Forniceal rupture is a rare event in pregnancy. We report a case of a 26-year-old primigravid woman who experienced a forniceal rupture at 23 weeks of gestation with no inciting cause except for pregnancy. Pregnancy is associated with ureteral compression due to increase in pelvic vasculature with the right ureter more dilated due to anatomic reasons. Hormones such as prostaglandins and progesterone render the ureter more distensible to allow for pressure build-up and an obstructive picture at the collecting system. We will discuss physiologic changes in pregnancies that predispose to this uncommon phenomenon and the most up-to-date management strategies.
Abstract:The fervent search for an early biomarker for diabetic nephropathy is continuing because this entity has become the leading cause of end-stage renal disease in many countries. Novel biomarkers are being described in a high-speed manner. Using urine as a biological source is especially appealing given its ease of collection and its ability to serve as a direct conduit to the site of injury. We begin by briefly discussing the merits and pitfalls of our gold standard of microalbuminuria, and shift quickly to several promising nontraditional protein and messenger (m)RNA biomarkers. The quality of the evidence for using urinary podocyte as a marker will be described. Exploring entire sets of protein in humans in terms of proteomics has been a favorite approach in the last decade because the technology of protein separation and mass spectrometry allows for the unbiased search for new biomarkers. Isolating urinary microRNA may become yet another preferred method because these small, noncoding mRNA that regulate gene expression are particularly stable and apt for biomarker studies. Finally, the latest development is perhaps the study of exosomes, which are nanometer particles derived from the fusion of internal vesicles to the plasma membrane. These particles harbor protein, mRNA, and microRNA that may be isolated for further study. With the advent of newer technologic approaches, we hope that these newly discovered biomarkers will be rigorously tested in large, prospective, clinical trials so they can be implemented in clinical practice.
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