Case report: Page kidney with multiple serosal effusions caused by bilateral spontaneous renal subcapsular hemorrhage

Page kidney is caused by the perirenal or subcapsular accumulation of blood or fluid pressing on the renal parenchyma and is a rare cause of secondary hypertension. In this study, we report a case of Page caused by bilateral spontaneous subcapsular renal hematoma, the main manifestations of which were secondary hypertension, multiple serous effusions, and renal insufficiency. After admission, drug blood pressure control was ineffective. After bilateral perirenal effusion puncture and drainage were performed to relieve bilateral perirenal compression, blood pressure gradually dropped to normal, multi-serous cavity effusion (pericardial, thoracic, and abdominal effusion) gradually disappeared, and kidney function returned to normal. Secondary hypertension caused by Page kidney can be treated. When Page kidney is complicated with multiple serous effusions, the effect of antihypertensive drugs alone is poor, and early perineal puncture drainage can achieve better clinical efficacy

Catheter-based intramyocardial delivery (NavX) of adenovirus achieves safe and accurate gene transfer in pigs.

BACKGROUND: Hepatocyte growth factor (HGF) is one of the major angiogenic factors being studied for the treatment of ischemic heart diseases. Our previous study demonstrated adenovirus-HGF was effective in myocardial ischemia models. The first clinical safety study showed a positive effect in patients with severe and diffused triple coronary disease. METHODS: 12 Pigs were randomized (1:1) to receive HGF, which was administered as five injections into the infarcted myocardium, or saline (control group). The injections were guided by EnSite NavX left ventricular electroanatomical mapping. RESULTS: The catheter-based injections caused no pericardial effusion, malignant arrhythmia or death. During mapping and injection, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, serum creatinine and creatine kinase-MB levels have no significant increase as compared to those before and after the injection in HGF group(P>0.05). HGF group has high HGF expression with Western blot, less myocardial infarct sizes by electroanatomical mapping (HGF group versus after saline group, 5.28 ± 0.55 cm(2) versus 9.06 ± 1.06 cm(2), P<0.01), better cardiac function with Gated-Single Photon Emission Computed Tomography compared with those in saline group. Histological, strongly increased lectin-positive microvessels and microvessel density were found in the myocardial ischemic regions in HGF group. CONCLUSION: Intramyocardial injection guided by NavX system provides a method of feasible and safe percutaneous gene transfer to myocardial infarct regions

Injection of speed and depth.

<p>Yes: the overflow and bubbling were detected in the endocardium. No: the overflow and bubbling were not detected in the endocardium, or MB staining not in the pericardium.</p

The myocardial perfusion and cardiac function.

<p>(A) Representative images of SPECT of saline (left) and HGF (right) treated porcine chronic myocardial infarct heart. Red arrows indicate regions with better myocardial perfusion; white arrows indicate regions that had similar myocardial perfusion. (B) Bar graph showing myocardial perfusion score, *P = 0.001 vs. four weeks after vector injection; (C) LVESV, *P<0.01 vs. four weeks after vector injection; (D) LVEDV, there was significant difference four weeks after the injection compared to that before the injection, P>0.05. (E) LVEF, *P<0.01 vs. four weeks after vector injection; B: before GTx; A: four weeks after GTx.</p

Infarct size and myocardial voltage.

<p>(A), (B) the left ventricular geometry before and after the GTx. Gray and purple respectively indicates the myocardial infarct and normal zones; the region between gray and purple is transitional zone. Red arrow indicates injected site marked with white dots. (C) Bar graph showed the infarct sizes significantly reduced in the HGF-injected hearts after GTx than those before GTx. (D), (E) Bar graph explained the myocardial voltage levels in the infarct and normal zones of HGF-injected hearts. There were significantly higher myocardial voltage levels in the infarct zone of HGF-injected hearts after GTx than those before GTx. *P<0.01 vs. before GTx in HGF group.</p

The accuracy and safety of injection.

<p>(A), (B) Representative images of methylene-blue injection. The yellow arrows pointed to injection sites, all of the sites were around the desired myocardial ischemic region (pale region). The red arrow pointed to the ligation site of the LAD. The myocardial ischemic region was marked with red curve. No MB staining was detected in the pericardium. (C) Representative image of the echocardiography. During the mapping and injection, the pericardial effusion was not detected in two groups. (D) Representative image of the surface electrocardiogram and intracardiac electrical recording. The operation did not cause malignant arrhythmia in real time.</p