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International Journal of Clinical and... 2014IgG4-related disease is a recently established systemic condition. Tubulointerstitial nephritis is the most common renal manifestation. Glomerular lesions, particularly... (Review)
Review
IgG4-related disease is a recently established systemic condition. Tubulointerstitial nephritis is the most common renal manifestation. Glomerular lesions, particularly membranous glomerulonephritis, can develop simultaneously. Some patients present with serological renal dysfunction associated with elevated IgG or IgE levels and hypocomplementemia, while others are incidentally found to have abnormalities in kidneys on imaging. A majority of patients with IgG4-related kidney disease have similar lesions at other anatomical sites, which help us to suspect this condition. Serum IgG4 elevation (>135 mg/dL) is the most, although not entirely, specific marker for the diagnosis. Imaging findings varies from small nodules to bilateral diffuse abnormalities. In addition to the renal parenchyma, the renal pelvis and perirenal adipose tissue can be affected. Histological features include dense lymphoplasmacytic infiltration, storiform or "bird's eye" fibrosis (highlighted by PAM stain), and IgG4-positive plasma cell infiltration (>10 cells/high-power field and IgG4/IgG-positive cell ratio >40%). Immune complex deposition is detectable in the tubular basement membrane by immunofluorescence and/or electron microscopy. Patients usually respond well to corticosteroids, but highly active diseases may require other immunosuppressive therapies. Further investigations will be required to fully understand pathophysiology underlying this emerging condition.
Topics: Autoimmune Diseases; Biomarkers; Biopsy; Glomerulonephritis, Membranous; Humans; Immunoglobulin G; Immunohistochemistry; Immunosuppressive Agents; Kidney; Nephritis, Interstitial; Predictive Value of Tests; Treatment Outcome
PubMed: 25337295
DOI: No ID Found -
Multimedia Manual of Cardiothoracic... Feb 2023The combination of a solitary pelvic kidney and an abdominal aortic aneurysm is extremely rare. We demonstrate a chimney graft implant in a patient with a solitary...
The combination of a solitary pelvic kidney and an abdominal aortic aneurysm is extremely rare. We demonstrate a chimney graft implant in a patient with a solitary pelvic kidney. A 63-year-old man was diagnosed with an abdominal aortic aneurysm found incidentally. Preoperative computed tomography illustrated a fusiform abdominal aortic aneurysm accompanying a solitary ectopic kidney in the pelvis with an aberrant renal artery. A bifurcated endograft was implanted, and a covered stent graft was placed into the renal artery using the chimney technique. Good patency of the chimney graft was documented with early postoperative and first month scans. To the best of our knowledge, this is the first report of the chimney technique used for a solitary pelvic kidney.
Topics: Male; Humans; Middle Aged; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Prosthesis Design; Stents; Aortic Aneurysm, Abdominal; Kidney; Pelvis; Treatment Outcome
PubMed: 36809336
DOI: 10.1510/mmcts.2022.119 -
British Journal of Cancer Nov 1994Eleven survivors of pelvic rhabdomyosarcoma underwent bladder function studies and upper urinary tract evaluation at a mean of 6.6 years after completion of therapy,... (Clinical Trial)
Clinical Trial
Eleven survivors of pelvic rhabdomyosarcoma underwent bladder function studies and upper urinary tract evaluation at a mean of 6.6 years after completion of therapy, which included a conservative, bladder-sparing surgical policy. Primary tumour sites were: bladder base/prostate, 6; bladder dome, 1; vagina, 2; and pelvic side wall, 2. Seven children (five bladder base/prostate, one vagina and one pelvic side wall tumours) had received irradiation to the pelvis with external beam alone, brachytherapy or both. All seven of these patients had markedly reduced functional bladder capacity (11-48% of mean expected value for age) and abnormal voiding patterns, though bladder compliance was not reduced and bladder emptying was almost complete in five cases. Four of these children also had upper tract dilatation and two required reconstructive bladder surgery because of severe bilateral hydronephrosis. By contrast, each of four children treated without radiotherapy had a normal functional bladder capacity and a normal voiding pattern. all survivors of pelvic rhabdomyosarcoma, especially those who have received radiotherapy, should be carefully monitored for dysfunction of both lower and upper urinary tracts. The frequency-volume voiding chart is a sensitive and easily accomplished method of assessing bladder function in these patients.
