Obstructive Hydronephrosis Research Articles

Study of renal blood flow in children with obstructive uropathies

Aim. To evaluate hemodynamic indicators of the kidneys in children with obstructive uropathies.Materials and Methods. The study was conducted at the Republican Scientific and Clinical Center of Pediatrics and Pediatric Surgery, involving 32 children aged 1 to 14 years, comprising 18 girls (56.3%) and 14 boys (43.7%). The children were divided into 3 groups: Group I with unilateral hydronephrosis - 14 (43.7%) children, Group II with bilateral hydronephrosis - 10 (31.3%) children, and Group III with ureterohydronephrosis - 8 (25%) children.Results and Discussion. Obstructive uropathy resulting from congenital kidney malformations, such as organic obstruction (hydronephrosis), causes dilation of the renal collecting system, increased ureteral pressure, reduced intrarenal blood flow, renal parenchyma atrophy, and progressive chronic renal failure.Conclusion. The above findings demonstrate that ultrasound using pulsed-wave Doppler and color Doppler mapping is an optimal non-invasive method for assessing renal hemodynamics.

Severe Hypertension in a Female Adolescent with Severe Chronic Obstructive Unilateral Hydronephrosis

Severe Hypertension in a Female Adolescent with Severe Chronic Obstructive Unilateral Hydronephrosis

Abstract C161: Rare Invasive Plasmacytoid Urothelial Carcinoma Presenting as Post-Renal Acute Kidney Injury: A Case Report

Abstract Purpose: Plasmacytoid urothelial carcinoma stands out as a rare and highly aggressive histological subtype within the spectrum of bladder carcinomas, constituting only 1-3% of all variants. Summary: In this case report, we present the case of a 72-year-old patient who initially presented with significant obstructive uropathy and hydronephrosis secondary to invasive plasmacytoid urothelial carcinoma. Admission labs were concerning for a hemoglobin level of 3.8, requiring 3 units of red blood cells for correction, potassium level of 8.8, for which urgent hemodialysis was given, and a lactate level of 5.4. The patient subsequently developed delayed hematuria one month later. Follow-up CT imaging revealed an alarming increase in the size of the bladder mass, underscoring the rapid progression of the malignancy. Discussion: The aggressive nature of this malignant neoplasm can be attributed to its diffuse pattern of infiltration and high risk of residual disease following radical surgery. Clinical manifestations often include abdominal pain, but lack early-onset hematuria and other urinary symptoms typically seen with other subtypes, leading to diagnostic delays and late-stage identification. Conclusion: This case report highlights the uncommon clinical presentation of plasmacytoid urothelial carcinoma (PUC), manifesting as obstructive nephropathy. The inherent aggressiveness associated with PUC poses a challenge in treatment due to the advanced stage of the malignancy at the time of diagnosis. The scarcity of guidelines for the management of PUC underscores the need for extensive future studies to bridge this gap. Citation Format: Andressa Uzeda, Toral Shastri, Kamilia Moalem, Kendra Van Kirk. Rare Invasive Plasmacytoid Urothelial Carcinoma Presenting as Post-Renal Acute Kidney Injury: A Case Report [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C161.

Chronic back pain in untreated gout

A 41-year-old man with a 10-year history of untreated chronic tophaceous gout presented with acute flare of gouty arthritis. He has chronic low back pain which has become more severe for the past 1 year. Clinically he has tenderness at lower lumbar spine although there was no neurological deficit. Laboratory test revealed raised inflammatory markers (ESR 70mm/hour) and C-reactive protein 287.1 mg/L, reactive thrombocytosis and leucocytosis, renal impairment and elevated serum uric acid (780 μmol/L). He had microscopic hematuria and ultrasound showed right mild hydronephrosis without any calculi identified. Computerized Tomography Urogram (CTU) confirmed the findings of an obstructive right hydronephrosis and hydroureter due to a right ureteric calculus. Incidentally, CTU revealed a lobulated, heterogenous hyperdense soft tissue ossified mass measuring (4.6x7.3x8.1 cm) at lumbar vertebral bodies (L2-L4) with overhanging edge erosions of adjacent vertebra mainly involving the facet joints, pedicles and lamina (Figure 1).

Newly modified 'pseudo flap' without compromising vascularity to enhance repair of long distal ureteral loss: A retrospective analysis of a prospective database.

