Friendship Hospital, No. 2 East Yinghuayuan Street, Chaoyang District, Beijing 100029, China.
| | - Wenge Li
- China-Japan Friendship Institute of Clinical Medicine, Graduate School of Peking Union Medical College, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China; Department of Nephrology, China-Japan Friendship Hospital, No. 2 East Yinghuayuan Street, Chaoyang District, Beijing 100029, China.
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Foster CH, Elahi C, Cheney S, Trier T, Torabi A, Manglik N. Thoracic Paraspinal Castleman Disease in a Young Mexican-American Man with Postcoital Hematuria. World Neurosurg 2018; 120:36-42. [PMID: 30165219 DOI: 10.1016/j.wneu.2018.08.091] [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: 05/22/2018] [Revised: 08/11/2018] [Accepted: 08/13/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Castleman disease (CD) is an uncommon disorder of deregulated lymphoproliferation with unicentric (UCD) and multicentric forms based on extent of nodal involvement. Gross resection with histopathologic analysis remains the gold standard for diagnosis of UCD and is curative in most cases. Symptomatic paraspinal UCD is a rare presentation with potentially dangerous complications, and its tendency to mimic more common spinal tumors presents a significant diagnostic challenge. CASE PRESENTATION A 25-year-old Hispanic man with no past medical history was evaluated for a known left-sided paraspinal mass that was incidentally discovered during an emergency department work-up for hematuria. Computed tomography on initial presentation revealed a 5.3 cm × 3.3 cm × 4.8 cm heterogeneously enhancing left paraspinal mass adjacent to the T11 vertebral body with tonguelike extension into the T11-T12 neural foramen. Although he remained neurologically intact throughout most of the diagnostic work-up, an inconclusive biopsy, worsening hematuria, and late-onset radiculopathy with severe back pain prompted surgical intervention. Microscopic histomorphology was consistent with CD. He continued to have intermittent hematuria and dysuria postoperatively, but repeat computed tomography at 7 months confirmed no recurrence of the mass. CONCLUSIONS Compared with previous reports, our case of postcoital hematuria and radiculopathy accompanying a paraspinal thoracic mass in a young Mexican-American man is a unique presentation. Awareness and early consideration of UCD in the work-up of a paraspinal mass may spare affected patients adverse and dangerous sequelae, such as spinal cord compression and excessive intraoperative hemorrhage.
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Affiliation(s)
- Chase H Foster
- Department of Neurological Surgery, George Washington University Hospital, Washington DC, USA
| | - Cyrus Elahi
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA.
| | - Stephen Cheney
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
| | - Todd Trier
- Department of Neurosurgery, University Medical Center of El Paso, El Paso, Texas, USA
| | - Alireza Torabi
- Department of Pathology, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Niti Manglik
- Department of Pathology, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
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Santangelo L, Netti GS, Giordano P, Carbone V, Martino M, Torres DD, Rossini M, Di Palma AM, Gesualdo L, Giordano M. Indications and results of renal biopsy in children: a 36-year experience. World J Pediatr 2018; 14:127-133. [PMID: 29569185 DOI: 10.1007/s12519-018-0147-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 05/25/2017] [Revised: 09/02/2017] [Accepted: 09/04/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND This study was conducted to investigate retrospectively the indications for renal biopsy (RB) in native kidneys and to analyze pathological findings in a single tertiary pediatric hospital in Southern Italy for the last 36 years. METHODS All patients who underwent RB at our hospital from 1979 to 2014 were included. All renal tissue specimens were studied under light and immunofluorescent microscopy, while electron microscopy was performed only for specific clinical indications. RESULTS The study group included 213 patients (female 43.2%) who underwent 225 percutaneous native kidney biopsies. Median age was 10.4 years (range 0.6-24 years). The most frequent indication for RB was nephrotic syndrome (44.4%), followed by proteinuria (27.6%), asymptomatic hematuria (17.3%) and acute kidney injury (9.8%). Gross hematuria appeared after biopsy in less than 5% of the patients, but none of them needed blood transfusion. Adequate renal tissue sample was obtained in 95.5% of the renal biopsies. Primary glomerulonephritis (GN) was the most common finding (61.4%), followed by secondary GN (21.4%), tubulointerstitial diseases (3.7%) and hereditary nephropathy (2.8%), while in 10.7% of the cases, normal renal tissues were found. According to histopathological diagnosis, the most common causes of primary GN were IgA nephropathy (20.9%), followed by minimal change disease (18.1%) and focal segmental glomerulosclerosis (11.6%). CONCLUSIONS The epidemiology of glomerular disease in our single-center cohort is similar to that shown in other national and international reports. Moreover, our study shows that percutaneous ultrasound-guided RB is a safe, reliable and effective technique in children.
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Affiliation(s)
- Luisa Santangelo
- Unit of Pediatric Nephrology and Dialysis, Pediatric Hospital "Giovanni XXIII", Bari, Italy
| | - Giuseppe Stefano Netti
- Clinical Pathology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Paolo Giordano
- Unit of Pediatric Nephrology and Dialysis, Pediatric Hospital "Giovanni XXIII", Bari, Italy
| | - Vincenza Carbone
- Unit of Pediatric Nephrology and Dialysis, Pediatric Hospital "Giovanni XXIII", Bari, Italy
| | - Marida Martino
- Unit of Pediatric Nephrology and Dialysis, Pediatric Hospital "Giovanni XXIII", Bari, Italy
- Unit of Nephrology, Dialysis and Transplantation, Department of Emergency and Organ, Transplantation, University "Aldo Moro", Bari, Italy
| | | | - Michele Rossini
- Unit of Nephrology, Dialysis and Transplantation, Department of Emergency and Organ, Transplantation, University "Aldo Moro", Bari, Italy
| | - Anna Maria Di Palma
- Unit of Nephrology, Dialysis and Transplantation, Department of Emergency and Organ, Transplantation, University "Aldo Moro", Bari, Italy
| | - Loreto Gesualdo
- Unit of Pediatric Nephrology and Dialysis, Pediatric Hospital "Giovanni XXIII", Bari, Italy
- Unit of Nephrology, Dialysis and Transplantation, Department of Emergency and Organ, Transplantation, University "Aldo Moro", Bari, Italy
| | - Mario Giordano
- Unit of Pediatric Nephrology and Dialysis, Pediatric Hospital "Giovanni XXIII", Bari, Italy.
