BackgroundThe poliovirus receptor (PVR) is an emerging therapeutic target currently under clinical investigation in combination with checkpoint inhibitors. Although it is broadly expressed across many malignancies, its prognostic and predictive value in renal and bladder cancers remains underexplored.MethodsQuantitative immunohistochemical analysis of PVR expression was performed in tumor tissue from patients with bladder cancer or renal cell carcinoma, including clear cell and papillary subtypes. Matched serum samples were analyzed using a custom enzyme-linked immunosorbent assay for total circulating PVR. To distinguish isoforms, we generated an antibody specific to the secreted isoform and developed an isoform-selective assay.ResultsSerum PVR levels were elevated in both bladder and renal cancer patients but did not correlate with tumor tissue expression, whether total or isoform-specific. In bladder cancer, tissue levels correlated with tumor grade and lymphovascular invasion. In renal cancer, expression was subtype-dependent, with only a subset of clear cell carcinoma samples showing tissue positivity. Importantly, reduced overall survival in clear cell carcinoma was linked to PVR expression, and rare cases with high levels consistently progressed to metastatic disease.ConclusionIn renal tumors, a preliminary subtype-specific pattern emerged: PVR expression was generally low in clear cell carcinoma but enriched in papillary carcinoma. Notably, in the expanded clear cell cohort all cases with high expression were associated with metastatic progression. These findings highlight PVR in tumor biopsies as a potential prognostic marker in clear cell carcinoma and support its further investigation as a biomarker and therapeutic target in renal cancers.

Background: Chronic kidney disease-mineral and bone disorder contributes to vascular calcification in kidney transplant recipients. However, the relationship between circulating bone turnover markers, Gla-rich protein (GRP), pelvic arterial calcification, and post-transplant outcomes remains uncertain. Methods: In this prospective single-centre study, 79 kidney transplant recipients underwent pre-transplant assessment of serum calcium, phosphate, alkaline phosphatase, parathyroid hormone, osteoprotegerin (OPG), receptor activator of nuclear factor kappa-B ligand (RANKL), and GRP. Pelvic arterial calcification was quantified using a validated CT-based scoring system. Associations between biomarkers, pelvic calcification severity, graft function, graft survival, patient survival, and major adverse cardiovascular events were evaluated. Results: Serum calcium was associated with serum creatinine (p = 0.039), and serum phosphate was associated with MAG-3 clearance (p = 0.009). OPG concentrations were significantly higher in patients receiving haemodialysis than in those receiving peritoneal dialysis (p = 0.021). No significant associations were observed between pelvic arterial calcification severity and circulating OPG, RANKL, or GRP concentrations. Furthermore, in univariable Cox proportional hazards models, none of the investigated biomarkers was significantly associated with graft or patient survival. Conclusions: Circulating OPG, RANKL, and GRP were not associated with pelvic arterial calcification, graft or patient survival. Larger multicentre studies with longer follow-up are warranted to clarify the prognostic value of these biomarkers.

Background: Balkan nephropathy (BEN) is an environmental form of aristolochic acid nephropathy (AAN) strongly associated with upper urinary tract urothelial carcinoma (UTUC). Clinical diagnosis remains challenging, and misclassification is frequent. The study reassessed BEN diagnoses in kidney transplant recipients from rural farming areas who did not undergo prophylactic bilateral nephroureterectomy and evaluated post-transplant outcomes. Methods: In this retrospective single-centre study, we analysed 12 kidney transplant recipients from rural Balkan farming regions. BEN diagnoses were reevaluated according to international consensus criteria. Key endpoints included patient and graft survival, post-transplant clinical course, and UTUC characteristics. Results: Upon reassessment, three of the six patients initially diagnosed with BEN were reclassified as having BEN. Among the remaining six patients, four were reclassified as having sporadic BEN. Overall, only 33% of patients had a diagnosis concordant with their admission records. During a median follow-up of 6.8 years (IQR 2.1-15.8), UTUC developed in seven out of 12 patients. The UTUC cases were predominantly high-grade and multifocal, and they were identified as the leading cause of death. Five-year patient and graft survival rates were 71% and 100%, respectively. Conclusions: BEN is frequently misdiagnosed or misclassified in kidney transplant candidates from rural farming areas. Despite excellent graft survival, the high incidence of post-transplant urothelial carcinoma underscores the necessity of accurate diagnosis and the consideration of prophylactic bilateral nephroureterectomy. Lifelong intensive surveillance is essential not only for patients from established BEN regions but also for individuals from other rural farming areas at risk for sporadic BEN.

