Nephrectomy for emphysematous pyelonephritis in a nonfunctional renal allograft due to rejection after kidney transplantation

Abstract Background Emphysematous pyelonephritis represents an acute and necrotizing infection characterized by the accumulation of gas within the kidney. This condition poses a swift progression toward sepsis, leading to a poor prognosis. We experienced a rare case of emphysematous pyelonephritis in a nonfunctioning renal allograft attributed to antibody‐mediated rejection after kidney transplantation. Case presentation A 71-year-old man with diabetes had undergone living-donor renal transplantation from his wife. Unfortunately, the transplanted kidney’s function declined due to antibody-mediated rejection, necessitating the introduction of hemodialysis 12 months post-transplantation. Subsequently, 4 months after initiating hemodialysis, the patient presented with pain and swelling in the right lower abdomen. A computed tomography scan revealed the enlargement of the transplanted kidney and gas formation. This constellation of symptoms led to the diagnosis of emphysematous pyelonephritis, resulting in his hospitalization. Further contrast-enhanced computed tomography scans demonstrated an absence of arterial flow and ischemia within the renal allograft. Despite antibiotic treatment and percutaneous drainage, both the gas and fluid in the renal parenchyma and surrounding tissue displayed minimal reduction. Given these compelling findings, an allograft nephrectomy was performed 20 days into his hospital stay. Pathological examination confirmed complete allograft necrosis, revealing nonviable renal parenchyma. The patient’s postoperative recovery progressed favorably. Conclusions Instances of emphysematous pyelonephritis within transplanted kidneys are infrequently documented. Among these cases, emphysematous pyelonephritis in a nonfunctioning renal allograft is very rare and may be associated with graft ischemia and the presence of injured tissue. The determination of an immediate diagnosis and surgery is important

Role of phospholipase A2 in the cytotoxic effects of oxalate in cultured renal epithelial cells

BACKGROUND: Oxalate, a common constituent of kidney stones, is cytotoxic for renal epithelial cells. Although the exact mechanism of oxalate-induced cell death remains unclear, studies in various cell types, including renal epithelial cells, have implicated phospholipase A2 (PLA2) as a prominent mediator of cellular injury. Thus, these studies examined the role of PLA2 in the cytotoxic effects of oxalate. METHODS: The release of [3H]-arachidonic acid (AA) or [3H]-oleic acid (OA) from prelabeled Madin-Darby canine kidney (MDCK) cells was measured as an index for PLA2 activity. The cell viability was assessed by the exclusion of ethidium homodimer-1. RESULTS: Oxalate exposure (175 to 550 microM free) increased the release of [3H]-AA in MDCK cells but had no effect on the release of [3H]-OA. Oxalate-induced [3H]-AA release was abolished by arachidonyl trifluoromethyl ketone (AACOCF3), a selective inhibitor of cytosolic PLA2 (cPLA2), but was not affected by selective inhibitors of secretory PLA2 and calcium-independent PLA2. The [3H]-AA release could be demonstrated within 15 minutes after exposure to oxalate, which is considerably earlier than the observed changes in cell viability. Furthermore, AACOCF3 significantly reduced oxalate toxicity in MDCK cells. CONCLUSIONS: Oxalate increases AA release from MDCK cells by a process involving cPLA2. In addition, based on the evidence obtained using a selective inhibitor of this isoform, it would appear that the activity of this enzyme is responsible, at least in part, for the cytotoxic effects of oxalate. The finding that oxalate can trigger a known lipid-signaling pathway may provide new insight into the initial events in the pathogenesis of nephrolithiasis

Necrotizing fasciitis after high-dose rate brachytherapy and external beam radiation for prostate cancer: a case report

Abstract Background In recent years, the delayed side effects associated with radiotherapy for prostate cancer have drawn the interest of urologists. Although urosymphyseal fistula is one of these delayed side effects, this serious complication is rarely described in literature and is poorly recognized. Case presentation We report our experience in treating a 77-year-old male patient with necrotizing fasciitis after high-dose rate brachytherapy plus external beam radiation for prostate cancer. The patient was referred to our hospital with complaints of inguinal swelling and fever. He had a past history of radiotherapy for prostate cancer and subsequent transurethral operation for a stricture of the urethra. Computed tomography showed extensive gas within the femoral and retroperitoneal tissues and pubic bone fracture. Surgical exploration suggested that necrotizing fasciitis was caused by urosymphyseal fistula. Conclusion To the best of our knowledge, this is the first case report of necrotizing fasciitis caused by urosymphyseal fistula after radiotherapy for prostate cancer. There is a strong association between urosymphyseal fistula and prostate radiotherapy with subsequent surgical intervention for bladder neck contracture or urethral stricture. Therefore, surgical treatment for bladder neck contracture or urethral stricture after radiotherapy for prostate cancer should be performed with care. The present case emphasizes the importance of early diagnosis of urosymphyseal fistula. Immediate removal of necrotic tissues and subsequent urinary diversion in the present case may have led to good patient outcome

