Diethylenetriamine Pentaacetic Acid Scan Research Articles

Prediction of post-donation renal function using machine learning techniques and conventional regression models in living kidney donors.

Accurate prediction of renal function following kidney donation and careful selection of living donors are essential for living-kidney donation programs. We aimed to develop a prediction model for post-donation renal function following living kidney donation using machine learning. This retrospective cohort study was conducted with 823 living kidney donors between 2009 and 2020. The dataset was randomly split into training (80%) and test sets (20%). The main outcome was the post-donation estimated glomerular filtration rate (eGFR) 12months after nephrectomy. We compared the performance of machine learning techniques, traditional regression models, and models from previous studies. The best-performing model was selected based on the mean absolute error (MAE) and root mean square error (RMSE). The mean age of the participants was 45.2 ± 12.3years, and 48.4% were males. The mean pre-donation and post-donation eGFRs were 101.3 ± 13.0and 68.8 ± 12.7mL/min/1.73m2, respectively. The XGBoost model with the eGFR, age, serum creatinine, 24-h urine creatinine, 24-h urine sodium, creatinine clearance, cystatin C, cystatin C-based eGFR, computed tomography volume of the remaining kidney/body weight, normalized GFR of the remaining kidney measured through a diethylenetriaminepentaacetic acid scan, and sex, showed the best performance with a mean absolute error of 6.23 and root mean square error of 8.06. An easy-to-use web application titled Kidney Donation with Nephrologic Intelligence (KDNI) was developed. The prediction model using XGBoost accurately predicted the post-donation eGFR after living kidney donation. This model can be applied in clinical practice using KDNI, the developed web application.

Determination of Renal Volume using Ultrasonography and its Correlation with Renal Function: A Cross-sectional Study

Introduction: Renal length and volume are important indicators for the presence or progression of disease in urology and nephrology. Estimation of renal volume by Ultrasonography (USG) has clinical utility for the physician, nephrologist, and urologist. Aim: To measure individual renal volume by ultrasonography and determine its relationship with renal function as measured by the Diethylene Triamine Penta-acetic Acid (DTPA) in normal adults. Materials and Methods: It was a cross-sectional study conducted on fifty patients who underwent DTPA scans both in Outpatient (OPD) and In-Patient Department in the Department of Urology, of a tertiary care centre from January 2020 to December 2020. All the transplant donors who underwent donor nephrectomy were included in the study. A sonographic assessment was done and the Glomerular Filtration Rate (GFR) was calculated by Technetium (Tc)-154 DTPA. The primary outcome was to determine the relationship between renal volume with renal function in normal adults. The secondary outcome was to measure individual renal parameters sonographically. They were assessed for correlation between renal parameters (mainly renal volume) and DTPA using Pearson’s coefficient. Results: The age range of the subjects was 18-70 years. GFR calculated by DTPA for the right kidney had a better correlation with renal volume (r=0.241) on the right and 0.162 on the left, both with a p-value of 0.001). GFR of the left kidney had a better correlation with left kidney volume (r=0.184) than right kidney volume (r=0.130). No correlation was found between GFR with renal Anteroposterior (AP) dimension, renal width, and renal length. The kidney volume was more significant on the left-side (r=0.351) than on the right kidney (r=0.263). Conclusion: Renal volume correlated well with renal function. Sonographic assessment of renal volume rather than renal length would serve as a tool to evaluate renal status for evaluation and follow-up.

Comparison of Differential Functional Outcomes After Partial Nephrectomy Between Moderate and High Complex Renal Tumor Evaluated with Diethylenetriamine Pentaacetic Acid Scan: A Propensity Score Matched Analysis.

The aim of this study was to compare functional outcomes after partial nephrectomy (PN) between moderate and high complex renal tumors evaluated with a diethylenetriamine pentaacetic acid (DTPA) scan [moderate vs. high: RENAL nephrometry score (RNS) 7-9 vs. 10-12]. From January 2004 to December 2019, 471 patients with an RNS of 7-9 (moderate) and 164 patients with an RNS of 10-12 (high) who underwent PN were analyzed for renal function outcomes. The glomerular filtration rate (GFR)was measured using a DTPA scanand calculated the GFR using the Modification of Diet in Renal Disease (MDRD) formula, respectively. Trifecta/pentafecta outcome, recurrence-free survival, and overall survival were compared after propensity score matched analysis (PSMA). After PSMA, 156 cases in each group were matched without significant difference in the preoperative factor. At the postoperative first year, there was no significant difference in the trifecta (p=0.320), MDRD-based (p=0.729), or DTPA-based pentafecta achievement rate (p=0.964) between groups. At postoperative 5 years, DTPA-based total GFR (93.6% vs. 93.8%) and the operated kidney GFR preservation rate (89.9% vs. 81.7%) did not differ significantly (p>0.05). Kaplan-Meier survival analysis showed no significant differences in survival outcomes (p>0.05). Significant predictors of de novo chronic kidney disease (CKD) stage 3 or higher at the postoperative first year were age [hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.03-1.17, p=0.005] and preoperative DTPA-based total GFR (HR 0.94, 95% CI 0.91-0.98, p=0.001). High complex tumors can be treated with PN without significant deterioration in renal function. The postoperative function of the operated kidney was preserved by up to 80% in the long term compared with the preoperative period. However, PN should be selectively performed with caution to avoid the occurrence of postoperative CKD.