Urolitijaza u bolesnika s transplantiranim bubregom nije česta. Njezinu razvojumogu pridonijeti mnogi čimbenici – poput metaboličkih abnormalnosti, imunosupresije ikirurških značajki same transplantacije. Zbog toga što je graft denerviran, nije prisutnaklasična slika renalne kolike, već su simptomi nespecifični. Od slikovnih pretraga najčešće sekoristi ultrazvuk te kompjutorizirana tomografija koja je zlatni dijagnostički standard. Uliječenju se u današnje vrijeme koriste minimalno invazivne metode koje uključuju izvantjelesnomrvljenje kamenaca šoknim valovima, perkutanu nefrolitotripsiju i ureterorenoskopiju.Metodu liječenja odabiremo s obzirom na veličinu, vrstu i položaj kamenca,anatomske specifičnosti bubrega i bolesnika te dostupnu opremu. S iskusnim urološkimtimom uspješnost ovih metoda veoma je visoka, broj komplikacija relativno malen uzzanemariv utjecaj na bubrežnu funkciju.

Cilj: Istovremena pojava primarnog karcinoma debelog crijeva i bubrega izuzetno je rijetka. Cilj je ovog prikaza slučaja naglasiti važnost multidisciplinarnog pristupa i planiranje kirurškog liječenja kompleksnih onkoloških bolesnika. Prikaz slučaja: Sedamdesetosmogodišnjem bolesniku, kojemu je u sklopu obrade anemije učinjena kolonoskopija, a potom i CT kolonografija, dijagnosticiran je stenozirajući proces sigmoidnog kolona te primarni tumor lijevog bubrega. U osobnoj anamnezi bolesnika prisutna je i dijagnoza karcinoma prostate, koji je u trenutku postavljanja novih dijagnoza bio pod kontrolom uz hormonsku terapiju. Nakon multidisciplinarnog konzilija i uz pristanak bolesnika, odlučeno je da se učini sinkroni operativni zahvat – laparoskopska prednja resekcija rektuma i ljevostrana nefrektomija. Poslijeoperacijski tijek protekao je uredno. Patohistološki nalaz potvrdio je adenokarcinom kolona i svjetlostanični karcinom bubrega. Bolesnik je redovito praćen u sklopu onkoloških kontrola te su, tijekom dosadašnjeg praćenja, sve tri primarne bolesti u stabilnoj fazi, bez znakova progresije. Zaključci: Ovaj prikaz ukazuje na važnost cjelovitog dijagnostičkog pristupa koji omogućuje pravovremeno otkrivanje dodatnih malignih oboljenja koja, iako rijetko, mogu biti prisutna istovremeno. U odabranih bolesnika, kada klinički uvjeti to dopuštaju, sinkrone su operacije izbor liječenja, uz multidisciplinarni pristup i pažljivo planiranje.

