Browsing by Author "Gyawali, Milan"
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Publication Clinicopathological Outcome of Early and Late Onset Renal Cell Carcinoma: An Observational Study(Institute of Medicine, Tribhuvan University, 2024) Pandit, Durga; Phuyal, Anjit; Gyawali, Milan; Guragain, Bipin; Parajuli, Purushottam; Pradhan, Manish Man; Poudyal, Sujeet; Chapagain, Suman; Luitel, Bhojraj; Chalise, Pawan Raj; Sharma, Uttam Kumar; Gyawali, PremAbstract: Introduction Renal cell carcinoma (RCC) is considered a disease of old age and is typically found in the 6th-8th decade of life. The diagnosis of RCC is increasing more rapidly in younger age patients. This study was conducted to evaluate the clinicopathological pattern and outcome of early onset RCC and compare them with the older age group patients. Methods This was a single center observational study. All the patients undergoing radical or partial nephrectomy during the period of November 2019 to October 2022 for renal masses and whose final histopathology report showed RCC were included in the study. Clinicopathological patterns and outcome were compared between the two age groups. Results Among 47 patients, 17 (36.2%) patients were at or below the age of ≤46 years and 30 (63.8%) patients in older age group. There was significant difference in male (29): female (18) ratio between the two age groups (p < 0.005). Younger age patients (≤46 yrs) had higher stage of disease at presentation compared with the older age (>46 yrs) patients [tumor extension into major veins and perinephric tissue (T3) and above 26 vs 21] and they had significantly higher mortality rate (29.4% vs 3.3%, p =0.01). Conclusion Patients aged ≤46 years of age were more frequently affected by RCC with female predominance. Younger age group had higher stage of disease at presentation with higher mortality in comparison to older age group.Publication Renal Function Evaluation Following Donor Nephrectomy in Tertiary Kidney Transplant Center of Nepal(Institute of Medicine, Tribhuvan University, 2024) Gyawali, Milan; Luitel, Bhojraj; Pradhan, Manish Man; Chalise, Pawan Raj; Chapagain, Suman; Gyawali, Prem RajAbstract: Introduction Live kidney transplant is the standard of care for patients requiring renal replacement therapy. Donors with increasing age and comorbid conditions such as obesity and hypertension are now included for transplant. This study was performed to evaluate the change in renal function of kidney donors over a period of one year. Methods This was an analytical study of patient’s who underwent donor nephrectomy from January 2022 to June 2023 at Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Nepal. Renal function of donors in terms of serum creatinine, glomerular filtration rate, size of kidney and general physical examination including blood pressure pre-donation were compared with post donation period at three, six and twelve months. Results There were total of 76 cases available for analysis. Mean age of the donors was 44.6±10.1 years, ranging from 22 to 67 years, with male: female ratio of 1:2.45. There was no significant change in post donation blood pressure and kidney size. There was increase in serum creatinine level from baseline 70.47±14.96 to 93.20±17.61 (p<0.001) at three months follow up. Post donation glomerular filtration rate (GFR) of remnant kidney had increased significantly. Conclusion Post donation GFR of remnant kidney as well as serum creatinine level in live donor nephrectomy including the expanded criteria donors had increased significantly. Short-term deleterious effects in renal function post donation were not seen.