Renal Parenchymal Lesions Research Articles

Immunosuppression with cyclosporine versus tacrolimus shows distinctive nephrotoxicity profiles within renal compartments.

Calcineurin inhibitors (CNIs) are the backbone for immunosuppression after solid organ transplantation. Although successful in preventing kidney transplant rejection, their nephrotoxic side effects contribute to allograft injury. Renal parenchymal lesions occur for cyclosporine A (CsA) as well as for the currently favored tacrolimus (Tac). We aimed to study whether chronic CsA and Tac exposures, before reaching irreversible nephrotoxic damage, affect renal compartments differentially and whether related pathogenic mechanisms can be identified. CsA and Tac were administered chronically in wild type Wistar rats using osmotic minipumps over 4 weeks. Functional parameters were controlled. Electron microscopy, confocal, and 3D-structured illumination microscopy were used for histopathology. Clinical translatability was tested in human renal biopsies. Standard biochemical, RNA-seq, and proteomic technologies were applied to identify implicated molecular pathways. Both drugs caused significant albeit differential damage in vasculature and nephron. The glomerular filtration barrier was more affected by Tac than by CsA, showing prominent deteriorations in endothelium and podocytes along with impaired VEGF/VEGFR2 signaling and podocyte-specific gene expression. By contrast, proximal tubule epithelia were more severely affected by CsA than by Tac, revealing lysosomal dysfunction, enhanced apoptosis, impaired proteostasis and oxidative stress. Lesion characteristics were confirmed in human renal biopsies. We conclude that pathogenetic alterations in the renal compartments are specific for either treatment. Considering translation to the clinical setting, CNI choice should reflect individual risk factors for renal vasculature and tubular epithelia. As a step in this direction, we share protein signatures identified from multiomics with potential pathognomonic relevance.

Renocolic Fistula after Extracorporeal Lithotripsy: Case Report and Literature Review of a Rare Complication of a Common Procedure

Extracorporeal lithotripsy (ESWL) is one of the most common urological procedures. Among its possible complications, renal parenchymal lesions are rare (approximately 7%). This is a case report of a renocolic fistula after ESWL. It is a very rare complication and without descriptions in the literature of association with ESWL. Because it is a rare lesion, there is no standardized treatment or data that makes it possible to determine the best conduct. The present case required a surgical approach to correct the fistula. It was possible to preserve the affected kidney, which is even rarer in the medical literature.

Predictive value of contrast-enhanced ultrasound combined with conventional ultrasound in solid renal parenchymal lesions.

This study aimed to develop a model to predict the risk of malignancy in solid renal parenchymal lesions based on the imaging features of combined conventional and contrast-enhanced ultrasound (CEUS). A retrospective review was performed among patients with focal solid renal parenchymal lesions on ultrasound images. Ultrasound features were characterized by two experienced radiologists independently. A multiple logistic regression analysis was performed to determine the most relevant features and to estimate the risk of malignancy. Scoring and counting methods were developed based on the most relevant features. The diagnostic performance was evaluated by the sensitivity, specificity, positive predictive value, negative predictive value and area under the receiver operating characteristic curve (AUC). A total of 519 renal lesions were included in this study. The conventional ultrasound features of diameter, echogenicity, hypoechoic rim and the CEUS feature of heterogeneity were identified as the most relevant features for prediction of malignancy. The sensitivity and specificity for the logistic regression model, the scoring method and the counting method were 95.3 and 93.4%, 93.8 and 87.8%, 88.8 and 93.9%, respectively. The logistic model had the best performance for diagnosing malignant renal lesions with AUC of 0.978, compared with the scoring method and the counting method with AUCs of 0.958 and 0.965. The combination of contrast-enhanced ultrasound with conventional ultrasound improved the diagnostic performance of solid renal lesions based on the logistic regression model. In this study, we revealed that the combination of CEUS and conventional ultrasound provided higher accuracy for diagnosing malignant renal tumors.