MP49-14 COMPARISON OF DIFFERENTIAL FUNCTIONAL OUTCOMES AFTER PARTIAL NEPHRECTOMY BETWEEN MODERATE AND HIGH COMPLEX RENAL TUMOR EVALUATED WITH DIETHYLENETRIAMINE PENTAACETIC ACID SCAN: A PROPENSITY SCORE MATCHED ANALYSIS

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (MP49)1 Sep 2021MP49-14 COMPARISON OF DIFFERENTIAL FUNCTIONAL OUTCOMES AFTER PARTIAL NEPHRECTOMY BETWEEN MODERATE AND HIGH COMPLEX RENAL TUMOR EVALUATED WITH DIETHYLENETRIAMINE PENTAACETIC ACID SCAN: A PROPENSITY SCORE MATCHED ANALYSIS Hwanik Kim, Jin Noh, Jae Won Lee, Sang Hun Song, Hakju Kim, Jung Kwon Kim, Hakmin Lee, Sangchul Lee, Jong Jin Oh, Seong jin Jeong, Sung Kyu Hong, and Seok-Soo Byun Hwanik KimHwanik Kim More articles by this author , Jin NohJin Noh More articles by this author , Jae Won LeeJae Won Lee More articles by this author , Sang Hun SongSang Hun Song More articles by this author , Hakju KimHakju Kim More articles by this author , Jung Kwon KimJung Kwon Kim More articles by this author , Hakmin LeeHakmin Lee More articles by this author , Sangchul LeeSangchul Lee More articles by this author , Jong Jin OhJong Jin Oh More articles by this author , Seong jin JeongSeong jin Jeong More articles by this author , Sung Kyu HongSung Kyu Hong More articles by this author , and Seok-Soo ByunSeok-Soo Byun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002075.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal function after partial nephrectomy (PN) depends on a complex of clinical conditions including preoperative parenchymal quality, postop parenchymal quantity, and the recovery of remaining nephrons from ischemic damages. However, the natural history and definitive predictors of long-term RF after PN in renal tumors with RENAL nephrometry score (RENAL) of 7-9 (moderate complex, M) or RENAL of 10-12 (high complex, H) remain unclear. Thus, the aim of the present study was to compare functional outcomes evaluated with diethylenetriamine pentaacetic acid (DTPA) scan and Modification of Diet in Renal Disease (MDRD) formula after PN between M and H renal tumors. METHODS: In 2004/01-2019/12, 471 patients with RNS 7-9 (M) and 164 with RNS 10-12 (H) who underwent PN were analyzed for renal function outcomes. Glomerular filtration rate (GFR) measured from DTPA scan, calculated GFR using Modification of Diet in Renal Disease (MDRD) formula, Trifecta/Pentafecta outcome, recurrence free survival (RFS), and overall survival (OS) were compared after propensity score matching analysis (PSMA). RESULTS: After PSMA, 156 cases in each group were matched without significant difference in preoperative factor. At postoperative (postop) 1st year, there was no significant difference in Trifecta (p=0.320), MDRD-based (p=0.729), or DTPA-based Pentafecta achievement rate (p=0.964) between groups. At postop 5 years, DTPA-based total GFR (93.6% vs. 93.8%) and operated kidney GFR preservation rate (89.9% vs. 81.7%) did not differ significantly (p>0.05). Kaplan-Meier survival analysis showed no significant differences in survival outcomes (p>0.05). Significant predictors of de novo chronic kidney disease (CKD) stage ≥3 at postop 1st year were age (Hazard ratio (HR): 1.10, 95% CI: 1.03-1.17, p=0.005) and preoperative DTPA-based total GFR (HR: 0.94, 95% CI: 0.91-0.98, p=0.001). CONCLUSIONS: High complex tumor can be treated with PN without significant renal function deterioration. Postoperative operated kidney’s function is preserved up to 80% in the long term. However, PN should be selectively performed with caution to avoid occurrence of postop CKD. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e881-e881 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hwanik Kim More articles by this author Jin Noh More articles by this author Jae Won Lee More articles by this author Sang Hun Song More articles by this author Hakju Kim More articles by this author Jung Kwon Kim More articles by this author Hakmin Lee More articles by this author Sangchul Lee More articles by this author Jong Jin Oh More articles by this author Seong jin Jeong More articles by this author Sung Kyu Hong More articles by this author Seok-Soo Byun More articles by this author Expand All Advertisement Loading ...

