Renal Angiography Research Articles

Application of Multi-Slice Spiral CT Renal Angiography Combined with Intraoperative Ultrasound in Laparoscopic Partial Nephrectomy.

This study aimed to evaluate the clinical significance of multi-slice spiral CT renal angiography combined with intraoperative ultrasound in laparoscopic partial nephrectomy. Eighty patients were seen at the Affiliated Hospital of Hebei University from January 2021 to December 2022. The patients were divided into two groups, the experimental group and the control group, with 40 cases in each group. The experimental group received laparoscopic partial nephrectomy combined with intraoperative ultrasound, while the control group received only conventional laparoscopic partial nephrectomy. The experimental group had significantly shorter operative time and intraoperative thermal ischaemia time (p <0.05) and had significant advantage in the detection of microscopic cancer foci (p = 0.04). The experimental group also had significantly lower of positive rate of postoperative incisal margin (p = 0.01). The experimental group had significantly lower of recurrence rate (p = 0.03). The study concluded that multi-slice spiral CT renal angiography combined with intraoperative ultrasound boasts various benefits in the treatment of patients with renal cell carcinoma, it is safe and effective with no significant impact on renal function. Key Words: CT renal angiography, Intraoperative ultrasound, Laparoscopic partial nephrectomy, Renal cancer.

Application of Multi-Slice Spiral CT Renal Angiography Combined with Intraoperative Ultrasound in Laparoscopic Partial Nephrectomy.

This study aimed to evaluate the clinical significance of multi-slice spiral CT renal angiography combined with intraoperative ultrasound in laparoscopic partial nephrectomy. Eighty patients were seen at the Affiliated Hospital of Hebei University from January 2021 to December 2022. The patients were divided into two groups, the experimental group and the control group, with 40 cases in each group. The experimental group received laparoscopic partial nephrectomy combined with intraoperative ultrasound, while the control group received only conventional laparoscopic partial nephrectomy. The experimental group had significantly shorter operative time and intraoperative thermal ischaemia time (p <0.05) and had significant advantage in the detection of microscopic cancer foci (p = 0.04). The experimental group also had significantly lower of positive rate of postoperative incisal margin (p = 0.01). The experimental group had significantly lower of recurrence rate (p = 0.03). The study concluded that multi-slice spiral CT renal angiography combined with intraoperative ultrasound boasts various benefits in the treatment of patients with renal cell carcinoma, it is safe and effective with no significant impact on renal function. Key Words: CT renal angiography, Intraoperative ultrasound, Laparoscopic partial nephrectomy, Renal cancer.

Spontaneous Renal Arteriovenous Malformation Presenting with Hematuria: A Case Report

Introduction: Rare vascular abnormalities called renal arteriovenous malformations (AVMs) can cause hematuria among other symptoms. Due to overlapping clinical and radiological symptoms, differentiating between renal AVMs and other disorders such renal cell carcinoma (RCC) can be difficult. Here, we report a case of a patient who developed hematuria and was first diagnosed with renal AVM. We go over the difficulties in diagnosing this ailment and the approaches to managing it. Case Presentation: A 34-year-old female patient, reported having hematuria with clots for one week, coupled with fever and left loin discomfort that persisted for four and one day, respectively. Her hemoglobin level was 4.5 g/dL at arrival, which required packed red cell transfusions. A left double-J stent was implanted after an emergency cystoscopy revealed bloody efflux from the left ureteric orifice. A potential arteriovenous malformation in the left kidney's upper pole area was discovered by further imaging. A cirsoid-type AV abnormality arising from the superior polar branch of the renal artery was verified by renal angiography. After therapeutic embolization, the patient's symptoms were relieved and hematuria stopped. Discussion: The case study highlights the need of taking renal AVMs into account when making a differential diagnosis for hematuria, especially if there haven't been any previous urological operations. It also emphasises how important imaging techniques like renal angiography and renal ultrasonography with Doppler are for making the right diagnosis. Distinctive diagnosis from other ailments, such as renal cell carcinoma, highlights the necessity of comprehensive assessment and monitoring to guarantee suitable treatment. Conclusion: Renal arteriovenous malformations are rare but important causes of hematuria. Prompt diagnosis and management are crucial to prevent complications and improve patient outcomes. This case report demonstrates the diagnostic challenges associated with renal AVMs and underscores the importance of a multidisciplinary approach in their evaluation and treatment.

Prevalence and Risk Factors of Renal Artery Stenosis in Patients Undergoing Simultaneous Coronary and Renal Artery Angiography: A Systematic Review and Meta-Analysis of 31,689 Patients from 31 Studies.

