Chronic Renal Failure in a Patient Due to Gluteal Compartment Syndrome After a Nephrectomy Operation
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Gluteal compartment syndrome is a rare reason of rhabdomyolysis resulting from atraumatic origin, and leading to renal failure. Beside to other atraumatic causes like drug abuse, alcohol intoxication, and antihyperlipidemic medications prolonged operation duration in a fi xed position is an important cause of this syndrome. Male sex, diabetes mellitus, hypertension and obesity are risk factors for gluteal compartment syndrome associated kidney failure. We report a 56 year old obese patient with a medical history of diabetes mellitus, and hypertension who undergo a nephrectomy operation resulting with gluteal compartment syndrome, and chronic kidney disease. We also highlight the importance of preventive cares and early recognition of gluteal compartment syndrome to avoid further morbidity.Keywords:
Chronic renal failure
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Nephrectomy in patients with polycystic kidney disease (PKD) is indicated in cases of hematuria, pain, hypertension, infections or before a renal transplant. The purpose of this study is to report our results of this procedure during a contemporary period of time in patients with PKD.The study consists on a retrospective of files from patients with PKD, including all cases with unilateral or bilateral nephrectomy. We analyzed general data and compared the results from the surgical procedure between bilateral nephrectomy, unilateral nephrectomy and 2 staged bilateral nephrectomy.A total of 14 PKD patients treated with nephrectomy where gathered. Mean patient age was 46 years; 78.5% has chronic renal insufficiency treated with dialysis. The decision of surgery was based predominantly on the presence of two or more symptoms. A total of 24 procedures where done; 7 patients with simultaneous bilateral nephrectomy, 3 with bilateral nephrectomy done in 2 different stages and 4 patients with unilateral nephrectomy. Good operative results where observed with minimal complications. Bilateral simultaneous nephrectomy was completed in a longer time interval than unilateral procedure (255 vs. 195 min, p = 0.008) and with a slight more bleeding (775 vs. 400cc, p = 0.008).Open nephrectomy remains as the standard procedure for patients with polycystic kidney disease (PKD). Although minimal operative differences where seen between unilateral or bilateral 2 stage nephrectomy and bilateral simultaneous nephrectomy, the overall morbidity was similar between procedures.
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Abstract BACKGROUND AND AIMS In some patients with autosomal dominant polycystic kidney disease (ADPKD), one or both native kidneys are removed in the work-up for kidney transplantation. There is no consensus if and when a nephrectomy should be performed. Some centers advocate to routinely perform a (bilateral) nephrectomy to prevent complications associated with the native polycystic kidneys in the post-transplantation period. In our ADPKD expertise center, a restrictive approach is pursued: a nephrectomy is only performed in case of serious volume related complaints, lack of space for the allograft, recurrent cyst infections, persistent cyst bleedings or chronic invalidating pain. We analyzed in a retrospective study whether this approach is justified. METHOD All records of patients ≥18 years with ADPKD who received a kidney transplantation (Tx) in our ADPKD expertise center between January 2000 and January 2019 were reviewed. Data were collected on incidence, timing, indication and complications of nephrectomy, as well as on the kidney transplantation, graft function and mortality. Patients were subdivided into three groups: no nephrectomy (no-Nx), nephrectomy prior to (pre-Tx) or after kidney transplantation (post-Tx). Patients were followed for at least 12 months after transplantation. RESULTS About 391 ADPKD (54 ± 9 years, 55.2% male) patients were included. The majority of patients did not undergo a nephrectomy (n = 257, 65.7%). A unilateral nephrectomy was performed pre-Tx in 114 patients (29.2%), in most cases because of a lack of space (49.6%) or recurrent kidney cyst infection (28.1%). More male patients underwent a nephrectomy compared to women (65.7% versus 34.3%, P = 0.003). After Tx, nephrectomy was performed in only 30 patients (11%, median 4.4 years post-Tx), of which 10 were contralateral nephrectomies in patients who also had a nephrectomy pre-Tx. Most frequent indications for nephrectomy post-Tx were recurrent kidney cyst infection (51.4%) or severe pain (24.3%). Duration of nephrectomy was slightly longer when performed post-Tx (3.1 h post-Tx versus 2.6 h pre-Tx, P = 0.052). However, the median length of hospital admission was significantly shorter in these patients (6.0 days post-Tx versus 10.0 days pre-Tx, P < 0.001). Surgery related complication rates did not differ between both groups (38.3% pre-Tx versus 27.0% post-Tx, P = 0.3), nor were there any differences in 10-year patient survival (74.4% pre-Tx versus 80.7% post-Tx versus 67.6% no-Nx, P = 0.4), or 10-year death-censored graft survival (84.4% pre-Tx versus 85.5% post-Tx versus 90.0% no-Nx, P = 0.9). CONCLUSION This study indicates that a minority of ADPKD patients require a native nephrectomy in the work-up for a kidney transplant. With a restrictive nephrectomy policy, only few patients need a nephrectomy after kidney transplantation for indications not foreseen before transplantation. Nephrectomy is a relatively safe procedure, even when performed in transplanted ADPKD patients where it did not result in more complications, graft failure or mortality. These data suggest that a restrictive nephrectomy policy in ADPKD is justified.