Topics: Child; Child, Preschool; Combined Modality Therapy; Female; Humans; Infant; Kidney; Male; Pelvic Neoplasms; Rhabdomyosarcoma; Time Factors; Urinary Bladder; Urinary Tract; Urinary Tract Physiological Phenomena; Urodynamics
PubMed: 7947075
DOI: 10.1038/bjc.1994.437 -
JSLS : Journal of the Society of... 1997Laparoscopic pyelolithotomy was performed in a pelvic kidney with a large renal pelvis calculus. (Review)
Review
BACKGROUND AND OBJECTIVES
Laparoscopic pyelolithotomy was performed in a pelvic kidney with a large renal pelvis calculus.
METHODS AND RESULTS
Laparoscopic pyelolithotomy was successfully performed in a pelvic kidney with an operative time of 310 minutes. The use of intraoperative fluoroscopy and a semi-automatic suturing device greatly facilitated the procedure. The patient's operative pain was managed with 3 doses of ketorolac; she resumed a regular diet the day after surgery, and was discharged on the first postoperative day.
CONCLUSIONS
For patients with a large stone in the renal pelvis of an ectopic kidney, laparoscopic pyelolithotomy provides an effective approach.
Topics: Female; Follow-Up Studies; Humans; Kidney; Kidney Calculi; Kidney Pelvis; Laparoscopy; Middle Aged; Nephrectomy; Tomography, X-Ray Computed; Treatment Outcome; Urography
PubMed: 9876666
DOI: No ID Found -
Kidney International Feb 1987
Review
Topics: Animals; Body Water; Humans; Kidney Concentrating Ability; Kidney Medulla; Kidney Pelvis; Kidney Tubules, Collecting; Muscle Contraction
PubMed: 3550232
DOI: 10.1038/ki.1987.43 -
Journal of Medical Case Reports Aug 2020Congenital anomalies of the urinary system are very common and have extremely varied presentation. Among them, the most rarely found structural anomaly is the pancake...
BACKGROUND
Congenital anomalies of the urinary system are very common and have extremely varied presentation. Among them, the most rarely found structural anomaly is the pancake kidney. When both kidneys are fused along their medial surfaces to form a round-shaped single renal mass, it is termed as pancake kidney. In this case report, a pancake kidney was incidentally detected in a girl. The majority of individuals who have pancake kidney are usually asymptomatic but surgeons should be aware of coexisting malformation of other organs and its potential risk of developing malignancy.
CASE PRESENTATION
A 12-year-old Bengali girl presented to our out-patient department with mild, dull aching, lower abdominal pain and dysuria. She had no history of fever, hematuria, menstrual abnormality, pelvic inflammatory disease, or trauma. Urine examination showed traces of albumin and 10-12 pus cells/high-power field. She had normal kidney function test but a digital X-ray of her kidney, ureter, and bladder region failed to demonstrate bilateral renal tissue shadows. Ultrasonography of her whole abdomen showed normal intra-abdominal organs except for empty bilateral renal fossa. A multi-detector computed tomography scan of her whole abdomen revealed one round-shaped mass measuring approximately 9 cm (vertical) × 10 cm (horizontal) in the pelvic cavity. That mass was finally identified as a pancake kidney. She was prescribed antibiotics based on urine culture and sensitivity test that cured her symptoms. She was advised to follow-up regularly in our out-patient department to evaluate her kidney function and to rule out any neoplastic change.
