Renal Parenchyma Research Articles

Exposure to bisphenol S promotes renal damage via aryl hydrocarbon receptor and NF-κB pathways in a mice model of obesity.

Leptospira interrogans biofilms in acute canine infection and their in vitro interactions with antibiotics and p-coumaric acid.

Eosinophilic/oncocytic renal cell neoplasms represent a diagnostically challenging group of tumors with overlapping morphologic and immunophenotypic features. Recent advances in molecular genetics have expanded the spectrum of FLCN-mutated renal tumors, including both Birt-Hogg-Dubé (BHD) syndrome-associated and sporadic cases. This study aimed to characterize the clinicopathologic and molecular features of five FLCN-mutated eosinophilic renal tumors, emphasizing their diagnostic pitfalls and heterogeneity. The cohort included three male and two female patients (median age: 61years) with solitary renal masses (median size: 3cm), all incidentally detected and managed surgically (partial/radical nephrectomy). All patients lacked clinical stigmata of BHD syndrome (cutaneous fibrofolliculomas, pulmonary cysts) or relevant family history. Histologically, tumors exhibited diverse patterns (solid-nested, tubuloacinar, trabecular) with uniform eosinophilic cytoplasm, low-grade nuclei, hemorrhagic and edematous stroma, and prominent branching dilated vasculature, along with distinctive features such as intraluminal foamy histiocytes, psammomatous calcification, and thyroid follicle-like secretions (all classified as non-conventional FLCN-mutated tumors). None of the cases showed renal oncocytosis in the surrounding renal parenchyma. Immunohistochemically, all cases showed diffuse GPNMB expression, while TFE3 was weakly expressed in one case. Molecular profiling identified pathogenic/likely pathogenic FLCN mutations (truncating mutations in four cases, missense variant in one) without concurrent alterations in TSC1/2, MTOR, FH, SDHx, or MiT family genes. Over a median follow-up of 38months, no recurrence or metastasis occurred, suggesting an indolent behavior. These findings highlight the morphologic mimicry of FLCN-mutated tumors with a spectrum of renal neoplasms characterized by low-grade eosinophilic features, particularly TSC/MTOR-altered or MiT family renal neoplasms, underscoring the necessity of integrated immunohistochemical (GPNMB) and molecular testing for accurate diagnosis. Despite their heterogeneity, FLCN-mutated tumors typically follow a benign clinical course, though rare aggressive variants warrant vigilance.

Emphysematous pyelonephritis (EPN) is a severe, necrotizing renal infection characterized by gas formation within the renal parenchyma, collecting system, or peri-renal spaces. It is most frequently seen in diabetic or immunocompromised patients and can be life-threatening. We report a case of a 45-year-old male with known prostate cancer and a prior left nephrostomy for moderate hydronephrosis, presenting with febrile abdominal pain. CT confirmed right-sided EPN. This case highlights the importance of early diagnosis and tailored management in high-risk patients.

