Corticomedullary Differentiation Research Articles

Multiparametric ultrasound findings in acute kidney failure due to rare renal cortical necrosis

Renal cortical necrosis (RCN) is a rare cause of acute kidney failure and is usually diagnosed on the basis of characteristic enhancement patterns on cross-sectional imaging. Contrast-enhanced ultrasound (CEUS) offers benefits in patients with kidney failure in the clinical setting including the use of a nonnephrotoxic intravascular contrast agent and the fact that it can be performed at the bedside in critical cases. Therefore, the aim of this study is to investigate whether CEUS can reliably identify typical imaging features of RCN. We retrospectively analyzed 12 patients with RCN examined in our department and confirmation of the diagnosis by either histopathology, other contrast-enhanced cross-sectional imaging tests, and/or CEUS follow-up. Assessed parameters in conventional US were reduced echogenicity, loss of corticomedullary differentiation, length and width of kidney, hypoechoic rim, resistance index and in CEUS delayed wash-in of contrast agent (> 20 s), reverse rim sign, maximum nonenhancing rim and additional renal infarction. Furthermore, imaging features in RCN were compared with the findings in renal vein thrombosis (RVT), among them echogenicity, corticomedullar differentiation, hypoechoic rim, RI value, delayed cortical enhancement, total loss of cortical perfusion and enhancement of renal medulla. All 12 patients showed the reverse rim sign, while a hypoechogenic subcapsular rim was only visible in four patients on B-mode ultrasound. A resistance index (RI) was available in 10 cases and was always less than 1. RI was a strong differentiator in separating RVT from RCN (RI > 1 or not measurable due to hypoperfusion as differentiator, p = 0.001). CEUS showed total loss of medullary enhancement in all cases of RVT. With its higher temporal resolution, CEUS allows dynamic assessment of renal macro- and microcirculation and identification of the typical imaging findings of RCN with use of a nonnephrotoxic contrast agent.

Leprechaunism.

Donahue syndrome is a chromosome recessive inherited disorder. It´s additionally called leprechaunism. Donahue syndrome is because of compound heterozygous or homozygous mutation within the INSR gene. It results in either complete or virtually complete absence of hypoglycaemic agent receptors. Donahue syndrome is the most severe type of hypoglycaemic agent disorder. A 21-year-old male, born to blood- related birth-givers, could be a noted case of Donahue syndrome. He was diagnosed with this syndrome at three years of age. He was a known Type1 diabetic with overstated hyperglycaemia with hyperinsulinism and dysmorphic characteristics and craniofacial abnormalities. Physical examination showed genitomegaly, lipoatrophy (A), abdominal distension, dermal disorders and huge depressed ears with elfin facies (B). Laboratory tests were conducted and the findings disclosed: Plasma aldohexose random-339 mg/dl, Blood Urea Nitrogen- 42 mg/dl, Creatinine-3.50 mg/dl, Insulin- >1000 micro-IU/ml and very low Testosterone-19.82 ng/dl. Clinical examinations for complete body systems were additionally performed. Chest X-ray and Echo was traditional. Retinopathy screening showed macular-star in the right eye. Ultrasound abdomen showed accrued cortical echoes in each kidney with reduced corticomedullary differentiation, therefore the patient was also on weekly chemical dialysis. Neurological examinations were intact. Deoxy ribonucleic acid analysis using period-time PCR are frequently used for distinguishing this syndrome. Other diagnosis are Type-A syndrome and Rabson Mildenhall syndrome. Treatment needs efforts from endocrinologists, dermatologists and numerous medical professionals. Treatment with insulin-like protein one can also be contemplated.

Clinical characteristics of Slovenian pediatric patients with autosomal recessive polycystic kidney disease.

