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BMC Nephrology Jun 2021Spontaneous perirenal hemorrhage is relatively uncommon but may be life-threatening. There are some challenges in early diagnosis due to the lack of specific... (Review)
Review
BACKGROUND
Spontaneous perirenal hemorrhage is relatively uncommon but may be life-threatening. There are some challenges in early diagnosis due to the lack of specific presentations.
CASE PRESENTATION
We report a case of spontaneous perirenal hemorrhage in a newly diagnosed systemic lupus erythematosus patient who initially presented with non-specific flank pain. Weakness and unstable vital signs were noted on admission. Abdominal ultrasonography and computed tomography revealed a sizable perirenal hematoma over the left retroperitoneal cavity. Renal arteriography identified active extravasation of contrast media from a distant branch of the left renal artery, and selective embolization effectively obliterated the bleeding spot. After cessation of bleeding, the patient received intensive immunosuppressive therapy for acute kidney injury and encephalopathy due to lupus. Her mental status recovered successfully, and she was withdrawn from short-term hemodialysis.
CONCLUSIONS
Spontaneous perirenal hemorrhage in the condition of systemic lupus erythematosus was a rare clinical entity with life-threatening potential. Early accurate diagnosis of spontaneous renal hemorrhage requires both detailed clinical examination and radiologic studies. Interventional embolization is essential and effective for both diagnosis and treatment. A high index of suspicion is necessary to avoid missing this potentially fatal syndrome, especially in patients with an increased risk of bleeding.
Topics: Acute Kidney Injury; Adult; Brain Diseases; Combined Modality Therapy; Embolization, Therapeutic; Female; Glucocorticoids; Hematoma; Humans; Immunosuppressive Agents; Kidney Diseases; Lupus Erythematosus, Systemic; Methylprednisolone; Renal Replacement Therapy; Rupture, Spontaneous
PubMed: 34107924
DOI: 10.1186/s12882-021-02424-9 -
Cureus Nov 2023Hemorrhagic complications arising from anticoagulant use are a well-recognized concern in clinical practice. This case study presents an 84-year-old woman with multiple...
Hemorrhagic complications arising from anticoagulant use are a well-recognized concern in clinical practice. This case study presents an 84-year-old woman with multiple cardiovascular risk factors, including atrial fibrillation, who developed a perirenal hematoma after just five doses of enoxaparin, prescribed for stroke prevention. The patient exhibited altered mental status and abdominal pain, prompting imaging studies revealing the hematoma. This case highlights the importance of vigilance in patients at risk for bleeding complications, especially in the initial days of anticoagulant therapy. Diagnostic imaging, particularly CT scans or ultrasound, is crucial for early detection. Management strategies range from discontinuing anticoagulants to potential interventions like anticoagulation reversal, angiography, or surgery. The decision to resume anticoagulation presents a challenge and requires a personalized approach based on patient factors. This case underscores the need for continued vigilance, early diagnosis, and evidence-based decisions in managing patients on anticoagulants, emphasizing the necessity for further research to establish clear guidelines in such complex clinical scenarios.
PubMed: 38111438
DOI: 10.7759/cureus.48986 -
The Journal of International Medical... Nov 2021To perform a prospective study to determine the risk factors associated with perirenal haematoma development after percutaneous renal biopsy (PRB).
OBJECTIVE
To perform a prospective study to determine the risk factors associated with perirenal haematoma development after percutaneous renal biopsy (PRB).
METHODS
This multivariate prospective study collected demographic and clinical data from all consecutive adult patients that underwent real-time ultrasound-guided PRB of native kidneys. All biopsies were performed by two well-trained ultrasound physicians using 16G biopsy needles. Routine renal ultrasounds were performed within 12-24 h after biopsies in order to observe post-biopsy perirenal haematoma formation. Patients were stratified based on the occurrence of post-biopsy haematoma development.