Serum Interleukin-6 and Interleukin-8 are Sensitive Markers for Early Detection of Pyelonephritis and Its Prevention to Progression to Chronic Kidney Disease.

Background:Pyelonephritis is the most common bacterial infection in children that can cause renal failure if not diagnosed or treated early. We used serum biomarker interleukins (IL-6 and IL-8) and then confirmed the results by the findings dimercaptosuccinic acid (DMSA) scan to distinguish upper-tract infection from lower-tract infection.Methods:Serum IL-6 and IL-8 were measured in 57 children with newly diagnosed untreated urinary tract infection (UTI) documented by a positive urine culture. All children had a DMSA to determine whether serum IL6, IL-8 can be used as a marker to predict upper-tract from lower-tract infection. IL-6 and IL8 were determined by the enzyme link immunosorbent assay (ELISA) technique.Results:Of the 57 patients, 24 (42%) had renal parenchymal lesions on the DMSA scan. Patients with abnormal DMSA had significantly higher serum IL-6 and IL-8 compared with those with normal DMSA scan (187.1 ± 113.1 ng/mL vs. 396.1 ± 246.0 ng/mL, P = 0.005; and 165 ± 76.1 ng/mLvs. 190.8 ± 60.8 ng/mL, P = 0.026, respectively). Pyelonephritis was more frequent in children younger than 20 months old (n = 36, 63%, P < 0.005) and more prevalent in girls (n = 36, 63%, P = 0.005). Serum IL-6 had a sensitivity of 67.3% and a specificity of 63.0% and serum IL8 had a sensitivity of 80.1% and a specificity of 73.5% in the differential diagnosis of pyelonephritis and cystitis (P = 0.03).Conclusions:Serum levels of IL-6 and IL-8 are both sensitive biomarkers of UTI and can discriminate the upper from lower tract urinary infections. Determination of these biomarkers may help to identify patients with acute pyelonephritis and need for DMSA study.

Анализ кривой обучения хирургов в зависимости от сложности нефрометрической оценки при выполнении лапароскопической резекции почки у пациентов с локализованными образованиями паренхимы почки

Aim to analyze the learning curve of surgeons while performing laparoscopic partial nephrectomy in patients with localized renal parenchymal lesions by calculating the MIC (negative surgical margin, ischemia, and complications) index depending on tumor complexity according to the R.E.N.A.L. and PADUA nephrometric scores. Materials and methods the retrospective study included the results of laparoscopic partial nephrectomies in 320 patients with localized renal parenchymal lesions. The procedures were carried out by four surgeons from the Institute of Urology and Human Reproductive Health of FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia (EC-1; ESH-4; EB-7; ME-13) from January 2014 to June 2019. At baseline, all operators had experience of performing at least 30 laparoscopic interventions. In addition to the standard preoperative examination, a 3D virtual planning was carried out using the Amira 3D modeling program. In all cases, the nephrometric assessment of complexity was performed according to the R.E.N.A.L. and PADUA scores. The learning curve was assessed based on the results of operations based on the MIC index. All surgical interventions were divided into eras. In the era, 40 consecutive procedures for each operator were evaluated. Acquired skills were assessed over two eras. Results The average age of patients, of which 191 (59.7%) were men, was 54.4+/-11.37 years. The average body mass index was 28.55+/-3.85 kg/m2, the absolute volume of kidney lesions was 26.72+/-43.72 cm3, the average Charlson comorbidity index was 1.46+/-1.29, the average R.E.N.A.L. and PADUA scores were 6.38+/-1.75 and 7.92+/-1.51, respectively, the average duration of procedure was 150.36+/-50.18 min, the average blood loss was 227.94+/-280.22 ml, the average time thermal ischemia was 13.28+/-7.82 min. Postoperative complications were seen in 36 (11.2%) cases, of which grade III and more according to Clavien-Dindo developed in 8 patients (2.5%). A positive surgical margin was found in 4 (1.2%) patients. The overall MIC index was achieved in 243 (75.9%) cases; in era 1 it was seen in 71.9% cases in comparison with 80% in era 2. With the 1st degree of complexity (152 (47.5%) patients), MIC was achieved in 80.9% of cases, compared to 76.6% and 56.8% in patients with 2nd degree of complexity (n=124, 38.8%) and 3rd degree of complexity (n=44, 13.8%), respectively. Rate of MIC achievement in eras 1 and 2 for different surgeons were as following: 65% and 72.5%, 75 and 80%, 87.5 and 85% and 60 and 82.5%, for operator 1, 4, 7 and 13, respectively. Age, tumor complexity, R.E.N.A.L. score and PADUA score were the most significant parameters for determining MIC, identified on the basis of the criterion of equality of group means of discrete analysis. Conclusion In all surgeons, the MIC index increased with the accumulation of experience in performing laparoscopic partial nephrectomy, but was lower with an increased degree of complexity of procedures. The minimum number of laparoscopic partial nephrectomies required to achieve an MIC more or equal 70% should be at least 40.

