Renal Intervention Research Articles

Real-time US/cone-beam CT fusion imaging for percutaneous ablation of small renal tumours: a technical note.

Fusion imaging is gaining attention as an imaging technique to assist minimally invasive tumour ablation. Ultrasound (US) and computed tomography (CT) are the most common imaging modalities to guide thermal ablation of renal tumours, yet cone-beam CT (CBCT) has recently been described to successfully assist percutaneous renal interventions. Our goal was to evaluate primary technical success and correct lesion targeting of US/CBCT fusion imaging to guide the ablation of kidney masses < 2 cm in a small group of patients. Six renal lesions (maximum diameter 11-17 mm) were treated with RFA in 5 different patients using real-time US/CBCT. Fusion imaging was used to identify and monitor tumour ablation. Demographics, tumour characteristics and mean serum creatinine levels were recorded before and after the procedure. Primary technical success and correct lesion targeting represented the main endpoints of the study. Primary technique efficacy was confirmed at 1-month and 3-month contrast-enhanced CT follow-ups. In all cases, a confident US/CBCT synchronisation was reached and allowed for a correct targeting and a successful percutaneous ablation. Primary technique efficacy was 100%. No recurrence was observed at the follow-up that ranged from 8 to 26 months (mean 16 months). US/CBCT fusion proved to be a viable method to precisely guide safe and effective percutaneous thermal ablation in patients with small renal tumours, especially when hardly detectable on US. • US/CBCT fusion imaging for renal ablation is safe and feasible. • US/CBCT fusion imaging allows for an improved targeting and complete ablation of small RCC with poor US-conspicuity.

Effect of Uncertainty on Target Registration Error in Image-guided Renal Interventions: From Simulation to in-vitro Assessment.

It is imperative that image-guided intervention (IGI) systems provide accurate and precise navigation information to enable the user to trust the system and not place unwarranted confidence in the guidance capabilities of the system. Unfortunately, the actual error associated with the overall targeting capabilities of an IGI system is not readily known. Here we are primarily interested in the application of image-guided surgery in the context of renal interventions. We built a simulation pipeline to study the uncertainty propagation through an optically tracked IGI system to gain insight into the overall accuracy of the system. Our simulation pipeline models several stages, including stylus calibration, tool tracking, patient tracking, and image to patient registration. In the effort to realistically estimate tracking noise and user-associated fiducial localization error (FLE), we conducted several experiments using the optical tracking system. Our simulation suggested that a wider cone angle results in a more accurate tool calibration, which improves further with the collection of additional samples. Furthermore, our simulations also suggested that the image-to-patient registration was the most significant contributor to navigation uncertainty, followed by the fiducial localization error. Lastly, we also observed a 0.72 correlation between the Target Registration Error (TRE) estimated at target fiducials and the distance between the the centroids of the registration and target fiducial landmarks. To validate the simulation predictions, we also conducted several in vitro experiments using a 3D printed patient specific kidney phantom and compared the simulation-based registration predictions with those observed experimentally in vitro. The experiments confirmed the registration metrics (Fiducial Registration Error and TRE) predicted by the simulations, given several specific combinations of fiducial landmarks used to perform the image to patient registration.

