Ultrasonography-guided Percutaneous Nephrolithotomy with Chinese One-shot Tract Dilation Technique Based on Stimulated Diuresis:A Report of 67 Cases

The safety and effectiveness of a novel Chinese one-shot dilation technique based on stimulated diuresis for percutaneous nephrolithotomy(PCNL) were investigated.After the feasibility of the Chinese one-shot dilation based on stimulated diuresis was verified by an animal study,this technique was applied in the clinical practice.A total of 67 patients in our department underwent the modified PCNL from July 2014 to June 2015.After the renal infundibulum was distended by stimulated diuresis,the kidney was punctured under the ultrasonographic guidance via the fornix of the target calyx.The working channel was dilated using a special designed pencil-shaped fascial dilator.The successful access rate,nephrostomy tract creation time,pre-and postoperative hemoglobin values and serum creatinine concentrations,stone-free rate and complications were recorded and analyzed.The renal infundibulum was successfully distended in all of the patients by the diuresis treatment.Under the ultrasonographic guidance,the successful access rate was 100% and the mean tract creation time was 2.0 min(range:1.5–5.0 min).The stone-free rate right after surgery was 91.0%.Although the postoperative hemoglobin was significantly reduced(P<0.01),transfusion was not clinically necessary.There was no significant difference in serum creatinine concentrations before and after operation(P>0.05).No severe complication occurred during or after the PCNL.It was suggested that this Chinese one-shot dilation technique based on stimulated diuresis is an efficient and safe innovation for PCNL,and is even helpful for those patients with non-dilated pelvicaliceal systems.

Post-Obstructive Diuresis: Physiopathology, Diagnosis and Management after Urological Treatment of Obstructive Renal Failure

Obstructive acute renal failure is both a medical and a surgical emergency. The first treatment modality is urological by relief of obstruction. Post-obstructive diuresis is an abnormal condition of prolonged polyuria, involving both excessive solute and water loss, after acute drainage of obstructed urinary tract system. Physiopathology mechanisms are multiples. In most patients, diuresis will resolve once the kidneys normalize the volume and solute status and homeostasis is achieved. Post-obstructive diuresis can occur in up to 50% of patients with substantial urinary tract obstruction and can be life-threatening if it becomes pathologic. It can be detected by hourly monitoring of diuresis. Medical treatment of post-obstructive diuresis consists of oral or intravenous fluids adjusted to the findings of clinical examination, diuresis (volume and electrolytes) and close monitoring of patient. Fluid compensation should be tapered off over several days. Patients at high risk of post-obstructive diuresis should be identified and appropriately monitored.

Effect of Cassia nomame on Small Intestine Movement, Diuresis,and Anti-inflammation in Rats

Objective To investigate the preliminary pharmacological screening of Cassia nomame.Methods The effect of aqueous extract from C.nomame on gastrointestinal motor function was investigated by assessing the intestinal transit rate(ITR)of charcoal modeled into gastrointestinal motility dysfunction(GMD)by the administration of dopamine,atropine,or noradrenaline to the rats,respectively.Diuresis was studied in vivo by estimating the urine output.The anti-inflammatory activity was expressed as the percentage of swelling reduction by comparison on the mean thickness of ear swelling in mice.Results The ITR in these GMD animals was significantly retarded compared to that in normal animals.The retardation,however,was significantly inhibited by the ig administration of C.nomame(2 g/kg)for all GMD animals.The results suggested that C.nomame had the potential for development into a prokinetic agent that could prevent or alleviate GMD in patients.C.nomame increased urine output and suppressed significantly ear swelling induced by dirnethyl benzene in mice.Conclusion C.nomame could increase the gastrointestinal contractile activity of rats and has the effects of diuresis and anti-inflammation.

Obstructive uropathy-acute and chronic medical management

Obstructive uropathy is an important cause of acute and chronic kidney disease.Decompression of the urinary tract is an essential aspect of treatment.The cause and aetiology of obstruction typically determine the surgical approach.Acute relief of obstruction is frequently complicated by fluid and electrolyte imbalance.Standard therapeutic interventions for acute or chronic renal failure also apply for cases of obstructive uropathy.This narrative review summarises the early and long-term medical management of obstructive uropathy.

Diabetes mellitus and electrolyte disorders

Diabetic patients frequently develop a constellation of electrolyte disorders. These disturbances are particularly common in decompensated diabetics, especially in the context of diabetic ketoacidosis or nonketotic hyperglycemic hyperosmolar syndrome. These patients are markedly potassium-, magnesium- and phosphatedepleted. Diabetes mellitus(DM) is linked to both hypo- and hyper-natremia reflecting the coexistence of hyperglycemia-related mechanisms, which tend to change serum sodium to opposite directions. The most important causal factor of chronic hyperkalemia in diabetic individuals is the syndrome of hyporeninemic hypoaldosteronism. Impaired renal function, potassiumsparing drugs, hypertonicity and insulin deficiency are also involved in the development of hyperkalemia. This article provides an overview of the electrolyte disturbances occurring in DM and describes the underlying mechanisms. This insight should pave the way for pathophysiology-directed therapy, thus contributing to the avoidance of the several deleterious effects associated with electrolyte disorders and their treatment.