Background/Objectives: Renal artery stenosis (RAS) is associated with coronary artery disease (CAD), exacerbation of arterial hypertension, and progression to heart failure, but remains frequently unrecognized in clinical practice. Methods: We conducted a systematic review and meta-analysis of studies by pooling data of patients undergoing CAG due to suspected or stable CAD that received a bilateral renal artery angiography. Results: A total of 31 studies with 31,689 patients were included (mean age 63.2 ± 8.7 years, 20.9% were female). Overall, 13.4% (95%CI 10.5-16.7%) of patients undergoing coronary angiography had significant RAS, with 6.5% (95% CI 4.5-8.9%) and 3.7% (95%CI 2.5-5.2%) having severe and bilateral RAS. The mean weighted proportion of patients with three-vessel coronary disease (3VD) was 25.1 (95%CI 19.6-30.9%) while 4.2% (95%CI 2.6-6.2%) had left main (LM) coronary disease. Patients with RAS compared to those without RAS were significantly older (mean difference, MD 4.2 years (95%CI 3.8-4.6)). The relative risk of RAS was greater for the female sex (risk ratio, 95%CI; RR 1.3, 1.03-1.57), presence of diabetes (RR 1.2, 1.10-1.36), arterial hypertension (RR 1.3, 1.21-1.46), dyslipidemia (RR 1.1, 1.06-1.14), peripheral artery disease (PAD) (RR 2.1, 1.40-3.16), chronic kidney disease (CKD) (RR 2.6, 2.04-3.37), 3VD (RR 1.6, 1.30-1.87), and LM disease (RR 1.8, 1.28-2.47). Smoking had a neutral effect on the risk of RAS occurrence (RR 1.0, 0.94-1.06). Conclusions: RAS is common in patients undergoing coronary angiography. CKD, PAD, older age, and severe CAD were among the strongest predictors for the presence of significant RAS.

Ten-Year Outcomes in Patients Undergoing Simultaneous Coronary and Renal Angiography-Does Renal Artery Stenosis Matter?

Background: We aimed to characterize the population of consecutive patients undergoing coronary angiography with simultaneous renal artery angiography and assess prognostic factors at a 10 year follow-up. Methods: The KORONEF study was a prospective, single-center, observational, and descriptive study with 492 patients included. We analyzed several baseline demographics, clinical and periprocedural characteristics, and laboratory data, and we assessed the results of coronary angiography and renal artery angiography. Results: The study population consisted of 37.2% women, and the mean age was 64.4 ± 9.9 years (min. 30 years, max. 89 years). Angiography revealed significant renal artery stenosis (RAS) in 35 (7.1%) patients. Among patients with significant RAS (≥50%), we observed more women (57.1% vs. 35.7%, p = 0.011), and patients were older (69.1 ± 10.4 years vs. 64.0 ± 9.7 years, p = 0.005). In the whole population, all-cause death was reported in 29.9% of patients, myocardial infarction (MI) rate-in 11.8%, and stroke-in 4.9%. In the multivariable analysis, independent predictors of death were age 65-75 years (HR 2.88), age > 75 years (HR 8.07), diabetes (HR 1.59), previous MI (HR 1.64), chronic kidney disease (HR 2.22), unstable angina (HR 0.37), and left ventricular ejection fraction > 60% (HR 0.43). Conclusions: Over a 10 year follow-up, the all-cause death rate was 29.9%, showing no statistically significant differences between patients with and without significant RAS.

#2169 Transplant renal artery stenosis in recipients with resistant arterial hypertension

Abstract Background and Aims Transplant Renal Artery Stenosis (TRAS) is a vascular complication after kidney transplantation. It worsens the prognosis of the graft and the patient's life. The aim was to study the incidence of TRAS as a cause of resistant arterial hypertension in kidney transplant recipients in the Republic of Belarus and the efficiency of its endovascular treatment. Method The study included 187 kidney transplant recipients. Blood pressure of 72 (38.5%) patients was less than 130/80 mmHg without taking antihypertensive drugs. Arterial hypertension was diagnosed in 115 (61.5%) recipients. The study included clinical, laboratory and instrumental methods (24-hour blood pressure monitoring, Doppler ultrasound, graft scintigraphy with captopril). Results 31 (16.6%) recipients needed to take one antihypertensive drug, 43 (23.0%)—2 drugs, 41 (21.9%)—3 or more. 17 (9.1%) recipients did not have target blood pressure correction while taking more than 4 antihypertensive drugs. There was decreased blood flow in the graft artery with a peak systolic velocity &amp;gt; 200 cm/s in 14 (7.5%) cases. These patients were submitted to the graft nephroscintigraphy with caplopril where 8 grafts (4.3%) were diagnosed signs of TRAS. These recipients were submitted to the renal angiography with the injection of 150 (100; 200) ml of contrast agent. 5 (2.7%) recipients were diagnosed with hemodynamically significant TRAS of more than 70 (65; 75) % and received percutaneous transluminal angioplasty and stenting. All these patients had a decrease of glomerular filtration rate and resistant arterial hypertension before operation. The average age of the patients with TRAS was 57.4 ± 11.0 years, the period after transplantation was 11 ± 3 months. Their blood tests did not show dyslipidemia, but 4 out of 5 cases had diabetes mellitus. Their postoperative period had no complications. The patient was placed on dual antiplatelet therapy with aspirin and clopidogrel. There was an increase in glomerular filtration rate by 27 ± 7 ml/min/1.73 m2 and a decrease in systolic blood pressure by 40 (40; 45) mm Hg in the early postoperative period. Graft artery stenting allowed reducing the number of antihypertensive drugs to one tablet in 4 out of 5 patients. Conclusion Transplant Renal Artery Stenosis is a rare but significant complication of the late postoperative period that may cause resistant hypertension in kidney transplant recipients. Timely identification and stenting of the graft artery improves the graft functioning and reduces blood pressure.

