Renal Parenchymal Changes Research Articles

Nephropathic Changes in Renal Parenchyma of Wistar Rats Following Sub-chronic Exposure to Methanol Extract of Caladium bicolor (Aiton)

To assess nephropathic potential of Caladium bicolor methanolic extract within the renal parenchyma of experimental Wistar rats. Twenty four albino Wistar rats (weighing between 180-195 g) were divided into four groups which include Group I treated with distilled water (2 ml/kg b.w.), Group II treated with methanolic extract of C. bicolor (100 ml/kg b.w.), Group III treated with methanolic extract of C. bicolor (200 ml/kg b.w.), Group IV treated with methanolic extract of C. bicolor (300 ml/kg b.w.). All administrations were done orally and once daily for a period of thirty five days. Body weight of animals was recorded during days 0, 7, 14, 21, 28 and 35 of study. After the study period, kidney tissue of study animals was harvested, weighed and processed for histopatho logical study. Staining of renal tissue sections was done using H & E technique, examined under microscope for observable histopathological changes that were scored using image-J software.
 Results of this study showed that sub-chronic exposure to methanolic extract of C. bicolor caused reduction in body and renal tissue weight. Moreover, exposure to the extract increases significantly (p < 0.05) renal histopatho logical changes including inflammation, necrosis, glomerular congestion and tubular dilatation within the renal parenchyma of study animals.
 Therefore, methanol extract of C. bicolor exhibited dose-independent nephropathic effect on the renal parenchyma following a sub-chronic exposure in experimental Wistar rats.

MP80-19 IS RENAL VOLUME AND FUNCTION COMPROMISED IN ONCOCYTOMA PATIENTS ON ACTIVE SURVEILLANCE?

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance III (MP80)1 Apr 2020MP80-19 IS RENAL VOLUME AND FUNCTION COMPROMISED IN ONCOCYTOMA PATIENTS ON ACTIVE SURVEILLANCE? Amandip Cheema*, Arun Menon, Tashionna White, Gaybrielle James, and Eric Kauffman Amandip Cheema*Amandip Cheema* More articles by this author , Arun MenonArun Menon More articles by this author , Tashionna WhiteTashionna White More articles by this author , Gaybrielle JamesGaybrielle James More articles by this author , and Eric KauffmanEric Kauffman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000972.019AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The oncologic safety of active surveillance in renal oncocytoma is well reported. However concern remains at the hypothetical possibility of renal functional deterioration due to mechanical effects of an enlarging tumor on normal renal parenchyma. Here we tested this hypothesis by evaluating renal functional outcomes of oncocytoma tumors on AS, including 3-dimension (3-D) imaging software to measure ipsilateral renal parenchymal volumetric changes in patients with large and/or actively growing oncocytoma tumors. METHODS: A renal tumor AS database at Roswell Park Comprehensive Cancer Center was queried to identify all renal oncocytoma patients with at least 18 months follow up on AS. Renal functional outcomes (Cr, GFR) were retrospectively reviewed to determine changes during AS. Tumor volume was calculated using the formula 0.5362*x*y*z when 3 dimensions were available and 0.5362*x*y*(x+y/2) when two dimensions were available. Oncocytoma patients with an estimated volume increase on AS of at least 10 cm3 were selected for automated 3-D volumetric assessment of the tumor and ipsilateral renal parenchyma using CT images with Myrian ® software. Ipsilateral renal parenchymal volume and tumor volume were compared between first and last available CT images. RESULTS: Among a total of 32 oncocytoma patients on AS, 22 with at least 18 months follow up were identified (median 33, mean 37.5, range 19-95 months). Median (mean) estimated tumor volume for these 22 patients was 8.5 cm3 (27.3 cm3) at AS initiation compared to 16.8 cm3 (42.73 cm3) at last follow up. Median (mean) Cr and GFR for these 22 patients was 1.02 mg/dl and 70.9 ml/min/1.73m2 (1.0 and 68.6) at AS initiation compared to 0.89 mg/dl and 79.5 ml/min/1.73m2 (0.9 and 74.2) at last follow up. A total of 9 patients were identified with estimated volume increase of at least 10 cc on AS, most of whom had tumor size >5 cm at last follow up. Tumor volumes calculated for these 9 patients using 3-D imaging software (range 11.3-222) correlated well with estimated tumor volumes (range 9.2-232). The median change in 3-D tumor volume on AS was 26.1 cm3 (mean 40.5, range 12.2-108), while the median change in normal renal parenchymal volume was 4.0 cm3 (mean -1.6, range -35-23). 6/9 (67%) tumors had minimal-to-no decrease (10 cm3 or more) in 3-D renal parenchymal volume on AS. CONCLUSIONS: Loss of renal parenchyma and function may be uncommon in oncocytoma patients regardless of tumor growth and size. This result supports the renal functional safety of AS for oncocytoma, however larger studies with longer follow up and larger tumor volume increases are needed. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1233-e1234 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amandip Cheema* More articles by this author Arun Menon More articles by this author Tashionna White More articles by this author Gaybrielle James More articles by this author Eric Kauffman More articles by this author Expand All Advertisement PDF downloadLoading ...