Renal autotransplant for major ureteric loss: Results from median 11 years of follow-up.

Renal autotransplant (RA) is an underutilized procedure to treat major ureteric loss. Studies on long-term outcomes and follow-up after RA are scarce. This study aimed to report the long-term outcomes and follow-up after RA. We identified 9 patients, from 2007 to 2019, who underwent RA after major ureteric loss (where direct restoration of continuity was not possible). We collected data regarding the etiology of ureteric loss, preoperative differential renal function, method of nephrectomy (laparoscopic or open), method of anastomosing the residual ureter/pelvis to the bladder, postoperative complications, duration of hospital stay, and renal function and drainage postoperatively and until the last follow-up. Changes in renal function and/or any obstruction to urinary drainage of the ipsilateral kidney postoperatively or during follow-up were measured. The Wilcoxon matched-pairs signed-rank test was used to compare the mean creatinine values preoperatively, postoperatively, and at last follow-up (p<0.05 was considered statistically significant). All the patients had uneventful intraoperative and postoperative periods. The mean hospital stay was 6.4 (5-8) days. The median follow-up was 132 (46-156) months. The mean preoperative serum creatinine level was 1.0 (0.7-1.7) mg/dL. The mean creatinine value postoperatively and at last follow-up had no significant difference with preoperative value (p=0.96 and 0.75, respectively). The postoperative diethylene triamine pentaacetic acid scan demonstrated good perfusion and drainage. There was no deterioration of renal function or drainage during the follow-up. RA is an excellent modality to treat major ureteric loss. It preserves renal function and avoids the problems related to bowel interposition and the need for long-term follow-up.

Urinary biomarkers as point-of-care tests for predicting progressive deterioration of kidney function in congenital anomalies of kidney and urinary tract: trefoil family factors (TFFs) as theemerging biomarkers.

Children with congenital anomalies of kidney and urinary tract (CAKUT) are at high risk of progressive deterioration of kidney function and further developing stage5 chronic kidney disease (CKD5), even after a successful surgery. This prospective study was designed to determine whether urinary biomarkers can predict progressive deterioration of kidney function in children with CAKUT. The study included 50 consecutive children, aged < 14 years, who were diagnosed with congenital uropathies (PUV, VUR, and PUJO) and 20 age-matched controls. Examination of four urinary biomarkers, i.e., trefoil family factors (TFF) 1 and 3, neutrophil gelatinase-associated lipocalin (NGAL) and microalbuminuria (MALB) was done at the beginning of follow-up. Kidney function was assessed, at the beginning and after 12-months of follow-up, by technetium-99m diethylene triamine pentaacetic acid (DTPA) and technetium-99m dimercaptosuccinic acid (DMSA) scans. Progressive deterioration in the kidney function was defined as a fall in the GFR from ≥ 60 to < 60 ml/min/1.73 m2 on comparing the baseline and latest DTPA scans; and/or new-onset cortical scar/scars or increase in the size of previous scar/scars on serial DMSA scans. Group 1 and group 2 included children without and with progressive functional deterioration respectively. The median (IQR) age of children with CAKUT and controls was 3 (1.5-5) and 2.3 (1.2-3.6) years, respectively, and showed no significant difference (p = 0.29). Median concentrations of TFF1, TFF3, NGAL, and microalbumin in patients were 44.5, 176.5, 281.2, and 15.5 mcg/gCr, respectively, and were significantly elevated as compared to controls (p < 0.05). Children belonging to group 2 had significantly higher concentration of biomarkers as compared to those in group 1. TFF3 was found have the highest AUC (0.9198) on ROC curve for predicting progressive functional deterioration. Urinary TFFs, NGAL, and microalbumin significantly correlate with progressive deterioration of kidney function in children harboring CAKUT. TFF3, with the strongest prediction of functional deterioration, is an emerging peptide showing sufficient potential to be included in the biomarker panel. Graphical abstract.