RESULTS
This prospective study enrolled 218 patients and stratified them into a haematoma group ( = 126) and a non-haematoma group ( = 92). Binary logistic regression analysis identified female patients (odds ratio [OR] 1.990; 95% confidence interval [CI] 1.125, 3.521), patients with a body mass index (BMI) ≥28 kg/m (OR 2.660; 95% CI 1.097, 6.449) and patients with immediate post-biopsy active bleeding (IPAB) (OR 2.572; 95% CI 1.422, 4.655) as being more likely to have perirenal haematoma after real-time ultrasound guided PRB of native kidneys.
CONCLUSION
Female sex, a BMI ≥28 kg/m and IPAB were risk factors for perirenal haematoma after real-time ultrasound-guided PRB of native kidneys.
Topics: Adult; Biopsy; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Image-Guided Biopsy; Kidney; Prospective Studies; Ultrasonography, Interventional
PubMed: 34786995
DOI: 10.1177/03000605211058377 -
Nutrients Nov 2020Nelumbinis Semen (NS, the seeds of ) extract is a traditional Korean medicine with anti-oxidant activity. The present study examined the anti-obesity and antidiabetic...
Nelumbinis Semen (NS, the seeds of ) extract is a traditional Korean medicine with anti-oxidant activity. The present study examined the anti-obesity and antidiabetic effects of NS powder in high-fat diet (HFD)-induced obese C57BL/6 mice. Mice ( = 8/group) were fed a normal diet (CON), HFD, HFD containing 5% NS powder (HFD-NS5%), or HFD containing 10% NS powder (HFD-NS10%) for 12 weeks. Food intake was relatively higher in groups HFD-NS5% and HFD-NS10%, while the food efficiency ratio was highest in group HFD ( < 0.05). HFD-NS5% reduced the body weight (-39.1%) and fat weight (-26.6%), including epididymal fat and perirenal fat, and lowered the serum triglyceride levels (-20.6%) compared with HFD. Groups HFD-NS5% and HFD-NS10% showed hepatoprotective properties, reducing the serum ALT levels ( < 0.05) and fat globules (size and number) in the liver compared with group HFD. HFD-NS5% and HFD-NS10% regulated the blood glucose, improved the glucose intolerance, and showed a 12.5% and 15.0% reduction in the area under the curve (AUC) of intraperitoneal glucose tolerance test (IPGTT), and a 26.8% and 47.3% improvement in homeostatic model assessment insulin resistance (HOMA-IR), respectively, compared with HFD ( < 0.05). Regarding the expressions of genes related to anti-obesity and antidiabetes, there was a 1.7- and 1.3-fold increase in PPAR-α protein expression, 1.4- and 1.6-fold increase in PPAR-γ protein expression, and 0.7- and 0.6-fold decrease in TNF-α protein expression, respectively, following HFD-NS5% and HFD-NS10% treatments, compared with HFD, and GLUT4 protein expression increased relative to CON ( < 0.05). These results comprehensively provide the fundamental data for NS powder's functional and health-promoting benefits associated with anti-obesity and antidiabetes.
Topics: Animals; Anti-Obesity Agents; Blood Glucose; Diet, High-Fat; Drugs, Chinese Herbal; Glucose Transporter Type 4; Hypoglycemic Agents; Insulin Resistance; Lipids; Liver; Male; Mice; Mice, Inbred C57BL; Obesity; PPAR alpha; PPAR gamma; Plant Extracts; Republic of Korea; Tumor Necrosis Factor-alpha; Weight Gain
PubMed: 33266423
DOI: 10.3390/nu12113576 -
Contrast Media & Molecular Imaging 2022This study was to explore the diagnostic value of magnetic resonance imaging (MRI) optimized by residual segmentation attention dual channel network (DRSA-U-Net) in the...
