CVIR award 2012-2013: Dr H. Westerlinck. An unusual complication after renal biopsy

Major complications after renal biopsy are those that don’t resolve spontaneously and are in need of an intervention (blood transfusion, angiography, cystoscopy, etc.). They occur in only 6,4% of the cases and include massive hematuria, hematoma, arteriovenous fistula, renal obstruction, acute renal failure, hemoglobin drop or septicemia

Growing bone cysts in long-term hemodialysis

All patients with chronic renal failure undergoing hemodialysis for more than 10 years in the university hospitals of Leuven were selected for this study. The medical records and radiographs of these 21 patients were studied retrospectively. Skeletal surveys were examined for the presence and location of subchondral cysts. The predialysis films and the films taken after 5, 10, 15 and 20 years of dialysis were reviewed. Subchondral cysts that grew in size and number were found in the wrist, humeral head, hip, and patella. Accurate measurements were made of cysts in the wrist and compared with a control group. In the dialysis group, cystic involvement of the wrist was more common and the size and number of the cysts were larger. Soft tissue swelling was seen in the dialysis group but not in controls. Soft tissue swelling was assessed on shoulder radiographs by measuring the acromiohumeral distance (ACD) and in the knees by ultrasonic measurement of synovial thickness [25]. In 11 patients synovial or bone biopsies or aspirated synovial fluid were available. All these patients had swollen joints and multiple subchondral periarticular cysts. Amyloid deposition was found in ten of these patients, and this proved to be composed of B2 microglobulins in seven (Table 1).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46797/1/256_2004_Article_BF00197929.pd

A proteinuria cut-off level of 0.7 g /day after 12 months of treatment best predicts long-term renal outcome in lupus nephritis: Data from the MAINTAIN Nephritis Trial

Background: Although an early decrease in proteinuria has been correlated with good long-term renal outcome in lupus nephritis (LN), studies aimed at defining a cut-off proteinuria value are missing, except a recent analysis performed on patients randomised in the Euro-Lupus Nephritis Trial, demonstrating that a target value of 0.8 g/day at month 12 optimised sensitivity and specificity for the prediction of good renal outcome. The objective of the current work is to validate this target in another LN study, namely the MAINTAIN Nephritis Trial (MNT). Methods: Long-term (at least 7 years) renal function data were available for 90 patients randomised in the MNT. Receiver operating characteristic curves were built to test the performance of proteinuria measured within the 1st year as short-term predictor of long-term renal outcome. We calculated the positive and negative predictive values (PPV, NPV). Results: After 12 months of treatment, achievement of a proteinuria <0.7 g/day best predicted good renal outcome, with a sensitivity and a specificity of 71% and 75%, respectively. The PPV was high (94%) but the NPV low (29%). Addition of the requirement of urine red blood cells 645/hpf as response criteria at month 12 reduced sensitivity from 71% to 41%. Conclusions: In this cohort of mainly Caucasian patients suffering from a first episode of LN in most cases, achievement of a proteinuria <0.7 g/day at month 12 best predicts good outcome at 7 years and inclusion of haematuria in the set of criteria at month 12 undermines the sensitivity of early proteinuria decrease for the prediction of good outcome. The robustness of these conclusions stems from the very similar results obtained in two distinct LN cohorts

An Experimental Approach to the Joint Effects of Relations with Partner, Friends and Parents on Happiness

Personal relations constitute an important life domain and satisfaction therein affects happiness in people. In an experimental approach with a 3×3×3 vignettes study in which 103 first year psychology students participated, the contribution of the quality of relationships with parents, friends, and a partner are studied. It is found that the studied relationships contribute to imagined happiness according to an averaging model with equal weights, whereby relationship with a partner is weighted the most important, followed by the relationship, with friends and parents respectively. The averaging model implies that the impact of the quality of the one kind of relationship can be compensated for by the effect from another kind of relationship. The equal weighting implies that the impact of each kind of relationships (parents, friends, and a partner), within the relationships domain, is constant and so does not depend on its quality. Moreover, it seems that at some high level of satisfaction the positive effect of a very good relationship with a partner cannot further be increased by better relationship with friends. Further research with participants from different age groups is needed to further understand the impact of relations with parents, friends, and a partner on happiness

Giant right ventricular outflow tract thrombus in hereditary spherocytosis: a case report

Background: In hereditary spherocytosis with severe anemia, splenectomy is a recommended treatment. However, the spleen carries an important role both in immune function and coagulation. The increased risk of bacterial infections associated with splenectomy is well known. Recently, hypercoagulation disorders have also been linked to splenectomy through loss of regulation of platelet activity, loss of filtering function and post-splenectomy thrombocytosis. Case presentation: A 28 year-old smoking women who had previously undergone splenectomy due to hereditary spherocytosis with a moderate thrombocytosis (platelet count 553–635*109/L), presented with recurrent episodes of pulmonary embolisms. Further examination by multimodality cardiac imaging demonstrated a giant chronic thrombus in the right ventricular outflow tract, which eventually had to be surgically removed. Conclusions: The present case highlights the increased risk of severe thromboembolic complications following therapeutic splenectomy in hereditary spherocytosis, and emphasis the important role of multimodality cardiac imaging in recurrent pulmonary embolism, diagnosing a giant chronic thrombus in the right ventricular outflow tract