The effectiveness of extracorporeal shock wave lithotripsy for lower calyx stones in children

Introduction. According to current clinical guidelines, the use of extracorporeal shock wave lithotripsy (ESWL) for lower calyx stones is indicated when their size is less than 1 cm. This is due to the low efficiency and high frequency of repeated procedures for larger stones.Purpose of the study. To examine the results of ESWL usage in the treatment of children with lower calyx stones of various sizes.Materials and methods. ESWL was performed on 33 children with lower calyx stones during 2013 - 2018 yrs. Patients were divided into 2 groups: Group I - 24 (72.7%) patients with primary stones, Group II - 9 (27.3%) patients after ESWL of kidney pelvis stones that migrated to the lower calyx. Both groups are divided into subgroups: a - children with stones less than 1 cm and b - with stones more than 1 cm. ESWL was performed under general anesthesia and ultrasound guidance. In all patients after ESWL we used the inversion technique. The result was considered positive in case of the complete elimination of stones was achieved.Results. After the first ESWL session, stone-free status was achieved in 21/33 (63.6%) patients of all groups, after the second ESWL session in 26/33 (78.8%), after 3 sessions - 30/33 (90.9%). In subgroups Ia and IIa, there were 14/22 (63.6%) children after the first ESWL with complete elimination of calculi, and after subsequent sessions, the success rate was 90.9% (20/22 calculi). After the first ESWL session in subgroups Ib and IIb, complete elimination of stones was achieved in 7/11 (63.6%) children, after repeated sessions in 10/11 (90.9%) children.Conclusions. ESWL demonstrates a high efficiency in the treatment of lower calyx stones less and more than 1 cm, both after the first and third sessions, and in the treatment of primary and residual (migrated) stones.

The pelvis urinary microbiome in patients with kidney stones and clinical associations

Background The long-held notion that, without urinary tract or circulatory infection, bladder urine and blood are sterile biofluids has been disproven. There have been no previous reports on the kidney pelvis urinary microbiome after bladder disinfection in kidney stone patients. This study aimed to determine whether a kidney pelvis urinary microbiome is present after eliminating the influence of the bladder urinary microbiome, whether the microbiome composition is different in patients with stone kidney pelvis (SKP) and non-stone kidney pelvis (NSKP), and the correlation between SKP and patient clinical characteristics. Results Comparisons of bacterial diversity and community structure exhibited that urine in bladder was similar to SKP and NSKP. However, the comparisons showed that urine samples were different from blood. The most common operational taxonomic units were shared by all three types of urine samples. Corynebacterium was significantly higher in SKP compared to NSKP. Several bacteria were associated with patient characteristics, including Lactobacillus, which was positively correlated with fasting blood glucose, and Prevotella was negatively correlated with BMI. Lactobacillus was significantly higher in SKP compared to blood but not in NSKP compared to blood. Conclusions The composition of the kidney pelvis urinary microbiome after disinfection of the bladder and its similarity to the bladder microbiome indicate that bladder urine can be used to replace kidney pelvis urine in microbiome research. Additionally, the comparison of SKP and NSKP and clinical associations suggest that the occurrence of kidney stones is responsible for the SKP urinary microbiome.

Histopathological review of renal pelvic tumours of Balkan nephropathy cases from Southern Serbia

Background Urothelial tumour frequently associates with atrophied kidney pelvis in Balkan endemic nephropathy but histopathology illustration lacks both definition and immune profile for differential diagnosis from renal cell carcinoma. Methods Histology sections of anonymized archived renal tumours and associated kidney of eight local Balkan nephropathy patients were stained by haematoxylin and eosin, and immune profiles revealed by automated clinical immunohistochemistry, to refine carcinoma diagnosis and illustration. Results Two low-grade and four high-grade papillary carcinomas were diagnosed. Two cases of high-grade urothelial carcinomas with solid architecture, invasive features and aggressive biological behaviour are also described with illustrated immune profiles. Conclusion Refined pelvic tumour histopathology can now facilitate comparison across endemic areas within the Balkans and beyond. Notably, immune profiles of the present tumours correspond to those of contemporary urothelial cancers studied in Slovakia, where Balkan-like nephropathies have not been recognised. Some etiological considerations can be discussed.

