Nordeval Cavalcante Araújo

Doença parenquimatosa renal: correlação histológico-sonográfica

PURPOSE: This study was designed to address the correlation between sonography of a kidney with histological lesions and clinical findings in patients with renal parenchymal disease based on a multivariate logistic regression analysis. METHODS: Clinical and laboratory data, sonograms and renal biopsies were evaluated in 154 patients. Cortical echogenicity was graded as less than (0), equal to (1) or greater than (2) liver/spleen parenchyma. Histological lesions - mesangial proliferation (MP), leukocyte permeation (LP), fibrinoid necrosis and crescents (FNC), interstitial infiltrate (II), segmental glomerular sclerosis (SGS), glomerular obsolescence (GO), tubular atrophy (TA) interstitial fibrosis (IF) and interstitial edema (IE) - were graded according to extension and severity as normal (0%), mild ( 25% 50%). RESULTS: a) II, IF, SGS, IE and increased creatinine occurred less in cortical echogenicity grade 0; b) MP, arterial hypertension and normal parenchymal thickness predict cortical echogenicity grade 1; c) IF, IE, increased creatinine and thin parenchyma predict occurrence of echogenicity grade 2; d) Excluding obese patients, both youth and hematocrit accounted for pyramid prominence; e) increased creatinine and GO was probable in patients with small kidneys. CONCLUSIONS: Increased cortical echogenicity was a very sensitive marker of renal parenchymal disease. Different lesions rather than degree of lesion severity accounted for progressive increase of cortical echogenicity. IE exponentially increased the effect of IF on cortical echogenicity.

Um índice clínico preditor de sobrevida renal

INTRODUCTION: A clinical index that discriminates disease progression independent of histopathologic features may be valuable in the best timing of biopsy. OBJECTIVE: This study addresses the question if a clinical index based on cortical echogenicity, renal length to body height ratio (KL/H), and serum creatinine levels predicts renal survival. METHODS: The study enrolled 154 patients. Biopsy specimens were graded for chronic (glomerular obsolescence, segmental glomerular sclerosis, tubular atrophy and interstitial fibrosis) and acute (mesangial proliferation, leucocyte permeation, crescent and fibrinoid necrosis and interstital infiltrate) index by the sum of scored lesions. A chronic clinical index was created by the sum of scored cortical echogenicity relative to liver or spleen, creatinine serum levels and KL/H. The study end point was start on dialisis. RESULTS: Higher grade of chronic clinical and biopsy indices were associated with poorer long-term renal survival. Five out of six patients with serum creatinine levels > 2.5mg/dL, highest cortical echogenicity and KL/H < 0.60, before biopsy, startet on dialysis and one increased creatinine levels up to 4.5 mg/dL. The chronic clinical index correlates well with chronic biopsy index. CONCLUSIONS: The chronic clinical index could be useful to predict a clinical setting in which a renal biopsy will show advanced chronic and irreversible lesion. In patients with highest grade of clinical parameters renal biopsy can be obviate. As a chronicity of illness index for groups of patients with renal medical diseases, the system could be useful in outcome comparisons and evaluation of therapeutic efficacy.

