The Experts below are selected from a list of 264 Experts worldwide ranked by ideXlab platform
Ramesh Cuganesan - One of the best experts on this subject based on the ideXlab platform.
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renal vein doppler sonography of Obstructive Uropathy
American Journal of Roentgenology, 2002Co-Authors: Grant A Bateman, Ramesh CuganesanAbstract:OBJECTIVE. Obstructive Uropathy in the early stages can be difficult to diagnose using either standard sonography or the arterial resistive index. We tested the hypothesis that acute obstruction of the renal collecting system reduces the intraparenchymal renal compliance, which affects the intraparenchymal venous blood flow to a greater degree than the arterial flow.SUBJECTS AND METHODS. Twelve patients with clinical evidence of acute Obstructive Uropathy were referred for helical CT to confirm the diagnosis and to provide a gold standard by which we could evaluate the sonographic findings in the 12 test patients. Twelve patients without renal disease served as a control group. Doppler sonography of the interlobar arteries and veins of both kidneys then was performed, with the sonographer unaware of which kidney had an obstruction. Peak venous flow measurements and arterial resistive and venous impedance indexes were obtained. The impedance indexes of the obstructed and unobstructed kidney were compared f...
Richard G Robinson - One of the best experts on this subject based on the ideXlab platform.
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Obstructive Uropathy as the etiology of renal failure in ovarian hyperstimulation syndrome
Fertility and Sterility, 2008Co-Authors: David Alastair Merrilees, Andrew Kennedysmith, Richard G RobinsonAbstract:Objective To make people aware that there is potential for Obstructive Uropathy to complicate ovarian hyperstimulation syndrome (OHSS) and cause renal impairment. Design Case report. Setting Hospital. Patient(s) A 28-year-old Caucasian female presenting with acute severe OHSS. Intervention(s) Bilateral JJ stenting. Main Outcome Measure(s) Resolution of renal impairment. Result(s) Successful treatment of renal failure. Conclusion(s) Patients with severe OHSS and renal impairment should be evaluated with renal ultrasound to rule out hydronephrosis and therefore an Obstructive Uropathy. Patients potentially at risk for such a complication from OHSS may include those with prior abdominal or pelvic surgery.
Mark P. Johnson - One of the best experts on this subject based on the ideXlab platform.
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Fetal Obstructive Uropathy in trisomy syndromes.
Fetal Diagnosis and Therapy, 2000Co-Authors: Faisal Qureshi, Suzanne M. Jacques, Baruch Feldman, Barbara J. Doss, Anthony Johnson, Mark I. Evans, Mark P. JohnsonAbstract:Fetal Obstructive Uropathy has seldom been described in trisomy syndromes, and its relationship to these syndromes remains unclear. Five trisomic male fetuses, four with trisomy 18 and one with trisomy 21, were identified out of 110 fetuses evaluated for fetal Obstructive Uropathy. We performed detailed examination on the urinary tracts of four of these fetuses, three with trisomy 18 and one with trisomy 21, following termination in the second trimester. All four had a markedly distended urinary bladder (megacystis), abdominal wall distension, and a small, poorly developed urethra thoughout its full length. All four also had poor development of the prostate with virtual absence of glandular development, as compared to age-matched controls. Posterior urethral valves were not identified in any case. Three of the fetuses (two with trisomy 18 and one with trisomy 21) had unilateral or bilateral hydroureters, and resulting renal tubulocystic or glomerulocystic change. Review of this database reveals an unexpectedly high frequency of trisomies, particularly trisomy 18, suggesting that the relationship may not be coincidental. Abnormal prostate development may be causally related to fetal Obstructive uropathies and may be an under-recognized trait in trisomy syndromes. Karyotypic analysis of all fetuses with Obstructive Uropathy is important since in utero surgical intervention may be contraindicated in cases of fetal aneuploidy.
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fetal therapy for Obstructive Uropathy past present future
Pediatric Nephrology, 2000Co-Authors: Andrew L Freedman, Mark P. Johnson, Ricardo GonzalezAbstract:Antenatal treatment of Obstructive Uropathy, although widely performed, remains controversial. An overview of prenatal therapy for Obstructive Uropathy, the limitations of the early published experience, advances of recent years, and future directions for treatment are reviewed. The clinical approach and outcomes of the Fetal Treatment Program of Hutzel Hospital and Wayne State University are presented. Patient selection for antenatal treatment is based on the existence of a significant threat of neonatal death due to pulmonary hypoplasia, pending exclusion criteria such as anatomical structural anomalies and chromosomal defects. Ultrasonography, karyotyping, and sequential urinary electrolyte analysis are essential. Current treatment involves the placement under ultrasonic guidance of a Rodeck vesicoamniotic shunt. Recent technical advances include the use of amnioinfusion for fetal visualization, temporary fetal paralysis, routine antibiotics, and more-precise catheter placement. The establishment of standardized short- and long-term outcome measures and the documentation of fetal and maternal complications are in progress. Procedural refinement, development of fetoscopic techniques and equipment, identification of urinary markers to aid patient selection, and the collection of multicenter outcome data will assist the future management of prenatally detected Obstructive Uropathy.
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Fetal intervention for Obstructive Uropathy
Seminars in Perinatology, 1999Co-Authors: Danielle S. Walsh, Mark P. JohnsonAbstract:Obstructive Uropathy is a significant source of morbidity and mortality in the neonate and infant, despite advances in postnatal management. Diagnosis is typically made early in the second trimester on the basis of sonographic measurements. In utero therapy holds promise for improved outcomes by preventing progressive urinary tract damage and permitting drainage of urine into the amniotic space to minimize the pulmonary sequelae of oligohydramnios. Multiple studies with animal models have showed the benefits of midgestational intervention, but large prospective, randomized studies have not yet been performed to confirm these findings in humans. Standardization of the diagnostic evaluation allows for refined patient selection, resulting in improved postnatal outcomes after fetal vesicoamniotic shunting. Research into the role of specific growth factors and immunoproteins in renal development and function may further improve patient selection and outcome. This article reviews diagnosis, technique, and outcomes for fetal treatment of Obstructive Uropathy.
