Global Journal of Urology and Nephrology

Research Article of Global Journal of Urology and Nephrology Accuracy of Prostate Specific Antigen Density in Predicting Prostate Cancer- A single-centre UK experience Rahul Pandya#, Ayesha Butt#, Andrei Bancu, S I Miakhil Urology, North West Anglia NHS trust   # Co-lead author Introduction and objectives: PSA has been a useful tool in identifying prostate cancer since its discovery. However relying on this alone can lead to unnecessary over investigation as it can be falsely raised in other conditions. PSA density is a possible enhanced marker for prostate biopsy indication, however it is not standard practice or recommended in national guidelines. Previous studies have shown that PSA density is most useful when the PSA is in the range of 4-10. We aim to study the effectiveness of PSA density at detecting prostate cancer within that range as well as outside that range. Methods: Retrospective single centre study at Peterborough City Hospital including 500 patients who had a MRI prior to prostate biopsy between July 2017 to July 2018. Patients undergoing repeat biopsy already on a cancer pathway were excluded. PSA density was calculated by dividing PSA from the prostate volume recorded on the MRI. A cut of value of PSA density was chosen at 0.15 and 0.10. Results: Data from 500 patients with a mean age of 65 and mean PSA of 10.7 (PSA range 0.32 to 99). 251 (50.2%) patients had cancer on histology with 152 having clinically significant cancer. Mean PSA density was 0.11ng/ml/cm3 with benign histology, 0.36ng/ml/cm3 for all cancer and 0.48ng/ml/cm3 for clinically significant cancer. Overall the mean PSA density in prostate cancer was found to be 0.15. Sensitivity of PSAD at detecting all prostate cancer at cutoff of 0.10 with PSA 4-10 was 76% and 88% for clinically significant prostate cancer (Gleason 7>). The negative predictive value ...

Review Article of Global Journal of Urology and Nephrology Heat Stress Nephropathy and Cardiovascular Surgery-Associated Renal Failure: Similarities and Implications Puneet Dhawan, MD, Timothy L. Van Natta, MD, MS Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA Climate changes associated with global warming are producing challenges increasingly relevant to clinicians. Rising temperatures and extended heat waves are associated with a growing incidence of a recently described condition termed heat sensitivity nephropathy. Considering all causes of acute kidney injury and chronic kidney disease, those producing renal dysfunction consequent to cardiovascular surgery may most closely overlap those tied to kidney disease following excessive chronic or acute heat exposure. In this review, heat sensitivity nephropathy and cardiovascular surgery related renal injury are characterized and compared. While both are global in distribution, the former has highest prevalence in remote, rural areas and difficult to study and quantify. Renal injury following cardiovascular surgery, occurring by contrast in relatively controlled settings, is more amenable to evaluation of diagnostic approaches, prognostic indicators, and potential treatments. Such findings may ultimately apply not only to surgically-related kidney damage but to heat sensitivity nephropathy as well. Despite many studies addressing post-cardiovascular surgery renal failure, no single management method has emerged as definitively superior. Nonetheless, reasonably standardized worldwide conduct of cardiac and vascular surgery provides fertile conditions for research that could lead to improved diagnostic and therapeutic approaches. Such findings may ultimately apply to not only surgically-related renal injury but perhaps also to heat sensitivity nephropathy. Instead of anticipating discovery of major isolated preventative or treatment methods applicable to either cause of renal failure, it is more realistic that a series of marginally successful measures employed in combination will engender the most nearterm progress. Potentially complimenting currently available options is biomarker analysis that may better guide both renal ...

Research Article of Global Journal of Urology and Nephrology NON-DIABETIC GLUCOSURIA AS ONE OF THE POSSIBLE FACTORS OF FORMATION OF CHRONIC KIDNEY DISEASE Berdichevskyу B.A., Berdichevskyу V.B. Clinic of Urology "Tyumen State Medical University" Russia Relevance. The reason for this study was the discovery of patients with clinical and laboratory manifestations of chronic kidney disease (CKD) in the lumen of the tubules of red blood cells and their decay products during nephrobiopsy1. It is known that the appearance of glucose in urine makes an ideal nutrient base for microorganisms that provoke chronic microbial inflammatory damage to the kidneys. Glycated hemoglobin is included in 5% of red blood cells in healthy adults. Its increase is associated with episodes of glycemia exceeding 6.5 mmol/l. which occuts in diabetes decompensation. Moreover, glycated hemoglobin has toxic properties with respect to the viability of the surrounding cytomembranes. This explains the large number of multiple organ diabetic complications 2,3. At the same time, it was found that the biochemical process of glycation of not only hemoglobin, but also other cellular glucoproteins is accompanied by oxidative damage to cytomembranes leading to their structural and functional failure 4,5. However, the role of glycated hemoglobin and glucose released during the deteriation of erythrocytes in the renal tubules, as one of the possible pathogenetic factors in the occurrence of chronic kidney disease, no one has previously analyzed. Goal. To conduct a comparative study of the results of nephrobiopsy and biochemical parameters of carbohydrate metabolism in 120 patients with the first clinically established diagnosis of chronic kidney disease. Materials and methods. Separately, the results of nephrobiopsy and biochemical studies of carbohydrate metabolism in 120 patients with newly diagnosed (CKD) were analyzed. The studies were carried out according to the standard method with generally accepted statistical processing of the obtained scientific data ...

Review Article of Global Journal of Urology and Nephrology Hepatitis C positive donor kidney transplants to decrease wait time for kidney recipients: Review of data and recent trials Amarpreet S Sandhu, DO, MBA, FASN. Department of Kidney Transplant, California Pacific, Medical Center, San Francisco, CA. A kidney transplant is superior to dialysis for patients with end-stage renal disease. The increasing number of end-stage renal disease patients and limited number of available donor kidneys have led to long waiting times to receive a life-saving kidney transplant. Approximately, 14% of the patients wait for more than five years to receive a kidney transplant. The risk of death and becoming too sick to receive a transplant while on the waitlist poses another healthcare challenge. About 21% of the patients are removed from the waitlist every year without receiving a kidney transplant. Over time many strategies are being proposed and used to eliminate the shortage of kidney organs. The advent of the novel therapy for HCV infection and the increasing number of HCV infected donor kidneys due to the unfortunate opioid epidemic has provided new opportunities for kidney recipients. More than 500 high-quality HCV positive donor kidneys are discarded every year. The recent trials of HCV positive donor kidney transplants to HCV negative recipients followed by successful HCV treatment are very motivating. The studies have illustrated that the quality of HCV positive donor kidneys are very similar or even better than HCV negative donor kidneys. HCV positive donor kidney transplants will shorten wait-time for kidney transplant recipients and save lives. Keywords: HCV infected kidney transplant, HCV positive kidney transplant, Underutilized HCV positive donor kidneys ...