O6B.7 Aristolochic acid and the risk of cancers in patients with diabetes

BackgroundThe purpose of this study was to investigate the association between the use of herbal medicine containing aristolochic acid (AA) and the risk of cancers among patients with diabetes.MethodsWe conducted a population-based cohort study on patients older than 18 years who had a diagnosis of diabetes (ICD-9 codes 250) between January 1, 1997 and December 31, 2010. To ensure comparability, we included only patients with diabetes who had visited traditional Chinese medicine clinics between January 1, 1997 and one year before the diagnosis of cancer or the censor dates. The use of herbal medicine containing AA was identified from January 1, 1997 to October 31, 2003 (the ban of herbs containing AA in November 2003). Each patient was individually tracked to identify incident cases of cancer (140–208) between January 1, 1999 and December 31, 2013.FindingsA total of 4 30 377 male and 4 31 956 female patients with diabetes were identified by using the National Health Insurance Research Database in Taiwan. There were 37 554 and 31 535 cancers during the follow-up period. AA use increased the risks of incident liver (155.0), kidney (189.0), pelvis and ureter (189.1, 189.2), and bladder (188) cancer in male patients with diabetes in a dose-dependent relationship. Similarly, there were increased risks of incident liver, pelvis and ureter, and bladder cancer in female diabetic patients in a dose-dependent manner.InterpretationOur study suggests that AA exposure plays an important role in the carcinogenesis of liver, kidney, pelvis, ureter, and bladder cancers in patients with diabetes.

Epithelium Lining Rat Renal Papilla: Nomenclature and Association with Chronic Progressive Nephropathy (CPN)

Chronic progressive nephropathy (CPN) occurs commonly in rats, more frequently and severely in males than females. High-grade CPN is characterized by increased layers of the renal papilla lining, designated as urothelial hyperplasia in the International Harmonization of Nomenclature and Diagnostic Criteria classification. However, urothelium lining the pelvis is not equivalent to the epithelium lining the papilla. To evaluate whether the epithelium lining the renal papilla is actually urothelial in nature and whether CPN-associated multicellularity represents proliferation, kidney tissues from aged rats with CPN, from rats with multicellularity of the renal papilla epithelium of either low-grade or marked severity, and from young rats with normal kidneys were analyzed and compared. Immunohistochemical staining for uroplakins (urothelial specific proteins) was negative in the papilla epithelium in all rats with multicellularity or not, indicating these cells are not urothelial. Mitotic figures were rarely observed in this epithelium, even with multicellularity. Immunohistochemical staining for Ki-67 was negative. Papilla lining cells and true urothelium differed by scanning electron microscopy. Based on these findings, we recommend that the epithelium lining the papilla not be classified as urothelial, and the CPN-associated lesion be designated as vesicular alteration of renal papilla instead of hyperplasia and distinguished in diagnostic systems from kidney pelvis urothelial hyperplasia.

Profil CT-Scan Non-kontras pada Penderita Nefrolitiasis di Bagian Radiologi FK Unsrat/SMF Radiologi RSUP Prof. Dr. R. D. Kandou Manado periode 1 Januari – 30 Agustus 2016

