Renal Pedicle Research Articles

Abstract 4115634: Potential Role for Circadian Disruption in Acute Kidney Injury-driven Cardiovascular Disease

Background/Hypothesis: Circadian disruption and AKI, even if kidney function recovers, are linked to an increased risk of CVD and death. We explored the hypothesis that AKI was associated with CVD through circadian disruption. Approach: Sixteen ~25-week-old PER2::Luciferase (a real-time reporter of circadian rhythm) C57BL/6J male mice had micro-clamps applied to both renal pedicles for ~26 minutes to produce a recoverable AKI. Three animals underwent a sham procedure. Three animals had to be euthanized all others had serum creatinine (Scr) measured on day 2. Twelve weeks after surgery, all animals (n=13) were euthanized. Results: The sham group's day 2 Scr (n=3; mean 0.10 [range 0.08 - 0.15]) was unchanged from baseline (0.11 [0.07 - 0.18]). Based on the day 2 Scr, 3 mice were classified as having mild/moderate AKI (Scr increased ≤ 3-fold) (0.16 [0.08 - 0.20]) and 7 as having severe AKI (Scr increased > 3-fold) (0.98 [0.26 - 1.93]). By 12 weeks post-AKI, the Scr (0.16 [0.1 - 0.2 mg/dl]) of all animals returned to a level statistically similar to baseline. Immunohistochemistry demonstrated that 6 of 7 mice with severe AKI had atherosclerotic-like lesions in the aortic root (A), sinus, or coronaries (B): 4 mice had lesions averaging 9,754.7 µm 2 and 2 mice had coronary artery lumen narrowing averaging 56.2%. Similar lesions were found in 1 of 3 mice with mild/moderate AKI, but no lesions were found in the sham animals (C). The lesions had CD45+ cells on their surface and in the adventitia (A inset), but were devoid of CD68+ and SMC alpha-actin+ cells. In the neointima, SMC alpha-actin+ cells predominated (B inset). Mouse liver, lung, adrenal gland, renal cortex, outer and inner medulla were collected at 15:00 and analyzed for 5 days by Lumicycle. Circadian rhythms were evaluated with JTK_CYCLE. No apparent AKI-dependent differences were observed in the liver, lung, adrenal, or renal outer medulla. However, the amplitude of renal inner medulla rhythms decreased with AKI (P = 0.008), while the amplitude of renal cortex increased with AKI (P = 0.01, E&F). Conclusions: This is the first report of an AKI model resulting in atherosclerosis-like lesions in wild-type mice without the need for a high-fat diet, genetic manipulation, or further provocation. The lesions were associated with a disruption of the intrarenal circadian rhythms. We will discuss the implications of this research as well as the metabolic consequences of the circadian disruption.

Nephroprotective role of resveratrol in renal ischemia-reperfusion injury: a preclinical study in Sprague-Dawley rats.

Renal ischemia-reperfusion injury (IRI) is a significant contributor to renal dysfunction, acute kidney injury (AKI), and associated morbidity and mortality. Resveratrol, a polyphenol and phytoalexin, is known for its anti-inflammatory, antioxidant, and anti-cancer properties. This study investigates the nephroprotective potential of resveratrol in a rat model of renal IRI. Twenty-eight male Sprague-Dawley rats were divided into four groups: Sham, IRI, DMSO, and Resveratrol. The Sham group underwent identical procedures without renal pedicle clamping, while the IRI group experienced 30min of ischemia followed by 2h of reperfusion. The DMSO group received dimethyl sulfoxide (DMSO) intraperitoneally 30min before ischemia, and the Resveratrol group received 30mg/kg resveratrol intraperitoneally 30min before ischemia. Biochemical parameters (Urea, creatinine, IL-1β, NF-κβ, SOD, GSH, Bcl-2, and caspase-3) and histopathological changes were assessed. IRI caused a substantial increase in serum creatinine, Urea, IL-1β, NF-κβ, and caspase-3 levels, while simultaneously decreasing SOD, GSH, and Bcl-2 levels. Resveratrol treatment mitigated these effects by lowering inflammatory and apoptotic markers, enhancing antioxidant defenses, and improving histological outcomes. Resveratrol demonstrates significant nephroprotective effects in renal IRI, primarily through its antioxidant, anti-inflammatory, and anti-apoptotic properties.

Impact of Tumor Volume and Other Factors on Renal Function After Partial Nephrectomy.

