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Poor Renal Function (poor + renal_function)
Selected AbstractsHigh incidence of and risk factors for metachronous bilateral upper tract urothelial carcinoma in TaiwanINTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2006PO-CHIEN HUANG Aim:, Urothelial carcinoma (UC) can occur multifocally in the whole urothelium. A higher rate of bilateral metachronous upper tract (UT) UC was noted in Taiwan. The incidence and risk factors were largely unknown and hence were explored in the study. Methods:, From January 1977 through June 2003, 462 patients with unilateral UT-UC were studied retrospectively. The cumulative incidence of contralateral recurrence was analysed with the Kaplan,Meier analysis. Potential risk factors for contralateral recurrence including age, smoking, bladder cancer, renal function, diagnostic year etc. were evaluated with the log,rank test. Independent risk factors were identified by using the Cox regression analysis. Results:, The median follow-up time was 34 months (6,337). Among the 462 patients, 52 (11.3%) developed metachronous contralateral UC. The 2, 5, and 10-year contralateral disease-free survivals were 93.5%, 84.0%, and 75.7%, respectively. The median time to contralateral recurrence was 31.0 months. With the univariate analysis, only poor renal function (serum creatinine < or ,2.0 mg/dL, P < 0.001) and late diagnostic year (before or after 1990, P < 0.001) were risk factors for contralateral recurrence. In the multivariate analysis, poor renal function (hazard ratio: 2.98; 95% confidence interval: 1.67,5.33; P < 0.001) and late diagnostic year (hazard ratio: 4.27; 95% confidence interval: 1.71,10.65; P = 0.002) remained independent risk factors. Conclusions:, The incidence of metachronous UT-UC is high in Taiwan. Patients who had either chronic renal insufficiency or a disease diagnosed after 1990 had a higher risk of contralateral recurrence. [source] Acucise endopyelotomy: A technique with limited ef,cacy for primary ureteropelvic junction obstruction in adultsINTERNATIONAL JOURNAL OF UROLOGY, Issue 10 2005STEFFEN WEIKERT Abstract Aim:, To retrospectively evaluate the ef,cacy of Acucise endopyelotomy in a series of patients with primary ureteropelvic junction obstruction (UPJO). Methods:, Twenty-four patients with a symptomatic primary UPJO underwent Acucise endopyelotomy. Patients with high-grade hydronephrosis and/or poor renal function were excluded. Patients were followed by ultrasound imaging, intravenous urography, diuretic renography, and clinical review. Results:, The overall success rate was 58% (14/24 patients), with a median follow up of 32 months. Of the ten patients in whom Acucise endopyelotomy failed, seven underwent open pyeloplasty, one required nephrectomy, and two received a permanent ureteral stent. A poor outcome was noted in patients without perioperative extravasation. Conclusions:, Our experience with Acucise endopyelotomy indicates that the success rate is lower than initially reported. Larger studies are needed to clarify the role of Acucise endopyelotomy in comparison with other techniques. [source] Imaging and intervention of retroperitoneal fibrosisJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 1 2007T Geoghegan Summary Retroperitoneal fibrosis is a rare condition characterized by the development of fibrous plaques in the retroperitoneal space. The fibrous plaques characteristically arise distal to the bifurcation of the abdominal aorta and progress to encase the iliac vessels distally and are defined by the associated encasement of one or both ureters. Imaging plays an important role in not only establishing the diagnosis, but also in monitoring disease progression. Historically, the radiological diagnosis was made predominantly by intravenous urography and retrograde pyelography. More recently, advances in cross-sectional imaging with ultrasound and contrast-enhanced CT have allowed for a more precise diagnosis as well as helping to accurately define the extent of the disease. At our institution, we have found ultra-fast MRI to also play a useful role in establishing the diagnosis. In particular, magnetic resonance urography using HASTE (half Fourier-acquired single shot turbo spin-echo) sequences allow a safe alternative to intravenous urography, particularly in patients with poor renal function. The purpose of this article is to describe the role of the various imaging methods available to the radiologist and to emphasize the important role that the interventional radiologist now plays, not only in obtaining tissue for diagnosis, but also in providing treatment of the disease by percutaneous nephrostomy drainage and subsequent stent placement in select cases. [source] Increased incidence of cardiovascular events in patients with antineutrophil cytoplasmic antibody,associated vasculitides: A matched-pair cohort studyARTHRITIS & RHEUMATISM, Issue 11 2009Matthew D. Morgan Objective To explore the risk of cardiovascular disease in patients with antineutrophil cytoplasmic antibody,associated vasculitides (AAVs) and to assess contributing risk factors. Methods In a retrospective matched-pair cohort study, 113 of 131 patients with AAVs from a vasculitis clinic registry were matched 1:1 for renal function, age at diagnosis, sex, smoking status, and previous history of a cardiovascular disease to patients with noninflammatory chronic kidney disease (CKD). Cardiovascular events were defined as acute coronary syndrome, new-onset angina, symptomatic peripheral vascular disease, stroke, and transient ischemic attack. Results Median followup times were 3.4 years for the AAV patients and 4.2 years for the CKD patients. More cardiovascular events occurred in the AAV group (23 of 113) than in the CKD group (16 of 113). Cox regression survival analysis showed a significantly increased risk of a cardiovascular event for AAV patients, with a hazard ratio (HR) of 2.23 (95% confidence interval [95% CI] 1.1,4.4) (P = 0.017). Within the cohort of AAV patients, the most strongly predictive factors were previous history of cardiovascular disease (HR 4 [95% CI 1.7,9.8]), history of dialysis dependency (HR 4.3 [95% CI 1.5,12.1]), ever having smoked (HR 3.9 [95% CI 1.5,10]), age at diagnosis (HR 1.038 [95% CI 1.006,1.072]), estimated glomerular filtration rate at remission (HR 0.977 [95% CI 0.957,0.998]), and serum cholesterol concentration at presentation (HR 0.637 [95% CI 0.441,0.92]). Conclusion In this retrospective study, patients with AAVs appear at greater risk of cardiovascular disease, with increased risk in those with a previous history of cardiovascular disease, dialysis dependency, poor renal function at remission, or a history of smoking. Measures to reduce the risk of cardiovascular disease should be integral to the management of systemic vasculitis. [source] | ||||||||||