Global Journal of Urology and Nephrology

Case Report of Global Journal of Urology and Nephrology Turning complexity into clarity: polyuria and hypernatremia Awad Magbri, MD, FACP, Shaukat Rashid, MD Surgery and Vascular Center at Regency Park, LLC, Toledo, OH Case history The patient is 65-year old African American male with history of hypertension. He was admitted to hospital with lethargy, disorientation, and confusion. His clinical evaluation and CT of the head revealed subarachnoid hemorrhage. He had h/o stroke 5 years ago. The patient didn’t have fever, but did have a diarrhea of 1-day duration. He is receiving parenteral feeding and his urine output is 4L/day. His physical examination revealed blood pressure of 100/70mmHg, with heart rate of 100 BPM. He has dry mucous membranes and the rest of examination was unremarkable. His laboratory investigation showed sodium 159meg/L, K+ 4.6meg/L, chloride 114mEq/L, HCO3 26mEq/L, creatinine 1.9mg/L, Blood urea nitrogen 64mg/L, and glucose 200mg/L His urine sodium 70mEq/L, and urine osmolality 380mOsm/Kg H2O. His volume status is slightly dry, and he weighs 70Kg. Case discussion This case illustrated several information including polyuria with parenteral nutrition, low blood pressure and dry mucous membranes denoting low extracellular fluids volume. High serum sodium, and high urine osmolality in the face of hypovolemia and hypernatremia. As a consequence of his illness he suffered from low perfusion to the kidneys with worsening kidney function. Hypernatremia is a common electrolyte abnormality and defined as a serum sodium >145mEq/L (1,2,3). Hypernatremia is hyperosmolar state caused by a decrease in total body water (TBW), relative to electrolytes content (4). Therefore, hypernatremia is a water problem not sodium problem. It often occurs in elderly and hospitalized patients with restricted access to water and in those with impaired thirst mechanism (hypodipsia/adepsia) or mental status changes. Developing hypernatremia is virtually impossible if the thirst mechanism is intact and water ...

Case Report of Global Journal of Urology and Nephrology Two Options the sweetest among them is bitter: Fournier-gangrene associated with sodium-glucose co-transporter 2-inhibitors Awad Magbri, MD, FACP, Mariam El-Magbri, BSC, MPH, Kamran Suljuki, PharmD, MBA, Shaukat Rashid, MD. Regency Vascular Access, Toledo, OH The authors discuss a case of sodium-glucose co-transporter 2 inhibitor associated with Fournier-gangrene in a patient with type-2 diabetes millets. The patient had extensive surgical intervention and skin graft but succumbed to her disease. Keywords: Fournier’s gangrene, diabetes, perineum infection, sodium-glucose cotransporter-2 inhibitors, glycosuria ...

Case Report of Global Journal of Urology and Nephrology Large urinary bladder leiomyoma causing right hydronephrosis, a rare case report: diagnosis and management Manjeet Kumar1, Kailash barwal1, Girish Kumar1, Kalpesh Mahesh Parmar2, Pamposh raina1 1 Department of Urology, IGMC, Shimla, Himachal Pradesh, India 2 Department of Urology, PGIMER, Chandigarh, India Background Leiomyoma of the urinary bladder is a rare tumor despite the routine use of ultrasonography. These tumors are typically asymptomatic, sometimes present with hematuria, dysuria, and bladder outlet obstruction. Leiomyoma is a benign tumor which is detected incidentally and rarely causes upper urinary tract changes. (1, 2) We present an extremely rare case of leiomyoma in urinary bladder causing right hydronephrosis and presenting with flank pain. Case summary A 42 years female presented with flank pain in the emergency room as result of hydronephrosis in the right kidney. Imaging of urinary tract revealed 6 x 6.5 cm, a well-circumscribed tumor with right hydroureteronephrosis suggestive of leiomyoma of the urinary bladder. Excision of leiomyoma was done intravesically with preservation of bilateral ureteral orifices’. Conclusion Our case highlights despite being a large tumor there was no ureteral involvement. The hydronephrosis was the result of compression from large sized leiomyoma which was successfully managed by excision of leiomyoma. Keywords: Leiomyoma, urinary bladder, Hydronephrosis, Transurethral biopsy, ureteric orifice ...

Research Article of Global Journal of Urology and Nephrology Mineral-Bone Disorders in Chronic Hemodialysis Patients in Sub-Saharan Africa: Dakar Experience (Senegal West Africa) LEMRABOTT Ahmet Tall2, KANE Yaya1 *, FAYE Maria2, FALL Khodia2, BANGOURA Mohamed1, FAYE Moustapha1, DIA Gueye Diatou3 , AIDARA Chérif Mohamadou1, CISSE M Moustapha4, SECK S Mohamed3, KA El Hadji Fary2, NIANG Abdou2, DIOUF Boucar2 1Nephrology and Hemodialysis Department - Orthopedic, Radiology Department, Peace Hospital, Assane Seck University, ZIGUINCHOR, Senegal; 2Nephrology and Hemodialysis Department, UCAD HALD, Dakar; 3Nephrology, Hemodialysis and internal medicine Department, CHR, St. Louis, Gaston Berger University; 4Nephrology and Hemodialysis Department, CHR, University of Thies Introduction: Mineral bone disorders (BMD) are almost constant complications in chronic hemodialysis patients. The objective of our study was to determine the prevalence and profiles of BMD in chronic hemodialysis patients. Patients and methods: This is a six-year descriptive and analytical retrospective study from January 1st, 2010 to December 31st, 2015, at the hemodialysis department of the University Hospital Center (CHU) Aristide Le Dantec. Were also included patients on chronic hemodialysis for at least 3 months, with at least one prescribed amount of parathyroid (PTH). For each included patient, the epidemiological, dialytic, diagnostic and therapeutic parameters were collected and analyzed. Results: Over 86 patients, 71 (82.5%) had BMD. The average age was 48.92 ± 15.5 years old, with a sex ratio of 0, 65. Nephroangiosclerosis was the most frequent initial nephropathy (56.3%). The dialysis seniority was 5.2 ± 2.9 years old and 93% of patients profited from 3 sessions of 4 hours per week. Eleven patients (15.5%) had previous aluminum intoxication. Fifty-eight patients (81.6%) had secondary hyperparathyroidism, 12.6% had adynamic osteopathy (OA), and 1.4% had osteomalacia. In patients with secondary hyperparathyroidism, the average age was 48.6 ± 15 years old. 37.9% of these patients had articular pains, 22.4% had bone ...