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Register a new userRenal Transplantation in Patients with Lower Urinary Tract Abnormality
غرس الكلية عند مرضى تشوهات السبيل البولي السفلي
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Damascus University ورقة بحثية
Publication date
2009
fields
Medicine
and research's language is
العربية
Authors
سمير العنزاوي( باحث )
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Shamra Editor
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خلفية البحث: يعد مرضى القصور الكلوي النِّهائِي (End stage renal disease) ESRD و المصابون بتشوهات في السبيل البولي السفلي (Lower urinary tract LUTA) (abnormality ) من ذوي الخطورة العالية في غرس الكلية. المرضى و الطرائق: أجريت دراسة تحليلية ل 17 حالة قصور كلوي نهائي كانت مصابة بتشوهات في السبيل البولي السفلي، و ذلك في مستشفى المواساة الجامعي بين أيار - 2003 أيار 2009 من أجل تقييم درجة الخطورة. و بعد إجراء تقييم دقيق من الناحية البولية، أجري للمرضى نوعان من عمليات التحويل (Urinary ،diversion) البولي إما تحويل بولي غير مستمسك على الجلد (Bricker) عند مريضين، أو تحويل بولي مستمسك على الجلد مع تكبير مثانة عند 14 مريضاً، و تم ذلك قبل إجراء عمليات غرس الكلية. النتائج: بلغت نسبة بقيا المرضى و الكلية المغروسة خلال مدة الدراسة 84.62% و 100 %على التتالي. و لم يكن لزرع حالب الكلية المغروسة على عروة معوية معزولة أي تأثير سلبي في بقيا الكلية المغروسة. المضاعفة الأكثر شيوعاً هي الخمج البولي المتكرر(> 6 مرات/سنة) الذي حدث عند المرضى جميعاً في دراستنا، و لم ينتج عنه أي خسارة للكلية المغروسة، و إنما حدثت وفاة مريضين بسبب إنتانات جهازية، و كانت وظيفة الكلية المغروسة لديهما جيدة. الخلاصة: نستنتج من ذلك بأن خيار غرس الكلية لدى المرضى المصابين بتشوهات بولية سفلية (LUTA) و المجرى لهم عملية تحويل بولي قبل إجراء عملية غرس الكلية هو اختيار مرضٍٍ و آمن، و لكن من المهم إجراء تقييم مفصل و دقيق للجهاز البولي السفلي قبل عملية الغرس.
Back pound: Patients with end stage renal disease (ESRD) and lower urinary tract anomalies (LUTA) are often considered high risk for renal transplantation. Methods and subjects: To evaluate the degree of risk, we have reviewed our experience of 17 patients with (ESRD) and (LUTA). The study was carried out in Almoussat university hospital, between 5/ 2003 and 5/2009. After a detailed urological assessment, the patients had been undergone either non-continent cutaneous diversion (Bricker) (Two patients) or continent cutaneous diversion with bladder augmentation (14 patients), before renal transplantation. Results: The patient and graft survival rates were 84.62% and 100%, respectively. The presence of an ileal conduit did not adversely affect graft survival. And the commonest complication was persistent urinary tract infection, which occurred in all patients (100%), but didn’t cause any graft loss. However two patients died because of systemic infections and their graft function was good. Conclusion: Renal transplantation is a satisfactory option for patients with ESRD due to LUTA, but it is important to carry out detailed urological assessment prior to the transplant procedure.
References used
Ewatt DH, Allen TD. Urinary tract reconstruction in children undergoing renal transplantation. Adv Ren Replace Ther 1996; 3: 69-76
Cairns HS, Leaker B, Woodhouse CRJ, et al. Renal transplantation into abnormal lower urinary tract. Lancet 1991; 338: 1376-1379
Hatch DA et al. Fate of renal allografts transplanted in patients with urinary diversion. Transplantation 1993; 56: 838-842
Lien B, Brekke IB, Sodal G, Bentdal OH, Pfeffer P, Jakobsen A. Renal transplantation and intestinal urinary diversion: a 10-year experience. Transplant Proc 1993; 25: 1338-1339
Kelly WD, Merkel FK, Markland C. Ileal urinary diversion in conjuction with renal homotransplantation. Lancet 1966; 1: 222-226
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Early and accurate detection of kidney involvement in primary and secondary glomerulopathy, and therapeutic regimen mayimprove outcomes. Renal biopsy is required for definitive diagnosisof renal disease.
