Hydatid cyst of a solitary congenital kidney is a rare entity because of the small percentage of cases with renal hvdatidosis and the reduced number of cases with this renal anomaly.We report a case presenting this ex...Hydatid cyst of a solitary congenital kidney is a rare entity because of the small percentage of cases with renal hvdatidosis and the reduced number of cases with this renal anomaly.We report a case presenting this extremely rare combination and having a favorable outcome.The diagnosis was confirmed based on an association of iniagistic techniques and positive serology.The case was managed using a minimal invasive surgical technique(PAIR) that reduced the operative risks.Additionally,an antihelminthic agent[albendazole) was administered.To our knowledge,this is the first case with such comorbidity and treated through percutaneous approach.展开更多
The critically ill patient is capable of presenting a multiple organ dysfunction syndrome (MODS) caused by different diseases, which can be infectious (sepsis, septic shock) as well as non-infectious (pancreatitis, la...The critically ill patient is capable of presenting a multiple organ dysfunction syndrome (MODS) caused by different diseases, which can be infectious (sepsis, septic shock) as well as non-infectious (pancreatitis, large surgeries, traumatic injuries, burn patients and brain injuries), this syndrome is characterized by global hemodynamic and organ perfusion alterations accompanied by an uncontrolled and marked inflammatory response unresponsive to pharmacological treatment due to which extracorporeal organ support can be a viable option. Acute renal lesion can occur in up to 60% of patients receiving intensive care, and close to 10% - 20% require renal replacement therapy (RRT) globally this can be provided as peritoneal dialysis (PD) or intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), hybrid therapies known as sustained slow efficiency dialysis (SLED), which combines the benefits IHD and CRRT, slow continuous ultrafiltration (SCUF). Extracorporeal membrane oxygenation (ECMO) and extracorporeal elimination of CO<sub>2</sub>, have been used more frequently lately, these are temporal artificial support used for respiratory and/or cardiac insufficiency that is refractory to conventional treatment. Acute liver failure in adults has a mortality rate close to 50% furthermore one-third of patients hospitalized for cirrhosis are likely to progress to acute liver failure which will drastically increase its mortality. Based on concepts of albumin dialysis, one of its most known is the following: Molecular Adsorbent Recirculating System (MARS), Fractionated Plasma Separation and Absorption—FPSA (Prometheus<sup>®</sup>) and also, hemoperfusion with different cartridges used in different extracorporeal therapies, used in liver failure, rhabdomyolysis, cytokine release syndrome and more in the context of the pandemic covid19. The objective of this review is to know the different extracorporeal therapies and the therapeutic utility in critical patients.展开更多
Whether on dialysis or not, native kidneys in chronic kidney disease (CKD) patients undergo morphological and structural changes. <strong>Objective:</strong> To study native kidney morphometric and structu...Whether on dialysis or not, native kidneys in chronic kidney disease (CKD) patients undergo morphological and structural changes. <strong>Objective:</strong> To study native kidney morphometric and structural aspects in CKD patients on dialysis and non-dialysis patients. <strong>Methods:</strong> It was a descriptive, analytical, and cross-sectional study conducted from May to December 2018. The study enrolled CKD patients on dialysis or not followed at CNHU-HKM in Cotonou. Renal ultrasound was performed to locate cysts and uroscanner completed in the presence of atypical cysts. Through logistic regression, associated factors were determined. <strong>Results:</strong> The sample size was 240 patients, of which 151 (62.9%) were receiving dialysis and 89 (37.1%) non-dialysis patients. Male subjects were predominant (sex ratio = 1.5). The average size of the right kidney, expressed in mm in patients on dialysis was: pole-to-pole length = 78.56;width = 42.06;cortical thickness = 11.80;and the left kidney: pole-to-pole length = 79.76;width = 41.53;cortical thickness = 12.6. For non-dialysis patients, the following size was recorded for the right kidney: pole-to-pole length = 92.35;width = 47.61;cortical thickness = 15.64;and left kidney: length = 92.13;width = 47.82;cortical thickness = 15.43. Predictive factors for the occurrence of acquired renal cysts were: old age (p = 0.0001), dialysis (p < 0.001) and diabetic nephropathy (p = 0.0014). <strong>Conclusion:</strong> CKD patients on dialysis have small kidneys and are more likely to develop acquired renal cysts. There is a need to carry out an annual ultrasound screening for native kidneys in patients receiving dialysis.展开更多
We report a case with a primary papillary RCC with concurrent presence of a separate occult cystic carcinoma posing as a simple cyst on preoperative imaging studies.
