Letter to the Editor
Post-renal acute renal failure secondary to peritoneal pseudomyxoma after appendectomy; an uncommon entity
Fracaso renal agudo posrenal secundario a seudomixoma peritoneal tras apendicectomía; una entidad infrecuente
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Linear enlargement with increased uptake in some areas of the parietal peritoneum (arrow) and mesenteric infiltration. Moderate septated ascites in the pelvis (*). Tubular structure adjacent to the caecum related to the appendiceal mucinous tumour (arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Postrenal (obstructive) acute kidney injury (AKI) accounts for 10–17% of all AKI cases.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> It is characterised by obstruction of the flow of urine and may be caused by lithiasis, abdominopelvic cancers, anatomical abnormalities, etc.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of an 80-year-old woman with a history of appendectomy who subsequently developed peritoneal pseudomyxoma (PPM).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">An 80-year-old woman that 12 years earlier underwent appendectomy due to acute appendicitis secondary to appendiceal mucinous cystadenoma. Now she complains of asthenia, pain and increased abdominal girth in the last few months, and, urinary incontinence and oligo-anuria during the last few days.</p><p id="par0020" class="elsevierStylePara elsevierViewall">On examination, BP 137/82<span class="elsevierStyleHsp" style=""></span>mmHg. Cardiopulmonary auscultation and neurological examination: normal. Abdomen distended, painful to palpation. Distended bladder in hypogastrium.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Lab tests: deterioration of kidney function (creatinine 2.45<span class="elsevierStyleHsp" style=""></span>mg/dl and GFR 18<span class="elsevierStyleHsp" style=""></span>ml/min) and microalbumin 180<span class="elsevierStyleHsp" style=""></span>mg/g. Other lab measurements were normal.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Abdominal computed axial tomography (CT) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>): increased uptake in the parietal peritoneum, mesenteric infiltration and a structure adjacent to the caecum related to the appendiceal mucinous tumour, as well as bilateral hydronephrosis (grade 3 on the left and grade 1–2 on the right). Doppler ultrasound of the kidneys without renal artery stenosis. Fine-needle aspiration biopsy: mucinous material with few cells with low-grade atypia compatible with low-grade PMP.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">After urinary catheterisation the urine the volumen of collected was 1900<span class="elsevierStyleHsp" style=""></span>ml.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The patient underwent cytoreductive surgery, but she died during the postoperative period of respiratory distress syndrome. Kidney function after urinary catheterisation and prior to surgery was improving, reaching baseline kidney function. The evolution of the analytical parameters is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The pathogenesis of PPM has been attributed to the rupture, effusion or metastasis of a primary mucinous neoplasm in a peritoneal organ, especially the appendix and ovaries.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The most common signs and symptoms are pain, intestinal distension/obstruction, overinfection and urinary symptoms.</p><p id="par0055" class="elsevierStylePara elsevierViewall">There are two types: disseminated peritoneal adenomucinosis (DPAM) or low-grade PPM, and peritoneal mucinous carcinomatosis (PMCA), which is comparatively more aggressive.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The main treatment is cytoreductive surgery, including appendectomy, bilateral oophorectomy and omentectomy plus systemic chemotherapy. Other authors have proposed intraperitoneal chemotherapy or postoperative abdominal radiotherapy.</p><p id="par0065" class="elsevierStylePara elsevierViewall">PPM is a rare process associated with tumours with a low grade of malignancy, the origin of which is unclear, although appendiceal neoplasm has been suggested as its primary origin.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Removal of the appendix is recommended in cases of pseudomyxoma, even where it appears macroscopically healthy.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4–6</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The prognosis depends on the stage and differentiation of the associated tumour.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5,6</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Borrego García E, Martín-Lagos Maldonado A, García Castillo L, Ruiz Sancho AL. Fracaso renal agudo posrenal secundario a seudomixoma peritoneal tras apendicectomía; una entidad infrecuente. Nefrologia. 2018;38:565–567.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1896 "Ancho" => 2500 "Tamanyo" => 475824 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CT: (a and b) bilateral hydronephrosis, grade 2 on the right and grade 3 on the left; (c and d) dilation of the distal ureter (U). Linear enlargement with increased uptake in some areas of the parietal peritoneum (arrow) and mesenteric infiltration. Moderate septated ascites in the pelvis (*). Tubular structure adjacent to the caecum related to the appendiceal mucinous tumour (arrow).