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Grabsky AM, Manukyan EV, Muradyan AA. [Cytological evaluation of urothelial damage in extracorporeal shock-wave lithotripsy]. Urologiia 2016:4-9. [PMID: 28248012] [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: 06/06/2023]
Abstract
INTRODUCTION The study proposed a technique for early detection of the damaging effect of shock waves on the urinary tract tissues, for monitoring the state of urothelial cells in the early post-procedure period and choosing an adequate method for preventing and managing possible complications. MATERIALS AND METHODS The study analyzed the urine samples of 300 patients aged 20 to 50 years, who for the first time underwent ESWL for kidney stones. The urine sediment smears were fixed in the May-Grunwald stain and stained with azure eosin solution according to Pappenheim. Besides evaluating general cytologic characteristics, a morphometric examination of urine sediment was performed. RESULTS AND DISCUSSION To define quantitative parameters, the total number of epithelial cells (ep) was determined with further calculation of the mean number of epithelial cells in the field of view (ep= ep/10). Correlation between the number of abnormal epithelial cells (cp) and the total number of epithelial cells (ep) was analyzed. The resulted "destruction index" (DI) was the "pool" of all cytopathological changes in epithelial cells DI = cp/ep. Immediately after ESWL, DI markedly increased with significant difference (<0.05) in numeric values. Two hours after the procedure, the DI reduced compared to the previous value. And only at day 4 DI was close to the norm, although remaining somewhat elevated. CONCLUSION Extracorporeal shock waves lithotripsy produces the acute urothelial damage resulting in cytopathological changes of varying severity. The above-mentioned technique provides objective and highly significant clinical and diagnostic information on the state of the urothelium after the exposure to shock waves.
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Affiliation(s)
- A M Grabsky
- Department of Urology and Andrology, Yerevan M. Heratsi State Medical University
- Urology Clinic, Izmirlyan Medical Center, Yerevan, Armenia
| | - E V Manukyan
- Urology Clinic, Izmirlyan Medical Center, Yerevan, Armenia
| | - A A Muradyan
- Department of Urology and Andrology, Yerevan M. Heratsi State Medical University
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Shephard RJ. Exercise proteinuria and hematuria: current knowledge and future directions. J Sports Med Phys Fitness 2016; 56:1060-1076. [PMID: 25854772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Transient proteinuria and hematuria are apparently benign sequelae of intensive physical activity. However, there is a need to establish underlying causes and reasons for progression to chronic renal damage, as well as effects of training in healthy individuals and in those with microalbuminuria. EVIDENCE ACQUISITION The Ovid/Health Star database was searched from 1994 to November 2014. Terms for the kidneys (adverse effects, blood supply, epidemiology, injuries, pathology, physiology and secretion) and proteinuria (classification, complications, epidemiology, etiology, mortality, physiopathology, prevention and control) with terms related to physical activity (physical activity/motor activity, exercise/exercise therapy, fitness/physical fitness, physical education/physical education and training, and rehabilitation). EVIDENCE SYNTHESIS Review of 519 abstracts yielded 194 relevant hits, supplemented by 70 items from other sources. This material related to both healthy adults (125 items) and renal disease (139 items). The prevalence (18-100%) and duration (1-6 days) of exercise proteinuria varied widely, with risks affected by exercise intensity, posture, age, heat load, altitude and disease. Moderate training reduced exercise proteinuria in healthy individuals and in chronic renal disease. Factors contributing to exercise proteinuria may include vascular changes, hypoxia, lactate accumulation, oxidant stress, hormonal changes and sepsis. Exercise hematuria is frequent; some potential causes are similar to those for proteinuria, but foot-strike and bladder trauma are probably more important. Progression to permanent renal damage is rare. CONCLUSIONS Exercise proteinuria and hematuria are generally transient. However, there remains a need to clarify causation and factors leading to permanent renal damage.
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Affiliation(s)
- Roy J Shephard
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada -
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Abstract
Renal epithelial proliferation has previously been found to be a common condition in a colony of Lewis × Brown Norway (BN) F2 hybrid rats. The aim of this study was to investigate the prevalence and clinical consequences of this condition in pure inbred BN and Lewis rats. Renal epithelial proliferation was found in 29 of 49 BN rats (59%) examined and in four of 50 Lewis rats (8%) examined. Serum creatinine and serum corticosterone was not influenced by the condition. Haematuria was more common in BN rats with (74%) than without renal papillary proliferation (35%, P < 0.05), but it may not be used to diagnose renal epithelial proliferation, as we found rats having renal epithelial proliferation without showing haematuria and rats showing haematuria without having renal epithelial proliferation. Haematuria was also common in Lewis rats (16-56% dependent of age and gender), in which renal epithelial proliferation were found in only 8%. Fluctuating asymmetry, which was used as a measure of developmental instability, was found to be increased in rats with renal epithelial proliferation ( P < 0.05). Haematuria was also found to be related to the degree of fluctuating asymmetry ( P < 0.01). Although the prevalence of renal epithelial proliferation is clearly higher in BN rats than in Lewis rats ( P < 0.01), and although in previous reports the condition was found in F2 BN × Lewis hybrids and not in F1 BN × Lewis hybrids it cannot clearly be defined as having been caused by a single Mendelian gene, as we found it in both inbred strains. Futhermore, we found that morphologically the proliferations could be placed on the papillary as well as the medullary wall of the renal pelvis, while previously it has only been described on the papillary wall.
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Affiliation(s)
- C Stub
- Division of Laboratory Animal Science and Welfare, Department of Pharmacology and Pathobiology, Royal Veterinary and Agricultural University, 3 Ridebanevej, DK-1870 Frederiksberg C, Denmark
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Lee HM, Hyun JI, Min JW, Lee K, Kim YK, Choi EJ, Song HC. The Natural Course of Biopsy-Proven Isolated Microscopic Hematuria: a Single Center Experience of 350 Patients. J Korean Med Sci 2016; 31:909-14. [PMID: 27247500 PMCID: PMC4853670 DOI: 10.3346/jkms.2016.31.6.909] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/23/2016] [Indexed: 11/20/2022] Open
Abstract
The increasing interest in healthcare and health screening events is revealing additional cases of asymptomatic isolated microscopic hematuria (IMH). However, a consensus of the evaluation and explanation of the IMH prognosis is controversial among physicians. Here, we present the natural course of IMH together with the pathological diagnosis and features to provide supportive data when approaching patients with IMH. We retrospectively evaluated 350 patients with IMH who underwent a renal biopsy between 2002 and 2011, and the pathological diagnosis and chronic histopathological features (glomerulosclerosis, interstitial fibrosis, and tubular atrophy) were reviewed. Deterioration of renal function was examined during follow up. The patients with IMH were evaluated for a mean of 86 months. IgA nephropathy was the most common diagnosis in 164 patients (46.9%). Chronic histopathological changes were observed in 166 (47.4%) but was not correlated with proteinuria or a decline in renal function. Ten patients developed proteinuria, and all of them had IgA nephropathy. Three patients progressed to chronic kidney disease with an estimated glomerular filtration rate < 60 mL/min/1.73 m(2) but none progressed to end stage renal disease. In conclusion, IMH had a generally benign course during 7-years of observation, although IgA nephropathy should be monitored if it progresses to proteinuria. Future prospective randomized studies may help conclude the long-term prognosis and lead to a consensus for managing IMH.