The Importance of Follow-Up and Evaluation of Intraoperative Findings to Determine Surgical Indications for Retractile Testis

Objectives. Ascending testis or acquired undescended testis develops in approximately 30% of cases of retractile testis, and orchiopexy is recommended for these cases. This study aimed at assessing the intraoperative anatomical findings of ascending testis and acquired undescended testis in search of better management for retractile testis. Methods. We retrospectively collected data of patients with confirmed diagnosis of retractile testis between February 2012 and November 2021. Orchiopexy was performed for cases with ascending testis and for patients with increasing difference of right and left testicular volume. The site of gubernaculum attachment and patent processus vaginalis were evaluated during surgery. Results. A total of 119 testes in 71 patients with retractile testis were included in this study. Sixteen retractile testes in 12 patients (17%) underwent orchiopexy. The weight at birth was significantly higher, and bilateral retractile testes were significantly more common in the follow-up group than in the surgical intervention group. In the surgical intervention group, the abnormal site of gubernaculum attachment was found in 12 out of 16 testes (75%), and patent PV was found in nine out of sixteen testes (56%). Sites of gubernaculum attachment in testes with patent PV were significantly higher than in sites with closed processus vaginalis, and all testes with patent processus vaginalis had abnormal site of gubernaculum attachment. Conclusion. Patients with ascending testis and acquired undescended testis have clinical features and intraoperative abnormal findings similar to a cryptorchidism. Therefore, our surgical indication for retractile testis is considered appropriate

Prognostic Impact of Lymphatic Invasion in Patients with High-Risk Prostate Cancer after Robot-Assisted Radical Prostatectomy and Extended Lymph Node Dissection: A Single-Institution Prospective Cohort Study

The prognostic impact of lymphatic invasion in patients with high-risk prostate cancer (PC) remains unclear. The aim of our single-institution prospective cohort study was to examine the impact of lymphatic invasion on biochemical recurrence (BCR) in patients with high-risk PC according to National Comprehensive Cancer Network (NCCN) criteria who underwent robot-assisted radical prostatectomy (RARP) and extended lymph node dissection (eLND). A total of 183 patients were included who underwent RARP and eLND for NCCN high-risk PC between June 2014 and August 2019. Lymphatic invasion in resected specimens was observed in 47 patients (26%), whereas lymph node metastasis was observed in 17 patients (9%). During follow-up, BCR was observed in 48 patients (26%). The BCR rate in patients with lymphatic invasion was significantly higher than that in patients without lymphatic invasion (p < 0.01). According to multivariable Cox proportional hazards regression analyses, lymphatic invasion was a significant independent predictor of BCR in the overall patient group and was independently associated with BCR, even in patients without lymph node metastasis. In conclusion, evaluation of lymphatic invasion could be useful in predicting BCR in patients undergoing RARP and eLND for high-risk PC

Transplantation of Horseshoe Kidney from Living, Genetically Unrelated Donor

We report a case of renal transplantation using a horseshoe kidney from a living, genetically unrelated donor. The recipient was a 60-year-old man with diabetic nephropathy, and the donor was the 63-year-old wife of the recipient with a horseshoe kidney free of complications. Computed tomography showed two renal arteries and one renal vein on the left side, and the isthmus was perfused by several accessory arteries and veins. To demarcate the boundary of the isthmus, the left renal artery was ligated and cannulated for in situ perfusion. Furthermore, the isthmus was clamped, and the boundary of the isthmus was confirmed. The kidney was divided at the left margin of the perfused boundary. The cut ends of the isthmus were closed by sutures. The left kidney was transplanted into the right iliac fossa of the recipient. Asymptomatic fluid collection occurred on the cut surface at the isthmus of the donor, and this fluid decreased in due course. On the other hand, the recipient experienced no surgical complication or rejection, while maintaining serum creatinine levels of 2.00–2.20 mg/dL over a 22-month follow-up period. Horseshoe kidneys may be used for transplantation in selected cases after a detailed preoperative evaluation

Phospholipase A2 mediates immediate early genes in cultured renal epithelial cells: possible role of lysophospholipid