IMPACT OF ACCESSORY RENAL ARTERIES ON HYPERTENSION IN YOUNG PATIENTS

Objective: To determine whether there is a correlation between hypertension, accessory renal arteries, and levels of renin and aldosterone. Design and method: From March 2023 to December 2023, 11 young patients (9 males and 2 females) between 22-41 years were hospitalized with suspected secondary arterial hypertension (AH). Prior to hospitalization, all underwent standard pre-analytical medication preparation with cessation of hormone affecting medications and transferred to alternative treatment. For all patients, a computer tomography was conducted following a renal angiography protocol for the presence of adrenal glands formations and the presence of accessory renal arteries. In parallel with the imaging study, laboratory analyses for renin/aldosterone, metanephrine, and normetanephrine were done. ECG, echocardiography and 24-hour monitoring of arterial blood pressure were performed. Results: In 10 (91%) of the examined patients, accessory renal arteries were identified - 2 (20%) on the right with two accessory renal arteries; 4 (40%) on the left, and the remaining 4 (40%) had bilateral accessory renal arteries. One patient exhibited an accessory artery in conjunction with Nutcracker Syndrome, and another patient with a combination of a hormonally inactive adenoma of the right adrenal gland. The average blood pressure during 24-hour monitoring was 165/96±12/8 mmHg. Echocardiography revealed initial left ventricular hypertrophy in 50% of the examined patients, with a trend towards reduced relaxation. Overall, 8 patients had abnormal renin/aldosterone abnormalities - 7 (64%) in the group with accessory renal arteries (ARA), and 1 (9%) in the group without ARA where primary hyperaldosteronism was diagnosed. In the ARA, 6 had elevated levels of both renin and aldosterone. In 1 case in ARA group, only renin was elevated. Metanephrine and normetanephrine levels were within normal limits in all cases. Conclusions: We find relatively high rate of the presence of ARA, which may be regarded as an etiological entity. Elevated levels of renin and aldosterone were detected in a significant subset of the patients. Hypertensive patients with ARA may develop early severe damage of target organs.

Segmental artery angioembolization as an efficient treatment modality for delayed hematuria with normal angiography: two case reports

BackgroundPercutaneous nephrolithotomy is the most commonly used modality for the removal of kidney stones larger than 2 cm in size. Like other stone removal methods, percutaneous nephrolithotomy also has some complications, including bleeding and delayed hematuria. These complications are improved with conservative management and bed rest most of the time. However, it may require more invasive treatments. Angioembolization following an abnormal renal angiography is an efficient treatment modality for delayed hematuria. Furthermore, nephrectomy is suggested in uncontrolled cases of delayed hematuria when renal angiography is normal.Case presentationWe described two cases of uncontrolled delayed hematuria after percutaneous nephrolithotomy and angioembolization were carried out rather than potential nephrectomies. The first case was a 61-year-old Iranian man with left kidney stones, for whom percutaneous nephrolithotomy was planned. The patient was referred to the hospital after discharge with massive hematuria and had normal angiographic findings. An angioembolization was suggested for the patient and was carried out. His hematuria was dramatically improved within 30 minutes, and his hemoglobin level started to increase 2 days later. The second case was a 53-year-old Iranian man with kidney stones who was a candidate for right kidney percutaneous nephrolithotomy. The patient was referred to the hospital 4 days after discharge with a decreased hemoglobin level and massive hematuria. The patient had normal angiographic findings and was planned for angioembolization to control his hemorrhage, which dramatically decreased after the angioembolization within 60 minutes.ConclusionEmbolization of the segmental arteries of the targeted calyx can eliminate hematuria of the patient and prevent further nephrectomy.