Independent predictors of mortality for patients with traumatic renal injury

To investigate the parameters of renal trauma, including emergent intervention type, that predict the mortality of patients with traumatic renal injury. A retrospective database analysis was performed on patients who sustained a traumatic renal parenchymal injury identified by the 2017 National Trauma Data Bank. Data were analyzed to identify differences in hospital length of stay, ER and hospital disposition, and mortality based on patient age, gender, race, Injury Severity Score, renal injury grade, and need for emergent intervention (angioembolization versus open surgery). Logistic regression was used to correlate intervention type and trauma parameters to mortality. A total of 4,876 of 1,004,440 trauma patients (0.49%) had a traumatic renal injury. Of those, 220 (4.5%) underwent an emergent intervention-29 (0.59%) angioembolization and 191 (3.9%) open renal surgery. 83 patients with a blunt renal trauma (2.0%) underwent renal intervention, whereas 136 (21.0%) with a penetrating injury required a procedure. Forty-five of the 220 patients (20.5%) who had a renal intervention died, while 377 of 4,656 (8.1%) who did not have an intervention died. Multiple logistic regression identified black race, age > 45years, penetrating trauma, and ISS > 15 to be independent predictors of mortality. Neither angioembolization nor open renal surgery was associated with a significantly higher likelihood of mortality in the multivariable model. While procedural interventions are associated with higher mortality for patients with traumatic renal injury, other factors, such as race, age, trauma type, and injury severity may be more predictive of death under care.

Incidence, Predictors, and Clinical Implications of New Renal Impairment Following Percutaneous Coronary Intervention

Renal impairment post-percutaneous coronary intervention (PCI) is a well-described adverse effect following the administration of contrast media.

Пути улучшения результатов лечения пациентов с терминальной стадией хронической почечной недостаточности в исходе урологических заболеваний и активным течением пиелонефрита

Introduction. Patients in the outcome of urological diseases after the beginning of treatment with hemodialysis in the presence of permanent drainage in the kidneys, or with recurrent pyelonephritis have high risks of urosepsis and death. In order to improve the results of diagnosis and treatment of this category of patients, we analyzed our own results. Materials and methods. The study included 58 patients with end-stage chronic renal failure (ESRD) who were treated with hemodialysis and had a nephrectomy for active pyelonephritis in the period from 2013 to 2020. Results. The most informative method in the diagnosis of pyelonephritis was magnetic resonance imaging using diffuse-weighted image protocols (MRI-DWI), the diagnostic efficiency was 94%. There were no differences in the frequency of intraoperative complications in laparoscopic and open nephrectomy. The mortality rate after nephrectomy was 25.9% (n=15). With a preoperative C-reactive protein (CRP) level of more than 95 mg/l (p=0.011) and a Charlson comorbidity index of more than 5 (p=0.003), a high probability of death was predicted. Long-term (more than 14 days) antibacterial preoperative therapy was significantly associated with sepsis before surgery, postoperative antibiotic-associated colitis, and infectious-inflammatory complications from the postoperative wound. Discussion. Our work, as well as many other publications, demonstrates a high incidence of septic complications in patients with ESRD. Patients with permanent drainage in the upper urinary tract are most at risk. this study convincingly showed that the results of nephrectomy are significantly worse in the presence of a systemic inflammatory reaction (SIRS), and therefore it is advisable to perform a nephrectomy before the development of SIRS. Our opinion on the possibility and safety of laparoscopic nephrectomy in chronic pyelonephritis in patients with ESRD who have undergone repeated renal interventions is consistent with a number of other studies in recent years. Conclusion. Diagnosis of pyelonephritis in patients with ESRD is advisable to start with MRI-DWI. The results of nephrectomy are better in the absence of a systemic inflammatory response. It is necessary to minimize antibacterial therapy before surgery. Laparoscopic nephrectomy is a safe procedure for inflammatory kidney diseases.

Clinical experience with distal transradial access for endovascular treatment of various noncoronary interventions in a multicenter study.

