The aim of this study was to assess incidence and risk factors for acute kidney injury (AKI) in patients with dengue fever (DF). A total of 223 patients (males, 130; females, 93; mean age, 26.2 ± 18.2 years) from a tertiary care centre in southern India were retrospectively analysed. Acute renal failure (ARF) developed in 24 (10.8%) patients. Based on the Acute Kidney Injury Network (AKIN) criteria, the results revealed that: 12 (5.4%) had mild AKI; seven (3.1%) had moderate AKI; and five (2.2%) had severe AKI. A further 54 (24%) were diagnosed with dengue haemorrhagic fever (DHF); 11 (5%) were co-infected with leptospirosis; thrombocytopenia was present in 157 (70%); and 64 (29%) were hypotensive. Patients were divided into either group A (with AKI) or group B (without AKI), and group A was divided into mild (A1), moderate (A2) and severe (A3) subgroups. We recorded: a higher total white count (A = 9824; B = 6706; P = 0.01); serum glutamic pyruvic transaminase (SGPT; A = 450; B = 144; P = 0.001); alkaline phosphatase (ALP) levels (A = 207; B = 42; P = 0.001); lower albumin (A = 2.65; B = 3.09; P < 0.001); and serum bicarbonate (A = 20.57; B = 23.21; P = 0.009). Hypotension (P = 0.01), coexisting viral hepatitis (P < 0.001), sepsis (P < 0.001), multiple organ dysfunction syndrome (MODS; P < 0.001) and the need for inotropes (P < 0.001) were associated with DF. Total white count (P = 0.038), glomerular filtration rate (GFR) on discharge (P = 0.034), specific gravity of urine (P = 0.006), ALP (P = 0.013), SGPT (P = 0.042), MODS (P = 0.05) and use of platelet fresh frozen plasma (FFP; P = 0.007) were significantly different between mild, moderate and severe AKI subgroups. Twenty-two (9%) died. AKI is associated with an increased mortality in DF (P = 0.005).

Purpose:To assess the value of arterial spin-labeling (ASL) perfusion magnetic resonance (MR) imaging in the characterization of solid renal masses by using histopathologic findings as the standard of reference. Materials and Methods:This prospective study was compliant with HIPAA and approved by the institutional review board. Informed consent was obtained from all patients before imaging. Fortytwo consecutive patients suspected of having renal masses underwent ASL MR imaging before their routine 1.5-T clinical MR examination. Mean and peak tumor perfusion levels were obtained by one radiologist, who was blinded to the final histologic diagnosis, by using region of interest analysis. Perfusion values were correlated with histopathologic findings by using analysis of variance. A linear correlation model was used to evaluate the relationship between tumor size and perfusion in clear cell renal cell carcinoma (RCC). P , .05 was considered indicative of a statistically significant difference. Results:Histopathologic findings were available in 34 patients (28 men, six women; mean age 6 standard deviation, 60.4 years 6 11.7). The mean perfusion of papillary RCC (27.0 mL/min/100 g 6 15.1) was lower than that of clear cell RCC (171.6 mL/min/100 g 6 61.2, P = .001), chromophobe RCC (152.9 mL/min/100 g 6 80.7, P = .04), unclassified RCC (208.0 mL/min/100 g 6 41.1, P = .001), and oncocytoma (373.9 mL/min/100 g 6 99.2, P , .001). The mean and peak perfusion levels of oncocytoma (373.9 mL/ min/100 g 6 99.2 and 512.3 mL/min/100 g 6 146.0, respectively) were higher than those of papillary RCC (27.0 mL/min/100 g 6 15.1 and 78.2 mL/min/100 g 6 39.7, P , .001 for both), chromophobe RCC (152.9 mL/min/100 g 6 80.7 and 260.9 mL/min/100 g 6 61.9; P , .001 and P = .02, respectively), and unclassified RCC (208.0 mL/ min/100 g 6 41.1 and 273.3 mL/min/100 g 6 83.4; P = .01 and P = .03, respectively). The mean tumor perfusion of oncocytoma was higher than that of clear cell RCC (P , .001). Conclusion:ASL MR imaging enables distinction among different histopathologic diagnoses in renal masses on the basis of their perfusion level. Oncocytomas demonstrate higher perfusion levels than RCCs, and papillary RCCs exhibit lower perfusion levels than other RCC subtypes.q RSNA, 2012

Although the procedure can be performed when transjugular intrahepatic portosystemic shunt is contraindicated or when endoscopic management fails, balloon-occluded retrograde transvenous obliteration is successful as a first-line or second-line therapy. Gastric variceal rebleeding rates are low and serious complications are rare. Randomized controlled trials are required to evaluate the superiority of this procedure over other methods of treating gastric varices and to determine which sclerosant should be used. In the near future, this procedure may play a larger role in emergency care and in the management of nongastric varices.

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