Deep-learning-based renal artery stenosis diagnosis via multimodal fusion.

Diagnosing Renal artery stenosis (RAS) presents challenges. This research aimed to develop a deep learning model for the computer-aided diagnosis of RAS, utilizing multimodal fusion technology based on ultrasound scanning images, spectral waveforms, and clinical information. A total of 1485 patients received renal artery ultrasonography from Peking Union Medical College Hospital were included and their color doppler sonography (CDS) images were classified according to anatomical site and left-right orientation. The RAS diagnosis was modeled as a process involving feature extraction and multimodal fusion. Three deep learning (DL) models (ResNeSt, ResNet, and XCiT) were trained on a multimodal dataset consisted of CDS images, spectrum waveform images, and individual basic information. Predicted performance of different models were compared with senior physician and evaluated on a test dataset (N=117 patients) with renal artery angiography results. Sample sizes of training and validation datasets were 3292 and 169 respectively. On test data (N=676 samples), predicted accuracies of three DL models were more than 80% and the ResNeSt achieved the accuracy 83.49%±0.45%, precision 81.89%±3.00%, and recall 76.97%±3.7%. There was no significant difference between the accuracy of ResNeSt and ResNet (82.84%±1.52%), and the ResNeSt was higher than the XCiT (80.71%±2.23%, p<0.05). Compared to the gold standard, renal artery angiography, the accuracy of ResNest model was 78.25%±1.62%, which was inferior to the senior physician (90.09%). Besides, compared to the multimodal fusion model, the performance of single-modal model on spectrum waveform images was relatively lower. The DL multimodal fusion model shows promising results in assisting RAS diagnosis.

Primary Thyroid-Like Follicular Carcinoma of Kidney: Review and Update

Thyroid-like follicular carcinoma of the kidney (TLFCK) is an exceedingly uncommon tumor which has been reported sporadically on very rare occasions that afflict individuals whose ages had tended to range between 10 years and 83 years. There are no specific manifesting symptoms for this neoplasm and TLFCK had most often been diagnosed incidentally during assessment of individuals for other conditions. Confirmation of the diagnosis of TLFCK is based upon histopathology examination and immunohistochemistry staining features of the tumor and exclusion of a primary thyroid follicular carcinoma metastasizing to the kidney with radiology imaging evidence of absence of follicular carcinoma of the thyroid gland. It also needs to be appreciated that immunohistochemistry staining features for thyroid-like follicular carcinoma of the kidney are different from the features of primary follicular carcinoma of thyroid gland. TLFCK does tend to afflict one kidney only generally. On rare occasions the kidney could be afflicted by metastasis from primary follicular carcinoma of thyroid gland but in such scenarios, there tends to be evidence of multiple metastases afflicting many other organs as disseminated tumor. TLFCK tends to portend generally a low-rate of malignancy; however, few cases had been reported associated with metastasis. Even though TLFCK is regarded to most often be a tumor that is associated with a low-rate of malignancy with no development of local recurrence or distant metastasis, because few cases of TLFCT had been ensued by the subsequent development of metastasis after a long-time, it would be recommended that all patients who had undergone treatment for a diagnosed TLFCK should be followed-up regularly over a period of a long-time. Patients who had been diagnosed as having primary TLFCK have tended to be treated by means of surgery in the form of partial nephrectomy or radical nephrectomy which could entail the undertaking of open surgery, laparoscopic surgery or robotic surgery. Other procedures including pre=operative biopsy of the tumor for pathology examination confirmation of the diagnosis followed by undertaking of less-invasive procedures including: cryotherapy of the tumor, radiofrequency ablation of the tumor, irreversible electroporation of the tumor, and selective renal artery angiography and super-selective embolization of the branch of renal artery supplying the tumor in the kidney, to the knowledge of the author has so far not been reported as treatment procedures for cases of primary TLFCK.

