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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 -
Radiology Case Reports Feb 2024Perirenal hematoma is a common complication of traumatism and renal procedures such as nephrostomy, angiography, and lithotripsy. It may constitute a challenging...
Perirenal hematoma is a common complication of traumatism and renal procedures such as nephrostomy, angiography, and lithotripsy. It may constitute a challenging diagnosis in a pre-existing tumor context or in case of an atypical imaging appearance. We present a female patient followed for cervix cancer, who developed bilateral perirenal hematoma with an atypical MRI appearance evoking a malignant tumor. The diagnosis is established by the association of different imaging data (MRI with diffusion and ADC, CT scan without contrast, and CT scan after injection of contrast product). Percutaneous drainage remains the best management option for the perirenal hematoma in hemodynamic stable patients.
PubMed: 38074436
DOI: 10.1016/j.radcr.2023.09.101 -
International Journal of Molecular... Nov 2023Perirenal adipose tissue (PRAT) surrounding the kidney is emerging as a player and novel independent risk factor in diabetic kidney disease (DKD); DKD is a complication...
Perirenal adipose tissue (PRAT) surrounding the kidney is emerging as a player and novel independent risk factor in diabetic kidney disease (DKD); DKD is a complication of diabetes and is a major cause of increased cardiovascular (CV) risk and CV mortality in affected patients. We determined the effect of diabetes induction on (i) kidney and CV damage and (ii) on the expression of proinflammatory and profibrotic factors in both the PRAT and the mesenteric adipose tissue (MAT) of Munich Wistar Frömter (MWF) rats. The 16-week-old male MWF rats (n = 10 rats/group) were fed standard chow (MWF-C) or a high-fat/high-sucrose diet for 6 weeks together with low-dose streptozotocin (15 mg/kg i.p.) at the start of dietary exposure (MWF-D). Phenotyping was performed at the end of treatment through determining water intake, urine excretion, and oral glucose tolerance; use of the homeostatic model assessment-insulin resistance index (HOMA-IR) evidenced the development of overt diabetes manifestation in MWF-D rats. The kidney damage markers and were significantly higher in MWF-D rats, as were the amounts of PRAT and MAT. A diabetes-induced upregulation in , , , and was observed in both the PRAT and the MAT. was increased in the PRAT but not in the MAT of MWF-D, whereas was lower and higher in the PRAT and the MAT, respectively. Urinary albumin excretion and blood pressure were not further increased by diabetes induction, while heart weight was higher in the MWF-D. In conclusion, our results show a proinflammatory and profibrotic in vivo environment in PRAT induced by diabetes which might be associated with kidney damage progression in the MWF strain.
Topics: Humans; Rats; Male; Animals; Rats, Wistar; Albuminuria; Up-Regulation; Kidney Diseases; Diabetes Mellitus; Inflammation; Collagen; Adipose Tissue
PubMed: 38069331
DOI: 10.3390/ijms242317008 -
Archivos Espanoles de Urologia Nov 2023Percutaneous nephrolithotomy (PCNL) is a proven and efficient treatment method; Nevertheless, it is essential to note that there is still a risk of significant bleeding....
BACKGROUND
Percutaneous nephrolithotomy (PCNL) is a proven and efficient treatment method; Nevertheless, it is essential to note that there is still a risk of significant bleeding. The purpose of this paper is to explore the risk factors for massive hemorrhage after PCNL in the oblique supine position and provide a basis for the development of measures to prevent massive hemorrhage.
METHODS
The clinical data of 97 patients who underwent PCNL in the oblique supine position at Changshu No. 2 People's Hospital from January 2019 to December 2020 were retrospectively analyzed. Patients were placed in the massive hemorrhage group if their hemoglobin levels decreased by ≥20 g/L 24 h after the operation, and the other patients were placed in the nonmassive hemorrhage group. Differences in sex, age, body mass index (BMI), hypertension, diabetes, surgical side, perirenal fat stranding (PFS), calculus long diameter, surgical access, and operation time were compared between the two groups to determine the risk factors for massive bleeding. Multivariable logistic regression analysis was used to determine the risk factors for massive hemorrhage after PCNL.
RESULTS
There were no significant differences in sex, BMI, hypertension, diabetes, surgical side, or calculus long diameter between the two groups ( > 0.05), and there were statistically significant differences in age, PFS, surgical access, and operation time ( < 0.05). Multivariate logistic regression analysis indicated that PFS and extensive surgical access were independent risk factors ( < 0.05).
