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CYP24A1 is an enzyme that inactivates vitamin D and encodes vitamin D 24-hydroxylase. Mutations in this enzyme have been linked with idiopathic infantile hypercalcemia, nephrolithiasis, and nephrocalcinosis. Genetic testing for this mutation should be considered in the presence of calciuria, elevated serum calcium, elevated 1,25- dihydroxyvitamin D, and suppressed parathyroid hormone. We present a previously healthy eight-month-old male infant with macrohematuria, hypercalciuria (6 mg/kg/24 h), albuminuria (54 mg/24 h) and left-sided nephrolithiasis found on urinary tract ultrasound. The values of alpha 1 microglobulin, parathyroid hormone, vitamin D, serum electrolytes, amino acids, glycols, oxalates and citrates in urine, as well as coagulation tests were normal. Genetic testing excluded suspected Dent’s disease but confirmed heterozygous missense variant CYP24A1 c.469C>T, p.(Arg157Trp) classified as polymorphism. He was treated with hydrochlorothiazide and potassium citrate. Children presenting with hypercalcemia, hypercalciuria and nephrolithiasis should be tested because of the importance of recognition, genetic diagnosis and proper treatment of CYP24A1 mutations that can present with a wide range of phenotypic presentations, from asymptomatic to chronic renal disease., CYP24A1 je enzim koji inaktivira vitamin D i regulira funkciju 25-OH-D3-24-hidroksilaze, a njegove mutacije uzrokuju idiopatsku infantilnu hiperkalcemiju, nefrolitijazu i nefrokalcinozu. Genetsko testiranje trebalo bi učiniti u slučaju hiperkalciurije, hiperkalcemije, povišenih vrijednosti 1,25 dihidroksivitamina D i sniženih vrijednosti paratireoidnog hormona. Prikazujemo slučaj prethodno zdravog muškog dojenčeta u dobi od 8 mjeseci s makrohematurijom, hiperkalciurijom (6 mg/kg/24 h), albuminurijom (54 mg/24 h) i ultrazvučno vidljivim nefrolitom u lijevom bubregu. Vrijednosti alfa 1 mikroglobulina, paratireodinog hormona, vitamina D, elektrolita u serumu, aminokiselina, glikola, oksalata i citrata u mokraći te koagulacijskih testova bile su uredne. Učinjeno je genetsko testiranje zbog sumnje na Dentovu bolest koja nije potvrđena. Bolesnik je heterozigotan za missense varijantu CYP24A1 c.469C>T, p.(Arg157Trp) te je klasificirana kao polimorfizam. Liječen je hidroklorotiazidom, potom kalij citratom. Kod djece s hiperkalcemijom, hiperkalciurijom i nefrolitijazom treba provesti genetsko testiranje zbog važnosti prepoznavanja, dijagnoze i pravilnog liječenja mutacija CYP24A1 koje su širokog kliničkog spektra, od asimptomatskog do kronične bubrežne insuficijencije.

Although medically children are not at risk, but inthe ongoing COVID 19 pandemic has serious implications for children. New evidence donot clearly definerenal manifestations. Among the reasons for the lack of efficacy of the ongoing treatment of patients with renal complications, an incomplete understanding of its pathogenesis in children who have had a coronavirus infection plays a special role.Biochemical blood tests revealed the elevated blood and urine MC levels which in 1/5 of the patients with high parameters. Moderate proteinuria and transient macrohaematuria were observed in children in the COVID-19 group with renal complications. Children with moderate to severe ChKD with COVID-19 or with recurrent nephrotic syndrome are at risk of severe complications, including severe AKF or ChKF. This data indicates that the children with COVID-19 infection should be closely monitored for the development and progression of RF and special measures should be taken to prevent it.

A 21-year-old woman presented with renal dysfunction during macrohematuria. A kidney biopsy revealed IgA nephropathy with a small percentage of crescent formation and macrohematuria-associated tubular injury. Macrohematuria-associated acute kidney injury could explain her renal dysfunction. However, she was seropositive for myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibody (ANCA) and showed fibrin deposition around one arteriole. Corticosteroids and mycophenolate mofetil were administered as for ANCA vasculitis, and the serum creatinine, abnormal urinalysis and MPO-ANCA titer all gradually ameliorated. The presence of extra-glomerular vasculitis, which was probably induced by ANCA, suggested that MPO-ANCA was an exacerbating factor for her prolonged renal dysfunction. This condition has so far only rarely been addressed in ANCA-positive IgA nephropathy.