AIM To delineate changes in miRNA expression localized to the peri-cystic local microenvironment(PLM) in an orthologous mouse model of autosomal dominant polycystic kidney disease(ADPKD)(mcwPkd1^(nl/nl)).METHODS We pr...AIM To delineate changes in miRNA expression localized to the peri-cystic local microenvironment(PLM) in an orthologous mouse model of autosomal dominant polycystic kidney disease(ADPKD)(mcwPkd1^(nl/nl)).METHODS We profiled miRNA expression in the whole kidney and laser captured microdissection(LCM) samples from PLM in mcwPkd1^(nl/nl)kidneys with Qiagen miScript 384 HC miRNA PCR arrays. The three times points used are:(1) post-natal(PN) day 21, before the development of trichrome-positive areas;(2) PN28, the earliest sign of trichrome staining; and(3) PN42 following the development of progressive fibrosis. PN21 served as appropriate controls and as the reference time point for comparison of miRNA expression profiles.RESULTS LCM samples revealed three temporally upregulated miRNAs [2 to 2.75-fold at PN28 and 2.5 to 4-fold(P ≤ 0.05) at PN42] and four temporally downregulated miRNAs [2 to 2.75 fold at PN28 and 2.75 to 5-fold(P ≤ 0.05) at PN42]. Expression of twenty-six miRNAs showed no change until PN42 [six decreased(2.25 to 3.5-fold)(P ≤ 0.05) and 20 increased(2 to 4-fold)(P ≤ 0.05)]. Many critical miRNA changes seen in the LCM samples from PLM were not seen in the contralateral whole kidney.CONCLUSION Precise sampling with LCM identifies miRNA changes that occur with the initiation and progression of renal interstitial fibrosis(RIF). Identification of the target proteins regulated by these miRNAs will provide new insight into the process of fibrosis and identify unique therapeutic targets to prevent or slow the development and progression of RIF in ADPKD.展开更多
It is very important for outpatients who have had a kidney transplant to take care of themselves after discharge. However, outpatients have limited access to medical care by hospital staff after discharge;therefore, m...It is very important for outpatients who have had a kidney transplant to take care of themselves after discharge. However, outpatients have limited access to medical care by hospital staff after discharge;therefore, medical staff are unaware of the patient’s living conditions, and the uncertainties and problems that they encounter related to self-management. We conducted a questionnaire survey among 161 of 200 outpatients who received kidney transplants to investigate their recognition and actual practice of daily self-management. To determine the characteristics of adherent outpatients, we divided patients into two groups (the adherent and non-adherent group) and compared them. The Chi-squared test was conducted to test the equality of proportions among the groups, and then multiple logistic regression analysis was used to explore the factors significantly associated with regularly taking medicine or failing to take medicine. As a result of the logistic regression model using demographic factors as independent factors, the periods after transplantation (2 - 5 and 5 - 10 years) and living-donor kidney transplantation or cadaveric kidney transplantation were selected as significant factors associated with good self-management. As a whole, 68.3% of the 145 patients were correctly predicted using the model. The results of this study suggest that in the short period after transplantation (2 - 5 years), cadaveric kidney transplantation and that the patient has a job are significant factors associated with good self-management. Behind these results, a unique Japanese concept, “amae”, could be found. Therefore, medical knowledge and techniques as well as cultural background should be studied.展开更多
目的对危重患者应用连续性静脉-静脉血液滤过（CVVH）治疗过程中低磷血症的防治进行初步分析与探讨。方法选择危重患者30例，按急性生理与慢性健康评分（APACHEⅡ评分）不同分为2组（〈15分13例为A组，≥15分17例为B组）。两组均行CVVH...目的对危重患者应用连续性静脉-静脉血液滤过（CVVH）治疗过程中低磷血症的防治进行初步分析与探讨。方法选择危重患者30例，按急性生理与慢性健康评分（APACHEⅡ评分）不同分为2组（〈15分13例为A组，≥15分17例为B组）。两组均行CVVH治疗，置换液速度A组2000ml／h、B组4000ml／h，持续时间8～12h／d；补充甘油磷酸钠A组10～20ml／d，B组为30～40ml／d；治疗前、24小时、48小时、72小时检测血清磷的浓度、进行APACHEⅡ评分，井作血磷与APACHⅡ评分的相关分析，计算磷清除率。结果B组磷清除率大于A组[（42．76±2．39）ml／min vs （23．84±3．05）ml／min，P〈0．05]；治疗前B组血磷浓度低于A组[（0．78±0．19）mmol／L vs（1．25±0．27）mmol／L，P〈0．05]；第24小时两组血磷浓度均开始下降．补磷后第48小时A组血磷浓度正常，B组为轻度低磷血症，经调整补磷剂量后，第72小时恢复正常；CVVH治疗后两组患者APACHEⅡ评分均有降低的趋势；血磷与APACHEⅡ评分的相关分析提示两者呈负相关。结论危重患者易发生低磷血症，且与病情危重程度相关，采用CVVH治疗更易加重低磷血症，补磷应做到个体化，且不必拘泥于常规剂量限制。同时通过密切监测血磷变化来调整。展开更多
文摘Hydatid cyst of a solitary congenital kidney is a rare entity because of the small percentage of cases with renal hvdatidosis and the reduced number of cases with this renal anomaly.We report a case presenting this extremely rare combination and having a favorable outcome.The diagnosis was confirmed based on an association of iniagistic techniques and positive serology.The case was managed using a minimal invasive surgical technique(PAIR) that reduced the operative risks.Additionally,an antihelminthic agent[albendazole) was administered.To our knowledge,this is the first case with such comorbidity and treated through percutaneous approach.