CONCLUSIONS
PFS and extensive surgical access were independent risk factors. Carefully reading computed tomography (CT) films before surgery and reducing the size of the surgical access area are important measures for reducing the risk of massive hemorrhages.
Topics: Humans; Nephrolithotomy, Percutaneous; Kidney Calculi; Nephrostomy, Percutaneous; Retrospective Studies; Supine Position; Hemorrhage; Risk Factors; Hypertension; Diabetes Mellitus; Treatment Outcome
PubMed: 38053425
DOI: 10.56434/j.arch.esp.urol.20237609.85 -
EJHaem Nov 2023
PubMed: 38024641
DOI: 10.1002/jha2.766 -
Cancers Oct 2023Kidney cancer accounts for 3% of adult malignancies and is increasingly detected through advanced imaging techniques, highlighting the need for effective treatment...
Kidney cancer accounts for 3% of adult malignancies and is increasingly detected through advanced imaging techniques, highlighting the need for effective treatment strategies. This retrospective study assessed the safety and efficacy of a new single-probe percutaneous cryoablation system using liquid nitrogen for treating T1a renal cancers. From May 2019 to May 2022, 25 consecutive patients from two academic hospitals, with a median age of 64.8 years [IQR 59; 75.5], underwent cryoablation for 26 T1a renal tumors. These tumors had a median size of 25.3 mm [20; 30.7] and a median RENAL nephrometry score, indicating tumor complexity, of 7 [5; 9]. No major complications arose, but three non-clinically relevant perirenal hematomas were detected on post-procedure CT scans. With a median follow-up of 795 days [573; 1020], the primary local control rate at one month stood was 80.8% (21 out of 26). The five recurrent lesions, which exhibited a higher renal score ( = 0.016), were treated again using cryoablation, achieving a secondary local control rate of 100%. No patient died, and the disease-free survival rate was 92% (23 out of 25). In conclusion, single-probe percutaneous cryoablation emerges as a promising modality for managing small renal masses. Notably, recurrence rates appear influenced by RENAL nephrometry scores, suggesting a need for further research to refine the technique.
PubMed: 37958366
DOI: 10.3390/cancers15215192 -
Cureus Oct 2023Subcapsular hematoma (SRH) or perirenal hematoma (PRH) can be seen after trauma, interventional radiological procedures, urological procedures, anticoagulant...
Subcapsular hematoma (SRH) or perirenal hematoma (PRH) can be seen after trauma, interventional radiological procedures, urological procedures, anticoagulant medications, coagulation disorders, infections, and spontaneously in some patients. Within the urological procedures, PRH can occur after percutaneous nephrolithotomy and extracorporeal shortwave lithotripsy but has only been reported a few times after cystoscopy/ureteroscopy. Here, we present the case of PRH as a complication from cystoscopy with retrograde pyelography in a patient with underlying chronic kidney disease (CKD) and an extensive surgical history for nephrolithiasis. In addition to this, our patient had a further complication of sepsis by , of which the source is proven to be urinary, and it appears that the fungemia was triggered during the procedure as well. The diagnosis was confirmed by abdominal computed tomography (CT), and PRH was proven to resolve with conservative management on repeat imaging months later.
PubMed: 37933348
DOI: 10.7759/cureus.46602 -
Cureus Sep 2023Emphysematous pyelonephritis (EPN) is a suppurative necrotizing form of renal infection with abscess and gas formation in the renal parenchyma and perirenal tissue. EPN...
Emphysematous pyelonephritis (EPN) is a suppurative necrotizing form of renal infection with abscess and gas formation in the renal parenchyma and perirenal tissue. EPN with scrotal extension is rare; if not recognized and treated promptly, the clinical course can be severe and life-threatening. The most common causative organism is and association with diabetes mellitus has been found in almost all cases. Prompt control of blood sugar and intravenous antibiotics are essential steps in management. Here, we report a rare form of extensive EPN extending from the right kidney to the scrotum retroperitoneally in a 47-year-old male with uncontrolled blood sugar. The patient was managed with a right percutaneous perinephric drain with right double J (DJ) stenting. His blood sugar was controlled by subcutaneous insulin. The patient was discharged on day 7 in satisfactory general condition with right percutaneous drainage and right DJ stent in situ.