“开后窍以启前窍”治疗癃闭探讨

According to TCM: because pissing and shitting are both contrloed by kidney,correlative in physiology and affect each other in pathogeny,with ancient persons’ dissertations about diuresising to treat Longbi(retention of urine),we put fordward "treating Longbi by Diuresising"——an idea to treat Longbi,Furthermore,particularize some formulae used in treating Longbi by diuresising in some medicine books,some disquisition of treating Longbi by resent persons,and also,two proved recipes.

Influence of SLYWG on malignant tumor ascites

Objective To search the effect of Chinese traditional medicine "Shang Lu Yu Wang Gao"(SLYWG)on the ascites induced by tumor,and its mechanism.Methods The tumor ascites model and diuretic experiments were introduced to evaluate the effect of SLYWG.Physical characteristics,the tumor cell counting,volume of the ascites,protein content in ascites,the characters of ascites,the life duration of S180 tumor bearing animals as the indexes of evaluation.the diurtic experiments were performed on rats nad rabbits,the osmotic pressure,K+,Na+,Cl-,Ca2+ and pH in urine were determined.Results The inhibitions to ascites of SLYWG were displayed in three dosage(30 g·kg-1,15 g·kg-1 and 7.5 g·kg-1).Ascites caused by tumor was significantly inhibited by the local administration of SLYWG.The increase of mice ascites was slow down,the content of ALB and the TP in ascites were decreased,the surviving time of mice was extended.SLYWG had remarkable diuresis effect on the rats and rabbits,it could reduce the osmotic pressure of urine,decrease the exclude of K+ but had no effect on the Na+,Cl-,Ca2+ and pH in urine.Conclusions Tumor ascites was significantly inhibited by the ventral administration of SLYWG.SLYWG had diuretic effect in rats and rabbits,it reduced the osmotic pressure of urine,decrease the exclude of K+ but had no effect on Na+,Cl-,Ca2+ and pH of urine.

Potential effect of Silybum marianum L. and Cistus ladaniferus L.extracts on urine volume, creatinine clearance and renal function

Objective:To investigate the diuretic and renal effects of Silybum marianum L.and Cistus ladaniferus L.in normal rats.Methods:Four groups of rats were used in each experiment.The first group received water,the second group received Cistus ladaniferus L.extract(100 mg/kg b.wt),the third group received Silybum marianum L.extract(100 mg/kg b.wt),and the fourth group received furosemide(10 mg/kg b.wt).Variables including urine volume,plasma and urine sodium,potassium and creatinine,and creatinine clearance were measured.Two experiments were conducted.A single dose of each intervention was used and the variables were measured during 24 h,and the interventions were given daily for a total of 8 d and the variables were measured during various intervals.Results:The single dose of each plant extract increased urine volume at all-time intervals and increased urine sodium and potassium excretion without affecting plasma sodium and potassium(P<0.05).On the day 8 after daily administration,the plant extracts induced a significant diuresis and natriuresis without affecting serum electrolytes(P<0.05),while furosemide caused hypokalemia.Both plant extracts significantly increased creatinine clearance(P<0.05).Conclusions:Silybum marianum L.and Cistus ladaniferus L Increase creatinine clearance and have a significant diuretic effect without affecting serum electrolytes.Silybum marianum L.is more potent than furosemide or Cistus ladaniferus L.

A Comparative Study on Hypotensive and Diuretic Effects of Atriopeptin III and its Analogues

In order to find atriopeptin （AP） analogues with more potent and longer-lasting effects,we have synthesized rat APⅢ and its three analogues A1, A2, A3 , and assayed their bioactivitiesin anesthetized rats. The results demonstrate that the synthesized APⅢ has powerful diuretic,natriuretic effects, and can remarkably lower arterial blood pressure, while the heart rote remainsunchanged in the process. The aforementioned effects of APⅢ are dose-dependent. The hypotensionof APⅢ is independent of the diuresis caused by APⅢ. The three analogues’ of APⅢ are all 24peptides. A1 and A3 had no bioactivities, while A2 possessed atriopeptin-like, but weaker activities.The results suggest that the 5th, 6th and 7th amino add residues and their configurations in thepeptide chain of AP Ⅲ are crucial for eliciting bioactivities.

