Journal of Renal and Hepatic Disorders
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Comparison of Standard Percutaneous Nephrolithotomy with Mini-Percutaneous Nephrolithotomy for Removal of Renal Stones in Adults
Get PDFRenal stones are the third most common problem affecting about 10% of global population. The management of nephrolithiasis has undergone a complete transformation since the 1980s. Percutaneous nephrolithotomy (PCNL) has established itself an effective and safe technique that delivers high stone-free rate as well as overall shorter treatment time. We aim to compare the outcome of mini-PCNL with standard-PCNL in patients presenting with renal stones. In all, 90 patients fulfilled the selection criteria and randomized into two groups. Group A underwent mini-PCNL whereas Group B underwent standard-PCNL. Pre-operative hemoglobin level was recorded. Duration of procedure as well as drop in hemoglobin level was also recorded. A kidney, ureter, and bladder (KUB) X-ray was performed to confirm the presence of stone and stone-free status. The mean age of patients in mini-PCNL group was 43.11 years and in standard-PCNL group, it was 36.91 years. The mean stone size in patients of mini-PCNL group was 29.53 mm and 31.58 mm in standard-PCNL group. The mean duration of renal stone in mini-PCNL group was 1.91 years and that in standard-PCNL group 1.80 years. The mean operative time in mini-PCNL group was 59.56 min and 61.22 min in standard-PCNL group. The mean fall in hemoglobin in mini-PCNL group was 0.38 g/dL and that in standard-PCNL group 0.51 g/dL. In mini-PCNL group, stone clearance was observed in 42 (93.3%) patients, while in standard-PCNL group, it was observed in 45 (100%) patients. This difference was insignificant (P > 0.05). Mini-PCNL and standard-PCNL have no significant differences in terms of outcome, operative time, and stone clearance, although fall in hemoglobin level was less in mini-PCNL group, which showed less blood loss in this group, thereby making it a more appropriate method for renal stone removal
Metabolic Syndrome in Adults with Nonalcoholic Fatty Liver Disease
Get PDFNonalcoholic fatty liver disease (NAFLD) is associated with insulin resistance, obesity, and other features of metabolic syndrome. It is identified as the most common cause of liver enzyme derangement. Lately, NAFLD has generated interest in exploring treatment options, including weight loss and dietary interventions. An association of NAFLD with metabolic syndrome has been suggested in contemporary literature. In this study, we attempted to look into the association of NAFLD with metabolic syndrome. In this study, 80 adult NAFLD patients were recruited from a tertiary care hospital. Among these, 42 were males and 38 females with a mean age of 44.46±13.146 years (range 18–82 years). Grades of fatty liver and presence or absence of metabolic syndrome were studied in this patient population. Patients who did not qualify for the criteria of metabolic syndrome were placed in Group 1 and those who fulfilled the stated criteria were considered in Group 2. There were 29 (36.25%) patients in Group 1 and 51 (63.75%) in Group 2. All the patients in Group 1 were having Grade I fatty liver whereas patients in Group 2 were found to having varying grades of fatty liver, with six patients having Grade III fatty liver. We found statistically significant difference in various parameters of study (liver enzymes, high-density lipoprotein (HDL), triglycerides, and blood pressure) between Group 1 and Group 2. Ultrasound evidence of a fatty liver should be considered as a predictor of metabolic syndrome, and these patients must be investigated for the different components of metabolic syndrome so as to have early diagnosis and intervention to alter development of long-term metabolic disorders and their inherent complications
Sewing Needle as Foreign Body in Urethra of an Adolescent Boy: Case Report
Get PDFSelf-insertion of a foreign body in the urethra is an uncommon presentation clinically. The cases usually arise due to fulfillment of sexual desire, for recreation, play, or exploration, or the foreign body insertion may take place accidentally. We present a case of an adolescent boy with a foreign body urethra presenting to the emergency room with urinary retention, pain, and dysuria. Attending urologist suspected urethral stricture and ordered ultrasonography to investigate which turned out to be a sewing needle in his urethra. The patient was then enquired about the foreign body. He tried to self-dilate his urethra as he was experiencing lower urinary tract symptoms. The sewing needle was removed by endoscopy and he was administered with antibiotics and painkillers. The urethral foreign bodies may present with pain, dysuria, or urinary incontinence and these foreign bodies are mostly seen in the male population in the adolescent age group
Hepatic Vein and Inferior Vena Cava Reconstruction during Hepatic Surgery Resection for Cancer
