To analyze the clinical profile and therapeutic effect of re-operation treatment in uremic patients complicated with persistent secondary hyperparathyroidism(SHPT)after parathyroidectomy with autotransplantation.Twelve persistent SHPT patients who were treated with reoperation of paramyroidectomy(PTX)were enrolled in this study during the period from Jan 2014 to Jul 2017 in our hospital.We evaluated the location of the remaining parathyroid glands by ultrasonography,dual-phase 99 Tcm-sestamibi scintigraphy,CT and MR imaging of the neck before the operation.We resected the parathyroid gland tissue in situ,and the ectopic parathyroid glands hiding in thymus,mediastinal,tracheal esophageal groove,thyroid gland and other locations in the neck.During the surgery,nanocarbon imaging was used to help identify the parathyroid gland and parathyroid hormone assay(IOPTH)was measured at the end of the surgery.We observed the changes of clinical symptoms after the surgery and collected blood parameters including serum intact aramyroidhomone(i-PTH),calcium(Ca),phosphoms(P),calcium and phosphorus product before and after surgery.Complications and failure were also analyzed.All the 12 patients underwented successful operation.The postoperative pathological results were hyperplastic parathyroid glands tissue.22 parathyroid glands were resected,among which 14 were located at the neck in situ,8 were ectopic,i.e.,located at thymus in 4 cases,superior mediastinum in 2 cases and thyroid parenchyma in 2 cases.The clinical symptoms were significantly improved including osteoarthritis,skin itching and limb weakness.The levels of serum iPTH,calcium,phosphorus and calcium and phosphorus product were significantly lower than those before operation(<0.05).Ten patients presented hypocalcemia after surgery and the level of calcium returned to normal after supplement of calcium.Temporary injury of laryngeal nerve was found in4 cases,but there was no patient with transient bucking,dyspnea or death.No recurrence was found during 1 year follow-up.It was very important to locate the residual parathyroid gland accurately with a variety of imaging methods in uremic patients complicated with persistent or recurrent SHPT when they needed re-operation.Surgeons should explorate ectopic parathyroid gland according to the concept of the superior mediastinum dissection and the central compartment neck dissection.Meanwhile,the use of nanocarbon assisted parathyroid gland negative imaging and rapid IOPTH can significantly improve the success rate of surgery and reduce surgical complications.
Humans ; Hyperparathyroidism, Secondary ; complications ; surgery ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroidectomy ; Reoperation ; Transplantation, Autologous ; Uremia ; complications

Uremic encephalopathy is a well-known disease with typical MR findings including bilateral vasogenic or cytotoxic edema at the cerebral cortex or basal ganglia. Involvement of the basal ganglia has been very rarely reported, typically occurring in uremic-diabetic patients. We recently treated a patient who had non-diabetic uremic encephalopathy with an atypical lesion distribution involving the supratentorial white matter, without cortical or basal ganglia involvement. To the best of our knowledge, this is only the second reported case of non-diabetic uremic encephalopathy with atypical MR findings.
Adult ; Brain Diseases, Metabolic/*diagnosis ; *Diffusion Magnetic Resonance Imaging ; Humans ; Male ; Uremia/*complications

To evaluate the preoperative high risk factors in the management of benign prostatic hyperplasia. a score system has been devised which includes associated medical diseases and urologic complications such as urinary retention. urinary tract infection and uremia. A score of one to three was given for each high risk factor. The patients with a total score of one to three of each risk factor were regarded as grade I, four to six as grade II and more than seven as grade III. According to this score and grade system, the high grade group showed the high incidence of postoperative complications and morbidity. So. the more careful preoperative evaluations and postoperative cares might be needed in the high risk patients. On the base of this analysis, if more further studies will be performed. we may expect that we have achieved low mortality and morbidity rates even in high operative risk patients.
Humans ; Incidence ; Mortality ; Postoperative Complications ; Prostatic Hyperplasia* ; Risk Factors* ; Uremia ; Urinary Retention ; Urinary Tract Infections

Although ultrasonography is regarded as the gold standard in the diagnosis of obstructive nephropathy, dilatation is sometimes not observed by ultrasonography. We report upon a case of minimally dilated obstructive nephropathy due to an ureter stone in a kidney donor with volume depletion. A 54-year-old man was admitted due to anuria and abdominal pain of 2 days duration. Ten years previously, his right kidney was donated for transplantation, and one month before admission, he abstained from all food except water and salt, for 30 days for religious reasons. He had lost 8 kg of body weight. On admission, he had clinical signs of volume depletion, i.e., a dehydrated tongue and decreased skin turgor. Laboratory data confirmed severe renal failure, his blood urea nitrogen level was 107.3 mg/dL, and his serum creatinine 16.5 mg/dL. The plain X-ray was unremarkable and ultrasonography showed only minimal dilatation of the renal collecting system. On follow-up ultrasonography, performed on the 5th hospital day, the dilatation of the collecting system had slightly progressed and a small stone was found at ureter orifice by cystoscopy. Removal of stone initiated dramatic diuresis with a rapid return of renal function to normal by the third day.
Anuria/*etiology ; Diagnosis, Differential ; Human ; Male ; Middle Aged ; Nephrosis, Lipoid/complications/*ultrasonography ; *Tissue Donors ; Uremia/*diagnosis ; Ureteral Calculi/*complications