Autosomal recessive polycystic kidney disease (ARPKD) is a rare inherited disease. We reviewed the clinical characteristics, management, and outcomes in Slovenian pediatric patients with ARPKD. All patients with ARPKD who were treated at the Pediatric Nephrology Department of the University Children's Hospital in Ljubljana between 1980 and 2020 were included in the study. The data were assessed retrospectively by reviewing the patients' medical records and analyzed using descriptive statistics. We included 13 patients, 6 boys and 7 girls. A prenatal diagnosis was established in 3 (23%) patients. In 4 (31%) patients, the diagnosis was confirmed within the first few days of life, while in 6 (46%) patients the disease manifested later during childhood. Four babies (31%) needed ventilatory support after birth. Arterial hypertension developed in all patients. Liver function was affected in 12 (92%) patients and was the predominant clinical concern in 2 of them. Two (15%) patients presented with end-stage renal disease (ESRD). Portal hypertension was found in 7 (54%) patients. Initial sonography revealed enlarged kidneys in 12 (92%) patients, hyperechoic kidneys or poor cortico-medullary differentiation in 10 (77%), and liver abnormalities in 5 (38%) patients. Unilateral nephrectomy was necessary before dialysis in 1 patient. Six (46%) patients started maintenance dialysis at an average age of 15.3 years. Kidney transplantation was performed in 2 (15%) and liver transplantation in 1 (8%) patient. Two (15%) patients died because of sepsis or respiratory failure. ARPKD is a progressive disease leading to ESRD and renal replacement treatment in almost half of our patients. Our data confirm the phenotypic variability of ARPKD in Slovenian patients.

Sonographic Assessment of Kidneys in Human Immunodeficiency Virus Seropositive Patients: A systematic Review

Background: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) remains a major challenge globally, and approximately 180,000 people died from AIDS-related illnesses in Nigeria in 2015. HIV associated nephropathy is the third most common cause of end-stage renal failure.
 Objectives: To review published original research articles on the sonographic evaluation of kidneys in HIV seropositive patients, identifying missing gaps and coming up with an area of further study.
 Methodology: The study was retrospective and a secondary source of data from published original research articles was used. The search was performed through Google search using Google Scholar, EMBASE, PubMed and Medline. All the published original research articles in the English language and the availability of full-text articles were included in the study.
 Results: An electronic search using the search terms had identified 58 related published articles, but only 12 articles were reviewed. This study found out that human immunodeficiency virus-associated nephropathy (HIVAN) to be a most predominant renal disease in HIV positive patients leaving in sub-Saharan Africa with increased renal parenchymal echogenicity and decreased corticomedullary differentiation sonographically, which correlate in raised of serum creatinine level and the degree of patients immune competence (CD4 count). Few studies correlated the sonographic findings with histopathological feature and none uses Doppler ultrasound.
 Conclusion: This study has identified a correlation of the sonographic findings with the histopathological features and the use of Doppler ultrasound as the missing gaps from the previously published research articles in the subject area.

Sonographic Assessment of Some Abdominal Organs in Children with Sickle Cell Disease in Ilorin, Nigeria.

Background:The irregular sickle cells can block blood vessels, causing tissue and organ damage and in most cases presented with pain as a result of organ ischemia. Ultrasonography is an easily available instrument for investigating abdominal organs which are most commonly affected by sickle cell disease (SCD). This study was aimed to assessing liver, gall bladder, spleen, and kidney in children with SCD in Ilorin, Kwara State.Methods:A prospective cross-sectional study was conducted among children with SCD in Ilorin from September 2017 to April 2018. An ethical approval was obtained from the Human Research and Ethics Committee of the Kwara State Ministry of Health. In this study, 106 children with SCD and 106 normal children for control were included. Abdominal ultrasound scan was performed on all the selected subjects and the findings were recorded on the data capture sheet. Descriptive and inferential statistic was used in the data analysis, SPSS version 20 was used and the P = 0.05.Results:In the children with SCD, hepatomegaly was found in 45 (42.5%), 29 (27.4%) had coarse echo pattern of liver and 16 (15.1%) had hyperechoic liver, 5 (4.7%) had gallbladder stone, 2 (1.9%) had gallbladder sludge, and 6 (5.6%) had thickened gallbladder wall. Twenty-five (23.6%) had splenomegaly, and 7 (6.6%) had autosplenectomy. Four (3.8%) showed reduced corticomedullary differentiation in each kidney, five (4.7%) in each kidney had mild calyceal dilatation. One (0.9%) had mild calyceal dilatation with reduced corticomedullary differentiation with accompanying loss of renal sinus fat.Conclusion:Abdominal ultrasound imaging for patients with SCD showed a high incidence of abdominal abnormalities, especially in solid organs such as liver, kidney, and spleen.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ ЭХОГРАММ ПОЧЕК И СЕРДЦА У БОЛЬНЫХ СОБАК ЭНДОМЕТРИТОМ И КОШЕК – ПИОМЕТРОЙ

