Submited on: 16 May 2013 04:07:30 AM GMT
Published on: 16 May 2013 05:50:48 AM GMT
 
We Should be awere of pseudorenal failure.
Posted by Dr. Yoshihiro Moriwaki on 16 Jun 2013 04:38:54 AM GMT

  • What are the main claims of the paper and how important are they?

    pseudorenal failure due to bladder injury following blunt abdominal trauma.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    I think it not so nlovel, because the condition is not so rare.


  • Are the claims properly placed in the context of the previous literature?

    There have been many literatures concerning pseudorenal failure.


  • Do the results support the claims? If not, what other evidence is required?

    Yes.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    No comment.


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Biochemical examination of intraperitoneal fluid and urethrography may be desirable.


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    The authors should clearly describe what pathological conditions they suspect before the surgery.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Yes. I would like to present this article in our case conferences.


  • Other Comments:

    No.

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    Yes
  • References:

    Japanese articles

  • Experience and credentials in the specific area of science:

    I have experienced some cases with bladder injury presenteing pseudorenal failure.

  • How to cite:  Moriwaki Y .We Should be awere of pseudorenal failure.[Review of the article 'Pseudo Acute Renal Failure due to delayed presentation of intra-peritoneal bladder injury following blunt abdominal trauma ' by Ramachandra L].WebmedCentral 2013;4(6):WMCRW002763
1 2 3 4 5 6 7 8 9
Report abuse
 

  • What are the main claims of the paper and how important are they?

    Authors have claimed to present a rare a case of intra-peritoneal bladder rupture following blunt abdominal injury presenting after four days of injury with abdominal pain without hematuria or anuria.

     

    The author has claimed that only one case  has been previously reported and this current presentation is the second case in the literature.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    No! The clinical presentation described in this case report is not absolutely rare. In fact about 10% of blunt abdominal trauma with bladder injury/rupture present without hematuria.


  • Are the claims properly placed in the context of the previous literature?

    The claims are not properly placed! Details are lacking in the following areas:

    1. Urine output. Volume needed to say oliguria or anuria or normal

    2. Why Folleys cath was introduced in the initial presentation when the patient was able to pass urine freely? Any blood in the meatus?

    3.Results of urinanalysis has not been provided!

    4.Details of Ultrsonography as regards to bladder

    5. Why DTPA was not preferred

    6. If fear of contrast use is entertained, Why Non-contrast CT was not done in this case especially a case of road traffic accident with abdominal pain, distension and intreabdominal free fluid

    7.Why cystogram was not done? Cystogram is not totally contraindicated as the absorption of contrast across the bladder is insignificant and moreover the contrast will be drained out or micturated after the procedure,


  • Do the results support the claims? If not, what other evidence is required?

    No!

    At least the following other evidences are required:

    Thorough urine analysis is required as, if not gross hematuiria, microscopic hematuria occurs in at least 8-10 % of cases

     

    Detail study of Ultrsonography as regards to bladder and pelvis

    DTPA study

    Plain NECT non-contrast CT was not done in this case especially a case of road traffic accident with abdominal pain, distension and intreabdominal free fluid

    Cystogram was not done! Cystogram is not totally contraindicated as the absorption of contrast across the bladder is insignificant and moreover the contrast will be drained out or micturated after the procedure

     


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Methodology described is insufficient


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    Yes! The vital requirements are described above


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    No! The case is good example; but case report is suboptimal!


  • Other Comments:

    Pseudo-azotaemia (ARF) due to intraperitoneal urine leakage is a known clinical entity!

    The author has claimed that this current presentation is the second case in the literature. But, many cases have been reported with such clinical presentation.

     

    In fact, any intraperitoneal rupture of the bladder, if not treated properly or treated belatedly can lead to azotaemia. The elevated serum levels of creatinine is due to the absorption through the peritoneal membrane of creatinine from the urine leaked into the peritoneal cavity.

     

    Ascitis (abdominal distension) and oliguria or anuria also are associated with high creatinine in many cases.

     

    Therefore clinical presentation will be that of acute kidney injury (ARF).

     

    Cystogram could have been performed in this case; it is not totally contraindicated as the absorption of contrast across the bladder is insignificant and moreover the contrast will be drained out or micturated after the procedure

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    A lot of abdominal trauma cases have been seen, imaged and interpreted by me. Many bladder rupture cases have been analyzed by me.

  • How to cite:  Abdul Kareem M M.Pseudo Acute Renal Failure due to delayed presentation of Intra-peritoneal bladder injury following blunt abdominal trauma[Review of the article 'Pseudo Acute Renal Failure due to delayed presentation of intra-peritoneal bladder injury following blunt abdominal trauma ' by Ramachandra L].WebmedCentral 2013;4(6):WMCRW002756
1 2 3 4 5 6 7 8 9
Report abuse
 

  • What are the main claims of the paper and how important are they?

    To present a case where acute renal failure occured after intra peritoneal bladder injury after blunt abdominal trauma.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Yes


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    Yes


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    N/A


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    I have one question for the author as why the word psuedo acute renal faiure is used as in the paper there is no mention about its justification & comparison with true renal failure with causes & its incidence.

     

    An additional mention about extra-peritoneal bladder injury incidence following blunt abdominal trauma & its presentations & comparison with current case would have been nice.

     

    overa all the paper has been written nicely.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Yes


  • Other Comments:

    No

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:

    No

  • Experience and credentials in the specific area of science:

    I have managed similar cases of bladder injuries similarly.

  • How to cite:  Belekar D M.Pseudo Acute Renal Failure Due to Delayed Presentation of Intra-Peritoneal Bladder Injury Following Blunt Abdominal Trauma[Review of the article 'Pseudo Acute Renal Failure due to delayed presentation of intra-peritoneal bladder injury following blunt abdominal trauma ' by Ramachandra L].WebmedCentral 2013;4(5):WMCRW002747
1 2 3 4 5 6 7 8 9
Report abuse
 

  • What are the main claims of the paper and how important are they?

    Bladder injury shows external features by virtue of a hematuria or anuria. Both were missing and hence,bladder injury can certainly be missed. More over, there were features of acute renal failure, which could in all possiblilities have been managed by dialysis without success causing perplexity in the mind of the physician and, possibly, a mortality.  Unless a mechanical continuity is maintained, dialysis cannot improve the patients condition as the urine produced by the normalised kidney will be absorbed by the peritoneum causing persistant extremely high levels of renal paramenters. This condition has been promptly and rightly managed and requires to be published.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Yes


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    Yes


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    NA


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    NA


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Yes. It is an integration of disciplines as the perplexity of nephrology is solved by surgery


  • Other Comments:

    Good paper. Can save lives if a diagnostic laparoscopy is done in patients with blunt injury abdomen whose high renal parameters are not normalising post dialysis

  • Competing interests:
    None
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    Undetected bladder injuries during pelvic surgery can cause similar situations

  • How to cite:  K L K .Pseudo Acute renal failure due to delayedpresentation of intra-peritoneal bladder injury following blunt abdominal trauma[Review of the article 'Pseudo Acute Renal Failure due to delayed presentation of intra-peritoneal bladder injury following blunt abdominal trauma ' by Ramachandra L].WebmedCentral 2013;4(5):WMCRW002732
1 2 3 4 5 6 7 8 9
Report abuse