Browsing by Author "Rai, Bipendra DK"
Now showing 1 - 3 of 3
Results Per Page
Sort Options
Publication Correlation of Differential Function and Glomerular Filtration Rate Estimated from Computed Tomography based Renal Volume and Diuretic Renogram in Living Renal Donor(Institute of Medicine, 2022) Rai, Bipendra DK; Gnyawali, Diwas; Poudyal, Sujeet; Pradhan, Manish; Chapagain, Suman; Luitel, Bhoj R; Chalise, Pawan R; Gyawali, Prem R; Sharma, Uttam K; Nepali, Rabin; Gurung, GhanashyamABSTRACT Introduction: In renal transplant, serum creatinine and isotope studies are used for determination of donor glomerular filtration rate (GFR). Studies have shown computed tomography measured renal volume can also be used. Our main objective was to assess the accuracy of volume based estimated GFR (vGFR) with diethylene triamine penta acetic acid (DTPA) measured GFR in living kidney donors. Methods: An observational analytical study was conducted from July 2018 to June 2019 in Department of Urology and Kidney Transplant Surgery and Department of Radiodiagnosis in Tribhuvan University Teaching Hospital where a total of 38 eligible potential donors were evaluated and serum creatinine level, computed tomography with contrast and DTPA renogram were used to measure GFR and differential function. Results: The mean age of the donors were 42.8±10.9 years with 70% of donors being females. Renal volume was not statistically different between male and female donors. There was moderate correlation between volume based and DTPA based GFR (r=0.76) and differential function (r=0.71). Compared to creatinine, volume based GFR estimate showed better correlation to DTPA renogram. There was no significant difference in differential function estimated by DTPA and volume based estimates (p = 0.96). The upper and lower limit of agreement between the volume based and DTPA based differential function was –4.7 and 4.6 respectively. Conclusion: GFR measurement by CT volume overestimates total GFR compared to DTPA renogram but it has better correlation than creatinine based estimates. It can be used to estimate the differential function of the donor kidney. Keywords: Computed tomography, DTPA, glomerular filtration rate, renal transplant, renal volumePublication Nephron Sparing Surgery for Small Renal Mass at a University Teaching Hospital: A Six Years Retrospective Review(Institute of Medicine, 2019) Rai, Bipendra DK; Poudyal, Sujeet; Dhital, Pawan; Pradhan, Manish; Chapagain, Suman; Luitel, Bhoj R; Chalise, Pawan R; Sharma, Uttam K; Gyawali, Prem RABSTRACT Introduction Nephron-sparing surgery (NSS) is the standard of care for clinical T1 (cT1), renal mass less than 7 cm, whenever intervention is indicated. It has oncological outcome equivalent to radical nephrectomy in small renal masses and it also minimizes the progression to chronic kidney disease. However, there is paucity of data on outcomes of NSS in Nepalese population. Methods A six years retrospective review of medical records of patients undergoing partial nephrectomy from Jan 2012 to Dec 2017 in Department of Urology and Kidney Transplant Surgery at Tribhuvan University Teaching Hospital was done to determine its demographics and outcomes. Results Twenty eight patients underwent nephron sparing surgery for clinical T1 renal masses in the past six years. Complications occurred in three cases. Five of the lesions were benign and 23 malignant on final histology. Clear cell carcinoma was the commonest variant of renal cell cancer. Margin was positive in two cases and both were kept in close surveillance. There was no local recurrence and renal impairment during five to 60 months follow-up. Conclusion Nephron sparing surgery is a safe procedure with good oncological outcome for clinical T1 renal mass. It prevents unnecessary nephrectomy in benign lesions as well as chronic renal impairment at the same time. Keywords: Nephron sparing surgery, small renal massPublication Retrospective Review of Adrenalectomy in a Tertiary Center in Nepal(Institute of Medicine, 2019) Dhital, Pawan; Rai, Bipendra DK; Pradhan, Manish; Poudyal, Sujeet; Chapagain, Suman; Luitel, Bhoj R; Chalise, Pawan R; Sharma, Uttam K; Gyawali, Prem RABSTRACT Introduction Adrenal gland surgery is a challenging art as it encompasses diverse physiological derangements which are even life-threatening. Also, it remains a medical finesse to rightly identify the correct patient who will benefit from surgery which include strong biochemical and radiological resource. Soundly performed surgery will lead to oncologic and homeostatic correction leading to near normal course. Methods This is a retrospective analysis of adrenalectomy cohort over three years in a tertiary center in Nepal identifying diagnosis, perioperative management and postoperative course. The objective of this study is to review the presentation, histopathology and clinical outcomes of patients operated for adrenal mass in our center. Results There were 42 surgeries performed via open approach. The number of adenoma, phaeochromocytoma, carcinoma and non-functioning tumor were 13, 16, 12 and one respectively. In most of the hypertensive patients, control was achieved with minimal drug and recurrences were observed in 25% of carcinoma in postoperative follow up. Conclusion A large proportion of operative adrenal mass are observed clinically in our setup. The surgical outcome is satisfactory but judicious perioperative management is essential. Keywords: Adrenalectomy, adrenocortical carcinoma, phaeochromocytoma