Normal Contralateral Kidney Research Articles

The Long-Term Functional and Oncologic Outcomes of Kidney-Sparing Surgery in Upper Tract Urothelial Carcinoma.

This study investigated the utilization of kidney-sparing surgery (KSS) as an alternative option to radical nephroureterectomy (RNU) in managing upper urinary tract urothelial carcinoma (UTUC) patients. Our study aimed to compare the functional outcomes and oncological outcomes between KSS and RNU. We retrospectively analyzed 252 patients with UTUC without clinical node positivity or metastasis who had been treated with either RNU or KSS. We collected information on each patient, including clinicopathological factors, renal function variations, and oncological outcomes. Hemodialysis-free survival (HDFS), stage 4 chronic kidney disease (CKD4) progression-free survival (PFS), recurrence-free survival (RFS), and overall survival (OS) were assessed using inverse probability of treatment weighting (IPTW)-weighted Kaplan-Meier analysis. The hazard ratio for oncological and functional outcomes of KSS was analyzed using the Cox proportional hazards model. The OS at 8 years was 77.06% (RNU) and 70.59% (KSS) and did not significantly differ between the two groups (p=0.691), although the KSS group experienced a higher recurrence rate. Functional outcomes indicated no significant difference in postoperative renal function at 1year; however, KSS was associated with better preservation of renal function (23.44% vs. 28.23%), albeit not statistically significant (p=0.055). Kaplan-Meier analysis revealed no significant disparities in CKD4 PFS between the KSS and RNU groups involved in the study (p=0.089), although the KSS group displayed poorer HDFS than the RNU group (p=0.001). KSS had no compromising survival outcomes when compared with RNU, not only in low-risk patients but also in high-risk patients with a normal contralateral kidney. The efficacy of renal function preservation was presented in this study, however the results were below our expectations.

Unilateral Renal Cystic Disease

Background: Unilateral renal cystic disease of kidney is a non familial and non progressive disorder, characterized by replacement of the renal parenchyma by a cluster of multiple cysts with a normal contralateral kidney. Case: A 2-day-old newborn baby came to the Urology Department of the Perinatology Department of Andalas University Hospital. The baby with prenatal ultrasound results showed unilateral hydronephrosis and multicystic kidneys. From the postnatal ultrasound, it was found: The right kidney was normal in shape and size; clear differentiation of the cortex and medulla; the pelvic calyx system was not dilated; No stones were seen; There were multiple cystic lesions with regular borders in the renal cortex, the largest cyst size was 5.5x4 cm. The left kidney was normal in shape and size; clear differentiation of the cortex and medulla; The pelvic calyx system was not dilated; No stones or sludge were seen. The impression of multiple renal cysts. The patient was followed up for renal function and cyst development. Conclusion : This case highlights the importance of early diagnosis and follow-up in infants with unilateral renal cystic lesions. Differentiating URCD from other cystic renal diseases is essential for appropriate management and counseling. Further studies are needed to elucidate the pathogenesis and long-term outcomes of URCD.

The Impact of Pelvicalyceal System Anatomy on Stone Formation in Patients with Single Lower Pole Calyceal Stone on Computed Tomography Urography.

To compare various lower pole pelvicalyceal anatomical factors of stone bearing kidney with contralateral normal kidneys and determine whether these factors predispose to stone formation in one kidney. A descriptive study was done with Computed Tomography of 54 patients with solitary lower pole calculus in one kidney and normal contralateral kidney were included. Various lower pole pelvicalyceal anatomical factors like infundibulopelvic angle, infundibular width, infundibular length and calyceopelvic height of both stone bearing and contralateral kidneys were measured and compared for any differences Results: The mean infundibular width was 5.4±1.9mm on stone bearing kidneys and 5.2±2.05mm on contralateral normal kidneys. The mean infundibular length was 18.9±4.4mm on stone bearing kidneys and 18.8±3.9mm on contralateral normal kidneys. The mean infundibulopelvic angle was 47.9±10.8° on stone bearing kidneys and 47.6±11.2° on contralateral kidneys. The mean calyceopelvic height was 15.7±4.6mm on stone bearing kidneys and 15.5±3.9mm (range 7.5to 23.1mm) on contralateral kidneys. There were no statistically significant differences between stone bearing and contralateral normal kidneys in respect to these pelvicalyceal anatomical factors. In this study, we found no significant difference in lower pole pelvicalyceal anatomical factors between stone bearing kidneys and contralateral normal kidneys and therefore these factors do not seem to have significant role in stone formation in one kidney compared with the other.

Differential renal length index: useful measure in management of isolated unilateral hydronephrosis?