Diffusion Weighted Magnetic Resonance Imaging in the Assessment of Renal Function and Parenchymal Changes in Chronic Kidney Disease: A Preliminary Study.

BackgroundThe aim of this study was to evaluate the feasibility of using intravoxel incoherent motion (IVIM) imaging for noninvasive assessment of pathologic changes in chronic kidney disease (CKD).Material/MethodsThirty-four patients with CKD and 20 healthy volunteers were examined on a 1.5 T magnetic resonance imaging (MRI) unit. The examination consisted of morphologic sequences and diffusion-weighted echo-planar sequence with 10 b values. Diffusion parameters were calculated with the use of mono- (apparent diffusion coefficient, ADC) and bi-exponential model: pure diffusion coefficient (D) and perfusion fraction (Fp). Blood samples to assess the serum creatinine level were taken immediately before examination. Ultrasound guided biopsies were performed in less than 30 days from MRI and were scored by an experienced nephropathologist. Parametrical unpaired t-test and ROC curve analysis were used to investigate differences in diffusion parameters in relation to estimated glomerular filtration rate (eGFR). Pearson’s correlation coefficients were calculated to assess relationship between diffusion parameters and laboratory and histopathological markers of renal damage. P-value <0.05 indicated statistical significance.ResultsBoth ADC and D correlated positively with eGFR (respective r 0.74 and 0.72), however D showed a more significant correlation with histopathology: while D correlated negatively with parameters reflecting chronic glomerular (r −0.48) and tubulo-interstitial changes (r −0.47), ADC correlated only with interstitial infiltrations (r −0.44). Flow-related diffusion parameters showed high standard deviation.ConclusionsIVIM imaging is sensitive to functional and morphologic changes in CKD. The separation of influence of Fp from true diffusion improves the assessment of chronic changes in renal parenchyma.

Hypoparathyroidism, Sensorineural deafness and renal disease (Barakat syndrome) caused by a reduced gene dosage in GATA3: a case report and review of literature

BackgroundBarakat syndrome is an autosomal dominant rare genetic disease caused by haploinsufficiency of the GATA binding protein 3 (GATA3) gene. It is also known as HDR syndrome, and is characterized by varying degrees of hypoparathyroidism, sensorineural deafness and renal disease. This is the first report of a heterozygous GATA3 whole gene deletion causing HDR syndrome in a Sri Lankan family.Case presentationA 13-year-old boy with an acute febrile illness, hypocalcaemia and bilateral carpopedal spasm was referred for evaluation. A past medical history of treatment for persistent hypocalcaemic symptoms since the age of 7 months was obtained. Biochemical investigations showed persistent low serum corrected calcium levels with hyperphosphataemia, hypomagnesaemia, low parathyroid hormone levels, hypercalciuria, and low total 25-hydroxy vitamin D levels. His renal functions and renal sonography were normal. Audiometry showed bilateral moderate to severe sensorineural hearing loss. On screening, his mother was also found to have asymptomatic hypocalcaemia, hypomagnesaemia, hyperphosphataemia, hypercalciuria and low total 25-hydroxy vitamin D levels. She had impaired renal functions and chronic parenchymal changes in the renal scan. Audiometry showed bilateral profound sensorineural hearing loss. Genetic analysis using multiplex-ligation dependent probe amplification showed a reduced gene dosage for GATA3 that is consistent with a heterozygous whole gene deletion in both the child and mother.ConclusionsThis report demonstrates the wide intra-familial phenotypic variability observed in HDR syndrome and adds further to the existing scientific literature on the genotype-phenotype correlation of this syndrome. It highlights the need for HDR syndrome to be considered in the differential diagnosis of persistent hypocalcaemia with sensorineural deafness and/or renal involvement, and for appropriate genetic evaluation to be done to confirm the diagnosis.