Cilj: Cilj je rada prikazati pacijenticu sa pseudocistom nadbubrežne žlijezde te predstaviti dijagnostički izazov i način liječenja ovog kliničkog entiteta. Prikaz slučaja: Pacijentica u dobi od 69 godina zaprimljena je na Kliniku za urologiju zbog kirurškog liječenja asimptomatske ciste desnog bubrega klasificirane kao Bosniak III. Operacija je učinjena laparoskopskim pristupom. Intraoperacijski je pronađena cistična tvorba veličine oko 5 cm iznad i medijalno od gornjeg pola desnog bubrega koja je od njega bila odvojena. Tvorba je u cijelosti odstranjena, a patohistološki nalaz pokazao je da se radi o kalcificiranoj pseudocisti kore nadbubrežne žlijezde veličine 5 x 4 x 3 centimetra. Poslijeoperacijski tijek bio je uredan. Budući da se radi o benignoj patologiji, bolesnica se jednom godišnje prati kod urologa. Zaključak: Pseudocista nadbubrežne žlijezde veoma je rijedak klinički entitet. Dijagnoza se postavlja na temelju slikovnih pretraga, prvenstveno CT-a. Liječenje ovisi o simptomima, ali i o nalazu dijagnostičkih pretraga. Ovisno o tome indicira se kirurški zahvat ili praćenje rasta pseudociste, a prognoza je odlična.

Neplodnost pogađa 10-15 % parova, a u 30 % slučajeva uzrok je muški faktor. Među ključnim uzrocima muške neplodnosti nalazi se oksidacijski stres, stanje poremećene ravnoteže između oksidacije i redukcije koje rezultira stvaranjem reaktivnih kisikovih spojeva (ROS). Molekule ROS imaju važne fiziološke uloge, uključujući kapacitaciju spermija, hiperaktivaciju i fuziju s oocitom, no njihovo prekomjerno stvaranje uzrokuje štetu, poput lipidne peroksidacije, fragmentacije DNA i apoptoze. Značajne količine ROS-a nastaju u stanicama spermatogenetske loze, ali i kao nusprodukt aerobnog metabolizma te u leukocitima s peroksidaznom aktivnošću. Stanja poput varikokele, infekcija, dijabetesa, alkoholizma i pretilosti, zajedno s pušenjem, izloženosti toksinima i ftalatima dodatno pogoršavaju oksidacijski stres. Iatrogeni čimbenici, uključujući tehnike potpomognute oplodnje, krioprezervaciju i liječenje malignih bolesti radioterapijom i kemoterapijom, također povećavaju rizik. Obranu protiv oksidacijskog stresa pružaju antioksidansi koji neutraliziraju ROS. Enzimski antioksidansi, poput superoksid-dismutaze (SOD), katalaze i glutation-peroksidaze, prisutni su u spermijima i sjemenoj tekućini. Neenzimski antioksidansi, poput vitamina E, vitamina C, cinka i selena, unose se prehranom. Nedostatak antioksidansa zbog neuravnotežene prehrane povećava rizik od oksidacijskog stresa, stoga je pravilna i uravnotežena prehrana ključna za očuvanje plodnosti. Učinkovita strategija za prevenciju uključuje i smanjenje izloženosti rizičnim čimbenicima te primjenu dodataka prehrani s antioksidansima u odabranim slučajevima.

Cilj: Analizirati i usporediti kliničko-patološke karakteristike te petogodišnje ishode liječenja niskorizičnih i visokorizičnih bolesnika s karcinomom prostate operiranih radikalnom prostatektomijom od 2014. do 2018. godine. Ispitanici i metode: Retrospektivna kohortna studija obuhvatila je 240 bolesnika s histološki potvrđenim karcinomom prostate koji su liječeni radikalnom prostatektomijom u Kliničkom bolničkom centru Rijeka. Bolesnici su stratificirani u niskorizičnu (117 bolesnika) i visokorizičnu skupinu (123 bolesnika) prema smjernicama Europskog urološkog društva (EAU). Analizirane su demografske, kliničke i patohistološke karakteristike te petogodišnje preživljavanje. Rezultati: Petogodišnje preživljavanje iznosilo je 92,31 % za niskorizičnu i 78,05 % za visokorizičnu skupinu (P = 0,004). Biokemijski relaps doživjelo je 21 % niskorizičnih i 61 % visokorizičnih bolesnika. Metastatsku bolest razvilo je 0,9 % niskorizičnih i 15 % visokorizičnih bolesnika. Zaključci: Stratifikacija rizika prema EAU smjernicama omogućuje preciznu diferencijaciju ishoda liječenja. Niskorizični bolesnici imaju izvrsnu prognozu, dok visokorizični postižu zadovoljavajuće preživljavanje uz multimodalni pristup. Ključni izazovi u budućnosti bit će implementacija napredne slikovne dijagnostike i genomskih analiza kako bismo još preciznije definirali rizične kategorije, time naravno i personalizirali odabir terapije te poboljšali onkološke ishode uz paralelnu optimizaciju pristupačnosti ovih metoda u resursno ograničenim područjima.