Águas minerais de algumas fontes naturais brasileiras

PURPOSE To divulge information on the chemical composition and physical-chemical features of some mineral waters from Brazilian natural sources that will be of useful protocol investigation and patient advice. METHODS The survey was based on bottle labels of non-gaseous mineral waters commercially available in the city of Rio de Janeiro. The íon concentration of each mineral was calculated from the salt content. RESULTS 36 springs were enralled from different states of the country. The pH (25 degrees C), 4.1 to 9.3, varied on dependence of the source and it was linearey correlated with the cations calcium, magnesium and sodium and the anion bicarbonate. It was atributed to high alkalinity (about 70% of bicarbonate in the molecula-gram) of these salts. The calcium (0.3 to 42 mg/l), magnesium (0.0 to 18 mg/l) and bicarbonate (4 to 228 mg/l) contents are relatively low. CONCLUSION The mineral content of the Brazilian springs enrolled in this survey is low; about 70% of the sources having calcium and magnesium less than 10 mg/l and 1.0 mg/l, respectively, similar to local tap water.Paciente de litiase renal e estimulado a aumentar a ingestao hidrica, principalmente na forma de agua tratada da torneira, pela irrelevante biodisponibilidade de minerais em sua composicao. O beneficio e atribuido a reducao da saturacao dos sais urinarios. Nao esta claro se as aguas minerais naturais comercialmente disponiveis tambem e benefica. OBJETIVO. Divulgar as informacoes sobre as caracteristicas quimicas e fisico-quimicas de aguas minerais naturais de algumas das diversas fontes brasileiras. Essas informacoes serao de utilidade na analise de protocolos de pesquisa e na orientacao do paciente. METODOS. Foi feito uma coletânea das informacoes que constam nos rotulos de garrafas de aguas minerais naturais, predominantemente nao-gasosas, acessiveis ao consumo carioca. A partir da composicao salina provavel, foi calculada a concentracao ionica de cada mineral. RESULTADOS. Foram estudadas as informacoes de 36 fontes situadas em alguns estados brasileiros. O pH, a 25oC, variou de 4,1 a 9,3 na dependencia da fonte e foi linearmente correlacionado com as concentracoes dos cations calcio, magnesio, sodio e do anion bicarbonato. Isto foi atribuido a alta alcalinidade desses sais, que contem cerca de 70% de bicarbonato na molecula. Os teores de calcio (0,3 a 42 mg/l), de magnesio (0,0 a 18 mg/l) e de bicarbonato (4 a 228 mg/l) foram considerados relativamente baixos. CONCLUSAO. O teor mineral das fontes brasileiras que compuseram esse levantamento e baixo, com cerca de 70% delas apresentando teores de calcio e de magnesio abaixo de 10 mg/l e 1 mg/l, respectivamente, semelhantes ao da agua tratada da torneira.

Achados de ultrassonografia transcraniana na doença de Parkinson e no tremor essencial: relato de casos

Over the last years, transcranial sonography has been investigated as a diagnostic tool in neurology. It allows a good visualization of midline brain structures, a frequent site of involvement in movement disorders. The authors discuss cases of Parkinsons disease and essential tremor where transcranial sonography could suggest the diagnosis of the condition.

Postbiopsy Arteriovenous Fistula in Renal Transplant: Two Cases of Spontaneous Resolution:

Spontaneous outcomes of percutaneous biopsy-related arteriovenous fistulas in renal allografts instead of embolization are reported by describing two cases of postbiopsy arteriovenous fistula followed by color Doppler sonography (CDS). One patient developed gross hematuria, but no intervention was required. Doppler application showed spontaneous resolution in both cases but later in the patient with hematuria. Both cases support close observation, including CDS, as another alternative to early embolization.

Contrast-Enhanced Ultrasound Reveals Masked Post-Baseline Wedge Transplant Biopsy Pseudoaneurysm

Biopsy of the transplanted kidney is known to cause intraparenchymal renal vascular injury. The most common vascular complications include arteriovenous fistula (AVF) and pseudoaneurysm (PA). We report a case of a patient who underwent cadaveric renal transplantation and developed an AVF and a PA after an on-table wedge biopsy. The PA was missed during the standard Doppler sonographic examination because of its small size but was unmasked with the use of contrast-enhanced ultrasound (CEUS). Fourteen days after the first CEUS, the procedure was repeated and showed complete thrombosis of the PA.

Screening for CLCN5 mutation in renal calcium stone formers patients

UNLABELLED Thirty-five patients (23 males and 12 females), age 35 +/- 13 years old, presenting either idiopathic calcium nephrolithiasis, nephrocalcinosis or mild renal failure with idiopathic calcium nephrolithiasis were selected for the analysis of low molecular weight proteinuria and the possible mutations occurrence in the chloride channel gene CLCN5. The urinary ratio of beta2-microglobulin and creatinine (beta2M/Cr) was very high in a transplanted woman with nephrocalcinosis (> 3.23 mg/mmol) and slightly high in five patients (> 0.052 or < 1.0 mg/mmol) with multiple urological manipulations. Other studied patients showed beta2M/Cr ratio at normal range (0.003-0.052 mg/mmol) without gender difference (p > 0.05). Mutation analysis of CLCN5 gene was performed in 26 patients of 35 selected (11 with idiopathic hypercalciuria; 6 men with normal calciuria; 3 with mild renal insufficiency and 6 with nephrocalcinosis) and was normal in all subjects even in those with abnormal molecular weight proteinuria. CONCLUSION CLCN5 gene mutation is not a common cause of kidney stone disease or nephrocalcinosis in a group of Brazilian patients studied.