To present an alternative technique called pseudo-flap for reconstructing long ureteral defects as an alternative to Boari flap. Despite being used for more than 70 years by urologists for tension-free reconstruction of distal and mid-ureteral defects, the Boari flap exhibits high complication rates, with an average of 27% (range 5.5%-30.4%). These complications arise from compromised blood supply, attributed to incisions made on all three sides of the flap and dependence on the flap base as the sole source of blood supply. We retrospectively reviewed patients who underwent our modified technique by a single surgeon between 2008 and 2021. We used a semi-oblique cystotomy on the lowest part of the anterior and contralateral aspects of the bladder after complete release from adhesions and sacrificing the superior vesical pedicle, if necessary. The innovative part of the technique involved making short relaxing incisions at different levels on both sides of a pseudo-flap while pushing the bladder dome upward to reach the healthy ureter in a tension-free manner, followed by anastomosis with a non-refluxing or refluxing technique. Fifteen patients underwent the pseudo-flap technique with a mean follow-up of 16.9months. Four had prior radiation, three had hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis, and one had a ureteral stricture in a transplanted kidney. Eight procedures were performed during intraoperative consultations.Only one patient (7%) developed a major complication (Clavien-Dindo grade ≥2). This patient developed postoperative leak, and none developed obstructive hydronephrosis, suggesting stricture or flap ischemia. The mean length of the flap was 9.3cm. Our pseudo-flap technique has lower complication rates than the traditional Boari flap. It is not technically challenging, minimally compromises blood supply and is thus especially suitable for complex, highly morbid patients with decreased tissue vascularity, such as those with prior radiation and peritoneal carcinomatosis.

When the Model Trains You: Induced Belief Revision and Its Implications on Artificial Intelligence Research and Patient Care — A Case Study on Predicting Obstructive Hydronephrosis in Children

When the Model Trains You: Induced Belief Revision and Its Implications on Artificial Intelligence Research and Patient Care — A Case Study on Predicting Obstructive Hydronephrosis in Children

Unintended placement of a double-J stent in the contralateral renal pelvis during laparoscopic pyeloplasty for pediatric hydronephrosis: a case report.

The double-J stent (DJS) is a commonly used ureteral stent in urological surgeries, which provides support and drainage. However, the DJS may result in various complications such as infection, hematuria, stone formation, stent occlusion, and migration. Normally, one end of the DJS is located in the renal pelvis, and the other end in the bladder. In this case report, we describe the rare occurrence of a misplaced DJS during laparoscopic pyeloplasty, which was unintentionally placed in the contralateral renal pelvis. A 4-month-old male infant was diagnosed with left hydronephrosis. After confirmation of the diagnosis, laparoscopic left pyeloplasty was performed with the placement of a DJS. The patient did not experience any discomfort, such as nausea, vomiting, refusal to feed, crying and restlessness, or fever, after the operation, and was discharged on postoperative day 4. The patient returned to the hospital for DJS removal 6 weeks after the operation. However, the kidneys, ureters, and bladder (KUB) X-ray examination showed that the DJS was unintentionally placed in the contralateral ureter and renal pelvis. The stent was confirmed and removed under cystoscopy. Postoperative examination of the DJS showed that there was a hole in the side of the middle of the stent for urine drainage, with no obstruction or contralateral hydronephrosis. Misplacement of a DJS in the contralateral renal pelvis during laparoscopic pyeloplasty is a rare but potentially serious complication. Surgeons should be cautious when placing the stent and confirm its placement with imaging studies. Patients should be closely monitored for postoperative complications and prompt intervention should be taken if necessary.

Clinical Characterization of Alagille Syndrome in Patients with Cholestatic Liver Disease.