BackgroundTransradial access is a well-known alternative to conventional transfemoral access for interventional procedures. Recently, transradial access through the “snuffbox”, which lies in the radial dorsal aspect of the hand, has been introduced as a new technique with positional versatility. In this study, we aimed to evaluate the clinical feasibility and safety of distal transradial access for interventional procedures in a retrospective, multicenter study.Material & methodsDistal transradial access was attempted in 46 patients (36 men and 10 women; mean age, 64 years) who underwent 47 consecutive procedures from January 2018 to December 2019. Procedures included chemoembolization (19/47, 40.4%), bronchial artery embolization (7/47, 14.9%), renal intervention (3/47, 6.4%), arteriovenous fistula angioplasty (7/47, 14.9%), subclavian artery stenting (5/47, 10.6%), other embolization (5/47, 10.6%), and uterine artery embolization (1/47, 2.1%). We recorded the success rate of the procedures, complications, and postprocedural hemostasis time during the follow-up period.ResultsThe technical success of distal transradial access without major complications was 97.9% (46/47). Of the 46 patients, one patient (2.2%) had a minor complication, which was a thrombotic segmental occlusion of the distal radial artery. Of the enrolled patients, only one patient did not complete the transradial access procedure via the snuffbox because the left proximal subclavian artery was occluded and a crossover to conventional transfemoral access was performed. The mean postprocedural hemostasis time was 131.7 minutes (range, 120–360 minutes).ConclusionDistal transradial access can be a valid option for the endovascular treatment of various noncoronary interventions with technical feasibility and safety.

Surgical Tracking, Registration, and Navigation Characterization for Image-guided Renal Interventions.

Most image-guided interventions rely on surgical tracking and image/model to patient registration to establish a spatial relationship between the patient and the pre- and intraprocedural images, by using surgical tracking and localization systems. In this work, we characterize the tracking, registration and navigation accuracy using two different surgical localization systems - the NDI Polaris Spectra optical tracking system and the NDI Aurora electromagnetic tracking system - in the context of an image-guided renal intervention, using a 3D printed life-size model of a patient-specific kidney phantom generated from a CT image. Our results reported a 0.05 mm fiducial localization error, 0.70 mm fiducial registration error, and 0.78 mm target registration error, and 0.63 mm overall navigation error using the optical tracking, and 0.12 mm fiducial localization error, 0.78 mm fiducial registration error, 0.93 mm target registration error and 0.89 mm overall navigation error using electromagnetic tracking. Additionally, our study also showed similarity between the overall navigation accuracy using optical (0.63 mm RMS error) or electromagnetic tracking (0.89 mm RMS error) and the overall navigation accuracy achieved using direct visualization of the surgical scene (0.68 mm and 1.06 RMS error respectively), which serves as a baseline control metric.

Barriers to and Enablers of Implementation of High-Value Interventions by Renal Pharmacists: A Qualitative Study Informed by the Theoretical Domains Framework

Previous studies have shown that patients with chronic kidney disease who are followed by a renal clinical pharmacist have improved clinical outcomes. In 2016, a consensus list of quality indicator drug therapy problems (QI-DTPs) was developed by renal clinical pharmacists to help prioritize which renal patients should receive interventions. Before QI-DTP interventions can be implemented in clinical practice, barriers to and enablers of their use need to be identified, to allow development of strategies to overcome the barriers and apply the enablers. To identify modifiable barriers to and enablers of implementation of renal QI-DTP interventions by renal clinical pharmacists. In this exploratory qualitative descriptive study, one-on-one, semistructured, audio-recorded telephone interviews were conducted with renal clinical pharmacists to identify the barriers to and enablers of implementation of renal QI-DTP interventions. The interviews consisted of questions developed according to the Theoretical Domains Framework. Interviews were conducted with 13 renal pharmacists from across Canada. The main barriers to implementation of renal QI-DTP interventions that participants identified were knowledge gaps, prioritization, and nephrologist acceptance. The main enablers identified were training, colleague support, and better patient care. Three barriers to and three enablers of implementation of renal QI-DTP interventions were identified. These barriers and enablers can be used to help with pharmacist education and to optimize the care that pharmacists provide to renal patients.