According to the data provided by the Veterinary Hospital of the Saratov State Agrarian University, in the cities of Saratov, Balakovo and Engels, renal and heart failure in patients with endometritis and cats with pyometra were registered in 26.8-34.5% of all surveyed domestic animals. The results of abdominal echography, made by sick cats with pyometra and dogs with endometritis, showed the presence of renal failure of the following types: – 92.9% – glomerulonephritis, pyelonephritis; – 2.4% – focal diseases (cysts); in 4.7% – hydronephrosis. In this group of animals with pathologies were identified: – pyelonephritis, glomerulonephritis in 81.3%; – pathologies of a focal nature (cysts, masses) – in 4.0%; – pathologies of a hereditary nature – in 3.1%; – pathology of the collecting system, incl. hydronephrosis, nephrolithiasis in 10.7% and 0.9% of sick dogs and cats, respectively. Echographically, the signs of heart failure (pericarditis, endcardiosis) are fairly objectively detected in 60.6% of the examined patients with endometritis and in 73.5% of patients with pyometra. Moreover, the combination of renal and heart failure in sick dogs and cats is recorded in 56.79% of cases. In inflammatory diseases in dogs in this case with endometritis and cats with pyometra in acute form, ultrasound shows: an increase in size (especially dorsoventral); the contours of the kidneys are indistinct; cortico-medullary differentiation is weak; the thickness of the parenchyma is heterogeneous and uneven, the collecting system of the kidneys is expanded. Echographically, the signs of heart disease and heart failure are quite objectively detected (pericarditis – 23.97%, endcardiosis – 16.83%, arrhythmias of various origins – 44.2% and other diseases of the heart and vascular system – 14.0%), in 60, 6% of the examined sick dogs with endometritis and 73.5% of sick cats with pyometra. Moreover, the combination in sick dogs and cats of renal and heart failure is recorded in 56.79% of cases.

CRANIOFACIAL FIBROUS DYSPLASIA: A CASE REPORT

Craniofacial fibrous dysplasia (CFD) is a benign bone development anomaly characterized by involvement of the skull and facial bones. This disease can affect 1 bone or multiple bones resulting in deformity, fractures, and pain. An 18-year-old male with facial asymmetry presented with an extensive and not well-demarcated lesion involving the left craniofacial side. Tomographic examination showed an expansive bone lesion with loss of corticomedullary differentiation affecting the left maxilla, maxillary sinus, ethmoid, sphenoid infundibulum, and nasal and frontal bones. After biopsy, the microscopic examination revealed irregular trabeculae of the lamellar bone immersed in a moderately cellularized and vascularized dense connective tissue. Curvilinear bone trabeculae arranged in a pattern of Chinese letter form was noted. The diagnosis of CFD was made. The treatment has consisted of multiple surgeries to restore the facial contour and asymmetry. The patient remains in follow-up.

One-stop assessment of renal function and renal artery in hypertensive patients with suspected renal dysfunction: non-enhanced MRI using spatial labeling with multiple inversion pulses.

To assess whether spatial labeling with multiple inversion pulses (SLEEK) sequence can be employed as a one-stop assessment method for evaluating renal function and displaying renal artery in hypertensive patients with suspected renal dysfunction. A total of 78 patients with suspected hypertensive renal damage were enrolled in this retrospective study. All patients underwent MRI examinations, and both SLEEK and DWI sequences were performed simultaneously. According to estimated glomerular filtration rate (eGFR), patients were divided into three groups (Group 1, eGFR> 90; Group 2, eGFR = 60-90; Group 3, eGFR< 60). Twenty-two of these patients also underwent CT angiography (CTA) examination. Comparison between CTA, DWI, and eGFR was performed to assess the value of SLEEK in evaluating renal function and displaying renal artery. The performance of SLEEK to display renal artery was highly consistent with the results of CTA (kappa = 0.713). The corticomedullary contrast ratio positively correlated with eGFR (p = 0.004, r = 0.322) and was significantly higher in SLEEK images than in DWI images in all three groups (p < 0.001). There was no significant difference in corticomedullary contrast ratio in SLEEK images between Group 1 and Group 2 (p = 0.285). However, the minimal renal cortical thickness, which significantly correlated with eGFR (p < 0.001, r = 0.866), was significantly different between Group 1 and Group 2 (p < 0.001). ROC analysis showed good diagnostic performance when differentiating patients with eGFR> 60 from those with eGFR< 60. The SLEEK sequence could evaluate simultaneously renal function through corticomedullary differentiation and renal arteries, enabling one-stop assessment in hypertensive patients with suspected renal dysfunction. • Spatial labeling with multiple inversion pulses (SLEEK) improves renal corticomedullary differentiation in hypertensive patients with renal dysfunction compared with DWI. • SLEEK clearly displays renal artery in hypertensive patients with renal dysfunction. • SLEEK could be utilized as a one-stop assessment method for evaluating renal function and renal artery in hypertensive patients.