Alagille syndrome (ALGS) is a multisystem condition characterized by cholestasis and bile duct paucity on liver biopsy and variable involvement of the heart, skeleton, eyes, kidneys, and face and caused by pathogenic variants in the JAG1 or NOTCH2 gene. The variable expressivity of the clinical phenotype and the lack of genotype-phenotype correlations lead to significant diagnostic difficulties. Here we present an analysis of 18 patients with cholestasis who were diagnosed with ALGS. We used an NGS panel targeting coding exons of 52 genes, including the JAG1 and NOTCH2 genes. Sanger sequencing was used to verify the mutation in the affected individuals and family members. The specific facial phenotype was seen in 16/18 (88.9%). Heart defects were seen in 8/18 (44.4%) patients (pulmonary stenosis in 7/8). Butterfly vertebrae were seen in 5/14 (35.7%) patients. Renal involvement was detected in 2/18 (11.1%) cases-one patient had renal cysts, and one had obstructive hydronephrosis. An ophthalmology examination was performed on 12 children, and only one had posterior embryotoxon (8.3%). A percutaneous liver biopsy was performed in nine cases. Bile duct paucity was detected in six/nine cases (66.7%). Two patients required liver transplantation because of cirrhosis. We identified nine novel variants in the JAG1 gene-eight frameshift variants (c.1619_1622dupGCTA (p.Tyr541X), c.1160delG (p.Gly387fs), c.964dupT (p.C322fs), c.120delG (p.L40fs), c.1984dupG (p.Ala662Glyfs), c.3168_3169delAG (p.R1056Sfs*51), c.2688delG (p.896CysfsTer49), c.164dupG (p.Cys55fs)) and one missense variant, c.2806T > G (p.Cys936Gly). None of the patients presented with NOTCH2 variants. In accordance with the classical criteria, only six patients could meet the diagnostic criteria in our cohort without genetic analysis. Genetic testing is important in the diagnosis of ALGS and can help differentiate it from other types of cholestasis.

PD37-12 THE USE OF URINARY BIOMARKERS IN PEDIATRIC PATIENTS WITH UNILATERAL HYDRONEPHROSIS TO IDENTIFY TRUE URETEROPELVIC JUNCTION OBSTRUCTION

You have accessJournal of UrologyCME1 Apr 2023PD37-12 THE USE OF URINARY BIOMARKERS IN PEDIATRIC PATIENTS WITH UNILATERAL HYDRONEPHROSIS TO IDENTIFY TRUE URETEROPELVIC JUNCTION OBSTRUCTION Shao Tao, Tianjia Ge, Kritika Sharma, Aliyah Davis, James Brooks, and Kunj Sheth Shao TaoShao Tao More articles by this author , Tianjia GeTianjia Ge More articles by this author , Kritika SharmaKritika Sharma More articles by this author , Aliyah DavisAliyah Davis More articles by this author , James BrooksJames Brooks More articles by this author , and Kunj ShethKunj Sheth More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003335.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In patients with unilateral neonatal hydronephrosis, early discrimination between true obstructive hydronephrosis (OH) and nonobstructive dilation (NOD) is challenging. At present, patients are managed on observation protocols with serial ultrasounds and occasional diuretic renography to assess drainage and differential renal function (DRF). Triggers for pyeloplasty are worsening hydronephrosis, decreased DRF, infection, and flank pain, indicative of OH. We evaluate urinary inflammatory biomarkers as an alternative less invasive prognostic indicator for OH. METHODS: Pediatric patients with hydronephrosis and healthy controls were prospectively enrolled in this IRB-approved study. Exclusion criteria were bilateral grade 3-4 hydronephrosis, chronic renal disease, and immunosuppressant medication. Hydronephrotic patients were subcategorized as OH and NOD, based on need for pyeloplasty. Urine samples were analyzed for neutrophil gelatinase-associated lipocalin (NGAL), Human Carbohydrate Antigen 19-9 (HCA19-9), interferon-gamma inducible protein 10 kDa (IP10), and monocyte chemoattractant Protein 1 (MCP1) by enzyme-linked immunosorbent assay (ELISA). Statistical analyses (t-test, Spearman correlation, and logistic regression) were done on SPSS Version 29.0. RESULTS: Patients with hydronephrosis, and more specifically OH compared to NOD, had significantly higher NGAL, HCA19-9, and IP10 levels (Table 1). NGAL and HCA19-9 levels were significantly higher in patients with decreased differential function. NGAL levels correlated with the presence of OH in a logistic regression model with 94.1% sensitivity and 92.3% specificity. NGAL levels also demonstrated a high negative Spearman correlation (r=-0.893, p=0.007) with the affected kidney DRF. CONCLUSIONS: In this pilot study of hydronephrotic patients, elevated inflammatory biomarker levels correlate with the presence of OH and decreased DRF. In particular, NGAL is a promising biomarker with a strong linear correlation to DRF and the presence of OH. Further longitudinal studies are needed to validate these biomarkers and identify their utility in the clinical management of unilateral hydronephrosis. Source of Funding: Stanford Pediatric Innovation Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e992 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shao Tao More articles by this author Tianjia Ge More articles by this author Kritika Sharma More articles by this author Aliyah Davis More articles by this author James Brooks More articles by this author Kunj Sheth More articles by this author Expand All Advertisement PDF downloadLoading ...