Renal artery angiography in pediatric trauma using a national data set

With limited pediatric renal trauma management literature, treatment pathways for children have been extrapolated from the adult population. A shift to non-operative management has led to higher renal preservation rates; however, characterization of endovascular intervention in the pediatric trauma population is lacking. This study uses the National Trauma Data Bank (NTDB), to evaluate renal outcomes after use of renal artery angiography. We hypothesized that patients undergoing renal artery angiography for renal trauma are unlikely to require additional surgical interventions. All children ≤18 years old treated for traumatic renal injuries from 2012 to 2015 were identified by the Abbreviated Injury Scaled Score (AISS) codes in the NTDB. AISS codes were converted to American Association for Surgery of Trauma (AAST) grades. ICD-9 codes were used to identify patients that had renal artery angiography, and additional renal interventions such as nephrectomy, partial nephrectomy, percutaneous nephrostomy tube or ureteral stent placement. 536,379 pediatric trauma cases were in the NTDB from 2012 to 2015, with 4506 renal injury cases identified. A total of 88 patients had renal artery angiography (ICD-9 88.45). Only 10% (n=9) of patients who received renal artery angiography underwent an additional urological intervention. Of those nine, two patients were excluded due to renal angiography taking place after nephrectomy was performed. The remaining seven patients had high grade laceration (AAST grade 4-5). Overall, two patients underwent post angiography nephrectomies, two patients had partial nephrectomies, one percutaneous nephrostomy tube was placed (prior to partial nephrectomy), one aspiration of a kidney (prior to ureteral stent placement), and three had ureteral stent placements. The limitations of this study include: the NTDB is a national dataset that is not population based, inclusion is limited to the first hospitalization, inaccuracies exist in encounter coding, and the database is lacking laterality of the renal injury. Based on nonspecific nature of ICD-9 coding for angioembolization, we are unable to discern the number of cases that subsequently had angioembolization after or at the time of angiography. Renal artery angiography in children remains a rare procedure, 88/4,506, in children with renal trauma. In pediatric trauma cases that undergo renal artery angiography additional procedures are more common with higher grade injuries. Further studies are needed to create pediatric specific trauma management algorithms.

Review and meta-analysis of renal artery damage following percutaneous renal denervation with radiofrequency renal artery ablation.

We aimed to estimate the rate of renal artery adverse events following renal denervation with the most commonly applied radiofrequency catheter system based on a comprehensive review of published reports. We reviewed 50 published renal denervation (RDN) trials reporting on procedural safety including 5,769 subjects with 10,249 patient-years of follow-up. Twenty-six patients with renal artery stenosis or dissection (0.45%) were identified of whom 24 (0.41%) required renal artery stenting. The primary meta-analysis of all reports indicated a 0.20% pooled annual incidence rate of stent implantation (95% CI: 0.12 to 0.29% per year). Additional sensitivity analyses yielded consistent pooled estimates (range: 0.17 to 0.42% per year). Median time from RDN procedure to all renal intervention was 5.5 months (range: 0 to 33 months); 79% of all events occurred within one year of the procedure. A separate review of 14 clinical trials reporting on prospective follow-up imaging using either magnetic resonance imaging, computed tomography or angiography following RDN in 511 total subjects identified just 1 new significant stenosis (0.20%) after a median of 11 months post procedure (one to 36 months). Renal artery reintervention following renal denervation with the most commonly applied RF renal denervation system (Symplicity) is rare. Most events were identified within one year.

Comparing Mobile C-Arm with a Hybrid Operating Room for Imaging in Fenestrated Stent-Graft Endovascular Abdominal Aortic Aneurysm Repair

