ORCID Profile
0000-0002-2618-6750
Current Organisation
Flinders Medical Centre
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Publisher: Springer Science and Business Media LLC
Date: 16-01-2023
DOI: 10.1007/S11255-023-03463-X
Abstract: To evaluate whether symptomatic recurrent nephrolithiasis leads to loss of kidney function. Adults who presented to the Emergency Department at least twice with symptomatic and radiologically confirmed nephrolithiasis were retrospectively recruited. Primary endpoint was the change in glomerular filtration rate (GFR) between baseline and at the time of data collection. Secondary endpoints include GFR slope defined as the mean rate of change in GFR from baseline to the end of the study period. 240 patients had recurrent symptomatic nephrolithiasis. Median follow-up was 5.4 years. The median age of first acute presentation was 51.6 years and the median baseline serum creatinine (bsCr) was 85.5 umol/l. 17.5% ( n = 42) had worsening GFR, with the average change in GFR of − 8.64 ml/min/1.73 m 2 per year. Four patients progressed to ESKD requiring haemodialysis. 14.5% ( n = 35) had calcium oxalate stones. Univariate analysis showed older patients ( p 0.001), more symptomatic stone episodes ( p 0.001) and non-calcium-containing stones ( p 0.001) were strongly associated with deteriorating kidney function. Age ( p = 0.002) and number of acute stone episodes ( p = 0.011) were significant predictive factors when unadjusted to co-morbidities. Age ( p = 0.018) was the only predictive factor of worsening GFR when adjusted for co-morbidities. Average mean GFR slope was − 2.83/min/1.73 m 2 per year. Recurrent symptomatic nephrolithiasis is associated with loss of kidney function, in older patients, increased episodes of symptomatic nephrolithiasis and non-calcium-containing stones. Age is the only predictive factor for progression to chronic kidney disease in this subgroup.
Publisher: Hindawi Limited
Date: 10-12-2022
DOI: 10.1155/2022/1748141
Abstract: Background. We report and review the literature of two rare complications of simultaneous pancreas-kidney transplantation (SPKT) occurring in one patient. Case Report. A 39-year-old man with dialysis-dependent kidney failure secondary to type 1 diabetes mellitus underwent successful SPKT in October 2018. Three months later, he presented with an acute kidney injury (AKI) and returned to dialysis. Kidney scintigraphy showed a central photopenic region, and angiograms showed absent flow in the kidney transplant artery without treatable thrombus and the incidental finding of two pseudoaneurysms of the pancreatic Y-graft. He remained dialysis-dependent for three weeks before spontaneous partial recovery of allograft function repeat kidney scintigraphy showed significant improvement in perfusion. However, in April 2019 he was readmitted with a sudden deterioration in kidney allograft function again necessitating haemodialysis. Repeat imaging confirmed that the kidney allograft had shifted from the left iliac fossa to the midline. He underwent surgical exploration, during which torsion of the kidney allograft was confirmed and a nephropexy was performed. The kidney allograft was originally implanted in the left retroperitoneum via a midline transperitoneal approach, which likely predisposed it to torsion. The pseudoaneurysms of the pancreatic Y-graft were managed conservatively, and surveillance imaging demonstrated that they remained stable in size. The patient regained reasonable kidney allograft function (estimated glomerular filtration rate, eGFR, of 45 mL/min) and maintained normal pancreatic allograft function. Conclusion. Kidney allograft torsion should be considered post-SPKT in patients with AKI and absent arterial flow. Although most case reports describe surgical management of pseudoaneurysms post-SPKT, our case demonstrates successful conservative management.
Publisher: Wiley
Date: 04-03-2021
DOI: 10.1111/NEP.13866
No related grants have been discovered for Rachel YP Tan.