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Ahmed El-Asmy

Publications and source records attributed to Ahmed El-Asmy.

2 recordsLinked to original sources
PubMed2002

Recoverability of renal function after relief of acute complete ureteral obstruction: clinical prospective study of the role of renal resistive index.

OBJECTIVES: To study the values of the renal resistive index (RI) before and at different points after relief of obstructive anuria and to correlate these values with the corresponding values of serum creatinine and with the recovery of renal function after release of obstruction. METHODS: A total of 32 consecutive patients with obstructive anuria were prospectively evaluated by measurement of RI before drainage and at 3 days, 1 week, 2 weeks, and 4 weeks after drainage. Serum creatinine was measured at all points of the RI examination. Moreover, RI was measured in an age and sex-matched control group of 24 consecutive healthy donors and volunteers. RESULTS: The study included 40 obstructed and 48 normal kidneys. In the obstructed kidneys, the mean RI values decreased significantly from 0.78 +/- 0.05 before drainage to 0.70 +/- 0.09 at 3 days after drainage (P <0.001) with an additional significant reduction to 0.68 +/- 0.08 at 7 days after drainage (P <0.01) and stabilized thereafter. Serum creatinine decreased significantly from 8.4 +/- 4.4 mg/dL before drainage to 4.7 +/- 3.8 mg/dL 3 days after drainage (P <0.001) and then to 3.6 +/- 3.7 mg/dL 7 days after drainage (P <0.001) and stabilized thereafter. The correlation between the RI and serum creatinine at the overall points of measurement was good. Obstructed kidneys were classified into two groups according to the recovery of renal function after obstruction relief: those that showed significant improvement of serum creatinine (24 kidneys, group 1) and those with no significant improvement of serum creatinine (16 kidneys, group 2). In group 1, the difference between the mean RI values before and after drainage was statistically significant (0.78 +/- 0.05 versus 0.64 +/- 0.06, P <0.001); in group 2, the difference between the before and after drainage RI values was not significant (0.781 +/- 0.040 versus 0.779 +/- 0.039). The mean RI of the normal kidneys was 0.66 +/- 0.04. A comparison between the mean RI values of the control group and the mean RI values of the obstructed patients after drainage showed no significant difference in group 1; markedly higher values were noted in group 2 at all points after drainage. CONCLUSIONS: In the setting of acute complete renal obstruction, the RI has a good positive correlation with serum creatinine. Recovery of renal function could not be predicted from the changes in RI before obstruction release. However, a reversal of a previously elevated RI could be used as an early indicator that renal function recovery is likely.

Adult↗
PubMed2002

Noncontrast computed tomography in obstructive anuria: a prospective study.

OBJECTIVES: To evaluate the role of noncontrast computed tomography (NCCT) in the determination of the cause of obstructive anuria and to compare its accuracy with that of the traditional methods of combined plain abdominal x-ray (KUB) and gray-scale abdominal ultrasonography (US). METHODS: The study included 40 consecutive patients with obstructive anuria. In addition to the routine evaluation, which included history, clinical examination, biochemical profile, KUB, and US, all patients underwent NCCT. The study patients were tested against an age and sex-matched control group that included the normal contralateral kidneys of 57 consecutive patients who underwent KUB, US, and NCCT for acute flank pain during the same study period. The reference standard for the determination of the cause of obstruction was retrograde or antegrade ureterography with or without ureteroscopy or open surgery. The absence of obstruction in the control group was confirmed by nonequivocal normal intravenous urography of the side free of flank pain. Both NCCT and combined KUB and US were compared regarding the sensitivity, specificity, and overall accuracy. RESULTS: The study group had 48 renal units, because obstruction was bilateral in 8 patients and of a solitary kidney in 32. Of the 42 renal units with calculus obstruction, the site of stone impaction was identified in all renal units by NCCT (sensitivity 100%) and in only 25 by combined KUB and US (sensitivity 59.5%)-a significant difference (P = 0.0001). Of the 6 renal units with noncalcular obstruction, both NCCT and US diagnosed the cause of obstruction in 3. The overall sensitivity of NCCT in the determination of the cause of obstructive anuria was 94% and that of combined KUB and US was 58%-a significant difference (P = 0.0001). The specificity of NCCT was not significantly different from that of combined KUB and US (96.5% versus 93%, respectively). The overall accuracy of NCCT was 95% and that of combined KUB and US was 77%-a significant difference (P = 0.0003). CONCLUSIONS: In patients with obstructive anuria, conventional KUB and US could not identify the cause of ureteral obstruction in about 40% of the patients. Under such conditions, NCCT can accurately provide the diagnosis, obviating the need of invasive and expensive diagnostic procedures.

Anuria↗