NEPHROPATHY IN A CHILD SUFFERING FROM TETRALOGY OF FALLOT

Cyanotic nephropathy is a type of renal impairment, occurring due to chronic exposure to hypoxia, seen in unoperated cases of cyanotic congenital heart diseases (CCHDs). Due to a paucity of the literature and lack of general awareness of this condition, many times, the occurrence of this nephropathy is left untreated, leading to chronic kidney disease (CKD). The mortality rate is 51% in children who suffer from CCHD with CKD. Here, we report a case of an 11-year-old male child with tetralogy of Fallot (unoperated), requiring repeated admissions for breathlessness. An incidental finding of proteinuria on multiple admission was further investigated. The patient had hemoconcentration with deranged renal function tests, [hypoalbuminemia (2.2 gm/dl), serum creatinine 3.4 mg/dl, eGfR 16.28, and urine protein:creatinine ratio 3.95]. USG KUB done reported a bilateral medicorenal disease with a complete loss of corticomedullary differentiation. The patient already had Stage IV CKD at the time of presentation and expired 8 months after diagnosis.

Renal manifestations of sickle cell disease in children

Background: Sickle cell disease prevalence is more in central part of India. This study tries to find extent of renal involvement, risk factors and screening tests in sickle cell disease.Methods: Study was Cross sectional observational study. Demographic and clinical findings were recorded. Renal function tests like serum creatinine, blood urea nitrogen, eGFR were studied. Presence of microalbuminuria was checkeed. Ultrasonography abdomen was done to see the texture and corticomedullary differentiation of kidney.Results: Total 143 patients were studied. Out of which, 117 homozygous (SS type), 26 heterozygous (AS type). Majority belonged to school going age group (i.e. 5 to 10 year age group) with male preponderance in homozygous state. Microalbuminuria was more common in crisis state (61.84% in SS pattern and 83.33% in AS pattern) as compared to steady state in both SS and AS pattern patients. Dipstic method detected more proteinuria than heat coagulation suggesting dipstick method superior to heat coagulation test. Low eGFR was common in patients with SS pattern as compared to patients with AS pattern and was significantly associated with microalbuminuria in both steady state and crisis state. Abnormal USG was seen 3.44% in patients with SS pattern. Renal involvement started below 5 years of age and then increases with age, homozygous childrens in crisis state are affected more.Conclusions: Renal involvement is common in sickle cell anemia i.e it is seen in 50% of the patients. Increasing age, male sex and homozygous state were risk factors. Simple test like dipstic method and heat coagulation test can be used as screening test to detect microalbumiburia, with dipstic method being superior. Presence of microalbuminuria can detect early renal involvement in sickle cell disease. This will help in early diagnosis and management of such patients which avoids further renal complications and thus prevents mortality and morbidity.

COLOR DOPPLER ULTRASONOGRAPHY FINDINGS IN KIDNEY ALLOGRAFTS BEFORE AND AFTER TRANSPLANTATION

Method: A sample size of 40 kidney allograft recipients undergoing color Doppler Ultrasonography evaluation included in the study.&#x0D; Result: Corticomeduallry differentiation of kidney allografts within 24 hours post transplant period: There was no significant difference between CMD of kidney allorgrafts with complication and kidney allografts without any complication within 24 hour because the standard deviations of both groups were 0. Corticomeduallry differentiation in all kidney allografts, all were shows maintained corticomedullary differentiation.&#x0D; Conclusion: This study is aimed to assessing the role of CDUS in kidney allograft recipients to evaluate the graft perfusion immediate after anastamosis, within 24 hours and follow up period after engraftment of kidney allograft. Analyse the Color Doppler Ultrasound (CDUS) indices changes in parenchymal, and vascular cause of allograft dysfunction at follow up periods, to evaluate the uroloical, surgical and vascular complications in kidney recipients by using gray scale and color Doppler US at follow up periods and compare the results with biochemical parameter (serum creatinine).&#x0D; Immediate Doppler ultrasound is highly useful in the diagnosis of primary graft dysfunction and in follow-up of the transplanted patient.&#x0D; Keywords: Graft Perfusion, Anastamosis, Color, Doppler, Ultrasound

