The Association between Autosomal Dominant Polycystic Kidney Disease and Renal Cell Carcinoma

Objectives: The relationship between autosomal dominant polycystic kidney disease (ADPKD) and renal cell carcinoma (RCC) is investigated to determine a link that would guide management due to elevated RCC risk. Current literature is inconclusive on this topic. Methods: This study is a retrospective chart review of patients having undergone nephrectomy. Those with pathology and history consistent with ADPKD were reviewed for presence of RCC. Results: The review at this institution revealed RCC in 18% of ADPKD patients who underwent nephrectomy. These rates are significantly higher than those found in the general population, and even greater than those would be expected in patients suffering end-stage renal disease (ESRD). Conclusions: Due to the increased prevalence of RCC in ADPKD, clinicians managing patients with ADPKD should maintain a high index of suspicion. Our data suggest a link between ADPKD and RCC, most likely at the genetic level. In light of this, we feel that further genetic research is needed to potentially discover the link between these two disease processes.

Patient selection and preparation strategies for the use of contrast material in patients with chronic kidney disease

The prevalence of chronic kidney disease and peripheral arterial disease is increasing.Thus,it is increasingly problematic to image these patients as the number of patients needing a vascular examination is increasing accordingly.In high-risk patients with impaired kidney function,intravascular administration of iodinated contrast media can result in contrast-induced acute kidney injury and Gadolinium can induce nephrogenic systemic fibrosis(NSF).It is important to identify these highrisk patients by means of se-creatinine/e glomerular filtration rate.The indication for contrast examination should counterbalance the increased risk.One or more alternative examination methods without contrast media,such as CO 2 angiography,Ultrasound/Doppler examination or magnetic resonance angiography without contrast should be considered,but at the same time,allow for a meaningful outcome of the examination.If contrast is deemed essential,the patient should be well hydrated,the amount of contrast should be restricted,the examination should be focused,metformin and diuretics stopped,and renal function monitored.Sodium bicarbonate and N-acetylcysteine are popular but their efficiency is not evidence-based.There is no evidence that dialysis protects patients with impaired renal function from contrast-induced nephropathy or NSF.

Retroperitoneal laparoscopic partial resection of the renal pelvis for urothelial carcinoma:A case report

BACKGROUND The standard treatment of transitional cell carcinoma of the upper urinary tract consists of radical nephroureterectomy with bladder cuff removal,which can be performed either in open or laparoscopy or robot-assisted laparoscopy.Treatment of chronic renal insufficiency patients with upper urothelial tumor is in a dilemma.Urologists weigh and consider the balance between tumor control and effective renal function preservation.European Association of Urology guidelines recommend that select patients may benefit from endoscopic treatment,but laparoscopic treatment is rarely reported.CASE SUMMARY In this case report,we describe a case of 79-year-old female diagnosed with urothelial carcinoma of the renal pelvis and adrenal adenoma with chronic renal insufficiency.The patient was treated with retroperitoneal laparoscopic partial resection of the renal pelvis and adrenal adenoma resection simultaneously.CONCLUSION Retroperitoneal laparoscopic partial resection of the renal pelvis is an effective surgical procedure for the treatment of urothelial carcinoma of the renal pelvis.

慢性肾功能不全彩色多普勒肾血流动力学分析

目的 应用彩色多普勒血流显像(CDFI)及脉冲多普勒(PD)检测多囊肾所致慢性肾功能不全(CRF)的肾血流动力学改变。方法 运用CDFI和PD检测多囊肾所致的CRF30例的肾动脉内径、血流量和阻力指数(RI),并以30例老年健康查体者做对照。结果 多囊肾所致CRF肾动脉内径变细,血流量明显减低,阻力指数增高,与正常对照组比较有显著性差异。结论 CDFI及PD快速实时动态的优点,为临床评价肾动脉的功能状态、疾病的转归及疗效的判定提供了又一新的方法。

