BACKGROUND The study focuses on the use of multi-parametric ultrasound[gray scale,color Doppler and shear wave elastography(SWE)]to differentiate stable renal allografts from acute graft dysfunction and to assess time...BACKGROUND The study focuses on the use of multi-parametric ultrasound[gray scale,color Doppler and shear wave elastography(SWE)]to differentiate stable renal allografts from acute graft dysfunction and to assess time-dependent changes in parenchymal stiffness,thereby assessing its use as an efficient monitoring tool for ongoing graft dysfunction.To date,biopsy is the gold standard for evaluation of acute graft dysfunction.However,because it is invasive,it carries certain risks and cannot be used for follow-up monitoring.SWE is a non-invasive imaging modality that identifies higher parenchymal stiffness values in cases of acute graft dysfunction compared to stable grafts.AIM To assess renal allograft parenchymal stiffness by SWE and to correlate its findings with functional status of the graft kidney.METHODS This prospective observational study included 71 renal allograft recipients.Multi-parametric ultrasound was performed on all patients,and biopsies were performed in cases of acute graft dysfunction.The study was performed for a period of 2 years at Sanjay Gandhi Postgraduate Institute of Medical Sciences,Lucknow,a tertiary care center in north India.Independent samples t-test was used to compare the means between two independent groups.Paired-samples t-test was used to test the change in mean value between baseline and follow-up obser-vations.RESULTS Thirty-one patients had experienced acute graft dysfunction at least once,followed by recovery,but none of them had a history of chronic renal allograft injury.Mean baseline parenchymal stiffness in stable grafts and acute graft dysfunction were 30.21+2.03 kPa(3.17+0.11 m/s)and 31.07+2.88 kPa(3.22+0.15 m/s),respectively;however,these differences were not statistically significant(P=0.305 and 0.252,respectively).There was a gradual decrease in SWE values during the first 3 postoperative months,followed by an increase in SWE values up to one-year post-transplantation.Patients with biopsy-confirmed graft dysfunction showed higher SWE values compared to those with a negative biopsy.However,receiver operating characteristic analysis failed to show statistically significant cut-off values to differentiate between the stable graft and acute graft dysfunction.CONCLUSION Acute graft dysfunction displays higher parenchymal stiffness values compared to stable grafts.Therefore,SWE may be useful in monitoring the functional status of allografts to predict any ongoing dysfunction.展开更多
BACKGROUND Open ureteric reimplantation by cross trigonal technique described by Cohen is considered a common surgical option for correction of vesicoureteral reflux(VUR). There is a lack of evidence in literature tho...BACKGROUND Open ureteric reimplantation by cross trigonal technique described by Cohen is considered a common surgical option for correction of vesicoureteral reflux(VUR). There is a lack of evidence in literature though for what happens to such kidneys, in the long run, particularly those which are poorly functioning.AIM To assess the long-term outcomes of ureteric reimplantation in poorly functioning kidneys in children with unilateral primary VUR.METHODS Children with unilateral primary VUR and a relative renal function of less than 35% who underwent open or laparoscopic ureteric reimplantation between January 2005 and January 2017 were included in the study. Patients who had a follow up of less than five years were excluded. Preoperative evaluation consisted of a voiding cystourethrogram and Dimercaptosuccinic acid(DMSA) scan. In the follow-up period, patients underwent a diuretic scan at 6 weeks and 6 months.Follow up ultrasound was done for change in grade of hydronephrosis and retrovesical ureteric diameter. Subsequent follow up was done at 6 monthly intervals with evaluation for proteinuria and hypertension and any recurrent urinary tract infection(UTI). For assessment of cortical function, DMSA was repeated annually for 5 years after surgery. A paired-samples t-test was used to test the mean difference of DMSA between pre-post observations.RESULTS During this period, 36 children underwent ureteric reimplantation for unilateral primary VUR. After excluding those with insufficient follow-up, 31 were included in the analysis. Most of the patients were males(n = 26/31, 83.8%). Patient’s age(mean ± SD, range) was 5.21 ± 3.71, 1-18 years. The grades of VUR were grade Ⅱ(1patient), grade Ⅲ(8 patients), grade Ⅳ(10 patients), and grade Ⅴ(12 patients). The pre and postoperative DMSA was 24.064 ± 12.02 and 24.06 ± 10.93, which was almost the same(statistically equal, paired-samples t-test: P = 0.873). The median(range) follow-up duration was 82(60-120)mo. One patient had persistent reflux after surgery(preoperative: grade Ⅳ, postoperative: grade Ⅲ), and the very same patient developed recurrent UTI. The difference in the preoperative and postoperative DRF was less than 10% in 29 patients. In one patient, the DRF decreased by 17%(22% to 05%) while in another patient, the DRF increased by 12%(25% to 37%) after surgery. None of the patients had an increase in scarring after surgery. 15% of patients were hypertensive before surgery and all of them continued to be hypertensive after surgery while none developed hypertension after surgery. None of the patients had significant proteinuria(> 150 mg/d) during the follow-up period.CONCLUSION Children with unilateral primary VUR and poorly functioning kidney maintain the renal function over the long term in most cases. Hypertension and proteinuria do not progress over time in these patients.展开更多