A study of gross and histological structure of thymus gland in fetuses and adolescent

The thymus is the lymphoid organ of greatest importance. It is a structurally separated lobules through the tissue of the connective septa. That lobule has a cortex and a medulla in it. Many studies of this organ related to the histology of early fetuses are focused on animals. The present study focuses on certain features relating to the histogenesis of the thymus and adolescent fetuses. In the present study, 50 normal human stillborn/aborted fetuses and one is 15 years thymus gland in adolescent was studied from 18 to 35 weeks were examined. The acquired fetuses were set in formalin of 10 per cent. They have been exposed to dissection after correct fixation. The specimens acquired had been processed through a well-known paraffin block making process. Sections were taken with haematoxylin &amp; eosin, and painted. The stained sections had been tested using 40x and 100x optical magnifications and pictures taken under light microscopy. Compared to its CRL, the gland's dimension has changed. Compared to gestational age, the mass of the gland and fetuses was. It has been demonstrated capsule, septae, cortex, medulla, blood vessel, lymphocytes, reticular epithelial cells, adipose cells, and the corpuscle of Hassall.Thymus gland involution, pondered in its anatomy and histology, will serve as a basis for becoming conscious of pathological conditions. Within the first 18 weeks of gestation, all structural changes viz. cortico-medullary differentiation, lobulation, and maturity of the hassall's corpuscles happened.

Multiparametric Assessment of Changes in Renal Tissue after Kidney Transplantation with Quantitative MR Relaxometry and Diffusion-Tensor Imaging at 3 T.

Background: Magnetic resonance relaxometry (MRR) offers highly reproducible pixel-wise parametric maps of T1 and T2 relaxation times, reflecting specific tissue properties, while diffusion-tensor imaging (DTI) is a promising technique for the characterization of microstructural changes, depending on the directionality of molecular motion. Both MMR and DTI may be used for non-invasive assessment of parenchymal changes caused by kidney injury or graft dysfunction. Methods: We examined 46 patients with kidney transplantation and 16 healthy controls, using T1/T2 relaxometry and DTI at 3 T. Twenty-two early transplants and 24 late transplants were included. Seven of the patients had prior renal biopsy (all of them dysfunctional allografts; 6/7 with tubular atrophy and 7/7 with interstitial fibrosis). Results: Compared to healthy controls, T1 and T2 relaxation times in the renal parenchyma were increased after transplantation, with the highest T1/T2 values in early transplants (T1: 1700 ± 53 ms/T2: 83 ± 6 ms compared to T1: 1514 ± 29 ms/T2: 78 ± 4 ms in controls). Medullary and cortical ADC/FA values were decreased in early transplants and highest in controls, with medullary FA values showing the most pronounced difference. Cortical renal T1, mean medullary FA and corticomedullary differentiation (CMD) values correlated best with renal function as measured by eGFR (cortical T1: r = −0.63, p < 0.001; medullary FA: r = 0.67, p < 0.001; FA CMD: r = 0.62, p < 0.001). Mean medullary FA proved to be a significant predictor for tubular atrophy (p < 0.001), while cortical T1 appeared as a significant predictor of interstitial fibrosis (p = 0.003). Conclusion: Cortical T1, medullary FA, and FA CMD might serve as new imaging biomarkers of renal function and histopathologic microstructure.