EVALUATION OF ANATOMICAL VARIATIONS OF EXTRARENAL RENAL ARTERIAL VASCULATURE IN VOLUNTARY KIDNEY DONORS

Objective: The present study was aimed at evaluating the variations in extrarenal renal arterial vasculature in voluntary kidney donors who had undergone Multi-Detector Computed Tomography (MDCT) renal angiography for preoperative workup. Methods: A retrospective hospital based cross-sectional study was carried out in a tertiary care Army hospital in Delhi from Jan 2019 to June 2020. All voluntary kidney donors included in the study underwent Multi-Detector Computed Tomography Angiography (MDCTA) of renal arteries as a part of routine pre-operative imaging protocol and were referred by the treating physician/surgeon for MDCTA study. Retrospective analysis of the image datasets was undertaken by the principal investigator and individual patient consent was waived off by the institutional Ethics committee. Results: The mean age of study participants was 45.9±10.2 y. Accessory renal artery was relatively more common on left side (p-value 0.001). There was statistically no significant difference between gender and the presence of accessory renal artery. There was statistically no significant difference on the comparison of side and gender with distance of segmentary bifurcation of MRA. The orthogonal diameters at the origin of the MRA and accessory renal artery on both sides were also comparable. Origin of accessory renal arteries were caudal to MRA was more frequently seen. Early segmentary bifurcation of MRA was commoner on the right side. Conclusion: The study emphasizes the importance of meticulous preoperative assessment, highlighting the need for surgeons to be cognizant of the potential variations in extrarenal renal artery anatomy. Such awareness is crucial for planning successful kidney transplant surgeries.

Successful Endovascular Management of Juxta Internal Iliac Vessel Pseudoaneurysm with Allograft Preservation in Post-Renal Transplant

Vascular complications following renal transplant surgery are extremely uncommon, and pseudoaneurysm is even rarer, with an incidence of 0.3%. The presentation can vary from acute blood loss to chronic dull aching pain, anorexia, etc. Majority of pseudoaneurysms are associated with allograft loss. We present a case of an anastomotic pseudoaneurysm successfully managed with an endovascular approach. A 54-year-old female, post cadaveric renal transplant (end-to-end anastomosis between the renal artery and right internal iliac artery) presented on post-operative day 159 with complaint of fever with chills. On treating conservatively with antibiotics, the fever subsided, only to recur after 5-days. On further investigation, c-reactive protein (CRP) was found to be persistently elevated. Patient’s fever of unknown origin was further investigated with repeat blood culture and fluoro-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT). Blood culture was positive for Klebsiella pneumoniae sensitive to colistin and tigecycline and FDG-PET showed a 5 cm aneurysm of the juxta anastomotic segment of the right internal iliac vessels, a possible pseudoaneurysm. After a multidisciplinary discussion, the patient underwent renal angiography, an aneurysm was delineated, and a covered stent was placed which partially excluded the aneurysm. The patient responded well to the intervention. Pseudoaneurysm formation is a rare and potentially life-threatening complication and can present even in the late post-operative period. Endovascular management can be a safe approach in carefully selected cases with allograft preservation being of paramount importance.

Influencing Factors of Massive Hemorrhage and High-Grade Renal Vascular Injury after PCNL: A Retrospective Comparative Study.

Severe hemorrhage after percutaneous nephrolithotomy (PCNL) is a rare but alerting event. In this study, we report the factors affecting massive hemorrhage after PCNL, various levels of vascular damage during renal angiography, and the therapeutic effect of superselective renal artery embolization (SRAE). Patients and Methods. A retrospective analysis was performed on the data of 69 patients with postoperative PCNL hemorrhage who underwent SRAE from January 2010 to March 2021. Inclusion criteria for all cases were failure of conservative treatment for severe renal hemorrhage after surgery and then treatment with SRAE. In addition, 98 patients without significant hemorrhage after PCNL were randomly selected as the control group. All clinical data are confirmed by imaging and laboratory examinations. We performed univariate and multivariate analyses to find risk factors of massive hemorrhage and high-grade renal vascular injury after PCNL. A total of 69 patients underwent angiography, 64 of which received SRAE due to positive hemorrhages detected by angiography. Urinary tract infection (OR (95% CI) = 11.214 (2.804∼44.842)), high blood pressure (OR (95% CI) = 5.686 (1.401∼23.083)), and no hydronephrosis (OR (95% CI) = 0.189 (0.049∼0.724)) are the most important factors leading to massive hemorrhage after PCNL. In patients who need SRAE after hemorrhage, high-grade vascular injury (grade III) is related to advanced age and decreased hemoglobin. During the perioperative period of PCNL, patients with a risk of hypertension, urinary tract infection, and no hydronephrosis should be strengthened to monitor their high risk of postoperative hemorrhage. For patients with postoperative hemorrhage, we can use the patient's age and decreased hemoglobin before and after operation for analysis. In this way, individualized assessment can greatly improve the efficiency of SRAE treatment.

Bright, photostable and long-circulating NIR-II nanoparticles for whole-process monitoring and evaluation of renal transplantation.