The objective of study is retrospective analysis, estimate and publish the initial experience of selective chemoembolization of the bladder arteries in the combined treatment of a patient with metastatic bladder cancer complicated by refractory macrohematuria. Material and methods. In the course of the work the results of treatment of metastatic bladder cancer with the use of X-ray endovascular selective chemoembolization of the bladder arteries in the conditions of the «Feofaniya» clinical hospital were studied. Simmons/Sidewinder 3 and UFE Type 1 (Terumo) catheters with an outer diameter of 5 F were used during the intervention. Vascular chemoembolization was performed with LifePearl (Terumo) microspheres with a diameter of 200±50 nm in a volume of 2 ml, which were saturated with the chemotherapeutic agent Doxorubicin “Ebeve” at a dose of 50 mg. The results were studied immediately and after three months. Results. According to control intraoperative angiography all arterial branches feeding the tumor were excluded from the blood supply. After the intervention, the patient retained an independent act of urination, the need for catheterization of the bladder or other methods urine derivation after surgery did not arise. Three months later, according to the results of the control examination, signs of regression of the bladder tumor were revealed while maintaining the reservoir potential of the bladder. No recurrences of macrohematuria occurred during the follow-up period. Conclusions. The technique of X-ray endovascular selective chemoembolization seems promising to us, and the initial experience of its use motivates the further introduction of such operations in patients with locally advanced or metastatic (mostly hypervascular) neoplasias of different localizations. In addition, this process is actualized by the possibility of effective and minimally invasive prevention of the occurrence or cessation of existing tumor-associated bleeding, which in this work is successfully illustrated by the example of refractory macrohematuria., Цель. Ретроспективно проанализировать, обобщить и обнародовать инициальный опыт селективной химиоэмболизации мочепузырных артерий в рамках комбинированного лечения больного метастатическим раком мочевого пузыря, осложненного рефрактерной макрогематурией. Материал и методы. В ходе работы изучены результаты лечения метастатического рака мочевого пузыря с применением рентген-эндоваскулярной селективной химиоэмболизации мочепузырных артерий в условиях клинической больницы «Феофания» Государственного управления делами. В ходе вмешательства использовали катетеры Simmons/Sidewinder 3 и UFE Type 1 (Terumo) с внешним диаметром 5 F. Химиоэмболизацию сосудов проводили микросферами LifePearl (Terumo) диаметром 200±50 нм в объеме 2 мл, которые насыщали химиопрепаратом Доксирубицин «Эбеве» в дозе 50 мг. Результаты изучали непосредственно и через три месяца. Результаты. По данным контрольной интраоперационной ангиографии все питающие опухоль артериальные ветви удалось исключить из кровоснабжения. После вмешательства у больного был сохранен самостоятельный акт мочеиспускания, потребности в катетеризации мочевого пузыря или других способах отведения мочи после операции не возникало. Через три месяца, по результатам контрольного обследования, выявлены признаки регресса опухоли мочевого пузыря при сохранении его резервуарного потенциала. В течение всего времени наблюдения за пациентом рецидивы макрогематурии не возникали. Выводы. Методика рентген-эндоваскулярной селективной химиоэмболизации представляется нам перспективной, а полученный инициальный опыт ее применения мотивирует на дальнейшее внедрение таких операций у больных с местно-распространенными или метастатическими (преимущественно гиперваскулярными) опухолями различных локализаций. Дополнительно актуализирует этот процесс возможность эффективного и малоинвазивного преду-преждения возникновения или остановки уже существующего тумор-ассоциированного кровотечения, что в рамках данной работы успешно проиллюстрировано на примере рефрактерной макрогематурии., Мета. Ретроспективно проаналізувати, узагальнити та оприлюднити ініціальний досвід селективної хіміоемболізації сечоміхурових артерій в рамках комбінованого лікування хворого на метастатичний рак сечового міхура, що ускладнений рефрактерною макрогематурією. Матеріал та методи. У ході роботи вивчено результати лікування метастатичного раку сечового міхура із застосуванням рентген-ендоваскулярної селективної хіміоемболізації сечоміхурових артерій в умовах клінічної лікарні «Феофанія» Державного управління справами. У ході втручання використовували катетери Simmons/Sidewinder 3 та UFE Type 1 (Terumo) із зовнішнім діаметром 5 F. Хіміоемболізацію судин проводили мікросферами LifePearl (Terumo) діаметром 200±50 нм в об’ємі 2 мл, які насичували хіміопрепаратом Доксирубіцин “Ебеве” у дозі 50 мг. Результати вивчали безпосередньо і через три місяці. Результати. За даними контрольної інтраопераційної ангіографії всі живлячі пухлину артеріальні гілки вдалось виключити із кровопостачання. Після втручання у хворого було збережено самостійний акт сечовипускання, потреби у катетеризації сечового міхура або інших способах відведення сечі після операції не виникало. Через три місяці, за результатами контрольного обстеження, виявлено ознаки регресу пухлини сечового міхура при збереженні резервуарного потенціалу останнього. Протягом всього часу спостереження за пацієнтом рецидиви макрогематурії не виникали. Висновки. Методика рентген-ендоваскулярної селективної хіміоемболізації вбачається нам перспективною, а одержаний ініціальний досвід її застосування мотивує на подальше впровадження таких операцій у хворих із місцево-розповсюдженими або метастатичними (переважно гіперваскулярними) пухлинами різних локалізацій. Додатково актуалізує цей процес можливість ефективного та малоінвазивного попередження виникнення або зупинки вже існуючої тумор-асоційованої кровотечі, що в рамках даної роботи успішно проілюстровано на прикладі рефрактерної макрогематурії.