文摘The critically ill patient is capable of presenting a multiple organ dysfunction syndrome (MODS) caused by different diseases, which can be infectious (sepsis, septic shock) as well as non-infectious (pancreatitis, large surgeries, traumatic injuries, burn patients and brain injuries), this syndrome is characterized by global hemodynamic and organ perfusion alterations accompanied by an uncontrolled and marked inflammatory response unresponsive to pharmacological treatment due to which extracorporeal organ support can be a viable option. Acute renal lesion can occur in up to 60% of patients receiving intensive care, and close to 10% - 20% require renal replacement therapy (RRT) globally this can be provided as peritoneal dialysis (PD) or intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), hybrid therapies known as sustained slow efficiency dialysis (SLED), which combines the benefits IHD and CRRT, slow continuous ultrafiltration (SCUF). Extracorporeal membrane oxygenation (ECMO) and extracorporeal elimination of CO<sub>2</sub>, have been used more frequently lately, these are temporal artificial support used for respiratory and/or cardiac insufficiency that is refractory to conventional treatment. Acute liver failure in adults has a mortality rate close to 50% furthermore one-third of patients hospitalized for cirrhosis are likely to progress to acute liver failure which will drastically increase its mortality. Based on concepts of albumin dialysis, one of its most known is the following: Molecular Adsorbent Recirculating System (MARS), Fractionated Plasma Separation and Absorption—FPSA (Prometheus<sup>®</sup>) and also, hemoperfusion with different cartridges used in different extracorporeal therapies, used in liver failure, rhabdomyolysis, cytokine release syndrome and more in the context of the pandemic covid19. The objective of this review is to know the different extracorporeal therapies and the therapeutic utility in critical patients.
文摘Whether on dialysis or not, native kidneys in chronic kidney disease (CKD) patients undergo morphological and structural changes. <strong>Objective:</strong> To study native kidney morphometric and structural aspects in CKD patients on dialysis and non-dialysis patients. <strong>Methods:</strong> It was a descriptive, analytical, and cross-sectional study conducted from May to December 2018. The study enrolled CKD patients on dialysis or not followed at CNHU-HKM in Cotonou. Renal ultrasound was performed to locate cysts and uroscanner completed in the presence of atypical cysts. Through logistic regression, associated factors were determined. <strong>Results:</strong> The sample size was 240 patients, of which 151 (62.9%) were receiving dialysis and 89 (37.1%) non-dialysis patients. Male subjects were predominant (sex ratio = 1.5). The average size of the right kidney, expressed in mm in patients on dialysis was: pole-to-pole length = 78.56;width = 42.06;cortical thickness = 11.80;and the left kidney: pole-to-pole length = 79.76;width = 41.53;cortical thickness = 12.6. For non-dialysis patients, the following size was recorded for the right kidney: pole-to-pole length = 92.35;width = 47.61;cortical thickness = 15.64;and left kidney: length = 92.13;width = 47.82;cortical thickness = 15.43. Predictive factors for the occurrence of acquired renal cysts were: old age (p = 0.0001), dialysis (p < 0.001) and diabetic nephropathy (p = 0.0014). <strong>Conclusion:</strong> CKD patients on dialysis have small kidneys and are more likely to develop acquired renal cysts. There is a need to carry out an annual ultrasound screening for native kidneys in patients receiving dialysis.
文摘We report a case with a primary papillary RCC with concurrent presence of a separate occult cystic carcinoma posing as a simple cyst on preoperative imaging studies.