Abstract Background and Aims The progression of chronic kidney disease (CKD) is characterized by hemodynamic and biochemical changes, as well as the establishment of an intense local inflammatory process, which culminates in the development of renal fibrosis and the progressive loss of organ function. The pharmacological inhibition of the renin-angiotensin-aldosterone system (RAAS) and the SGLT2 cotransporters are currently the main strategies in the clinical management of CKD; however, it has limited effects, as it does not fully block the progression of renal inflammation and fibrosis. The lack of effective treatments to slow disease progression or reverse the already established damage guide the investigation of cellular and inflammatory mechanisms involved in the process, in search for new drugs. Given the relevance of fibrosis in the progression of CKD, the aim of this study was to evaluate the potential renoprotective effect of pirfenidone, a drug approved for idiopathic pulmonary fibrosis, in an experimental model of hypertensive nephrosclerosis (NAME model) in rats. Method All the animals included in our protocol were fed with high-sodium (HS) diet, containing 3% of sodium chloride (NaCl). Hypertensive nephrosclerosis was induced in 36 male Wistar rats, by the oral administration of 70 mg/kg/day of L-NAME (NAME), a nitric oxide synthase inhibitor, in drinking water. These animals were divided among the following groups: NAME (animals receiving only L-NAME with no therapeutic treatment, N = 12), LOS: NAME (rats treated with 50 mg/kg/day of Losartan, n = 12) and PIRF: (NAME rats treated with 750 mg/kg/day of pirfenidone, N=12). Further 12 healthy rats were kept only with HS diet and used as Control. After 30 days of treatment, the following parameters were evaluated: systolic blood pressure (SBP, mmHg), albuminuria (UAE, mg/24 h), percentage of glomerulosclerosis (GS%) and collapsed glomeruli (CG%), percentage of interstitial fibrosis (INT%), percentage of interstitial area occupied by myofibroblast (α-SMA%) and collagen (COL1%), tubulointerstitial infiltration by T-cells (CD3, cells/mm2), and enzymatic activity of matrix metalloproteinases (MMP-2 and MMP-9). Our experimental protocol was fully approved by the Ethics Committee of the University of São Paulo Clinical Hospital (CAPPesq 730/01). Results Corroborating the observed in clinical practice, the standard treatment of CKD with LOS resulted in a considerable improvement in renal function, promoting the reduction of all the studied parameters. Surprisingly, the treatment with PIRF promoted similar or even superior renoprotective effects compared to those achieved with LOS: PIRF was effective in reducing SBP, UAE, glomerular structural damage and interstitial fibrosis, as evidenced by the decrease in COL1 levels and the increase in MMP expression, suggesting an important role in the degradation of excessive extracellular matrix (ECM) deposition. Additionally, PIRF exhibited anti-inflammatory activity, once it reduced the number of infiltrating T lymphocytes and myofibroblasts in the renal parenchyma of rats underwent the NAME model. Results were presented as Mean ± SE. For statistical analysis we performed One-way ANOVA, with Tukey's post-test, and considered P < 0.05 vs.: *Control, #NAME, &LOS. Conclusion Our preliminary data indicate that PIRF promoted significant renoprotective effect in the NAME model of CKD, comparable to the protection achieved with LOS treatment. Such positive effect can be probably attributed to the antifibrotic action of PIRF, which may have contributed to reduce both the glomerular and the tubulointerstitial damage in NAME rats. Although further studies are still required in order to confirm our findings, here we suggest that pirfenidone may represent a promising therapeutic alternative in the treatment of progressive CKD.

Abstract Background and Aims Waldenström macroglobulinemia (WM)-associated nephropathy is a rare clinicopathological entity with a heterogeneous histological presentation. In addition to lymphoplasmacytic lymphoma directly infiltrating the renal parenchyma, various glomerular and tubular lesions—most commonly monoclonal gammopathy-related lesions—have been described, although they remain uncommon. We present the case of a 72-year-old man with no significant previous medical history. In 2022 during routine blood and urine analysis, an IgM kappa monoclonal gammopathy was first detected. At presentation, the patient was asymptomatic, and physical examination was unremarkable. Laboratory results showed the following: normal blood count (WBC 7900/µL, Hb 15.7 g/dL), preserved kidney function (sCr 0.8 mg/dL), proteinuria (100 mg/dL) on urine analysis with no evidence of Bence Jones proteinuria. A kidney ultrasound revealed morphologically normal kidneys with no macroscopic masses. By 2024, an increase in glomerular non-selective proteinuria up to 4.2 g/day was noticed. Method A workup for autoimmune diseases including ANA, anti-dsDNA, ENA, ANCA, anti-PLA2R and anti-THSD7A antibodies, as well as a virological panel including HIV, HBV and HCV serologies, turned out negative. LDH and beta-2-microglobulin levels were within normal ranges, no other abnormality was noted in further blood or urine tests. The patient was referred to our center for a kidney biopsy. Light microscopy revealed 2/17 glomeruli in global sclerosis, focal mesangial expansion in some glomeruli, with an area of mesangiolysis. In the interstitium a dense CD20+, CD5−, CD3−, CD23−, cyclin D1− multifocal lymphocytic infiltrate with a low Ki67 index was identified. Congo Red staining excluded renal amyloidosis. Immunofluorescence microscopy demonstrated an interstitial infiltrate positive (++) for IgM and kappa light chains. Electronic microscopy analysis is ongoing. As the findings were consistent with low-grade renal lymphoma, the patient underwent a bone marrow biopsy and a contrast-enhanced total-body CT scan to evaluate potential systemic involvement. Results The total-body CT scan showed no renal morphological alterations, and no lymphadenopathies were detected. The bone marrow biopsy revealed a diffuse interstitial and paratrabecular lymphoid infiltrate composed of small-sized B lymphocytes (CD20+, CD79a+, CD3−, CD5−, CD23−, CD138−, cyclin D1−, C43−) with predominant expression of kappa light chains. The histological findings are consistent with bone marrow involvement by a lymphoplasmacytic lymphoma. The demonstration of a lymphoplasmacytic lymphoma, along with a IgM monoclonal gammopathy and a renal lymphomatous infiltrate, led to the diagnosis of WM with kidney involvement. Conclusion In this patient, nephrotic-range proteinuria was the only clinical manifestation that prompted a kidney biopsy, which revealed tumor infiltration of the renal interstitium and led to a diagnosis of WM. While interstitial infiltration was confirmed, it does not explain the presence of glomerular nephrotic-range proteinuria, suggesting an underlying glomerular injury. The kidney biopsy ruled out the most common WM-associated glomerulopathies, such as AL amyloidosis, cryoglobulinemic GN, non-cryoglobulinemic MPGN, and light-chain deposition disease (LHCDD), as well as cast nephropathy. This led to the hypothesis that an underlying podocytopathy is the most likely cause of the proteinuria. WM-associated nephropathies can lead to end-stage kidney disease (ESKD) and adversely affect prognosis. Therefore, despite their rarity, these conditions must be accurately identified, and kidney function should be closely monitored.