EVALUATION OF INTRARENAL RESISTIVE INDEX BY DUPLEX COLOR DOPPLER ULTRASONOGRAPHY IN PATIENTS WITH DIABETIC NEPHROPATHY – COMPARISON BETWEEN HEALTHY ADULT CONTROL SUBJECTS

Background: Renal Doppler Ultrasonography (USG) has become a useful adjunct to gray scale sonography in the evaluation of renal function in various pathophysiological conditions like diabetic nephropathy. We can diagnose diabetic nephropathy by serum creatinine level and creatinine clearance rate. But early stage diagnosis of diabetic nephropathy is not always possible. In this study we have focused on resistive index of interlobar arteries of kidney to see changes of renal parenchyma for early stage diagnosis of diabetic nephropathy.&#x0D; Objectives: To observe the difference between values of intrarenal resistive index measured by duplex color Doppler USG in type 2 diabetic patients having diabetic nephropathy and in healthy adult control subjects.&#x0D; Materials and methods: This cross sectional observational study was conducted in the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. 65 diabetic nephropathy patients were taken as study group and 65 healthy subjects were included as healthy control subjects. Duplex Color Doppler Ultrasonography of interlobar artery was carried out in both groups to measure the peak systolic velocity, the end diastolic velocity and arterial Resistive Index.&#x0D; Results: The Resistive Index of interlobar artery of left kidney in control group was 0.58±0.08 and the mean RI of interlobar artery of left kidney in diabetic nephropathy patients was 0.74±0.53. The difference of Resistive index of interlobar artery of left kidney in the two groups were statistically significant and the RI of right kidney of control &amp; that of case groups were 0.60±0.09 and 0.76±0.03 respectively. In between control and case groups the RI of right kidney were statistically significant. So, resistive index of interlobar artery was increased in type 2 diabetic nrphropathy patients compared to control group.&#x0D; Conclusion: It can be concluded in present study that resistive index remains significantly higher in patients with diabetic nephropathy than in controls. Thus Duplex Doppler ultrasonography allows the rapid, noninvasive evaluation of the intrarenal vasculature and can be used as an easily available parameter of the evolution and a predictor in patients with clinical diabetic nephropathy.&#x0D; Keywords: Doppler Ultrasonography, Intrarenal Resistive Index, Diabetic Nephropathy

Successful outcomes in laparoscopic pyeloplasty using knotless self-anchoring barbed suture in children

Laparoscopic pyeloplasty for ureteropelvic junction obstruction in children has gained increasing importance over the last decade. Intracorporeal knot tying still remains a technical challenge for the surgeon. Self-anchoring suture incorporates a new concept for tissue approximation and reduces intracorporeal knot tying problems. There are very few reports on self-anchoring knotless suture and its application for laparoscopic pyeloplasty in children. We present our results of a series of consecutive children undergoing laparoscopic pyeloplasty with knotless barbed sutures. We prospectively evaluate 15 consecutive patients who underwent laparoscopic pyeloplasty with knotless barbed sutures (V-LocTM, Covidien) for ureteropelvic anastomosis. The decision of the operation was given by pediatric nephrology-urology-radiologic imaging diagnostic team, and all patients were operated by a single surgeon. Pyeloplasty was performed without pelvic reduction, and the anastomosis was made by barbed sutures using running fashion. The mean age of the patients were 5.39 (3 months-17 years). Two cases had undergone a right-sided pyeloplasty, and thirteen had undergone a left-sided pyeloplasty. The duration of the operative procedure was 60-110min. Neither intraoperative nor postoperative complication was encountered in any of the cases. Patients were followed by ultrasonographic evaluation. The anteroposterior diameter (AP) diameter of renal pelvis and hydronephrosis grade Society for Fetal Urology (SFU) are significantly different when compared with pre-operative and postoperative period (p=0.001 and p=0.001, respectively). Owing to the renal parenchymal thickness change by age pre-operative and postoperative thickness comparison is adjusted by age, because age is considered as a covariate (confounder variable). We observed statistically significant (p=0.003) difference in parenchymal thickness in all cases. Follow-up periods of the 15 consecutive pediatric pyeloplasty cases were 6-54 months. In the present study, successful outcome of the laparoscopic pyeloplasty using barbed suture was shown for the first time in children in literature. We believe that successful outcome of laparoscopic pyeloplasty could be achieved by eliminating knots and less manipulation on the wound edge also minimizes tissue injury during the procedure.

Clinical and morphologic review of 60 hereditary renal tumors from 30 hereditary renal cell carcinoma syndrome patients: lessons from a contemporary single institution series.

