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Frontiers in Pediatrics 2020The crucial point for prompt diagnostics, ideal therapeutic approach, and follow-up of hydronephrosis associated with UPJ anomalies in children is the severity of... (Review)
Review
The crucial point for prompt diagnostics, ideal therapeutic approach, and follow-up of hydronephrosis associated with UPJ anomalies in children is the severity of hydronephrosis. Such many hydronephrosis grading systems as AP diameter, SFU, radiology, UTD, and Onen have been developed to evaluate hydronephrosis severity in infants. Unfortunately, it is still an ongoing challenge and there is no consensus between different disciplines. AP diameter is a very dynamic parameter and is affected by many factors (hydration, bladder filling, position, respiration). More importantly, its measurement is very variable and misleading due to different renal pelvic configurations. The radiology grading system has the same grades 1, 2, and 3 as the SFU grading system with addition of the AP diameter for the first 3 grades. This grading system divides parenchymal loss into two different grades. Grade 4 represents mild parenchymal loss while grade 5 suggests severe parenchymal loss. However, it is operator dependent, is not decisive, and does not differentiate grades 4 and 5 clearly. All grades of SFU are very variable between operators and clinicians. UTD classification aims to put all significant abnormal urinary findings together including the kidney, ureter, and bladder and thus determines the risk level for infants with any urinary disease. Different renal deterioration risks occur depending on the mechanism of hydronephrosis. Therefore, SFU and UTD classification may result in significant confusion and misleading in determining the severity of hydronephrosis. SFU-4 and UTD-P3 represent a considerable range of severity of hydronephrosis. Both represent minimal thinning of the medullary parenchyma and severe thinning of the cortical parenchyma (cyst-like hydronephrotic kidneys) at the same grade. The wide definition of SFU-4 and UTD-P3 fails to indicate accurately the severity of hydronephrosis and thus significantly misleads from a prompt treatment. They do not suggest who need surgical treatment and who can safely be followed non-operatively. The anatomy and physiology of the 4 suborgans of the kidney (renal pelvis, calices, medulla, and cortex) are completely different from each other. Therefore, each part of the kidney affect and behave differently as a response to UPJ-type hydronephrosis (UPJHN) depending on the severity of hydronephrosis. The upgraded Onen hydronephrosis grading system has been developed based on this basic evidence both for prenatal and post-natal periods. The Onen grading system determines specific detailed findings of significant renal damage, which clearly show and suggest who can safely be followed conservatively from who will need surgical intervention for UPJHN. Neither AP diameter nor radiology, SFU, or UTD classification is the gold standard in determining the severity of hydronephrosis. All these grading systems are based on subjective parameters and are affected by many factors. They do not determine the exact severity of UPJHN and thus cause permanent renal damage due to a delay in surgical decision in some infants while they may cause an unnecessary surgery in others. The Onen grading system has resolved all disadvantages of other grading systems and promises a safer follow-up and a prompt treatment for UPJHN. It is an accurate and easily reproducible grading that has high sensitivity and specificity.
PubMed: 32984198
DOI: 10.3389/fped.2020.00458 -
Clinical Case Reports Feb 2018Emphysematous pyelonephritis is a gas-producing, necrotizing infection involving the renal parenchyma and surrounding tissue that is associated with high mortality and...
Emphysematous pyelonephritis is a gas-producing, necrotizing infection involving the renal parenchyma and surrounding tissue that is associated with high mortality and morbidity. Common causative organisms include and . While most patients are being managed conservatively these days, nephrectomy may be needed in severe cases.
PubMed: 29445494
DOI: 10.1002/ccr3.1364 -
Kidney360 Apr 2021CKD represents the ninth most common cause of death in the United States but, despite this large health burden, treatment options for affected patients remain limited.... (Review)
Review
CKD represents the ninth most common cause of death in the United States but, despite this large health burden, treatment options for affected patients remain limited. To remedy this, several relevant pathways have been identified that may lead to novel therapeutic options. Among them, altered renal lipid metabolism, first described in 1982, has been recognized as a common pathway in clinical and experimental CKD of both metabolic and nonmetabolic origin. This observation has led many researchers to investigate the cause of this renal parenchyma lipid accumulation and its downstream effect on renal structure and function. Among key cellular components of the kidney parenchyma, podocytes are terminally differentiated cells that cannot be easily replaced when lost. Clinical and experimental evidence supports a role of reduced podocyte number in the progression of CKD. Given the importance of the podocytes in the maintenance of the glomerular filtration barrier and the accumulation of TG and cholesterol-rich lipid droplets in the podocyte and glomerulus in kidney diseases that cause CKD, understanding the upstream cause and downstream consequences of lipid accumulation in podocytes may lead to novel therapeutic opportunities. In this review, we hope to consolidate our understanding of the causes and consequences of dysregulated renal lipid metabolism in CKD development and progression, with a major focus on podocytes.
Topics: Humans; Kidney; Kidney Glomerulus; Lipid Metabolism; Podocytes; Renal Insufficiency, Chronic
PubMed: 35373048
DOI: 10.34067/KID.0006152020 -
BJR Case Reports Apr 2021We present a case of 6-year-old female with history of respiratory distress who went into respiratory failure requiring intubation. Patient was subsequently found to be...
We present a case of 6-year-old female with history of respiratory distress who went into respiratory failure requiring intubation. Patient was subsequently found to be in hypertensive crisis with hyponatremic hypochloremic metabolic acidosis and acute kidney injury. Renal ultrasound was performed to find the cause of hypertension. The ultrasound study demonstrated lobulated isoechoic to hyper echoic mass-like lesion in the middle and lower pole of the right kidney with increased vascularity on Color Doppler examination. The renal mass was finally diagnosed as a pseudotumour, representing hypertrophied portion of the spared normal renal parenchyma in otherwise atrophic right kidney. Diagnosis was made using a combination of US, MRI, DMSA and CT angiography thus avoiding unnecessary surgical intervention.
PubMed: 33841898
DOI: 10.1259/bjrcr.20200088