Effectiveness of Urinary Diversion in Patients with Cervical Cancer at Kariadi General Hospital

BACKGROUND: Obstructive uropathy and hydronephrosis are common complications of cervical cancer. In order to provide an alternative route due to ureteral obstruction, urinary diversion was performed. Urinary diversion procedures are a therapeutic option for obstructive uropathy but their effectiveness is remain unclear. There is limited data that support urinary diversion as a treatment of ureteral obstruction to improve overall survival and progression-free survival. AIM: To determine the effectiveness of urinary diversion in the treatment of obstructive uropathy in cervical cancer patients. METHOD: This study is a cross sectional involved cervical cancer patients with symptoms of obstructive uropathy. Data were obtained from medical records and limited to patients admitted from May, 2020 to May, 2021. Primary outcome was urea level, creatinine level, stage of hydronephrosis and overall survival rate of patients. RESULT: A total of 100 patients were included in the study. In both groups, the mean age of study subjects was 52-53 years with stage IIIB being the most widely reported. There was an improvement in post creatinine in the urinary diversion group. There was a significant difference in post creatinine levels between the non-urine diversion and urinary diversion groups (p=0.039).The 12-month survival rate, in the non-urinary diversion group had a value of 86% while the urinary diversion group had a value of 94%. CONCLUSION: This study shows that urinary diversion procedure is effective in increasing the renal function and increasing the 12-month survival of cervical cancer patients with obstructive uropathy.

A Case of Contained Rupture of the Common Iliac Artery with Idiopathic Retroperitoneal Fibrosis: Efficacy of Surgical Treatment and Immunosuppressive Therapy at 2-Year Follow-Up

Rupture of inflammatory aortic aneurysm associated with retroperitoneal fibrosis (RF) is rare. We report a 62-year-old man with an inflammatory abdominal aortic aneurysm (IAAA) complicated with idiopathic RF, resulting in a contained rupture of the common iliac artery. The patient also presented with mild renal insufficiency due to urethral obstruction and left hydronephrosis. Surgical procedures including graft replacement and ureterolysis relieved the symptoms. Postoperative immunosuppressive treatment using corticosteroid and methotrexate successfully maintained clinical remission without signs of recurrence of RF and IAAA at the 2-year follow-up.

3D autofluorescence imaging of hydronephrosis and renal anatomical structure using cryo-micro-optical sectioning tomography.

Rationale: Mesoscopic visualization of the main anatomical structures of the whole kidney in vivo plays an important role in the pathological diagnosis and exploration of the etiology of hydronephrosis. However, traditional imaging methods cannot achieve whole-kidney imaging with micron resolution under conditions representing in vivo perfusion. Methods: We used in vivo cryofixation (IVCF) to fix acute obstructive hydronephrosis (unilateral ureteral obstruction, UUO), chronic spontaneous hydronephrosis (db/db mice), and their control mouse kidneys for cryo-micro-optical sectioning tomography (cryo-MOST) autofluorescence imaging. We quantitatively assessed the kidney-wide pathological changes in the main anatomical structures, including hydronephrosis, renal subregions, arteries, veins, glomeruli, renal tubules, and peritubular functional capillaries. Results: By comparison with microcomputed tomography imaging, we confirmed that IVCF can maintain the status of the kidney in vivo. Cryo-MOST autofluorescence imaging can display the main renal anatomical structures with a cellular resolution without contrast agents. The hydronephrosis volume reached 26.11 ± 6.00 mm3 and 13.01 ± 3.74 mm3 in 3 days after UUO and in 15-week-old db/db mouse kidneys, respectively. The volume of the cortex and inner stripe of the outer medulla (ISOM) increased while that of the inner medulla (IM) decreased in UUO mouse kidneys. Db/db mice also showed an increase in the volume of the cortex and ISOM volume but no atrophy in the IM. The diameter of the proximal convoluted tubule and proximal straight tubule increased in both UUO and db/db mouse kidneys, indicating that proximal tubules were damaged. However, some renal tubules showed abnormal central bulge highlighting in the UUO mice, but the morphology of renal tubules was normal in the db/db mice, suggesting differences in the pathology and severity of hydronephrosis between the two models. UUO mouse kidneys also showed vascular damage, including segmental artery and vein atrophy and arcuate vein dilation, and the density of peritubular functional capillaries in the cortex and IM was reduced by 37.2% and 49.5%, respectively, suggesting renal hypoxia. In contrast, db/db mouse kidneys showed a normal vascular morphology and peritubular functional capillary density. Finally, we found that the db/db mice displayed vesicoureteral reflux and bladder overactivity, which may be the cause of hydronephrosis formation. Conclusions: We observed and compared main renal structural changes in hydronephrosis under conditions representing in vivo perfusion in UUO, db/db, and control mice through cryo-MOST autofluorescence imaging. The results indicate that cryo-MOST with IVCF can serve as a simple and powerful tool to quantitatively evaluate the in vivo pathological changes in three dimensions, especially the distribution of body fluids in the whole kidney. This method is potentially applicable to the three-dimensional visualization of other tissues, organs, and even the whole body, which may provide new insights into pathological changes in diseases.