Feline Morbillivirus Infection Associated With Tubulointerstitial Nephritis in Black Leopards (Panthera pardus).

Feline morbillivirus (FeMV) is an emerging RNA virus in the Paramyxoviridae family that was recently discovered in domestic cats (Felis catus). To date, 2 genotypes (FeMV-1 and FeMV-2) have been detected in cats from various countries, and FeMV-1 is recognized as a pathogen associated with nephritis. However, information regarding the pathological roles and potential transmission to other felids is limited. In this article, we describe the identification of FeMV in 2 black leopards (Panthera pardus) in Thailand that showed severe azotemia and tubulointerstitial nephritis. Molecular analysis of the partial coding sequence of the L gene revealed that these leopard FeMV strains were genetically close to the FeMV-1 isolate from domestic Thai cats. Immunohistochemistry and immunofluorescence analyses using polyclonal IgG antibodies against the FeMV matrix (M) protein showed FeMV-M antigen in renal tubular epithelial cells. These analyses also showed infiltrating lymphocytes in the renal parenchymal lesions and in the cytoplasm of lymphoid cells residing in the spleen, suggesting viral tropism and a possible pathological role. These findings are the first evidence that indicates that the black leopard could be a possible host for FeMV infection. As for other cats, the role of FeMV as a potential cause of renal disease remains to be established. The pathogenesis of FeMV infection in black leopards, or in other wild felids, through a viral transmission mechanism warrants further investigation.

Urinary System Manifestation of IgG4-Related Disease: Clinical, Laboratory, Radiological, and Pathological Spectra of a Chinese Single-Centre Study.

Background IgG4-related disease is a new disease entity, but little attention was drawn to urinary system involvement besides nephritis or nephropathy. Here, we described clinical, radiological, and pathological manifestations of IgG4-related urinary disease (IgG4-RUD) and assess its treatment responses. Methods We conducted a retrospective study enrolling 65 IgG4-RUD patients from an IgG4-related disease (IgG4-RD) cohort of the Peking Union Medical College Hospital. Clinical, laboratory, radiological, pathological data were collected, and treatment response to immunosuppressants were analysed. Results IgG4-related interstitial nephritis (TIN, 32.3%), glomerular nephritis (GN, 7.7%), renal pelvis and ureter involvement (21.5%), abnormal radiology with quiescent clinical presentation (13.8%), and renal parenchymal lesion plus retroperitoneal fibrosis (RPF, 18.5%) were major lesion types of IgG4-RUD. All patients had elevated serum IgG4, 76.9% had hyperglobulinemia, and 92.3% had elevated serum IgE at diagnosis. IgG4-TIN patients presented with renal dysfunction, and 94.3% had low serum complement C3 and IgG4-GN presented with nephrotic syndrome, while renal pelvis and ureter involvement had normal renal function and urinalysis. IgG4-RPF with renal parenchymal involvement presented with acute renal dysfunction and required emergency medical intervention. Renal cortex low-density areas, parenchyma or pelvis nodular mass, bilateral enlargement of the kidney, and renal pelvis and ureter mass/wall thickening were specific image patterns of IgG4-RUD. Infiltration of plasma lymphocytes and storiform fibrosis were histopathological features of IgG4-RUD. Patients showed satisfactory responses to immunosuppressive treatment, but complete recovery of renal function was difficult to achieve in IgG4-TIN. Four patients (6.2%) experienced clinical relapses during the maintenance period. Conclusion IgG4-RUD had diverse lesion types and distinctive manifestations. Radiological examinations were helpful for diagnosis and treatment evaluation. Patients showed good initial response to immunosuppressive treatment but relapses could occur at the maintenance period.