Abstract Background and Aims Conventionally, the conservative management of chronic kidney disease (CKD) is based on the pharmacological blockade of the renin-angiotensin-aldosterone system (RAAS), associated to SGLT2 receptor inhibitors and other antihypertensive drugs. Nevertheless, this therapeutic approach can only partially decelerate CKD progression. In the last decades, a number of experimental and pre-clinical studies have been showing promising results regarding the renoprotective effects of mesenchymal stem cells (MSC) in treating CKD, especially when the cell therapy is associated to the conventional pharmacological arsenal. However, challenges remain in optimizing the delivery methods for this therapy. There is still no consensus about the best route for MSC administration in order to ensure the safety and effectiveness of treatment. In this context, the aim of the present study is to present a feasible, safe and innovative approach for intra-renal MSC delivery in rats submitted to a severe model of CKD (Nx), through a minimally invasive ultrasound-guided (USG) procedure. Method MSC were obtained from the perigonadal adipose tissue (ASC) of 3 male Wistar rats. Cells were cultured until P4, when they were characterized by flow cytometry and in vitro differentiation, counted and prepared to the inoculation into the experimental animals. CKD was induced in 30 male Wistar rats through the surgical 5/6 renal ablation (Nx model). Fifteen days after surgery, when the nephropathy was already well established, Nx rats were stratified into the groups: Nx (kept untreated, N = 9), Nx+LOS (treated with 50 mg/kg/day of Losartan, orally, N = 9), Nx+ASC (received a single application of ASC by the minimally invasive method described below, N = 5) and Nx+LOS+ASC (treated with both Losartan and ASC, N = 7). Further 7 healthy rats which were not submitted to renal ablation were used as controls (Sham). The minimally invasive technique employed for the local renal inoculation of ASC consisted in the injection of 2 x 106 ASC diluted in 150 µL of sterile PBS directly into the renal cortex, using an insulin syringe, through percutaneous route. For this purpose, the renal parenchyma of each animal was clearly visualized and carefully analyzed by an expert veterinarian, using a high-definition ultrasound MyLab™ Gamma (Esaote®) with a 9–19mHz multifrequency transducer. The remaining renal portion was identified using color doppler, which is capable of detecting the blood flow inside the vessels, as well as its resistance and speed. In this way, the cells were carefully applied in the vicarious region of the organ, as close as possible to the renal capsule (outer cortex). All animals were studied after 30 days of CKD induction, when the following parameters were evaluated: systolic blood pressure (SBP, mmHg), urinary protein excretion (UPE, mg/24 h), urinary albumin excretion (UAE, mg/24h), serum creatinine (SCR, mg/dL) and urea (SUR, mg/dL) concentrations and the presence of interstitial macrophages (CD68, cells/mm2) analyzed by immunohistochemistry. Statistical analyzes were performed with the Graph Prism software (version 8.0.1) using the One-Way ANOVA test. Our experimental protocol was approved by the Ethics Committee for the Use of Experimental Animals of the University of São Paulo Medical School (CEUA-FMUSP No 1762/2022). Results The combination of LOS+ASC reduced hypertension, proteinuria, albuminuria, serum creatinine and urea and infiltrating macrophages, compared to the monotherapy with LOS, as can be seen in Table 1. Renal doppler ultrasound was used to guide ASC application, as illustrated in Fig. 1. Conclusion It is possible to conclude that a minimally invasive percutaneous intrarenal inoculation of ASC in rats is feasible and was performed successfully. Preliminary results suggest that cell therapy provided additional renoprotection to the animals, ensuring a marked improvement in hypertension, significant control of protein excretion in the urine, more specifically albumin, in addition to tissue inflammatory control. Cell therapy has proven to be an important adjuvant to limit CKD progression.