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline data \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">On admission \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">At one week \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.23<span class="elsevierStyleHsp" style=""></span>mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.45<span class="elsevierStyleHsp" style=""></span>mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.15<span class="elsevierStyleHsp" style=""></span>mg/dl \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21<span class="elsevierStyleHsp" style=""></span>mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82<span class="elsevierStyleHsp" style=""></span>mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27<span class="elsevierStyleHsp" style=""></span>mg/dl \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sodium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">138<span class="elsevierStyleHsp" style=""></span>mEq/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">138<span class="elsevierStyleHsp" style=""></span>mEq/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">135<span class="elsevierStyleHsp" style=""></span>mEq/l \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Potassium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.7<span class="elsevierStyleHsp" style=""></span>mEq/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.1<span class="elsevierStyleHsp" style=""></span>mEq/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4<span class="elsevierStyleHsp" style=""></span>mEq/l \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chlorine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100<span class="elsevierStyleHsp" style=""></span>mEq/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">95<span class="elsevierStyleHsp" style=""></span>mEq/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">102<span class="elsevierStyleHsp" style=""></span>mEq/l \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Albuminuria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Undetectable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">180<span class="elsevierStyleHsp" style=""></span>mg/g \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Undetectable \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1894091.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Evolution of analytical parameters.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insuficiencia renal aguda. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 6 | 14 |
| 2024 October | 45 | 43 | 88 |
| 2024 September | 81 | 25 | 106 |
| 2024 August | 96 | 54 | 150 |
| 2024 July | 63 | 19 | 82 |
| 2024 June | 88 | 42 | 130 |
| 2024 May | 97 | 30 | 127 |
| 2024 April | 69 | 31 | 100 |
| 2024 March | 61 | 22 | 83 |
| 2024 February | 57 | 27 | 84 |
| 2024 January | 59 | 31 | 90 |
| 2023 December | 40 | 32 | 72 |
| 2023 November | 68 | 39 | 107 |
| 2023 October | 127 | 22 | 149 |
| 2023 September | 88 | 25 | 113 |
| 2023 August | 52 | 23 | 75 |
| 2023 July | 80 | 26 | 106 |
| 2023 June | 62 | 21 | 83 |
| 2023 May | 72 | 30 | 102 |
| 2023 April | 62 | 24 | 86 |
| 2023 March | 64 | 27 | 91 |
| 2023 February | 71 | 17 | 88 |
| 2023 January | 54 | 31 | 85 |
| 2022 December | 91 | 28 | 119 |
| 2022 November | 74 | 28 | 102 |
| 2022 October | 54 | 53 | 107 |
| 2022 September | 71 | 37 | 108 |
| 2022 August | 63 | 48 | 111 |
| 2022 July | 41 | 44 | 85 |
| 2022 June | 50 | 47 | 97 |
| 2022 May | 44 | 27 | 71 |
| 2022 April | 71 | 56 | 127 |
| 2022 March | 100 | 38 | 138 |
| 2022 February | 90 | 39 | 129 |
| 2022 January | 62 | 40 | 102 |
| 2021 December | 68 | 36 | 104 |
| 2021 November | 69 | 37 | 106 |
| 2021 October | 56 | 53 | 109 |
| 2021 September | 78 | 44 | 122 |
| 2021 August | 41 | 57 | 98 |
| 2021 July | 49 | 32 | 81 |
| 2021 June | 52 | 34 | 86 |
| 2021 May | 56 | 43 | 99 |
| 2021 April | 136 | 64 | 200 |
| 2021 March | 78 | 66 | 144 |
| 2021 February | 71 | 34 | 105 |
| 2021 January | 74 | 27 | 101 |
| 2020 December | 47 | 14 | 61 |
| 2020 November | 45 | 21 | 66 |
| 2020 October | 34 | 21 | 55 |
| 2020 September | 38 | 28 | 66 |
| 2020 August | 67 | 19 | 86 |
| 2020 July | 38 | 20 | 58 |
| 2020 June | 37 | 27 | 64 |
| 2020 May | 56 | 31 | 87 |
| 2020 April | 37 | 25 | 62 |
| 2020 March | 45 | 18 | 63 |
| 2020 February | 41 | 24 | 65 |
| 2020 January | 62 | 23 | 85 |
| 2019 December | 47 | 30 | 77 |
| 2019 November | 75 | 29 | 104 |
| 2019 October | 38 | 18 | 56 |
| 2019 September | 55 | 24 | 79 |
| 2019 August | 31 | 19 | 50 |
| 2019 July | 50 | 37 | 87 |
| 2019 June | 46 | 26 | 72 |
| 2019 May | 35 | 25 | 60 |
| 2019 April | 65 | 53 | 118 |
| 2019 March | 28 | 19 | 47 |
| 2019 February | 31 | 25 | 56 |
| 2019 January | 41 | 30 | 71 |
| 2018 December | 62 | 45 | 107 |
| 2018 November | 124 | 28 | 152 |
| 2018 October | 51 | 9 | 60 |
| 2018 September | 61 | 11 | 72 |
| 2018 August | 39 | 13 | 52 |
| 2018 July | 16 | 1 | 17 |
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