P43 Immunoglobulin G4-related disease in a 10 year-old girl with multisystem involvement

Abstract Background IgG4-related disease (IgG4RD) is an immune-mediated fibroinflammatory condition characterized by the infiltration of IgG4-carrying plasma cells and storiform fibrosis in most of the tissues. The condition is reported to cause multisystem involvement, however salivary gland is the most commonly affected organ with IgG4-related sialadenitis. Raised IgG4 concentrations in the serum and prominent infiltration by plasmacytes expressing IgG4 in the lacrimal and salivary glands have been confirmed. Methods We conducted a retrospective case review of a 10 year-old girl who was diagnosed with IgG4-RD at Great Ormond Street Hospital for Children in 2017. Patient’s clinical, laboratory and imaging data was extracted from our database and literature search was done to find out different manifestations of the IgG4-RD in Children. Results 10 year-old-girl with lacrimal and salivary gland swelling, sicca symptoms and fatigue. Ultrasound scan neck revealed multiple small lymph nodes and enlargement of both submandibular glands (Picture1) Salivary glands also appeared bulky and heterogenous with multiple small hypoechoic focci. Appearances likely to represent sialoadenitis and there was no evidence of malignancy or lymphoma. USS abdomen normal. Full blood count, routine biochemistry and urine microscopy normal. Autoantibodies came back negative (ANA: Negative, ANCA: Negative, Anti-Ro and Anti-La: Negative, RF:Negative, Thyroid autoantibodies:Negative) IgG level elevated (in repeated samples). IgA, IgM and IgE levels normal. IgG subgroups revealed significantly elevated IgG4 levels (21.49 Normal range: 0-1.1) IgG1, IgG2 and Ig G3 levels elevated as well. Lymphocyte subsets were normal. The biopsy of salivary gland: Chronic inflammation with IgG4 staining, suggestive of IgG4 related disorder. Lung function test showed decreased DLCO at 76 %, FEV1 at 82% and FVC at 89% suggestive of interstitial lung involvement. CT Thorax: Multiple abnormalities including moderate lymphadenopathy, renal parenchymal lesions and interstitial lung abnormality. MRI Abdomen: T2 hypointense renal foci, suggestive of infiltration as part of the IgG4 related disease. Diagnosed with IgG4 related disease. Treatment started with intravenous methylprednisolone followed by Anti-CD20 (Rituximab) therapy and a weaning plan for steroids. Mycophenolate mofetil commenced for the maintenance therapy. Patient has shown good response with clinical and lung function improvement. Conclusion IgG4-RD is a rare condition which can cause multisystem involvement with the infiltration of IgG4-bearing plasma cells in the tissues. We wanted to emphasize that this condition could also be seen in the paediatric population. We also wanted to highlight that after further investigations multisystem involvement can be discovered. Steroids are mainstay of the treatment with Anti-CD20 medication (Rituximab) and steroid sparing agents such as mycophenolate mofetil could be the choice for maintenance therapy. However, further studies need to be done in paediatric age group. Conflicts of Interest The authors declare no conflicts of interest.