The Surgical Intervention in Genitourinary Tuberculosis

Introduction: Genitourinary tuberculosis (GUTB) is the leading cause of morbidity and mortality worldwide especially in developing countries. Surgery is an essential management modality in genitourinary tuberculosis when indicated. Objective: This study aims to document the role of surgery for genitourinary tuberculosis according to the organ involved. Materials and Methods: Retrospective review of 33 GUTB cases was done that underwent surgery at department of urology, Bangabandhu Sheikh Mujib Medical University from January 2008 to December 2014. Patient’s baseline characteristics, mode of presentation, organ involvement, investigation, surgical intervention and follow up were studied. Results: Among enrolled patients, mean age at presentation was 31.5 years and 64% (21, 33) were male. The most common presentation was irritative voiding symptoms. Kidney was the most common organ involved in 39% (13, 33) cases, and next common site was bladder in 30% (10, 33) cases. Preoperative bacteriologic diagnosis was confirmed only in 21% (7, 33) cases. A total of 41 surgical procedures were performed as some patients needed more than one procedure. These included 13 endoscopic, 6 temporary diversion, 19 ablative procedures and 3 reconstructive procedures. Post surgical follow up of all the patients were given after 3, 6 and 12 months. Then the patients were followed with RFT and ultrasonography 6 monthly for 3 years and then annually. The intravenous urography and diethylenetriamine pentaacetic acid scan were performed when indicated. Conclusion: Multidrug chemotherapy with judicious surgery when indicated is the ideal treatment. Surgery plays an important role in symptomatic relief and helps to lead a normal life. The results of reconstructive surgery are good and should be done when possible. Rigorous and long term follow up is necessary in patients undergoing reconstructive surgery. Bangladesh Journal of Urology, Vol. 19, No. 2, July 2016 p.69-73

The Role of Mean Platelet Volume in Pediatric Chronic Kidney Disease

Background: Platelets are heterogeneous in size, density, metabolic, functional, and biochemical properties. Mean platelet volume (MPV) is a measure of the average size of platelet in a blood sample. Objectives: The aim of the work was to study the relationship between MPV levels and the glomerular filtration rate (GFR) in pediatric patients with chronic kidney disease (CKD) and its role to be a marker for the disease progression. Patients and methods: Seventy-five children with chronic kidney disease subdivided into four subgroups according to GFR were included in this study. Seventy-five healthy subjects were enrolled as a control group. All subjects were subjected to detailed history taking, physical examination and Laboratory investigations. Pelvi- abdominal ultrasound used for diagnosis of chronic kidney disease, Tc-99m DTPA (diethylenetriaminepentaacetic acid) scan used for measurement of GFR. Results: MPV levels in the whole patient group were significantly higher than in controls (9.1±0.57fL versus 6.95±0.63fL). There were no significant differences between subgroups of patients with CKD as regard sex, age, weight, systolic, diastolic blood pressure, MPC and PDW while significant differences in disease duration and MPV levels were found among them. In patients with CKD, we have found a significant negative correlation between MPV and GFR. Also, we have found a significant negative correlation between MPV and Mean platelet count per thousand (MPC). Conclusion: It could be concluded that MPV value can be an easy, rapid, inexpensive, and simple marker for disease progression in pediatric patients with CKD.

The Role of Mean Platelet Volume in Pediatric Chronic Kidney Disease

Background: Platelets are heterogeneous in size, density, metabolic, functional, and biochemical properties. Mean platelet volume (MPV) is a measure of the average size of platelet in a blood sample. Objectives: The aim of the work was to study the relationship between MPV levels and the glomerular filtration rate (GFR) in pediatric patients with chronic kidney disease (CKD) and its role to be a marker for the disease progression. Patients and methods: Seventy-five children with chronic kidney disease subdivided into four subgroups according to GFR were included in this study. Seventy-five healthy subjects were enrolled as a control group. All subjects were subjected to detailed history taking, physical examination and Laboratory investigations. Pelvi- abdominal ultrasound used for diagnosis of chronic kidney disease, Tc-99m DTPA (diethylenetriaminepentaacetic acid) scan used for measurement of GFR. Results: MPV levels in the whole patient group were significantly higher than in controls (9.1±0.57fL versus 6.95±0.63fL). There were no significant differences between subgroups of patients with CKD as regard sex, age, weight, systolic, diastolic blood pressure, MPC and PDW while significant differences in disease duration and MPV levels were found among them. In patients with CKD, we have found a significant negative correlation between MPV and GFR. Also, we have found a significant negative correlation between MPV and Mean platelet count per thousand (MPC). Conclusion: It could be concluded that MPV value can be an easy, rapid, inexpensive, and simple marker for disease progression in pediatric patients with CKD.

Neurological Complications and Associated Risk Factors in Children Affected with Chronic Kidney Disease.