Hereditary renal cell carcinoma syndromes (HRCCS) are characterized by the presence of pathogenic germline variants that predispose patients to renal cell carcinomas as well as additional extra-renal manifestations. The importance of identifying HRCCS patients cannot be overemphasized, as patients and their families can begin surveillance for syndrome-associated manifestations once identified. The present study is a retrospective clinical and morphologic review of 60 hereditary renal tumors from 30 HRCCS patients treated at our institution with either Von Hippel-Lindau disease (VHL), Birt-Hogg-Dubé syndrome (BHD), tuberous sclerosis complex (TSC), hereditary leiomyomatosis and renal cell cancer syndrome, or succinate dehydrogenase (SDH) deficiency syndrome. Hereditary renal cell carcinoma syndromes kidney tumors often demonstrate specific morphologic features, characteristic background changes in renal parenchyma, and extra-renal manifestations, which, when recognized by the pathologist, can trigger genetic testing referral for specific familial cancer syndromes. Our study demonstrates the majority of tumors were consistent with the anticipated clinicopathologic profile of renal tumors found within HRCCS patients, although we found some unique characteristics within this cohort including a case of clear cell papillary renal cell carcinoma within a VHL patient, and a unique renal tumor with tubulopapillary features present in a patient with a germline SDHD mutation. Additionally, although the literature reports the presence of epithelioid angiomyolipoma (AML) as a common occurrence in TSC patients, our cohort of 3 patients with AMLs demonstrated only classic features. The findings we describe facilitate pathologist-based recognition of HRCCS and can prompt genetic evaluation for relevant patients.

Modulation of Renal Parenchyma in Response to Allogeneic Adipose-Derived Mesenchymal Stem Cells Transplantation in Acute Kidney Injury.

Background and ObjectivesIn regenerative medicine, mesenchymal stem cells derived from adipose tissues (Ad-MSCs) are a very attractive target to treat many diseases. In relation to nephrology, the aim of the current study is to investigate the effects of Ad-MSCs for the amelioration of acute kidney injury and to explore the mechanism of renal parenchymal changes in response to allogeneic transplantation of Ad-MSCs.Methods and ResultsThe nephrotoxicity was induced by cisplatin (CP) in balb/c mice according to RIFLE Class and AKIN Stage 3. PCR, qRT-PCR and fluorescent labeled cells infusion, histopathology, immunohistochemistry, functional analyses were used for genes and proteins expressions data acquisition respectively. We demonstrated that single intravenous infusion of 2.5×107/kg mAd-MSCs in mice pre-injected with CP recruited to the kidney, restored the renal structure, and function, which resulted in progressive survival of mice. The renal tissue morphology was recovered in terms of diminished necrosis or epithelial cells damage, protein casts formation, infiltration of inflammatory cells, tubular dilatation, and restoration of brush border protein; Megalin and decreased Kim-1 expressions in mAd-MSCs transplanted mice. Significant reduction in serum creatinine with slashed urea and urinary protein levels were observed. Anti-BrdU staining displayed enhanced tubular cells proliferation. Predominantly, downgrade expressions of TNF-α and TGF-β1 were observed post seven days in mAd-MSCs transplanted mice.ConclusionsAd-MSCs exerts pro-proliferative, anti-inflammatory, and anti-fibrotic effects. Ad-MSCs transplantation without any chemical or genetic manipulation can provide the evidence of therapeutic strategy for the origin of regeneration and overall an improved survival of the system in functionally deprived failed kidneys.

Renal duplex ultrasonography among adult native Nigerian diabetics and diabetic nephropathy population

Background: Diabetes mellitus (DM) is a serious global health problem with grave socioeconomic impact and debilitating complications especially diabetic nephropathy (DN). This study evaluated the usefulness of renal parenchymal and vascular sonography among three groups-diabetics with nephropathy, diabetes with no evidence of nephropathy and nondiabetics. Materials and Methods: The renal volume, parenchymal changes, and intrarenal vascular indices of three groups of participants (Group A - Diabetic with nephropathy; Group B - diabetic without nephropathy; and Group C - nondiabetic controls) were assessed using B-mode and Duplex ultrasonography. Results: The difference in the means of resistance index (RI) and pulsatility index (PI) in the diabetic patients (Group A and Group B) was significantly higher compared to the controls (RI mean ± standard deviation [SD]: Group A diabetic patients, 0.71 ± 0.11 cm3; Group B diabetics, 0.68 ± 0.08 cm3; controls, 0.62 ± 0.07 cm3; P < 0.0001); (PI ± SD: Group A diabetic patients, 1.22 ± 0.25 cm3; Group B diabetics, 1.16 ± 0.29 cm3; controls, 1.03 ± 0.23 cm3; P = 0.003). The mean renal volume among DM patients (Group A and Group B) were higher than in nondiabetic controls, (mean renal volume ± SD: Group A DM patients with nephropathy, 13.99 ± 3.95 cm3, the diabetic group without DM patients 13.39 ± 4.59 cm3, controls 12.05 ± 3.39 cm3). Conclusion: This study showed that renal RI and PI were significantly increased in patients with diabetes than in healthy controls with a trend of increase from controls to DM without nephropathy to DM with nephropathy. Duplex ultrasonography is useful for the clinical evaluation of diabetes and DN. 13.95 + 7.02% VS 8.20 + 4.19% P = 0.000

The pathological evaluation of nonneoplastic kidney disorder in tumor nephrectomy specimens.

