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World Journal of Urology Jul 2022To evaluate the decompression of the pelvicalyceal system between urologists and radiologists. (Review)
Review
PURPOSE
To evaluate the decompression of the pelvicalyceal system between urologists and radiologists.
METHODS
A survey was distributed to urologists and to radiologists comparing double-J stent (DJS), percutaneous nephrostomy (PN) and primary ureteroscopy (URS) for three clinical scenarios (1-febrile hydronephrosis; 2-obstruction and persistent pain; 3-obstruction and anuria) before and after reading literature The survey included perception on radiation dose, cost and quality of life (QoL).
RESULTS
Response rate was 40% (366/915). 93% of radiologists believe that DJS offers a better QOL compared to 70.6% of urologists (p = 0.006). 28.4% of urologists consider PN to be more expensive compared to 8.9% of radiologists (p = 0.006). 75% of radiologists believe that radiation exposure is higher with DJS as opposed to 33.9% of urologists. There was not a difference in the decompression preference in the first scenario. After reading the literature, 28.6% of radiologists changed their opinion compared to 5.2% of urologists (p < 0.001). The change favored DJS. In the second scenario, responders preferred equally DJS and they did not change their opinion. In the third scenario, 41% of radiologists chose PN as opposed to 12.6% of urologists (p < 0.001). After reading the literature, 17.9% of radiologists changed their opinion compared to 17.9% of urologists (p < 0.001), in favor of DJS. Although the majority of urologists (63.4%) consistently perform primary URS, only 3, 37 and 21% preferred it for the first, second and third scenarios, respectively.
CONCLUSION
The decision on the type of drainage of a stone-obstructing hydronephrosis should be individualized.
Topics: Decompression; Humans; Hydronephrosis; Nephrostomy, Percutaneous; Quality of Life; Radiologists; Stents; Ureter; Urologists
PubMed: 35286423
DOI: 10.1007/s00345-022-03979-4 -
Renal Failure 2023Peritoneal dialysis-related peritonitis (PDRP) presents a significant challenge for nephrologists. Continuous intraperitoneal cefazolin and ceftazidime are recommended...
OBJECTIVE
Peritoneal dialysis-related peritonitis (PDRP) presents a significant challenge for nephrologists. Continuous intraperitoneal cefazolin and ceftazidime are recommended for the treatment of peritonitis. However, some pharmacokinetic studies have shown that doses of 15-20 mg/kg/d may not achieve sufficient therapeutic levels. In this study, we investigated the pharmacokinetics of ceftazidime and cefazolin in patients with continuous ambulatory peritoneal dialysis-related peritonitis and compared the pharmacokinetic characteristics between traditional and modified treatment groups.
METHODS
From February 2017 to December 2019, 42 PDRP patients (17 males, 25 females; mean age: 50.7 ± 12.1 years; mean body weight: 60.9 ± 11.8 kg) were recruited for the study, all participants were anuric. Twenty patients were enrolled in the traditional group and treated with cefazolin (1.0 g) and ceftazidime (1.0 g) intraperitoneal administration once daily for 14 days. Twenty-two patients were enrolled in the modified group and received the same dose of antibiotics twice daily for the initial five days, followed by once daily for the subsequent nine days. Serum and dialysate samples were collected after days 1, 2, 3, 5, 7, 10, and 14 and analyzed liquid chromatography-mass spectrometry.
RESULTS
In the traditional group, the highest and lowest serum concentrations of ceftazidime were 35.9 and 21.7 µg/mL, respectively. The highest concentration of cefazolin was 54.6 µg/mL on day 5 and the lowest concentration was 30.4 µg/mL on day 1. In the modified group, the highest and lowest serum concentrations of ceftazidime were 102.2 and 54.8 µg/mL, respectively. The highest concentration of cefazolin was 141.7 µg/mL and the lowest concentration was 79.8 µg/mL. All antibiotic concentrations were above the minimum inhibitory concentration (MIC) level (8 µg/mL of ceftazidime and 2 µg/mL of cefazolin) throughout the treatment period. However, on day 1, the concentration of ceftazidime in the third bag of dialysate effluent from the traditional group fell below the MIC level. Despite remaining above the MIC, cefazolin concentration was consistently lower in the third bag of dialysate effluent from the traditional group throughout the treatment period.