CONCLUSIONS
This condition can be managed conservatively, if the individual remains asymptomatic, by regular monitoring of renal function. Surgeons should remain alert for the development of infections, any obstructive manifestations leading to calculus formation, and any malignant changes. The individual should be careful in avoiding trauma to low-lying pelvic kidney. Extensive surgeries should be avoided and only selective procedures should be done so that the patient may lead a normal lifestyle.
Topics: Abdominal Pain; Child; Female; Humans; Kidney; Ultrasonography; Ureter; Urinary Bladder
PubMed: 32792017
DOI: 10.1186/s13256-020-02455-0 -
The Journal of Physiology Aug 2020Platelet-derived growth factor receptor-α (PDGFRα) is a novel biomarker along with smooth myosin heavy chain for the pacemaker cells (previously termed 'atypical'...
KEY POINTS
Platelet-derived growth factor receptor-α (PDGFRα) is a novel biomarker along with smooth myosin heavy chain for the pacemaker cells (previously termed 'atypical' smooth muscle cells) in the murine and cynomolgus monkey pelvis-kidney junction. PDGFRα cells present in adventitial and urothelial layers of murine renal pelvis do not express smooth muscle myosin heavy chain (smMHC) but are in close apposition to nerve fibres. Most c-Kit cells in the renal pelvis are mast cells. Mast cells (CD117 /CD45 ) are more abundant in the proximal renal pelvis and pelvis-kidney junction regions whereas c-Kit interstitial cells (CD117 /CD45 ) are found predominantly in the distal renal pelvis and ureteropelvic junction. PDGFRα cells are distinct from c-Kit interstitial cells. A subset of PDGFRα cells express the Ca -activated Cl channel, anoctamin-1, across the entire renal pelvis. Spontaneous Ca transients were observed in c-Kit interstitial cells, smMHC PDGFRα cells and smMHC PDGFRα cells using mice expressing genetically encoded Ca sensors.
ABSTRACT
Rhythmic contractions of the renal pelvis transport urine from the kidneys into the ureter. Specialized pacemaker cells, termed atypical smooth muscle cells (ASMCs), are thought to drive the peristaltic contractions of typical smooth muscle cells (TSMCs) in the renal pelvis. Interstitial cells (ICs) in close proximity to ASMCs and TSMCs have been described, but the role of these cells is poorly understood. The presence and distributions of platelet-derived growth factor receptor-α (PDGFRα ) ICs in the pelvis-kidney junction (PKJ) and distal renal pelvis were evaluated. We found PDGFRα ICs in the adventitial layers of the pelvis, the muscle layer of the PKJ and the adventitia of the distal pelvis. PDGFRα ICs were distinct from c-Kit ICs in the renal pelvis. c-Kit ICs are a minor population of ICs in murine renal pelvis. The majority of c-Kit cells were mast cells. PDGFRα cells in the PKJ co-expressed smooth muscle myosin heavy chain (smMHC) and several other smooth muscle gene transcripts, indicating these cells are ASMCs, and PDGFRα is a novel biomarker for ASMCs. PDGFRα cells also express Ano1, which encodes a Ca -activated Cl conductance that serves as a primary pacemaker conductance in ICs of the GI tract. Spontaneous Ca transients were observed in c-Kit ICs, smMHC PDGFRα cells and smMHC PDGFRα cells using genetically encoded Ca sensors. A reporter strain of mice with enhanced green fluorescent protein driven by the endogenous promotor for Pdgfra was shown to be a powerful new tool for isolating and characterizing the phenotype and functions of these cells in the renal pelvis.