Renal cell carcinoma (RCC) comprises 2%-3% of all visceral and 80%-85% of all adult kidney malignancies. Nephrectomy is the treatment of choice for renal tumors. The accurate pathological evaluation of nonneoplastic renal parenchyma in nephrectomy specimens is important for subsequent management. Eighty-two patients with RCC who underwent surgery at Imam Khomeini Hospital, Urmia, Iran, from April 2006 to February 2015 were studied. Paraffin blocks of the hospital archives were stained by hematoxylin and eosin (H and E) and periodic acid-Schiff staining. Microscopic examination was performed on nontumoral portions that were in the farthest possible distance from the tumor. Out of total 82 cases, 24 (29.3%) had normal renal parenchyma and 58 (70.7%) had pathological changes in renal parenchyma. The most frequent pathological findings were vascular sclerosis with parenchymal scarring and pyelonephritis. Other findings include focal and diffuse mesangial hypercellularity, eight; focal segmental glome-rulonephritis, five; membranoproliferative glomerulonephritis, three; and membranous glome-rulonephritis, two. Parenchymal scarring and vascular change included 36% of clear cell type, 41% of papillary type, and 53.8% of chromophobe type. Although there is not any statistical relation between the gender of patients and pathological findings, there was an obvious correlation between age and pathological findings. Before the age of 55 years, vascular sclerosis with parenchymal scarring and glomerular diseases and then chronic pyelonephritis are more prevalent.Evaluation of pathological changes in nonneo-plastic renal parenchyma is an essential step in recognizing patients at risk of accelerated functional failure of the single remaining kidney, particularly in patients with a background of chronic vascular injury associated with diabetes or hypertension.

Qualitative analysis of the nephrotoxicity of gold nanoparticles in case of enteral administration

The experiments on animals show the different effects of gold nanoparticles. Gold particles of various sizes may have a variety of toxic effects on the tissues, and more damage is often produced by small nanoparticles. In this work histological and ultrastructural changes of renal parenchyma caused by enteric administration of gold nanoparticles of small sizes (2 nm) were studied used different concentrations of colloidal solutions of gold nanoparticles: 10 µg/ml; 50 μg/ml; 100 µg/ml in drinking water within 7, 14 and 28 days. There were 9 groups of animals (non-linear mice weighing 20-25 g) on different dates of the experiment, as well as 3 control groups of mice, respectively, each term of experiment. Histological and ultrastructural changes were detected in the material of all groups of experimental animals compared with control. In general all small focal alterations relate to a small number of vessels, individual profiles of tubules and single cells. Light microscopy analysis of the overall picture of integrity of renal parenchyma showed that the most pronounced changes are observed in the cortex of the organ. Medulla is less affected. It identifies, first of all, microvascular disorders, then the renal tubular epithelium changes and finally, a minor involvement of interstitial elements in the response. Tubules of nephrons compared with the renal corpuscles undergo more changes at all dose levels of exposure and in all periods under study. Signs of dystrophy and necrobiosis often relate to the cell cytoplasm and less of their nuclei. Evidence of microvessel disorders detected in the renal cortex is not dependent on the dose of administered nanoparticles already in the early stages of the experiment. Histological findings as a whole are confirmed by the presence of ultrastructure alterations, that points to the primacy of cell damage.

Renal nuclear isotope study using dimercaptosuccinic acid in evaluating renal parenchymal changes in urinary tract infection in children

Background: Urinary tract infections (UTI) are among the most common diseases in childhood. The diagnosis and management of complicated UTI are difficult. The renal cortical scintigraphy using dimercaptosuccinic acid (DMSA) has been reported to be useful in children for confirmation of the diagnosis and for localization of parenchymal changes in acute pyelonephritis with renal scars. Objectives: To assess the role of 99m Tc-DMSA in identifying renal scars due to UTI in children. Materials and Methods: This study was a hospital-based prospective study conducted from November 2014 to October 2015. 53 children admitted with the first episode of the culture proven UTI. Children with vesicoureteric reflux or congenital renal anomalies were excluded from the study. All the patients were subjected to 99m Tc-DMSA. Results: An abnormal renal scan was observed in 28 out of 53 children (52.83%). The most common organism isolated was Escherichia coli (75.4%). All the children had fever (100%) followed by dysuria/increased frequency (50.94%). The majority of the renal parenchymal changes confined to the upper poles followed by lower poles and mid poles. Left kidney was involved more commonly (56%) than the right kidney (44%), whereas 3 children had bilateral involvement (10.71%). Parenchymal changes were common among children in 2-5 year age group (46.4%) followed by in children more than 5 years. Conclusion: DMSA renal scan has confirmed the high incidence of radiographically demonstrable renal scars in a significant number of children. It has helped to define parenchymal involvement in the form of pyelonephritic scars, the most common complication of UTI which is preventable.