Background Macroscopic hematuria-associated acute kidney injury (AKI) is a well-known complication of immunoglobulin A (IgA) nephropathy. In such cases, intratubular obstruction by red blood cell (RBC) casts and acute tubular necrosis are mainly observed pathologically. Herein, we report the case of a patient with IgA nephropathy presenting with AKI following an episode of macrohematuria. The patient presented with severe renal tubular hemosiderosis and acute tubular necrosis and without any obvious obstructive RBC casts. Case presentation A 68-year-old woman, who was diagnosed with IgA nephropathy on renal biopsy 6 years ago, was admitted to our hospital after an episode of macroscopic glomerular hematuria and AKI following upper respiratory tract infection. Renal biopsy showed mesangial proliferation of the glomeruli, including crescent formation in 17 % of the glomeruli, and acute tubular necrosis without obvious hemorrhage or obstructive RBC casts. The application of Perls’ Prussian blue stain showed hemosiderin deposition in the renal proximal tubular cells. Immunofluorescence showed granular mesangial deposits of IgA and C3. Based on these findings, she was diagnosed with acute tubular necrosis with a concurrent IgA nephropathy flare-up. Moreover, direct tubular injury by heme and iron was considered to be the cause of AKI. She was treated with intravenous pulse methylprednisolone followed by oral prednisolone. Thereafter, the gross hematuria gradually faded, and her serum creatinine levels decreased. Conclusions IgA nephropathy presenting with acute kidney injury accompanied by macrohematuria may cause renal hemosiderosis and acute tubular necrosis without obstructive RBC casts. Hemosiderosis may be a useful indicator for determining the pathophysiology of macroscopic hematuria-associated AKI. However, renal hemosiderosis may remain undiagnosed. Thus, Perls’ Prussian blue iron staining should be more widely used in patients presenting with hematuria.

О bjective is to evaluate the rate of bladder cancer in children and adolescents, characteristics of its histological variant, and treatment approaches. Materials and methods. A review of international literature on the problem of bladder cancer in children and adolescents as well as our own clinical observations of this pathology in 7 male patients aged 5–17 years in the period from 2012 to 2017 are presented. Results. According to the literature data and our own clinical observations, bladder cancer in children and adolescents is a rare pathology and it is a well-differentiated transitional cell carcinoma, localized, with favorable prognosis and rare recurrence. Treatment approach for bladder cancer in children and adolescents is the same as in adults, and usually is limited to transurethral resection of the bladder tumor. Conclusion. These observations serve as a reminder that bladder cancer can occur in children and adolescents, as well as in adults, which should elevate oncological vigilance among general practitioners.