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Affiliation(s)
- Hae Min Lee
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Ji In Hyun
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Ji-Won Min
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Kyungsoo Lee
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Yong Kyun Kim
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Euy Jin Choi
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Ho Cheol Song
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
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Fiorentino M, Bolignano D, Tesar V, Pisano A, Van Biesen W, D'Arrigo G, Tripepi G, Gesualdo L. Renal Biopsy in 2015--From Epidemiology to Evidence-Based Indications. Am J Nephrol 2016; 43:1-19. [PMID: 26844777 DOI: 10.1159/000444026] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although the number of patients reaching end-stage kidney disease without a biopsy-proven diagnosis is increasing, the utility of renal biopsy is still an object of debate. We analyzed epidemiological data and the main indications for renal biopsy with a systematic, evidence-based review at current literature. SUMMARY There is a high discrepancy observed in biopsy rates and in the epidemiology of glomerular diseases worldwide, related to the different time frame of the analyzed reports, lack of data collection, the different reference source population and the heterogeneity of indications. The evidence-based analysis of indications showed that renal biopsy should be crucial in adults with nephrotic syndrome or urinary abnormalities as coexistent hematuria and proteinuria and in corticosteroid resistant-children with severe proteinuria. The knowledge of renal histology can change the clinical management in patients with acute kidney injury significantly, after the exclusion of pre-renal or obstructive causes of kidney damage. Scarce evidence indicates that renal biopsy can be useful in patients with advanced chronic kidney disease and its use should always be considered after weighing the benefits and potential risks. Renal biopsy should be crucial in patients with renal involvement due to systemic disease. In patients with diabetes with atypical features, renal biopsy may be fundamental to diagnose an unexpected parenchymal disease mislabeled as diabetic nephropathy. Finally, in elderly patients, the indications and the risks are not different from those in the general population. KEY MESSAGE Renal biopsy still remains a concrete approach for managing a substantial percentage of renal diseases.
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Affiliation(s)
- Marco Fiorentino
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy
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Hsiao PJ, Chiang WF, Chao TK, Lin SH. Life-threatening hematuria in a hemodialysis patient with systemic light-chain amyloidosis. Clin Chim Acta 2015; 451:180-2. [PMID: 26434538 DOI: 10.1016/j.cca.2015.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/13/2015] [Revised: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Direct amyloid invasion of prostate tissue resulting in massive bleeding may be fatal, and rapid diagnosis is difficult. CASE REPORT A 71-y-old male undergoing regular hemodialysis with primary light-chain (AL) amyloidosis was admitted due to gross hematuria for 2 days. Cystoscopy revealed oozing from the prostatic urethra. Therefore, electrocauterization was performed, and his symptoms resolved. Unfortunately, he experienced recurrent massive hematuria 3 months later. Tests for serum D-dimer and fibrin degradation products were both positive. Followed serum factor X level was low at 5.4%. Gross hematuria persisted despite of blood transfusions, desmopressin, and vitamin K therapy. Emergent cystoscopy revealed oozing from the prostatic urethra, as was found previously. Therefore, electrocauterization and transurethral resection of the prostate were performed. Analysis of a biopsy specimen of prostate demonstrated strong amyloid deposition in the vascular and perivascular regions. Electron microscopy showed relatively straight fibrils with diameters of 7-10nm in the perivascular region. Gross hematuria subsided then, and no recurrence was noted at a 6-month follow-up. CONCLUSIONS Systemic AL amyloidosis can cause potentially life-threatening hemorrhage. Hemostatic defects and direct invasion with amyloid angiopathy are main pathogenic factors. Timely surgical intervention may be imperative.
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Affiliation(s)
- Po-Jen Hsiao
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taiwan
| | - Wen-Fang Chiang
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taiwan
| | - Tai-Kuang Chao
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Hua Lin
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Abstract
Isolated microscopic, or non-visible, haematuria of glomerular origin was previously regarded a benign finding, but it is now known that, even in the absence of proteinuria, hypertension or renal impairment at presentation, haematuria is associated with increased risk of kidney failure in the long term. The most common causes of isolated microscopic haematuria among children and young adults are IgA nephropathy, Alport syndrome (AS), and thin basement membrane nephropathy (TBMN). AS, which is usually inherited as an X-linked or autosomal recessive trait, and TBMN, which is usually autosomal dominant, are caused by mutations in the genes encoding type-IV collagen, an abundant component of the glomerular basement membrane. A detailed family history with screening of at-risk relatives is important, allowing prompt diagnosis of affected relatives and helping determine the mode of transmission. As costs fall and availability increases, genetic testing is increasingly being used in clinical practice to provide diagnostic and predictive information for patients and their families.
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Affiliation(s)
- Melanie My Chan
- Centre for Nephrology, University College London, Royal Free Hospital, London, UK
| | - Daniel P Gale
- Centre for Nephrology, University College London, Royal Free Hospital, London, UK
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Imafuku A, Ubara Y. [A Case of Chronic Microscopic Hematuria]. Nihon Naika Gakkai Zasshi 2015; 104:2237-2240. [PMID: 30161322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Bottini PV, Andreguetto BD, Krempser K, Lauand JR, Garlipp CR. UriSed as an Alternative to Phase-Contrast Microscopy in the Differentiation between Glomerular and Non-Glomerular Hematuria. Clin Lab 2015; 61:643-6. [PMID: 26118201 DOI: 10.7754/clin.lab.2014.141118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Differentiation between glomerular and non-glomerular hematuria by observation of the erythrocyte morphology using phase-contrast is a time-consuming and labor-intensive procedure that requires skilled personnel. This paper has the purpose to evaluate the performance of UriSed (also called sediMAX in some countries) as an alternative to the phase-contrast microscopic analysis of erythrocyte morphology. METHODS 312 urine samples with hematuria were analyzed by UriSed and by phase-contrast microscopy. Based on the presence of codocytes and/or acanthocytes, samples were classified as non-glomerular and glomerular. Kappa correlation was used to assess the agreement between both methods. RESULTS Our data showed excellent agreement between erythrocyte morphology analyzed by both methods (r = 0.974, kappa = 0.9484, p < 0.001) with only 8 samples presenting discordant results. CONCLUSIONS UriSed proved to be a precise and accurate alternative to the gold standard phase-contrast microscopy.