To evaluate the advantages of a hybrid operating room (OR) (group 2) compared with a fluoroscopic mobile C-arm (group 1) during fenestrated stent-graft endovascular aneurysm repair (f-EVAR). This single-center study retrospectively analyzed prospectively collected data of consecutive patients treated with f-EVAR for short-necked, juxtarenal, and suprarenal aortic aneurysms between January 2006 and July 2016. Primary end points were technical success and perioperative complications. Secondary end points included 30-day and 1-year mortality as well as target vessel patency. About 96 patients were treated (85 men; 74.1±6.3years); 46 patients (48%) belonging to group 1 and 50 (52%) patients belonging to group 2. Technical success was achieved in 92.7% of the procedures (group 1 91.3% vs. group 2 94%, P=0.72). Significantly more complex interventions were performed in group 2 (n=38 of 50) compared with group 1 (n=14 of 46; P<0.001), in which primarily renal f-EVAR interventions were performed. In group 2, significantly less contrast was used (median 150mL vs. 100mL; P<0.001). The 30-day mortality in group 1 was 9% and 2% in group 2 (P=0.14), and 1-year survival was also not significantly different between both groups. Target visceral vessel primary patency was significantly higher in group 1 (87.6% vs. 85.5% [P=0.006] and 83.8% vs. 78.3% [P=0.03]) at 6 and 12months, respectively). There was no significant difference in renal artery primary patency at 6 and 12months. Immediate and 1-year outcomes after f-EVAR for abdominal aortic aneurysm were comparable using a hybrid OR compared with a mobile C-arm, despite the use of significantly more complex stent grafts in the patients treated in the hybrid OR. The use of a hybrid OR may assist in achieving satisfying results in complex f-EVAR.

Identification of the Perturbed Metabolic Pathways Associating With Renal Fibrosis and Evaluating Metabolome Changes of Pretreatment With Astragalus polysaccharide Through Liquid Chromatography Quadrupole Time-Of-Flight Mass Spectrometry.

Renal fibrosis is glomerulosclerosis and renal tubulointerstitial fibrosis caused by the increase of interstitial cells and intercellular substances and the accumulation of extracellular matrix, and is a common pathological manifestation of renal disease progressing to end-stage renal failure. It has proved that Astragalus polysaccharide (AP) has curative effect on renal disease; however, its therapeutic mechanism on renal fibrosis is still unclear. Metabolomics approach provides an opportunity to identify novel molecular biomarkers. The purpose of this study is to study the changes of serum metabolic profile of rats with unilateral tubal ligation and replication of renal fibrosis model and the therapeutic effect of AP on it. The blood samples of rats in the control group, renal fibrosis model group, and AP treatment group collected on the 21st day were analyzed by metabolomics method based on UPLC-Q-TOF-MS. Principal component analysis (PCA) showed that clustering was obvious and significantly separated, and paired partial least squares discriminant analysis (OPLS-DA) was used for further analysis. Combined with the network databases such as HMDB and KEGG and a large number of literatures, 32 potential biomarkers related to renal fibrosis were preliminarily screened out and further verified by MS/MS secondary debris information. After pretreatment with AP, 20 biomarkers were significantly regulated, and correlated with phenylalanine, tyrosine, and tryptophan biosynthesis, phenylalanine metabolism, arachidonic acid metabolism, etc. It also revealed the metabolic changes of renal fibrosis and intervention effect of AP. These data uncover a link between metabolism and the molecular mechanism with potential implications in the understanding of the intervention effect of AP. Conclusively, UPLC-Q-TOF-MS–based metabolomics can be valuable and promising strategy to understand the disease mechanism and natural drug pretreatment.

Renal Thermal Ablation Trends of American Urologists.

Objective: To define current trends in the utilization of renal thermal ablation by urologists in the United States. Material and Methods: A six-month case log data for renal procedures submitted by certifying and recertifying American urologists from 2003 to 2018 were obtained from the American Board of Urology and stratified by current procedural terminology code. The utilization of thermal ablative techniques was examined with respect to overall trends, surgeon, and practice characteristics associated with its use. Results: Six thousand two hundred eleven unique urologists performed 54,075 renal procedures, including 1916 (3.5%) thermal ablations, 630 (1.2%) renal biopsies, 17,361 (32.1%) partial nephrectomies, 20,403 (37.8%) radical nephrectomies, and 7957 (14.7%) nephroureterectomies. Eight hundred twenty-five (13.3%) unique urologists performed renal ablations, including 1344 (70.2%), 418 (21.8%), and 154 (8.0%) laparoscopic, percutaneous, and open ablation procedures, respectively. The annual volume of ablation was highest in 2008, followed by 2010 and 2009. On multivariate modeling of those performing renal interventions, the first decade of practice, self-declared endourologist, urologist who completed an endourology fellowship, urologist who practices in the Mid Atlantic, North Central, South Central, and South Eastern United States (compared with New England) were more likely to perform thermal ablation for renal masses. Urologists who perform renal biopsies and partial nephrectomies are also more likely to perform ablation of renal masses. Conclusions: Thermal ablation accounted for a small percentage of renal interventions performed by urologists in the last 1.5 decades with definable associations to practice characteristics. Renal ablation was most commonly performed laparoscopically, with declining use in recent years.