Abstract Background and Aims Chronic kidney disease (CKD) treatment is based on the renin-angiotensin-aldosterone system (RAAS) blockade, associated to antihypertensive drugs and SGLT2 receptor inhibitors. However, this therapeutic approach cannot stop CKD progression completely. Recent studies have been showing interesting renoprotective effects of cell therapy with both mesenchymal stem cells (MSC) or its derivatives, such as MSC-released extracellular vesicles (EV). According to the literature, the beneficial effects of MSC are not due to direct in situ cell differentiation, but to paracrine factors produced and released by these cells, through the EV. In the present study we aimed to investigate if the association of an application of EV derived from MSC to the conventional treatment with Losartan would promote additional renoprotective effects in a model of experimental CKD. Additionally, we present here an innovative and safe method of EV delivery, through a minimally invasive ultrasound-guided (USG) procedure, directly into the renal parenchyma of CKD. Method MSCs from rat adipose tissue (ASC) were collected from 3 male Wistar rats and cultured until P4, when the culture medium was deprived of fetal bovine serum for 24 h, collected and subjected to serial ultracentrifugation at 100.000G for 160 minutes, in order to obtain a pellet containing around 1 x 1011 particles with a mean size of 290 nm each (EV) This pellet was resuspended in 150 µL of sterile PBS for further application in the animals. CKD was induced by surgical 5/6 renal ablation (Nx model) in 48 male Wistar rats. Fifteen days after induction, when Nx rats already exhibited sever hypertension and proteinuria, these animals were stratified into groups: Nx (kept untreated, N = 12), Nx+LOS (received 50 mg/kg/day of Losartan, in drinking water, N = 13), Nx + EV (received a single local application of EV, as described below, N = 10) and Nx+LOS+EV (treated with both Losartan and EV, N = 13). Additional 13 healthy rats were used as controls (Sham). EV solution (inoculum) was applied directly into the remnant mass of the outer part of renal cortex of experimental animals through ultrasound-guided percutaneous administration, using an insulin syringe. This technique was performed by an expert veterinarian, using a high-definition ultrasound MyLab™ Gamma (Esaote®) with a 9–19mHz multifrequency transducer. Color doppler was used to identify the remaining portion of the kidney, as well to detect the blood flow inside the vessels, the resistance and its speed. After 30 days of CKD induction (15 days after the inoculations), all animals were studied regarding the following parameter: systolic blood pressure (SBP, mmHg), urinary protein excretion (UPE, mg/24h), urinary albumin excretion (UAE, mg/24h), serum creatinine (SCR, mg/dL) and urea (SUR, mg/dL) concentrations and the presence of interstitial macrophages (CD68, cells/mm2) evaluated by immunohistochemistry. Our experimental protocol was approved by the Ethics Committee for the Use of Experimental Animals of the University of São Paulo Medical School (CEUA-FMUSP No 1762/2022). Statistical analyzes were performed with the Graph Prism software (version 8.0.1) using the One-Way ANOVA test. Results The association of LOS + EV drastically reduced hypertension, proteinuria and albuminuria in the Nx model. Serum levels of creatinine and urea were also reduced when compared to the monotherapy with LOS, as well as the renal interstitial macrophage infiltration, as can be seen in Table 1. The minimally invasive technique of EV administration guided by ultrasound is illustrated in Fig. 1. Conclusion Preliminary results suggest that the therapy with EV provided additional renoprotection to the animals submitted to a severe model of CKD, ensuring improvement in hypertension, control of protein and albumin excretion and the reducing of infiltrating macrophages. The concentrations of serum creatinine and urea has also reduced, demonstrating efficacy with the treatment. Thus, we can conclude that the minimally invasive percutaneous intrarenal administration of EV can be considered as a potential adjuvant to the pharmacological treatment of CKD.