Renal artery and parenchymal changes after renal denervation: assessment by magnetic resonance angiography

ObjectivesRelatively little is known about the incidence of long-term renal damage after renal denervation (RDN), a potential new treatment for hypertension. In this study the incidence of renal artery and parenchymal changes, assessed with contrast-enhanced magnetic resonance angiography (MRA) after RDN, is investigated.MethodsThis study is an initiative of ENCOReD, a collaboration of hypertension expert centres. Patients in whom an MRA was performed before and after RDN were included. Scans were evaluated by two independent, blinded radiologists. Primary outcome was the change in renal artery morphology and parenchyma.ResultsMRAs from 96 patients were analysed. Before RDN, 41 renal anomalies were observed, of which 29 mostly mild renal artery stenoses. After a median time of 366 days post RDN, MRA showed a new stenosis (25–49% lumen reduction) in two patients and progression of pre-existing lumen reduction in a single patient. No other renal changes were observed and renal function remained stable.ConclusionsWe observed new or progressed renal artery stenosis in three out of 96 patients, after a median time of 12 months post RDN (3.1%). Procedural angiographies showed that ablations were applied near the observed stenosis in only one of the three patients.Key Points• The incidence of vascular changes 12 months post RDN was 3.1%.• No renal vascular or parenchymal changes other than stenoses were observed.• Ablations were applied near the stenosis in only one of three patients.

INFLUENCE OF COMBINED INJECTION OF THYROXIN AND PROPYLTHIOURACILUM ON SCTRUCTURAL INDICATORS OF RENAL PARENCHYMA

THE AIM: to study of the dynamics of structural changes in renal parenchyma of rats exposed to long-term combined effects of thyroxine and propylthiouracilum (PTU). MATHERIAL AND METHODS – studies were performed on mongrel white male rats weighing 250-300g. Hyperthyroidism was caused by daily intragastric administration of thyroxine (T4) in amount of 50g per 100g of body weight over 30 days. On the first day of the experiment animals were divided into 2 groups. Animals of the first group (n = 25) received only T4. The rats of the second group (n = 25) were administrated propylthiouracilum and T4 daily. PTU was administered intragastric in amount of 1 mg per 100g of body weight. Kidney tissue samples were collected on the 10th, 20th and 30th days of the experiment. In addition, there were collected kidney tissue samples of the animals treated with only T4 after 20 days after cessation of hormone. Obtained tissue samples were fixed and treated by the usual method, followed by filling in paraffin. Sections were stained with hematoxylin and eosin. RESULTS – it was established that course of experimental hyperthyroidism leads to significant structural abnormalities of the renal parenchyma. Leading features of kidneys pathology at a hyperthyroidism are rough structural damages of the nephron tubular epithelium. CONCLUSIONS – combined administration in rats of thyroxin and propylthiouracilum has weakly expressed beneficial effect by limiting the development of structural damages to the renal parenchyma and clot formation.

Parenchyma-to-hydronephrosis Area Ratio Is a Promising Outcome Measure to Quantify Upper Tract Changes in Infants With High-grade Prenatal Hydronephrosis