BACKGROUND: Exposure to high levels of oxalate induces oxidant stress in renal epithelial cells and produces diverse changes in cell function, ranging from cell death to cellular adaptation, as evidenced by increased DNA synthesis, cellular proliferation, and induction of genes associated with remodeling and repair. These studies focused on cellular adaptation to this oxidant stress, examining the manner by which oxalate exposure leads to increased expression of immediate early genes (IEGs). Specifically, our studies assessed the possibility that oxalate-induced changes in IEG expression are mediated by phospholipase A2 (PLA2), a common pathway in cellular stress responses. METHODS: Madin-Darby canine kidney (MDCK) cells were exposed to oxalate in the presence or absence of PLA2 inhibitors: mepacrine and arachidonyl trifluoromethyl ketone (AACOCF3). Expression of IEG (c-jun, egr-1, and c-myc) mRNA was assessed by Northern blot analysis. PLA2 activity was determined by measuring the release of [3H]arachidonic acid (AA) from prelabeled cells. RESULTS: Oxalate exposure (1 to 1.5 mmol/L) induced time- and concentration-dependent increases in IEG mRNA. Treatment with mepacrine resulted in a 75 to 113% reduction of oxalate-induced c-jun, egr-1, and c-myc mRNA, while AACOCF3 caused a 41 to 46% reduction of oxalate-induced c-jun and egr-1 mRNA. Of the two major byproducts of PLA2, only lysophosphatidylcholine (20 micromol/L) increased c-jun and egr-1 mRNA. In contrast, AA (25 micromol/L) attenuated the oxalate-induced increase in c-jun and egr-1 mRNA, presumably by inhibiting PLA2 activity. CONCLUSIONS: These findings suggest that PLA2 plays a major role in oxalate-induced IEG expression in renal epithelial cells and that lysophospholipids might be a possible lipid mediator in this pathway

Usefulness of Preoperative High Systemic Immune-Inflammation Index as a Prognostic Biomarker in Patients Who Undergo Radical Cystectomy for Bladder Cancer: Multicenter Analysis

Evidence of the prognostic value of pretreatment systemic immune-inflammation index (SII) after radical cystectomy (RC) for bladder cancer is limited. This study aims to assess the association between preoperative SII and prognosis after RC for bladder cancer. In this multicenter retrospective study, we calculated preoperative SII as well as the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in 237 patients who underwent RC for bladder cancer between March 2009 and March 2018. Patients were classified into high SII and low SII groups by using the optimal cutoff value (438 × 109/L) based on receiver operating characteristic curve analysis for cancer-specific death. We compared cancer-specific survival (CSS) and overall survival (OS) between the two groups. To evaluate the prognostic impact of preoperative SII, we also performed Cox proportional regression analyses for CSS and OS. Of 237 patients, 127 patients were classified into the high SII group and 110 patients into the low SII group. During the follow-up period, 70 patients died of bladder cancer (30%) and 21 patients died from other causes (9%). Patients with high SII had significantly lower rates of CSS and OS than those with low SII (p < 0.01 and p < 0.01, respectively). Multivariable Cox proportional hazard analysis showed that high SII was independently associated with poor CSS (p = 0.01) and poor OS (p < 0.01). In conclusion, high SII could be an independent significant predictor of poor prognosis after RC in patients with bladder cancer

Dynamic Changes in Fluid Temperatures during Laser Irradiation Using Various Laser Modes: A Thermography-Based In Vitro Phantom Study

The differences in dynamic thermal changes during laser lithotripsy between various laser pulse modes are unclear. We used thermography to evaluate the temporal changes in high-temperature areas during laser activation in order to compare different laser pulse modes. An unroofed artificial kidney model was used for the experiments. The laser fired for 60 s with a laser setting of 0.4 J/60 Hz in the following four different laser pulse modes without saline irrigation: short pulse mode (SPM), long pulse mode (LPM), virtual basket mode (VBM) and Moses mode (MM). Using the first 30 s of moving images, we compared the ratio of a high-temperature area of >43 °C to the total area every 5 seconds. The dynamic changes in fluid temperatures were shown to be different between the laser pulse modes. The extent of the high-temperature areas during the laser activation was large in the LPM and MM compared with the SPM and VBM. While the high-temperature areas expanded in an anterior direction in the early laser irradiation period using the LPM, they spread in a posterior direction in the early laser activation period using the MM. Although only the temperature profile in one specific plane was investigated, these results are considered useful for preventing thermal injuries during retrograde intrarenal surgeries