To explore the usefulness of the 'differential renal length index' (iDRL) before and after pyeloplasty, as the anteroposterior diameter is commonly used to quantify hydronephrosis but inaccuracies arise due to interobserver variability, hydration status and pure intra-renal dilatation. Prospectively collected data, from two centres, of all children undergoing pyeloplasty for isolated unilateral pelvi-ureteric junction obstruction (PUJO) (2015-2021) were analysed. Subgroup analysis was undertaken: Group A - differential renal function (DRF) ≥40%, Group B - subnormal DRF (20-39%), and Group C - symptomatic. Children with structural anomalies of upper and lower urinary tract, bilateral involvement, and subnormal DRF (<20%) were excluded. All the children had a pre- and postoperative ultrasound scan and Tc99m mercapto-acetyltriglycine (MAG3) renograms. The iDRL was calculated as follows: iDRL = ([a - b]/b) × 100, where 'a' is the length of hydronephrotic kidney (cm) and 'b' is the length of contralateral normal kidney (cm). The mean difference and standard error of mean (SEM) between the pre- and postoperative iDRL was evaluated using the paired Student's t-test, with P < 0.05 considered statistically significant. A total of 119 children with 1-year follow-up were included. For the entire cohort, the mean (SEM) preoperative iDRL was 27.7 (1.4) and postoperatively was 12.5 (1.1), with a mean (range) DRF improvement of 54% (44-66%) (P < 0.001). In Group A (n = 97), the mean (SEM) preoperative iDRL was 26.6 (1.5) and postoperatively was 13.1 (1.2), with a mean (range) DRF improvement of 50% (38-63%) (P < 0.001). In Group B (n = 22), the mean (SEM) preoperative iDRL was 32.6 (3.5) and postoperatively was 10.0 (2.8), with a mean (range) DRF improvement of 69% (49-89%) (P < 0.001). In Group C (n = 28), the mean (SEM) preoperative iDRL was 19.9 (2.3) and postoperatively was 7.7 (1.9), with a mean (range) DRF improvement of 61% (38-85%) (P < 0.001). Our study identifies the iDRL as a useful measure of improvement following successful pyeloplasty. In the subgroup with DRF of >39% minimum improvement was >37%. Similar minimum DRF improvement was also noted (>37%) in hypo-functioning kidneys and symptomatic PUJO.

Utility of ultrasound-based scoring system in post-pyeloplasty recovery.

Differentiation of uretero-pelvic junction obstruction (UPJO) from non-obstructive dilatation (NOD) is a major challenge. The aim of this retrospective study is to determine whether pyeloplasty prediction score (PPS) could predict the need for surgery and resolution after surgery. Among patients with antenatally diagnosed hydronephrosis, those who were stable during post-natal follow-up were considered NOD. The UPJO group were the ones who worsened and underwent pyeloplasty based on conventional indications. All patients with UPJO underwent laparoscopic dismembered pyeloplasty. PPS was determined based on three ultrasound parameters obtained retrospectively: Society of Fetal Urology (SFU) grade of hydronephrosis, transverse anteroposterior (APD), and the absolute percentage difference of ipsilateral and contralateral renal lengths. Among 137 patients included (R:L=59:73; M:F 102:35), 96 were conservatively managed (NOD), while 41 patients (29%) needed pyeloplasty (UPJO). Mean PPS was 4.2 (1.2) in the NOD group and it was significantly higher at 10.8 (1.63) in the UPJO group (p=0.001). All patients with PPS>8 needed a pyeloplasty, while two patients with PPS of 7 needed pyeloplasty due to drop in renal function. PPS cutoff value of >8 had a sensitivity 95%, specificity 100% and a likelihood ratio of 20. Post-pyeloplasty PPS resolution was proportional to the duration of follow-up. A PPS cutoff value of 8 or above is associated with the presence of significant UPJO. PPS is also useful in the assessment of hydronephrosis recovery post-pyeloplasty. The limitation of PPS: it can only be applied in the presence of contralateral normal kidney.

Morbidity of elective surgery for localized renal masses among elderly patients: A contemporary multicenter study

BackgroundThe aging population and the incidence of renal cell carcinoma (RCC) are increasing worldwide. Over 25% of newly diagnosed LRM (localized renal masses) occur in patients over the eighth decade of life. The decision-making and treatment approach to LRM in this population represents a clinical dilemma due to inherited decreased functional reserve and competing mortality risks. Current literature reports conflicting evidence regarding age as a risk factor for worst surgical outcomes. As such, we aimed to evaluate the contemporary morbidity of elective surgery for LRM among elderly patients, focusing on intraoperative and postoperative complications. MethodsAfter Ethical Committee approval, we queried our prospectively maintained databases to identify patients with preoperative eGFR ≥60 ml/min/1.73 m [(David and Bloom, 2022) 22 and a normal contralateral kidney who underwent partial or radical nephrectomy (PN or RN) for a single cT1-T2N0M0 LRM between 1/2015–12/2021 at four high-volume European Academic Institutions. Patients were categorized by age groups: <50 yrs (young) vs. 50–75 (middle-aged) yrs vs.> 75 yrs (elderly). Postoperative complications were recorded according to Clavien-Dindo (CD) classification. The primary objectives were the proportion of patients experiencing intraoperative (IOC), any grade (AGC), and high-grade postoperative complications (HGC), defined as CD grade 3–5. ResultsOverall, 2469/3076 (80.2%) patients met the inclusion criteria. Of these, 363 (14.7%) were young, 1682 (68.1%) were middle-aged, and 424 (17.2%) were elderly. Compared to middle-aged and young patients, elderly patients had a higher median Charlson Comorbidity Index (6 vs. 4 vs. 0, p < 0.01) and a higher proportion of cT1 renal mass (87.6% vs. 93.0% vs. 93.6%, p < 0.01). No differences among the study groups were found regarding surgical approach (open vs. minimally-invasive) and type of surgery (PN vs. RN). We found that older patients experienced similar IOC (4.5% vs. 4.2% vs. 3.3%, p = 0.7) and AGC (23.1% vs. 20.0% vs. 21.5%, p = 0.4) compared to middle-aged and young patients, respectively. Similarly, there were no significant differences in HGC between the study cohorts (0.7% vs. 1.4% vs. 1.7%, p = 0.8). At multivariable analysis, open approach and PN significantly predicted the occurrence of AGCs, while only the open surgical approach was associated with the occurrence of HGCs. ConclusionIn kidney cancer tertiary referral centers, the risk of IOC and postoperative HGC after PN or RN for localized renal masses (LRM) is low, despite a non-negligible risk of AGC, especially in elderly patients. Further efforts should focus on identifying multidisciplinary strategies to select patients most likely to benefit from surgery among elderly candidates with LRMs and decrease the morbidity of surgery in this specific setting.