Diffusion-weighted magnetic resonance imaging is more sensitive than dimercaptosuccinic acid scintigraphy in detecting parenchymal lesions in children with acute pyelonephritis: A prospective study

Static renal scintigraphy is the gold standard for detection of inflammatory changes in the renal parenchyma in acute pyelonephritis. Our aim was to determine whether diffusion-weighted magnetic resonance imaging (DW-MRI) was comparable with static renal scintigraphy (DMSA-SRS) to demonstrate acute renal parenchymal lesions. To compare 99mTc-dimercaptosuccinic acid static renal scintigraphy (DMSA-SRS) with diffusion-weighted magnetic resonance imaging (DW-MRI) for detecting acute inflammatory changes in the renal parenchyma in children with febrile urinary tract infection. Thirty-one children (30 girls) aged 3-18 years with a first episode of febrile UTI without a previously detected congenital malformation of the urinary tract, were prospectively included. DMSA-SRS and DW-MRI were performed within 5 days of diagnosis to detect renal inflammatory lesions. The DW-MRI examination was performed without contrast agent and without general anesthesia. Late examinations were performed after 6 months using both methods to detect late lesions. DW-MRI confirmed acute inflammatory changes of the renal parenchyma in all 31 patients (100%), mostly unilateral. DMSA-SRS detected inflammatory lesions in 22 children (71%; p=0.002). The lesions were multiple in 26/31 children (84%) on DW-MRI and in 9/22 (40%) on DMSA-SRS. At the control examination, scarring of the renal parenchyma was found equally by DW-MRI and DMSA-SRS in five patients (16%), three of whom were the same patients. The overall concordance of positive and negative late findings occurred in 87% of patients. There was correspondence in the anatomical location of acute and late lesions. The clinical significance of acute and late parenchymal findings on DWI-MR is yet to be determined. A limitation of our study is the age of the patients (older than 3 years) who are less sensitive to scar development; therefore, a smaller number of patients with scars could be analyzed during control examination. Further studies using the DW-MRI should confirm its reliability to detect acute and late lesions in younger children and infants and determine the clinical consequences. DW-MRI has higher sensitivity for detecting acute renal inflammatory lesions and multifocal lesions than DMSA-SRS. The incidence of scars was low and corresponded with the anatomical location of acute and late lesions.

A monoclonal antibody against CD86 and its protection in a murine lupus nephritis model of chronic graft-versus-host disease

Context: Lupus nephritis is the most common complication that causes the death of systemic lupus erythematosus patients. CD28/CTLA4 and their ligands CD80 or CD86 costimulatory pathway play a pivotal role in autoimmune disease and organ transplantation.Objectives: We generated a monoclonal antibody (clone 1D1) against human CD86 (1D1) that could recognize both human and mouse CD86, and blocked the CD86/CD28 costimulatory pathway with our mAb on a murine lupus nephritis model induced with chronic graft-versus-host disease (cGVHD).Materials and methods: Experimental lupus nephritis mice were induced with cGVHD, and splenocyte population were analyzed by flow cytometry. Autoantibodies and proteinuria were detected to evaluate the severity of lupus nephritis. The change of histopathology was observed by microscopy, fluorescence microscopy and electron microscopy.Results: we successfully generated a monoclonal antibody against human CD86(1D1). 1D1 mAb could recognize not only human CD86, but also mouse CD86. 1D1 was applied to the cGVHD-induced experimental lupus nephritis model, and our study found the production of ANA and anti-dsDNA in the 1D1-treated group was lower than those in IgG-treated group after four weeks. The pathological injure of kidney in the 1D1-treated group was lighten than that in IgG-treated group.Discussion and conclusions: Our data showed that blockade of CD86/CD28 with 1D1 induced a significant remission of proteinuria, production of autoantibodies, immune complex deposition and renal parenchyma lesions in experimental mice. Anti-CD86 Abs might be a potential method for immune therapy in autoimmune diseases and transplantation.