Aim: The use of minimal-invasive surgical methods in kidney donation surgery led to an increased number of living kidney donors. The laparoscopic donor nephrectomy has become the gold standard for living kidney donation but nowadays the robot-assisted nephrectomy for living kidney donation (RADN) has been performed in expert centres. We present a case of RADN followed by a successful kidney transplantation. Case report: The 77-year-old man with adult polycystic kidney disease gradually progressed to end-stage renal disease and started with dialysis in December 2022. After extensive assessment, his 61-year-old sister was prepared to be a donor. In September 2023, a successful RADN was performed. The left kidney was procured. The kidney was successfully transplanted to the recipient with a cold ischemia time of 4 hours and 30 minutes. The postoperative course was uneventful for both donor and recipient. Three months after surgery the renal function is stable in both patients. Conclusion: The RADN is a safe and effective method with comparable results to laparoscopic donor nephrectomy used in centres with robotic surgery.

Liječenje karcinoma bubrega predstavlja pravi izazov za kliničare zbog biološkeheterogenosti i često kasne dijagnoze, pri čemu je kod metastatskih oblika petogodišnjepreživljavanje samo 12 %. Uvođenje inhibitora imunoloških kontrolnih točaka (PD-1, PD-L1,CTLA-4) u kombinaciji s inhibitorima tirozin-kinaza značajno je poboljšalo ishode liječenjakod bolesnika s metastatskim rakom bubrega, s medijanom ukupnog preživljavanja od 46 do53 mjeseca. Adjuvantna primjena pembrolizumaba nakon nefrektomije pokazala je32-postotno smanjenje rizika od recidiva ili smrti, čime je postala novi standard skrbi zabolesnike visokog rizika. Biomarkeri poput ekspresije PD-L1 i sistemskog imunoinflamatornogindeksa omogućuju stratifikaciju rizika, dok personalizirani testovi ctDNA detektirajuprogresiju do 13,6 tjedana prije radioloških promjena. Glavni izazovi uključuju visok postotakimunološki posredovanih nuspojava, atipične odgovore poput pseudoprogresije i hiperprogresijete ekonomska ograničenja zbog visokih troškova terapija. Tumorska heterogenosti mehanizmi rezistencije dodatno otežavaju predviđanje odgovora na terapiju. Budućemogućnosti liječenja nalaze se u tripletnim kombinacijama, radioterapiji u sinergiji s imunoterapijomte u razvoju prediktivnih modela umjetne inteligencije za precizniju personalizacijutretmana. Integracija različitih biomarkera i strojnog učenja obećava poboljšanje kliničkeodluke i smanjenje toksičnosti, čime će se postići održiviji i učinkovitiji model skrbi zabolesnike s uznapredovanim karcinomom bubrega.

