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Circulation May 2018The diverse causes of right-sided heart failure (RHF) include, among others, primary cardiomyopathies with right ventricular (RV) involvement, RV ischemia and... (Review)
Review
BACKGROUND AND PURPOSE
The diverse causes of right-sided heart failure (RHF) include, among others, primary cardiomyopathies with right ventricular (RV) involvement, RV ischemia and infarction, volume loading caused by cardiac lesions associated with congenital heart disease and valvular pathologies, and pressure loading resulting from pulmonic stenosis or pulmonary hypertension from a variety of causes, including left-sided heart disease. Progressive RV dysfunction in these disease states is associated with increased morbidity and mortality. The purpose of this scientific statement is to provide guidance on the assessment and management of RHF.
METHODS
The writing group used systematic literature reviews, published translational and clinical studies, clinical practice guidelines, and expert opinion/statements to summarize existing evidence and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science through September 2017. The document is organized and classified according to the American Heart Association to provide specific suggestions, considerations, or reference to contemporary clinical practice recommendations.
RESULTS
Chronic RHF is associated with decreased exercise tolerance, poor functional capacity, decreased cardiac output and progressive end-organ damage (caused by a combination of end-organ venous congestion and underperfusion), and cachexia resulting from poor absorption of nutrients, as well as a systemic proinflammatory state. It is the principal cause of death in patients with pulmonary arterial hypertension. Similarly, acute RHF is associated with hemodynamic instability and is the primary cause of death in patients presenting with massive pulmonary embolism, RV myocardial infarction, and postcardiotomy shock associated with cardiac surgery. Functional assessment of the right side of the heart can be hindered by its complex geometry. Multiple hemodynamic and biochemical markers are associated with worsening RHF and can serve to guide clinical assessment and therapeutic decision making. Pharmacological and mechanical interventions targeting isolated acute and chronic RHF have not been well investigated. Specific therapies promoting stabilization and recovery of RV function are lacking.
CONCLUSIONS
RHF is a complex syndrome including diverse causes, pathways, and pathological processes. In this scientific statement, we review the causes and epidemiology of RV dysfunction and the pathophysiology of acute and chronic RHF and provide guidance for the management of the associated conditions leading to and caused by RHF.
Topics: Biomarkers; Diuretics; Heart Defects, Congenital; Heart Failure; Heart Transplantation; Hemodynamics; Humans; Hypertension, Pulmonary; Kidney; Ventricular Function, Right
PubMed: 29650544
DOI: 10.1161/CIR.0000000000000560 -
International Braz J Urol : Official... 2018Renal ptosis is defined as the renal descent when there is a change from supine to orthostatic position, usually with a change of two vertebral bodies or more than five...
INTRODUCTION
Renal ptosis is defined as the renal descent when there is a change from supine to orthostatic position, usually with a change of two vertebral bodies or more than five cm apart. Although rare, it is one of the causes of chronic flank pain or of upper abdomen. The typical patient of renal ptosis is young, female, thin, with complaint of pain when in an upright position (1, 2).
OBJECTIVE
Demonstrate a robot-assisted nephropexy technique in a young woman diagnosed with symptomatic renal ptosis on the right kidney, confirmed by imaging tests.
MATERIALS AND METHODS
A 29-year-old female patient with a history of chronic right-sided pain and palpable renal mobility on physical examination. The diagnosis of renal ptosis was confirmed by ultrasound imaging, excretory urography (Figure -1), and renal scintigraphy with 99mTc-DTPA (Figure-2). She was submitted to a robotic-assisted right nephropexy with a polypropylene mesh fixing the right kidney to the ipsilateral psoas muscle fascia.
RESULT
We reported a 96-minute surgical time. The patient was discharged in the first postoperative day. At the one-month follow-up, there was an important improvement of the symptoms, with normality renal function and imaging tests describing adequate renal positioning.
CONCLUSIONS
Robotic-assisted nephropexy is feasible and can be an excellent minimally invasive alternative technique for the proposed surgery. We reported a shorter hospital stay and a faster postoperative recovery compared with the opened procedure.