Case Study: Suicide Attempt by Intentional Ingestion of Chlormequat

Chlormequat is a quaternary ammonium and choline chlorinated derivated is used as plant growth regulating agent. There are very few documented cases of poisoning in humans. We reported a case of non-fatal suicide attempt by chlormequat in France. A 34-year-old woman was admitted to hospital after deliberate consumption of plant growth regulator, C5 SUN, containing chlormequat chloride (460 g/L) and choline chloride (320 g/L). Immediately, she developed symptoms of respiratory distress and a cardiac massage was begun by her father. In this case report, we described the method for an accurate and reliable screening of chlormequat which was based on the combination of Target Analysis powerful software and a high performance TOF-MS (Impact HD from Bruker). After forced diuresis, the kinetic of elimination of chlormequat is biphasic: vascular phase diffusion (half-life of 5.6 hr) followed by a phase of free elimination (half-life of 16.2 h). Although chlormequat poisoning is clinically similar to that observed with anticholinesterase compounds, chlormequat chloride is not an acetylcholinesterase inhibitor. Chlormequat seems to be a weak substrat competitor for cholinesterase leading to acetylcholine accumulation and prolonged depolarization in muscular junction. Cardiac massage, artificial respiration and forced diuresis have significantly improved the prognosis of our patient.

Alcohol-Induced Cardiomyopathy Presenting with Left Ventricular Apical Thrombus

Background: Chronic excessive alcohol consumption has been strongly associated with alcohol-induced cardiomyopathy (AC) in patients with no evidence of coronary artery disease (CAD). AC may cause cardiovascular complications and significant impact on the quality of life. We discuss an interesting case of dilated cardiomyopathy, associated complication, diagnostic work-up and management. Case Report: A young male presented to our service with worsening dyspnea, orthopnea, and scrotal and lower extremity edema. On average, he consumed a pack of 12 beers every day and had a 30-pack-years smoking history. He was found to be in acute heart failure with evidence of pulmonary edema and cardiomegaly on chest imaging. He had biventricular dilatation and severely reduced left ventricular ejection fraction (LVEF) 15% in addition to a thrombus in the LV apex. The cardiac catheterization was unremarkable for CAD. He was diuresed appropriately resulting in significant weight loss and resolution of symptoms. LV thrombus was treated with unfractionated heparin infusion that was transitioned to warfarin. He was maintained on guidelines-directed medical therapy for heart failure. Extensive counseling was provided regarding alcohol and tobacco cessation. On follow-up echocardiogram, his LVEF improved and there was no evidence of LV thrombus. We think, the readership will benefit from our experience of treating a case of AC, and the importance of clinical history. Conclusion: Chronic excessive alcohol use is detrimental to cardiac function leading to alcohol-induced cardiomyopathy. A careful approach to clinical history of alcohol consumption and prompt diagnostic workup negative for ischemic causes may confirm the diagnosis. Cardiac function improves with guidelines-directed medical therapy for heart failure and abstinence from alcohol.

Oval-Shaped Radiographic Opacity Mimicking a Lung Mass

Phantom tumor of the lung is an infrequent presentation of volume overload in congestive heart failure. This finding is often mistaken for a lung mass that leads to extensive workup and unnecessary treatments. A 75-year-old male was evaluated for a right lower lobe rounded opacity. A transthoracic echocardiogram showed normal left ventricular function. Biopsy of the mass was unremarkable. Patient was managed with diuretics, and subsequent lung imaging revealed resolution of the opacity.

Eating Habits among Lithiasic Patients in Kinshasa, the Democratic Republic of Congo

Introduction: Worldwide, the incidence of kidney stones has been progressively increasing. Various factors can influence the risk of stone formation, including lifestyle and eating habits. The dietary investigation is a standard of care in patients with urolithiasis. The objectives of this study were to determine the dietary habits of lithiasis patients in the city of Kinshasa and to investigate the association between dietary habits and the composition of the stones. Material and Methods: From January 2017 to September 2019, 85 patients attending 8 hospitals participated in the nutrition survey. Various foods commonly consumed in the Democratic Republic of Congo were categorized based on their composition: foods rich in animal proteins, foods rich in calcium, foods high in sugar, foods high in oxalate, and various vegetables and fruits. We also investigated daily water intake. The composition of the collected stones was analyzed by infrared spectrophotometry. Results: The mean (SD) age of patients was 47.1 (14.0) years, 63.5% of patients were males, 75.3% of the patients had stones located in the upper urinary tract, and 7.1% were undernourished. Most of patients consumed vegetables (77.6%), animal proteins (62.4%), and foods rich in oxalate (58.8%). The daily water intake was less than 1500 mL in more than half of the patients (68.2%). Major anhydrous uric acid stones were associated with a high body mass index (p = 0.025). Male patients with a high oxalate diet had more calcium oxalate stones (64.3%) compared to other types of stones (p = 0.041). Conclusion: High consumptions of vegetables and low water intake were linked to the formation of calcium oxalate monohydrate stones. More data are needed to confirm these findings.

Understanding the Use of Radix Astragali Seu Hedysari in the Treatment of Edema Due to Renal Diseases

Radix Astragali seu Hedysari is warm in nature and slightly sweet in taste.It belongs to the lung,spleen,and kidney meridians.It passes through a waterway,dredges the triple energizer,and has a significant effect on edema due to renal diseases.Ancient doctors believed that Radix Astragali seu Hedysari is excellent in tonifying the middle,supplementing Qi,and dredging through the triple energizer.In modem times,many doctors have found that whether it is used as a single drug or in combination with other drugs,it is widely used in clinical practice and has a good effect in inducing diuresis.