SAT-433 RENAL CORTICAL NECROSIS IN NON-HEMORRHAGIC DENGUE FEVER- A RARE CASE REPORT

Dengue fever is a tropical febrile illness caused by one of the 4 genotypes of dengue virus. Acute Kidney Injury (AKI) is a rare complication of Dengue Fever and is usually associated with severe forms of the disease as in Dengue hemorrhagic fever (DHF) and Dengue shock syndrome (DSS). We present a patient diagnosed as a case of Dengue fever without Shock or any Hemorrhagic manifestation, developing Acute Cortical Necrosis and requiring maintenance Haemodialysis. Patient was admitted with Acute febrile illness, diagnosis of Dengue Fever was confirmed by positive IgM for Dengue. He underwent extensive diagnostic workup to rule out other causes of Acute Kidney Injury. 30 year old married, male, patient was admitted complaints of Abdominal pain and fever since 3 days with history of decreased urine output since one day. There was no history of any Malena or hematemesis or any chronic illness like Hypertension or Diabetes. Blood pressure was within normal limit. His blood investigations revealed Hb 12.7g/dl, Total Leucocyte count-10860/cumm, Platelet counts-3,65000/cumm, Hematocrit-37.3%, Reticulocyte count-1%, ESR-02, APTT-26, INR was 1.20, Peripheral Smear showed Normocytic Normochromic RBCS with no schistocytes. SGPT-92, SGOT-94, Total bilirubin-0.8, Total Serum Proteins-6.2g/dl, Serum Albumin-3.5g/dl, Serum Globulin-2.7g/dl, Lipase-65, Amylase-73, LDH-1297, TSH-1.67, RBS-102, Blood urea-111mg/dl, Serum Creatinine-6.27mg/dl, Na-138, K-4.3, Bicarbonate-18.1mmol/L, Creatinine Phosphokinase-193, C3 level was normal, Calcium-8.4mg/dl, iPTH-75 pg/ml, Dengue Serology showed positive IgM for Dengue, Malaria antigen was negative. His Direct coombs test, Antinuclear Antibody, ANCA c & p, Lupus anticoagulant, Antiphospholipid antibody, Anticardiolipin antibodies, Protein C and S deficiency were negative.G6PD quantitative was within normal limits and Sickling test was negative. His heavy metal screening was also negative. Urine RM showed Protein 3+, WBCs-03, RBCs-02(isomorphic type). Patient was initially managed with Intravenous fluids and later Haemodialysis was started in view of severe acidosis and fluid overload. He underwent extensive radiological evaluation with Ultrasonography of Abdomen showing normal liver echoes with bilateral normal sized kidney and intact corticomedullary differentiation with decreased cortical blood flow on power doppler, CT Contrast study of Abdomen confirmed poor renal cortical blood flow. Renal Biopsy was done which showed Cortical Necrosis with near complete thrombotic occlusion in medium sized vessels. In view of persistent Anuria, the patient was put on maintenance Haemodialysis. Irreversible Kidney Injury is an extremely rare complication of Dengue fever as most of the patients of AKI recover with supportive treatment. In our case a young patient with a short clinical history of Dengue Fever presented with AKI. Renal Biopsy showed Renal Cortical Necrosis with medium sized vessels showing near complete occlusion of vascular lamina by thrombi suggesting Thrombotic Microangiopathy. Hence, delay in recovery of AKI in Dengue patients presenting without Hemorrhage or shock should prompt the clinician to evaluate further regarding the underlying pathological mechanisms of Acute Kidney Injury.

Sonographically Diagnosed Urothelial Thickening in Kidney Allografts: A Noninvasive and Clinically Highly Relevant Marker for the Detection of Acute Rejection.

OBJECTIVE. The objective of our study was to investigate the significance of sonographic features in assessing for acute kidney allograft rejection in the modern era. MATERIALS AND METHODS. In this retrospective study, 107 adult patients with a kidney allograft biopsy performed between 2015 and 2018 and diagnostic ultrasound performed within 2 weeks of the biopsy were included. Acute rejection was diagnosed on the basis of biopsy tissue sample results using the Banff criteria. The following ultrasound features were assessed: perfusion, cortical echogenicity, corticomedullary differentiation, urothelial thickening, change in renal length, renal artery velocity, and intraparenchymal arterial resistive index. Subjective measures of perfusion, echogenicity, corticomedullary differentiation, and urothelial thickening were assessed independently and in consensus by three abdominal radiologists; multirater kappa values were calculated for interobserver variability. The Wilcoxon rank sum test and chi-square test were used to evaluate the differences between two groups (rejection vs no rejection) and the sonographic features. Sensitivity, specificity, positive predictive value, and negative predictive value (NPV) were calculated for sonographic features that are associated with acute rejection. RESULTS. Of the sonographic features, only the presence of urothelial thickening was significantly associated with acute rejection (p < 0.001) and had substantial agreement (κ = 0.61) among readers. Urothelial thickening was highly sensitive (96%; 95% CI, 79-100%) with a high NPV (98%; 95% CI, 86-100%). CONCLUSION. Urothelial thickening on ultrasound is a highly sensitive finding for acute kidney rejection with a high NPV and thus may play a role in sonographic prebiopsy screening. Other historically associated sonographic features seem to play little, if any, role in the screening and assessment for kidney allograft rejection in the modern era.