Topics: Adult; Female; Humans; Kidney; Robotic Surgical Procedures; Treatment Outcome; Urologic Surgical Procedures
PubMed: 29211400
DOI: 10.1590/S1677-5538.IBJU.2017.0390 -
Urologia Internationalis 2020Right kidney living donor transplantation is considered more difficult and associated with more complications. The objective was to evaluate donor safety and graft...
INTRODUCTION
Right kidney living donor transplantation is considered more difficult and associated with more complications. The objective was to evaluate donor safety and graft function of right hand-assisted laparoscopic donor nephrectomy (HALDN).
METHODS
A total of 270 consecutive HALDN procedures have been performed in our institution up to April 2017. We retrospectively compared the outcomes of right-sided nephrectomy (R-HALDN) to left-sided nephrectomy (L-HALDN) to evaluate donor safety and graft function of R-HALDN.
RESULTS
Sixty-seven right kidneys were removed for functional asymmetry in favour of left kidney (35/67) or left kidney multiple arteries (28/67). Among the donors, neither conversion to open surgery nor preoperative blood transfusion was necessary. There was no significant difference in operative time, compared to L-HALDN group (170 ± 37 min vs. 171 ± 32 min; p value = 0.182). Warm ischaemia time was significantly longer for R-HALDN (4.0 ± 1.6 min vs. 3.0 ± 1.7 min; p < 0.001). There was no significant difference in terms of post-operative complications and serum Cr levels. Among the recipients, there were no graft venous thrombosis. There was no significant difference in delayed graft function (3 for R-HALDN group and 8 for L-HALDN group; p value = 0.847), serum Cr levels, and graft survival.
CONCLUSION
R-HALDN is a safe procedure for kidney donors, with excellent graft function for the recipients, compared to L-HALDN.
Topics: Adult; Female; Hand-Assisted Laparoscopy; Humans; Kidney; Kidney Transplantation; Living Donors; Male; Middle Aged; Minimally Invasive Surgical Procedures; Nephrectomy; Retrospective Studies; Tissue and Organ Harvesting; Treatment Outcome
PubMed: 32702689
DOI: 10.1159/000509064 -
Acta Veterinaria Scandinavica Jan 2021The ultrasonographic examination technique is a well-established, non-invasive diagnostic tool for diverse conditions in humans and different animal species. The purpose...
BACKGROUND
The ultrasonographic examination technique is a well-established, non-invasive diagnostic tool for diverse conditions in humans and different animal species. The purpose of our study was to describe ultrasonographic localisation, sonographic appearance and dimensions of the kidneys and spleen of clinically healthy llamas and alpacas. Differences between llamas and alpacas and the influence of sex and ages were investigated. Results of this study may aid veterinarians performing ultrasonography in diseased animals and the technique can be used for routine protocol screening.
RESULTS
Ultrasonography was performed in 135 clinically healthy, non-sedated llamas and alpacas. Screening was performed with a 6.6 MHz curve linear transducer with only alcohol as contact medium between the probe and unclipped skin. The kidneys could be imaged from the paralumbar region. The right kidney only was visualized when scanning from the right and the left kidney only from the left. While the left kidney appeared in sagittal view as an oval shape in most llamas and alpacas, in one third of animals the left kidney had a triangular shape. The L-shaped base of the spleen, with its homogeneous, echoic pattern, could be seen craniolateral to the left kidney. Anechoic areas displaying vessels inside the spleen and a thin echoic capsule surrounding the splenic tissue could be differentiated. While sonographic appearances of the examined organs showed no differences between llamas and alpacas, selected dimensions of both of kidney and spleen showed significant differences between species. In terms of age and sex, significant differences in respect of kidney size could be found only in alpacas. Sex seemed to have no influence on kidney and spleen sizes in llamas.
CONCLUSIONS
The present study provides species-specific information on ultrasonographic appearance and reference values for kidney and spleen dimensions of clinically healthy llamas and alpacas. Results show differences in organ sizes between llamas and alpacas and in alpacas of different sex and age. The results of this study can be used as references for veterinarians performing ultrasound examinations in diseased animals.