Get PDFInvasion of tumor in the liver requires surgical interventions that may reduce the effects or may eliminate the tumor-affected cells. The renewal of the hepatic vein and inferior vena cava has enabled most specialized oncologists and medical specialists to use advanced diagnostic methods in the treatment of the liver tumors. Liver resection has prolonged the lives of many patients and the invention of live donor organ transplants has effectively enabled the use of liver resection in most cancer centers across the world. By reviewing data from 10 articles, 21 surgical analyses were investigated and analyzed for the risks involved in the applications of reconstructions of hepatic vein and inferior vena cava in the surgical liver resection. The postoperative complications and the indications of reconstructions were mentioned. The results indicated that with these surgical procedures, complications are still involved but may be successful for particular patients
Echocardiographic Changes in Patients with End-Stage Renal Disease at Initiation of Dialysis
Get PDFEchocardiography is a simple and established method of evaluating cardiac functions, assessing left ventricle geometry, and systolic and diastolic functions. Patients with chronic kidney disease have a tremendous burden of cardiovascular disease (CVD), and patients with end-stage renal disease (ESRD) are at a greater risk of CVD and deaths. In this study, 245 incident dialysis patients were included, and none of the patient was on erythropoietin. All the patients were aged >18 years. Patients with ESRD, already on maintenance dialysis, were not included in this study. Patient’s data such as demographic details, comorbidities, laboratory values, echocardiographic changes, management, and outcome were recorded. Out of 245 patients, 165 (67.3%) were males and 80 (32.6%) females. The mean age of the patients was 49.7 years. Left ventricular hypertrophy (LVH) was observed in 188 (76.7%), mild left ventricular dysfunction (LVD) in 25.7%, moderate LVD in 23.67%, severe LVD in 8.5%, global hypokinesia in 33.8%, valvular heart disease in 26.5%, regional wall motion abnormality in 4.4%, and pericardial effusion in 1.6% patients. Echocardiographic changes, such as LVD, LVH, and global hypokinesia, were observed in greater number in hypertensive group com-pared to normotensive group (P < 0.05). On regression analysis adjusted for age and gender, we found that hypertension and anemia (<10 g/dL) were associated with LVH. Further, hypertension and anemia (Hb < 10 g/dL) were associated with LVD. Similarly, anemia (Hb < 10 g/dL) was associated with global hypokinesia and valvular heart disease. LVD was associated with death in our study. Echocardiography is a noninvasive diagnostic test which detects early changes in cardiac parameters. All ESRD patients with hyper-tension and anemia at the time of initiation of renal replacement therapy must undergo echocardiography screenin
Gabapentin Toxicity and Role of Dialysis; Case Series and Literature Review
Get PDFGabapentin is frequently used as an analgesic in patients with chronic kidney disease (CKD). It is excreted exclusively through kidney, and therefore impairment in kidney function could lead to gabapentin accumulation and hence toxicity. We present our experience of 3 cases with Gabapentin toxicity who were managed according to the severity of symptoms. Case 1: A 32-year-old male was found lying unconscious after consuming around 12,000 mg of gabapentin and had respiratory depression, rhabdomyolysis, and acute kidney injury (AKI). Patient was managed with supportive care and hemodialysis (HD). Case 2: A 64-year-old male CKD Stage 5 (5D) patient with diabetic neuropathy was started on gabapentin 300 mg daily by his primary care physician 1 week back. Patient started to feel sleepy and developed altered sensorium and myoclonus. Discontinuation of gabapentin and a session of HD led to dramatic improvement in patient’s status. Case 3: A 70-year-old female diabetic patient with CKD Stage 3 and had diabetic neuropathy. Her neuropathic symptoms had improved with gabapentin 300 mg twice daily, but lately patient was feeling sleepy during the day and was confused. Discontinuation of the drug led to improvement in symptoms. Gabapentin is a relatively safe medication, but in certain clinical scenarios, particularly in impaired renal functions, can lead to severe complications. Moreover, it per se can rarely lead to rhabdomyolysis and AKI. Clinical suspicion and timely decontamination are needed, and sometimes dialytic therapy may be needed
Clinicopathological Features of Lupus Nephritis Patients in North-East India; A Single Center Retrospective Observational Study