2030. Risk Factors for Recurrent Percutaneous Nephrostomy Tube Infections in Patients with Gynecological Malignancies

Abstract Background Percutaneous nephrostomy tube infections (PCNIs) are complex, affect quality of life, necessitate implant exchanges, and increase health care costs. Here, we analyzed risk factors for recurrent PCNIs in patients treated with our standardized institutional algorithm. Methods At our institution, we prospectively evaluated consecutive patients with gynecological malignancies who developed PCNIs between July 2019 to September 2021. All patients were treated using our institutional algorithm for PCNI, which consists of obtaining blood cultures plus urine analyses and cultures from each percutaneous nephrostomy tube (PCN); utilizing ultrasound or abdominal pelvic computed tomography scans to rule out obstructive hydronephrosis, pyelonephritis, or renal abscess; exchanging the PCN once patients are receiving concordant antimicrobial therapy; and having patients complete an adequate course of targeted antimicrobials. Thereafter, patients were followed up until reinfection, routine PCN exchange at 3 months, being lost to follow-up, or death. Results We treated 100 patients. Their median age was 54 years; 53% were White. The most common malignancies were cervical (61%), ovarian (23%), and endometrial (13%), with 60% being metastatic. To analyze the risk factors for developing a recurrent PCNI, patients were placed in 3 different groups: those reinfected with the same organism (19%), reinfected with a different organism (17%), and not reinfected (64%). Overall, there were no differences among the patient groups regarding demographics, comorbidities, clinical presentation, infection timing, PCN exchange (Table 1) or microorganisms encountered (Table 2). However, patients with prior radiation therapy or pelvic fistulas (urinary-vaginal-rectal or their permutations) had higher rates for developing a recurrent PCNIs with the same organism (P< .002). Conclusion Patients with prior radiation therapy and underlying pelvic fistulas have an increased risk for reinfection with the same pathogen. Therefore, further studies should be performed to mitigate this increased risk of recurrent infections with more frequent PCN exchanges or, more invasive procedure such as ureteral embolization, sclerosis, or ligation to dissociate the upper and lower urinary tracts. Disclosures All Authors: No reported disclosures.

Diuretic Renal Scintigraphy

Hydronephrosis can be caused by obstruction or by nonobstructive disorders such as infection, vesicoureteral reflux, or congenital anomalies. Diuretic renal scintigraphy is critical in differentiating between obstructive and nonobstructive hydronephrosis. Under physiologic conditions, urine may pool

A misplacement of a ureteral stent into the abdominal aorta: a case report of a rare retrograde ureteral stenting complication

BackgroundCervical cancer is often associated with malignant ureteral obstruction and consequent hydronephrosis. Hydronephrosis caused in this way can be resolved by placing ureteral stents or performing a percutaneous nephrostomy. Complications that may occur during the retrograde ureteral stent placement are usually mild, but serious complications such as stent migration into the cardiovascular system are also possible. Here we present an unusual case where a ureteral stent entered the abdominal aorta during the cystoscopic ureteral stenting, which was resolved by a cystoscopic stent removal kept in check by endovascular catheters.Case presentationsThe 48-year-old female patient was treated in the regional secondary healthcare facility due to bilateral hydronephrosis caused by cervical cancer. The patient had bilateral percutaneous nephrostomies and ureteral stents. Due to the calcification of the left ureteral stent, an urethrorenoscopy with lithotripsy of the calculus in the left ureter was performed in the regional secondary healthcare facility, and the ureteral stent was cystoscopically replaced. The control radiography of the urinary tract showed a misplacement of the left ureteral stent, and a computed tomography showed that the stent was located in the abdominal aorta. The patient was referred to the University Clinical Center of Serbia, where a ureteral stent was cystoscopically removed from the abdominal aorta under the control of endovascular catheters. The patient was in good general condition at all times, with no signs of bleeding, and she was discharged from the hospital on the fourth postoperative day.ConclusionsThe migration of a ureteral stent into the abdominal aorta and the cardiovascular system in general is a rare type of ureteral stenting complication whose treatment requires a multidisciplinary approach. In order to prevent such complications, it is necessary to strictly adhere to the indications for the ureteral stent placement in the case of malignant ureteral obstruction. Also, this procedure should be performed according to the current guidelines and controlled by an X-ray or ultrasound.