Topics: Animals; Camelids, New World; Female; Kidney; Male; Reference Values; Species Specificity; Spleen; Ultrasonography
PubMed: 33478520
DOI: 10.1186/s13028-021-00571-5 -
Cells May 2020Chronic kidney disease (CKD) remains a worldwide public health problem associated with serious complications and increased mortality rates. Accumulating evidence... (Review)
Review
Chronic kidney disease (CKD) remains a worldwide public health problem associated with serious complications and increased mortality rates. Accumulating evidence indicates that elevated intracellular levels of reactive oxygen species (ROS) play a major role in the pathogenesis of CKD. Increased intracellular levels of ROS can lead to oxidation of lipids, DNA, and proteins, contributing to cellular damage. On the other hand, ROS are also important secondary messengers in cellular signaling. Consequently, normal kidney cell function relies on the "right" amount of ROS. Mitochondria and NADPH oxidases represent major sources of ROS in the kidney, but renal antioxidant systems, such as superoxide dismutase, catalase, or glutathione peroxidase counterbalance ROS-mediated injury. This review discusses the main sources of ROS and antioxidant systems in the kidney, and redox signaling pathways leading to inflammation and fibrosis, which result in abnormal kidney function and CKD progression. We further discuss the important role of the nuclear factor erythroid 2-related factor 2 (Nrf2) in regulating antioxidant responses, and other mechanisms of redox signaling.
Topics: Animals; Antioxidants; Humans; Kidney; Oxidation-Reduction; Reactive Oxygen Species; Renal Insufficiency, Chronic; Signal Transduction
PubMed: 32481548
DOI: 10.3390/cells9061342 -
Clinical Radiology Jul 2022To report the morphology of maternal kidneys captured on fetal magnetic resonance imaging (MRI) including kidney length, volume, renal pelvis diameter, and...
AIM
To report the morphology of maternal kidneys captured on fetal magnetic resonance imaging (MRI) including kidney length, volume, renal pelvis diameter, and corticomedullary differentiation in pregnancy.
MATERIALS AND METHODS
A retrospective study of maternal kidney morphology captured incidentally on fetal MRI. Women without chronic kidney disease, with a complete view of both kidneys and a singleton pregnancy were included. Kidney length, maximal renal pelvis diameter, kidney volume, and corticomedullary differentiation ratio were measured independently in duplicate. Associations with maternal and pregnancy variables were explored using linear regression.
RESULTS
MRI images from 42 women were performed at 22-32 weeks' gestation. Serum creatinine concentrations are not checked routinely during pregnancy and were available for 15 (36%) women, with a median creatinine of 57 μmol/l (IQR: 50-63 μmol/l). Mean interpolar lengths were 10.9 and 10.4 cm for the left and right kidneys and varied with height. Mean maximal renal pelvis diameters were 9 mm and 12 mm, with upper reference intervals of 17 and 25 mm for the left and right kidneys, respectively. Renal volume in pregnancy was within the non-pregnant reference interval and varied with height and gestation.
CONCLUSIONS
Maternal kidney length and volume in pregnancy are within the normal reference intervals for non-pregnant women. Renal pelvis diameter in pregnancy measured using MRI is substantially higher than described previously by ultrasound, with implications for routine reporting.
Topics: Female; Gestational Age; Humans; Kidney; Magnetic Resonance Imaging; Male; Pregnancy; Retrospective Studies; Ultrasonography; Ultrasonography, Prenatal
PubMed: 35570156
DOI: 10.1016/j.crad.2022.03.019 -
Transplant International : Official... 2022Right-sided living donor kidneys have longer renal arteries and shorter veins that make vascular anastomosis more challenging. We sought to determine whether recipients... (Observational Study)
Observational Study
Right-sided living donor kidneys have longer renal arteries and shorter veins that make vascular anastomosis more challenging. We sought to determine whether recipients of right-sided living donor kidneys have worse outcomes than left-sided kidney recipients. An observational analysis of the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) was undertaken. We used adjusted logistic regression to determine the association between side and delayed graft function (DGF) and time-stratified adjusted cox regression models for graft and patient survivals. Between 2004 and 2018, 4,050 living donor kidney transplants were conducted with 696 (17.2%) using right kidneys. With reference to left kidneys, the adjusted OR (95% CI) for DGF was 2.01 (1.31-3.09) for recipients with right kidneys. Within 30 days, 46 allografts (1.4%) were lost, with major causes of overall graft loss being technical, primary non-function and death. Recipients of right donor kidneys experienced a greater risk of early graft loss (aHR 2.02 [95% CI 1.06-3.86], = 0.03), but not beyond 30 days (aHR 0.97 [95% CI 0.80-1.19], = 0.8]). Technical challenge is the most common cause of early graft loss. The risk of early graft loss among recipients who received right kidneys is doubled compared to those who received left living donor kidneys.