Get PDFClinicopathological presentation of lupus nephritis (LN) patients varies with different race and ethinicity of the population. Only few studies describe clinicopathological spectrum of LN patients in the Indian population. The aim of this study was to determine the clinicopathological spectrum of LN in the North-East Indian population. This was a retrospective observational study that included patients with LN at a tertiary care center in North-East India from March 2007 to August 2018. Clinical and histopathological data at the time of presentation were collected from hospital records. Renal biopsies were examined by light microscopy and direct immunofluorescence techniques. A total of 340 patients of LN were included in this study. The mean age of presentation was 22.42 ± 4.3 years. The minimum age at presentation was 8 years and 18.8% belonged to the <18 year age group. The present study showed a male:female ratio of 1:8. The majority of patients were of class IV (71.9%). Arthralgia (47.1%) and anemia (60.3%) were the most common presenting symptom and sign, respectively. Immunoglobulin (Ig) G was the most abundant immunoglobulin (positive in 98.47%) and the least positive was IgA (positive in 41.18%). Complement (C) 3 and C1q were positive in all. Full house deposition was found in 59.3% of the biopsies. The rates of hypertension, microscopic hematuria, renal dysfunction, and nephrotic syndrome were 43.5, 59.12, 45.9, and 35.3%, respectively. Patients of LN in the North-East Indian population present at an earlier age with a more severe form of the disease (class IV) at the time of presentation
Orthotopic Liver Transplantation in a Case of Novel YAP1-TFE3 Hepatic Epithelioid Hemangioendothelioma [HEHE]; Case Report and Review of Literature
Get PDFEpithelioid hemangioendothelioma is an extremely rare vascular neoplasm arising in soft-tissues and different visceral organs, with liver being the most commonly involved viscera. Hepatic epithelioid hemangioendothelioma (HEHE) is a malignant tumour with an indolent behaviour and unpredictable clinical course. It has a better prognosis among the malignant tumours of the liver, in spite of being a diffuse multifocal liver disease or metastatic at the time of presentation. HEHE is usually found to be noted in the fifth decade with slight female preponderance. No single treatment strategy has yet been established owing to its variable clinical course, ranging from an indolent tumour with prolonged survival to an aggressive, metastatic disease with a fatal outcome. Here, we present a case of a novel HEHE in a 25-year-old female who was treated successfully with orthotopic living donor liver transplantation and discuss the presentation, histopathology and management of this rare, fatal yet treatable malignant tumour
Ex vivo Resection for Renal Cancer: Indications and Results in Specific Clinical Scenarios
Get PDFTo retrospectively evaluate databases for indications and results of “bench surgery technique” in ex vivo or ex situ renal cancer resection as a lost alternative of savage renal function in renal malignancy or benign large tumors.
We retrospectively evaluated PUBMED databases, including studies from 1980 to 2020. Only very few studies had analyzed “ex vivo [and] ex situ renal resection, extracorporeal renal resection, [and] renal autotransplantation.”
Ex vivo renal resection and autotransplantation is the last chance in patients with renal cancer, but manifests numerous difficulties during and after the surgery. However, we noted that in some patients it provided good control over cancer, prevented long-term dialysis, and avoided renal transplantation, thus giving patients a good quality of life
Clinical Profile and Outcomes of COVID-19 in Renal Transplant Recipients
Get PDFThere is minimal information on coronavirus disease 2019 (COVID-19) in developing countries regarding renal transplant recipients (RTRs). This paper aimed to study the clinical profile, immunosuppressive regimen, treatment, and outcomes in an RTR with COVID-19. This retrospective study was conducted in the nephrology department of Sri Aurobindo Medical College & Postgraduate Institute, Indore (MP), India, from April 1, 2020 to December 15, 2020. We studied 15 patients, of which 13 were treated at our hospital and two were treated in OPD. The median age of transplant recipients was 45 (Interquartile range [IQR]: 26–62) years, the majority being males, and recipients presented at a median of 4 (IQR: 0.3–11) years after transplant. The most common comorbidities included hypertension in 14 (94%) and diabetes 3 (20%) patients. The presenting symptoms at presentation were cough (80%), headache (52%), fever (46%), and breathlessness (26%). Clinical severity as per computerized tomography (CT) severity score ranged from mild (20%), moderate (53%), and severe (27%). Strategies to modify immunosuppressants included discontinuation of antimetabolites without changes in calcineurin inhibitors and steroids (100%). Antiviral therapy (Favipiravir and Remdesivir) was associated with better outcomes and reduced hospital stay. Risk factors for mortality included ABO-incompatibility, severity of disease, high Coronavirus Disease 2019 (COVID-19) Reporting and Data System (CO-RADS) score, allograft dysfunction before COVID-19 infection, acute kidney injury, elevated inflammatory markers, and intensive care unit/ventilator requirement. Overall patient mortality was 13.2%. Risk factor for mortality in COVID-19 positive with RTR appears to be ABO-incompatible transplant, having a previous history of rejection, and patient requiring ventilatory support