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Yuste C, Rubio-Navarro A, Barraca D, Aragoncillo I, Vega A, Abad S, Santos A, Macias N, Mahillo I, Gutiérrez E, Praga M, Egido J, López-Gómez JM, Moreno JA. Haematuria increases progression of advanced proteinuric kidney disease. PLoS One 2015; 10:e0128575. [PMID: 26016848 PMCID: PMC4446357 DOI: 10.1371/journal.pone.0128575] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/28/2015] [Indexed: 02/04/2023] Open
Abstract
Background Haematuria has been traditionally considered as a benign hallmark of some glomerular diseases; however new studies show that haematuria may decrease renal function. Objective To determine the influence of haematuria on the rate of chronic kidney disease (CKD) progression in 71 proteinuric patients with advanced CKD (baseline eGFR <30 mL/min) during 12 months of follow-up. Results The mean rate of decline in eGFR was higher in patients with both haematuria and proteinuria (haemoproteinuria, HP, n=31) than in patients with proteinuria alone (P patients, n=40) (-3.8±8.9 vs 0.9±9.5 mL/min/1.73m2/year, p<0.05, respectively). The deleterious effect of haematuria on rate of decline in eGFR was observed in patients <65 years (-6.8±9.9 (HP) vs. 0.1±11.7 (P) mL/min/1.73m2/year, p<0.05), but not in patients >65 years (-1.2±6.8 (HP) vs. 1.5±7.7 (P) mL/min/1.73m2/year). Furthermore, the harmful effect of haematuria on eGFR slope was found patients with proteinuria >0.5 g/24 h (-5.8±6.4 (HP) vs. -1.37± 7.9 (P) mL/min/1.73m2/year, p<0.05), whereas no significant differences were found in patients with proteinuria < 0.5 g/24 h (-0.62±7.4 (HP) vs. 3.4±11.1 (P) mL/min/1.73m2/year). Multivariate analysis reported that presence of haematuria was significantly and independently associated with eGFR deterioration after adjusting for traditional risk factors, including age, serum phosphate, mean proteinuria and mean serum PTH (β=-4.316, p=0.025). Conclusions The presence of haematuria is closely associated with a faster decrease in renal function in advanced proteinuric CKD patients, especially in younger CKD patients with high proteinuria levels; therefore this high risk subgroup of patients would benefit of intensive medical surveillance and treatment.
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Affiliation(s)
- Claudia Yuste
- Renal Unit. Gregorio Marañón Hospital, Madrid, Spain
| | - Alfonso Rubio-Navarro
- Renal, Vascular and Diabetes Research Lab. IIS-Fundación Jiménez Díaz, Autonoma University, Madrid, Spain
| | | | | | - Almudena Vega
- Renal Unit. Gregorio Marañón Hospital, Madrid, Spain
| | - Soraya Abad
- Renal Unit. Gregorio Marañón Hospital, Madrid, Spain
| | - Alba Santos
- Renal Unit. Gregorio Marañón Hospital, Madrid, Spain
| | | | - Ignacio Mahillo
- Department of Epidemiology. IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | - Manuel Praga
- Department of Nephrology. Doce de Octubre Hospital, Madrid, Spain
| | - Jesús Egido
- Renal, Vascular and Diabetes Research Lab. IIS-Fundación Jiménez Díaz, Autonoma University, Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Fundación Renal Iñigo Alvarez de Toledo-Instituto Reina Sofía de Investigaciones Nefrológicas (FRIAT-IRSIN), Madrid, Spain
| | | | - Juan Antonio Moreno
- Renal, Vascular and Diabetes Research Lab. IIS-Fundación Jiménez Díaz, Autonoma University, Madrid, Spain
- * E-mail:
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Abstract
Kidneys and lungs are the most common organs involved in microscopic polyangiitis (MPA). A retrospective analysis of pediatric MPA patients with pulmonary lesions over the past 10 years was performed to investigate clinical features of MPA in children with pulmonary lesions. There were 9 patients enrolled in our study, including 2 boys and 7 girls, with a median age of 6.6 years at the time of disease onset and a median disease course of 2 months. All of the patients exhibited tachypnea, and 7 exhibited cough and hemoptysis. The most common presentation on pulmonary imaging was ground glass or patchy shadows, which were observed in 6 cases. Seven patients manifested with hematuria and proteinuria, with renal histopathology of fibrinoid necrosis/exudation of the glomerular capillaries. All of the patients presented with normocytic normochromic anemia. Of the 9 patients, 7 were positive for perinuclear antineutrophil cytoplasmic antibody (p-ANCA) and/or myeloperoxidase (MPO), and 2 were positive for p-ANCA/MPO and cytoplasmic ANCA/proteinase 3. Eight patients had normal complement 3 (C3) levels, and one had an elevated C3 level. Five of the 9 patients were positive for antinuclear antibody ANA, and 4 were positive for double strand DNA (ds-DNA) antibody (3 were positive for both). The 7 patients who exhibited renal involvement received steroid plus cyclophosphamide (CTX) treatment. Of these patients, 4 achieved various degrees of remission, 2 were at the beginning of induction therapy, and one was lost to follow-up. Two patients with isolated pulmonary involvement received steroid plus leflunomide treatment and achieved complete remission. Diffuse alveolar hemorrhage was the most frequent presentation of lung involvement in children with MPA, and tachypnea, cough, hemoptysis and anemia were the common clinical symptoms. The majority of these patients exhibited hematuria, proteinuria and renal insufficiency. The efficacy of steroid plus CTX or leflunomide was evident in these patients.
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Affiliation(s)
- Haiyan Wang
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, Peoples’ Republic of China
| | - Liangzhong Sun
- Children’s Kidney Disease Center, Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, Peoples’ Republic of China
| | - Weiping Tan
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, Peoples’ Republic of China
- * E-mail:
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Affiliation(s)
- M C Gubler
- INSERM U.192, Hôpital Necker-Enfants Malades, Paris, France
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Wang Z, Vathsala A, Tiong HY. Haematuria in postrenal transplant patients. Biomed Res Int 2015; 2015:292034. [PMID: 25918706 PMCID: PMC4395992 DOI: 10.1155/2015/292034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 12/25/2022]
Abstract
Haematuria has a prevalence of 12% in the postrenal transplant patient population. It heralds potentially dangerous causes which could threaten graft loss. It is important to consider causes in light of the unique, urological, and immunological standpoints of these patients. We review the literature on common causes of haematuria in postrenal transplant patients and suggest the salient approach to the evaluation of this condition. A major cause of haematuria is urinary tract infections. There should be a higher index of suspicion for mycobacterial, fungal, and viral infection in this group of immunosuppressed patients. Measures recommended in the prevention of urinary tract infections include early removal of foreign bodies as well as prophylactic antibiotics during the early transplant phase. Another common cause of haematuria is that of malignancies, in particular, renal cell carcinomas. When surgically managing cancer in the setting of a renal transplant, one has to be mindful of the limited retropubic space and the need to protect the anastomoses. Other causes include graft rejections, recurrences of primary disease, and calculus formation. It is important to perform a comprehensive evaluation with the aid of an experienced multidisciplinary transplant team.
