Genitourinary Disorders

Intrarenal Resistive Index after Renal Transplantation.

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BACKGROUND

The intrarenal resistive index is routinely measured in many renal–transplantation centers for assessment of renal-allograft status, although the value of the resistive index remains unclear.

METHODS

In a single-center, prospective study involving 321 renal-allograft recipients, we measured the resistive index at baseline, at the time of protocol-specified renal-allograft biopsies (3, 12, and 24 months after transplantation), and at the time of biopsies performed because of graft dysfunction. A total of 1124 renal-allograft resistive-index measurements were included in the analysis. All patients were followed for at least 4.5 years after transplantation.

RESULTS

Allograft recipients with a resistive index of at least 0.80 had higher mortality than those with a resistive index of less than 0.80 at 3, 12, and 24 months after transplantation (hazard ratio, 5.20 [95% confidence interval {CI}, 2.14 to 12.64; P<0.001]; 3.46 [95% CI, 1.39 to 8.56; P=0.007]; and 4.12 [95% CI, 1.26 to 13.45; P=0.02], respectively). The need for dialysis did not differ significantly between patients with a resistive index of at least 0.80 and those with a resistive index of less than 0.80 at 3, 12, and 24 months after transplantation (hazard ratio, 1.95 [95% CI, 0.39 to 9.82; P=0.42]; 0.44 [95% CI, 0.05 to 3.72; P=0.45]; and 1.34 [95% CI, 0.20 to 8.82; P=0.76], respectively). At protocol-specified biopsy time points, the resistive index was not associated with renal-allograft histologic features. Older recipient age was the strongest determinant of a higher resistive index (P<0.001). At the time of biopsies performed because of graft dysfunction, antibody-mediated rejection or acute tubular necrosis, as compared with normal biopsy results, was associated with a higher resistive index (0.87±0.12 vs. 0.78±0.14 [P=0.05], and 0.86±0.09 vs. 0.78±0.14 [P=0.007], respectively).

CONCLUSIONS

The resistive index, routinely measured at predefined time points after transplantation, reflects characteristics of the recipient but not those of the graft.

 

Souirce: NEJM

 

 

Striking cysts: recurrent haematuria in a kickboxer.

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A 42-year-old man presented with recurrence of haematuria after extensive body-building exercises.

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He had a history of renal failure due to polycystic kidney disease, complicated by recurrent bleeding, particularly after kickboxing or body-building exercises. Ultrasonography  and abdominal CT scan without contrast  showed widespread polycystic kidney and liver disease. However, the source of bleeding could not be identified. MRI (T2-weighted, half-Fourier acquired single-shot turbo spin echo) showed multiple cysts with decreased signal density , suggestive of recent bleeding; this was further confirmed by distinct fluid levels in some of the cysts. Cyst bleeding is a common complication of polycystic kidney disease, occurring in 30—50% of cases. Our case shows that trauma can be a causative factor. MRI can elegantly reveal the exact location of cysts in which recent bleeding has occurred.

Source: Lancet

Emphysematous cystitis.

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A 55-year-old man with a history of aortic valve replacement was admitted because of pelvic pain. He had been treated with antibiotics over the past 4 weeks for a presumed lower urinary tract infection with fever. Treatment had been unsuccessful. Both urine and blood cultures grew Enterobacter cloacae. Abdominal radiography showed a thin line of air within the bladder wall, outlining its perimeter .A bacteraemic emphysematous cystitis complicated by prosthetic valve endocarditis was diagnosed, and effective antibiotic treatment was initiated.

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Emphysematous cystitis is a potentially life-threatening condition caused by gas-producing pathogens. This rare form of urinary tract infection typically occurs in middle-aged diabetic women. Contrary to radiological findings, clinical features are non-specific (irritative bladder symptoms, pyuria, haematuria, and, rarely, pneumaturia). Plain abdominal radiography, as well as ultrasonography, may lead to the diagnosis but CT scan is regarded as the procedure of choice, particularly to rule out a vesicocolic fistula. Early diagnosis and management consists of antibiotic therapy, bladder drainage, and sometimes surgery.

Source: Lancet

No Relation Between Length of Treatment for UTIs and Early Recurrence in Men.

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How long to continue antibiotics in men with urinary tract infections is still up for debate.

 

Most research to examine length of antibiotic treatment for uncomplicated urinary tract infections (UTIs) has been conducted in women, for whom clinical guidelines are well established. In a retrospective study of 33,336 veterans with uncomplicated UTIs (all outpatients; mean age, 68; median antibiotic-therapy duration, 10 days), researchers explored whether length of antibiotic therapy was associated with recurrence in men. Most patients received ciprofloxacin or trimethoprim-sulfamethoxazole; about one third were treated for 7 days, and the rest were treated for >7 days.

Researchers found 1373 cases of early recurrence (at 30 days; 4% of the cohort) and 3313 cases of late recurrence (at >30 days; 10%). In multivariate analyses, no difference was noted in risk for early recurrence between men who received longer- or shorter-duration initial treatment; risk for late recurrence was significantly higher among those who received longer-duration treatment than among those who received shorter initial courses (11% vs. 8%).

Comment: This retrospective study involved an administrative database that could not capture fully the many factors that influence clinical decision making and that also might be associated with recurrence (i.e., catheter use). However, this study does suggest that the same clinical trials that were conducted in women would be justified in men to develop more precise guidelines on length of treatment.

 

Source: Journal Watch General Medicine