Fibroblast activation protein (FAP) has been proposed as a pan-tumor target for PET imaging using FAP-targeted tracers. Here, we explore the potential value of FAP PET in renal tumors. Methods: Six patients with renal tumors (4 with clear cell renal cell carcinoma, 1 with papillary renal cell carcinoma, and 1 with renal oncocytoma) who were included in a prospective imaging study (NCT04147494) underwent [68Ga]Ga-FAPI-46 PET before nephrectomy. FAP PET radiotracer uptake and FAP expression by immunohistochemistry were assessed in the tumors and surrounding renal parenchyma. Results: Tumoral FAP radiotracer uptake was highest in clear cell renal cell carcinoma (median SUVmax, 3.1; range, 2.5-5.3), followed by renal oncocytoma (SUVmax, 1.9) and papillary renal cell carcinoma (SUVmax, 1.1). The FAP PET signal strongly correlated with FAP expression by immunohistochemistry (SUVmax; r = 0.93; P = 0.007). Conclusion: FAP expression in different renal tumors, including renal cell carcinoma, was lower when compared with cancers with known FAP expression, such as sarcoma. Although our data do not favor FAP-based theranostic approaches in renal cell carcinoma, studies in larger cohorts are warranted for conclusive evidence.

The aim of this study was to evaluate the diagnostic utility of elasticity with shear wave elastography (SWE) technique and microvascularization with super microvascular imaging (SMI) technique in renal parenchymal scar areas developing as a result of vesicoureteral reflux (VUR) and to compare the effectiveness of these two methods in detecting damage in the renal parenchyma with the results of dimercaptosuccinic acid (DMSA) scintigraphy. Between July 2022 and July 2023, 40 patients diagnosed with VUR by voiding cystourethrogram (VCUG) and 31 patients in the control group were included in this prospective, unicenter study. The vascularity characteristics of all kidneys and the parenchymal stiffness levels were examined respectively with superb microvascular imaging and SWE by two independent radiologists. A statistically significant difference was found between the mean SWE and SMI values of normal renal parenchyma and renal scar tissue (p < 0.05). The mean SWE and SMI values of kidneys with scar tissue were found to be statistically higher than those of kidneys with VUR but without scar tissue (p < 0.05). Also, a relationship was found between the duration of VUR exposure and the formation of scar tissue in the kidneys. The sensitivity and specificity values for predicting the presence of scar tissue in the kidneys were determined as 73.7% and 70.5% with the SMI method, and 89.5% and 67.2% with the SWE method, respectively. SWE and SMI techniques can be considered as complementary alternative methods in the follow-up of pediatric patients with VUR in whom scar tissue is detected in the kidneys with DMSA, as they are inexpensive, radiation-free, and useful methods for the detection and evaluation of scar tissue.

Separate renal function assessment is important in clinical decision making. The single-photon emission computed tomography is commonly used for the assessment although radioactive, tedious and of high cost. This study aimed to automatically assess the separate renal function using plain CT images and artificial intelligence methods, including deep learning-based automatic segmentation and radiomics modeling. We performed a retrospective study on 281 patients with nephrarctia or hydronephrosis from two centers (Training set: 159 patients from Center I; Test set: 122 patients from Center II). The renal parenchyma and hydronephrosis regions in plain CT images were automatically segmented using deep learning-based U-Net transformers (UNETR). Radiomic features were extracted from the two regions and used to build radiomic signature using the ElasticNet, then further combined with clinical characteristics using multivariable logistic regression to obtain an integrated model. The automatic segmentation was evaluated using the dice similarity coefficient (DSC). The mean DSC of automatic kidney segmentation based on UNETR was 0.894 and 0.881 in the training and test sets. The average time of automatic and manual segmentation was 3.4s/case and 1477.9s/case. The AUC of radiomic signature was 0.778 in the training set and 0.801 in the test set. The AUC of the integrated model was 0.792 and 0.825 in the training and test sets. It is feasible to assess the renal function of each kidney separately using plain CT and AI methods. Our method can minimize the radiation risk, improve the diagnostic efficiency and reduce the costs.