Anatomical variants of Renal vasculature: A study in adults on multidetector Computerized Tomography angiography scan.

Objectives: To determine renal artery variation in adults in a subset of Karachi population by using Multidetector Computed Tomography (MDCT) angiography. Study Design: A cross sectional study. Setting: Dr. Ziauddin Hospital, Radiology Department, Karachi. Period: From January, 2017 to June, 2017. Material &amp; Methods: Study participants were 250 individuals, who were presented to Dr. Ziauddin hospital, Karachi, Distribution, number and morphology of renal artery variation were reported on Multidetector computed angiography (MDCTA). Renal artery variation with side of the kidney and gender were analyzed. Data was analyzed on SPSS version 20 (Statistical Package for Social Sciences). Frequencies and percentages were calculated for renal artery variations. Results: Following parameters were observed. Out of total 250 study participants single renal artery was present in 73.6 % (184) individuals and accessory renal artery was present in 26.4% (66) individuals. Accessory renal arteries (ARA) were present in 13.8% (35) individuals and 12.6% (31) individuals on respectively on right and left sides. Among accessory renal arteries superior polar arteries were present in 14.9% (37) kidneys, hilar arteries in 10.2 % (26) kidneys and inferior polar arteries in 1.3 % (3) kidney. Conclusion: A complete knowledge of renal artery variations is essential for surgeons and interventional radiologist especially during procedures such as renal vascular interventions and renal transplant. Frequency of ARA in our studied population is comparable to Asian population.

Cardiac surgery outcomes in patients with antecedent kidney, liver, and pancreas transplantation: a meta-analysis.

Cardiovascular events are among the most common causes of late death in the transplant recipient (Tx) population. Moreover, major cardiac surgical procedures are more challenging and risky due to immunosuppression and the potential impact on the transplanted organ's functional capacity. We aimed to assess open cardiac surgery safety in abdominal solid organ transplant recipients, comparing the postoperative outcomes with those of nontransplant (N-Tx) patients. Electronic databases of PubMed, EMBASE, and SCOPUS were searched. The endpoints were: overall rate of infectious complications (wound infection, septicemia, pneumonia), cardiovascular and renal events (stroke, cardiac tamponade, acute kidney failure), 30-days, 5-years, and 10-years mortality post-cardiac surgery interventions in patients with and without prior solid organ transplantation. This meta-analysis included five studies. Higher rates of wound infection (Tx vs. N-Tx: OR: 2.03, 95% CI: 1.54 to 2.67, I2 = 0%), septicemia (OR: 3.91, 95% CI: 1.40 to 10.92, I2 = 0%), cardiac tamponade (OR: 1.83, 95% CI: 1.28 to 2.62, I2 = 0%) and kidney failure (OR: 1.70, 95 %CI: 1.44 to 2.02, I2 = 89%) in transplant recipients were reported. No significant differences in pneumonia occurrence (OR: 0.95, 95% CI: 0.71 to 1.27, I2 = 0%) stroke (OR: 0.89, 95% CI: 0.54 to 1.48, I2 = 78%) and 30-day mortality (OR: 1.92, 95% CI: 0.97 to 3.80, I2 = 0%) were observed. Surprisingly, 5-years (OR: 3.74, 95% CI: 2.54 to 5.49, I2 = 0%) and 10-years mortality rates were significantly lower in the N-Tx group (OR: 3.32, 95% CI: 2.35 to 4.69, I2 = 0%). Our study reveals that open cardiac surgery in transplant recipients is associated with worse postoperative outcomes and higher long-term mortality rates.