Topics: Animals; Interstitial Cells of Cajal; Kidney Pelvis; Macaca fascicularis; Mice; Muscle, Smooth; Myocytes, Smooth Muscle
PubMed: 32415739
DOI: 10.1113/JP278888 -
Medicina (Kaunas, Lithuania) Jan 2020: Extended pelvic resection might be the option of choice in patients presenting locally advanced cervical cancer. However, the possibility of a co-existence of an... (Review)
Review
: Extended pelvic resection might be the option of choice in patients presenting locally advanced cervical cancer. However, the possibility of a co-existence of an ectopic, pelvic kidney that is invaded by such a tumor is extremely rare. : A 54-year-old female patient, diagnosed with locally advanced cervical cancer in the presence of a pelvic kidney, was submitted to surgery with curative intent. A large, abscessed cervical tumor invading the urinary bladder and the rectum was found, so a total exenteration was planned. Intraoperatively, tumor invasion of the left kidney, which was found in an ectopic, pelvic position was also encountered; therefore, total pelvic exenteration in association with a left nephrectomy was successfully performed. The presence of an ectopic, pelvic disposition of the kidney makes it susceptible to be invaded by locally advanced pelvic tumors; in such cases, a nephrectomy might also be needed.
Topics: Choristoma; Female; Female Urogenital Diseases; Humans; Kidney; Middle Aged; Neoplasm Invasiveness; Nephrectomy; Pelvic Exenteration; Pelvis; Uterine Cervical Neoplasms
PubMed: 31952297
DOI: 10.3390/medicina56010033 -
Archivio Italiano Di Urologia,... Jun 2020Urolithiasis is one of the most frequent disease in the population and it represents one of the most frequent causes of access to emergency department. In addition.... (Review)
Review
Urolithiasis is one of the most frequent disease in the population and it represents one of the most frequent causes of access to emergency department. In addition. congenital anomalies occur more often in the kidney than in any other organ and the association of both renal abnormalities and stones is of clinical relevance. In this report, we discuss a case of a women with pelvic ectopic kidney affected by a large pyelic stone treated with ESWL (Extracorporeal Shockwave Lithotripsy).
Topics: Female; Humans; Kidney; Kidney Calculi; Lithotripsy; Middle Aged; Pelvis
PubMed: 32597111
DOI: 10.4081/aiua.2020.2.109 -
International Braz J Urol : Official... 2017Ectopic pelvic kidneys with renal stones are challenging to treat. We report our experience in managing a case of ectopic pelvic kidney with a pelvic stone by robotic...
INTRODUCTION AND OBJECTIVES
Ectopic pelvic kidneys with renal stones are challenging to treat. We report our experience in managing a case of ectopic pelvic kidney with a pelvic stone by robotic pyelolithotomy after failure of flexible ureteroscopy.
MATERIALS AND METHODS
A 46-year old male with 2 months history of vague lower abdominal pain was found to have on Computed Tomography scan a left ectopic pelvic kidney with a 12mm stone in an anomalous renal pelvis. Flexible ureteroscopy failed to reach the stone twice and a 4.7 French ureteric stent was placed.
RESULTS
Side docking was utilized with the patient in supine Trendelenburg position. Port placements were similar to robotic assisted laparoscopic prostatectomy. Docking time was 35 minutes and console time was 150 minutes. Multiple attempts failed to follow the course of the ureter to the renal pelvis. Subsequently the renal pelvis was directly opened through the mesocolon and a flexible cystoscope was used to basket the stone out. Estimated Blood Loss was < 100ml. The patient was discharged 2 days postoperatively.
CONCLUSION
Robotic pyelolithotomy is safe and feasible for management of ectopic pelvic kidneys with pelvic stones. The use of flexible cystoscopy helped in localizing and extracting the stone in our case. Detailed understanding of patient's anatomy helps in the success of this procedure.
Topics: Humans; Kidney Calculi; Kidney Pelvis; Laparoscopy; Male; Middle Aged; Patient Positioning; Prostatectomy; Reproducibility of Results; Robotic Surgical Procedures; Treatment Outcome; Urologic Surgical Procedures
PubMed: 27778490
DOI: 10.1590/S1677-5538.IBJU.2016.0059