Nephrolitiasis is a disease indicated by the existence of a single or more solid masses of hard material in the kidney tubule, calyx, infundibulum, kidney pelvis, and the whole parts of the kidney. Imaging such as non-contrast CT-Scan is usually used to ascertain the diagnosis of nephrolitiasis. This study was aimed to obtain the profile of non-contrast CT-Scan of the kidney performed on nephrolithiasis cases at Radiology Division of Medical Faculty University of Sam Ratulangi/Prof. Dr. R. D. Kandou Hospital Manado in the period of January 1 to Agust 30, 2016. This was a descriptive retrospective study using medical records at the Radiology Division. The results showed that there were 63 cases of nephrolitiasis in this study. The highest percentages were in males (71.43%) and age group of 56-65 tahun (25.39%). According to the location, most cases with bilateral nephrolitiasis (25.39%). Complication of hydronephrosis was found in 14.29% of cases. Conclusion: Based on the non-contrast CT-Scan of the kidney, most nephrolithiasis cases were found in males, age group of 46-55 years, bilateral nephrolithiasis, and without complication.Keywords: non-contrast CT-Scan of the kidney, nephrolitiasisAbstrak: Nefrolitiasis merupakan suatu penyakit dengan gejala ditemukannya satu atau beberapa massa keras yang terdapat di dalam tubuli ginjal, kaliks, infundibulum, pelvis ginjal, serta seluruh bagian ginjal. Pemeriksaan yang sering digunakan dalam penegakan diagnosis nefrolitiasis ialah pemeriksaan imaging, salah satunya CT-Scan. Penelitian ini bertujuan untuk mengetahui profil CT-Scan non-kontras pada penderita nefrolitiasis di Bagian Radiologi Fakultas Kedokteran Universitas Sam Ratulangi/RSUP Prof. Dr. R. D. Kandou Manado periode 1 Januari-30 Agustus 2016. Jenis penelitian ialah deskriptif retrospektif dengan memanfaatkan data rekam medik di Bagian Radiologi RSUP Prof. Dr. R. D. Kandou Manado periode 1 Januari -30 Agustus 2016. Hasil penelitian mendapatkan 63 kasus nefrolitiasis dengan hasil CT-Scan ginjal non-kontras, lebih banyak terjadi pada laki-laki (71,43%) dan kelompok usia 46-55 tahun (33,33%). Berdasarkan letak batu, lebih sering ditemukan letak batu bilateral (36,68%). Komplikasi hidronefrosis ditemukan pada 14,29% kasus. Simpulan: Berdasarkan hasil CT-Scan non-kontras pada penderita nefrolitiasis didapatkan nefrolitiasis lebih sering ditemukan pada laki-laki, kelompok usia 46-55 tahun, dengan letak batu bilateral dan tanpa komplikasi.Kata kunci: CT-Scan tanpa kontras pada ginjal, nefrolitiasis

EXPRESSION miRNA-21 IN RENAL TISSUE AND URINE IN RATS WITH UNILATERAL URETERAL OBSTUCTION

THE AIM: to estimate the level of expression miRNA-21 inthe urine and renal tissue in rats with unilateral ureteral obstruction (UUO). MATHERIAL AND METHODS. UUO was induced by ligation of the left ureter in male Wistar rats (n=10). Follow-up period was 14 days after UUO modeling. Urine was collected one day before the operation (UmiRNA21C), and one day before the end of experiment (UmiRNA21I ) during 24 hours. Before releasing animal out of experiment collected urine from left kidney pelvis (UmiRNA21O) and tissue of left kidney (KmiRNA21O) and right kidney (KmiRNA21I). MiRNA-21 expression in kidney tissues and urine was carried out with reaction amplification (RealTime PCR-protocol). Calculation was realized by 2-deltaCtmethod. Statistical analysis was performed with Wilcoxon test and Spearman correlation coefficient. Results are demonstrated as median [low – upper quartile]. RESULTS. UmiRNA21I(3.78[2.0-5.28]) and UmiRNA21O(3.78[3.25-3.82]) were significantly higher than UmiRNA21C (1.15[0.71-1.74]; P=0.0125 and P=0.0069, respectively). UmiRNA21I and UmiRNA21O values were practically equal. In kidneys with UUO the tissue levels of miRNA21 expression was a higher than in contralateral organ (P=0,0926). Revealed direct correlation between KmiRNAIand KmiRNAO(RS=0,770, P=0,0092). CONCLUSION. UOO can cause specific changes in the expression, distribution and excretion of micro RNA-21 and its role in the development of renal tubulointestitsial fibrosis requires further studies. Key words: miRNA-21, tubulointerstitial fibrosis, unilateral ureteral obstruction

Spontaneous Age-related Lesions of the Kidney Fornices in Sprague-Dawley Rats

The upper portion of the rat kidney pelvis has specialized anatomic structures referred to as fornices. Fornices have a role in urine concentration. Spontaneous lesions including mineralization, epithelial hyperplasia, and inflammatory cell infiltration may occur in the area of the fornices. However, little information regarding specific historical control data or the spontaneous development of these findings in male and female fornices is known. Understanding spontaneous age-related lesions in the area of the fornices versus other portions of the kidney pelvis may be relevant in the identification of test article–induced changes. A retrospective study was conducted of male and female Sprague-Dawley rat kidney fornices over several time points to determine the incidence and severity of mineralization, epithelial hyperplasia, and inflammatory cell infiltration. Based on this investigation, these lesions appeared to increase over time and, in general, occurred earlier and with a greater incidence in females. Regarding those chemicals that may result in lesions of the kidney pelvis, it may be important for pathologists to separately diagnose lesions of the fornices from other portions of the kidney pelvis to help differentiate between any spontaneous age-related and induced changes.

