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Nephrology, including fluid and electrolytes
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
10.8. Which of the following statements is/are true of vesicoureteric reflux?Young siblings of children with vesicoureteric reflux should be screened.Incidence increases with increasing age.A normal renal ultrasound appearance in a child of 2 years rules out the possibility of vesicoureteric reflux.Renal ultrasonography is the most sensitive imaging modality in the detection of renal scarring (reflux nephropathy).Amoxycillin is an appropriate antibiotic for long-term prophylaxis for urinary infection in children with vesicoureteric reflux.
Diagnostic Approach to Acute Kidney Injury in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Sonali Gupta, Divyansh Bajaj, Sana Idrees, Joseph Mattana
Renal ultrasonography is particularly helpful to rule out the underlying existing structural renal disease and diagnosing obstruction of the urinary collecting system. Loss of corticomedullary differentiation and decreased kidney size are findings suggestive of chronic kidney disease, which can help in cases when the diagnosis of AKI is uncertain, such as in a patient presenting to the hospital with an elevated serum creatinine but without any prior available laboratory testing or any helpful medical history. In cases where ultrasound is not available or if there is concern about potential disease of the retroperitoneum such as tumor, fibrosis, and hemorrhage, then non-contrast computed tomography can be done. Renal Doppler ultrasound and contrast-enhanced ultrasound have recently emerged as potential tools for bedside assessment of renal perfusion and renal microcirculation, respectively, and for predicting the reversibility of AKI, especially in the critical care setting [35,36]. Beyond being a convenient bedside tool to assess renal perfusion, it offers the advantage of providing noninvasive real-time imaging with the ability to perform dynamic and repeated assessment. It can detect early renal insults and help distinguish transient from persistent AKI as well as the impact of vasopressors and fluid challenges on renal perfusion. However, Doppler-based resistive index (RI) needs to be interpreted carefully, taking into account patient age, pre-existing subclinical vascular stiffness, and intra-abdominal pressure [37].
Birt–Hogg–Dubé Syndrome
Published in Dongyou Liu, Handbook of Tumor Syndromes, 2020
Marianne Geilswijk, Mette Sommerlund, Mia Gebauer Madsen, Anne-Bine Skytte, Elisabeth Bendstrup
As BHD-associated RCC has been described in young age, at-risk individuals are recommended genetic testing in the beginning of their 20s [32,57]. All BHD-affected individuals should have an abdominal imaging at least every 36 months [55,94]. Generally, MRI is preferred as the screening tool for long-term surveillance. Renal ultrasonography is investigator-dependent and might not detect small tumors. CT with intravenous contrast is a sensitive and informative imaging but should be saved for special situations (e.g., CT-guided cryotherapy) to reduce the exposure of radiation to the patient [55]. An individual surveillance program should be followed after the identification of a renal tumor, depending on the size and histology of the tumor as well as the age and comorbidities of the patient.
Increase in serum creatinine levels after PARP inhibitor treatment
Published in Journal of Obstetrics and Gynaecology, 2023
Di You, Lan Zhong, Rutie Yin, Liang Song
After fully informed communication, the patient selected olaparib for maintenance therapy. Hence, oral maintenance therapy with olaparib was commenced at a dose of 300 mg bid. Renal function was measured regularly, and serum creatinine levels were observed to increase progressively. Renal ultrasonography revealed that there was no post-renal obstruction or nephropathy. However, the patient was worried about a further increase in creatinine levels and irreversible damage to renal function; hence, we suggested that the patient discontinue the drug and visit a nephrologist. Olaparib was discontinued on the 42nd day of administration, and the serum creatinine decreased afterward (Figure 1). The nephrologist recommended a glomerular filtration rate (GFR) scan to evaluate renal function further. Unfortunately, the patient refused to undergo the test after understanding the test method. After the creatinine levels decreased, the patient was advised to recommence olaparib, reduce the dose to 150 mg bid, and monitor creatinine levels dynamically.
Urinary undiversion by conversion of the incontinent ileovesicostomy to augmentation ileocystoplasty in spinal cord injured patients
Published in The Journal of Spinal Cord Medicine, 2022
Patrick J. Shenot, Seth Teplitsky, Andrew Margules, Aaron Miller, Akhil K. Das
Follow-up video urodynamic evaluation six months after undiversion revealed low-pressure storage of urine with no demonstrable overactivity.(Table 1). There was no vesicoureteric reflux in any subject (Figure 3). All three patients, including the female with a prior obstructing pubovaginal sling, achieved complete continence without any use of pads or diapers. Serum creatinine remained stable from prior to undiversion was 0.63 mg/dL (range 0.54–0.72 mg/dL). Median serum creatinine at last follow-up (mean 6.9 years) was 0.53 mg/dL (range 0.40–0.64 mg/dL). None of these patients had stones, cortical renal atrophy, or hydronephrosis at baseline prior to undiversion and all have stable upper urinary tracts on renal ultrasonography, with no hydronephrosis, renal stones, or cortical atrophy at last follow-up. All patients are continuing intermittent catheterization, and are completely continent without the use of anticholinergic medications, beta-3 adrenergic agonists, or botulinum toxin use, at a mean of 6.9 years following undiversion.
Prognosis of severe drug-induced acute interstitial nephritis requiring renal replacement therapy
Published in Renal Failure, 2021
Li Huang, Shaoshan Liang, Jianhua Dong, Wenjing Fan, Caihong Zeng, Ti Zhang, Shuiqin Cheng, Yongchun Ge
In this retrospective study, we reviewed the records of patients who underwent native renal biopsy between 2009 and 2019 at the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine. There were 2433 patients with renal biopsy confirmed AIN were screened. All of the patients received renal ultrasonography examination and showed normal or relatively large renal size before biopsy. The inclusion criteria of this study were patients > 14 years of age, with a definitely medication history before AKI onset, received RRT after admission, and had a minimum of 6 months follow-up. The exclusion criteria were patients consistent with autoimmune or malignant diseases, chronic or acute glomerulonephritis, AIN with uveitis syndrome (TINU), already initiated RRT or corticosteroids therapy before admission. Whether the patients received corticosteroids, the dosage and route of steroids administration were decided by the physician. This study was reviewed by the Ethics Committee of Jinling Hospital (2014KLY-001).