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sequential urinalysis improves evaluation of fetal renal function in Obstructive Uropathy
American Journal of Obstetrics and Gynecology, 1995Co-Authors: Mark P. Johnson, Faisal Qureshi, Paul Corsi, William Bradfield, Roderick F Hume, Craig Allen Smith, Alan W Flake, Mark I. EvansAbstract:Abstract OBJECTIVES: The purpose of our study was to determine whether sequential vesicocenteses improve the evaluation of renal damage, compared with single urine sampling in Obstructive Uropathy. STUDY DESIGN: A total of 29 fetuses with complete Obstructive Uropathy underwent a minimum of three sequential complete vesicocenteses at 48- to 72-hour intervals. First and last urine values were analyzed for multiple parameters. The ability of first versus last urine values to detect the presence of renal damage was compared according to postnatal or fetal autopsy information. RESULTS: Fetuses with minimal renal damage had patterns of decreasing hypertonicity and last urine values below cutoff thresholds indicative of favorable prognosis. Fetuses with significant renal damage had higher initial values and patterns of increasing hypertonicity. For five of six parameters, last urine samples were more predictive of renal damage than first urine samples. CONCLUSION: Last urine values together with pattern-of-change trend analysis after serial vesicocenteses improve diagnostic precision in fetuses with complete Obstructive Uropathy.
Mark I. Evans - One of the best experts on this subject based on the ideXlab platform.
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Fetal Obstructive Uropathy in trisomy syndromes.
Fetal Diagnosis and Therapy, 2000Co-Authors: Faisal Qureshi, Suzanne M. Jacques, Baruch Feldman, Barbara J. Doss, Anthony Johnson, Mark I. Evans, Mark P. JohnsonAbstract:Fetal Obstructive Uropathy has seldom been described in trisomy syndromes, and its relationship to these syndromes remains unclear. Five trisomic male fetuses, four with trisomy 18 and one with trisomy 21, were identified out of 110 fetuses evaluated for fetal Obstructive Uropathy. We performed detailed examination on the urinary tracts of four of these fetuses, three with trisomy 18 and one with trisomy 21, following termination in the second trimester. All four had a markedly distended urinary bladder (megacystis), abdominal wall distension, and a small, poorly developed urethra thoughout its full length. All four also had poor development of the prostate with virtual absence of glandular development, as compared to age-matched controls. Posterior urethral valves were not identified in any case. Three of the fetuses (two with trisomy 18 and one with trisomy 21) had unilateral or bilateral hydroureters, and resulting renal tubulocystic or glomerulocystic change. Review of this database reveals an unexpectedly high frequency of trisomies, particularly trisomy 18, suggesting that the relationship may not be coincidental. Abnormal prostate development may be causally related to fetal Obstructive uropathies and may be an under-recognized trait in trisomy syndromes. Karyotypic analysis of all fetuses with Obstructive Uropathy is important since in utero surgical intervention may be contraindicated in cases of fetal aneuploidy.
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sequential urinalysis improves evaluation of fetal renal function in Obstructive Uropathy
American Journal of Obstetrics and Gynecology, 1995Co-Authors: Mark P. Johnson, Faisal Qureshi, Paul Corsi, William Bradfield, Roderick F Hume, Craig Allen Smith, Alan W Flake, Mark I. EvansAbstract:Abstract OBJECTIVES: The purpose of our study was to determine whether sequential vesicocenteses improve the evaluation of renal damage, compared with single urine sampling in Obstructive Uropathy. STUDY DESIGN: A total of 29 fetuses with complete Obstructive Uropathy underwent a minimum of three sequential complete vesicocenteses at 48- to 72-hour intervals. First and last urine values were analyzed for multiple parameters. The ability of first versus last urine values to detect the presence of renal damage was compared according to postnatal or fetal autopsy information. RESULTS: Fetuses with minimal renal damage had patterns of decreasing hypertonicity and last urine values below cutoff thresholds indicative of favorable prognosis. Fetuses with significant renal damage had higher initial values and patterns of increasing hypertonicity. For five of six parameters, last urine samples were more predictive of renal damage than first urine samples. CONCLUSION: Last urine values together with pattern-of-change trend analysis after serial vesicocenteses improve diagnostic precision in fetuses with complete Obstructive Uropathy.
Grant A Bateman - One of the best experts on this subject based on the ideXlab platform.
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renal vein doppler sonography of Obstructive Uropathy
American Journal of Roentgenology, 2002Co-Authors: Grant A Bateman, Ramesh CuganesanAbstract:OBJECTIVE. Obstructive Uropathy in the early stages can be difficult to diagnose using either standard sonography or the arterial resistive index. We tested the hypothesis that acute obstruction of the renal collecting system reduces the intraparenchymal renal compliance, which affects the intraparenchymal venous blood flow to a greater degree than the arterial flow.SUBJECTS AND METHODS. Twelve patients with clinical evidence of acute Obstructive Uropathy were referred for helical CT to confirm the diagnosis and to provide a gold standard by which we could evaluate the sonographic findings in the 12 test patients. Twelve patients without renal disease served as a control group. Doppler sonography of the interlobar arteries and veins of both kidneys then was performed, with the sonographer unaware of which kidney had an obstruction. Peak venous flow measurements and arterial resistive and venous impedance indexes were obtained. The impedance indexes of the obstructed and unobstructed kidney were compared f...