This study was to explore the diagnostic value of magnetic resonance imaging (MRI) optimized by residual segmentation attention dual channel network (DRSA-U-Net) in the diagnosis of complications after renal transplantation and to provide a more effective examination method for clinic. 89 patients with renal transplantation were selected retrospectively, and all underwent MRI. The patients were divided into control group (conventional MRI image diagnosis) and observation group (MRI image diagnosis based on DRSA-U-Net). The accuracy of MRI images in the two groups was evaluated according to the comprehensive diagnostic results. The root mean square error (RMSE) and peak signal-to-noise ratio (PSNR) of DRSA-U-Net on T1WI and T2WI sequences were better than those of U-Net and dense U-Net ( < 0.05); comprehensive examination showed that 39 patients had obstruction between ureter and bladder anastomosis, 13 cases had rejection, 10 cases had perirenal hematoma, 5 cases had renal infarction, and 22 cases had no complications; the diagnostic sensitivity, specificity, accuracy, and consistency of the observation group were higher than those of the control group ( < 0.05). In the control group, the sensitivity, specificity, and accuracy in the diagnosis of complications after renal transplantation were 66.5%, 84.1%, and 78.32%, respectively; in the observation group, the sensitivity, specificity, and accuracy in the diagnosis were 67.8%, 86.7%, and 80.6%, respectively. DRSA-U-Net denoising algorithm can clearly display the information of MRI images on the kidney, ureter, and surrounding tissues, improve its diagnostic accuracy in complications after renal transplantation, and has good clinical application value.
Topics: Algorithms; Artificial Intelligence; Humans; Kidney Transplantation; Magnetic Resonance Imaging; Retrospective Studies
PubMed: 36072641
DOI: 10.1155/2022/8930584 -
Metabolomics investigation on antiobesity effects of on high-fat high-sugar diet-induced obese rats.Chinese Herbal Medicines Jul 2022(CB) is a well-used medicinal herb in Mongolian folk medicine and has been traditionally applied as an antiobesity agent. However, the evidence-based pharmacological...
OBJECTIVE
(CB) is a well-used medicinal herb in Mongolian folk medicine and has been traditionally applied as an antiobesity agent. However, the evidence-based pharmacological effects of CB and its specific metabolic alterations in the obese model are not entirely understood. This study aimed to utilize untargeted metabolomic techniques to identify biomarkers and gain mechanistic insight into the serum metabolite alterations associated with weight loss and lipid metabolism in obese rats.
METHODS
A high-fat high-sugar (HFHS) diet was used to induce obese models in rats. CB extract was orally gavaged at 0.18, 0.9 and 1.8 g/kg doses for six weeks, and feed intake, body weight, fat pad weight, and blood indexes were measured. Blood serum metabolites were evaluated by gas chromatography/quadrupole time-of-flight tandem mass spectrometry (GC-TOF/MS).
RESULTS
The results showed that compared with the obese group, the administration of CB extract caused significant decreases in body weight ( < 0.05), feed intake, Lee's index, and perirenal, mesenteric, epididymal fat weight. CB extract also reduced blood triglyceride and total cholesterol levels ( < 0.05) of obese rats. Metabolomic findings showed that nine differential metabolites, including pyruvic acid, -glucuronic acid, malic acid, dimethylglycine, oxoglutaric acid, pantothenic acid, sorbitol acid, fumaric acid and glucose 6-phosphate were identified under CB treatment and altered metabolic pathways such as TCA cycle, pantothenate and CoA biosynthesis, and glycolysis/gluconeogenesis.
CONCLUSION
This study demonstrated weight loss and lipid lowering effects of CB on HFHS diet-induced obese rats and identified nine metabolites as potential biomarkers for evaluating the favorable therapeutic mechanism of CB via regulation of lipid and glucose metabolism.
PubMed: 36118007
DOI: 10.1016/j.chmed.2022.04.001 -
Evidence-based Complementary and... 2022Since the introduction of the ALARA ("as low as reasonably achievable") concept, the management of severe renal trauma has shifted. Our hospital promotes delayed...
BACKGROUND
Since the introduction of the ALARA ("as low as reasonably achievable") concept, the management of severe renal trauma has shifted. Our hospital promotes delayed surgical intervention for grade IV closed renal injury, to preserve renal function. In this study, we retrospectively reviewed the management and outcomes of patients with grade IV closed renal injury in our hospital.
OBJECTIVE
To evaluate the management and outcome of grade IV closed renal injury.