Background/Objectives: Autonomic dysreflexia (AD) is a clinical syndrome affecting persons with spinal cord injury (SCI). The aim of the study was to present the experience of individuals with SCI and AD in Croatia. Single-center questionnaire study. Setting: Faculty of Medicine, University of Rijeka, Rijeka, Croatia. Persons with SCI were divided into those with an SCI at T6 and above (n = 41) and those with an SCI at T7 and below (n = 29). Based on anamnestic data, patients with an SCI at T6 and above were further divided into those with and without self-reported clinical symptoms of AD (respectively: n = 33 and n = 8). Methods: The online survey included 23 questions of various types. It consisted of a general (demographic) section, section with specific questions about AD, and a section on self-assessment and quality of life. Based on the answers, the experience and knowledge of AD among individuals with an SCI in Croatia was assessed. Results: A total of 70 individuals with an SCI completed the whole survey. The average age was 40.6 years. The patients were predominantly male (72.9%) and mostly with a traumatic SCI (84.3%). Of the 70 individuals with an SCI, 35 (50%) reported they were familiar with AD, with the majority indicating that the internet was their primary source of information. Among those with an SCI who were unaware of AD, most (34/35 = 97.1%) wanted to learn about AD. The self-assessed quality of life was insignificantly better in patients with an SCI below T6 than in those with higher lesions. Patients with AD reported different symptoms and the most frequently reported symptom was a headache (70%). In 64% of participants, the primary trigger of AD were issues with the urinary bladder. In most individuals (55%), symptoms were not recognized by the healthcare providers. The individuals with AD were dissatisfied with the information about AD they received from doctors or nurses. Overall, 61% of all participants with AD rated their quality of life as good. Conclusions: Persons with an SCI are not adequately informed about AD. In most persons with AD, their symptoms are not properly recognized by healthcare providers. Our results suggest the need for more education of healthcare professionals about AD.

Urinary incontinence remains a frequent complication after radical prostatectomy, with significant implications for patients’ physical health, emotional well-being, and social quality of life. Postprostatectomy incontinence manifests as stress urinary incontinence,typically resulting from injury to the external urethral sphincter and its supporting structures. Contributing factors include patient age, baseline urinary function, surgical technique, and anatomical variations. Management options range from conservative measures such as pelvic floor muscle training, pharmacotherapy, and lifestyle adjustments to surgical interventions, including male slings and artificial urinary sphincters for persistent or severe cases. Although advances in surgical technique and perioperative care have improved continence outcomes, postprostatectomy urinary incontinence remains a significant challenge, underscoring the need for personalized treatment approaches and continued research into preventive strategies.

Aim: We report a rare case of a symptomatic, inflamed giant retroperitoneal cyst. The lesion was found to represent an afunctional, sac-like upper pole of the right kidney with a dilated, duplicated collecting system and a megaureter ectopically inserted into the ipsilateral seminal vesicle, resulting in male infertility. Case report: A 26-year-old male patient presented to the emergency department with the right flank pain, nausea, and high body temperature. A giant retroperitoneal cyst was diagnosed which proved to be afunctional, sack-like upper pole of the right kidney with its dilated, separated collecting system and megaureter ectopically inserted into the ipsilateral seminal vesicle. Although the patient’s symptoms were relieved after percutaneous drainage of the cyst, the symptoms recurred one month later, and an open surgical excision was performed. The patient’s symptoms disappeared and his impaired fertility was fully recovered after surgery. Conclusion: There is a close relation between congenital anomalies of the urinary tract and the seminal vesicle cysts due to their close embryological origin which often cause concurrent malformations of the ipsilateral upper urinary tract. Cystic formations of the retroperitoneum require thorough evaluation and extensive imaging to rule out congenital urogenital malformations. Additionally, male fertility testing is required if there is any indication of genitourinary system development anomalies because early detection and treatment of anomalies can lead to a partial or full recovery of fertility.

In patients with Congestive Heart Failure (CHF), neurohormonal activation leads to fluid overload that can be treated with high doses of furosemide unless diuretic resistance and hyponatremia develop. End-stage CHF, including patients with normal or slightly deteriorated kidney function, can resist medical treatment. In some cases of refractory CHF, ultrafiltration (UF) is required. To manage a refractory CHF population, extracorporeal UF is commonly used as an emergency treatment, but peritoneal UF should be considered a follow-up therapy option. This method offers potential advantages over extracorporeal therapies, including better preservation of residual renal function, tighter control of sodium balance, less neurohumoral activation, and the possibility of daily treatment in the home environment. Using glucose as an osmotic agent leads to the deterioration of the peritoneal membrane. The UF properties of icodextrin depend on the dwell time, whereby the maximum effect of icodextrin concerning glucose is achieved at a prolonged dwell time. Icodextrin may offer improved peritoneal membrane biocompatibility compared with conventional glucose-based dialysates by decreasing glucose exposure, iso-osmolarity, and reduced carbonyl stress. The proper anesthesia technique and surgical approach for peritoneal dialysis (PD) catheter placement in CHF patients must be based on the patient’s characteristics, available equipment, and surgeon’s experience. An open procedure using a transversus abdominis plane block for PD catheter placement in patients with CHF is strongly recommended.