This study investigated whether patients with
proteinuria < 1500 my/24 h without ARF have significant renal disease and should be biopsied. 50 patientsunderwent kidney biopsies during 2011-2013 in Al-Assad University Hospital and Al-Mousah University Hospital in Damascus. Sixteen of them have 24-h urine protein < 1500 mg andnormal kidney function.Female to male ratio was 3:1. Five patients(31.25%) have MN, 3 patients (18.75%) have FSGS, 2 patients (12.5%) have MCD, one case (6.25%) MPGN, and finely 5 patients (31.25%) have LNfrom which there is a case with class I,2 cases with class III(superimposed classV),and a case with IV(superimposed classV), and one case with class V.Out of 8 patients without hematuria at the time of biopsy, 2 (25%) had MN, 2 (25%) had FSGS,one patient(12.5%) MCD, 3 patients(37.5%) had LN.Three patients (18.75%) hadproteinuria <500 mg/24 h, andwere diagnosed with (MN,MCD,MPGN).Our findings showa significant renal involvement(MN-FSGS-MPGN-LN), whichreveals the importanceof conducting biopsyearly and routinely in the patient population.
renal biopsy
proteinuria
(Focal Segmental Glomerulosclerosis (FSGS
(Membranous Nephropathy (MN
(Lupus Nephritis (LN
(Membranoproliferative Glomerulonephritis (MPGN
(Minimal Change Disease (MCD
خزعة الكلية
بيلة بروتينية
تصلب كبي قطعي بؤري
التهاب كبب و كلية غشائي تكاثري
اعتلال كلوي ذئبي
اعتلال كلوي غشائي
الداء قليل التبدلات
المزيد..
Renal diseases are an important medical subject because of their prevalence, so to know frequency of glomerular diseases in Syria and compare it with international studies we studied 261 renal biopsies over a period (1/1/2007–31/12/2012), in Al As
sad Hospital of the University in Damascus, investigated by light microscopy immunofluorescence. One hundred and ten cases (59.8%) were primary glomerulonephritis from 184 cases of glomerular disease focal/segmental glomerulosclerosis FSGS was the most common type of primary glomerulonephritis found (30.9%) of primary glomerulonephritis), followed by membranous nephropathy(MN) in 29.1 % , IgAnephropathy (IgAN) in 10%, then membranoproliferative glomerulonephritis (MPGN) and minimal change disease(MCD) 9.1% and, crescentic glomerulonephritis (CerGN) in 6.4% and finally postinfectious glomerulonephritis (PIGN) 5.5 % of the secondary glomerulonephritis were (74 cases constituting 40.2% of the biopsies) lupus nephritis(LN) was the most frequently diagnosed disease (85.1% of secondary glomerulonephritis) diabetic nephropathy (DN) was found in 8.1% of cases amyloidosis (AMD) in 6.8%.
vascular complications are impotent after kidney Transplantation, They
influence on patient and graft survival . There are a lot of factors that play are a role in incidence of these
vascular compilations as technical and anatomical ones .
the aim
is to determine the incidence of vascular complications in kidney transplant
patients in addition to signs and symptoms related to these complications, diagnosis modalities,
management and results.
Objective:
Evaluate sensitivity and specificity of nitrite test to urine culture(gold standard) for
diagnosing urinary tract infection in patients with sickle cell anemia with urinary
symptoms and signs.
Methods:
The study sample included 79 chi
ldren aged 2 to 14 years with SCA presenting with
fever (temperature >38°C),abdominal pain, urgency, dysuria or increased urinary
frequency who referral to the general pediatric clinic and the children's ambulance
department in Tishreen University Hospital in Lattakia during( 2016-2017).
Midstream urine specimen was collected from children. Samples were subjected to nitrite
test, culture and sensitivity.
Results :
There was significant bacteriuria in 17 (21.5%) children with SCA. A positive test
for nitrite was obtained in 12 of the 17(70.5%) children. The nitrite test has a specificity of
95.2% in detecting bacteriuria, a sensitivity of 70.6%, a positive predictive value of 80%
and a negative predictive value of 92%. A positive nitrite test was significantly associated
with bacteriuria, while a negative test was also significantly associated with an absence of
bacteriuria.
Introduction: Urinary tract infections are very common in childhood (especially under the age of 5 years) and because of the large number of complications resulting from it (renal failure – hypertension- kidney scarring) had to be diagnosed and early
treatment, although that urine culture is the standard Golden diagnosis, but its results are late to appear, Many studies have indicated an accompanying increase in platelet counts in urinary tract infections, so that platelet counts may be a vital indicator directed to it without asylum to the costly analyzes in its diagnosis. Objective: the objective of the following study is to assess the sensitivity and specificity of the plate count (PLT) in UTI. Methods: The study included 65 Patients (14 males, 51females) They were between (3-6) year with upper urine tract infections were diagnosed through symptoms, urological test, Serum tests, and radiology, who were admitted to the pediatric department at Tishreen University Hospital in Lattakia City. PLT was obtained through a complete CBC blood count (sensitivity and sensitization), and comparison of the ratio Percentage of Thrombocytosis between urine culture with Gram-positive germs and Gram-negative germs. Results: The study showed a good sensitivity=80.39% [75–84] to platelet counts compared to urine culture. it also showed statistically significant paper p-value=0.003 between platelet count and type of pathogen (positive or negative Gram) and the increase was more favorable to positive urine culture. Also showed that the average value of platelets is higher in culture a positive gram 521.9±90.9 x103 platelet/mcl than in gram negative 432.3±73.5 x103 platelet/mcl. Conclusion: higher Platelet numbers are a good analysis or sensitivity for the diagnosis of upper urinary tract infection in children with reliable urinary symptoms to start treatment. So that we get the results of culture urine .and the higher platelet count must be taken gram positive bacteria into account.
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