Vascular endothelial growth factor-A gene polymorphism is associated with congenital renal lesions in children with urinary tract infections.

This study investigated the relationship between vascular endothelial growth factor-A (VEGF-A)-460C/T functional gene polymorphism and renal parenchymal lesions, vesicoureteral reflux and other urinary tract abnormalities in children with a urinary tract infection (UTI). VEGF-A-460C/T gene polymorphism was investigated with restriction length polymorphism analysis in 76 children with their first UTI and in 63 controls without infections. Genotype and allele frequencies were compared between children with UTIs and controls and between different groups with UTIs. The VEGF-A-460C/T genotype frequencies differed significantly between those with and without renal parenchymal lesions in the UTI cohort. Allele C homozygosity was significantly more common in those with renal parenchymal lesions (36.6% versus 8.7%, p = 0.007). A separate analysis showed that allele C was associated with lesions compatible with hypodysplasia, rather than with focal ones associated with infections, with an odds ratio of 11.55 and 95% confidence interval of 3.03-43.9 (p = 0.0001). No significant differences in genotypes or allele frequencies were found between children with and without reflux or other urinary tract anomalies. In children with UTIs, C allele polymorphism of the VEGF-A gene was associated with hypodysplastic renal parenchymal lesions, which were possibly congenital and existed before the infection.

Assessment of acute kidney injury in rhabdomyolytic mice by transcutaneous measurement of sinistrin excretion.

Early and accurate assessment of renal function is required for the successful detection and treatment of acute kidney injury (AKI). However, only retention parameters such as plasma urea and creatinine, and the indirect estimation of glomerular filtration rate are commonly available. Here, we measured the kinetics of plasma fluorescein isothiocyanate (FITC)-sinistrin excretion to detect alterations of renal function over time in a murine model of rhabdomyolysis-induced AKI. The half-life of FITC-sinistrin was evaluated using a transcutaneous device at different time points in conscious mice, from 4 days before renal damage up to 30 days after. Retention markers were also evaluated, in parallel. Evaluation of the FITC-sinistrin half-life revealed early reduction of renal filtration, observed as early as 6 h after renal damage, and maintained up to 12 h following AKI. Plasma creatinine and urea levels correlated with the transcutaneous measurements of sinistrin excretion. Evaluation of sinistrin excretion also demonstrated that glycerol-treated animals did not develop AKI. Finally, histological analysis showed the presence of renal parenchymal lesions, which developed following the reduced renal filtration and persisted over time, highlighting the causative role of vascular dysfunction and myoglobin toxicity on the subsequent induction of tissue damage. Taken together, the results of this study provide important insights into the pathophysiology of kidney injury in rhabdomyolytic mice, and indicate that the transcutaneous measurement of FITC-sinistrin is an efficient and simple method to assess renal function precisely. This method also allows reduction of the required number of experimental animals by monitoring the same mouse over time.

IgG4-Related Kidney Disease and IgG4-Related Retroperitoneal Fibrosis.

Immunoglobulin G4-related kidney disease (IgG4-RKD) is the collective name encompassing renal parenchymal and renal pelvic lesions. The hallmark of renal parenchymal lesions of IgG4-related disease is plasma cell-rich tubulointerstitial nephritis with numerous IgG4-positive plasma cells and characteristic fibrosis. In addition, glomerular lesions are sometimes present, with membranous glomerulonephritis being the most common. Although IgG4-RKD shows good responsiveness to corticosteroid therapy, follow-up imaging studies have revealed that partial cortical scars persist when the start of therapy is delayed. In this review, the authors provide an overview of the latest knowledge of IgG4-RKD, focusing in particular on its pathological and imaging characteristic features.

MORPHOLOGICAL CHANGES OF RENAL STAGHORN NEPHROLITHIASIS.

