MR urethrography compared with operative findings for the evaluation of urethral strictures

Usefulness of retroperitoneoscopic renal needle biopsy for patients with contraindications for percutaneous renal biopsy

Efficacy and safety of leflunomide in IgA nephropathy: a systematic review and meta-analysis Abstract Background The optimal therapy for immunoglobulin A nephropathy (IgAN) remains uncertain. Leflunomide (LEF) is an immunosuppressive drug which may reduce deposition of glomerular autoantibodies and immune complexes. Several clinical trials were designed to evaluate the efficacy of LEF, but their results were controversial. Methods Ovid Medline, Embase, the Cochrane Library, PubMed, and CNKI were systematically searched. Search terms included (“glomerulonephritis” OR “nephritis”) AND (“immunoglobulin A” OR “IgA”) AND “leflunomide”. Studies in which patients were diagnosed with IgAN based on renal biopsy were included. Studies needed to report clinical outcomes via either short- or long-term clinical examination, remission rate, or complication rate. Results Forty-four studies encompassing 1802 patients were included, of which 35 were randomized controlled trials. Results of 24 h post-treatment urine protein tests and serum creatinine tests were significantly lower in patients treat with LEF and corticosteroids (CS) or valsartan (ACEI) (CS + LEF or CS + ACEI) compared with patients treated with CS or ACEI alone (P < 0.05). More patients treated with CS + LEF (31.2%) achieved complete remission (CR) than patients treated with CS alone (22.2%) (RR = 0.71, 95% CI 0.59–0.85, P < 0.05). Although there was no significant difference in CR between patients treated with cyclophosphamide and CS (CS + CTX) and those treated with CS + LEF, the complication rate in the former group was higher (28.4%) than in the latter one (11.4%) (RR = 2.46, 95% CI 1.47–4.13, P < 0.005). Conclusion LEF appears to improve renal function while decreasing loss of urine protein. Combination regimens including LEF were better and safer compared with CS or ACEI alone or combinations including CTX.

Intravesical stent position as a predictor of quality of life in patients with indwelling ureteral stent Abstract Purpose The internal drainage provided by a ureteral stent helps with the relief and prevention of ureteral obstruction. By definition, correct stent placement is one with a complete loop in both the renal pelvis and bladder. This prevents stent migration proximally or distally despite urinary flow, patient movement, and ureteral peristalsis. Methods We performed a comparative prospective cross-sectional study assessing the impact of intravesical stent position on the quality of life in 46 patients with a ureteral stent. This is done using the Ureteral Stent Symptom Questionnaire (USSQ). Results 52.5% of patients had an ipsilateral positioned intravesical stent, while the remaining had their stent positioned contralaterally. Intravesical stent position significantly influenced the quality of life. The USSQ score was worse for the contralateral group. Subscore analysis found that urinary symptoms and body pain index contribute significantly to the morbidity. Majority of patients in the ipsilateral group reported no discomfort as compared to the contralateral group. Conclusions To the best of our knowledge, this is the first study assessing the impact of intravesical stent position on the quality of life in the Asian population. Intravesical stent position has a significant influence on patient’s morbidity and quality of life in particular towards their urinary irritative symptoms and body pain. It is imperative to ensure correct distal placement of ureteric stent that does not cross the midline to the contralateral site. We believe that the USSQ should be used in daily clinical practice in assessing the symptoms related to indwelling ureteric stents.

Scintigraphic evaluation of remote pre-conditioning protection against unilateral renal ischemia/reperfusion injury in rats: a longitudinal study Abstract Purpose To determine the role of remote perconditioning (RPeC) on renal function and histology in an animal model of unilateral renal ischemia and reperfusion (IR) injury. Methods Rats were subjected to 60 min unilateral renal ischemia. RPeC protocol was the application of four cycles of 5 min IR of left femoral artery during renal ischemia. Assessments of histological changes and renal function were made 24 h, 1 week, or 3 weeks later. 99mTc-DMSA scan was performed using a small-animals SPECT system. Results 24-h reperfusion decreased the 99mTc-DMSA uptake in the left kidney compared to the intact kidney of control animals. RPeC group has higher uptake compared to the IR group. After 1 week and 3 weeks, uptakes were gradually increased in both groups and no differences were observed. Severe morphological changes in the ischemic kidneys of both groups were observed after 24 h which attenuated after 1 week and 3 weeks. Moreover, no differences in creatinine and BUN levels between IR-treated and intact animals were observed. Conclusion These data suggest that RPeC exerts a partially transient improvement in the renal function in the first day after reperfusion. However, long-term follow-up study showed no beneficial effects of RPeC. Moreover, noninvasive 99mTc-DMSA scan revealed a suitable tool in the follow-up evaluation of recovery process in the unilateral renal IR injury models.