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No AccessJournal of UrologyAdult Urology1 Nov 2010Staged Nephrectomy Versus Bilateral Laparoscopic Nephrectomy in Patients With Autosomal Dominant Polycystic Kidney Disease Steven M. Lucas, Tobechukwu C. Mofunanya, William C. Goggins, and Chandru P. Sundaram Steven M. LucasSteven M. Lucas , Tobechukwu C. MofunanyaTobechukwu C. Mofunanya , William C. GogginsWilliam C. Goggins , and Chandru P. SundaramChandru P. Sundaram View All Author Informationhttps://doi.org/10.1016/j.juro.2010.06.150AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: In patients with autosomal dominant polycystic kidney disease we compared the outcome of bilateral laparoscopic nephrectomy at a single operation vs staged nephrectomy, including 1 during transplantation and the other via laparoscopic unilateral nephrectomy. Materials and Methods: We reviewed the records of patients with autosomal dominant polycystic kidney disease requiring renal transplantation and native bilateral nephrectomy. We compared transplantation with ipsilateral nephrectomy to transplantation alone and then compared unilateral to bilateral laparoscopic native nephrectomy. Indications included pain, infection, bleeding and compressive symptoms. Results: We followed 42 patients, including 16 with transplantation and nephrectomy, 22 with transplantation alone and 4 awaiting transplantation. In those with transplantation vs transplantation with nephrectomy there were no differences in median age (48.3 vs 53.3 years, p = 0.178) or greatest kidney length (19.5 vs 20.9 cm, p = 0.262). Operative time (208 vs 236 minutes, p = 0.104), estimated blood loss (200 vs 250 ml, p = 0.625), hospital discharge creatinine (1.60 vs 1.50 mg/dl, p = 0.491) and complications were similar. We separately compared 24 bilateral and 18 unilateral laparoscopic native nephrectomies, and noted similarities in median age (52.0 vs 56.3 years, p = 0.281) and kidney length (19.5 vs 19.8 cm, p = 0.752). Bilateral nephrectomy showed greater estimated blood loss (125 vs 50 ml, p = 0.001) and operative time (302.8 vs 170.2 minutes, p <0.001). There were 4 open conversions, 9 perioperative complications at bilateral surgery and 1 complication after unilateral surgery. Median followup in the unilateral and bilateral groups was 13.3 vs 35.9 months (p = 0.015). Conclusions: Renal transplantation and ipsilateral native nephrectomy carry no significant additional morbidity compared to that of renal transplantation alone. Staged unilateral laparoscopic nephrectomy was superior to the bilateral procedure in perioperative outcome. References 1 : Autosomal dominant polycystic kidney disease. N Engl J Med1993; 329: 332. Google Scholar 2 : The diagnosis and prognosis of autosomal dominant polycystic kidney disease. N Engl J Med1990; 323: 1085. Google Scholar 3 : Laparoscopy for adult polycystic kidney disease: a promising alternative. Am J Kidney Dis1996; 27: 224. Google Scholar 4 : Hypertension in autosomal dominant polycystic kidney disease. Saudi. J Kidney Dis Transpl1999; 10: 349. Google Scholar 5 : Pain management in polycystic kidney disease. Kidney Int2001; 60: 1631. Google Scholar 6 : Bilateral nephrectomy in patients with polycystic renal disease. Surg Gynecol Obstet1973; 137: 819. Google Scholar 7 : Transplantation in autosomal dominant polycystic kidney disease without nephrectomy. Urol Int1996; 56: 75. Google Scholar 8 : Experience with autosomal dominant polycystic kidney disease in patients before and after renal transplantation: a 7-year observation. Transplant Proc2009; 41: 177. Google Scholar 9 : Limitations of laparoscopy for bilateral nephrectomy for autosomal dominant polycystic kidney disease. J Urol2007; 177: 627. Link, Google Scholar 10 : Simultaneous renal transplantation and native nephrectomy in patients with autosomal-dominant polycystic kidney disease. Transplant Proc2007; 39: 2483. Google Scholar 11 : Simultaneous transabdominal bilateral nephrectomy in potential kidney transplant recipients. Transplant Proc2006; 38: 28. Google Scholar 12 : Selective, concurrent bilateral nephrectomies at renal transplantation for autosomal dominant polycystic kidney disease. J Urol2007; 177: 2250. Link, Google Scholar 13 : Simultaneous bilateral native nephrectomy and living donor renal transplantation are successful for polycystic kidney disease: the University of Maryland experience. J Urol2009; 181: 724. Link, Google Scholar 14 : Bilateral nephrectomy with concomitant renal graft transplantation for autosomal dominant polycystic kidney disease. J Urol2000; 164: 661. Link, Google Scholar 15 : Bilateral nephrectomy before renal transplantation in autosomal dominant