New-onset Chronic Kidney Disease After Surgery for Localised Renal Masses in Patients with Two Kidneys and Preserved Renal Function: A Contemporary Multicentre Study

BackgroundThere is a lack of evidence on acute kidney injury (AKI) and new-onset chronic kidney disease (CKD) after surgery for localised renal masses (LRMs) in patients with two kidneys and preserved baseline renal function. ObjectiveTo evaluate the prevalence and risk of AKI and new-onset clinically significant CKD (csCKD) in patients with a single renal mass and preserved renal function after being treated with partial (PN) or radical (RN) nephrectomy. Design, setting, and participantsWe queried our prospectively maintained databases to identify patients with a preoperative estimated glomerular filtration rate (eGFR) of ≥60 ml/min/1.73 m2 and a normal contralateral kidney who underwent PN or RN for a single LRM (cT1-T2N0M0) between January 2015 and December 2021 at four high-volume academic institutions. InterventionPN or RN. Outcome measurements and statistical analysisThe outcomes of this study were AKI at hospital discharge and the risk of new-onset csCKD, defined as eGFR <45 ml/min/1.73 m2, during the follow-up. Kaplan-Meier curves were used to examine csCKD-free survival according to tumour complexity. A Multivariable logistic regression analysis assessed the predictors of AKI, while a multivariable Cox regression analysis assessed the predictors of csCKD. Sensitivity analyses were performed in patients who underwent PN. Results and limitationsOverall, 2469/3076 (80%) patients met the inclusion criteria. At hospital discharge, 371/2469 (15%) developed AKI (8.7% vs 14% vs 31% in patients with low- vs intermediate- vs high-complexity tumours, p < 0.001). At the multivariable analysis, body mass index, history of hypertension, tumour complexity, and RN significantly predicted the occurrence of AKI. Among 1389 (56%) patients with complete follow-up data, 80 events of csCKD were recorded. The estimated csCKD-free survival rates were 97%, 93% and 86% at 12, 36, and 60 mo, respectively, with significant differences between patients with high- versus low-complexity and high- versus intermediate-complexity tumours (p = 0.014 and p = 0.038, respectively). At the Cox regression analysis, age-adjusted Charlson Comorbidity Index, preoperative eGFR, tumour complexity, and RN significantly predicted the risk of csCKD during the follow-up. The results were similar in the PN cohort. The main limitation of the study was the lack of data on eGFR trajectories within the 1st year after surgery and on long-term functional outcomes. ConclusionsThe risk of AKI and de novo csCKD in elective patients with an LRM and preserved baseline renal function is not clinically negligible, especially in those with higher-complexity tumours. While baseline nonmodifiable patient/tumour-related characteristics modulate this risk, PN should be prioritised over RN to maximise nephron preservation if oncological outcomes are not jeopardised. Patient summaryIn this study, we evaluated how many patients with a localised renal mass and two functioning kidneys, who were candidates for surgery at four referral European centres, experienced acute kidney injury at hospital discharge and significant renal functional impairment during the follow-up. We found that the risk of acute kidney injury and clinically significant chronic kidney disease in this patient population is not negligible, and was associated with specific baseline patient comorbidities, preoperative renal function, tumour anatomical complexity, and surgery-related factors, in particular the performance of radical nephrectomy.

PD22-08 ACOUSTIC RADIATION FORCE IMPULSE IMAGE FOR EVALUATION OF PARENCHYMA ELASTICITY IN ACUTE HYDRONEPHROTIC KIDNEY: A PRELIMINARY REPORT