Kidney transplantation is the gold standard for the treatment of end-stage renal diseases (ESRDs). However, the scarcity of donor kidneys has caused more and more ESRD patients to be stuck on the waiting list for transplant surgery. Improving the survival rate for renal grafts is an alternative solution to the shortage of donor kidneys. Therefore, real-time monitoring of the surgical process is crucial to the success of kidney transplantation, but efficient methods and techniques are lacking. Herein, a fluorescence technology based on bright, photostable and long-circulating aggregation-induced emission (AIE) active NIR-II nano-contrast agent DIPT-ICF nanoparticles for the whole-process monitoring and evaluation of renal transplantation has been reported. In the aggregated state, DIPT-ICF exhibits superior photophysical properties compared with the commercial dyes IR-26 and IR-1061. Besides, the long-circulating characteristic of the AIE nano-contrast agent helps to achieve renal angiography in kidney retrieval surgery, donor kidney quality evaluation, diagnosing vascular and ureteral complications, and assessment of renal graft reperfusion beyond renovascular reconstruction, which considerably outperforms the clinically approved indocyanine green (ICG).

Characteristics of patients with non-specific aortoarteritis and arterial hypertension based on retrospective analysis

The aim was to study the medical history, laboratory and instrumental data, the trends of arterial hypertension (AH), risk factors for cardiovascular events, target organ damage (TOD), and the development of cardiovascular complications in patients with NSAA (Non-Specific Aortoarteritis).Materials and Methods. The study included 33 women with confirmed NSAA who had been treated at the 5th Cardiology Department of the E.I. Chazov National Medical Research Center of Cardiology since 2005. Complete blood count, biochemical blood analysis, urine analysis, the following instrumental examinations, such as, ECG, echocardiography, ultrasound of the brachial, femoral, aortic, and renal arteries, MRA or CT angiography with contrast, blood pressure measurement in the arms and legs were performed for all patients. Telephone interviews were conducted to assess some patient's condition over time.Results. The most common symptom (84% of patients) was AH, the average age of AH onset was 30 [19; 40] years and the AH average duration is 7,5 [2; 13] years. Nearly half of the patients (45%) had AH as the leading symptom that led them to perform the examination that helped to the diagnosis of NSAA. The average systolic and diastolic blood pressure values were 123±35 mmHg and 66±17 mmHg in the upper extremities, and 166±31 mmHg and 78±18 mmHg in the lower extremities, respectively. About half of patients (51%) had stage 3 AH, and almost all of them had type 3 according to E. Lupi-Herrera classification. The most common risk factors for cardiovascular events were dyslipidemia (82%), a family history of early cardiovascular events (51%), resting heart rate above 80 bpm (25%), and carbohydrate metabolism disorders (21%). When assessing cardiovascular risk, moderate risk of developing cardiovascular events was observed in 3 patients (10,7%), high risk in 16 patients (57,1%), and very high risk in 9 patients (32,1%). The most common TODs were nervous system damage (53%), including cerebrovascular ischemic events (14%) and left ventricular hypertrophy (42%). This group of patients was characterized by resistant hypertension, and combination with other risk factors for cardiovascular events, it leds to severe TOD and influenced survival rate. In terms of antihypertensive therapy, 61% of patients received combination therapy, with CCB, beta-blockers, and imidazoline receptor agonist being the most prescribed. Two fatal cases were identified in the long-term follow-up, and cardiovascular events, most frequently stroke, were the main complications observed. Additionally, AH progression and its uncontrolled course despite going through multiple drug therapy were characteristic.Conclusion: AH is often difficult to diagnostic in patients with NSAA, and it significantly contributes to the structure of complications and mortality in this patient cohort, progressively worsening over time. It is important to measure blood pressure in both arms and legs to detect elevated values early. The main goals of treatment are achieving NSAA remission and blood pressure control and preventing cardiovascular events.

Recurrent flash pulmonary edema in unilateral renal artery stenosis with contralateral kidney shrinkage: A case report.

Flash pulmonary edema is a critical medical condition characterized by sudden and severe fluid accumulation in the lungs, which poses an immediate and life-threatening emergency. This can arise from a variety of underlying causes. This manuscript presents a case of recurrent pulmonary edema that was successfully managed through the insertion of a renal artery stent. A 78-year-old woman visited the emergency room with recurrent acute dyspnea. Computed tomography renal angiography revealed renal artery stenosis of a single-functioning kidney. Flash pulmonary edema caused by renal artery stenosis of a functioning single kidney. Percutaneous transluminal angioplasty and stenting were performed for the renal artery stenosis. The patient's kidney function rapidly improved, and she has been free of flash pulmonary edema for 2 years. Flash pulmonary edema can have various causes and can immediately be a life-threatening emergency. However, it can be treated with percutaneous revascularization if it is caused by renal artery stenosis. This case report reinforces the importance of accurate and immediate diagnosis when dealing with flash pulmonary edema. This case emphasizes the potential therapeutic benefit of renal artery stenting in the management of flash pulmonary edema caused by renal artery stenosis in patients with a single-functioning kidney.

