Academic literature on the topic 'Intra-Obstructive Kidney'

Background. Patients with simultaneous relevant internal carotid artery stenosis and coronary artery heart or valve disease represent a high-risk collective with respect to cerebral or cardiovascular severe events when undergoing surgery. There exist several concepts regarding the timing and modality of carotid revascularization, which are controversially discussed in patients with heart disease. More data regarding outcome predictors and measures are needed to gain a better understanding of the best treatment option of the discussed patient collective. Methods. This single-center study retrospectively analyzed n = 111 patients undergoing heart surgery with coronary artery bypass grafting or heart-valve surgery and concomitant carotid surgery due to significant internal carotid artery stenosis. In order to do so, patients were divided into two groups with respect to postoperative major adverse cardiac and cerebrovascular events (MACCE) with thirty-day all-cause mortality, valve related mortality, myocardial infarction, stroke and transitory ischemic attack. Results. Preoperative patient’s characteristic in the no-MACCE and MACCE group were mainly balanced, other than higher rates of chronic obstructive pulmonary disease, chronic kidney disease, instable angina pectoris and prior transitory ischemic attack in the MACCE cohort. The analysis of intraoperative characteristics revealed a higher number of intra-aortic balloon pump implantation, which is in line for a higher number of postoperative supports. Besides MACCE, patients suffered significantly more often from postoperative bleeding events and re-thoracotomy, cardiopulmonary reanimation, new onset postoperative dialysis and prolonged intensive care unit stay related complications. Conclusions. Within the reported patient population suffering from MACCE after a simultaneous carotid endarterectomy and heart surgery, a preoperative history of transitory ischemic attack and kidney disease might account for worse outcomes, as severe events were not only neurologically driven but also associated with postoperative cardiovascular complications following heart surgical procedures.

BackgroundThoracic ureteric herniation is an uncommon finding with a varying presentation. Since its first documen-tation in 1958, few case reports have been published, and there is no consensus on its management. This condition is typically asymptomatic, with most cases identified incidentally from cross-sectional imaging or discovered intra-operatively.As a result of differing presentations and a lack of consensus or evidence of best practice, this rare finding’s management is not defined. This can range from adopting a conservative approach to more invasive measures such as ureteric stenting or pyeloplasty to repair the thoracic hernia.The authors present a case of thoracic ureteric herniation in a 74-year-old male presenting with right-sided abdominal pain. This patient was known to have a diaphragmatic hernia following pulmonary fibrosis investigations and chronic obstructive pulmonary disease (COPD). At presentation, there was acute kidney injury (AKI), and subsequent computed topography (CT) demonstrated right-sided hydronephrosis and perinephric fat stranding. This was caused by ureteric obstruction with a transition point at the site of thoracic herniation. The patient was successfully managed with retrograde ureteric stent insertion.This case report aims to highlight variance in the presentation of ureteric thoracic herniation and discuss management options. There is no consensus on management for this condition and choices dependant on specific symptoms and patient factors to the best of our knowledge.

Introduction: An ectopic ureter is an anomaly in which the ureter has a non-orthotopic distal insertion (not in the bladder trigonum). It has incidence of 1:4000, and it is two to three times more frequent in women. 80% of women with an ectopic ureter have a duplex kidney, and in 80% of the cases the ectopic ureter originates form the upper pole. In 69% of the cases the ectopic ureter has an insertion in the bladder neck or in the urethra, in 31% in the vagina. In men – the insertion is in the posterior urethra - 57%, seminal vesicles - 33%, vas deferens - 10%. The ectopic ureter can be obstructive and therefore cause hydroureteronephrosis of the kidney pole or non-obstructive often refluxing, causing urinary tract infections. A common symptom in women is urinary incontinence Objectivе: Presentation of laparoscopic treatment of an eleven-year-old girl with a left duplex kidney with ectopic ureter and hydroureteronephrosis of the upper pole. A terminolateral ipsilateral uretero-uretero anastomosis was performed. Material and methods: At the age of one upper pole hydronephrosis was found during routine US examination. No further diagnostic evaluation was done, because of the lack of symptoms, the child was followed up only by US by a nephrologist. Currently, ultrasound revealed loss of parenchymal tissue of the upper pole of the left kidney in comparison to previous studies. The anatomy and functionality of the urinary tract were examined using CT Urography, Systoscopy, RPG and VCUG. We started with a cystoscopy - a glide wire and a JJ stent 6CH/24cm were introduced into the ureter draining the lower pole of the duplex kid- ney (the JJ stent had a magnetic end (Magnetic Black-Star), a urethral catheter was inserted. Using three 5 mm ports, a 30-degree camera, the ectopic ureter on the left side was dissected transperitoneally at the level of the iliac vessels. The distal part was cut off to the level of the bladder neck, the normal ureter was located and terminolateral uretero-uretero anastomosis was performed with a running 5-0 monofilament suture (Monocril) ( 13 mm needle). Repositioning of the JJ stent in the ectopic ureter, draining the upper pole, was done under visual control. The urethral catheter was kept postoperatively for 24 hours. Results: No intra- and postoperative complications were observed. No draining tubes were required. The operative time was 270 minutes. The hospital stay was 4 days. Removal of the JJ stent was performed after 6 weeks using a magnetic end catheter. Control ultrasound was performedin the first month after removal of the JJ stent. Discussion: The ectopic ureter is a rare and sometimes difficult to diagnose. The symptoms depend on the insertion of the ureter and the sex of the child. One should consider the possibility of its presence in case of urinary incontinence (dribbling) with normal uroflow, recurrent urinary tract infections, dysplasia or hydronephrosis of the upper renal pole, lumbar pain. Laparoscopic treatment in these cases leads to a shortening of the hospital stay, minimal trauma, excellent aesthetic result and less pain in the postoperative period.

Purpose: The study aimed to investigate patients' characteristics, fluid and hemodynamic management, and outcomes according to the severity of cardiac surgery-associated acute kidney injury (CSA-AKI). Methods: In a single-center, prospective cohort study, we enrolled 282 adult cardiac surgical patients. In a secondary analysis, we assessed preoperative patients' characteristics, physiological variables, and medication for intra- and postoperative fluid and hemodynamic management and outcomes according to CSA-AKI stages by the Renal risk, Injury, Failure, Loss, End-stage renal disease (RIFLE) classification. Variables of fluid and hemodynamic management were further assessed with regard to the need for postoperative renal replacement therapy (RRT) and in-hospital mortality by the area under the curve for the receiver operating characteristic (AUC-ROC) and multivariate regression analysis. Results: Patients with worsening RIFLE stage, were significantly older, had lower estimated glomerular filtration rate and higher body mass index, more peripheral vascular and chronic obstructive pulmonary disease, atrial fibrillation, and prolonged duration of cardiopulmonary bypass (all p < 0.01). Patients with more severe AKI stage stayed longer in the intensive care and hospital, had higher in-hospital mortality, and requirement for RRT (all p < 0.001). Also, with worsening RIFLE stage, patients had lower intraoperative mean arterial pressure (MAP); p = 0.047, despite higher doses of norepinephrine (p < 0.001). The intraoperative MAP showed the best discriminatory ability (AUC-ROC: >0.8) for and was independently associated with RRT and in-hospital mortality. Moreover, with increasing AKI severity, patients received significantly more fluid infusion, and required higher dose of furosemide; nonetheless, they had increased postoperative fluid balance. Conclusions: In this cohort, reduced MAP and increased fluid balance were independently associated with increased mortality and need for RRT after cardiac surgery.