You have accessJournal of UrologyCME1 Apr 2023PD22-08 ACOUSTIC RADIATION FORCE IMPULSE IMAGE FOR EVALUATION OF PARENCHYMA ELASTICITY IN ACUTE HYDRONEPHROTIC KIDNEY: A PRELIMINARY REPORT Jen-Chieh Chen, Shih-Yen Lu, Tzu-Ping Lin, and William J. Huang Jen-Chieh ChenJen-Chieh Chen More articles by this author , Shih-Yen LuShih-Yen Lu More articles by this author , Tzu-Ping LinTzu-Ping Lin More articles by this author , and William J. HuangWilliam J. Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003295.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The acoustic radiation force impulse (ARFI) imaging is a new technique with great promise in the field of elastography. It had been used widely in evaluation of various disease involving tissue stiffness, such as liver fibrosis, thyroid nodules, subcutaneous lymph nodes, and breast lesions. However, in kidney, the blood flow is thought to affect the elasticity more than tissue stiffness. To date, the utility of ARFI imaging in acute hydronephrotic kidney remains unexplored. In this study, we aim to compare the shear wave velocity (SWV) measured by ARFI ultrasound elastography of hydronephrotic kidneys caused by ureteral stones and the normal contralateral kidneys. METHODS: A total of 31 patients presented to our emergency room (ER) due to unilateral renal colic caused by ureteral stone with hydronephrosis from April 2020 to September 2022 were prospectively recruited. The patient’s character was recorded. The kidney ultrasound with ARFI imaging of the affected kidney and the contralateral side was performed by a single experienced technician immediately after the diagnosis was made. The SWV value, expressed as speed (m/sec.) of wave propagation through the tissue, was calculated for each kidney in its outer renal cortex. To each of the kidney, the SWV value was assigned through the average of ten different measurements. The Wilconxon signed rank test was used to compare the SWV value of affected and contralateral kidney in an individual. All P values less than 0.05 were considered statistically significant. RESULTS: Among 31 patients, 16 patients presented to our ER at acute/intermediate phase (<24 hours of symptoms onset) and 15 patients at late phase (≥ 24 hours). The SWV value showed variable changes between the affected and contralateral kidneys in patients who came to our ER within 24 hours of symptoms onset. However, in patients who presented to our ER at late phase, the SWV value was significantly lower in their affected kidney (p=0.043). Subsequent analysis found that the SWV value did not showed any significant correlations with age, side of the affected kidney, pain score, stone size, degree of hydronephrosis, presence of urinary tract infection, or presence of acute kidney injury. All patients received stone management successfully afterward. After a mean follow-up of 3 months, there was no evidence of significant sequelae. CONCLUSIONS: The SWV value showed variable changes in patients whose interval between the onset of the symptoms and the kidney stiffness measurement was less than 24 hours. However, SWV value decreased significantly in patients whose interval was greater than 24 hours. This finding may compatible with the concept that the renal blood flow decreases after 24 hours of obstructive uropathy. To our knowledge, this is the first study to evaluate the ARFI image in acute hydronephrotic kidney. Source of Funding: Nil © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e667 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jen-Chieh Chen More articles by this author Shih-Yen Lu More articles by this author Tzu-Ping Lin More articles by this author William J. Huang More articles by this author Expand All Advertisement PDF downloadLoading ...

MP58-16 SIGNIFICANCE OF GLUCOSE CONTROL FOR PERIOPERATIVE AND LONG-TERM RENAL FUNCTIONS AFTER NEPHRON-SPARING SURGERY FOR RENAL CANCER IN PATIENTS WITH DIABETES

You have accessJournal of UrologyCME1 Apr 2023MP58-16 SIGNIFICANCE OF GLUCOSE CONTROL FOR PERIOPERATIVE AND LONG-TERM RENAL FUNCTIONS AFTER NEPHRON-SPARING SURGERY FOR RENAL CANCER IN PATIENTS WITH DIABETES Do Gyeong Lim, Jeong Hoon Oh, Jiwon Ryu, Seong Hyeon Yu, Ho Seok Chung, Kyung Jin Oh, Sun-Ouck Kim, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park, and Eu Chang Hwang Do Gyeong LimDo Gyeong Lim More articles by this author , Jeong Hoon OhJeong Hoon Oh More articles by this author , Jiwon RyuJiwon Ryu More articles by this author , Seong Hyeon YuSeong Hyeon Yu More articles by this author , Ho Seok ChungHo Seok Chung More articles by this author , Kyung Jin OhKyung Jin Oh More articles by this author , Sun-Ouck KimSun-Ouck Kim More articles by this author , Seung Il JungSeung Il Jung More articles by this author , Taek Won KangTaek Won Kang More articles by this author , Dong Deuk KwonDong Deuk Kwon More articles by this author , Kwangsung ParkKwangsung Park More articles by this author , and Eu Chang HwangEu Chang Hwang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003311.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This study aimed to evaluate the predictive factors for perioperative and long-term renal functions after nephron-sparing surgery (NSS). METHODS: The clinical records of 379 patients who underwent NSS for a single renal tumor with a normal contralateral kidney between 2009 and 2016 were retrospectively analyzed. After surgery, the occurrence of acute kidney injury (AKI) within 7 days and the progression of chronic kidney disease (CKD) 5 years later were assessed using serum creatinine (S-Cr) levels. Perioperative AKI was defined as an increase in the S-Cr level by ≥ 0.3 mg/dL or 1.5–1.9 times the baseline value. CKD was defined as the estimated glomerular filtration rate (eGFR) decreasing from > 60 mL/min/1.73 m2 to <60 mL/min/1.73 m2. RESULTS: Changes in the eGFR were assessed during 5 years after surgery. Among 379 patients, 81 (21.4%) patients presented diabetes mellitus (DM), and 30 (7.92%) experienced uncontrolled DM. The AKI occurrence and CKD progression were observed in 50 (13.2%) patients and 79 (20.8%) patients, respectively. Multivariate analyses revealed that female gender (odds ratio [OR] = 0.39, 95% confidence interval [CI]: 0.16–0.91, p=0.029), uncontrolled DM (OR=2.63, 95% CI: 1.05–6.60, p=0.039), and intermediate NePhRO score (OR=2.02, 95% CI: 1.07–3.80, p=0.03) were associated with perioperative AKI. In addition, old age (OR=1.14, 95% CI: 1.10–1.18, p<0.001) and uncontrolled DM (OR=4.57, 95% CI: 1.84–11.4, p=0.001) were associated with long-term CKD progression. CONCLUSIONS: Uncontrolled DM is the only predictive factor for perioperative and long-term renal functions after nephron-sparing surgery. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e802 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Do Gyeong Lim More articles by this author Jeong Hoon Oh More articles by this author Jiwon Ryu More articles by this author Seong Hyeon Yu More articles by this author Ho Seok Chung More articles by this author Kyung Jin Oh More articles by this author Sun-Ouck Kim More articles by this author Seung Il Jung More articles by this author Taek Won Kang More articles by this author Dong Deuk Kwon More articles by this author Kwangsung Park More articles by this author Eu Chang Hwang More articles by this author Expand All Advertisement PDF downloadLoading ...