To investigate the correlation between chronic kidney disease (CKD) and the development of neurological disease among pediatric patients in Saudi Arabia. The present retrospective study recruited patients admitted to King Abdulaziz University Hospital during 2018. We reviewed electronic records to collect data on essential demographics including age, gender, and nationality; history of prior CNS disease or related symptoms; results of neurological physical examination; and findings of radiological investigations such as abdominal ultrasound, dimercaptosuccinic acid scan, micturating cystourethrogram, diethylene triamine pentaacetic acid scan, brain computed tomography, and magnetic resonance imaging. The most commonly diagnosed renal pathologies were neurogenic bladder and cystic kidney disease. The most common neurological manifestation was seizure disorder. Males were more frequently affected with neurological sequelae than females. The prevalence of neurological disorders was higher in patients over two years old. The most frequently observed stage of chronic kidney disease was stage 5. Most children who were affected with a neurological disorder required hemodialysis as part of their management plan. Patients with chronic kidney disease are at a high risk of neurocognitive defects. The type of management and renal diagnosis are significant factors that should be considered when anticipating central nervous system involvement in the case of chronic kidney disease.

Etiology of Hydronephrosis in Neonates

Background: Hydronephrosis as a major health issue, has a significant contribution to the loss of kidney function and dialysis. Based on this the aim of this was to evaluate the probably etiology of hydronephrosis in neonates. Methods: We have evaluated 314 neonates with fetal hydronephrosis (by ultrasonography) as a study group. Cases were followed by voiding cystourethrogram 3 weeks after the start time. In addition, we took a Diethylenetriaminepentaacetic Acid scan at the end of 1st month of childbirth. At the end, we evaluated data based on the statistical analysis. Based on these examinations, etiology of hydronephrosis were examined and recorded. Results: In total 314 infants with hydronephrosis (55.7% male and 44.3% female) were included. Idiopathic cause (42%) as the most common etiology and vesicoureteric reflux as 2nd most common etiology of hydronephrosis have been evaluated (37.4%). Conclusions: Based on this finding, different causes can induce hydronephrosis as a different etiology; therefore, we can control and reduce hydronephrosis by checking vesicoureteric reflux as the most common possible etiology.

Adaptive functional change of the contralateral kidney after partial nephrectomy.

Partial nephrectomy aims to maintain renal function by nephron sparing; however, functional changes in the contralateral kidney remain unknown. We evaluate the functional change in the contralateral kidney using a diethylene triamine penta-acetic acid (DTPA) renal scan and determine factors predicting contralateral kidney function after partial nephrectomy. A total of 699 patients underwent partial nephrectomy, with a DTPA scan before and after surgery to assess the separate function of each kidney. Patients were divided into three groups according to initial contralateral glomerular filtration rate (GFR; group 1: <30 ml·min-1·1.73 m-2, group 2: 30-45 ml·min-1·1.73 m-2, and group 3: ≥45 ml·min-1·1.73 m-2). Multiple-regression analysis was used to identify the factors associated with increased GFR of the contralateral kidney over a 4-yr postoperative period. Patients in group 1 had a higher mean age and hypertension history, worse American Society of Anesthesiologists score, and larger tumor size than in the other two groups. The ipsilateral GFR changes at 4 yr after partial nephrectomy were -18.9, -3.6, and 3.9% in groups 1, 2, and 3, respectively, whereas the contralateral GFR changes were 10.8, 25.7, and 38.8%. Age [β: -0.105, 95% confidence interval (CI): -0.213; -0.011, P < 0.05] and preoperative contralateral GFR (β: -0.256, 95% CI: -0.332; -0.050, P < 0.01) were significant predictive factors for increased GFR of the contralateral kidney after 4 yr. The contralateral kidney compensated for the functional loss of the ipsilateral kidney. The increase of GFR in contralateral kidney is more prominent in younger patients with decreased contralateral renal function.

Characterizing renal abnormalities in children with high anorectal malformation with renal scintigraphy: A single-centre experience