GAMBARAN ULTRASONOGRAFI GINJAL PADA PENDERITA NEFROLITIASIS DIBAGIAN RADIOLOGI FK UNSRAT BLU RSUP PROF. DR. R. D. KANDOU MANADO PERIODE 1 JANUARI – 30 JUNI 2014

Nephrolithiasis is a disease which the symptom is indicated by the existence of a single or more solid mass of hard material like a stone which is found in the kidney tubule, calyx, infundibulum, kidney pelvis, and the whole of kidney calyx of the sufferer. Mostly, the doctors use imaging like ultrasonography to checkup the patients’ condition in order to ascertain the diagnosis of nephrolithiasis. Ultrasonography can give the spesific image if there is any stone located in the kidney. As a result, doctors will get some easiness in determining the patients diagnosis. The objective of this research is to figure out the kidney image resulted from ultrasonography of nephrolithiasis sufferers in Radiology Division, Medical Faculty, Samratulangi University/ Faculty Students Senate of Radiology, Public Service Corporation of Prof. Dr. R. D. Kandou Hospital, Manado, In the period of January 1st – June 30th 2014.The researcher used descriptive retrospective as the research method. By using medical notes found in Radiology Division, Public Service Corpration of Prof. Dr. R. D. Kandou Hospital, Manado, In the period of January 1st – June 30th 2014 as secondary data. Conclusion:The researcher then found that there were 105 cases of nephrolithiasis from totally result of kidney ultrasonography to the sufferers of nephrolithiasis. Many of the suferrers were men (62,9%) in average ages from 56 to 65 years old (36,2%). According to the location, kidney stone were found mostly in bilateral nepholithiasis (37,1%). The resercher also figured out that most of nephrolithiasis sufferers had a complication with chronic kidney disease (39,0%) and complication with hidronephrosis (19,0%). The patients who complain about pain on their weists should have kidney ultrasonography test to help the doctor to diagnose the causes, to avoid the possibity of another abnormal organ, and prevent the serious nephrolithiasis causes.Keywords: kidney ultrasonography, nephrolithiasisAbstrak: Nefrolitiasis merupakan suatu penyakit dengan gejala ditemukannya satu atau beberapa massa keras seperti batu yang terdapat di dalam tubuli ginjal, kaliks, infundibulum, pelvis ginjal, serta seluruh kaliks ginjal. Pemeriksaan yang sering digunakan dalam penegakan diagnosis nefrolitiasis adalah pemeriksaan imaging salah satunya adalah Ultrasonografi.Ultrasonografi dapat memberikan gambaran yang jelas apabila terdapat batu yang berlokasi di ginjal. Sehingga mempermudah dokter untuk menentukan diagnosis pasien. Tujuan penelitian ini untuk mengetahui gambaran hasil Ultrasonografi ginjal pada penderita Nefrolitiasis di Bagian Radiologi FK UNSRAT/SMF Radiologi BLU RSUP Prof. Dr. R. D. Kandou Manado Periode 1 Januari – 30 Juni 2014.Penelitian ini merupakan penelitian deskriptif retrospektif dengan memanfaatkan data sekunder berupa catatan medik yang terdapat di Bagian Radiologi BLU RSUP Prof. Dr. R. D. Kandou Manado Periode 1 Januari – 30 Juni 2014. Simpulan:Keseluruhan hasil Ultrasonografi ginjal pada penderita Nefrolitiasis ditemukan 105 kasus nefrolitiasis, dengan penderita nefrolitiasis lebih banyak terjadi padalaki-laki(62,9%).Penderita nefrolitiasis terbanyak pada kelompok umur 56 – 65 tahun (36,2%).Penderita nefrolitiasis berdasarkan letak batu yaitu nefrolitiasis bilateral (37,1%).Penderita nefrolitiasis dengan komplikasi CKD yaitus ebanyak (39,0%).Penderita nefrolitiasis dengan komplikasi Hidronefrosis yaitu sebanyak (19,0%). Penderita yang datang dengan keluhan rasa nyeri pada daerah pinggang sebaiknya dipastikan penyebabnya melalui pemeriksaan Ultrasonografi ginjal untuk membantu mendiagnosis, menyingkirkan kemungkinan kelainan pada daerah organ lainnya dan mencegah memberatnya penyebab nefrolitiasis.Kata kunci: ultrasonografi ginjal, nefrolitiasis