An 83-year-old Japanese man had a history of chronic heart failure due to bradycardia-tachycardia syndrome. He was admitted to our hospital because of macrohematuria and acute kidney injury (AKI), which were detected by an urologist at an outpatient visit. He had a history of recurrent macrohematuria and transurethral resection of bladder tumors twice in the preceding 2 years. He had been on warfarin for 12 years, with a stable international normalized ratio (INR) that was usually less than 2.1. Urinalysis revealed numerous red blood cells (RBCs) and mild proteinuria without RBC casts. His serum creatinine level was elevated to 2.41 mg/dL from 0.96 mg/dL at 3 weeks before admission. INR was 1.44. Hydronephrosis was not observed. Ureteroscopy detected invasive urothelial carcinoma of the renal pelvis, and right laparoscopic nephroureterectomy was performed at 41 days after diagnosis of AKI. The background renal parenchyma displayed tubular obstruction by red blood cell casts and acute tubular injury, which were changes compatible with warfarin-related nephropathy (WRN). Warfarin was discontinued, and the serum creatinine level recovered to 1.66 mg/dL after 3 months. In the present patient with nephrosclerosis, WRN occurred at a therapeutic INR level after 12 years of uneventful warfarin therapy, and the coexisting urothelial malignancy was a unique feature.

The intrauterine device (IUD) is a common method of contraception among women. As one of complications of IUD, perforation occurs in approximately 1-2 in 1000 insertions. Although migration of IUD may pursue asymptomatic course, symptoms of migration to the urinary bladder can include lower urinary tract symptoms, stone formation around the IUD and uterovesical fistula. In this report, we present a case of an IUD migration into the urinary bladder of a 34-year-old woman at the Clinical Hospital Center Zagreb.

Uvod: Karcinom mokraćnog mjehura je u najvećem postotku maligna novotvorina prijelaznog epitela mokraćnog mjehura te je ujedno jedan od najčešćih tumora urogenitalnog sustava. Svrha rada: Svrha rada je prikazati dijagnostiku i liječenje karcinoma mokraćnog mjehura te kliničke značajke bolesnika koji su bili kirurški liječeni. Ispitanici i metode: Od 01. siječnja 2013. do 31. prosinca 2017. u Kliničkom bolničkom centru Rijeka, zbog karcinoma mokraćnog mjehura, kirurški je liječeno 847 bolesnika. Retrospektivno je provedena analiza medicinske dokumentacije tih pacijenata. Rezultati: Od ukupno 847 bolesnika s karcinomom mokraćnog mjehura, 636 (75%) bolesnika je muškog spola, a 211 (25%) bolesnika je ženskog spola. Raspon godina bolesnika je bio od 22 do 94 godine, a prosječna životna dob je iznosila 70 godina. Više od 80% bolesnika je imalo simptome, najčešći simptom je bila makrohematurija. Najveći postotak bolesnika sa karcinom mokraćnog mjehura (76%) boluje od pT1 stadija bolesti. Transuretralna resekcija je učinjena u 89% bolesnika, radikalna cistektomija u 10% bolesnika, a u 1% parcijalna cistektomija. Kod 59% pacijenata je zabilježen ponovni povratak bolesti i to najčešće u prvoj godini nakon TUER-a. U promatranom razdoblju ukupno je umrlo 53 (6%) pacijenata. Zaključak: Učestalost karcinoma mokraćnog mjehura kao i pojava recidiva se povećala tijekom posljednjih pet godina. Jedan od glavnih razloga toga su novije dijagnostičke metode te učestaliji odlasci na preglede koji omogućuju njegovo otkrivanje u ranijoj fazi bolesti. U konačnici to dovodi do sve češćeg kirurškog liječenja bolesti te smanjenja smrtnosti kod pacijenata koji boluju od karcinoma mokraćnog mjehura. Introduction: Bladder cancer is in the highest percentage malignant neoplasm of transitional urinary bladderkepithelium and is also one of the most common urogenital tumors. Purpose: The purpose was to show the diagnosis and treatment of bladder cancer and clinical features of surgically treated patients. Patients and Methods: From 01 January 2013 to 31 December 2017, 847 patients were treated surgically at the Clinical Hospital Center in Rijeka because of urinary bladder cancer. Medical documentation of these patients was performed retrospective. Results: Out of 847 patients with bladder cancer, 636 (75%) patients were male and 211 (25%) were female patients. In the range of 22 to 94 years, the mean agekof the patiens was 70 years. More than 80% of the patients had symptoms, the most common symptom was macrohemuria. The highest percentage of patients with bladder cancer (76%) suffer from pT1 stage of illness. Transurethral resection was performed in 89% of patients, radical cystectomy in 10% of patients, and in 1% partial cystectomy. In 59% of patients was a recurrence of the disease, mostly in the first year after the TUER. In the observed period, 53 (6%) patients died. Conclusion: The incidence of bladder cancer as well as the recurrence has increased over the last five years. One of thekmainkreasons for this is the new diagnostic methods and more frequent exits to examinations that allow its detection in the earlykstage of the disease. Ultimately it leads to more frequent surgical treatment of the disease and reduction of mortality in patients who suffering from bladder cancer.