Morphological changes in the kidneys of patients with staghorn nephrolithiasis at the time of endoscopic surgery staghorn calculi. In all cases, the morphological study of biopsy specimens revealed varying degrees of renal parenchyma lesions that may be predictors of chronic renal failure in patients with staghorn nephrolithiasis. Assessment of the extent of damage of the renal parenchyma is necessary for the timely implementation of renoprotective therapy.

Renal angiomyolipoma: preoperative identification of atypical fat-poor AML.

The preoperative distinction between benign and malignant renal masses is a well-known radiographic diagnostic challenge. With angiomyolipoma (AML) and renal cell carcinoma (RCC) representing the most common benign and malignant renal parenchymal lesions, respectively, differentiating these two entities is especially important due to their vastly different treatments and prognoses. Renal AML is typically composed of smooth muscle cells, dysmorphic blood vessels, and varying amounts of adipose tissue. In most cases, "typical" AML can be diagnosed by identifying macroscopic fat with ultrasound, computed tomography, or magnetic resonance imaging. However, approximately 4-5% of AML tumors have fat that is grossly undetectable by conventional techniques, precluding a straightforward diagnosis. The overlapping radiographic features between "atypical" or "fat-poor" AML and RCC, especially in smaller (<3-4cm) lesions, lead many patients with benign AML to undergo unnecessary surgery for suspected RCC when the diagnosis is not established beforehand. This review presents the most recent studies and developments in preoperative evaluation of fat-poor AML.

Intérêt de la scintigraphie rénale au DMSA dans les pyélonéphrites aiguës de l’enfant

IntroductionAcute pyelonephritis is responsible for significant morbidity during the acute phase and distant irreversible kidney damage. However, diagnosis is often difficult in children. The aim of our study was to evaluate in children hospitalized for suspected acute pyelonephritis prevalence of acute lesions revealed by scintigraphy with 99mTc labeled dimercaptosuccinic acid (DMSA) and the relationship between renal parenchymal lesions and different clinical factors and biological risks. MethodsThis is a prospective study collecting 40 children admitted with suspected infection of the high urinary tract. All have benefited from DMSA renal scintigraphy. ResultsThe average age of our patients was 3.25years. The DMSA scan showed signs of acute pyelonephritis in 32.5% of cases. Taking this examination as a reference, fever was the most sensitive clinical signs (76.9%), but the specificity was only 48.1%. CRP (≥20mg/mL) was the most sensitive (92.3%) but with a specificity of 40.7% organic signs. A high CRP was associated with acute pyelonephritis significantly (P=0.0033). Sixty-three percent of refluxing kidneys were associated with acute pyelonephritis versus 20.8% of non-refluxing kidneys, with a significant difference (P=0.007). ConclusionIn case of urinary tract infection in children, a complete clinical and laboratory table may be sufficient to retain the diagnosis of acute pyelonephritis. However, this possibility is rare. In the opposite case, a DMSA scan should be performed to confirm the diagnosis.

Computed Tomography Urography for Diagnosis of Calyceal Diverticulum Complicated by Urolithiasis: The Accuracy and the Effect of Abdominal Compression and Prolongation of Acquisition Delay

To evaluate the accuracy of computed tomography urography (CTU) in the detection of caliceal diverticulum (CD) complicated with urolithiasis and the effect of compression and prolongation of acquisition delay. All data were collected from a previous research between 2002 and 2011 at 3 hospitals. A total of 182 patients with evidence of renal parenchymal cystic lesion with calcific density were evaluated by CTU. Excretory phase imaging was acquired at 10 minutes and 60 minutes for each patient. Eighty-three patients received abdominal compression intervention during 10-minutes delay. CDs with stones were finally diagnosed in 41 patients (22.5%). Opacification within an apparent cyst was found in 31 patients (75.6%) when excretory phase images were acquired at 10 minutes and 38 patients (92.7%) at 60 minutes. The sensitivity and accuracy were significantly better with 60-minutes delay than with 10-minutes delay (92.7% vs 75.6%, P= .016 and 97.8% vs 94.0%, P= .016, respectively). The diagnostic results of compression group had significantly higher sensitivity and accuracy than that of the noncompression group (94.4% vs 60.9%, P= .025 and 98.8% vs 90.9%, P= .023, respectively). It is important to distinguish CD from other diseases such as complex cyst when diagnosing a renal parenchymal cystic lesion with wall calcification. CTU has high sensitivity and accuracy in the detection of CD. Abdominal compression and longer imaging delay can significantly improve the diagnostic effect of CTU.