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Affiliation(s)
- Ziting Wang
- Department of Urology, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
| | - Anantharaman Vathsala
- Division of Nephrology, Department of Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
- National University Centre for Organ Transplantation, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
| | - Ho Yee Tiong
- Department of Urology, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
- National University Centre for Organ Transplantation, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
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Chouikh T, Ghorbel S, Charieg A, Mrad C, Kchaw R, Ben Ahmed Y, Nouira F, Ben Saada S, Ben Khalifa S, Jlidi S. Uncommun etiology of pediatric Hematuria: urethral lymphangioma. Tunis Med 2015; 93:107-108. [PMID: 26337310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report a case of urethral cystic lymphangioma. Hematuria is the revealing symptom. Im our knowledge, is the third case described in literature.
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Xu D, You X, Wang Z, Zeng Q, Xu J, Jiang L, Gong L, Wu F, Gu J, Tao Y, Chen J, Zhao J, Li M, Zhao Y, Zeng X. Chinese Systemic Lupus Erythematosus Treatment and Research Group Registry VI: Effect of Cigarette Smoking on the Clinical Phenotype of Chinese Patients with Systemic Lupus Erythematosus. PLoS One 2015; 10:e0134451. [PMID: 26280671 PMCID: PMC4539270 DOI: 10.1371/journal.pone.0134451] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 07/10/2015] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Our study aimed to investigate the effect of cigarette smoking on the clinical phenotype of patients registered in the Chinese Systemic Lupus Erythematosus (SLE) Treatment and Research (CSTAR) group registry database, the first online registry of Chinese patients with SLE. METHODS A prospective cross-sectional study of Chinese SLE patients was conducted using the CSTAR. Our case-control analysis was performed on age- and gender-matched subjects to explore the potential effect of cigarette smoking on the clinical manifestation of SLE. RESULTS Smokers comprised 8.9% (65/730) of patients, and the ratio of females/males was 19/46. Thirty-nine patients were current smokers, and 26 were ex-smokers. Data showed significant differences between smokers and nonsmokers in the following areas: nephropathy (58.5% vs. 39.2%; p = 0.003), microscopic hematuria (30.8% vs. 19.1%; p = 0.025), proteinuria (53.8% vs. 34.4%; p = 0.002), and SLE Disease Activity Index(DAI) scores (12.38±8.95 vs. 9.83±6.81; p = 0.028). After adjusting for age and gender, significant differences between smokers and nonsmokers were found with photosensitivity (35.9% vs. 18%; p = 0.006), nephropathy (59.4% vs. 39.8%; p = 0.011), and proteinuria (54.7% vs. 35.2%). Although smokers tended to have greater disease severity compared with nonsmokers (SLEDAI scores: 12.58±8.89 vs.10.5±7.09), the difference was not significant (p = 0.081). CONCLUSIONS Cigarette smoking triggers the development and exacerbation of SLE, especially with respect to renal involvement. Chinese smokers with SLE should be advised to discontinue cigarette use.
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Affiliation(s)
- Dong Xu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education; No.1 Shuaifuyuan, Beijing, 100730, China
| | - Xin You
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education; No.1 Shuaifuyuan, Beijing, 100730, China
| | - Zhengang Wang
- Department of Rheumatology, Beijing Tongren Hospital Affiliated to Capital Medical University, NO 1, Dong Jiao Min Xiang, Eastern District, Beijing, 100730, China
| | - Qingyu Zeng
- Department of Rheumatology, the First Affiliated Hospital of Shantou University Medical College, No.57 ChangPingLu, Shantou, 515041, China
| | - Jianhua Xu
- Department of Rheumatology, the First Affiliated Hospital of Anhui Medical University, No.218 JiXiLu, Hefei, 230022, China
| | - Lindi Jiang
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, No.180 FengLinLu, Shanghai, 200032, China
| | - Lu Gong
- Department of Rheumatology, the General Hospital of Tianjing Medical University, No.154 AnShanDao, Tianjing, 300052, China
| | - Fengqi Wu
- Department of Rheumatology, Capital Institute of Pediatrics, No.2 YaBaoLu, Beijing, 100020, China
| | - Jieruo Gu
- Department of Rheumatology, the Third Affiliated Hospital of Sun Yat-sen University, No.600 TianHeLu, Guangzhou, 510630, China
| | - Yi Tao
- Department of Rheumatology, the Second Affiliated Hospital of Guangzhou Medical College, No.107 YanJiangXiLu, Guangzhou, 510120, China
| | - Jinwei Chen
- Department of Rheumatology, the Second Xiangya Hospital of Central South University, No.139 RenMinZhongLu, Changsha, 410011, China
| | - Jiuliang Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education; No.1 Shuaifuyuan, Beijing, 100730, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education; No.1 Shuaifuyuan, Beijing, 100730, China
| | - Yan Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education; No.1 Shuaifuyuan, Beijing, 100730, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education; No.1 Shuaifuyuan, Beijing, 100730, China
- * E-mail:
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Yamamoto H, Hashimoto H, Nakamura M, Horiguchi H, Yasunaga H. Relationship between hospital volume and hemorrhagic complication after percutaneous renal biopsy: results from the Japanese diagnosis procedure combination database. Clin Exp Nephrol 2014; 19:271-7. [PMID: 24879288 DOI: 10.1007/s10157-014-0986-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 05/09/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although hemorrhagic complications are major complications of percutaneous renal biopsy (PRB), the relationship between procedure volume and morbidity remains unclear for PRB. The present study investigated the impact of hospital volume on the occurrence of hemorrhagic complications after PRB. METHODS Using large claims-based data in the diagnosis procedure combination database in Japan, we identified inpatients with renal disorders who underwent PRB within 4 days after admission during July to December 2007 to 2010. We assessed patient age, sex, clinical syndromes, hemorrhagic complications and diagnoses, and annual hospital volume of PRB divided into quintiles. Multivariate logistic regression analyses fitted with a generalized estimation equation were performed accounting for within-hospital clustering. RESULTS A total of 15,191 patients were identified from 942 hospitals. The overall proportion of hemorrhagic complications was 2.1 %, including diagnoses of hemorrhagic events (1.6 %), red blood cell transfusion (0.5 %), and requiring angiography or endovascular procedure (0.1 %). In-hospital deaths attributable to the complications occurred in 0.06 % of the patients. Patients with rapidly progressive nephritic syndrome (odds ratio 3.41, 95 % confidence interval 2.22-5.25) had significantly higher incidence than those with chronic nephritic syndrome. No significant association was observed between hospital volume and hemorrhagic complications, with odds ratios for the low-intermediate, intermediate, intermediate-high, and high-volume groups relative to the low-volume group of 0.74 (0.43-1.26), 1.19 (0.74-1.92), 1.16 (0.67-2.00), and 1.35 (0.78-2.34), respectively. CONCLUSIONS No significant relationship was observed between hemorrhagic complication incidence and hospital volume regarding PRB.