Urinalysis is one of common examination as a clinical screening test and primary healthcare. Screening urinalysis gives us useful pieces of information to detect renal and urinarytract diseases. Urinary examination is also essential for the patients of hypertension, diabetesmellitus, and other systemic diseases. From nephrological point of view evaluation ofproteinuria is most important. A patient with continuous 2+ or more positive dipstickevaluation for proteinuria was recommended to consult a nephrologist. On the other hand,once asymptomatic macrohematuria is discovered, a patient should be examined byurologist.

67歳男.肉眼的血尿と尿閉を主訴に来院.DIPを含も画像診断では膀胱頸部にみられた粘膜下腫瘍と診断した.超音波下経直腸的生検では平滑筋組織を含む良性の前立腺腫瘍であった.腫瘍摘除術を施行.病理学的診断は前立腺平滑筋腫であった.術後排尿困難の著明な改善を認めた, Pure leiomyoma of the prostate is very rare. A 67-year-old man was hospitalized with gross hematuria and urinary retention. Drip infusion pyelography revealed a defect of the urinary bladder. By radiological examinations, submucosal tumor of the bladder neck was diagnosed. Transrectal biopsy suggested a benign prostatic tumor histologically. Open resection of the tumor was performed. Histological findings were pure leiomyoma of the prostate. The postoperative course was good and urinary retention was improved remarkably.

A 33-year-old woman was admitted with macrohematuria after contusion in the left lumber region. The excretory urogram showed no abnormal findings, but color doppler and RI-angiography revealed infrarenal left-sided inferior vena cava (left IVC). The pressure in the dilated left renal vein was higher than that in the right one. Renal contusion in addition to the congestion of the left renal vein due to left IVC was thought to be the cause of hematuria in this case. Hematuria disappeared after retrograde instillation of 0.2% AgNO3 water solution into the left renal pelvis. Left IVC rarely presents clinical symptoms, and is usually found by chance on CT scan or ultrasonography during examinations for upper abdominal organs. Our case is the 69th one of left IVC in Japan, and belongs to Type 2' according to our classification of left IVC.

Pure leiomyoma of the prostate is very rare. A 67-year-old man was hospitalized with gross hematuria and urinary retention. Drip infusion pyelography revealed a defect of the urinary bladder. By radiological examinations, submucosal tumor of the bladder neck was diagnosed. Transrectal biopsy suggested a benign prostatic tumor histologically. Open resection of the tumor was performed. Histological findings were pure leiomyoma of the prostate. The postoperative course was good and urinary retention was improved remarkably.

A 33-year-old woman was admitted with macrohematuria after contusion in the left lumber region. The excretory urogram showed no abnormal findings, but color doppler and RI-angiography revealed infrarenal left-sided inferior vena cava (left IVC). The pressure in the dilated left renal vein was higher than that in the right one. Renal contusion in addition to the congestion of the left renal vein due to left IVC was thought to be the cause of hematuria in this case. Hematuria disappeared after retrograde instillation of 0.2% AgNO3 water solution into the left renal pelvis. Left IVC rarely presents clinical symptoms, and is usually found by chance on CT scan or ultrasonography during examinations for upper abdominal organs. Our case is the 69th one of left IVC in Japan, and belongs to Type 2' according to our classification of left IVC.

Sixteen clinical records of patients 6 to 15 years old with renal tuberculosis registered over a 21 years period, were analysed. An increased incidence of this condition in the last 8 years was observed. Macrohematuria (56.3^ and enuiesis (18,8%) were the first evidences of the disease. Radiological findings at the excretory urography, corresponded to grades 0, in four patients 11 in six and II through IV in four children (Lattimer's modified classification). Lesions were of grades II or less, in 75% of the cases. In all patients the diagnosis was confirmed either by the isolation of tubercle bacilli from urine, as ocurred in 14 patients (87.5%) or by distinctive histological findings in the other two cases. The results of treatment were satisfactory in eleven properly followed cases (68.7 %). Three patients were followed up in different health centers and information of their final state was not available for us. The scarcity of clinical symptoms and radiological signs in the reported patients is attributed to early diagnosis and an adequate management. (