MP70-02 THE UTILITY OF RENAL MEDULLARY PYRAMIDAL THICKNESS MEASUREMENTS ON THE FIRST AND SECOND POSTNATAL ULTRASOUND IN INFANTS WITH CONGENITAL HYDRONEPHROSIS

You have accessJournal of UrologyCME1 Apr 2023MP70-02 THE UTILITY OF RENAL MEDULLARY PYRAMIDAL THICKNESS MEASUREMENTS ON THE FIRST AND SECOND POSTNATAL ULTRASOUND IN INFANTS WITH CONGENITAL HYDRONEPHROSIS Kathleen Kwiatkowski, Tomas Lence, Angelena Edwards, Gina Lockwood, Douglas Storm, Hanh Pham, and Christopher Cooper Kathleen KwiatkowskiKathleen Kwiatkowski More articles by this author , Tomas LenceTomas Lence More articles by this author , Angelena EdwardsAngelena Edwards More articles by this author , Gina LockwoodGina Lockwood More articles by this author , Douglas StormDouglas Storm More articles by this author , Hanh PhamHanh Pham More articles by this author , and Christopher CooperChristopher Cooper More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior studies demonstrating a medullary pyramid thickness (PT) < 3mm as a marker of obstruction and risk of pyeloplasty used the postnatal ultrasound (u/s) demonstrating the largest degree of hydronephrosis (hydro). Since early identification of children at risk of obstruction is clinically useful, we reviewed the PT on the 1st and 2nd postnatal u/s in infants with congenital hydro. Objectives were to determine the prognostic value of: 1) the PT on the 1st and 2nd u/s, 2) a change in PT between the 1st and 2nd u/s, and 3) the ratio of the PT in the hydronephrotic kidney to the contralateral PT in the normal kidney in those with unilateral hydro. We hypothesized that a smaller PT on either the 1st or 2nd ultrasound, as well as a decreasing PT between the 1st and 2nd u/s, and a decreased PT ratio with unilateral hydro, would each be early predictors of pyeloplasty. This study also analyzed the impact on predictive ability of the PT obtained on an u/s obtained<3 days of life compared to those in which the 1st u/s was obtained>3 days of life. METHODS: A chart and u/s review of children with isolated SFU grade 3 or 4 hydro was performed. 91 infants (77 boys and 14 girls) met eligibility criteria (105 kidneys). The median age (IQR) at 1st u/s was 1.5 (1.0-15.0) days and 54.0 (27.5-123.0) days at the 2nd u/s. RESULTS: For the group overall, a smaller PT on both the 1st and 2nd u/s was associated with an increased risk of pyeloplasty (p=0.02 and<0.001, respectively), however, a PT obtained on an u/s<3 days of life was not predictive. A PT of <3 mm on an u/s obtained>3 days of life was associated with higher risk of pyeloplasty (AUC=0.8). In addition, a decreasing PT between the 1st and 2nd u/s was a risk factor for pyeloplasty (p=0.002). The PT ratio of hydronephrotic to normal contralateral kidney of the children who had their 1st u/s>3 days of life was also significant in predicting pyeloplasty (p=0.018). A ratio < 6 mm, 6-9 mm, and > 9 mm conveyed a very high risk, intermediate risk, and low risk of pyeloplasty, respectively (AUC=0.83). CONCLUSIONS: PT measured on the 1st and 2nd postnatal u/s is useful in determining the risk of pyeloplasty. The PT obtained on the 1st u/s was less predictive when obtained <3 days of life compared to >3 days of life. A decreasing PT between 1st and 2nd u/s was a risk factor for pyeloplasty. With unilateral hydronephrosis, a smaller PT ratio of the hydronephrotic kidney to the normal contralateral kidney was a significant predictor of pyeloplasty. Source of Funding: Tyrone D. Artz Chair in Urology © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1003 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kathleen Kwiatkowski More articles by this author Tomas Lence More articles by this author Angelena Edwards More articles by this author Gina Lockwood More articles by this author Douglas Storm More articles by this author Hanh Pham More articles by this author Christopher Cooper More articles by this author Expand All Advertisement PDF downloadLoading ...

Significance of Glucose Control for Perioperative and Long-Term Renal Functions after Nephron-sparing Surgery for Renal Cancer in Patients with Diabetes.