Traumatic renal injury: Five-year experience at a major trauma centre in South Africa

BackgroundThis study is intended to assess the current optimal management of traumatic renal injuries (TRIs), with a focus on high-grade and penetrating injuries. MethodsThe Pietermaritzburg Metropolitan Trauma Service registry was interrogated retrospectively for patients managed for TRI between 1 January 2012 and 31 December 2016. ResultsOf 13,315 inured patients treated by the PMTS, 223 (1.7%) had TRIs with an incidence of 1.5 per 100,000 population per year. The majority were males between 20 and 39 years of age. The distribution of mechanism of injury was 56.1% (n = 125) blunt and 43.9% (n = 98) penetrating trauma with no association between mechanism and grade of injury. Penetrating trauma was associated with hollow viscus and diaphragm injuries and blunt trauma with solid organ injuries. A total of 118 patients (52.9%) were managed non-operatively, 60 (26.9%) were not explored at operation, 27 (12.1%) underwent initial nephrectomy and 8 (3.6%) underwent renorraphy. Low-grade injuries (AAST I and II) and high-grade injuries (AAST III-V) were managed without renal intervention (non-operatively or not explored at laparotomy for associated injuries) in 88.7% (n = 87) and 72.0% (n = 91) of cases respectively. Blunt and penetrating injuries were managed without renal intervention in 87.9% (n = 109) and 70% (n = 69) of cases respectively. The initial nephrectomy rate was 1% (n = 1) and 20.6% (n = 26) for low- and high-grade injuries respectively, and 6.5% (n = 8) and 19% (n = 19) for blunt and penetrating injuries respectively. High grade (AAST III-V) injury (OR 14.94; 95% CI 3.36 – 66.34; p<0.001), penetrating mechanism (OR 4.99; 95% CI 1.98 – 12.52; p = 0.001) and metabolic acidosis (OR 2.73; 95% CI 1.04 – 7.20; p = 0.042) were significant risk factors for nephrectomy. Four patients (1.8%) underwent ureteral stent insertion and 2 (0.9%) underwent embolisation. The failure rate of initial non-operative management was 1.1%. The mortality rate was 8.1% (n = 18), but no patients with solitary renal injuries died. ConclusionEven in high-grade injuries and penetrating trauma, the majority of patients with TRI can be managed non-operatively or with the assistance of endourological or endovascular techniques, with good outcomes. Risk factors for nephrectomy include the presence of high-grade injuries, penetrating trauma and metabolic acidosis on presentation.

Contrast-Enhanced Ultrasound in Renal Imaging and Intervention.

In recent years, there has been renewed interest in the use of contrast-enhanced ultrasound (CEUS) in abdominal imaging and intervention. The goal of this article is to review the practical applications of CEUS in the kidney, including renal mass characterization, treatment monitoring during and after percutaneous ablation, and biopsy guidance. Current evidence suggests that CEUS allows accurate differentiation of solid and cystic renal masses and is an acceptable alternative to either computed tomography (CT) or magnetic resonance imaging (MRI) for characterization of indeterminate renal masses. CEUS is sensitive and specific for diagnosing residual or recurrent renal cell carcinoma (RCC) following percutaneous ablation. Furthermore, given its excellent spatial and temporal resolution, CEUS is well suited to demonstrate tumoral microvascularity associated with malignant renal masses and is an effective complement to conventional grayscale ultrasound (US) for percutaneous biopsy guidance. Currently underutilized, CEUS is an important problem-solving tool in renal imaging and intervention whose role will continue to expand in coming years.

