Journal of Nephrology & Therapeutics

Objective: To compare the overall survival (OS) between radical nephrectomy (RN) and nephron-sparing surgery (NSS) by preoperative estimated glomerular filtration rate (eGFR) and tumor size. Methods: Patients with cT1 renal tumors (N0M0) treated by RN or NSS between 1994 and 2014 were included. OS was compared by the surgical technique using Kaplan- Meier curves for the whole population. Then, subgroup analyses for OS were performed by the presence (< 60 ml/min/1.73 m2) or absence (≥ 60 ml/min/1.73 m2) of preoperative chronic kidney disease (CKD) and by cT1a and cT1b disease status. Multivariate analysis was also performed. Results: 440 patients were included. There was no significant difference in OS by the surgical technique, including in patients with CKD. However, the group without CKD had a significantly better OS than the group with CKD. Moreover, compared with RN, the use of NSS was associated with a significantly better OS for patients without CKD, including those with cT1a tumors. There were no significant differences when OS was compared by the surgical technique in patients with CKD or cT1b tumors. Multivariate analysis showed that preoperative eGFR and tumor size were independent risk factors in the total population and the group without CKD, respectively. Conclusion: We have shown that NSS can be beneficial for patients with preoperative non-CKD and stage cT1a tumors. RN and NSS produce comparable OS in patients with unfavorable preoperative renal function or tumor size. Further investigation is needed with larger populations.

Purpose: We examined retrospectively whether outcomes of radical nephrectomy (RN) and partial nephrectomy (PN) are predictable on the basis of preoperative estimated glomerular filtration rate (eGFR) classifications. Material and methods: The study included 284 patients with renal tumor who underwent RN (n=195) or PN (n=89) at our institution. Preoperative eGFRs were categorized to reflect the stages of chronic kidney disease (CKD). The primary endpoint was postoperative onset of CKD stage 3b (eGFR<45 mL/min/1.73 m2). Also examined were the incidence of postoperative cardiovascular (CV) events, overall survival (OS), and cause-specific survival (CSS). The outcomes of RN and PN were compared per the preoperative eGFR categories. Results: PN was found to prevent postoperative CKD ≥ stage3b when the preoperative eGFR indicated CKD stage 2. The incidence of CV events was significantly low among patients with an eGFR indicative of CKD stage 3a and treated by RN. Regardless of patients’ pre-operative eGFR, there was no significant difference between procedures in OS or CSS. Multivariate analysis showed RN to be an independent risk factor for CKD ≥ stage 3b in patients with a preoperative eGFR indicative of CKD stage 2. Conclusions: In terms of postoperative renal function and CV events, the prognosis is equivalent for PN and RN when preoperative eGFR indicates CKD stage 1. However, PN is advisable when preoperative eGFR indicates CKD stage 2, and RN may be the better option when preoperative eGFR indicates CKD stage 3a. Categorized preoperative eGFR can serve as a reliable criterion for choosing between RN and PN.

The risk of bloodstream infection is thought to be as much as 2-3 times more common in patients dialysing from a central venous catheter than those via a fistula. It is not uncommon practice for some nephrology units to use prophylactic antibiotics in the hope of preventing blood stream infections in many patients already with some degree of immunosuppression. As there is no specific guidance we therefore aim to look at the rates of infections in those who received and did not receive antibiotics and their outcomes to try and produce guidelines in relation to their use. 420 lines inserted were analysed over a course of 2 years, the data was analysed and groups divided into those who received antibiotics and those who had not. Those found to be infected were followed up further by analysis of old medical notes and medication prescription charts to see the action taken following a positive line culture and the outcomes associated. In total 97 (23%) patients didn't receive antibiotics and 323 (77%) did receive prophylactic antibiotics. Positive cultures in the antibiotics and non-antibiotics groups after exclusions of the patient septic prior to line insertion were therefore 9 (2.8%) and 5 (5.2%) respectively. No severe complications from line sepsis occurred in either group and all patients made a full recovery from each group. The risk of developing a catheter related infection leading to a significant event requiring ICU admission or death does not increase regardless of the use of prophylactic antibiotics pre-procedure.