500 Long-term impact of unilateral diffuse renal parenchymal lesion in infants with primary vesicoureteral reflux: Outcome of 10 years follow up

500 Long-term impact of unilateral diffuse renal parenchymal lesion in infants with primary vesicoureteral reflux: Outcome of 10 years follow up

Risk Factors for Renal Scar Formation in Infants With First Episode of Acute Pyelonephritis: A Prospective Clinical Study

We prospectively determined the risk factors for renal scar formation after the first episode of acute pyelonephritis as confirmed on dimercapto-succinic acid scintigraphy in children younger than 1 year. A total of 213 infants with acute pyelonephritis were enrolled in the study. Infants with urological abnormalities other than vesicoureteral reflux were excluded from analysis. Followup scanning was performed 6 months after acute pyelonephritis and voiding cystourethrography was performed after the acute phase of infection. Possible risk factors were evaluated including gender, peak fever, duration of fever before and after treatment with antibiotics, white blood cell count, C-reactive protein concentration, presence of vesicoureteral reflux and reflux grade. Six months after acute pyelonephritis 37 of 213 (17.4%) infants and 41 of 248 (16.5%) renal units with acute photon defects on initial dimercapto-succinic acid scintigraphy had renal scars. The rates of scar formation were significantly higher in infants with vesicoureteral reflux than in those without (39.4% vs 7.5%, p <0.001, OR 9.433) and in renal units with vesicoureteral reflux than in those without (39.4% vs 8.2%, p <0.001, OR 7.237). Renal scar formation was related to reflux grade (none-8.2%, grade I-20%, grade II-22.7%, grade III-40%, grade IV-70%, grade V-55.6%, p <0.001) but not to any other clinical or laboratory variables. The presence of vesicoureteral reflux was the only independent risk factor for renal scar formation after acute pyelonephritis in infants. The prevalence of renal scarring was significantly correlated with reflux grade. Voiding cystourethrography is necessary in infants after the first acute pyelonephritis episode is confirmed on dimercapto-succinic acid renal scintigraphy.

An abundance of IgG4+ plasma cells is not specific for IgG4-related tubulointerstitial nephritis

IgG4-related tubulointerstitial nephritis (IgG4-TIN), the renal parenchymal lesion of IgG4-related sclerosing disease, is characterized, among other things, by the presence of numerous IgG4-positive plasma cells (IgG4+PC) in the kidney infiltrate. The specificity of this finding for IgG4-TIN has not been addressed. To address this we examined 100 consecutive renal biopsy samples with active interstitial inflammation for the presence of IgG4+PC, and correlated the findings with principal diagnosis, the available clinical histories, and the findings in four biopsy samples of IgG4-TIN. Eleven of the survey biopsy samples contained an average of more than 10 IgG4+PC per × 200 field, including two with IgG4+PC in numbers comparable to those in two of the IgG4-related tubulointerstitial disease biopsy samples. The principal pathological diagnoses in the IgG4+PC-rich cases included anti-neutrophil cytoplasmic antibody-positive necrotizing glomerulonephritis (five cases), diabetic nephropathy (two cases), idiopathic interstitial nephritis (two cases), membranous glomerulonephritis (one case), and lupus nephritis (one case). There was no reason, based on histology or clinical history, to believe that any of these cases represented previously unsuspected IgG4-related tubulointerstitial disease. We conclude that the presence of numerous IgG4+PC is essential to, but not sufficient for, the diagnosis of IgG4-TIN.