Losartan accelerates the repair process of renal fibrosis in UUO mouse after the surgical recanalization by upregulating the expression of Tregs Abstract Obstructive nephropathy is a common cause for chronic kidney disease. Surgery, which is adopted to promptly relieve the obstruction, is the most important method to save damaged kidneys. However, earlier studies have shown that renal function will continue to deteriorate until the terminal stage after the obstruction’ relief. The aim of this study is to explore the renal fibrosis and investigate the effect of losartan on renal fibrosis after the obstruction’ relief using an improved mouse model of relief for unilateral ureteral obstruction (RUUO). Experiments carried out using C57BL/6 mice (n = 30) were randomly divided into RUUO + Losartan group, RUUO group and sham group. Using an improved mouse RUUO model, this study revealed that the mouse kidney for 3- or 7-day unilateral ureteral obstruction undergoing the RUUO surgery was still in a state of injury and fibrosis, while losartan could effectively ameliorate renal fibrosis by upregulating the expression of CD4 + CD25 + Foxp3 + regulatory T cells (Tregs) in kidney after the surgery of RUUO.

Organ-sparing procedures in GU cancer: part 3-organ-sparing procedures in urothelial cancer of upper tract, bladder and urethra Abstract Purpose The impact of radical surgery for urothelial carcinoma is significant on patient’s quality of life. Organ-sparing surgery (OSS) can provide comparable oncological outcomes and with improved quality of life. In this review, we summarize the indications, techniques and outcomes of OSS for these tumors. Methods PubMed® was searched for relevant articles. Keywords used were: for upper tract urothelial carcinoma (UTUC): endoscopic, ureteroscopic/percutaneous management, laser ablation; for urothelial bladder cancer: bladder preservation, trimodal therapy, muscle invasive bladder cancer (MIBC); for urethral cancer: urethra/penile-sparing, urethral carcinoma. Results Kidney-sparing surgery is an option in patients with low-risk UTUC with better renal function preservation and comparable oncological control to radical nephroureterectomy. In select patients with MIBC, trimodal therapy has better quality of life and comparable oncological control to radical cystectomy. In distal male urethral cancer, penile conserving surgery is feasible and offers acceptable survival outcomes. In female urethral cancer, organ preservation can be achieved, in addition to OSS, through radiation. Conclusions In the appropriately selected patient, OSS in upper tract, bladder and urethral carcinoma has comparable oncological outcomes to radical surgery and with the additional benefit of improved quality of life.

Outcomes of sirolimus regimens in 65-year-old and older kidney transplant recipients: a registry-based observational study Abstract Purpose In large observational studies of adult kidney transplant recipients (KTRs) where older adults (65 years old and older) were not well represented, the mammalian target of rapamycin inhibitors (mTOR inhibitors) has poorer outcomes than the standard tacrolimus–mycophenolate–steroids (TAC–MPA–S) regimen. We conducted this study to compare the outcomes of regimens containing the common mTOR inhibitor, sirolimus (SRL) against TAC–MPA–S in older adult KTRs. Methods Using the 2000–2016 Scientific Registry of Transplant Recipients, Cox multivariable regression models were conducted to analyze the patient and graft outcomes associated with regimens containing SRL, steroids (S) and cyclosporine (CSA), tacrolimus (TAC), or mycophenolate (MPA) vs. the standard (TAC–MPA–S) regimen in older adult KTRs. Results Included in the analysis were 15,008 (95.19%) older adult KTRs on standard (TAC–MPA–S) regimen, 242 (1.53%) on SRL–MPA–S, 300 (1.90%) on SRL–TAC–S, and 217 (1.38%) on SRL–CSA–S. Compared with the standard regimen, the adjusted risks of all-cause death and overall graft loss over a maximum 5-year follow-up were highest with SRL–MPA–S, intermediate with SRL–TAC–S and not significantly different with SRL–CSA–S. The adjusted risks of all-cause death and overall graft loss were modified by a pre-transplant history of malignancy in older adult KTRs on SRL–TAC–S, not in those on SRL–MPA–S or SRL–CSA–S. Conclusions In older adult kidney transplant recipients, SRL–TAC–S or SRL–MPA–S, but not SRL–CSA–S is associated with higher risks of death and allograft loss than standard TAC–MPA–S regimen and a pre-transplant malignancy history worsens these risks in patients on SRL–TAC–S. Confirmation of our findings by a prospective randomized trial is needed before translation into clinical practice can be recommended.