CONCLUSIONS
Intraperitoneal administration of cefazolin and ceftazidime at a dose of 1 g twice daily for 5 days and then once daily for the rest of the treatment period ensured adequate therapeutic levels of antibiotics for treating anuric PDRP patients.
Topics: Male; Female; Humans; Adult; Middle Aged; Cefazolin; Ceftazidime; Peritoneal Dialysis, Continuous Ambulatory; Prospective Studies; Anti-Bacterial Agents; Peritonitis; Dialysis Solutions; Anuria
PubMed: 38044852
DOI: 10.1080/0886022X.2023.2285873 -
The National Medical Journal of India 2019Retrograde pyelography (RGP) is done to evaluate the collecting system when intravenous contrast studies are contraindicated due to renal insufficiency or prior adverse...
Retrograde pyelography (RGP) is done to evaluate the collecting system when intravenous contrast studies are contraindicated due to renal insufficiency or prior adverse reactions. We report a patient who developed acute renal shutdown following bilateral RGP in the same sitting done for evaluation of positive malignant cytology of urine. A 65-year-old man on treatment for left stroke and hypertension, with a baseline serum creatinine of 1.9 mg/dl presented with painless haematuria for 2 months. Plain computed tomogram revealed a small papillary growth on the posterior wall of the urinary bladder. Transurethral resection revealed inflammatory atypia. As the patient continued to have haematuria, he was taken up for bilateral ureteric washings for cytology and bilateral RGP. A 5-Fr universal ureteral catheter was used to cannulate the ureters, urine was aspirated for cytology and 6 ml of 76% meglumine diatrizoate (1:2) was injected, and sufficient opacification with no abnormality or pyelosinus/venous or lymphatic reflux was noted. In the immediate postoperative period, he developed anuria and the serum creatinine rose to 3.6 mg/dl on postoperative day 1 and to 7.5 mg/dl on day 5. He needed three sessions of haemodialysis. Ultrasonography showed no hydroureteronephrosis. Urine output improved and his serum creatinine stabilized at the preoperative level of 1.8 mg/dl. The patient is doing well with stable renal function at 12 months. Although RGP is useful, it needs to be done with caution if a bilateral procedure is contemplated. This entity is seldom reported, and routine double-J stenting following unilateral/bilateral RGP also needs evaluation.
Topics: Aged; Anuria; Humans; Kidney; Male; Renal Dialysis; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography; Ureter; Ureteral Obstruction; Urinary Bladder Neoplasms; Urography
PubMed: 31823934
DOI: 10.4103/0970-258X.272110 -
The Yale Journal of Biology and Medicine 1984This article will provide a pathophysiologic basis for the assessment of critically ill children who have developed disorders of urine volume. The anatomical and... (Review)
Review
This article will provide a pathophysiologic basis for the assessment of critically ill children who have developed disorders of urine volume. The anatomical and pathophysiologic causes of oliguria and polyuria are considered. The physiologic basis for the use of urinary sodium and osmolarity as a guide to the assessment of patients with disorders of urine volume are discussed in detail. In addition, guidelines for the management of children with acute renal failure, with particular emphasis on the consideration for nutritional support of these patients, is discussed as a part of the comprehensive approach to this problem. This article emphasizes an understanding of the pathophysiology of salt and water excretion by the kidney as a foundation to the diagnosis and management of patients with oliguria and polyuria.
Topics: Acute Kidney Injury; Anuria; Child; Child, Preschool; Critical Care; Humans; Hypertension; Infant; Infant, Newborn; Kidney; Nutritional Physiological Phenomena; Oliguria; Polyuria; Vasopressins; Water-Electrolyte Imbalance
PubMed: 6375163
DOI: No ID Found -
The Indian Medical Gazette Mar 1946
Topics: Anuria; Body Fluids; Sulfanilamide; Sulfanilamides; Sulfonamides; Urine
PubMed: 21064833
DOI: No ID Found -
Hinyokika Kiyo. Acta Urologica Japonica Aug 1983Palliative ureteral stent placement is effective in relieving obstructive renal impairment, especially that precedent to malignant spreading, and can take the place of...