Background: Among the recommendations for the prevention of high cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD) enhanced surveillance, detection and awareness of this condition include; which are mainly targeting populations with increased risk. Yet despite a high prevalence of CKD in these patients, there is limited knowledge of the disease in populations at high cardiovascular risk, especially in developing countries. To determine the awareness of CKD in the population of moderate and high cardiovascular risk. Methods: A prevalence study, multicenter was developed; the sample corresponds to adults over 18 with moderate or high cardiovascular risk (defined as Framingham criteria), treated at the outpatient clinic for health institutions in the city of Cartagena from April 2013 to October 2014. Statistical analysis: descriptive univariate and bivariate analyzes were performed using measures of central tendency and dispersion for continuous variables and proportions for qualitative variables. The association between variables was established by The Chi square test and Fisher's exact test. Results: 653 patients were included, the prevalence of CKD was 34.8% and overall awareness of it was 70.9% and 48.2% by the health system and the patient respectively. There was no association between awareness of CKD both the health system and the patient and the level of cardiovascular risk (p=0.916 and p=0.772). In unconscious patients with CKD have a higher proportion of women compared with patients with CKD awareness (95% CI for the difference, 4.3 to 29.7 66.1% vs 49.1%) was found. There was a significant association between CKD awareness, adherence to lifestyle (p ≤ 0.0001) and medication adherence (p=0.041), was determined that unconscious patients had lower compliance healthy lifestyles (22,9% vs 64.5%; 95% CI for the difference, 29.9 to 53.3) and pharmacological (92.4% vs 98.2%; 95% CI for the difference, 2.7 to 11.3) than patients aware for the disease. Conclusions: This study demonstrates the high prevalence of CKD in patients with moderate and high cardiovascular risk, highlighting the inadequate consciousness we have of it in this population.

Diabetic ketoacidosis (DKA) is typically treated with volume replacement (most commonly normal saline), insulin and monitored via serial chemistry and glucose lab values. Cerebral edema, a complication occurring in approximately 1% of DKA presentations in children, with a mortality of 40-90%, has no clear identifiable risk factors. While many cases have been reported in children, there are only a few cases of clinically significant cerebral edema in adults. It is postulated the underlying mechanism is similar to that in children; excessive fluid resuscitation, rapid reduction in plasma osmolarity, and/or the administration of sodium bicarbonate. We are reporting a case of a 26 year old male with no prior medical history, who presented in diabetic ketoacidosis and was treated as per the American Diabetic Association guidelines, however, deteriorated rapidly after acute complaints of headache and irritability consistent with diffuse cerebral edema.

Hypocomplementemic urticarial vasculitis (HUV) is the rare immune complex vasculitis, affecting small vessels and associated with anti-C1q antibodies, presenting with urticaria and hypocomplementemia. Glomerulonephritis, arthritis, obstructive pulmonary disease, and ocular inflammation are common in HUV. HUV may present as an idiopathic disease or be a part of systemic autoimmune or autoinflammatory condition, like systemic lupus erythematosus, arthritis-hives-angioedema (AHA) syndrome, cryoglobulinemic vasculitis, Schnitzler syndrome, Cogan’s syndrome and Muckle–Wells syndrome. Renal involvement includes proteinuria, sometimes of nephrotic range, hematuria and usually moderately impaired kidney function. Various pathology variants were found in patients with HUV: mesagnial proliferative, membranoproliferative, focal proliferative, membranous, minimal change, crescentic and severe sclerosing proliferative glomerulonephritis. Interstitial nephritis and C1q-associated small vessel vasculopathy are poorly described. Here we present a case of HUV with combined renal damage - crescentic glomerulonephritis, interstitial nephritis and small vessel vasculopathy, successfully treated with immunosuppressant’s, and discuss the differential diagnostics of HUV.

Cadmium is a toxic heavy metal in the contaminated environment which accumulates in different organs of the human and animal. Cd exposure leads to the production of reactive oxygen species present study was performed to evaluate the effect of cadmium on the biochemical criteria (ROS). The related to oxidative stress in kidney, liver and testis of adult male rats and to clarify the protective effect of pre and post treatment with lycopene on these criteria. The results showed that cadmium treatment caused significant elevations in liver and kidney weights, serum creatinine, urea, uric acid, aspartate aminotransferse (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamaglutamyltransferase (GGT), and lactate dehydrogenase (LDH) with significant reductions in weights of testes, epididymis, seminal vesicles and prostate, serum total protein and plasma testosterone. It also markedly increased lipid peroxidation and cadmium concentration in kidney, liver and testis tissues, while significantly decreased superoxide dismutase (SOD), catalase (CAT) activities and reduced glutathione in the tissues of the three organs. Cadmium intoxicated rats showed also considerable increase in the percentages of dead sperms and abnormal sperm rate, while marked decrease in sperm concentration and sperm motility as compared to the control group. Pre-supplementation with lycopene prevented degenerative changes induced by cadmium, reduced oxidative stress and restored the biochemical changes occurring in kidney, liver and testis tissues to near normal group (control). In addition pretreatment with lycopene was more effective than post- treatment in reversing almost all hepatorenal and testicular parameters.