Oncocitoma renal em paciente transplantado: achados de imagem naultrassonografia com contraste

Abstract Renal oncocytoma is an infrequently reported renal neoplasm, often asymptomatic, which usually behaves as a benign entity and is identified accidentally on radiological imaging. Transplant patients under long-term immunosuppressive drugs have a high prevalence of cancers, such as skin cancers, lymphoproliferative disorders, and renal carcinomas. We present a case report of an asymptomatic renal oncocytoma in a kidney transplant recipient presenting persistent hematuria. The features of computed tomography and contrast-enhanced ultrasound (CEUS) are presented. This was the first time we used CEUS in a transplant kidney recipient presenting a renal mass, allowing the real-time visualization of contrast-enhancement patterns during all vascular phases for the differential diagnosis of renal tumors. Although the pattern of intense vascularization could mislead to an early judgment as a malignant lesion, it could help to exclude other renal lesions without inducing nephrotoxicity.Renal oncocytoma is an infrequently reported renal neoplasm, often asymptomatic, which usually behaves as a benign entity and is identified accidentally on radiological imaging. Transplant patients under long-term immunosuppressive drugs have a high prevalence of cancers, such as skin cancers, lymphoproliferative disorders, and renal carcinomas. We present a case report of an asymptomatic renal oncocytoma in a kidney transplant recipient presenting persistent hematuria. The features of computed tomography and contrast-enhanced ultrasound (CEUS) are presented. This was the first time we used CEUS in a transplant kidney recipient presenting a renal mass, allowing the real-time visualization of contrast-enhancement patterns during all vascular phases for the differential diagnosis of renal tumors. Although the pattern of intense vascularization could mislead to an early judgment as a malignant lesion, it could help to exclude other renal lesions without inducing nephrotoxicity.

The Potential for CEUS to Detect Segmental Renal Allograft Infarction Case Report

This case study provides a report on a patient who had a segmental renal allograft infarction. The cause of this infarction within the segmental vessels was theorized to be due to prolonged warm ischemia within the organ donor. The area of infarction was visualized by the use of contrast-enhanced ultrasound (CEUS). This report raises the question as to whether routine sonographic imaging can demonstrated the sequence of infarction within a fresh renal allograft, as is routinely noted in native kidneys. This report highlights the importance of taking the segmental infarction into consideration when approaching the renal allograft recipient. CEUS could provide an important clinical application for the diagnosis of renal allograft infarctions and avoid more invasive procedures. Knowledge of the lack of sequence of sonographic changes in renal allograft infarction helps in assessing the function and outcomes of renal allograft recipients.

Imaging Features of Renal Capsule Leiomyoma on Contrast-Enhanced Ultrasonography: A Case Report:

Leiomyomas of the kidney are rare, mostly occurring in adults as incidental findings, and are a diagnostic challenge. In a renal transplant recipient population, an increased risk of tumors is observed due to the effect of immunosuppressive drugs. A differential diagnosis between leiomyomas and other malignant lesions is not possible with current imaging methods. This report presents a case of a native kidney capsular leiomyoma in a kidney transplant recipient and highlights the features of computed tomography and contrast-enhanced ultrasound (CEUS), along with the histopathologic analysis. The CEUS and quantification studies are helpful in demonstrating the vascularization pattern of the renal capsular leiomyoma. This entity appearing with chronic kidney disease can resemble a renal cell carcinoma, in an otherwise healthy kidney. In this case, CEUS was useful for diagnosing the vascularization of the renal mass, although the pattern of intense vascularization could be diagnostically misleading, implying a malignant lesion. However, the pattern of enhancement due to CEUS showed no peculiarities that indicated histopathologic diagnosis.