Objective: The purpose of this study was to characterize the renal abnormalities with renal scintigraphy in patients with high anorectal malformation (HARM). Patients and Methods: We retrospectively reviewed 53 patients who had undergone corrective surgery for HARM from July 2011 to January 2017 and who were referred to this department for Technetium-99m dimercaptosuccinic acid (Tc99m-DMSA) scan for evaluation of renal cortical scarring. Scintigraphic evaluation of all 53 patients included both dynamic renography [Tc-99m diethylene triamine penta acetic acid (DTPA) and Tc-99m-L, L-ethylenedicysteine (L-EC) scan] and cortical scintigraphy. A total of 68 scans were done in these 53 patients in which there were 38 Tc-99m DMSA scans, 15 Tc-99m DTPA and 15 Tc-99m EC scans. Tc-99m DTPA scans were done in 15 patients (26 kidneys) to look for glomerular filtration rate and drainage pattern. Results: Mean age of presentation of these 53 patients (86 kidneys or renal units) with HARM was 28.9 months. Out of 53 patients, male comprised 62.26% of cases (n = 33) and female comprised 37.7% of cases (n = 20). Spectrum of urologic abnormalities noted in our patients with HARM included unilaterally non-visualized kidney in 37.7% cases, i.e., 20/53 patients; hydroureteronephrosis in 28.3% of cases, i.e., 15/53 patients; hydronephrosis in 16.98% cases, i.e., 9/53 patients. Scarring was noted in 28.3% cases, i.e., 15/53 patients. Small kidney was noted in 10 patients out of 53, i.e., 18.8% of cases. Ectopic kidney was seen in 5.6% cases, i.e., 3/53 patients, horseshoe kidney in 3.7% (2/53) and duplex kidney was found in 1 patient, i.e., 1.8% of cases. Conclusion: Children with HARM have a high incidence of renal anomalies and these are the most common cause of morbidity and mortality in these patients. It is important to document these renal anomalies early in life and initiate management as early as possible. Apart from routine investigations, such as ultrasound, renal scintigraphy performed with Tc-99m DTPA, Tc-99m EC and Tc-99m DMSA-III are non-invasive investigations that may provide important help in diagnosis, follow-up and management of renal anomalies in these patients.

Renal artery compression by a huge pheochromocytoma

A 57-year-old woman was admitted to our hospital with abdominal pain in the left upper quadrant. She had left hemiplegia due to an intracranial hemorrhage 5 years previously, as well as hypertension and diabetes mellitus. Her blood pressure was 190/100 mmHg. Laboratory data revealed a serum creatinine level of 1.2 mg/dL and a serum potassium level of 3.4 mEq/L. Magnetic resonance imaging of the abdomen showed a large suprarenal mass containing hemorrhagic foci, and compressing the left kidney and left renal artery (Fig. 1). Plasma renin activity was 51.9 ng/mL/hr (normal range in the supine position, 0.15 to 2.33), and aldosterone level was 44.7 ng/dL (normal range in the supine position, 1.0 to 16). A 24-hour urine test showed the following results: vanillylmandelic acid, 82 mg/day (normal range, 0 to 8); metanephrine, 22.3 mg/day (normal range, 0 to 1.2); epinephrine, 59.4 pg/mL (normal range, 0 to 110); and norepinephrine, 29,658 pg/mL (normal range, 70 to 750). A technetium-99m diethylene triamine pentaacetic acid scan showed that perfusion of the left kidney was markedly lower than that of the right kidney, suggesting compression of the renal artery (Fig. 2). Figure 1. Magnetic resonance image of the abdominal cavity (A,T1 weighted image; B, C, gadolinum enhanced T1 fat suppression weighted image). Note the large left abdominal mass with hyperintense internal foci, indicating hemorrhage, and the small size and inferioposterior ... Figure 2. Technetium-99m (Tc-99m) diethylene triamine pentaacetic acid (DTPA) scan. Perfusion of the left kidney was lower compared with the right. After surgical resection of the mass, plasma renin activity, aldosterone, serum creatinine, and serum potassium levels normalized (to values of 0.1 ng/mL/hr, 1.0 ng/dL, 1.0 mg/dL, and 4.4 mEq/L, respectively), and blood pressure decreased to 140/90 mmHg. The left kidney was removed with the mass because of severe adhesion. The tumor measured 16 × 11 cm at its largest dimension, showed hemorrhage and necrosis at its center, and was composed of epithelioid to spindle-shaped cells without distinct sustentacular cells. Tumor cells stained positive for chromogranin A, synaptophysin, and CD56 (Fig. 3), but not for vimentin, S-100, or Melan-A; these findings were consistent with a pheochromocytoma. Figure 3. Microscope and immunohistochemical findings. The tumor was composed of epithelioid to spindle-shaped cells without distinct sustentacular cells (A: H&E, ×200). The tumor cells were immunoreactive for synaptophysin (B, ×200), chromogranin ...

Role of dynamic renal scintigraphy with Tc99m DTPA in symptomatic patients with horseshoe kidney