Sonic hedgehog pathway mediates genistein inhibition of renal cancer stem cells

Cancer stem cells (CSCs) have been implicated in the genesis, progression and recurrence of renal cancer. The sonic hedgehog (Shh) pathway serves a critical role in maintaining the stemness of CSCs. Genistein, a major isoflavone component extracted from soybeans and soy products, has been demonstrated to possess anticancer activity. However, the effects of genistein on renal CSCs and its underlying mechanisms remain to be fully elucidated. The aim of the present study was to investigate the role of the Shh pathway in genistein inhibition of renal CSCs. The results of the present study demonstrated that expression levels of renal CSC markers were markedly upregulated in the sphere-forming cells, which were isolated and enriched from 786-O and ACHN cells in a tumor sphere formation assay, and more cells were arrested at the G0/G1 phase instead of the S1 phase compared with the adherent cells. Furthermore, the present study demonstrated that genistein could effectively diminish the activity of renal CSCs by suppressing tumor sphere formation, decreasing renal CSCs markers, inhibiting proliferation and inducing apoptosis. Additionally, the downregulation of Shh pathway activity could inhibit renal CSCs. Genistein exhibited an inhibitory effect on renal CSCs by attenuating the activation of the Shh pathway. In conclusion, the results illustrated the role of the Shh pathway in regulating renal CSC traits and the intervention of renal CSCs by genistein, which could provide novel insights into the molecular mechanisms of renal CSC intervention.

SUN-259 RISK FACTORS OF KIDNEY DISEASES AND RENAL BIOPSY RESULTS IN MACKAY, NORTH QUEENSLAND: A RETROSPECTIVE STUDY

Mackay region has one of the highest rates of overweight and obesity in Queensland, Australia, comprising 83.4 per cent of its adult population. In this retrospective clinical audit, we studied the results of renal biopsies, risk factors of renal impairment, and biopsy-related complications at the Mackay Base Hospital (MBH), Queensland, Australia. Based on this epidemiology data, we aim to have earlier identification of the modifiable risk factors of renal diseases, targeted and effective public health promotion, earlier renal surveillance and intervention for at risk population before developing chronic renal failure.

The associations between initial radiographic findings and interventions for renal hemorrhage after high-grade renal trauma: Results from the Multi-Institutional Genitourinary Trauma Study.

Indications for intervention after high-grade renal trauma (HGRT) remain poorly defined. Certain radiographic findings can be used to guide the management of HGRT. We aimed to assess the associations between initial radiographic findings and interventions for hemorrhage after HGRT and to determine hematoma and laceration sizes predicting interventions. The Genitourinary Trauma Study is a multicenter study including HGRT patients from 14 Level I trauma centers from 2014 to 2017. Admission computed tomography scans were categorized based on multiple variables, including vascular contrast extravasation (VCE), hematoma rim distance (HRD), and size of the deepest laceration. Renal bleeding interventions included angioembolization, surgical packing, renorrhaphy, partial nephrectomy, and nephrectomy. Mixed-effect Poisson regression was used to assess the associations. Receiver operating characteristic analysis was used to define optimal cutoffs for HRD and laceration size. In the 326 patients, injury mechanism was blunt in 81%. Forty-seven (14%) patients underwent 51 bleeding interventions, including 19 renal angioembolizations, 16 nephrectomies, and 16 other procedures. In univariable analysis, presence of VCE was associated with a 5.9-fold increase in risk of interventions, and each centimeter increase in HRD was associated with 30% increase in risk of bleeding interventions. An HRD of 3.5 cm or greater and renal laceration depth of 2.5 cm or greater were most predictive of interventions. In multivariable models, VCE and HRD were significantly associated with bleeding interventions. Our findings support the importance of certain radiographic findings in prediction of bleeding interventions after HGRT. These factors can be used as adjuncts to renal injury grading to guide clinical decision making. Prognostic and Epidemiological Study, Level III and Therapeutic/Care Management, Level IV.