CONTEXT:Renal artery aneurysm (RAA) is uncommon and usually asymptomatic, but complications like rupture or thromboembolism of the aneurysm can occur, with consequent renal infarction. Most of the clinical findings are found incidentally through imaging examinations, in investigating other diseases. Renal autotransplantation (RAT) is an alternative treatment for complex RAA, with satisfactory results described in the literature.CASE REPORT:The patient was a 48-year-old man with a history of systemic arterial hypertension, thrombocytopenia and advanced hepatosplenic schistosomiasis. He complained of right lumbar pain, which was investigated through imaging examinations (computed tomography and angiotomography). These revealed right RAA of 2.5 cm in diameter. Evaluation by the vascular surgery team found that this was untreatable using endovascular methods. The treatment performed was open right nephrectomy with kidney preservation in solution, followed by aneurysmectomy, suturing of the injured artery and kidney reimplantation in the right iliac fossa with anastomosis of the iliac vessels and ureter. The durations of the surgery and kidney ischemia were 385 and 140 minutes, respectively. The patient was discharged on the 20th postoperative day, with creatinine concentration of 1.4 mg/dL, urea 41 mg/dL, urine volume 1400 mL/24 h and ascites treated with diuretics.CONCLUSION:RAT is indicated basically in three situations: extracorporeal reconstruction of complex aneurysms of the renal pedicle, extensive ureteral injury, and conservative kidney cancer surgery in patients with a single kidney. This study presents a case of a patient with advanced liver disease and RAA that was untreatable using endovascular methods and was successfully treated using RAT.

Systemic-enteric drainage is currently the most common technique for pancreas transplantation (PT). A novel alternative technique, portal-duodenal drainage (PDD), has potential physiological benefits and provides improved monitoring of the pancreatic graft. The current study describes 53 solitary PT procedures (43 pancreas after kidney and 10 pancreas transplant alone) using the PDD technique over the last three yr. This method resulted in one-yr patient survival at 96% and 83% graft survival. There were five cases (9.4%) of thrombosis, in which transplantectomy and two-layer closure of the native duodenum were performed. No fistulas were observed. Here, we demonstrate that the PDD technique in PT was as safe and effective as current techniques in clinical use.

Objetivo: Analisar a experiência com transplante renal em um serviço de transplante de órgãos abdominais conduzido por equipe multidisciplinar de transplante renal, pancreático e hepático. Métodos: De dezembro/2010 a dezembro/2012, foram realizados 72 transplantes renais no Hospital Bandeirantes, pela equipe de Hepato, e analisados em junho/2013. Resultados: Quanto aos dados demográficos, a idade média foi de 40 anos (19 – 69 anos), sendo que 50% dos pacientes eram portadores de diabetes mellitus, 6,94% eram transplantados renais pós-transplante hepático, e os demais eram portadores de nefroesclerose, glomerulonefrites, doença renal policística, causas idiopáticas, entre outras. A imunossupressão utilizada foi o tacrolimo, micofenolato sódico, prednisona e thymoglobulina (essa última, usada apenas em dois casos) de doadores vivos em 85% dos casos. As complicações cirúrgicas foram baixas: um caso de fístula urinária, um de hematoma, cinco de linfocele e um de deiscência de incisão; nenhum enxerto foi perdido por complicação cirúrgica. As complicações clínicas mais comuns foram: infecção urinária e CMV com 13,9% cada, rejeição celular aguda em 11,1%, diabetes pós-transplante em 8,3% e poliomavírus em 4,2%. Houve perda de dois enxertos: um por rejeição crônica e um por óbito por AVC. A creatinina sérica média ao final da avaliação foi 1,2 MG/dl. Conclusão: Os resultados obtidos demonstrados neste trabalho apresentaram como comorbidades, pacientes de alto risco como diabéticos pré e pós-transplante pancreático, e pacientes TOSNR (transplante de órgãos sólidos não renais).

OBJECTIVE Little information is available on glomerular function changes after surgical treatment of primary hyperparathyroidism. The acute effects of some head and neck operations on renal function were studied. MATERIAL AND METHODS Retrospective analysis of changes in creatinine levels and estimated glomerular filtration rate (eGFR) after surgery. Preoperative values were compared with values available until 72 hours after the operation. RESULTS In tertiary hyperparathyroidism, mean preoperative and postoperative eGFR values were 57.7 mL/min and 40.8 mL/min (p < 0.0001), respectively. A similar decrease was observed after parathyroidectomy for primary hyperparathyroidism, from 85.4 mL/min to 64.3 mL/min (p < 0.0001). After major head and neck procedures, there was a slight increase in eGFR (from 94.3 mL/min to 105.4 mL/min, p = 0.002). CONCLUSION Parathyroidectomy may be followed by a transient decrease in eGFR that is not often observed in other head and neck operations.