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Affiliation(s)
- Hiroyuki Yamamoto
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo, Japan
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Hooda MN, Siddique FH, Nabi S, Islam MW, Ara K, Bhuiyan ZI. Clinicopathologic features and treatment outcome of urinary bladder neoplasm. Mymensingh Med J 2014; 23:341-344. [PMID: 24858164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
More than ninety percent of bladder neoplasm is Transitional Cell Carcinoma (TCC). About 85% of patients present with symptom of painless haematuria. However haematuria is quite often intermittent so that a negative result has little meaning in ruling out the presence of bladder cancer. The present study was conducted to observe the natural history of different clinicopathologic stages of bladder cancer after transurethral resection bladder tumor (TURBT), either intravescical chemotherapy (IVC) or immunotherapy with BCG and of other forms of therapy like radio-chemotherapy (RCT) and radical surgery in few cases. A consecutive series of 52 cases with different grades and stages of bladder cancer patients were studied. Those who were noncompliant with surgery were sent for RCT. The age range of the patients was 34 to 75 with mean 53 year. Macroscopic haematuria, flank pain, microscopic haematuria, bladder irritability was found in 43(82.7%), 06(11.5%), 03(5.8%), 32(61.5%) cases respectively and coincidental ureteral TCC with hydronephrosis was found in 04(7.7%) cases for whom radical nephreureterectomy and cystectomy with ileal conduit was done. Amongst the other muscle invasive tumor only three cases were compliant to do radical surgery; rest were advised to consult with oncologist for possible RCT. Superficial bladder cancer was 19(36.5%) and invasive bladder cancer was 33(63.5%). TURBT and IVT were offered for all superficial bladder tumors. Of them 06(31.5%) patients showed recurrence during the study period. More recurrences occur in IVC group (35.7%) than immunotherapy with BCG group (20%) Re-TURBT and stage wise treatment was offered to them. All recurrent cases were G-3 tumor and were multifocal. Recurrence rate is about 30%. Screening program and structured referral system should be developed to have early diagnosis for prompt treatment and best prognosis.
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Affiliation(s)
- M N Hooda
- Dr Md Nurul Hooda, Associate Professor of Urology, National Institute of Kidney Diseases & Urology (NIKDU), Sher-E-Bangla Nagar, Dhaka, Bangladesh
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Schobel HP. [Surprising increase of creatinine]. MMW Fortschr Med 2013; 155:48-49. [PMID: 24724274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Chen S, Tang Z, Zhang Y, Liu Z, Zhang H, Hu W, Liu Z. Significance of histological crescent formation in patients with diffuse proliferative lupus nephritis. Am J Nephrol 2013; 38:445-52. [PMID: 24247741 DOI: 10.1159/000356184] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 10/01/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although crescentic nephritis is not rare in diffuse proliferative lupus nephritis (DPLN), little is known about the clinicopathological features in DPLN with crescents worldwide. This study was undertaken to investigate the clinicopathological features and outcome of Chinese DPLN patients with different degrees of crescents. METHODS 520 DPLN patients with more than 10% histological crescents (cDPLN) were enrolled in this retrospective study. They were divided into three groups: group 1 (10%≤ crescents <25%, n = 240), group 2 (25%≤ crescents <50%, n = 160), and group 3 (crescents ≥50%, n = 120). Another 100 patients without histological crescents were enrolled as a control group. Clinicopathological features, treatment responses, and outcomes were compared among the four groups. RESULTS There were 450 (86.6%) females and 70 (13.4%) males with an average age of 31.7 ± 11.4 years. Compared with the control group, cDPLN patients had shorter lupus nephritis duration (20.7 ± 34.1 vs. 30.4 ± 48.9 months), higher prevalence of rapidly progressive glomerulonephritis syndrome (21.8%), and gross hematuria (26.7%). Laboratory findings indicated more severe hypoproteinemia, hyperlipidemia, and renal insufficiency; heavier proteinuria and microscopic hematuria; higher tubular injury parameters, and lower serological activity in crescentic groups. Histologically, cDPLN patients have severe glomerular and tubulointerstitial lesions as well as extensive leukocyte infiltration together with a lesser degree of immune complex deposition. The proportion of death, end-stage renal disease, and treatment failure correlates positively with the degree of histological crescents. CONCLUSIONS cDPLN patients with acute onset and short disease duration mostly show severe renal manifestations, less extrarenal organ involvement, lower serological activity, serious capillary necrosis, severe tubulointerstitial inflammation, atrophy and fibrosis, prominent leukocyte infiltration, less glomerular immune complex deposition, poor treatment response, and worse renal outcome.
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Affiliation(s)
- Shasha Chen
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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Working Group for National Survey on Status of Diagnosis and Treatment of Childhood Renal Diseases. [Multicenter investigation of therapeutic status of children with IgA nephropathy in China]. Zhonghua Er Ke Za Zhi 2013; 51:486-90. [PMID: 24267127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Data of general status of clinical presentation and therapy of IgA nephropathy in children in China are lacking. This study aimed to investigate the clinical presentations and treatment status of children with IgA nephropathy in China. METHOD The investigation was organized by Chinese Society of Pediatric Nephrology. Thirty five centers from 23 provinces/municipalities of China participated in the study. Children no more than 18 years old who were diagnosed by renal biopsy as IgA nephropathy from July 1, 2008 to June 20, 2011 were included. The data on clinical presentations and treatment methods were collected. Descriptive method was used for data analysis. RESULT Totally 1417 children aged from 0.5 to 18 years old were included. The median age was 10.0 years old. Children more than 6 years old accounted for 89.8%. Most of the children presented with hematuria and proteinuria (37.0%), nephrotic syndrome type accounted for 30.6%, isolated hematuria type accounted for 15.8%, acute glomerulonephritis type accounteed for 12.7%, chronic glomerulonephritis type accounted for 1.8%, acute rapidly progressive glomerulonephritis type accounted for 1.3%, isolated proteinuria type accounted for 0.8%. The common drug used for children with hematuria and proteinuria type included angiotensin-converting enzyme inhibitor(ACEI)/angiotensin II receptor antagonists (ARB) (49.6%), oral prednisone (41.4%), intravenous methylprednisolone (20.8%), etc. The therapies with oral prednisone (76.2%), ACEI/ARB (60.5%), cyclophosphamide (40.0%), intravenous methylprednisolone (31.2%) were more often used for children with nephrotic syndrome type. CONCLUSION This is the first nationwide investigation on therapy status of children with IgA nephropathy in China. Steroid combined with ACEI/ARB and cyclophosphamide was the main treatment for children with nephrotic syndrome type. The effect of steroid combined with immunosuppressant on other types of IgA nephropathy needs further investigation.