Biopsy-proven acute phosphate nephropathy:A case report

BACKGROUND Acute phosphate nephropathy(APN)is a disease that can occur when exposed to high doses of phosphate.The most common cause of APN is the use of oral sodium phosphate for bowel cleansing preparations.However,there are other less commonly known sources of phosphate that are equally important.To date,our literature search did not identify any report of excessive dietary phosphate as a cause of APN.CASE SUMMARY We report an unusual case of a 39-year-old diabetic male who presented with epigastric pain and oliguria.Work-up showed elevated serum creatinine,potassium,and calcium-phosphate product,and metabolic acidosis.The patient was admitted in the intensive care unit and received emergent renal replacement therapy.Kidney biopsy revealed tubular cell injury with transparent crystal casts positive for Von Kossa staining,which established the diagnosis of APN.CONCLUSION This case confirmed that APN may occur with other sources of phosphorus,highlighting the importance of good history taking and kidney biopsy in patients with predisposing factors for APN.Raising awareness on the possibility of APN and its timely recognition and management is imperative so that appropriate measures can be instituted to prevent or delay its progression to end stage renal disease.

长期高血压和糖尿病患者肾脏的彩色多普勒评价

本文应用彩色多普勒超声技术对３０例高血压及２８例糖尿病患者的肾脏进行研究，将患者分为三期，即肾小动脉硬化期、肾功能不全代偿期和肾功能不全失代偿期。对各期肾脏叶间动脉的收缩期最大峰速（Ｖｍａｘ），舒张期最小流速（Ｖｍｉｎ），搏动指数（ＰＩ），及收缩期加速时间（ＡＴ）进行测量，并与３０例正常人对比，发现Ｖｍａｘ和Ｖｍｉｎ值都随病变程度的加重而降低，而ＰＩ和ＡＴ值随病情加重而增高。另外，本文还对慢性肾功能不全失代偿期患者进行灯盏花药物疗效对比研究，肯定了其近期疗效。

透析治疗慢性肾功不全彩色多普勒血流动力学分析

目的：应用彩色多普勒血流显像（CDFI）及脉冲多普勒（PO）检测多囊肾所致慢性肾功不全（CRF）的肾血流动力学改变．方法：运用CDFI和PD检测多囊肾所致的CRF30例的肾动脉内径，血流量和阻力指数（RI），并以30例老年健康查体做对照．结果：多囊肾所致CRF肾动脉内径变细，血流量明显减低，阻力指数增高，与正常对照组比较有显著性的差异（P＜0．01）．结论：CDFI及PD快速实时动态的优点,为临床评价肾动脉的功能状态及疾病的转归。

103例常染色体显性遗传多囊肾病患者临床特点分析

目的分析常染色体显性遗传多囊肾病(autosomal dominant polycystic kidney disease,ADPKD)的临床特点。方法回顾性分析2017年7月至2021年4月第1次在武汉大学人民医院住院的103例ADPKD患者的临床资料,分析不同肾功能时期患者的临床特点。采用多元线性回归分析法分析与疾病严重程度相关的因素。结果103例ADPKD患者中,年龄(51.23±10.99)岁,男性49例(47.6%)。肾外表现以多囊肝为主(64/71)。临床症状主要表现为肉眼血尿(25例,24.3%)、腰胀腰痛(37例,35.9%)、高血压(69例,67.0%),且可出现在疾病的整个过程。早期治疗以药物保守治疗为主(58例,56.3%),其次是肾囊肿穿刺抽液(34例,33.0%),少数行外科手术治疗(11例,10.7%);进入终末期肾病阶段以药物保守治疗为主(28/34)。实验室检查发现血红蛋白、血小板、淋巴细胞百分比、血白蛋白在慢性肾脏病4~5期低于1~3期(均P<0.05),凝血酶原时间(PT)、PT⁃国际标准化比值(INR)、血浆渗透浓度在慢性肾脏病4~5期高于1~3期(均P<0.05)。多元线性回归分析发现血红蛋白(β=0.249,P=0.005)、血小板(β=0.207,P=0.005)、淋巴细胞百分比(β=0.305,P<0.001)、血浆渗透浓度(β=-0.362,P<0.001)与估算肾小球滤过率相关。结论ADPKD患者临床表现主要为高血压、腰胀腰痛、肉眼血尿,可贯穿慢性肾脏病全期,肾外表现以多囊肝多见。血红蛋白、血小板、淋巴细胞百分比、血浆渗透浓度可能与ADPKD疾病进展相关。