Palliative ureteral stent placement is effective in relieving obstructive renal impairment, especially that precedent to malignant spreading, and can take the place of surgical intervention. Furthermore, cutaneous antegrade and/or endoscopic retrograde stenting can be indicated for other pyelo-ureteric operations and prevent their complications, but is has its consequences: We experienced three cases in which stenting had to be repeated because of its obstruction. The stent catheter blockage is discussed.
Topics: Adult; Aged; Anuria; Catheters, Indwelling; Cystitis; Female; Humans; Hyperemia; Male; Middle Aged; Ureteral Obstruction; Urinary Catheterization
PubMed: 6675443
DOI: No ID Found -
Glasgow Medical Journal Mar 1937
PubMed: 30438806
DOI: No ID Found -
Hong Kong Medical Journal = Xianggang... Jun 2015We report here a case of complication of peritoneal implantation of ureter in cadaveric renal transplant. The patient presented with anuria and delayed graft function.... (Review)
Review
We report here a case of complication of peritoneal implantation of ureter in cadaveric renal transplant. The patient presented with anuria and delayed graft function. The diagnosis was suspected upon physical examination and radiological investigation. The complication was managed with reimplantation of the ureter into the bladder and the patient recovered with good graft function. We discuss this case, review the literature on this rare complication, and share our suggestions on how it can be prevented.
Topics: Adult; Anastomosis, Surgical; Anuria; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Nephritis, Hereditary; Peritoneum; Reoperation; Replantation; Ureter; Urinary Bladder
PubMed: 26045069
DOI: 10.12809/hkmj134171 -
Urolithiasis Dec 2022To compare the role of primary and deferred ureteroscopy (URS) in the management of obstructive anuria secondary to ureteric urolithiasis in pediatric patients. This... (Randomized Controlled Trial)
Randomized Controlled Trial
To compare the role of primary and deferred ureteroscopy (URS) in the management of obstructive anuria secondary to ureteric urolithiasis in pediatric patients. This prospective randomized study included 120 children aged ≤ 12 years who presented with obstructive anuria secondary to ureteric urolithiasis between March 2019 and January 2021. The children were subdivided into group A, which included children who had undergone primary URS without pre-stenting, and group B, which included children who had undergone URS after ureteric stenting. All children were clinically compensated and sepsis-free. Patients with underlying urological structural abnormalities were excluded. The operative time, improvement of renal functions, stone-free rate, and complications were compared between the two groups. At the 1-month follow-up, urine analysis; kidney, ureter, and bladder radiography; and ultrasonography were performed. The patient characteristics of both groups did not show any significant difference. Primary URS had failed in ten children (16.6%) in group A. Moreover, failure of stenting was noted in six patients (11%) in group B. The mean operative time for group B was significantly lower than that for group A (p ≤ 0.001). The stone-free rate was significantly higher in group B (p ≤ 0.001). The rate of overall complications was higher in group A. Deferred URS is preferable over primary URS in the management of obstructive anuria secondary to ureteric urolithiasis". In children because of the lower need for ureteric dilatation, higher stone- free rate, shorter procedure time, and lower complication rate.
Topics: Humans; Child; Ureteroscopy; Ureter; Anuria; Prospective Studies; Urolithiasis
PubMed: 36459265
DOI: 10.1007/s00240-022-01389-0 -
Critical Care (London, England) Nov 2017The decision to initiate renal replacement therapy (RRT) and the optimal timing for commencement is a difficult decision faced by clinicians when treating acute kidney...
The decision to initiate renal replacement therapy (RRT) and the optimal timing for commencement is a difficult decision faced by clinicians when treating acute kidney injury (AKI) in the intensive care setting. Without clinically significant ureamic symptoms or emergent indications (electrolyte abnormalities, volume overload) the timing of RRT initiation remains contentious and inconsistent across health providers. Current trends of initiating RRT in the ICU are often based on isolated blood urea levels without clear guidelines demonstrating an upper limit for treatment. Although the appropriate upper limit remains unclear, it is reasonable to conclude that a blood urea level less than 40 mmol/L is not in itself an indication for RRT, especially in the absence of supporting evidence of kidney impairment (anuria, elevated serum creatinine), presenting a welcome reminder to treat the patient and not a number.
Topics: Acute Kidney Injury; Humans; Intensive Care Units; Renal Replacement Therapy; Time Factors; Urea; Uremia
PubMed: 29132411
DOI: 10.1186/s13054-017-1868-x