Using Ultra-Sonography in Acute and Chronic Renal Pathologies: A Cross-Sectional Study

Background: Sonographic evaluation of the kidneys is a key diagnostic step in determining kidney disorders. Previous studies have suggested that sonographic evaluation helps clinicians in determining the causes of either acute or chronic renal diseases. Objectives: The present study aimed to assess the role of ultra-sonography in acute and chronic renal pathologies. Methods: In this study, 29 patients with parenchymal kidney disease referred to Nephrology Department of Imam Reza Hospital, Tabriz, Iran, participated. The patients’ demographic information, internal diseases, kidney diseases, and other medical conditions were recorded. Then the Doppler and gray scale sonography were performed for both kidneys. Biopsies were taken from patients and were then compared with sonographic findings. The data were analyzed with SPSS software version 22. Results: According to pathologic findings, 69% of renal diseases was acute, and 31% of the diseases were chronic. According to the results of Gray Scale ultrasonography, there was a significant correlation between parenchyma thickness, cortex echogenicity (qualitative), medula echogenicity (qualitative and quantitative), and corticomedullary differentiation (quantitative) with pathologic findings (P < 0.05). Furthermore, no significant correlation was observed between the length of the kidney, cortex echogenecity (quantitative), and cortico-medullary differentiation (qualitative) with pathological findings (P < 0.05). In addition, there was a significant correlation between RI and pathologic findings based on Doppler ultrasonography (P < 0.05). Conclusions: According to the results of this study, ultrasonography and color Doppler would be useful as an assistance and non-invasive method for the diagnosis and differentiation of the conflict site and the type of pathology involved in all parenchymal kidney disorders

Лучевой мониторинг состояния внутренних органов новорожденных, перенесших общую терапевтическую гипотермию

Purpose: Learning the state of the internal organs in newborns with severe perinatal asphyxia after general therapeutic hypothermia.&#x0D; Material and methods: 80 newborns with severe perinatal asphyxia born from January 2014 to May 2019 in Kursk were under observation. In the first 6 hours of life, 52 patients were started with general therapeutic hypothermia (1st observation group), 28 newborns did not perform hypothermia (2nd control group). All children underwent a dynamic complex radiological examination, included ultrasound of the brain, abdominal organs and retroperitoneal space, echocardiography with Doppler, chest X-rays.&#x0D; Results and discussion: In both groups of observations, radiation symptoms of liver and gallbladder changes were identified: a uniform increase in the echogenicity of the hepatic parenchyma (98.1 % of cases in group 1 and 100 % of cases in group 2, p &gt; 0.05), visual “impoverishment” of the vascular pattern (98.1 % and 100 %, p &gt; 0.05), hepatomegaly (19.2 % and 21.4 %, p &gt; 0.05), thickening of the gallbladder walls, loose sediment or suspension in its lumen (7.7 % and 10.7 %, p &gt; 0.05). All 80 examined patients showed a bilateral increase in echogenicity of the renal parenchyma with visual impoverishment of intraorgan blood flow and impaired corticomedullary differentiation. The described internal organs changes were reversible and due, in our opinion, mainly to the effect of asphyxiation and resuscitation measures.&#x0D; According to the results of chest X-ray, we did not reveal the effect of therapeutic hypothermia on the incidence of hospital pneumonia: it was found in 34.6 % newborns from the 1st group and in 42.9 % – from the 2nd one (p &gt; 0.05). However, in the first 14 days of life the respiratory failure caused by edematous and hemorrhagic changes in patient’s lungs was detected more often in patients from observation group then in patients from control group: respectively 76.9 % and 42.8 % of cases (p &lt;0.05). This indicates a negative effect of general therapeutic hypothermia on the respiratory system of newborns with severe perinatal asphyxia.