Introduction: In prostate cancer (PC), it is well established that the wider the anatomical template of dissection, the higher the number of lymph nodes (LNs) retrieved, and the higher the nodal yield, the better the detection of metastasis1,2. Objectives: The objectives of this study were to evaluate if the change in submission methodology (en bloc vs. separate) had an impact on the number of total LNs identified per patient and the number of positive LNs found, and to determine the impact of individual pathologists on the number of total LNs and positive LNs. Patients and methods: We performed a retrospective analysis of hospital records of patients with PC in whom radical prostatectomy (RP) with pelvic lymphadenectomy (PLND) was done in the period from November 2012 to December 2018. We used only a single-surgeon series in order to avoid performance bias in the lymphadenectomy template. Pathohistological examinations were performed by our hospital's two dedicated urogenital pathologists. Patients were divided into high and intermediate risk groups according to the European Association of Urology (EAU) guidelines, based on submission methodology of the lymphadenectomy tissue and by the pathologist performing the examinations. The number of LNs and number of positive LNs acquired were then compared using the Mann-Whitney test. Results: Patients who underwent separate submission of lymphadenectomy tissue had a significantly higher nodal yield, but there was no difference in the number of positive LNs. There was no significant difference in the total number of LNs acquired and LN metastases detected between our two pathologists when comparing them by submission technique. Conclusions: Separate submission of lymphadenectomy tissue resulted in a higher nodal yield, but it did not translate to a higher number of positive LNs found.

Bubrežna presadba se smatra najboljim postupkom nadomještanja bubrežne funkcije u bolesnika sa završnim stupnjem kronične bubrežne bolesti. Povećanje dobi i darovatelja i primatelja dovodi do povećane složenosti implantacije bubrega. Dodatno, periferna žilna bolest je diljem svijeta u porastu, što dovodi do otežavanja kirurškog postupka, ali i do lošijih dugoročnih ishoda transplantacije uključujući i smanjeno preživljenje presatka i/ili bolesnika. Unatoč tomu dijalitičko liječenje ima lošije ishode te se i u vaskularno složenijih bolesnika preporučuje učiniti bubrežnu presadbu. Neki od otežavajućih vaskularnih čimbenika jesu izrazito kalcificirane krvne žile, postojanje aortoilijačnih ili endovaskularnih proteza te višestruke transplantacije (potreba za trećom i/ili četvrtom transplantacijom u prethodno zauzetim ilijačnim jamama). Prije same transplantacije u tih bolesnika veoma je važno učiniti prikladnu slikovnu obradu koja ponekada mora biti invazivna. Nužno je prije transplantacije odabrati mjesto implantacije, informirati bolesnika o složenosti zahvata i mogućim komplikacijama pa čak i o mogućem intraoperacijskom odustajanju od transplantacije. Moguće mjesto implantacije može biti sama žilna proteza, proksimalnije krvne žile sve do aorte i donje šuplje vene, uključujući i njih. U nekih bolesnika dobra alternativa je ortotopna bubrežna presadba. Broj komplikacija je veći nego u standardnoj transplantacijskoj populaciji. Zaključno, možemo reći kako je transplantacija u ovih bolesnika izazovan kirurški postupak s većim pobolom i većom smrtnosti te smanjenim preživljenjem presatka i bolesnika te zahtijeva iskusan kirurški tim.