Objectives: The purpose of this study was to diagnose obstructive hydronephrosis in symptomatic patients of horseshoe kidney with Technetium-99m (Tc-99m) diethylenetriamine pentaacetic acid (DTPA) diuretic renal scintigraphy. Patients and Methods: We retrospectively reviewed 30 symptomatic patients with horseshoe kidney who were referred to our department for Tc99m-DTPA/Tc99m L, L EC scan to look for subrenal drainage pattern from January 2011 to May 2016. Tc99m DTPA scan was done in all 30 patients. Tc99m dimercaptosuccinic acid III (DMSA-III) scan was done in 12 of these patients. Results: 30 symptomatic patients (21 adults and 9 children) with mean age 32.47 yrs and 5.55 years respectively with a known diagnosis of horse shoe kidney on ultrasonography (USG) were analysed with respect to patient symptoms, drainage pattern and consequences of stasis due to renal anomaly. Out of 30 patients (60 renal moieties), 24 were hydronephrotic as reported on USG by a competent radiologist. Out of these 24 moieties, 10 showed obstructed clearance pattern/slow sub-renal drainage and rest were normal. Other outcomes like asymmetrical cortical function, urolithiasis, Urinary tract infection (UTI) and scarring have also been described. Conclusion: DTPA renal scintigraphy is a non-invasive and sensitive investigation for the diagnosis of obstructive hydronephrosis in horseshoe kidney. It can very well be used in very young patients for an early diagnosis and management. Long term follow up would be advisable in these patients especially to monitor development of complications. Its importance along with USG cannot be downplayed as the added advantages like functional information, drainage pattern, differential function are necessary for a justified management protocol.

Transperitoneal laparoscopic pyeloplasty in children and adolescents

Background Open pyeloplasty has been the gold standard for the treatment of ureteropelvic junction obstruction (UPJO) in children and young adolescents. However, the use of laparoscopy for the treatment of pyeloplasty is increasing as it has the potential to provide a better and more desirable cosmetic outcome in addition to less postoperative pain and decreased recovery time. The aim of this study was to evaluate the long-term outcome of transperitoneal laparoscopic pyeloplasty (TLP) for the treatment of UPJO in children and young adolescents. Patients and methods Twenty-nine patients with UPJO with 32 renal units were subjected to TLP at Al-Azhar University Hospitals, Egypt, during the period from May 2008 to December 2012. The outcome measurements of this study included operative time, internal stent placement, hospital stay, intraoperative complications, and success rates. Success is defined as both symptomatic relief and radiographic resolution of hydronephrosis at the last follow-up. Patients were followed up with intravenous urography and diethylene triamine penta-acetic acid scan at 3, 6, and 12 months regularly for both functional and morphological outcomes. Results The study included 29 patients (12 male and 17female) with 32 obstructed renal units. The mean age was 4.23 ± 2.1 years (range 3–16 years). All procedures were completed laparoscopically without conversion. The mean operative time was 143.41 ±23 min (range 110–220 min). The mean postoperative hospital stay was 4.1 days (range 3–8 days). All patients achieved full recovery without any complications. The mean follow-up period of the patients was 36.34± 5.18 months (range 22–60 months). Success rate was 96.9%. Only one case developed recurrent UPJO and was treated with retrograde endopyelotomy and stenting. Conclusion TLP has the advantages of less postoperative pain, short hospital stay, and rapid recovery, with excellent functional and cosmetic outcomes. However, it requires advanced skill level for intracorporeal suturing and knot tying. Keywords: children, laparoscopy, long-term results, pyeloplasty, ureteropelvic junction obstruction

The surgical management of urogenital tuberculosis our experience and long-term follow-up.

Introduction:Urogenital tuberculosis (TB) is common in developing countries. We present our experience of surgically managed cases of genitourinary TB (GUTB).Materials and Methods:We retrospectively reviewed 60 cases GUTB who underwent surgery at our center from January 2003 to January 2010. Mode of presentation, organ involvement, investigation, surgical treatment and follow-up were studied.Results:There were 38 males and 22 females with a mean age of 32.5 years. The most common symptom was irritative voiding symptoms. The most common organ involved was bladder in 33 cases, and next most common was kidney in 30 cases. Preoperative bacteriologic diagnosis was confirmed in only 19 cases. A total of 66 procedures were performed as some patients needed more than one procedure. These included 35 ablative procedures and 31 reconstructive procedures. All the patients were followed-up with renal function test (RFT) at 3, 6 and 12 months. The intravenous urography and diethylenetriamine pentaacetic acid scan were performed at 3 months when indicated. Then the patients were followed with RFT and ultrasonography 6 monthly for 3 years and then annual RFT.Conclusion:Many patients of urogenital TB present late with cicatrisation sequelae. Multidrug chemotherapy with judicious surgery as and when indicated is the ideal treatment. The results of reconstructive surgery are good and should be done when possible. Rigorous and long term follow-up is necessary in patients undergoing reconstructive surgery.

Change in renal function following laparoscopic donor nephrectomy using 99mTc-diethylenetriaminepentaacetic acid scan.