Introduction : Nephrectomy inevitably reduces the functional renal parenchyma, resulting in loss of renal function[1]. Nephrons decrease with the nephrectomy procedure, and it leads to a decline in eGFR values. eGFR60 is associated with increased cardiovascular events, death, and hospitalization [3,4]. Under these circumstances, it is important for the preservation of renal function not only in healthy subjects but also in populations at risk. Patients who underwent tumor nephrectomy had a higher incidence of CKD compared to patients who underwent simple nephrectomy [1,5,6]. We designed a study to compare the incidence rate of CKD between tumor nephrectomy patients and simple nephrectomy patients and to evaluate predictive factors of CKD. Our objective is to compare the incidence of CKD in patients of radical, partial, and simple nephrectomy. Material And Methods : We retrospectively examined the patients who underwent RN (n-57), PN(n-10), and simple nephrectomy (n-17) between January 2019 to June 2023. All operations are performed by an expert surgeon. Demographic profile age, sex, laterality, comorbidity (hypertension, diabetes), addiction (smoking, alcohol), and preoperative proteinuria were collected. Serum creatinine results within one week, one month, three months, and six months postoperative follow-up were collected. Patients with eGFR above 60 were included in the study. Those who had an abnormal renal function before surgery or were lost to follow-up were excluded. Discussion : Radical nephrectomy is an independent risk factor for the development of CKD, so the preservation of a maximum renal reserve should be pursued in case of partial nephrectomy. Age is a prognostic factor for CKD development. The major reason is that as age increases, nephron atrophy occurs and eGFR decreases. HTN and DM have been identified as predictors of renal impairment in individuals undergoing nephrectomy. Tumour size and preoperative proteinuria are risk factors for CKD development. According to our study, gender, BMI, laterality, and smoking are not prognostic factors for CKD. Conclusion : Age, Co-morbidity, pre-operative proteinuria, type of surgery, immediate postoperative eGFR value, and tumor size are useful predictors of developing CKD after surgery. Therefore, More attention should be given to patients with decreased renal function during postoperative follow-up. PN should be strongly considered for the prevention of postoperative CKD.

An eleven-month labrador dog was brought to Veterinary clinical complex, Veterinary College and Research Institute, Namakkal with a history of anorexia, frequent vomition and progressive weight loss. Hematology and serum biochemical analysis showed severe anaemia, leukopaenia, azotemia, hyperphosphatemia and hypocalcemia. The case was tentatively diagnosed as Polycystic kidney disease based on clinical signs, haematobiochemical parameters and ultrasonography. In spite of the palliative treatment, the animal died within a week and the same was referred to Department of Veterinary Pathology for necropsy. The carcass was severely emaciated and ulcers were noticed in the oral cavity. Kidneys showed numerous, whitish, irregular and varying-sized fluid-filled cysts studded over the entire renal parenchyma. Histopathological examination of the kidney revealed large amount of fibrous tissue in the interstitium with irregularly dilated cysts and some cysts with homogeneous, acidophilic material in the lumen. On Masson’s trichrome staining and Van Gieson’s staining, the fibrous stroma appeared blue and bright red in colour respectively. The liver showed portal fibrosis with bile duct hyperplasia. This communication deals with the pathology of congenital polycystic kidney disease in a dog.

The aim of this cross-sectional study was to comparatively assess the levels of key pro-inflammatory (interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α)) and fibrotic (transforming growth factor-beta1 (TGF-β₁)) cytokines in both serum and urine of patients with primary glomerulonephritis (GN) associated with nephrotic syndrome (NS), and to evaluate their associations with clinical indicators of disease activity—particularly daily proteinuria—as well as histological features of chronic kidney injury. A total of 85 adult patients with newly diagnosed GN and NS who were hospitalized at the Ivano-Frankivsk Regional Clinical Hospital between 2022 and 2024 were enrolled in the study, along with 20 demographically matched healthy volunteers serving as controls. All patients underwent comprehensive clinical, laboratory, and histopathological evaluation. The concentrations of IL-6, TNF-α, and TGF-β₁ were measured in both serum and urine samples using standardized sandwich enzyme-linked immunosorbent assay (ELISA) kits. Statistical analysis included comparisons between study and control groups, as well as correlation assessments between biomarker levels and clinical-histological parameters, such as daily protein loss and the chronicity index of renal biopsies. Patients with GN and NS showed significantly elevated levels of IL-6, TNF-α, and TGF-β₁ in both serum and urine compared to healthy controls (p&lt;0.05), indicating activation of both systemic and localized inflammatory and fibrotic responses. Importantly, urinary IL-6 and TNF-α levels demonstrated moderate positive correlations with daily proteinuria (r=0.472 and r=0.546, respectively; p&lt;0.05), while their serum levels did not show significant associations. Urinary TGF-β₁ exhibited a weak but statistically significant correlation with proteinuria (r=0.256; p&lt;0.05) and a strong correlation with the histological chronicity score of kidney tissue damage (r=0.783; p&lt;0.01), which incorporates parameters such as interstitial fibrosis, tubular atrophy, and global glomerulosclerosis. These findings highlight the diagnostic and prognostic utility of urinary cytokines as non-invasive biomarkers. Urinary IL-6 and TNF-α may be particularly useful for assessing local inflammatory activity and glomerular barrier dysfunction, while urinary TGF-β₁ appears to reflect longer-term fibrotic remodeling of renal parenchyma. The superiority of urinary biomarkers over their serum counterparts underscores their potential for integration into clinical protocols for disease monitoring in GN and NS. This study adds to the growing body of evidence supporting urinary cytokines as meaningful indicators of disease activity and chronic progression in glomerular diseases. Nevertheless, limitations such as the cross-sectional design, relatively small sample sizes in histological subgroups, and lack of follow-up data must be acknowledged. Future prospective, multicenter investigations with longitudinal follow-up are needed to validate these findings and further explore the role of urinary cytokines in predicting disease trajectory and response to therapy in patients with GN and nephrotic syndrome.