Gender impact on baseline peritoneal transport properties in incident peritoneal dialysis patients Abstract Objective To explore the impact of gender on baseline peritoneal transportation properties and ultrafiltration (UF) ability. Method Patients who started peritoneal dialysis (PD) in our PD center were retrospectively analyzed. Peritoneal transportation characteristics and other UF-associated factors were compared between male and female patients. Stepwise linear regression analysis and propensity score (PS) analysis were used to identify the predictors of peritoneal equilibration test (PET) UF. Results A total of 1052 patients (424 women and 628 men) were included. Compared with male PD patients, females were older (48.4 ± 15.3 vs 46.0 ± 14.6 years), with less total body water (27.6 ± 2.5 vs 36.9 ± 3.8 L), lower body mass index (21.2 ± 3.4 vs 22.0 ± 2.9 kg/m2), lower albumin levels (37.4 ± 5.2 vs 38.0 ± 5.4 g/L), worse renal function [residual glomerular filtration rate: 2.6 (1.2, 3.9) vs 3.2 (1.8, 5.5) mL/min/1.73 m2], lower dialysate-to-plasma ratio of creatinine at 4-h PET (D/PCr; 0.68 ± 0.11 vs 0.72 ± 0.12), higher 4-h effluent glucose level/0-h effluent glucose level of PET (D4/D0; 0.41 ± 0.08 vs 0.38 ± 0.08), better UF ability [PET UF: 320 (200, 400) vs 260 (150, 360) mL], and higher Kt/V (2.66 ± 0.60 vs 2.23 ± 0.66) (all P < 0.05) when starting PD. Stepwise linear regression analysis showed that D4/D0, residual urine output, D/PCr, and gender are independently associated with PET UF. By propensity score analysis, female patients still showed significantly more PET UF than male counterparts even with balanced D/PCr, D4/D0, and residual urine. Conclusion Among the new PD patients, females showed much higher D4/D0, lower D/PCr, and more PET UF than males, with better PET UF being independent of slower solute transportation.

The effect of vitamin K2 supplementation on vascular calcification in haemodialysis patients: a 1-year follow-up randomized trial Abstract Purpose Vascular calcification (VC) is an independent risk factor for cardiovascular disease in hemodialysis patients while Matrix GLA protein (MGP) is one of the most potent inhibitors of VC and its activation is vitamin K dependent. The aim of this study is to investigate the role of oral vitamin K2 supplementation in the prevention of VC progression in haemodialysis patients. Methods We conducted a prospective randomized interventional study in patients on hemodialysis. Patients were randomly assigned to either receiving orally 200 μgr of vitamin K2 (vitamin K2/MK-7, Solgar) every day for 1 year or no treatment. Uncarboxylated MGP (uc-MGP) concentrations were quantified using ELISA at randomization, at 3 and at 12 months. Aortic calcification was evaluated using Agatston score after an abdominal computed tomography scan that was performed at the beginning and at 12 months of follow-up. Results There were 102 patients that were randomized. After 1 year of follow-up, 22 patients from the vitamin K2 group and 30 patients from the control group were included in the analysis. After 3 months of treatment, uc-MGP values remained unchanged in the vitK2 group but after 1 year were reduced by 47% (p = 0.005). Furthermore, uc-MGP at 1 year was increased by 12% in the control group. At 1 year, vitK2 group had significantly lower values of uc-MGP in comparison to controls (p = 0.03). Agatston score was increased significantly both in vitamin K2 and control group at 1 year with no difference between groups. Conclusions Oral administration of vitamin K2 in patients on haemodialysis reduced serum uc-MGP levels but did not have an effect in the progression of aortic calcification.