Accuracy of Ultrasound in Identifying Renal Scarring as Compared to DMSA Scan

ObjectiveTo assess the accuracy of renal ultrasound (RUS) in detecting renal scarring (RS). MethodsAll initial DMSA scans performed from 2006 to 2009 for history of urinary tract infection (UTI) or vesicoureteral reflux (VUR) in patients under 14 years old were identified, and clinical history obtained via chart review. Patients who had RUS within 4 months of DMSA scan and no documented UTI during that interval were included. Decreased uptake of tracer associated with loss of contours or cortical thinning defined a positive DMSA study. Increased echogenicity/dysplasia, cortical thinning, atrophic kidney and/or abnormal corticomedullary differentiation defined a positive RUS. The sensitivity and specificity of RUS in identifying RS were calculated using DMSA scan as the gold standard. ResultsA total of 144 patients had initial DMSA scans performed for UTI or VUR, with a RUS within 4 months, and no UTI between the 2 studies. Ninety-five of 144 (66%) had RS on DMSA and 49/144 (34%) did not. Patients with or without RS on DMSA were not different in gender (P = .073), age (P = .432), insurance (P = 1.000) or VUR grade (P = .132). Only 39/144 (27.1%) patients had positive RUS. The sensitivity of RUS for RS was 35.8% and the specificity was 89.8%, leading to an accuracy of 54.2% (95%CI; 45.7-62.5%, P = .999). ConclusionRUS demonstrated poor sensitivity for RS visualized on DMSA scan. This suggests that RUS is a poor screening test for RS or indicators of future renal scar. A normal ultrasound does not rule out RS or risk of future renal scar. Specificity of RUS was excellent.

Simultaneous Multislice Diffusion-Weighted Imaging of the Kidneys at 3 T.

The aim of this study was to compare respiratory-triggered diffusion-weighted imaging with simultaneous-multislice acceleration (SMS-RT-DWI) to a standard free-breathing echoplanar DWI (s-DWI) for 3 T renal imaging with respect to image quality and artifacts. A total of 40 patients who had undergone renal magnetic resonance imaging were included in this retrospective analysis of a prospectively planned cohort study. All examinations were performed on a 3 T whole-body magnetic resonance system. Both s-DWI and SMS-RT-DWI were obtained and images were independently reviewed by 2 radiologists on a 5-point Likert scale with respect to overall preference and image quality, renal edge and parenchymal sharpness, cortico-medullary differentiation, and sequence-related artifacts. Furthermore, discernibility of renal lesions was assessed. The signal-to-noise ratio (SNR) was measured from SNR maps. The derived mean apparent diffusion coefficients were also compared. Qualitative parameters were assessed with the Wilcoxon rank-sum test, and quantitative parameters, with the Student t test. Overall image quality, renal edge, and parenchymal sharpness of SMS-RT-DWI were rated as superior to s-DWI by the readers, with fewer sequence-related artifacts (P < 0.01 for all). Lesion discernibility was significantly improved for SMS-RT-DWI (P < 0.01). Both readers preferred SMS-RT-DWI to s-DWI in all cases (40/40). The acquisition time for SMS-RT-DWI was 30% shorter than for s-DWI. Mean SNR heterogeneity of SMS-RT-DWI at b = 800 s/mm was statistically significantly lower than s-DWI, whereas mean SNR was significantly higher for SMS-RT-DWI. Mean apparent diffusion coefficient values from both sequences were comparably homogeneous throughout the kidneys. Simultaneous multislice DWI of the kidney at 3 T with respiratory triggering yields substantially improved image quality and lesion discernibility compared with standard single-shot echoplanar DWI with a 30% reduction in scan acquisition time.

Sonographic assessment of kidneys in patients with hypertension co-existed with diabetes mellitus and ischemic heart disease.

Background:Hypertension is one of the major world health problems. Ultrasonography plays a useful role in the assessment of morphologicalchanges at the kidneys in hypertensive patients.Aim:To assess sonographic findings of the kidneys in hypertensive patients’ co-morbidities with type 2 diabetes mellitus and ischemic heart disease (IDH).Materials and Methods:This was a prospective cross-sectional study involved 100 participants with primary hypertension selected by a method of simple convenient sampling. The patients were examined using ultrasonography to assess the sonographic findings of the kidneys. The renal length, corticomedullary differentiation (CMD), and renal artery diameters were assessed. Statistical Package for the Social Sciences (SPSS version 23.0) was used in data analysis.Results:The length of the right kidney was 8.9850 ± 1.01 cm and 9.48 ± 0.98 cm for the left kidney. Among the hypertensive patients, the incidence of hypertension was highest in housewives (27%) and students (23%) as compared with the other groups. The sonographic findings were 18% affected with simple renal cysts, 7% poor CMD, and the majority had normal kidneys. Significant correlation was found between age and sonographic findings of kidneys (r = 0.21, P value = 0.033).Conclusion:Simple renal cysts, poor CMD, and stenosis of renal arteries were most common sonographic findings in hypertension. Simple renal cystshad a significant association with hypertension.