Emphysematous pyelonephritis (EPN) is a critical and life-threatening necrotizing urinary tract infection, marked by gas formation within the renal parenchyma, collecting system or peri-nephric tissue and is extremely rare in children. Proteinaceous calculi are a rare type of kidney stones, reported in only 0.5% of nephrolithiasis cases, and rarely reported in the pediatric population. We present a case of a 16-year-old female with concurrent EPN and proteinaceous calculi with recurrentEscherichia coliurinary tract infection.

Pyelonephritis is an infectious disease that affects the renal parenchyma and pelvis. It is typically caused by an ascending bacterial infection of the lower urinary tract, with a higher incidence in older dogs and females. Additional factors, such as concurrent diseases and corticosteroid use, increase the patient's susceptibility to this condition. A presumptive diagnosis is based on clinical history, laboratory tests, and imaging findings. Treatment generally involves the use of antibiotics and symptomatic therapy. This report describes a case of pyelonephritis in a 10-year-old Poodle with a history of chronic steroidal anti-inflammatory use. The patient presented with prostration, vomiting, diarrhea, lumbar pain, urinary incontinence, and greenish ocular discharge. A complete blood count (CBC), serum biochemistry panel, rapid test for leishmaniasis, Snap 4Dx test, and abdominal ultrasound were performed. The CBC revealed anemia and leukocytosis, and all biochemical enzymes assessed were above reference ranges. Both infectious disease tests returned negative results. Urine samples were collected via ultrasound-guided cystocentesis for urinalysis and urine culture with antimicrobial susceptibility testing. Based on the clinical history and diagnostic findings, a presumptive diagnosis of pyelonephritis was made and antibiotic therapy with enrofloxacin was initiated, along with symptomatic and supportive care. However, the patient died the day after admission. Subsequent urine culture and susceptibility testing identified a multidrug-resistant strain of Klebsiella pneumoniae. This case highlights the growing concern around antimicrobial resistance in veterinary medicine and their broader implications within the One Health framework.

Primary squamous cell carcinoma (SCC) of the renal parenchyma is exceedingly rare, with only seven cases reported to date. We report a 72-year-old woman with recurrent cystitis, gross hematuria, and a right renal mass. Imaging studies revealed a necrotic lesion in the renal parenchyma, initially suggestive of an abscess. Despite percutaneous drainage and antibiotic therapy, there was no clinical improvement. Trans-urinary tract fine-needle aspiration (FNA) provided preoperative cytologic evidence of malignancy with features consistent with SCC, and histopathologic examination of the nephrectomy specimen, supported by immunohistochemistry, confirmed primary renal parenchymal SCC. The patient subsequently underwent radical nephrectomy, and histopathological examination confirmed a primary SCC of the renal parenchyma without renal pelvic involvement. Although surgical treatment was performed promptly, metastatic spread to lymph nodes, vertebrae, and lungs was detected within months, and the patient died 18months postoperatively. This case highlights the importance of considering SCC in the differential diagnosis of abscess-like renal lesions, particularly when they fail to respond to antibiotics. In selected patients, trans-urinary tract FNA offers a rapid, minimally invasive means to obtain cytologic material, which can prevent delays and facilitate timely management, potentially improving outcomes in similarly challenging cases. Additional studies will clarify diagnostic and therapeutic strategies.