Case report on- Management and complication of vesicular calculi with obstructive Hydronephrosis with CKD

Hydronephrosis is the swelling of a kidney due to a build-up of urine. It happens when urine cannot drain out from a blockage or obstruction. Hydronephrosis can occur in one or both kidneys. The primary function of the urinary tract is to remove wastes and fluid from the body. In today's urology, multiple giant vesical calculi are a rare occurrence. In the English literature, only a few examples of vesical calculi weighing more than 100 g have been described. Arthur et al. created the world's most extensive vesical calculus, weighing 6294 g. Bladder stones can be asymptomatic and only detected by chance. Rat kidney transplantation is a common experimental model for the creation of general microsurgical or transplantation procedures, immunologic research, and the examination of transplant-related long-term alterations in arterial blood pressure. Main symptoms and Important clinical Findings:- A 45 years old male was admitted to a rural hospital in the medicine ward on date 11-01-2022 with the chief complaint of Vomiting, Nausea, fever and Urinary, Fatigue, high blood pressure, loss of appetite, malaise, or water-electrolyte imbalance Problem 1 week. The primary diagnosis, therapeutic interventions and outcome:-This case were diagnosed after a physical examination and research. Vesicular calculi with obstructive Hydronephrosis with CKD chief complaint pain, vomiting, and blood in the urine for one week. Weakness, severe muscle, severe loss of appetite and two weeks. Nursing perspective:- - NS and RL nebulization are examples of fluid replacement. Vitals are being monitored on an hourly basis.Conclusion:-vesicular calculi with obstructive Hydronephrosis with CKD case was rare. CysC more accurately depicts changes in renal function in patients with hydronephrosis brought on by ureteral calculi, and the CKD-EPI CysC equation has the highest accuracy. Early diagnosis and early treatment are necessary to prevent further complications. He responded to all medication, and her recovery was good.

Role of urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL), Monocyte Chemoattractant Protein-1(MCP-1), and Interleukin-6(IL-6) as biomarkers in pediatric patients with hydronephrosis.

The decision to surgically intervene in a hydronephrotic kidney in children is based on many debatable guidelines, some requiring repeated ultrasounds or renal scans. Urinary proteins have the potential to reflect renal disorders and hence can be the alternatives to such scans. Here, we aim to assess the role of urinary Neutrophil Gelatinase-Associated Lipocalin, Monocyte Chemoattractant Protein-1, and Interleukin-6 (IL-6) in such patients. Seventeen children had obstructive hydronephrosis requiring pyeloplasty (UPJO), while seven were kept on conservative management in view of non-obstructivedilation (NOD). Urine samples were measured for the three urinary proteins at the time of presentation and following pyeloplasty using commercially available ELISA kits. The levels of all three urinary proteins were significantly higher in patients with UPJO children compared to the NOD group. Cut-off values to differentiate obstructive from non-obstructive hydronephrosis were obtained. A significant fall in the post-operative value of urinary IL-6 was also observed. This study highlights the potentiality of urinary proteins as biomarkers in identifying children with hydronephrosis and picking out the ones with obstructive hydronephrosis who will require pyeloplasty. The drop in levels after pyeloplasty can be employed to evaluate the effectiveness of pyeloplasty when sent serially.

The silent trial - the bridge between bench-to-bedside clinical AI applications.

