Global Journal of Urology and Nephrology

  • The transurethral resection of the Prostate (TURP) syndrome and acute dilutional hyponatraemia (HN): A comprehensive literature review from first incidence in 1947 to disappearance in 2018

    Introduction and objective: To report on the literature review on the TURP syndrome from its first report in 1947 to disappearance from urology in 2018 Material and methods: The literature on the TURP syndrome from 1947 to 2018 was reviewed. We summarise the evidence on its incidence, prevalence, patho-aetiology, clinical picture and management. With the introduction of normal saline as irrigating fluid for the TURP procedure, the TURP syndrome as characterised with hyponatraemia (HN) has been eradicated. We introduce the concept of volumetric overload shocks (VOS) to be prepared when another syndrome induced by saline overload strikes. Results: The TURP syndrome is induced by massive absorption of the sodium-free irrigating fluid and is characterized with acute dilutional HN- hence it is eradicated with use of saline as irrigant. It presents with shock and multiple vital organ dysfunction and was easily mistaken for one of the recognised shocks calling for further volume expansion with isotonic solutions with disastrous consequences. Identifying the concept of VOS does not only help in the management of the TURP syndrome but also with recognizing the syndrome induced by saline overload. Hypertonic sodium therapy has proved effective in treatment. Conclusion: The review demonstrates that VOS in clinical practice is of two types; Type 1 (VOS1) induced by sodium-free fluid and type 2 (VOS2) induced by sodium-based fluids- the later has no serum marker of HN. Both conditions present with multi-system organ dysfunction but one system may predominate. VOS2 presents as the adult respiratory distress syndrome.

  • A Practical Approach for Pathophysiological Diagnosis of Refractory Hypokalemia

    Hypokalemia is a common finding in hospitalized patients. In most cases the cause will be obvious. However, in a subgroup of patients the cause is occasionally uncertain and establishing the diagnosis may present difficulties and can become a challenge. In such cases, measurement of urinary indices e.g. trans-tubular potassium gradient [TTKG] and random urine potassium/creatinine concentrations along with blood acid/base parameters and assessment of urinary excretion of potassium, chloride, calcium and creatinine have been employed in the differential diagnosis. TTKG and urine potassium/creatinine ratio are used as a rapid appropriate index of potassium excretion and to establish a proper diagnosis and management in this medical emergency. It helps to differentiate between hypokalemia caused by redistribution or renal potassium wasting. Urinary chloride excretion and urinary calcium/creatinine ratio in conjunction with plasma acid/base values, aldosterone, renin and cortisol values are used for narrowing the differential diagnosis of refractory hypokalemia. Conclusions: Calculating the trans-tubular potassium concentration gradient, urinary potassium/creatinine ratio, urinary chloride excretion and urinary calcium/creatinine ratio in conjunction with plasma acid/base values provided simple and reliable tests for differential diagnosis of causes of refractory hypokalemia and to provide a proper management in the intensive care unit and in the emergency until advanced further tests to be done.

  • Renal Ischemia-reperfusion Induces Renal Collagen Deposition Through Nadph Oxidase Activation in Rats

    Introduction:Acute kidney injury (AKI) may predispose the onset of chronic kidney disease (CKD) and hypertension through changes in renal NADPH oxidase and renal fibrosis. Objectives: To investigate, in rats, whether AKI induces later renal fibrosis through NADPH oxidase activation. Methodology: This protocol was approved by the Committee of Ethics in Animal Experimentation of UFPE (nº 23076.060473/2014-91). Male Wistar rats (120 days-old; n=8) were submitted to AKI through bilateral renal ischemia-reperfusion injury (IR; 45 min ischemia followed by 30 days of reperfusion). One group (n=8) was submitted to IR in the presence of oral apocynin administration (100 mg/kg) 24 hours before and after IR, to inhibit NADPH oxidase activity, while other (n=8), received daily oral treatment with apocynin (100 mg/kg) 24 hours after reperfusion until the end of experiment. These groups were compared to a control group submitted to simulation of IR procedure. Thirty days after reperfusion, it was evaluated creatinine clearance (ClCreat) and systolic blood pressure (SBP), as well as kidney collection, to evaluate lipid peroxidation, NADPH oxidase activity and collagen deposition. Statistical analysis was performed using one-way ANOVA followed by Newman-Keuls test (P

  • Histomorphometric Evaluation of the Renal Corpuscles of Mice Treated With Poly-ε-caprolactone Micro-spheres Containing Usnic Acid From the Acute Toxicity Test

    Introdution: Usnic acid, a hydrophobic lichen metabolite, has been highlighted in the literature with several biological activities, such as: anti-inflammatory, analgesic, antimicrobial, antiviral, antiparasitic, gastroprotective, antitumor and cicatrizant. Despite the fact that the usnic acid presents several biological activities, its use as a therapeutic agent has not yet been possible due to its inconvenient physico-chemical properties, such as low solubility, toxicity and difficult interaction with biological barriers. Thus, the incorporation of the usnic acid (UA) in controlled release systems, such as microparticles, can reduce the toxicity of this compound and make it a viable alternative for therapeutic application. Objective: To analyze the properties of poly-ε-caprolactone microspheres incorporated with usnic acid on the histomorphometry of the renal corpuscles of Swiss mice submitted to the acute toxicity test. Methodology: The groups treated with vehicle (0.9% NaCl and 5% cremophor), usnic acid (2000, 300 and 50 mg/kg) and microspheres incorporated with usnic acid (UA-Micro) in the dose of 2000 mg/kg were subjected to the acute toxicity test according to Organisation for Economic Co-operation and Development (OECD – Guideline, 423). Fragments of renal tissue were removed for preparation of histological slides, subsequently stained with Hematoxylin and Eosin. The morphometric analysis of renal capsule diameters was performed using the IMAGE software from the photomicrographs (final magnification 790 μm). Statistical analysis of the renal capsule diameters was performed using Variance (ANOVA), followed by the Tukey test. Results and Discussion: Treatment with UA-Micro (2000 mg/kg) and UA (50 mg/kg) did not show histomorphometric changes in the glomerular capsule, but treatments with UA (2000 and 300 mg/kg) caused histomorphometric changes in the glomerular capsule (**** p