This study aimed to evaluate the predictive factors for perioperative and long-term renal functions after nephron-sparing surgery (NSS). The clinical records of 379 patients who underwent NSS for a single renal tumor with a normal contralateral kidney between 2009 and 2016 were retrospectively analyzed. After surgery, the occurrence of acute kidney injury (AKI) within 7 days and the progression of chronic kidney disease (CKD) 5 years later were assessed using serum creatinine (S-Cr) levels. Perioperative AKI was defined as an increase in the S-Cr level by ≥ 0.3 mg/dL or 1.5-1.9 times the baseline value. CKD was defined as the estimated glomerular filtration rate (eGFR) decreasing from > 60 mL/min/1.73 m2 to < 60 mL/min/1.73 m2. Changes in the eGFR were assessed during 5 years after surgery. Among 379 patients, 81 (21.4%) patients presented diabetes mellitus (DM), and 30 (7.92%) experienced uncontrolled DM. The AKI occurrence and CKD progression were observed in 50 (13.2%) patients and 79 (20.8%) patients, respectively. Multivariable analyses revealed that female gender (95% confidence interval [CI]: 0.16-0.91, odds ratio [OR] = 0.39, P = 0.029), uncontrolled DM (95% CI: 1.05-6.60, OR = 2.63, P = 0.039), and intermediate NePhRO score (95% CI: 1.07-3.80, OR = 2.02, P = 0.03) were associated with perioperative AKI. In addition, old age (95% CI: 1.10-1.18, OR = 1.14, P < 0.001) and uncontrolled DM (95% CI: 1.84-11.4, OR = 4.57, P = 0.001) were associated with long-term CKD progression. Uncontrolled DM is the only predictive factor for perioperative and long-term renal functions after nephron-sparing surgery.

The utility of renal medullary pyramidal thickness measurements on the first and second postnatal ultrasound in infants with congenital hydronephrosis

Prior studies with postnatal ultrasound measurements of the medullary pyramid thickness (PT) demonstrate a PT<3mm as a significant risk factor for the diagnosis of UPJ obstruction and pyeloplasty. These studies used the postnatal ultrasound demonstrating the largest degree of hydronephrosis. Since early identification of children at increased risk of obstruction and pyeloplasty would be clinically useful, we reviewed the PT on the first and second postnatal ultrasound in infants with congenital hydronephrosis. The aims of the study were to determine the prognostic value of: 1) PT on the first and second postnatal ultrasound, 2) a change in PT between first and second ultrasounds, and 3) ratio of PT in the hydronephrotic kidney to the contralateral PT in the normal kidney in those with unilateral hydronephrosis. We hypothesized that a smaller PT on either the first or second ultrasound, as well as a decreasing PT between the first and second ultrasound, and a decreased ratio of hydronephrotic PT to the contralateral normal kidney, would each be early predictors of subsequent pyeloplasty. A retrospective chart and ultrasound review of children with a diagnosis of isolated high grade (SFU grade 3 or 4) hydronephrosis was performed. This study also analyzed the impact on predictive ability of the PT obtained on an ultrasound obtained before 3 days of life compared to those in which the first ultrasound was obtained after 3 days of life. 91 infants (77 boys and 14 girls) met eligibility criteria (105 kidneys). The median age (IQR) at first ultrasound was 1.5 (1.0-15.0) days and 54.0 (27.5-123.0) days at the second ultrasound. For the group overall, a smaller PT on both the first and second ultrasound was associated with increased risk of pyeloplasty, however, a PT obtained on an ultrasound prior to 3 days of life was not demonstrated to be predictive. Of note, PT was predictive in this same group of patients on their second ultrasound. A PT of <3mm on an ultrasound obtained beyond 3 days of life was associated with higher risk of pyeloplasty. The PT ratio of hydronephrotic to normal contralateral kidney of the children who had their first ultrasound after 3 days of life was also significant in predicting the odds of having surgery. In addition, a decreasing PT between the first and second ultrasound was also identified as a risk factor for pyeloplasty.

Partial Versus Radical Nephrectomy: Complexity of Decision-Making and Utility of AUA Guidelines.

The American-Urological-Association(AUA) Guidelines for renal cancer(2017) recommend consideration for radical-nephrectomy(RN) over partial(PN) whenever there is increased oncologic-risk; and RN should be prioritized if three other criteria are all also met: 1) increased tumor-complexity; 2) no preexisting chronic-kidney-disease/ proteinuria, and 3) normal contralateral kidney that will likely provide estimated glomerular-filtration-rate (eGFR) >45ml/min/1.73m2 even if RN is performed. Our objective was to assess the complexity of decision-making about RN/PN and utility of AUA Guidelines statements regarding this issue. Retrospective review of 267 consecutive RN/PN from 2019(100-RN/167-PN). High tumor-complexity was defined as R.E.N.A.L.≥9. Increased oncologic-risk was defined as tumor >7cm, locally-advanced or infiltrative-features on imaging, or high-risk pathology on biopsy, if obtained. New-baseline GFR after RN was estimated using global-GFR, split-renal-functioncontralateral, and presuming 25% renal-functional-compensation. 163 patients(61%) fit scenarios that are well-defined in the Guidelines. Of these, 34 had strong indications for RN, and all had RN. Twelve of 129 patients(9.3%) underwent RN despite Guidelines generally favoring PN. The remaining 104 patients(39%) did not fit within situations where the Guidelines provide specific recommendations. In these patients, RN was often performed despite functional-considerations favoring PN due to overriding concerns about oncologic-risk and/or tumor-complexity. Our data demonstrate complexity of decision-making about PN/RN as almost 40% of patients did not fit well-described AUA Guidelines descriptors. Compliance was generally strong although occasional overutilization of RN remains a concern in our series, and will be addressed with additional education. Further studies will be required to assess the generalizability of our findings in other institutions/settings.