Background: Vascular calcifications (VC) are increasingly prevalent in patients with chronic kidney disease. This study aimed to assess the incidence of iliac artery calcifications in kidney transplant (KT) patients and explore the relationship between iliac VC burden measured by pelvic calcification score (PCS) and renal transplant outcomes. Methods: This prospective study involved 79 KT recipients. VC quantification, using a pre-transplant computed tomography (CT) scan, was performed by assessing calcifications in the common and external iliac arteries bilaterally, resulting in an overall PCS ranging from 0 (no calcifications) to 44 (extensive calcifications). Based on PCS values, patients were divided into three equal-sized groups: PCS Group 1 (PCS 0-4), PCS Group 2 (PCS 5-19), and PCS Group 3 (PCS > 19). Post-transplant outcomes tracked for at least 1 year were patient and graft survival, graft function (urea, creatinine, MAG-3 clearance), and incidence of MACE during the first post-transplant year. Results: Calcifications were present in at least one arterial segment in 61 patients (77.2%). One-year patient survival was 95%, and one-year graft survival was 92.4%. Patients in PCS Group 3 had significantly lower one-year patient and graft survival compared to those in PCS Group 1 and 2 (p = 0.006 and p = 0.008, respectively). MACE and renal function indicators 1-year post-transplant were similar across all PCS groups. Conclusions: Our study demonstrated that a significant majority of KT recipients exhibited iliac VC during pre-transplant CT assessments. Patients in PCS Group 3 exhibited significantly lower one-year patient and graft survival rates compared to those in PCS Groups 1 and 2, indicating that this subgroup may require more intensive post-transplant monitoring and management.

Tetralogy of Fallot is the most common cyanotic congenital heart disease. This severe disorder of cardiac physiology can impair renal function and lead to the development of cardiorenal syndrome and eventually to end-stage renal disease. Kidney transplantation may be the best option for renal replacement treatment in patients with tetralogy of Fallot, but only after correcting cardiac abnormalities and optimizing cardiac functions, all of which require a multidisciplinary approach. We report the first case of kidney transplantation in an adolescent patient with tetralogy of Fallot. Our findings confirms that kidney transplantation is a valuable treatment option in selected congenital heart disease cases.

SAŽETAK.Bubrežna presadba se smatra najboljim postupkom nadomještanja bubrežne funkcije u bolesnika sa završnim stupnjem kronične bubrežne bolesti

Cilj: Prikazati pacijenticu s rupturom forniksa bubrega kao posljedice opstrukcije urotrakta ureterolitom te dati uvid u dijagnostiku i mogućnosti liječenja ovog hitnog stanja. Prikaz slučaja: Pacijentica je u dobi od 34 godine zaprimljena na hitni bolnički prijam zbog recidivne renalne kolike s lijeve strane. Fizikalnim je pregledom lijevo utvrđena pozitivna lumbalna sukusija, a laboratorijskom analizom krvi povišena razina kreatinina te smanjena procijenjena stopa glomerularne filtracije. Urin je bio pozitivan na leukocitnu esterazu i hemoglobin. Ultrazvukom je pronađeno proširenje pijelokalicealnog sustava lijevog bubrega II. stupnja i perirenalna kolekcija duž konveksiteta bubrega te je postavljena sumnja na rupturu forniksa lijevog bubrega. CT pregledom abdomena i zdjelice bez kontrasta prikazan je opstruktivni ureterolit, a postkontrastni CT presjeci potvrdili su prisustvo tekuće kolekcije u perirenalnom prostoru i potvrdili da se radi o rupturi forniksa bubrega. Pacijentica je hospitalizirana i postavljena joj je ureteralna endoproteza „double J“ i urinski kateter uz primjenu antibiotske i analgetske terapije. S obzirom na dobro opće stanje i regresiju simptoma otpuštena je sljedećeg dana na kućno liječenje. Dva mjeseca kasnije pacijentici je učinjena uspješna ureteroskopija uz ekstrakciju ureterolita. Poslijeoperacijski tijek bio je uredan. Zaključak: Klinička slika rupture forniksa bubrega je nespecifična. Najčešći je uzrok opstruktivna ureterolitijaza, a definitivna se dijagnoza postavlja slikovnim metodama. Drenaža urotrakta je prvi korak u liječenju koje može biti konzervativno i/ili kirurško.