To explore the value of renal parenchyma-to-hydronephrosis area ratio (PHAR) in detecting trends of hydronephrosis (HN) improvement or worsening and response to surgical intervention. Initial and follow-up sagittal renal ultrasound images of patients entered into a prenatal HN database from 2008 to 2016, with baseline Society for Fetal Urology (SFU) grades III and IV HN and without vesicoureteral reflux, were evaluated using National Institutes of Health-sponsored image-processing software. Renal parenchymal area, hydronephrosis area (HA), PHAR, anteroposterior diameter (APd), and SFU grade were captured at baseline and most recent visit. Data were analyzed based on the need for surgical intervention to address obstruction. Out of 193 infants (159 boys; 135 left side), 58 (30%) underwent surgery. Patients managed surgically compared with those managed nonsurgically had worse baseline HN severity markers: SFU grade (3.6 ± 0.5 vs 3.1 ± 0.4; P <.001), urinary tract dilation classification (2.7 ± 0.5 vs 2.2 ± 0.4; P <.001), APd (20.3 ± 10.1 vs 12.8 ± 8.0; P <.001), HA (10.0 ± 6.6 vs 4.7 ± 2.8; P <.001), and PHAR (1.3 ± 1.0 vs 3.0 ± 2.9; P <.001); but both patient groups had similar renal parenchymal area (9.4 ± 3.5 vs 9.7 ± 2.8; P = .5). At last follow-up, the following discrepancies persisted: SFU grade (2.3 ± 1.0 vs 1.7 ± 1.0; P <.001), urinary tract dilation classification (1.5 ± 0.7 vs 1.0 ± 0.7; P <.001), APd (11.7 ± 8.0 vs 7.7 ± 5.7; P <.001), and HA (6.4 ± 5.1 vs 3.6 ± 2.7; P <.001); however, PHAR was equalized for both groups (7.2 ± 14.0 vs 7.1 ± 6.1; P = .9). By concurrently considering changes in renal parenchyma and degree of HN, we found that PHAR appears to be a promising parameter that reflects similarities between patients managed surgically and those managed nonsurgically, despite initial discrepancies. Our data suggest that this variable may provide reassurance and a more objective assessment of improvement after surgery compared with other traditional ultrasound outcome measures.

Perfusion Patterns and Dynamics in Diabetic Nephropathy (DN) Rhesus Monkeys of Renal Parenchyma by Contrast-Enhanced Ultrasound

To assess perfusion patterns and dynamics in diabetic nephropathy (DN) rhesus monkeys of renal parenchyma by using contrast-enhanced ultrasound (CEUS). Ten rhesus monkeys were included in this study. The contrast agent was applied respectively in ten rhesus monkeys by intravenous bolus injection. The time-intensity curve was used to obtain flow-related parameters such as area under curve (AUC), time from peak to one half (HPT), intensity peak (PI), time to peak (TTP) and rise time (RT). Compared with normal control group, lesion group AUC, HPT and PI decreased significantly, and time to peak (TTP) delayed slightly. Analyzed RT in two groups, there was no significant difference. We found when blood biochemical indicators of renal function were no obvious abnormal findings, the perfusion indexes are more sensitive and dependent in early diagnosis of DN. AUC, HPT and PI might be useful in diagnostic predicting the hemodynamic changes of renal parenchyma.

Современные тенденции лечения пациентов с мочекаменной болезнью, осложненной хроническим калькулезным пиелонефритом

Urolithiasis as a chronic pathological process having a ubiquitous, coupled with the need for emergency medical care, often resulting in permanent disability, not to lose over the years its importance and relevance. This calculous pyelonephritis is a leading pathology among the diseases of the urinary system, accompanied by disturbances of urodynamics and changes in renal parenchyma. In connection with the above stated it seems urgent comprehensive comparative approach to the study of metabolic disturbances in patients with urolithiasis in order to identify possible causes Lithogenesis and its complications, including pyelonephritis, for further development of optimal schemes of urolithiasis treatment and prevention of stone formation in these patients. The objective: to evaluate litholytic and antiinflammatory efficacy of Flavia® drug in patients with chronic calculous pyelonephritis. Patients and methods. The study involved 115 patients (74 men and 41 women aged from 23 to 76 years) who had been diagnosed with a stone in cup size from 5 to 10 mm, followed by chronic calculous pyelonephritis in a phase of latent inflammation. 60 patients who took Flavia® 1 caps. 2 times a day for 3 months. the main group (OG), 55 patients with the comparison group (HS) took herbal diuretics. Results. The results show that particularly relevant is the use of Flavia ® in patients with chronic calculous pyelonephritis, as the drug helps rid the patients of stones and relief of the inflammatory process, which in turn reduces the likelihood of recurrence of stone formation. Conclusion. The use of the drug has a pronounced Flavia® litholytic and litokinetichesky effect, as evidenced by not only the self-discharge of stones from the exhaust of patients, as well as significant reduction in the size of stones trapped in the cups. Anti-inflammatory and anti-microbial effectiveness Flavia® due to synergistic action of its active ingredients provides clinical efficacy in 96.7% of patients, thus expanding the scope of conservative treatment of urolithiasis complicated by chronic calculous pyelonephritis.