Renal replacement lipomatosis (RRL) is a rare benign condition characterized by the replacement of the renal sinus, hilum, and perirenal space with extensive fatty tissue. It is also known as replacement lipofibromatosis and is generally observed in individuals aged 60-70 years. RRL is typically associated with renal calculi, chronic inflammation, and hydronephrosis, leading to severe atrophy of the renal parenchyma and, ultimately, a non-functional kidney. A study indicated that in 3,500 intravenous pyelogram cases, the incidence of RRL was 0.66%, with no significant gender preponderance. We report a case of a 65-year-old male patient who presented with a left renal mass and hematuria. Non-contrast CT of the kidneys, ureters, and bladder (NCCT KUB) revealed a 23 mm calculus at the pelvi-ureteric junction, with extensive peripelvic and periureteric fat stranding and a prominent renal fascia. Left nephroureterectomy was performed, and the excised specimen was submitted for histopathological examination. On gross examination, the specimen measured 11.5x7.5x4.5 cm; the ureter measured 7 cm in length and 0.6 cm in diameter. The outer surface was unremarkable. On sectioning, the pelvicalyceal system was markedly dilated and replaced by fat.

&amp;lt;i&amp;gt;Background&amp;lt;/i&amp;gt;: Chronic kidney disease (CKD) is a global health burden, with an estimated prevalence of 8–16%. Ultrasound and estimated glomerular filtration rate (eGFR) are critical tools for assessing renal function, but studies evaluating their correlation in Ethiopian populations remain lacking. Existing international studies often utilize limited sample sizes, potentially affecting their generalizability to local contexts. &amp;lt;i&amp;gt;Objective&amp;lt;/i&amp;gt;: To compare ultrasound-based renal parenchymal grading with eGFR in CKD patients at a tertiary care center in Addis Ababa, St. Paul’s Hospital Millennium Medical College. &amp;lt;i&amp;gt;Methods&amp;lt;/i&amp;gt;: We conducted an institutional cross-sectional study of 235 CKD patients from August 2022 to May 2023. eGFR was calculated using the MDRD formula from serum creatinine values. Standardized ultrasound evaluation assessed cortical echogenicity (graded 0-3 relative to splenic echogenicity), corticomedullary differentiation, renal length, and parenchymal thickness. Statistical analysis employed descriptive statistics, ANOVA, and Spearman&amp;apos;s correlation using SPSS version 27. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: The cohort demonstrated significant progressive decline in mean eGFR values corresponding to worsening ultrasound grades: 60.7 ± 14.7 mL/min/1.73m&amp;lt;sup&amp;gt;2&amp;lt;/sup&amp;gt; (Grade 0), 43.2 ± 11 (Grade 1), 26.8 ± 6.1 (Grade 2), and 12.2 ± 6.4 (Grade 3). Cortical echogenicity and corticomedullary differentiation showed particularly strong negative correlations with eGFR (P &amp;lt; 0.001). Renal length demonstrated a significant positive correlation with eGFR (right: r = 0.470; left: r = 0.454; both P &amp;lt; 0.001), while parenchymal thickness measurements did not demonstrate strong statistically significant associations. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: Our study confirms significant correlations between ultrasound-based renal grading and eGFR in CKD patients. We recommend adopting this grading system in clinical practice alongside serum creatinine and GFR measurements for comprehensive renal assessment. The results serve as valuable baseline data for future research, particularly regarding cases with Grade 3 parameters but normal renal size, which may need inclusion in the grading system.

Background and Objectives: In the current era of solid organ transplantation, the gap between available donors and patients on the waiting list is widening. Worldwide, surgeons are confronted with the challenge of optimizing the utilization of renal grafts, including the presence of multiple renal arteries (MRA), occurring in 20% to 30% of cases. The presence of a lower polar artery (LPA), which provides a significant vascular contribution to both the lower renal parenchyma and the upper urinary tract, constitutes an additional challenge, but its preservation is fundamental for the outcome of the kidney transplant (KT). The end-to-end (E/E) anastomosis with the recipient’s inferior epigastric artery (IEA) has been rarely reported in the literature, with variable results. The aim of this study is to report on technical aspects as well as on short- and long-term outcomes of this reconstruction in KT. Materials and Methods: A retrospective three-centre analysis was conducted on 13 KTs in which the graft’s LPA was anastomosed E/E with the recipient’s IEA. Results: Following an average follow-up period of 84 months, the patient and graft survival rate was 100%. Neither vascular nor urological complications were observed. Conclusions: In the event of KT with LPA, an E/E anastomosis with IEA performed with microsurgical technique is safe and provides excellent long-term results.