We assessed the change in remaining kidney function after laparoscopic donor nephrectomy using serial technetium 99m diethylenetriaminepentaacetic acid (DTPA) scans and investigated the factors affecting the course. Data from 155 donors were obtained from a prospectively maintained database. All donors underwent consecutive DTPA scans preoperatively and 1 month, 6 months and 1 year postoperatively. We investigated the longitudinal change in renal function after surgery and analyzed parameters to influence the perioperative glomerular filtration rate (GFR) change. The changes in GFR according to the DTPA scan presented significant improvement from 1 month up to 2 years after donation (all p < 0.001). The DTPA-GFR of the remaining kidney increased by 14.8% to 58.2 ± 10.6 ml/min/1.73 m(2) (p < 0.001) and by 33.9% to 78.0 ± 14.0 ml/min/1.73 m(2) at 1 month and 1 year after surgery, respectively (p < 0.001). Only 21.9% of donors categorized into chronic kidney disease (CKD) stage 3 or more at 1 year after donation were <60 ml/min/1.73 m(2) according to DTPA-GFR. Multivariate regression analysis revealed that the increase in DTPA-GFR at 1 year was negatively associated with patient age (p = 0.005), BMI (p = 0.04) and preoperative DTPA-GFR of remaining kidney (p = 0.009). The DTPA-GFR of remaining kidney increased steadily for up to 2 years after surgery. Younger donors with lower body mass index and those with lower initial function of the remaining kidney demonstrated a greater increase in DTPA-GFR after nephrectomy. Many of the donors with CKD stage 3 after donation have good renal function according to the results of DTPA-GFR.

Prospective Randomized Comparison of Retroperitoneoscopic vs Open Pyeloplasty With Minimal Incision: Subjective and Objective Assessment in Adults

To determine the subjective and objective outcomes of retroperitoneoscopic vs open pyeloplasty with minimal incision in a prospective randomized comparison study. In this study between August 2011 to July 2013, 30 patients underwent retroperitoneal laparoscopic pyeloplasty and 30 open pyeloplasty with minimal incision (incision length <10 cm) after randomization. The 2 groups were compared for the visual pain score on the first and second postoperative days as the primary end point of the study. Complications were recorded and graded using Dindo-modified Clavien classification of surgical complications. Success rates were evaluated by improvement in pain score and objectively by diethylene triamine penta-acetic acid renal scan and other parameters. Statistical analysis was performed with SPSS version 16.0 (IBM) with P <.05 considered statistically significant. The difference in the visual pain score (5.6 vs 3.2 on day 1; 3.8 vs 1.5 on day 2) and the diclofenac requirements (333.3 vs 178.75 mg) were statistically significant and more in the open pyeloplasty. The hospital stay and convalescence were significantly lower in retroperitoneoscopic group. Success rate was found to be 96.67% with 1 failure in each group. Two patients in retroperitoneoscopic group required conversion. Both groups showed significant improvement in pain score and drainage pattern on diethylene triamine penta-acetic acid scan with decrease in hydronephrosis on ultrasound evaluation. Although subjective and objective outcomes are equivalent in both the groups, the retroperitoneoscopic approach is associated with significantly less pain, less analgesic requirement, shorter hospital stay and short convalescence in comparison with open pyeloplasty.

Followup of Unilateral Renal Function After Laparoscopic Partial Nephrectomy

We assessed the change in unilateral renal function after laparoscopic partial nephrectomy to determine factors affecting the course and factors predicting the postoperative glomerular filtration rate decrease. From prospectively collected data on 116 patients who underwent laparoscopic partial nephrectomy we evaluated the glomerular filtration rate of the operated kidney using diethylenetriaminepentaacetic acid scans done preoperatively, and 3 months, and 1, 2 and 3 years postoperatively. Kidney volume was measured from the arterial phase of dynamic computerized tomography of the kidney done before and 3 months postoperatively to calculate the volume reduction. We analyzed clinicopathological and operative factors with the potential to influence the perioperative glomerular filtration rate decrease. In all patients the glomerular filtration rate was significantly decreased by 3 months postoperatively. It remained significantly lower compared to preoperative function despite the trend toward progressive recovery, which was noted until 3 years postoperatively. Recovery in individuals was significantly influenced by patient age (less than 55 vs 55 years or greater), medical comorbidities, tumor size (less than 2.5 vs 2.5 cm or greater), kidney volume reduction (less than 20% vs 20% or greater) and collecting system repair at surgery. Independent determinants of postoperative renal function were the preoperative glomerular filtration rate (β = 0.410, 95% CI 0.424-1.084; p <0.001), the percent of renal parenchymal volume reduction (β = 0.273, 95% CI 0.168-0.766; p = 0.003) and pelvicalyceal system repair (β = 0.284, 95% CI 2.960-15.788; p = 0.005). Function of the kidney undergoing laparoscopic partial nephrectomy progressively recovers after a significant decrease immediately after surgery. Although recovery differs according to patient age, comorbidities and tumor size, factors that independently predicted the postoperative glomerular filtration rate decrease were the renal parenchymal volume reduction and pelvicalyceal system repair.