In recent years, several studies have reported that the prevalence of diabetes mellitus is increasing every year, and also the acute and chronic complications accompanying this disease are increasing. Diabetic nephropathy is one of chronic complications of diabetes mellitus, and food intake which is burden to kidney function should be limited. At the same time, diet restriction could deteriorate quality of life of patient with diabetic nephropathy. According to the results of previous studies, the aggressive management is important for delaying of the progression to diabetic nephropathy. Also, the implementation of a personalized diet customized to individuals is an effective tool for preservation of kidney function. This is a case report of a patient with diabetic nephropathy who was introduced to a proper diet through nutrition education to prevent malnutrition, uremia and to maintain blood glucose levels.
Blood Glucose ; Diabetes Complications ; Diabetes Mellitus ; Diabetic Nephropathies* ; Diet ; Eating ; Education ; Humans ; Kidney ; Malnutrition ; Prevalence ; Quality of Life ; Uremia

Adult ; Antiviral Agents ; administration & dosage ; therapeutic use ; Hepatitis C ; complications ; drug therapy ; Humans ; Kidney Transplantation ; methods ; Male ; Premedication ; Renal Dialysis ; Uremia ; complications

Cervical Vertebrae ; surgery ; Fracture Fixation, Internal ; Humans ; Internal Fixators ; Male ; Middle Aged ; Treatment Failure ; Tuberculosis, Spinal ; complications ; surgery ; Uremia ; complications ; surgery

A clinical observation was made on 70 nephrectomized patients during the period from Jan, 1978 to June, 1981. The results were as follows. 1. The total number of inpatients during the period was 1,122 and nephrectomies were performed in 70 of the 744 total urologic operations (9.4%). 2. The age distribution showed the highest in 5th decade with 25.7% and the youngest case was observed at the age of 3, the oldest at 68 and 43 males and 27 females with male to female ratio 1.6:1. 3. The causative diseases of nephrectomy were tuberculosis (25.7%), renal stone (24.3%), renal injury (14.3%), renal tumor (10.0%) and hydronephrosis (8.0%) etc. 4. Percentage of nephrectomy in each disease were 39.1% in tuberculosis, 22.7% in renal stone, 31.3% in renal injury, 77.9 % in renal tumor and 50.0 % in hydronephrosis. 5. Surgical approaches consisted of frank subcostal approach in 38.6%, anterior abdominal extraperitoneal approach in 35.7 % and abdominal transperitoneal approach in 25.7 %. 6. Among the transfused patients who nephrectomized, the average amount of transfused whole bleed were 1757 ml on renal tumor, 1320 ml in renal injury, 700 ml in renal stone and 533 ml in renal tuberculosis. 7. Postoperative complications were postoperative bleeding in 3 cases, wound infection in 2 cases, paralytic ileus in 2 cases, wound disruption in 1 case, uremia in 1 case and upper G-I bleeding in 1 case.
Age Distribution ; Female ; Hemorrhage ; Humans ; Hydronephrosis ; Inpatients ; Intestinal Pseudo-Obstruction ; Male ; Nephrectomy ; Postoperative Complications ; Tuberculosis ; Tuberculosis, Renal ; Uremia ; Wound Infection ; Wounds and Injuries

A clinical observation was made on 49 cases of renal parenchymal incision: and/or partial nephrectomy in Department of Urology, Catholic Medical College, during the period from January 1969 to August 1978. The results were as follow ; 1. Patients who underwent renal parenchymal incision and /or partial nephrectomy were renal stone in 33 cases, staghorn calculi in 9 cases, renal tuberculosis in 2 cases, double pelvis in 2 cases, renal carbuncle in 1 case, polycystic kidney in 1 case and simple cyst in 1 case. 2. As methods of renal parenchymal surgery. Partial nephrectomy in 22 cases, nephrolithotomy in 22 cases, nephrolithotomy in 20 cases, bisection in 8 cases and renal cystectomy in 2 cases, were performed. 3. Postoperative complications were 10 cases of delayed bleeding (19.2 %), 9 residual stone (17.3 %), 2 wound infection (3.84 %), 2 pyonephrosis (3.84 %), 2 urinary fistula (3.84 %), 2 early bleeding (3,84 %), 2 uremia (3.84 %) and one case of death caused sepsis. 4. Among 6 cases of secondary nephrectomy due to postoperative complication 5 cases were caused by delayed bleeding and one case by pyonephrosis.
Calculi ; Carbuncle ; Cystectomy ; Hemorrhage ; Humans ; Nephrectomy* ; Pelvis ; Polycystic Kidney Diseases ; Postoperative Complications ; Pyonephrosis ; Sepsis ; Tuberculosis, Renal ; Uremia ; Urinary Fistula ; Urology ; Wound Infection

Colonic necrosis is known as a rare complication following the administration of Kayexalate (sodium polystryrene sulfonate) in sorbitol. We report a rare case of colonic mucosal necrosis following Kalimate (calcium polystryrene sulfonate), an analogue of Kayexalate without sorbitol in a 34-yr-old man. He had a history of hypertension and uremia. During the management of intracranial hemorrhage, hyperkalemia developed. Kalimate was administered orally and as an enema suspended in 20% dextrose water to treat hyperkalemia. Two days after administration of Kalimate enema, he had profuse hematochezia, and a sigmoidoscopy showed diffuse colonic mucosal necrosis in the rectum and sigmoid colon. Microscopic examination of random colonic biopsies by two consecutive sigmoidoscopies revealed angulated crystals with a characteristic crystalline mosaic pattern on the ulcerated mucosa, which were consistent with Kayexalate crystals. Hematochezia subsided with conservative treatment after a discontinuance of Kalimate administration.
Adult ; Colon/*pathology ; Gastrointestinal Hemorrhage/etiology ; Humans ; Hyperkalemia/drug therapy ; Intestinal Mucosa/*pathology ; Male ; Necrosis/*chemically induced/complications/pathology ; Polystyrenes/*adverse effects/therapeutic use ; Uremia/*physiopathology