文摘BACKGROUND The study focuses on the use of multi-parametric ultrasound[gray scale,color Doppler and shear wave elastography(SWE)]to differentiate stable renal allografts from acute graft dysfunction and to assess time-dependent changes in parenchymal stiffness,thereby assessing its use as an efficient monitoring tool for ongoing graft dysfunction.To date,biopsy is the gold standard for evaluation of acute graft dysfunction.However,because it is invasive,it carries certain risks and cannot be used for follow-up monitoring.SWE is a non-invasive imaging modality that identifies higher parenchymal stiffness values in cases of acute graft dysfunction compared to stable grafts.AIM To assess renal allograft parenchymal stiffness by SWE and to correlate its findings with functional status of the graft kidney.METHODS This prospective observational study included 71 renal allograft recipients.Multi-parametric ultrasound was performed on all patients,and biopsies were performed in cases of acute graft dysfunction.The study was performed for a period of 2 years at Sanjay Gandhi Postgraduate Institute of Medical Sciences,Lucknow,a tertiary care center in north India.Independent samples t-test was used to compare the means between two independent groups.Paired-samples t-test was used to test the change in mean value between baseline and follow-up obser-vations.RESULTS Thirty-one patients had experienced acute graft dysfunction at least once,followed by recovery,but none of them had a history of chronic renal allograft injury.Mean baseline parenchymal stiffness in stable grafts and acute graft dysfunction were 30.21+2.03 kPa(3.17+0.11 m/s)and 31.07+2.88 kPa(3.22+0.15 m/s),respectively;however,these differences were not statistically significant(P=0.305 and 0.252,respectively).There was a gradual decrease in SWE values during the first 3 postoperative months,followed by an increase in SWE values up to one-year post-transplantation.Patients with biopsy-confirmed graft dysfunction showed higher SWE values compared to those with a negative biopsy.However,receiver operating characteristic analysis failed to show statistically significant cut-off values to differentiate between the stable graft and acute graft dysfunction.CONCLUSION Acute graft dysfunction displays higher parenchymal stiffness values compared to stable grafts.Therefore,SWE may be useful in monitoring the functional status of allografts to predict any ongoing dysfunction.
文摘BACKGROUND Open ureteric reimplantation by cross trigonal technique described by Cohen is considered a common surgical option for correction of vesicoureteral reflux(VUR). There is a lack of evidence in literature though for what happens to such kidneys, in the long run, particularly those which are poorly functioning.AIM To assess the long-term outcomes of ureteric reimplantation in poorly functioning kidneys in children with unilateral primary VUR.METHODS Children with unilateral primary VUR and a relative renal function of less than 35% who underwent open or laparoscopic ureteric reimplantation between January 2005 and January 2017 were included in the study. Patients who had a follow up of less than five years were excluded. Preoperative evaluation consisted of a voiding cystourethrogram and Dimercaptosuccinic acid(DMSA) scan. In the follow-up period, patients underwent a diuretic scan at 6 weeks and 6 months.Follow up ultrasound was done for change in grade of hydronephrosis and retrovesical ureteric diameter. Subsequent follow up was done at 6 monthly intervals with evaluation for proteinuria and hypertension and any recurrent urinary tract infection(UTI). For assessment of cortical function, DMSA was repeated annually for 5 years after surgery. A paired-samples t-test was used to test the mean difference of DMSA between pre-post observations.RESULTS During this period, 36 children underwent ureteric reimplantation for unilateral primary VUR. After excluding those with insufficient follow-up, 31 were included in the analysis. Most of the patients were males(n = 26/31, 83.8%). Patient’s age(mean ± SD, range) was 5.21 ± 3.71, 1-18 years. The grades of VUR were grade Ⅱ(1patient), grade Ⅲ(8 patients), grade Ⅳ(10 patients), and grade Ⅴ(12 patients). The pre and postoperative DMSA was 24.064 ± 12.02 and 24.06 ± 10.93, which was almost the same(statistically equal, paired-samples t-test: P = 0.873). The median(range) follow-up duration was 82(60-120)mo. One patient had persistent reflux after surgery(preoperative: grade Ⅳ, postoperative: grade Ⅲ), and the very same patient developed recurrent UTI. The difference in the preoperative and postoperative DRF was less than 10% in 29 patients. In one patient, the DRF decreased by 17%(22% to 05%) while in another patient, the DRF increased by 12%(25% to 37%) after surgery. None of the patients had an increase in scarring after surgery. 15% of patients were hypertensive before surgery and all of them continued to be hypertensive after surgery while none developed hypertension after surgery. None of the patients had significant proteinuria(> 150 mg/d) during the follow-up period.CONCLUSION Children with unilateral primary VUR and poorly functioning kidney maintain the renal function over the long term in most cases. Hypertension and proteinuria do not progress over time in these patients.