INTRODUCTION:Kidney transplantation corrects endocrine imbalances. Nevertheless, these early favorable events are not always followed by rapid normalization of parathyroid hormone secretion. A possible deleterious effect of parathyroidectomy on kidney transplant function has been reported. This study aimed to compare acute and longterm renal changes after total parathyroidectomy with those occurring after general surgery.MATERIALS AND METHODS:This was a retrospective case-controlled study. Nineteen patients with persistent hyperparathyroidism underwent parathyroidectomy due to hypercalcemia. The control group included 19 patients undergoing various general and urological operations.RESULTS:In the parathyroidectomy group, a significant increase in serum creatinine from 1.58 to 2.29 mg/dl (P < 0.05) was noted within the first 5 days after parathyroidectomy. In the control group, a statistically insignificant increase in serum creatinine from 1.49 to 1.65 mg/dl occurred over the same time period. The long-term mean serum creatinine level was not statistically different from baseline either in the parathyroidectomy group (final follow-up creatinine = 1.91 mg/dL) or in the non-parathyroidectomy group (final follow-up creatinine = 1.72 mg/dL).CONCLUSION:Although renal function deteriorates in the acute period following parathyroidectomy, long-term stabilization occurs, with renal function similar to both preoperative function and to a control group of kidney-transplanted patients who underwent other general surgical operations by the final follow up.

Transmission of urothelial carcinoma via solid organ transplant has never been reported in the literature to our knowledge. We report a case of transmission of this tumour to a kidney recipient. The donor was a 37-year-old woman, victim of a subarachnoid haemorrhage. The recipient was a 21-year-old girl, with a history of chronic kidney disease secondary to neurogenic bladder. This fatality has been rarely described in literature, but never with this histological type of cancer. Nowadays, with the expanded criteria for donation, older people are accepted as donor because of the shortage of organs. However, this may increase the likelihood of the number of cancer transmission.

Genzini, Adriana Costa MD1,2; Dib, Ricardo MD1; Takahashi, Wagner MD2; de Almeida, Patrícia Souza MD3; de Miranda, Marcelo Perosa MD1,3; Genzini, Tércio MD1,3; Ianhez, Luiz Estevan MD1 Author Information

Plasma clearance of (51)Cr-EDTA ((51)Cr-EDTA-Cl) is an alternative method to evaluate glomerular filtration rate (GFR). This study aimed to investigate the concordance between (51)Cr-EDTA-Cl and renal inulin clearance (In-Cl) in renal transplant recipients as well to determine the repeatability of (51)Cr-EDTA-Cl in kidney donors. Forty four kidney recipients and 22 kidney donors were enrolled. Simultaneous measurements of (51)Cr-EDTA-Cl and In-Cl were performed. A single dose of 3.7MBq of (51)Cr-EDTA was injected and the plasma disappearance curve was created by taking blood samples at 2, 4, 6 and 8 h after injection. Bland and Altman statistical approach was used to quantify the agreement between In-Cl and (51)Cr-EDTA-Cl and to determine the better concordance between all possibilities of measure for the (51)Cr-EDTA-Cl. The mean of In-Cl was 44.5 +/- 17.9 ml/min/1.73 m(2). There was a positive correlation between In-Cl and all possible measurements of (51)Cr-EDTA-Cl. (51)Cr-EDTA-Cl with two samples taken at 4 and 8 h or at 4 and 6 h presenting the narrow limits of agreement and a difference (bias) of 2.8 and 2.7 ml/min, respectively. Two plasma sampling for (51)Cr-EDTA-Cl was a reliable method to measure GFR compared with In-Cl and comprises a suitable method to be used in kidney transplanted patients.

INTRODUCTION:The delay in the diagnosis of infections can be deleterious in renal transplant recipients. Thus, laboratory tests leading to an earlier diagnosis are very useful for these patients.PURPOSE:To assess the behavior of C-reactive protein (CRP) in renal transplant recipients with a diagnosis of cytomegalovirus (CMV) infection, tuberculosis (TB) and bacterial infection (BI).METHODS:A retrospective analysis of 129 patients admitted at our hospital, from 2006 to 2008 because of CMV, TB or BI, was carried out. Appropriate statistical analysis was done and values were expressed as medians, range.RESULTS:When CRP levels were compared among the groups with CMV disease, TB or BI, the group with CMV disease presented lower levels of CRP (18.4 mg/L, 0.28-44 mg/L) than the TB and BI (p < 0.05) groups. The area under the receiver-operating characteristics curve, distinguishing CMV disease from TB/BI, was 0.96 (p < 0.0001), resulting in 100% sensitivity and 90.63% specificity to detect CMV disease when CRP < 44.5 mg/L. The subgroup analysis of CMV infection showed increasing levels of CRP (0.28, 16 and 29.5 mg/L) in the asymptomatic, symptomatic and invasive disease subgroups, respectively (p < 0.05).CONCLUSION:The measurement of CRP levels may be a useful tool for differentiating CMV infection from the other types (bacterial or TB) of infection in kidney transplant recipients.