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Mammadov R, Musayev J, Hasanov A. Endovesical leiomyoma of bladder: a case report. Georgian Med News 2013:7-10. [PMID: 23787498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Benign mesenchymal tumors cover 0,04-0,5% of all bladder tumors and their major part consists of leiomyomas. Having the smooth muscle tissue origin, these tumors can exhibit intramural, endovesical and extravesical localization in the bladder. Clinically, the irritative and obstructive symptoms, hematuria accompany endovesical leiomyomas. Along side being asymptomatic, intramural and extravesical leiomyomas can sometimes be characterized by mass formation, hematuria, and irritative symptoms, rarely by obstructive symptoms. In the diagnostic process histopathology is of great importance, especially in exclusion of radiologically and cystoscopically indistinguishable lesions. A case of endovesical leiomyoma of bladder in 49 year-old male patient admitted to the hospital with a complaint of hematuria and irritative symptoms is presented. Transurethral resection is performed for the patient with the purpose of treatment and diagnosis, and follow-up with ultrasonography was deemed appropriate once every three months. In the macroscopic examination of the material 4,0 cc of white-and-pink-colored, soft tissue fragments from 0,5 to 1,8 cm in diameter were observed. A well-vascularized tumor tissue composed of spindle cells with uniform and elongated nucleuses and normal urothelial epithelium with no specific features on its surface was observed in the microscopic examination. Recurrence wasn`t observed during 32-month follow-up. As bladder leiomyoma is a rare pathology, generally accepted follow-up scheme for this disease after the treatment isn't reported. For this reason, we did the follow-up of the patient in a minimally invasive way that doesn't comply with the EAU guidelines - ultrasonography of urinary tract was performed on the patient on quarterly basis. After the 32 month-follow-up, no recurrence was seen. As a result, the bladder leiomyoma is a rare, and it requires careful pathological examination. Due to the lack of knowledge about this tumor large scale of studies.
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Sakata M, Oniki K, Kita A, Kajiwara A, Uchiyashiki Y, Saruwatari J, Yoshida A, Jinnouchi H, Nakagawa K. Clinical features associated with a rapid decline in renal function among Japanese patients with type 2 diabetes mellitus: microscopic hematuria coexisting with diabetic retinopathy. Diabetes Res Clin Pract 2013; 100:e39-41. [PMID: 23433540 DOI: 10.1016/j.diabres.2013.01.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 01/28/2013] [Indexed: 12/18/2022]
Abstract
Four patients who exhibited the greatest decline in the estimated glomerular filtration rate [12.3-23.5 ml/min/1.73 m(2)/year] among 320 patients with type 2 diabetes and were followed for a median of 6.8 years had several clinical features in common, including marked albuminuria, microhematuria, retinopathy and poor medication adherence.
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Affiliation(s)
- Misaki Sakata
- Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
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Guan N, Yao Y, Yang JY, Xiao HJ, Ding J. [Retrospective clinical features and renal pathological analysis of 15 children with anti-neutrophil cytoplasmic antibody-associated vasculitis]. Zhonghua Er Ke Za Zhi 2013; 51:283-287. [PMID: 23927802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a disorder with poor prognosis. This study aimed to improve the diagnosis and treatment of ANCA associated vasculitis of children, to analyze the clinical features, pathological characteristics and the prognosis of children with ANCA-associated vasculitis. METHOD Fifteen children with ANCA associated vasculitis who were hospitalized from 2003 to 2012 in our hospital were included. Their data of pre-diagnosis status, clinical manifestations, renal pathology, treatment and prognosis were reviewed retrospectively. RESULT Of the 15 children, 11 were girls and 4 boys with a mean age of 10.7 years. Fourteen children were categorized as microscopic polyangitis. The time to diagnosis varied from 0.5 month to 40 months. Hematuria and proteinuria were revealed by urine analysis in all of them, only 6 children complained with gross hematuria or edema of oliguria. Decreased glomerular filtration rate was revealed in 13 children, 8 of whom had a creatinine clearance rate of less than 15 ml/(min·1.73 m(2)). Twelve children underwent renal biopsy, crescent formation was found in 11 children. Most of the crescents were cellular fibrous crescents or fibrous crescents. Six children were diagnosed as crescentic nephritis; the process of rapidly progressive nephritis was only observed in 2 children. Segmental glomerulosclerosis or global glomerulosclerosis were found in 10 children, 3 of them were diagnosed as sclerotic glomerulonephritis. Anemia and pulmonary injury were the most common extra renal manifestations. Other extra renal manifestations included rash, pain joint, gastrointestinal symptoms, abnormal findings of cardiac ultrasonography and headache. Eight children were treated with steroid combined with cyclophosphamide, 4 were treated with steroid and mycophenolate mofetil, 2 were treated with steroid, cyclophosphamide and mycophenolate mofetil, 3 children were treated with plasma exchange. Fourteen children were followed up for 0.5 month to 4 years. The renal function did not recover in children with creatinine clearance rate of less than 30 ml/(min·1.73 m(2)), who showed crescentic glomerulonephritis or sclerotic glomerulonephritis. The children who had creatinine clearance rate of more than 30 ml/(min·1.73 m(2))had better prognosis. CONCLUSION More attention should be paid to ANCA-associated vasculitis among school age girls with anemia or pulmonary diseases. The renal damage was serious in children; however, the clinical manifestations were not obvious. Children with a creatinine clearance rate of less than 30 ml/(min·1.73 m(2)) had poor prognosis. Early accurate diagnosis is very important.