METHODS
We retrospectively reviewed the medical records of 45 patients with grade IV closed renal injury; namely, 36 men and 9 women with an average age of 35.6 years. All patients were diagnosed with grade IV closed renal injury in accordance with the guidelines of the American Association for the Surgery of Trauma. All hemodynamically-stable patients with renal trauma were treated conservatively for approximately 13 days and then underwent surgery only to clear the perirenal hematoma and not to repair or resect the affected kidney. Abstracted data included patient demographics, mechanism of injury, admission hemodynamics, CT findings, and mortality. The primary outcome was the success rate of nonsurgical treatment, and the secondary outcome was the complication of nonsurgical treatment.
RESULTS
All patients responded and were discharged, and no patients died. We followed 35 (77.8%) patients for at least 1 year. One patient with partially devitalized renal parenchyma underwent surgery to remove the affected kidney. Eleven patients (31.4%) suffered complications, namely, three (8.6%) cases of hypertension, four (11.4%) cases of hematuria, two cases (5.7%) of urinary tract infection, and two (5.7%) cases of urinoma.
CONCLUSIONS
Delayed exploratory surgery only to remove the hematoma should be considered in hemodynamically-stable patients with grade IV closed renal injury. This approach can avoid high nephrectomy rates associated with emergency surgery and reduce the complications that result from conservative treatment without surgery.
PubMed: 36185079
DOI: 10.1155/2022/5066278 -
World Journal of Surgical Oncology Jun 2023Targeted therapy combined with immunotherapy is the current first-line treatment for metastatic renal cell carcinoma (mRCC), but patients with tumor thrombus (TT) may...
Long-term outcomes after cytoreductive nephrectomy and thrombectomy of patients with metastatic renal cell carcinoma with venous tumor thrombus: a retrospective study from a large Chinese center.
BACKGROUND
Targeted therapy combined with immunotherapy is the current first-line treatment for metastatic renal cell carcinoma (mRCC), but patients with tumor thrombus (TT) may suffer from lower limb edema or even sudden cardiac death, so the purpose of this study is to investigate the efficacy and safety of surgical treatment in patients with mRCC and TT and explore worse factors to affect the prognosis in this series of patients.
PATIENTS AND METHODS
A total of 85 mRCC patients with TT who received cytoreductive nephrectomy and thrombectomy at our medical center from 2014 to 2023 are included. All patients received postoperative systemic therapy. Overall survival (OS) is defined as the time from surgery to death due to any reason or the last follow-up. Kaplan-Meier analysis was performed to evaluate OS and differences among groups were tested by log-rank. Multivariable Cox proportional hazards analysis was performed to ascertain independent relationships between clinicopathological factors and OS.
RESULTS
The median age of patients was 58 years old. Eleven patients (12.9%) had no symptoms, 39 patients (45.9%) had local symptoms, 15 patients (17.6%) had systemic symptoms, and 20 patients (23.5%) had both. Mayo grade of TT was 0, 1, 2, 3, and 4 for 12, 27, 31, 7, and 8 patients respectively. Fifty-five patients had lung metastasis, 23 had bone metastasis, 16 had liver metastasis, 13 had adrenal metastasis, and 9 had lymph node metastasis. Of all patients, 17 patients had multiple metastases. The median operation time is 289 min and the median intraoperative hemorrhage is 800 ml. Twenty-eight patients experienced postoperative complications, 8 of which were serious complications of modified Clavien grade III or higher. The median OS of all patients was 33 months and median follow up time was 26 months. In multivariate analysis, systemic symptom (p = 0.00753), pathological type (p = 0.0166), sarcomatous degeneration (p = 0.0334), and perirenal fat infiltration (p = 0.0202) are independent predictors of OS.
CONCLUSION
Cytoreductive nephrectomy and thrombectomy is relatively safe and effective for patients with mRCC accompanied by TT. In this series of patients, the worse prognosis is associated with systemic symptoms, non-clear cell carcinoma, sarcomatous degeneration and perirenal fat infiltration.