Topics: Graft Rejection; Graft Survival; Humans; Kidney; Kidney Transplantation; Living Donors; Registries; Tissue Donors; Tissue and Organ Harvesting
PubMed: 35444489
DOI: 10.3389/ti.2022.10117 -
American Journal of Transplantation :... Nov 2021
Topics: Humans; Kidney; Tissue and Organ Procurement
PubMed: 34327810
DOI: 10.1111/ajt.16771 -
In Vivo (Athens, Greece) 2022This study performed Tc-MAG renal scintigraphy on rabbit kidneys and evaluated its ability to identify obstructive or non-obstructive kidneys.
BACKGROUND/AIM
This study performed Tc-MAG renal scintigraphy on rabbit kidneys and evaluated its ability to identify obstructive or non-obstructive kidneys.
MATERIALS AND METHODS
Renal function was assessed during a four-week post-obstruction period by obtaining planar images of Tc-MAG activity following an ear vein injection. The individual renal function was evaluated by renal scintigraphy in conjunction with histopathological and morphological examinations.
RESULTS
The renal perfusion of Tc-MAG in the right kidney with a ureteral obstruction decreased with time. The width, height, and cortical thickness of the obstructed right kidney were significantly larger than those of the left kidney. A histopathological examination four weeks after the ureteral obstruction revealed a typical pattern of urinary tract obstruction, including multiple tubules, enlargement of the interstitial area, and cytoplasmic vacuoles.
CONCLUSION
Tc-MAG renal scintigraphy provides the kidney shape and size and can identify potential obstructive and non-obstructive kidneys in rabbits.
Topics: Animals; Kidney; Rabbits; Radioisotope Renography; Radiopharmaceuticals; Technetium Tc 99m Mertiatide; Ureteral Obstruction
PubMed: 34972716
DOI: 10.21873/invivo.12692 -
BMC Nephrology Jul 2020Men have larger kidneys than women, but it is unclear whether gender remains an independent predictor of kidney size (expressed as weight or length) after correction for...
BACKGROUND
Men have larger kidneys than women, but it is unclear whether gender remains an independent predictor of kidney size (expressed as weight or length) after correction for body size. We analysed autopsy data to assess whether relative renal length and weight (e.g. corrected for body weight, height or body surface area (BSA)) are also larger in men. Assuming that kidney size is associated with nephron number, opposite findings could partly explain why women are less prone to the development and progression of chronic kidney disease than men.
METHODS
All forensic autopsies performed between 2009 and 2015 at the local university hospital of Geneva in individuals of European descent aged ≥18 years without a known history of diabetes and/or kidney disease were examined. Individuals with putrefied or severely injured bodies were excluded. Relative renal weight and length were respectively defined as renal weight divided by body weight or BSA and renal length divided by body height or BSA.
RESULTS
A total of 635 autopsies (68.7% men) were included in the analysis. Left kidneys were on average 8 g heavier and 2 mm longer than right kidneys (both: p < 0.05). Absolute renal weight (165 ± 40 vs 122 ± 29 g) and length (12.0 ± 1.3 vs 11.4 ± 1.1 cm) were higher in men. Relative renal weight was also higher in men, but relative renal length was larger in women. In multivariable regression analysis, body height, body weight, the degree of blood congestion or depletion at autopsy and age were determinants of renal weight, whereas arterial hypertension and smoking were not. Percentile curves of renal weight and length according to sex and body height were constructed.
CONCLUSION
Absolute and relative renal weights were both smaller in women. This is in line with recent studies stating that nephron numbers are also lower in women. Relative renal length was longer in women, suggesting that female kidneys have a more elongated shape. In comparison with older autopsy studies, renal weight appears to be stable over time.
Topics: Adult; Aged; Autopsy; Body Height; Body Surface Area; Body Weight; Female; Forensic Pathology; Humans; Kidney; Male; Middle Aged; Organ Size; Reference Values; Sex Characteristics
PubMed: 32689967
DOI: 10.1186/s12882-020-01946-y