You have accessJournal of Urology1 Apr 2009N-ACETYLCYSTEINE ATTENUATES OXIDATIVE STRESS IN DECEASED RENAL TRANSPLANTATION Alexandre Danilovic, Antonio M Lucon, Antonio C Seguro, Maria H Shimizu, Luiz E Ianhez, William C Nahas, and Miguel Srougi Alexandre DanilovicAlexandre Danilovic More articles by this author , Antonio M LuconAntonio M Lucon More articles by this author , Antonio C SeguroAntonio C Seguro More articles by this author , Maria H ShimizuMaria H Shimizu More articles by this author , Luiz E IanhezLuiz E Ianhez More articles by this author , William C NahasWilliam C Nahas More articles by this author , and Miguel SrougiMiguel Srougi More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(09)62066-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "N-ACETYLCYSTEINE ATTENUATES OXIDATIVE STRESS IN DECEASED RENAL TRANSPLANTATION." The Journal of Urology, 181(4S), p. 740 © 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 181Issue 4SApril 2009Page: 740 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Alexandre Danilovic More articles by this author Antonio M Lucon More articles by this author Antonio C Seguro More articles by this author Maria H Shimizu More articles by this author Luiz E Ianhez More articles by this author William C Nahas More articles by this author Miguel Srougi More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of Urology1 Apr 2008LOWER URINARY TRACT RECONSTRUCTION AND RENAL TRANSPLANTATION: 19-YEAR EXPERIENCE William C Nahas, Marcos Lucon, Hideki Kanashiro, Ioannis M Antonopoulos, Affonso C Piovesan, Renato Falci, Fernando Saito, Elias David-Neto, Luiz E Ianhez, and Miguel Srougi William C NahasWilliam C Nahas More articles by this author , Marcos LuconMarcos Lucon More articles by this author , Hideki KanashiroHideki Kanashiro More articles by this author , Ioannis M AntonopoulosIoannis M Antonopoulos More articles by this author , Affonso C PiovesanAffonso C Piovesan More articles by this author , Renato FalciRenato Falci More articles by this author , Fernando SaitoFernando Saito More articles by this author , Elias David-NetoElias David-Neto More articles by this author , Luiz E IanhezLuiz E Ianhez More articles by this author , and Miguel SrougiMiguel Srougi More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)62028-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "LOWER URINARY TRACT RECONSTRUCTION AND RENAL TRANSPLANTATION: 19-YEAR EXPERIENCE." The Journal of Urology, 179(4S), p. 695 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 695 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information William C Nahas More articles by this author Marcos Lucon More articles by this author Hideki Kanashiro More articles by this author Ioannis M Antonopoulos More articles by this author Affonso C Piovesan More articles by this author Renato Falci More articles by this author Fernando Saito More articles by this author Elias David-Neto More articles by this author Luiz E Ianhez More articles by this author Miguel Srougi More articles by this author Expand All Advertisement PDF downloadLoading ...

Purpose To evaluate if children with urinary tract abnormalities, particularly bladder disorders, have different long-term outcome after renal transplantation, compared to those with non-urological cause of ESRD. Material and Methods 211 children (age <19 years) were submitted to 226 renal transplantations between 1989 and 2005. They were separated in three groups: 136 children with ESRD due to non-urological cause (GROUP 1), 56 children with urological disorders but with adequate bladders (GROUP 2) and 19 children with lower urinary tract dysfunction associated or not to inadequate bladder emptying (GROUP 3). In group 3, 15 children were submitted previously to a bladder augmentation (ureterocystoplasty in 6 and enterocystoplasty in 9), one to a bladder autoaugmentation, two children to a continent urinary diversion, and one to an appendical Mitrofanoff procedure. The renal transplantation was performed in a classical, extraperitoneal access, and the ureter implanted, whenever possible, with an antireflux technique. Results After a mean follow-up of 75 months, 13 children died, 59 grafts were lost, and 15 children received a second transplant. Two patients of GROUP 3 required a complementary urological procedure to preserve renal function (one enterocystoplasty and one vesicostomy). There was a total of 12 (5.3%) major surgical complications, with an equal incidence in the three groups. The overall graft survivals at 5 years were 75% (GROUP 1), 74% (GROUP 2) and 84% (GROUP 3). Conclusions With an individualized treatment, children with urological abnormalities, including those with lower urinary tract disorders, have the same long-term outcome as those with non-urological cause of ESRD.