polycystic renal disease. Nephrologie1997; 18: 181. Google Scholar 16 : Laparoscopic nephrectomy with intact specimen extraction for polycystic kidney disease. J Endourol2008; 22: 675. Google Scholar 17 : Pretransplant laparoscopic nephrectomy in adult polycystic kidney disease: a single centre experience. BJU Int2008; 101: 94. Google Scholar 18 : Laparoscopic nephrectomy for autosomal dominant polycystic kidney disease. Surg Endosc2004; 18: 751. Google Scholar 19 : Bilateral laparoscopic nephrectomy for significantly enlarged polycystic kidneys: a technique to optimize outcome in the largest of specimens. BJU Int2008; 101: 1019. Google Scholar 20 : A novel approach to bilateral hand-assisted laparoscopic nephrectomy for autosomal dominant polycystic kidney disease. Surg Endosc2006; 20: 679. 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Link, Google Scholar © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byShumate A, Bahler C, Goggins W, Sharfuddin A and Sundaram C (2015) Native Nephrectomy with Renal Transplantation is Associated with a Decrease in Hypertension Medication Requirements for Autosomal Dominant Polycystic Kidney DiseaseJournal of Urology, VOL. 195, NO. 1, (141-146), Online publication date: 1-Jan-2016.Tellman M, Bahler C, Shumate A, Bacallao R and Sundaram C (2014) Management of Pain in Autosomal Dominant Polycystic Kidney Disease and Anatomy of Renal InnervationJournal of Urology, VOL. 193, NO. 5, (1470-1478), Online publication date: 1-May-2015.Tyson M, Wisenbaugh E, Andrews P, Castle E and Humphreys M (2013) Simultaneous Kidney Transplantation and Bilateral Native Nephrectomy for Polycystic Kidney DiseaseJournal of Urology, VOL. 190, NO. 6, (2170-2174), Online publication date: 1-Dec-2013. Volume 184Issue 5November 2010Page: 2054-2059 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.Keywordskidney transplantationautosomal dominantkidneypolycystic kidneylaparoscopynephrectomyMetricsAuthor Information Steven M. Lucas More articles by this author Tobechukwu C. Mofunanya More articles by this author William C. Goggins More articles by this author Chandru P. Sundaram More articles by this author Expand All Advertisement PDF downloadLoading ...
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Study Type - Therapy (case series).4. What's known on the subject? and What does the study add? The indications and timing of native nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD) is controversial, especially for those undergoing renal transplantation. Post-transplant unilateral native nephrectomy appears to be the preferred intervention compared to pre-transplant native nephrectomy. There seems to be substantial additive risk to bilateral over unilateral nephrectomy, especially prior to transplantation. Pre-transplant native nephrectomy should only be carried out when there are clear indications such as massive size preventing allograft placement, severe pain, early satiety, recurrent bleeding and infections, or suspected malignancy.To analyse indications, timing and outcomes of native nephrectomy in autosomal dominant polycystic kidney disease (ADPKD) patients listed for kidney transplantation.A retrospective analysis of all ADPKD patients who had a native nephrectomy prior to or following transplantation between January 2003 and December 2009 at a single centre, including those undergoing the sandwich technique (removal of the most severely affected native kidney prior to transplantation, and the other afterwards), was undertaken.There were 35 individuals in our cohort (M : F = 16 : 19), with a median age of 51.5 years (range 43-65). Twenty patients were in the pre-transplant nephrectomy group, 12 in the post-transplant group, and three underwent the sandwich technique. Indications for nephrectomy varied but were most commonly pain/discomfort, space for transplantation, ongoing haematuria, recurrent infections, and gastrointestinal pressure symptoms (early satiety). Seven individuals in the pre-transplant group and three in the post-transplant group required critical care admission after nephrectomy. Transient renal graft dysfunction occurred in two post-transplant bilateral nephrectomy patients. Two patients in the bilateral nephrectomy pre-transplant group and one in the bilateral nephrectomy post-transplant group died in the immediate post-operative period. No complications were noted in the sandwich technique group.Native nephrectomy in ADPKD is a major undertaking associated with significant morbidity especially in the pre-transplant group. Post-transplant unilateral nephrectomy appears to be the safest approach with fewest complications.
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