As more artificial intelligence (AI) applications are integrated into healthcare, there is an urgent need for standardization and quality-control measures to ensure a safe and successful transition of these novel tools into clinical practice. We describe the role of the silent trial, which evaluates an AI model on prospective patients in real-time, while the end-users (i.e., clinicians) are blinded to predictions such that they do not influence clinical decision-making. We present our experience in evaluating a previously developed AI model to predict obstructive hydronephrosis in infants using the silent trial. Although the initial model performed poorly on the silent trial dataset (AUC 0.90 to 0.50), the model was refined by exploring issues related to dataset drift, bias, feasibility, and stakeholder attitudes. Specifically, we found a shift in distribution of age, laterality of obstructed kidneys, and change in imaging format. After correction of these issues, model performance improved and remained robust across two independent silent trial datasets (AUC 0.85–0.91). Furthermore, a gap in patient knowledge on how the AI model would be used to augment their care was identified. These concerns helped inform the patient-centered design for the user-interface of the final AI model. Overall, the silent trial serves as an essential bridge between initial model development and clinical trials assessment to evaluate the safety, reliability, and feasibility of the AI model in a minimal risk environment. Future clinical AI applications should make efforts to incorporate this important step prior to embarking on a full-scale clinical trial.

Role of CT-KUB for Detection of Obstructive and Non-Obstructive Hydronephrosis on The Basis of Frequency of Calculi

The kidneys and ureters are the most prevalent sites for stones. The swelling of the kidneys due to renal stones, most often ureteric stones, is known as hydronephrosis. For detecting the position of stones, CT-KUB has a high sensitivity. Objective: To determine the frequency of obstructive and non-obstructive hydronephrosis due to calculi in CT-KUB. Methods: A cross-sectional study was conducted from January, 2022 to May, 2022 at Tertiary Hospital in Lahore, Pakistan. A sample size of 166 patients was obtained using a non-probability convenient sampling technique based on the previously published articles. All patients with renal calculi were included. 64 Slices Aquilian CT Machine was used. SPSS ver. 22 was used for data entry and analysis. Results: 166 Patients were in the age ranges of (15-25), (26-35), (36-45), (46-55), (56-65), and (66-75) were 27(16.3%), 39(16.3%), 32(19.3%), 37(22.3%), 22(13.3%), 9(5.4%) respectively. There were 126(75.9%) males and 40 (24.1%) females. Flank pain was present in 154(94%) and hematuria in 68(41%) patients. Stones were noted in kidneys 102(46.6%), proximal ureter 35(16%), mid ureter 21(9.6%), distal ureter 51(23.3%), urinary bladder 10(4.6%). 96 patients were diagnosed with obstructing hydronephrosis (57.8%). Conclusion: Urinary tract stones are most commonly seen in the kidneys and ureters. Obstructive and non-obstructive hydronephrosis is mostly caused by kidney stones. Obstructive hydronephrosis accounted for 57.8% of the total, whereas non-obstructive hydronephrosis accounted for 42.2%. CT-KUB plays a vital role in the diagnosis of hydronephrosis.

Main Pathological Changes of Benign Ureteral Strictures.

ObjectiveTo identify the pathological classification of benign ureteral strictures according to the histological features and explore the relationship between various pathological types and inflammatory cells, fibroblasts, and collagen.Patients and MethodsThirty one specimens from patients diagnosed with ureteral strictures between 2013 and 2021 were included and classified according to the histopathological characteristics. The number of fibroblasts and inflammatory cells was counted, and the proportion of type I and type III collagen in ureteral stricture tissues was detected by picrosirius red staining.ResultsWe identified three types of benign ureteral strictures in 31 specimens: inflammatory cell infiltration (n = 10, 32%), fibroplasia (n = 14, 45%), and hyalinization (n = 7, 23%), with significant differences in obstruction history and hydronephrosis grades among the three types. The number of inflammatory cells (lymphocytes, neutrophils and eosinophils) was significantly lower in hyalinization ureteral strictures than in the other two types (p < 0.05). The number of foreign-body giant cells associated with foreign-body reactions increased significantly in suture-induced ureteral strictures (p < 0.05). Fibroplasia type had the largest number of fibroblasts, whereas the other two types had smaller numbers. The results of type I and III collagen analysis showed that type I and III collagen were the most abundant in hyalinization among all ureteral stricture types (p < 0.05). Compared to ureteral strictures, the content of type I and III collagen in atresia increased significantly (p < 0.05).ConclusionCommon pathological types of benign ureteral strictures include inflammatory cell infiltration, fibroplasia, and hyalinization. Changes in type I and III collagen, inflammatory cells, and fibroblasts in different pathological types may be related to the progression of ureteral strictures.