Topics: Humans; Middle Aged; Carcinoma, Renal Cell; Retrospective Studies; Kidney Neoplasms; Cytoreduction Surgical Procedures; East Asian People; Thrombosis; Nephrectomy; Prognosis; Thrombectomy
PubMed: 37280590
DOI: 10.1186/s12957-023-03048-z -
Obesity Science & Practice Dec 2020Abdominal fat ultrasound (US) is a simple clinical tool that may allow measures of fat depots not visible using common dual-energy X-ray absorptiometry (DEXA) or...
OBJECTIVE
Abdominal fat ultrasound (US) is a simple clinical tool that may allow measures of fat depots not visible using common dual-energy X-ray absorptiometry (DEXA) or computerized tomography (CT) imaging. The aim of this study was to validate the technique, give measures of and , , and (retroperitoneal) fat and correlate them with MS markers.
METHODS
Sequential US measures of these five abdominal fat layers were done at 397 adults. Blood pressure (BP), body mass index (BMI), waist, body fat %, HOMA-IR index (homeostatic model assessment of insulin resistance), lipid profile and leptin were recorded. Metabolic syndrome (MS) was defined according to Cholesterol education programme adult treatment panel III (ATPIII) criteria.
RESULTS
and fat were increased among people with obesity, whereas and fat did not show any difference according to BMI or waist. Women showed thicker fat (both superficial and profound), whereas men had bigger fat. Both postmenopausal and diabetic patients had changes in fat only, whereas patients with fatty liver showed thicker and fat, as well. MS patients showed both thicker and fat. A cut-off of 54 mm in male (M)/34 mm in female (F) of fat and 22.5 mm (M)/12.5 mm (F) of fat could be predictive of later MS onset.
CONCLUSIONS
US is a valid method to measure all different abdominal fat depots. and fat measures may classify patients at risk for MS. fat depot may also correlate with fatty liver disease.
PubMed: 33354344
DOI: 10.1002/osp4.453 -
Iranian Journal of Kidney Diseases Jul 2022Bleeding events are the most common complications after kidney biopsy. This study aims to evaluate the effect of desmopressin administration on bleeding complication, in... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Bleeding events are the most common complications after kidney biopsy. This study aims to evaluate the effect of desmopressin administration on bleeding complication, in native kidney biopsy candidates with reduced kidney function.
METHODS
This double-blind randomized clinical trial enrolled 18 to 80 years old patients with 15 < eGFR < 90 mL/min/ 1.73m² from July 2017 to August 2020. Patients were randomly assigned to receive either 3 µg/kg of intranasal desmopressin acetate or 1 mL/kg of intranasal sodium chloride 0.65%, one hour before ultrasound-guided, percutaneous native kidney biopsy. The primary outcome was the post-biopsy bleeding complications, and secondary outcomes were the volume of perirenal hematoma, and changes of post-biopsy hemoglobin and hematocrit level, plasma sodium and blood pressure (Clinical Trial Registration ID: IRCT20090701002112N3).
RESULTS
A total of 120 patients (58 men and 62 women), 60 patients in each group, were analyzed. The mean age and eGFR of the patients were 45.29 ± 15.95 years and 51.77 ± 18.02 ml/min/ 1.73m², respectively. Desmopressin administration significantly decreased post-biopsy perirenal hematoma compared to placebo (7/60 [11.6%]) vs. 33/60 [40%]; P < .05), and the hematoma volume was significantly smaller in the desmopressin group, in case of hematoma formation (2.31 ± 1.17 vs. 7.72 ± 5.45 mm³, P < .05).
CONCLUSION
Desmopressin administration before kidney biopsy is a safe and effective strategy to prevent bleeding complications. Considering absolute risk reduction of about 28%, the number needed to treat is about 4 procedures. We recommend considering desmopressin administration before percutaneous native kidney biopsy. DOI: 10.52547/ijkd.6966.
Topics: Adult; Biopsy; Deamino Arginine Vasopressin; Double-Blind Method; Female; Hematoma; Humans; Kidney; Kidney Diseases; Male; Middle Aged; Ultrasonography, Interventional; Young Adult
PubMed: 35962638
DOI: No ID Found