PubMed: 37842469
DOI: 10.7759/cureus.45065 -
Biomedicine & Pharmacotherapy =... Dec 2023The non-steroidal mineralocorticoid receptor antagonist (MRA) finerenone (FIN) improves kidney and cardiovascular outcomes in patients with chronic kidney disease (CKD)...
The non-steroidal mineralocorticoid receptor antagonist (MRA) finerenone (FIN) improves kidney and cardiovascular outcomes in patients with chronic kidney disease (CKD) in type 2 diabetes (T2D). We explored the effect of FIN in a novel model of type 1 diabetic Munich Wistar Frömter (MWF) rat (D) induced by injection of streptozotocin (15 mg/kg) and additional exposure to a high-fat/high-sucrose diet. Oral treatment with FIN (10 mg/kg/day in rat chow) in diabetic animals (D-FIN) was compared to a group of D rats receiving no treatment and a group of non-diabetic untreated MWF rats (C) (n = 7-10 animals per group). After 6 weeks, D and D-FIN exhibited significantly elevated blood glucose levels (271.7 ± 67.1 mg/dl and 266.3 ± 46.8 mg/dl) as compared to C (110.3 ± 4.4 mg/dl; p < 0.05). D showed a 10-fold increase of kidney damage markers Kim-1 and Ngal which was significantly suppressed in D-FIN. Blood pressure, pulse wave velocity (PWV) and arterial collagen deposition were lower in D-FIN, associated to an improvement in endothelial function due to a reduction in pro-contractile prostaglandins, as well as reactive oxygen species (ROS) and inflammatory cytokines (IL-1, IL-6, TNFα and TGFβ) in perivascular and perirenal adipose tissue (PVAT and PRAT, respectively). In addition, FIN restored the imbalance observed in CKD between the procalcifying BMP-2 and the nephroprotective BMP-7 in plasma, kidney, PVAT, and PRAT. Our data show that treatment with FIN improves kidney and vascular damage in a new rat model of DKD with T1D associated with a reduction in inflammation, fibrosis and osteogenic factors independently from changes in glucose homeostasis.
Topics: Humans; Rats; Animals; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Pulse Wave Analysis; Rats, Wistar; Kidney; Renal Insufficiency, Chronic
PubMed: 37832406
DOI: 10.1016/j.biopha.2023.115661 -
Heliyon Sep 2023Obesity, accumulation of adipose tissue, is a global disease that can lead to cardiovascular and metabolic complications. The aim of this study was to investigate the...
RATIONALE AND OBJECTIVES
Obesity, accumulation of adipose tissue, is a global disease that can lead to cardiovascular and metabolic complications. The aim of this study was to investigate the relationship between obesity indicators and metabolic risk factors in type 2 diabetes mellitus (T2DM) patients.
MATERIALS AND METHODS
A total of 337 T2DM subjects were included in our study. The metabolic risk factors including diabetes duration, fast plasma glucose (FPG), height, weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), estimated average glucose (eAG), glycated hemoglobin (HbA1c), total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-c), low-density lipoprotein-cholesterol (LDL-c), triglyceride (TG), blood urea nitrogen (BUN), serum creatinine (Scr), free fatty acid (FFA), uric acid (UA), cystatin c (cysc), albumin (Alb), urinary albumin creatinine ratio (UACR) were recorded. The obesity indicators included body surface area (BSA), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), -perirenal fat thickness (PRFT), total abdominal fat (TAF), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT). The association between obesity indicators and metabolic risk factors was investigated by univariate and multivariate analysis.
RESULTS
HDL-c was independently associated with WHR and PRFT (β = -0.126 vs. -0.214, both p < 0.05). TG and Scr were both independently associated with PRFT (β = 0.173 vs. 0.218, both p < 0.01, respectively). UA was independently associated with BSA (β = 0.172, p < 0.01) and PRFT (β = 0.151, p < 0.01). cysc, Alb and UACR were independently associated with WC (β = 0.274 vs. 0.204 vs. 0.182, all p < 0.01).
CONCLUSION
In T2DM patients, obesity indicators were significantly associated with metabolic risk factors.
PubMed: 37809456
DOI: 10.1016/j.heliyon.2023.e20013