25, 50 & 75 years ago.

25, 50 & 75 years ago.

Evidence‐based surgical guidelines for treating children with Wilms tumor in low‐resource settings

Survival of Wilms tumor (WT) is>90% in high-resource settings but<30% in low-resource settings. Adapting a standardized surgical approach to WT is challenging in low-resource settings, but a local control strategy is crucial to improving outcomes. Provide resource-sensitive recommendations for the surgical management of WT. We performed a systematic review of PubMed and EMBASE through July 7, 2020, and used the GRADE approach to assess evidence and recommendations. Initiation of treatment should be expedited, and surgery should be done in a high-volume setting. Cross-sectional imaging should be done to optimize preoperative planning. For patients with typical clinical features of WT, biopsy should not be done before chemotherapy, and neoadjuvant chemotherapy should precede surgical resection. Also, resection should include a large transperitoneal laparotomy, adequate lymph node sampling, and documentation of staging findings. For WT with tumor thrombus in the inferior vena cava, neoadjuvant chemotherapy should be given before en bloc resection of the tumor and thrombus and evaluation for viable tumor thrombus. For those with bilateral WT, neoadjuvant chemotherapy should be given for 6-12weeks. Neither routine use of complex hilar control techniques during nephron-sparing surgery nor nephron-sparing resection for unilateral WT with a normal contralateral kidney is recommended. When indicated, postoperative radiotherapy should be administered within 14 days of surgery. Post-chemotherapy pulmonary oligometastasis should be resected when feasible, if local protocols allow omission of whole-lung irradiation in patients with nonanaplastic histology stage IV WT with pulmonary metastasis without evidence of extrapulmonary metastasis. We provide evidence-based recommendations for the surgical management of WT, considering the benefits/risks associated with limited-resource settings.

Application of different methods used to measure the apparent diffusion coefficient of renal cell carcinoma on the same lesion and its correlation with ISUP nuclear grading.

To determine the most frequently used different apparent diffusion coefficient (ADC) measurement methods in renal cell carcinoma (RCC), and their correlation with the International Society of Urological Pathology (ISUP) histologic grading system. A total of 99 patients who underwent diffusion-weighted imaging and whose pathologic diagnosis of RCC was confirmed were included in the study. As a result of a literature review, region of interest (ROI) selection and measurement methods were determined in five ways. These included a small ROI (ADC1) on the solid part of the lesion showing the most restriction; a large ROI (ADC2) on the solid part of the lesion showing restriction; ROI (ADC3) that covered the lesion in the cross-section with the largest diameter, which was obtained by placing ROIs (ADC4) covering the lesion on all sections of the lesion; three small ROIs (ADC5) on solid parts of the lesion showing the most restriction. Then, ADC measurements were made from the contralateral normal kidney parenchyma. Tumors were pathologically subdivided [71 clear cell RCCs (ccRCC), 17 chromophobe RCCs (chRCC), 11 papillary RCCs (pRCC)], and graded according to the ISUP nuclear grading system (42 high-grade, 57 low-grade). Data were analyzed statistically. In all measurement methods, ADC values of RCCs were statistically significantly lower than normal kidney ADC values. There were no differences between the ADC3 and ADC4 measurements of RCCs (p = 0.999). There was a statistical difference in other measurement methods (p < 0.001). There were differences between ccRCCs and pRCCs and chRCCs in all measurement methods. In all measurement methods, pRCC and chRCC ADC values ​​were lower than ccRCC ADC values. When ISUP nuclear grading and ADC values ​​were compared, there was a statistically inverse correlation between all ADC measurements. The strongest correlation was found in the ADC1 and ADC5 measurements. When the ADC values ​​of ISUP low and high-grade groups were compared, a significant difference was found in the ADC5 measurement method (p = 0.046). According to the findings of the study, ADC5 is the measurement method that shows the best correlation with the ISUP histologic grading system. Therefore, we think that ADC5 can be the primary measurement method for determining the ADC value of RCCs.

Is the urinary kidney injury molecule an optimum biomarker for early detection of obstructive nephropathy? An experimental study

Abstract Objectives To evaluate the urinary kidney injury molecule-1 (KIM-1) as a predictor for early detection of acute kidney injury in cases with obstructive nephropathy in an animal model and to correlate urinary KIM-1 with the progress of obstructive nephropathy on a histopathological basis. Materials and methods Three models of obstruction were induced in 90 male rats: unilateral partial ureteral obstruction with a normal contra-lateral kidney, with nephrectomy of a contralateral kidney (solitary kidney), and bilateral partial ureteral obstruction. Each group was further divided into 2 subgroups; the sham-group (10 rats) and the disease group (20 rats). Serum creatinine, blood urea nitrogen, and urinary KIM-1 were collected on days 0, 7, and 14. Rats were sacrificed on the 7th and 14th day for histopathological examination of the obstructed kidney. Results By the end of first week, there was a significant rise of all biomarker levels in all groups when compared with basal levels. Similarly, biomarker levels at the 14th day were significantly higher than those obtained at the 7th day. The urinary KIM-1 level was not detected in the baseline condition. Expression of urinary KIM-1 showed a significant rise in all models ranging from 22 to 85 fold at the 7th day and even higher levels at the 14th day. Histopathological examination confirmed the presence of different forms of tubular injury. Conclusions Urinary KIM-1 is significantly elevated in obstructive uropathy. Such an elevation might be advantageous in the early diagnosis and subsequent early intervention of cases with partial ureteral obstruction.