Assessment of renal parenchymal changes using isotope renography for genitourinary indications in pediatric age group-a study of 47 cases

Background: With the introduction of isotope renography using DMSA (Dimercaptosuccinic acid), more stress than ever has been put on the evaluation of renal parenchyma in a morphologically normal but injured kidney. Objective: To study the pattern of renal dysfunction and anomalies noted after isotope renography using DMSA. Materials and methods: A retrospective study was conducted at department of Paediatrics of Amala Institute of Medical Sciences, Thrissur after evaluating the hospital records involving children undergoing isotope renography using DMSA (IRDMSA) for genitourinary indications between August 1st 2012 and August 1st 2013. Results: The common indications for IRDMSA were found to be urinary tract infections (UTI) (61.7%), multicystic dysplastic kidneys (MCDK) (12.7%), posterior urethral valve (PUV) (6.3%) and unilateral hydronephrosis (6.3%). Among the UTI group, 10.7% had the evidence of bilateral renal scarring and 42.8% unilateral renal scarring. Only 32.1% had bilaterally normal kidneys. Analysis of 7 cases with significantly reduced differential function (DF< 30/70) showed associated vesicoureteral reflux (VUR) in 100% cases. A male predominance was noticed even though only one case had posterior urethral valve. Right kidney was found to be more susceptible than the left. A study of the scar topography showed majority to be localized to the upper pole and superolateral border. 100% of the MCDKs were found to be non-functional and was not visualized in the renogram. Conclusion: IRDMSA is a reliable imaging modality in the follow up of acute pyelonephritis in children, detecting structural abnormalities and also for identifying kidneys in children at risk for subsequent renal scarring.

A Comparative Study of Sonographic Grading of Renal Parenchymal Changes and Estimated Glomerular Filtration Rate (eGFR) using Modified Diet in Renal Disease Formula.

The sonographic findings are of help in evaluating the nephrological diseases. Glomerular filtration rate is another parameter for assessing the reserved renal function and an indicator of prognosis. In clinical practice GFR estimation (eGFR) is done by using a mathematical formula. In our study, we compared the sonographic grading of renal parenchymal changes with eGFR calculated using Modified Diet in Renal Diseases formula based on serum creatinine, age, gender and ethnicity. To evaluate the relevance of sonographic grading of renal parenchymal changes in assessing the severity of the renal disease and comparing it to the eGFR calculated using MDRD formula based on the age, gender and serum creatinine value of the patient. The adult patients with suspected kidney disease referred for sonography of abdomen were our study participants. As per our study design following strict inclusion and exclusion criteria, patients were selected as study participants and for each of the patient's renal parenchymal status, serum creatinine, age, gender and ethnicity were documented. A total of 70 patients were our study participants, out of which 67.1% were males and 32.9% were females. Our study showed a linear correlation between sonographic grading of renal parenchymal changes with eGFR. We conclude that by evaluating the kidneys with sonography and calculating eGFR using MDRD formula the renal status will be more accurately interpreted.

Evaluation of Renal Histopathological Changes, as a Predictor of Recoverability of Renal Function Following Pyeloplasty for Ureteropelvic Junction Obstruction.

Background:Pyeloplasty is a widely accepted treatment for ureteropelvic junction obstruction (UPJO). However, the renal function recoverability after pyeloplasty is still a matter of debate. Different parameters have been used to predict renal functional recoverability after corrective surgery, with conflicting results.Objectives:In this study, renal biopsy was carried on a series of cases of UPJO, during pyeloplasty, to study the extent of histological alterations in renal parenchyma, as a result of obstruction, and its predictive value in renal function recoverability after pyeloplasty.Patients and Methods:We retrospectively analyzed the renal biopsy obtained during pyeloplasty in 53 adult patients. Histopathological changes were graded on a scale of 1 to 3, according to their severity, and compared with the differential renal function (DRF) revealed on the preoperative and postoperative follow up diethylene triamine pentaacetic acid (DTPA) renal scan. A Fischer’s t test was used to evaluate statistical differences between values.Results:This study showed a linear relationship between the severity of histological changes and renal function recovery, after pyeloplasty. Out of 24 obstructed renal units (ORU), with minimal histopathological changes (grade I), 21 ORU (87.5%), with > 35% DRF preoperatively, showed significant improvement in renal function after 12 months of pyeloplasty (P < 0.05). On the other hand, all kidneys (n = 29) with moderate to severe obstructive changes (grade II and III) had minimal improvement in DRF, after pyeloplasty, which was clinically insignificant (P > 0.05). Renal function deterioration after pyeloplasty was not observed in any of the cases.Conclusions:The severity of pathological changes in renal parenchyma, due to UPJO, is a good predictor of renal function recoverability, after pyeloplasty. The ORUs, with DRF > 35%, usually have normal (grade I) renal biopsy and might be expected to present better functional recoverability after pyeloplasty.