  • Importance of Early Diagnosis and Treatment in Cases of Phenylketonuria

    Introduction: Phenylketonuria is a hereditary disease characterized by the absence of the enzyme phenylalanine hydroxylase, which converts the amino acid phenylalanine to tyrosine. Phenylalanine, accumulates in the body, and confers toxicity mainly to the central nervous system. Diagnosis, as well as early treatment is essential for the child to develop normally. Objective: To describe the diagnosis and treatment of phenylketonuric patients. Methodology: A review of the literature was conducted through articles published in journals indexed in the Scielo and PubMed databases, In the Portuguese language, in the last 8 years, using the descriptors: diagnosis, phenylketonuria, treatment. Results and Discussion: The diagnosis of phenylketonuria is made through neonatal screening, foot test, where the concentrations of phenylalanine and tyrosine are identified. When phenylalanine levels are elevated and tyrosine levels are low, the diagnosis of the disease is proven. When performed early, the diagnosis and consequently the start of treatment, can prevent the irreversible neurological damage that high doses of phenylalanine cause in patients. The recommended treatment is still a restricted diet of phenylalanine, with the use of a diet with low intake of phenylalanine in the child’s diet, in the first month of life, can significantly prevent mental retardation. That is, a feed free of foods containing phenylalanine protein, such as food of animal origin (meats and their derivatives) vegetable origin (legumes and oilseeds) and sweeteners and / or foods containing aspartame. The greatest difficulty in the elaboration of these diets is to meet the nutritional needs of the patient so that it has its full development. Conclusion: Early diagnosis along with adequate treatment will allow the patient with phenylketonuria to develop and grow optimally. The monitoring of the nutritionist and the physician, is of paramount importance to minimize the adverse effects resulting from the accumulation of phenylalanine.

  • The Gestacional Diabetes Mellitus Approach and Their Implications

    Background: Diabetes mellitus is a clinical syndrome characterized by hyperglycemia due to a deficiency or decrease of insulin, causing metabolic disorders of carbohydrates, water, electrolytes, lipids and proteins, this affects the pancreatic function until the rupture of insulin production. This disease may manifest itself in pregnancy (Gestational Diabetes Mellitus or GDM), when a degree of glucose tolerance is observed, bringing various risks to the mother and fetus. Aim: The aim of this study was to identify the main causes of Gestacional diabetes, analyzing the complications of GDM, and the main treatments. Methods: Review of published researches from 2010 to 2017 in the Google Scholar, Scielo and Bireme databases, using the descriptors Diabetes Mellitus and Gestational Diabetes Mellitus. Results: The causes of gestational diabetes mellitus are mainly related to weight gain, family history, and occurrence of the disease during another pregnancy and it may cause damage such as premature rupture of membranes, pre-eclampsia, premature birth and hypertension. The fetus can develop hypocligemia, macrosomia, respiratory disorders, electrolyte disturbances, cardiomyopathy, neonatal asphyxia, among other complications. In the most recommended treatments, it is important to improve the lifestyle of the pregnant woman, and the drug treatment with oral anti-hyperglycemic agents as metformin and glibenclamide, or Insulin therapy, and according to the studies, the most efficient are the insulins glargine, aspart, regular and lispro. Discussion: The change in quality of life refers to the adoption of balanced diet and physical activity being the first treatment option for GDM, if this does not help controlling the glycemic levels, the drug therapy must be used. Conclusion: It is of great importance to be aware of the risks caused in gestational diabetes during the planning of a pregnancy, with emphasis on changing habits of life and weight control and monitoring of health professionals, preventing this and other diseases.

  • Self-care of the Patient With Diabetes Mellitus: Strategy to Prevent Complications of the Disease

    Introduction: Diabetes Mellitus (DM) is considered one of the most frequent diseases. Diabetic patients are very concerned about general health changes and early or late complications that this chronic disease can bring. Health education, associated with health promotion strategies, contribute to social development and promote quality of life, an important tool to reduce the complications and mortality of diabetics. The active participation of the patient in the management of changes in habits and behaviors will lead to progress in reducing the risks related to the disease. Objective: Describe health education and self-care strategies for patients with primary care Diabetes and early detection for penile cancer. Methodology: Narrative bibliographic review using electronic database Science Direct, with the keywords: self-care + “diabetes mellitus” + “healtheducation”. The original articles published in the last five years were evaluated. Results and Discussion: DM is an asymptomatic disease, which mainly affects people older than 40 years, systemic, and can damage several organs, causing complications including: kidney failure, blindness, stroke, amputation of limbs, among others. Lack of information promotes neglect of health education, in accordance with the self-control of blood glucose levels, physical activity and diet, contributes to the improvement of the quality of life. Acceptance of the situation, understanding of the disease and discipline to follow the multidisciplinary treatment are fundamental for the early diagnosis and control of DM. Conclusion: It is important to make routine medical appointments for the early diagnosis and control of DM, coupled with a healthy lifestyle and issues related to self-care so that the complications associated with this disease develop.