Preoperative versus Postoperative Compensation of the Contralateral Normal Kidney in Patients Treated with Radical Nephrectomy for Renal Cell Carcinoma.

Background: We sought to identify the factors affecting renal compensatory processes that occur preoperatively as well as postoperatively in patients treated with radical nephrectomy (RNx) for renal cell carcinoma (RCC). Methods: We retrospectively reviewed the records of 906 patients treated with RNx for RCC. We defined the early compensatory process (process 1) as compensatory adaptation of the contralateral normal kidney (CNK) before RNx. We defined the late compensatory process (process 2) as compensatory adaptation of the CNK after RNx. Total compensation was defined as the combination of these two processes. Multivariable logistic regression analyses were used to identify significant factors associated with processes 1, 2 and total compensation. Results: Mean preoperative, 1-week, and 5-year postoperative estimated glomerular filtration rates (eGFR) were 84.5, 57.6 and 63.7 mL/min/1.73 m2, respectively. Female sex (p < 0.001), lower body mass index (BMI) (p < 0.001), absence of hypertension (p = 0.019), lower preoperative eGFR (p < 0.001), larger tumor volume (p < 0.001), and larger CNK volume (p < 0.001) were significantly associated with process 1. Younger age (p = 0.019), higher BMI (p < 0.001), and absence of diabetes mellitus (DM) (p = 0.033) were significantly associated with process 2. Female sex (p < 0.001), younger age (p < 0.001), absence of DM (p = 0.002), lower preoperative eGFR (p < 0.001), and larger tumor (p = 0.001) and CNK volumes (p < 0.001) were significantly associated with total compensation. Conclusions: Different factors affected each compensatory process. Process 1 made a greater contribution to the entire renal compensatory process than process 2.

1324 Open Partial Nephrectomy for Renal Cell Carcinoma

Abstract Open partial nephrectomy, or nephron-sparing surgery (NSS), is now considered as the standard for small renal tumors treatment. The oncologic efficacy and safety of NSS for the treatment of stage-T1a renal tumors have been repeatedly demonstrated to be equivalent to radical nephrectomy. A 66-year-old gentleman chronic smoker was incidentally found to have a small mid pole lesion in the left kidney on routine ultrasound scan, CT finding was 2x2 cm mid pole tumor, no involvement or metastasis, the patient given the option of partial nephrectomy. In surgery, the left kidney was explored, and the tumor mass was seen to occupy the mid pole. The mid pole branch of the renal artery was clamped after cooling the kidney with ice slush following 300cc of 20% mannitol infusion. In-situ nephron-sparing left nephrectomy was done with a margin of 1cm minor upper calyceal injury repaired. The patient was discharged five days postoperative. Gross examination of the specimen revealed a wedge biopsy of the mid pole with attached perinephric fat with swelling part at the outer surface, pushing the capsule. Microscopic sections show a well-defined tumor mass in the renal parenchyma, surrounded by a fibrous capsule, composed of a multilocular cystic area lined by malignant cells. NSS initially was reserved for patients with solitary kidneys, tumors, and those with significant comorbidities predisposing to future renal failure; indications have expanded recently to allow elective partial nephrectomy in the setting of a normal contralateral kidney.

Parenchymal Volume Replacement by Renal Cell Carcinoma Prior to Intervention: Predictive Factors and Functional Implications

ObjectiveTo analyze predictors, extent and functional implications associated with renal parenchymal volume replacement (PVR) by renal cell carcinoma (RCC) prior to intervention. This phenomenon is well-recognized yet not adequately studied, and, if severe, can influence management. Materials and MethodsA retrospective review was performed of partial nephrectomy (PN) and radical nephrectomy (RN) patients with available preoperative nuclear-renal-scan and imaging demonstrating solitary RCC with normal contralateral kidney. Normal renal parenchymal volume of each kidney was measured by free-hand scripting from preoperative axial images. Primary endpoint was percent PVR which was estimated assuming that the contralateral-kidney serves as a control: PVR = (volume contralateral kidney – volume ipsilateral kidney) normalized by volume contralateral kidney. Multivariable linear-regression analysis assessed factors associated with preoperative PVR. Further analysis evaluated the functional effect of PVR prior to surgery. Results146 PN and 136 RN patients with necessary studies were analyzed. For RN, the median PVR was 15% and a quarter of patients had PVR ≥27%. In contrast, PVR was negligible in PN patients for whom median preoperative parenchymal volumes were nearly identical in the ipsilateral/contralateral kidneys (179/180cc, respectively). PVR inversely correlated with preoperative renal function in the ipsilateral kidney (P <.01). Tumor-size (P <.01), stage (P = .03), and endophytic properties (P = .03) associated with PVR on multivariable-analysis. ConclusionOur data suggest that substantial replacement of normal parenchyma by RCC occurs in many patients selected for RN and can contribute to preexisting renal-insufficiency. PVR prior to intervention is mainly driven by tumor characteristics in RN patients, but is negligible in most PN patients.