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Affiliation(s)
- Na Guan
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
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Kang JH, Park BR, Kim KS, Kim DY, Huh HJ, Chae SL, Shin SJ. Beta-thalassemia minor is associated with IgA nephropathy. Ann Lab Med 2013; 33:153-5. [PMID: 23479564 PMCID: PMC3589644 DOI: 10.3343/alm.2013.33.2.153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 11/15/2012] [Accepted: 01/14/2013] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jung Hyun Kang
- Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Medical Center, Dongguk University College of Medicine, Goyang, Korea
| | - Bo Rha Park
- Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Medical Center, Dongguk University College of Medicine, Goyang, Korea
| | - Kyung Soo Kim
- Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Medical Center, Dongguk University College of Medicine, Goyang, Korea
| | - Do Yeun Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Dongguk University Ilsan Medical Center, Dongguk University College of Medicine, Goyang, Korea
| | - Hee Jin Huh
- Department of Laboratory Medicine, Dongguk University Ilsan Medical Center, Dongguk University College of Medicine, Goyang, Korea
| | - Seok Lae Chae
- Department of Laboratory Medicine, Dongguk University Ilsan Medical Center, Dongguk University College of Medicine, Goyang, Korea
| | - Sung Joon Shin
- Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Medical Center, Dongguk University College of Medicine, Goyang, Korea
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He RJ, Xiao HJ, Wang SX, Guan N, Yao Y, Ding J. [Characteristics of pediatric C3 glomerulopathy with decreased factor H in 3 cases]. Zhonghua Er Ke Za Zhi 2012; 50:939-943. [PMID: 23324154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To study the characteristics of clinicopathology and prognosis of 3 pediatric cases diagnosed as C3 glomerulopathy, and to improve the understanding of C3 glomerulopathy in children. METHOD The medical record, plasma complement C3, Factor H (FH) and its autoantibody, and therapeutic response of the 3 cases were analyzed, and their prognosis were followed up. RESULT Of the 3 cases, 2 were male and 1 was female, the age of onset was 9 years, 12 years, 5 years 4 months, the duration from onset to renal biopsy was 3 months, 7 months and 20 days, and the follow-up period were 2.6 years, 8 months and 1.5 years respectively. CLINICAL MANIFESTATIONS All the 3 cases showed microscopic hematuria, with or without gross hematuria and proteinuria. Two showed persistently decreased plasma complement C3, in the other one C3 was in normal lower limit, all presented with decreased FH concertration, in 1 case anti-FH antibody was positive. Their clinical diagnosis was post-streptococcal glomerulonephritis, nephrotic syndrome (NS) nephritis type, and mesangial proliferative glomerulonephritis respectively. PATHOLOGICAL FINDINGS All showed evident deposition of C3 on glomerular basement membrance (GBM) and mesangial region by immunofluorescence (IF) and electron dense deposit in GBM, mesangial region or para-mesangial region by Electron microscopic (EM) examination Treatment and prognosis: The case with NS showed no response to steroid, so steroid was gradually stopped after renal biopsy and replaced by angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor antagonist (ARB). The other two cases were treated with ACEI and renal protective treatment. Of the 3 cases, one gradually showed elevated serum creatinine (Scr) and decreased creatinine clearance rate (Ccr), the other two were normal, but slightly increased indications for early kidney injury. CONCLUSION C3 glomerulopathy is characterized by evident C3 deposition under IF. Its clinical and pathological manifestations vary a lot. The decreased plasma C3 and FH suggest that the abnormal regulation of complement system play an importment role in its pathogenesis.
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Affiliation(s)
- Rui-juan He
- Department of Pediatrics, First Hospital, Peking University, Beijing 100034, China
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Liu H, Peng Y, Liu H, Liu Y, Yuan S, Liu F, Yang D, Chen X, He L, Fu M, Shao J, Yang L. Renal biopsy findings of patients presenting with isolated hematuria: disease associations. Am J Nephrol 2012; 36:377-85. [PMID: 23051982 DOI: 10.1159/000342233] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Most nephrologists have believed that patients with isolated hematuria (IH) generally do not require treatment and have a good prognosis. The aim of this study was to analyze the pathological characteristics and emphasize the importance of renal biopsy for patients with IH. METHODS The pathological characteristics of 90 patients with IgA nephropathy confirmed by renal biopsy and presenting with IH were reviewed. We analyzed their pathological features according to the Oxford classification by using light and immunofluorescence. RESULTS Total samples included 68 females and 22 males. The age of onset with IH focuses on 20-30 years. At presentation, the focal and/or segmental glomerulosclerosis (FSGS) was the most frequent diagnosis (52.22%). The distribution of hematuria focused on 20-40 thousand. 46.67% of cases had global glomerulosclerosis which excluded the physical glomerular sclerosis, and the incidence of crescent formation was 24.44%. However, the proportion of glomerular sclerosis was mainly concentrated in less than 10%. Direct immunofluorescence showed simple IgA deposition was the most common (43.33%). 46.67% of patients had accompanying complement deposition, and 92.89% had complement 3 deposition. According to the Oxford classification, M(1)S(0)E(0)T(0) accounted for 53.33%. The incidence of M, S, E, and T was 100, 30, 14.44, and 22.22% respectively. 46.67% of patients included two or more pathological lesions. CONCLUSIONS FSGS played an important role in patients with IgA nephropathy who presented with IH. For those patients, renal biopsy was a valuable diagnostic tool and should be offered in clinical settings to provide them with maximal potential benefits.
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Affiliation(s)
- Huanhuan Liu
- Nephrology Department, Renal Research Institute, Hunan Key Laboratory of Kidney Disease and Blood Purification, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011,China
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Woo KT, Chan CM, Wong KS, Choong HL, Tan HK, Foo MW, Anantharaman V, Lee EJ, Tan CC, Lee GS, Yap HK, Tan HB, Chin YM, Lim CH. National Health Survey on the prevalence of urinary abnormalities in the population: then and now (1975 to 2012). Ann Acad Med Singap 2012; 41:339-346. [PMID: 23010811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION This paper presents the results of a community survey on urinary abnormalities which covered 1/80th of the population of Singapore in 1975. These findings were compared with the data from the Singapore National Service Registrants in 1974 as well as data from a recent survey in Singapore and that of other Asian and Western countries. MATERIALS AND METHODS The study covered 18,000 persons aged 15 years and above, representing a sampling fraction of 1/80th of the population. A total of 16,808 respondents attended the field examination centres, of whom 16,497 had their urine sample tested representing 92.7% of the sample population. RESULTS In the dipstick urine testing at the field examination centres, 769 subjects (4.6%) were found to have urinary abnormalities. Two hundred and eighty-two (36.7%) of these 769 subjects were found to have urinary abnormalities based on urine microscopy constituting a prevalence of 1.71%. The prevalence of proteinuria was 0.63% and for both haematuria and proteinuria was 0.73%. The prevalence for hypertension was 0.43% and renal insufficiency was 0.1%. DISCUSSION The consensus is that routine screening for chronic kidney disease (CKD) in the general population is not cost effective as the yield is too low. Whilst, most studies showed that screening of the general population was not cost effective, it has been suggested that screening for targeted groups of subjects could help to identify certain risk groups who may benefit from early intervention to prevent or retard the progression of CKD. CONCLUSION The prevalence of urinary abnormalities in Singapore has remained the same, now and three decades ago.
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Affiliation(s)
- Keng Thye Woo
- Department of Renal Medicine, Singapore General Hospital, Outram Road, Singapore 169608.
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