The performance of duplex ultrasonography for the assessment of renal artery stenosis in Takayasu’s arteritis patients

BackgroundThis study intends to analyze the hemodynamic parameters of the renal artery in patients with Takayasu’s arteritis (TAK) to explore the diagnostic efficacy of duplex ultrasonography in assessing the involved renal artery in TAK patients.MethodsOne hundred fifteen TAK patients with 314 renal arteries were retrospectively analyzed, who were admitted to Peking Union Medical College Hospital between 2017 and 2022. These patients underwent both renal artery ultrasonography and angiography within a 4-week period. Specifically, the study compared seven ultrasonic parameters across groups categorized by the severity of renal artery stenosis (RAS), including noninvolvement, < 50% stenosis, 50–69% stenosis, and 70–99% stenosis. Receiver operating characteristic (ROC) curves were employed to determine the optimal threshold values for renal artery peak systolic velocity (RPSV), renal-aortic PSV ratio (RAR), and renal-interlobar PSV ratio (RIR) in order to diagnose various degrees of RAS in TAK patients.ResultsStatistically significant differences were observed in RAR and RIR among the four groups (all P < 0.05). However, no statistically significant differences were found in RPSV and AT between the moderate stenosis group (50–69% stenosis) and the severe stenosis group (70–99% stenosis). The discrimination of interlobar PSV (IPSV) and interlobar RI (IRI) was not significant, and IEDV did not show statistical significance among the four groups.For TAK patients, the recommended thresholds of RPSV for the diagnosis of renal artery involvement (RAI), ≥ 50% RAS, and ≥ 70% RAS were determined to be 143 cm/s, 152 cm/s, and 183 cm/s, respectively. The sensitivities, specificities, and accuracies of these thresholds were all found to be greater than 80%. Additionally, the optimal thresholds of RIR for detecting RAI, ≥ 50% RAS, and ≥ 70% RAS were determined to be 4.6, 5.6, and 6.4, respectively, with satisfactory diagnostic efficiencies. The areas under the curve (AUCs) for RPSV and RIR were calculated to be 0.908 and 0.910, respectively, for the diagnosis of ≥ 50% RAS, and 0.876 and 0.882 for the diagnosis of ≥ 70% RAS. When the aortic PSV is greater than or equal to 140 cm/s, the RAR exhibits inadequate diagnostic efficacy. Conversely, when the aortic PSV is less than 140 cm/s, a RAR value of 2.2 or higher can be employed as the diagnostic threshold for identifying RAS of 70% or greater, with a sensitivity of 84.00%, specificity of 89.93%, and an overall accuracy of 89.08%.ConclusionIn the present study, it has been demonstrated that RPSV and RIR possess substantial diagnostic value as ultrasonic parameters for diagnosing RAS in TAK patients. Furthermore, when assessing the diagnostic efficacy of RAR, it is crucial to consider the severity of aortic stenosis as a determining factor.

Spontaneous Coronary Artery Dissection Postpartum and Recurrence during Menopause: Hormonal Involvement in Acute Coronary Syndromes

In this case report, we present a case of a 38-year-old woman with no cardiac history and no risk factors who was admitted to the hospital with a spontaneous coronary artery dissection (SCAD) after pregnancy. Twelve years later, she suffered a recurrent SCAD during her menopause. SCAD is a rare occurrence of acute coronary syndromes and recurrence is even more rare. SCAD seems to occur predominantly in females and seems to be related to hormone levels. At first presentation, the patient was 38 years old and 4 weeks postpartum. She presented with chest pain. Electrocardiogram (ECG) showed loss of r-amplitude but no ST-segment deviation. Troponins were elevated and showed significant rise and fall. She was treated with dual anti-platelet strategy and underwent coronary angiography (CAG) which showed a type 1 dissection of the distal circumflex artery. The lesion was treated conservatively. Second presentation was 12 years later, in which she again presented with chest pain this time during menopause. ECG showed marginal changes and the troponins were again elevated. She underwent CAG again which showed a new SCAD (Type 2 B) in the second marginal obtuse artery. The old SCAD lesion was healed. Renal angiography was preformed which showed an renal bead pattern typical for fibromuscular dysplasia. Again, she was treated conservatively. This case is the first case report of a patient suffering from a recurrent SCAD in a different coronary artery, both events probably related to hormonal changes, that is, postpartum and during menopause. This may emphasize careful examination of chest pain in menopause patients with a history of earlier SCAD.

