BACKGRAUND: There is evidence of a multifactorial effect of SARS-CoV2 on carbohydrate metabolism with the development of hyperglycemia and the weighting of COVID19 even in people without DM.AIMS: Assess the prevalence of disorders carbohydrate metabolism (DCM) in hospitalized patients with a new coronavirus infection without a history of DM.MATERIALS AND METHODS: Patients with PCR-confirmed diagnosis of COVID19 aged 18-75 years (n=72) without a history of diabetes were examined. Observation was carried out from the moment of hospitalization to discharge. Patients were collected anamnesis data, laboratory and instrumental studies, HbA1c, fasting plasma glucose (FPG), postprandial glycemia.RESULTS: The prevalence of DCM (HbA1c≥6%) in 72 patients with COVID19 without a history of diabetes admitted to the hospital was 41,7%, while HbA1c ≥6,5% had 8,3%. The median HbA1c in the moderate-flow group was 5,7% [5,3–6,0], and in the severe-flow group it was 6,0% [5,8–6,2] (p=0,008). Participants were divided into groups according to the level of HbA1c≥6% and < 6%. The examined patients showed a high prevalence of risk factors for developing DM: age over 45 years — 83,3%, cardiovascular diseases — 46,3%, obesity — 50%. The study groups didn’t differ statistically in terms of risk factors for DM. In the group with HbA1c≥6%, FPG≥6,1 mmol / l on the second day and postprandial glycemia ≥7,8 mmol/l were observed in more cases than in the group with HbA1c<6% (39,1% vs 12,9%, p=0,051 and 47,8% vs 3,2%, p=0,0001, respectively). The prevalence of DCM in HbA1c was higher than in FPG (41,7% vs 29,2%, p=0,006). On the seventh day, the number of patients with FPG ≥ 6,1 mmol / l in the first group decreased from 39,1% to 4,4% (p=0,01), and in the second group-from 12,9% to 9,7% (p=1,0). There was a direct correlation between the level of HbA1c and C-reactive protein (r=0,271; p=0,048), and an inverse correlation with the content of lymphocytes in the blood (r=-0,25; p=0,068).CONCLUSIONS: In patients with a new coronavirus infection without a history of DM, a high prevalence of DCM was detected — 41,7%. Against the background of comparability of the studied groups by risk factors for DM, an increase in HbA1c, FPG and postprandial glycemia is a manifestation of transient hyperglycemia. Given the high prevalence of DCM, it can be assumed that SARS-CoV2 has diabetogenic properties.
This paper presents a clinical case of laparoscopic nephrectomy for a large (10 cm) renal sinus mass in an allograft kidney, followed by intrarenal urinary tract reconstruction with ureteral reimplantation. The surgery had an acceptable oncological outcome, without loss of kidney function. Regardless of the volume and extent of the tumor process, the use of minimally invasive, nephron-sparing treatment techniques takes a leading position in the treatment of renal cancer in kidney recipients. Intrarenal urinary tract reconstruction allows a kidney to be saved even if the tumor is significantly large and/or inoperable.
Introduction. In recent years, the number of patients with autosomal dominant polycystic kidney disease (ADPKD) who undergo kidney transplantation without nephrectomy has increased. The most frequent and adverse complication from your own kidneys is infection of cysts (IC). This dictates the need to predict the probability of IC and determine diagnostic and therapeutic approaches in this category of patients. Materials and methods. The results of observation and treatment of 55 patients with ADPKD who underwent kidney transplantation from 2000 to 2019 without prior nephrectomy were evaluated. Results. Bilateral nephrectomy in connection with IC was performed in 10 (18.1%) patients, and one patient died from sepsis progression. Burdened urological history (kidney operations for suppuration of cysts and recurrent urinary tract infection (UTI)) significantly increased the chances of nephrectomy for IC by 6.8 times (AOR 6.83; 95% CI 1.34-34.8; p=0.021). The median time from kidney transplantation to nephrectomy was 7 months (Q1-Q3: 2-8). Acute graf pyelonephritis was associated with IR (p=0.045) in single-factor analysis. Forty-five patients are under observation, with a median follow-up of 41 months (Q1-Q3: 19-76). Seventeen patients underwent magnetic resonance imaging using diffusely weighted image protocols (MRI-DWI). MR-signs of infection were detected in 5 patients. Given the absence of clinical and laboratory manifestations of inflammation, nephrectomy was not performed. Further followup did not indicate the development of clinical and laboratory signs of UTI in any case. Discussion. As our study and a number of other studies have shown, in patients with ADPKD after kidney transplantation, the most frequent indication for nephrectomy is inflammatory changes in their own kidneys. Patients with a history of severe pyelonephritis or IC who previously had pyelonephritis or IC before kidney transplantation are at risk for developing inflammatory changes after kidney transplantation, and it does not matter how long ago they had a history of pyelonephritis attacks or kidney surgery. This fact should be taken into account before kidney transplantation and offer patients a nephrectomy before kidney transplantation. Our work is consistent with a number of non-numerous publications that have shown that in the diagnosis of IC, the most informative non-invasive, imaging method is MRI of the kidneys, but this method has low specificity, which can lead to an increase in the number of false positive conclusions and an increase in the number of unjustified nephrectomies. Conclusion. The predictor of infection of own kidney cysts after transplantation is a burdened urological history. MRI DWI has high sensitivity and low specificity in the diagnosis of IR in ADPKD. When identifying single cysts with MR-signs of infection in the absence of clinical, laboratory manifestations of UTI, nephrectomy is not indicated.
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