Isolated Spontaneous Renal Artery Dissection Presented with Flank Pain

Spontaneous renal artery dissection is a rare but important cause of flank pain. We report a case of isolated spontaneous renal artery dissection in 56-year-old man complicated by renal infarction presented with flank pain. Doppler study pointed towards vascular pathology. Computed tomography (CT) angiography was used to make final diagnosis which demonstrated intimal flap in main renal artery with renal infarction

Can deceased donor with recurrent primary brain tumor donate kidneys for transplantation?

Kidney transplantation from deceased donors is in its infancy in India. Cadaver organ donation was accepted legally in 1994 by the “Human Organs Transplantation Act.” Marginal donors are now accepted by many centers for kidney transplantation. We report a case of procurement of both kidneys from a young deceased donor having recurrent primary brain tumor, transplanted into two adult recipients with successful outcome

Generalized seizure: A rare etiology of intraperitoneal rupture of the urinary bladder

Seizures can lead to different types of injuries which can be as simple as minor lacerations and at times as serious as fractures and head injuries. We are reporting a case wherein a female patient presented with a history of abdominal pain and not passing urine for 24h following an attack of seizure. After catheterization the urine drained was blood-stained. On clinical suspicion a cystogram was done which showed intraperitoneal rupture of the bladder. At laparotomy an isolated rent in the dome of the bladder was found which was repaired in three layers. Postoperative period was uneventful. To our knowledge this is the second case of its kind reported in the literature. Our case illustrates that a thorough abdominal examination is desirable while examining a patient following an episode of generalized seizure

Retroperitoneoscopic partial nephrectomy for renal cell carcinoma: A single-center Indian experience

Objective: Retroperitoneoscopy, by avoiding peritoneal breach and injury to intra-abdominal organs, provides a more direct and rapid access to the kidney and the renal hilum. Laparoscopic partial nephrectomy by retroperitoneal route (LPNR) is less commonly performed than transperitoneal route for early stage renal cancer. The objective of this study is to carry out the outcomes of partial nephrectomy using retroperitoneal approach. Materials and Methods: Patients, who underwent LPNR from period 2008 to 2014, were retrospectively analyzed. Outcomes of interest included demographic data, preoperative data, perioperative variables, surgical complications, recurrence of disease, and mortality, if any, during their follow-up. Results: Among 24 patients, 16 were male, and 8 were female. Mean age and mean body mass index, respectively, were 49.16 years (range: 25–75) and 25.35 kg/m2 (17.84–34.25). Among renal masses, the right-sided to left-sided distribution was 13:11. The proportions of low-risk and intermediate-risk nephrometry score (NS) cases were 13 (54.17%) and 11 (45.83%), respectively, as assessed by renal NS. Mean operative duration, mean warm ischemia time, mean estimated blood loss, and mean hospital stay, respectively, were 132.5 min (90–170), 21.83 min (15–44), 106 ml (25–300) ml, and 5.25 days. During the postoperative period, complications encountered were lung atelectasis in one, bleeding in two, and urinary leakage in one. Histopathology revealed malignancy in 23 patients and leiomyoma in the remaining one. All patients but two experienced a disease free survival during a median follow- up period of 33 months. Conclusion: Overall outcomes for LPNR is comparable to the outcomes for open and transperitoneal laparoscopic partial nephrectomy mentioned in the literature and is equally safe for the right-sided and left-sided lesions

Six end-stage renal disease patients benefited from first non-simultaneous single center 6-way kidney exchange transplantation in India

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Expanding the donor pool for kidney transplantation in India

The best and most cost-effective treatment for end-stage renal disease patients is living donor (LD) renal transplantation. It has survival benefit compared to deceased donor (DD) kidney transplant (DDKT) and long-term dialysis and provides a better quality of life. Efficient and effective kidney allocation methods are increasingly necessary to address the problem of organ scarcity. The use of kidney paired donation transplant has increased access to LD kidney transplantation (LDKT) with outstanding results. ABO-incompatible kidney transplantation (KT) and desensitization protocol can expand the donor pool, but as integral to any aggressive immunosuppression protocol, they are associated with increased risk of infection and malignancy. Given the widespread organ shortage, DDKT from donors with sepsis, donors who died from snakebite or acute kidney injury, controlled donation after cardiac death, older donors, can be considered for KT with an acceptable outcome. The acceptable outcome can be achieved with dual KT using kidneys from expanded criteria donors in older population. Dual KT from pediatric donors to adult recipients or from adult marginal DDs is a promising way to expand the donor pool. Carefully selected donor with HIV, HCV, and HBV positivity is not a contraindication for living kidney donation. Careful and meticulous selection of patient and donor is essential for successful outcome. Affordable or free transplantation is other way to increase transplantation rate in developing country. The community support can make transplantation available free to the poor patients under community-government partnership. Various steps should be taken to promote LDKT and DDKT program