Validation of MAP (Mayo Adhesive Probability) score and preoperative factors to predict adherent perinephric fat in robotic-assisted partial nephrectomy

BackgroundMayo Adhesive Probability (MAP) score is based on posterior perinephric fat thickness and perinephric fat stranding and ranges from 0 to 5. We intend to validate the score and identify preoperative factors predictive of Adherent Perinphric Fat (APF) encountered in robotic-assisted partial nephrectomy.MethodsThe retrospective and prospective observational study was done at a single tertiary care hospital after appropriate ethical clearance. Sixty-two patients with clinical stage cT1 renal mass planned for robotic-assisted partial nephrectomy were selected over a study period of 3 years after obtaining informed consent. Data that were collected included demographic details and perioperative details including CT renal angiography which was done in all patients preoperatively. Intraoperative and postoperative data were collected. Associations of patient and tumor characteristics with the presence of APF during RAPN were evaluated by multivariable logistic regression models and using Chi-square test to calculate p value.ResultsOut of total 62 patients included; 24 patients (38.7%) had intraoperative Adhesive Perinephric Fat (APF). Three patients required conversion to open surgery and three patients underwent conversion to radical nephrectomy. Thirty-five patients were males. Mean age was 51.27(20–77) years. We noted an increased likelihood of APF with an increase in age (p = 0.003), higher preoperative creatinine (p = 0.003), greater posterior perinephric fat thickness (p = 0.002), and perirenal fat stranding (p < 0.001). From these four variables, posterior perinephric fat thickness and fat stranding were the most predictive. The combined score given to these two highly predictive factors for APF and the calculated score, termed Mayo Adhesive Probability (MAP) score ranges from 0 to 5. APF was seen in 10.7% of patients with a MAP score of 0, 25% with a score of 1, 50% with a score of 2, 44.4% with a score of 3, 88.8% with a score of 4, and 100% of patients with a score of 5 was found. Our study validates the MAP score given by Davidiuk et al. Smoking, high BMI, Sex of patient, tumor size, lateral perinephric fat thickness do not significantly predict APF in our study.ConclusionMAP score can be easily calculated from a CT scan. We validate the MAP score in RAPN. Higher MAP score has higher APF which would be useful to all urologists doing RAPN.

A PROSPECTIVE MULTICENTER RANDOMIZED SHAM-CONTROLLED CLINICAL TRIAL TO EVALUATE THE SAFETY AND EFFECTIVENESS OF NETRODTM RADIOFREQUENCY RENAL DENERVATION SYSTEM FOR HYPERTENSION

Objective: To evaluate the safety and effectiveness of a novel basket-like six-electrode radiofrequency renal denervation (RDN) system (NetrodTM RDN System) in treating patients with uncontrolled hypertension. Design and method: This is a prospective, multicenter, randomized sham-controlled trial. Patients with uncontrolled hypertension (office BP &gt; = 150/90 and &lt;180/110mmHg, and average SBP &gt; = 135mmHg by 24-hour ambulatory BP monitoring (ABPM), after taking &gt; = 2 antihypertensive drugs with stable dose for &gt; = 4 weeks) were screened after informed consent. All eligible patients first entered a lead-in period for &gt; = 4 weeks of standardized medication (Nifedipine + hydrochlorothiazide), and those continued to meet definition of uncontrolled hypertension were randomized 2:1 to RDN group (using NetrodTM RDN System) and sham control group (renal artery angiography only). All continued with the 2-drug regimen and were evaluated at 7 days or discharge (whichever comes first), 1, 2, 3 and 6 months post procedure. Both patients and site investigators who evaluate the patients were blinded to treatment assignment. The primary endpoint is office SBP change from baseline at 6 months post procedure. Secondary endpoints include changes from baseline of office DBP. 24-hour ABPM at 6 months post procedure and safety events. Results: A total of 205 patients from 25 centers were enrolled and 139 randomized to RDN group and 66 to sham control group, with no statistical difference of baseline clinical characteristics between the 2 groups including baseline BP. Compared to baseline, at 6 months post procedure RDN group has a significantly greater office SBP reduction than sham group (25.53 ± 12.62mmHg vs 8.39 ± 11.89mmHg, p &lt; 0.001). Office DBP change was -13.49 ± 8.09mmHg (RDN) vs -3.93 ± 9.04mmHg (sham), p &lt; 0.001. For 24-hour ABPM, the average SBP and DBP reduction were also significantly greater in the RDN vs sham group (11.91 ± 12.23 vs 3.87 ± 12.45mmHg, p &lt; 0.001; 6.03 ± 7.50 vs 1.68 ± 7.30mmHg, p &lt; 0.001, respectively). Device or procedure related serious adverse events were rare throughout the trial. Conclusions: The novel NetrodTM RDN System is safe and effective in treating uncontrolled hypertension with significant reduction in both office and 24-hour ambulatory BP.