基金Supported by the Children’s Research Institute,the Lillian Goldman Charitable TrustAmy P Goldman FoundationEllsworth Family and Children’s Foundation of Children’s’Hospital and Health System of Wisconsin
文摘AIM To delineate changes in miRNA expression localized to the peri-cystic local microenvironment(PLM) in an orthologous mouse model of autosomal dominant polycystic kidney disease(ADPKD)(mcwPkd1^(nl/nl)).METHODS We profiled miRNA expression in the whole kidney and laser captured microdissection(LCM) samples from PLM in mcwPkd1^(nl/nl)kidneys with Qiagen miScript 384 HC miRNA PCR arrays. The three times points used are:(1) post-natal(PN) day 21, before the development of trichrome-positive areas;(2) PN28, the earliest sign of trichrome staining; and(3) PN42 following the development of progressive fibrosis. PN21 served as appropriate controls and as the reference time point for comparison of miRNA expression profiles.RESULTS LCM samples revealed three temporally upregulated miRNAs [2 to 2.75-fold at PN28 and 2.5 to 4-fold(P ≤ 0.05) at PN42] and four temporally downregulated miRNAs [2 to 2.75 fold at PN28 and 2.75 to 5-fold(P ≤ 0.05) at PN42]. Expression of twenty-six miRNAs showed no change until PN42 [six decreased(2.25 to 3.5-fold)(P ≤ 0.05) and 20 increased(2 to 4-fold)(P ≤ 0.05)]. Many critical miRNA changes seen in the LCM samples from PLM were not seen in the contralateral whole kidney.CONCLUSION Precise sampling with LCM identifies miRNA changes that occur with the initiation and progression of renal interstitial fibrosis(RIF). Identification of the target proteins regulated by these miRNAs will provide new insight into the process of fibrosis and identify unique therapeutic targets to prevent or slow the development and progression of RIF in ADPKD.
文摘It is very important for outpatients who have had a kidney transplant to take care of themselves after discharge. However, outpatients have limited access to medical care by hospital staff after discharge;therefore, medical staff are unaware of the patient’s living conditions, and the uncertainties and problems that they encounter related to self-management. We conducted a questionnaire survey among 161 of 200 outpatients who received kidney transplants to investigate their recognition and actual practice of daily self-management. To determine the characteristics of adherent outpatients, we divided patients into two groups (the adherent and non-adherent group) and compared them. The Chi-squared test was conducted to test the equality of proportions among the groups, and then multiple logistic regression analysis was used to explore the factors significantly associated with regularly taking medicine or failing to take medicine. As a result of the logistic regression model using demographic factors as independent factors, the periods after transplantation (2 - 5 and 5 - 10 years) and living-donor kidney transplantation or cadaveric kidney transplantation were selected as significant factors associated with good self-management. As a whole, 68.3% of the 145 patients were correctly predicted using the model. The results of this study suggest that in the short period after transplantation (2 - 5 years), cadaveric kidney transplantation and that the patient has a job are significant factors associated with good self-management. Behind these results, a unique Japanese concept, “amae”, could be found. Therefore, medical knowledge and techniques as well as cultural background should be studied.
文摘目的对危重患者应用连续性静脉-静脉血液滤过（CVVH）治疗过程中低磷血症的防治进行初步分析与探讨。方法选择危重患者30例，按急性生理与慢性健康评分（APACHEⅡ评分）不同分为2组（〈15分13例为A组，≥15分17例为B组）。两组均行CVVH治疗，置换液速度A组2000ml／h、B组4000ml／h，持续时间8～12h／d；补充甘油磷酸钠A组10～20ml／d，B组为30～40ml／d；治疗前、24小时、48小时、72小时检测血清磷的浓度、进行APACHEⅡ评分，井作血磷与APACHⅡ评分的相关分析，计算磷清除率。结果B组磷清除率大于A组[（42．76±2．39）ml／min vs （23．84±3．05）ml／min，P〈0．05]；治疗前B组血磷浓度低于A组[（0．78±0．19）mmol／L vs（1．25±0．27）mmol／L，P〈0．05]；第24小时两组血磷浓度均开始下降．补磷后第48小时A组血磷浓度正常，B组为轻度低磷血症，经调整补磷剂量后，第72小时恢复正常；CVVH治疗后两组患者APACHEⅡ评分均有降低的趋势；血磷与APACHEⅡ评分的相关分析提示两者呈负相关。结论危重患者易发生低磷血症，且与病情危重程度相关，采用CVVH治疗更易加重低磷血症，补磷应做到个体化，且不必拘泥于常规剂量限制。同时通过密切监测血磷变化来调整。