Background and Objectives: One of the main objectives of partial nephrectomy is to preserve as much renal function as possible. However, the removal of functioning nephrons and ischemic damage secondary to the clamping of the renal pedicle can be associated with a certain degree of renal function loss. We aim to evaluate the relationship between tumor volume and other factors on renal function in the short term (1-3 months) and long term (6-12 months) in our series of partial nephrectomies. Methods: A retrospective study was conducted on 147 patients who underwent open or laparoscopic partial nephrectomy between 2018 and 2022. Tumor volume was estimated through reconstructions from the computed tomography images. Univariate and multivariate analyses of the data were performed. Results: The mean age was 58.2 years, with an average glomerular filtration rate (GFR) of 79 mL/min/m2. Of all partial nephrectomies, 76.2% were laparoscopic, 57.1% were T1a tumors, and the mean volume was 17 cc. The average ischemia time during surgery was 14.3 min, with a mean hemoglobin loss of 2.8 g/dL in the immediate postoperative period. No significant differences were found either in the short or long term regarding ischemia time (p = 0.57, p = 0.32) or tumor volume (p = 0.57, p = 0.33). However, in the multivariate analysis, it was observed that the variable with the greatest influence on short-term renal function was perioperative glomerular filtration, while in the long term, ischemia time, age, and tumor volume also had an influence. Conclusions: Tumor volume is not an independent factor for renal function deterioration in the short or long term. Short-term renal function is primarily determined by perioperative glomerular filtration. Perioperative glomerular filtration, ischemia time, age, and tumor volume can jointly predict long-term renal function.

Extrarenal Visceral Arteries Injuries during Left Radical Nephrectomy: A 50-Year Continuing Problem

Due to their proximity to the left renal hilum, injuries to the superior mesenteric artery and celiac trunk are still reported during left radical nephrectomy, whether performed via open, laparoscopic, or robotic methods. The aim of this 50-year narrative review is to emphasize the anatomical and pathophysiological bases, risk factors, and strategies for the prevention, diagnosis, and treatment of such injuries.

Ultrasound-guided renal artery balloon catheter occluded hybrid partial nephrectomy (UBo-HPN) with branch renal artery occlusion: a single arm trial

BackgroundOne key focus of partial nephrectomy is preserving renal function. Segmental renal artery occlusion with microdissection at the renal hilum confines ischemia, effectively reducing warm ischemic injury. Ultrasound-Guided Renal Artery Balloon Catheter Occluded Hybrid Partial Nephrectomy (UBo-HPN) can achieve branch occlusion without the need for dissecting the renal hilum.ObjectiveTo investigate the feasibility and safety of UBo-HPN of branch renal artery occlusion in the treatment of localized renal tumors.Subject and methodsA prospective single-arm analysis involving 20 patients with renal localized tumors underwent robot assisted UBo-HPN with branch renal artery occlusion from August 2021 to July 2023, with an average follow-up of 12 months.ResultsAll patient was successfully operated on without conversion to conventional arterial clamping or radical nephrectomy. One case (5%) of minor complication occurred in the whole cohort, which was bruising around the puncture site. The mean total operative time was 95.8 min, with a mean operative time of 21.25 min for vascular intervention. The mean warm ischemia time was 20.35 min, and the median estimated blood loss was 50 ml. The median eGFR preservation percentage at postoperative 48 h, 30 days, and the latest follow-up were 87.52%, 91.47%, and 92.2%, respectively. After a median follow-up of 10.2 (2.3–19.2) months, no patients had radiological tumor recurrence or died from tumor-related causes.ConclusionsUBo-HPN with renal artery branch occlusion emerges as an efficient alternative to partial nephrectomy (PN), which achieved branch artery occlusion without dissecting the renal hilum. Long-term follow-up is expected for functional outcomes.

8071 Prevention Of Acute Kidney Injury By Reducing Mitochondrial Dysfunction In Diabetic Mice

Abstract Disclosure: M. Kim: None. C. Oh: None. A. Khang: None. J. Jeon: None. I. Lee: None. Background: Acute Kidney Injury (AKI) significantly contributes to the pathogenesis of diabetic kidney disease, often exacerbating chronic kidney disease (CKD) and accelerating the need for dialysis. Mitochondrial dysfunction, induced by an increase in reactive Oxygen Species (ROS) and inflammation, plays a crucial role in AKI. This study investigates the prevention of AKI by reducing mitochondrial dysfunction through pyruvate dehydrogenase kinase (PDK) inhibition in an ischemia-reperfusion (IR)-induced AKI model using streptozotocin (STZ)-induced diabetic mice. Methods: We utilized an IR-induced AKI model in STZ-induced diabetic C57BL6/J mice, subjecting them to IR by clamping both renal pedicles. Mitochondrial function tests, cellular apoptosis, and inflammatory markers were evaluated in NRK-52E cells and mouse primary tubular cells after hypoxia and reoxygenation using a hypoxia workstation. Results: In diabetic mice experiencing AKI following IR injury, there was a significant increase in pyruvate dehydrogenase E1α (PDHE1α) phosphorylation. This correlated with a notable increase in mitochondrial damage - TEM images of mice with IR-induced kidney injury revealed distension, loss of cristae, and fragmentation of the mitochondria. We also observed a decrease in oxygen consumption rate (OCR) accompanied by increased ROS, as well as increased production of inflammatory markers. Remarkably, the pan-PDK inhibitor, sodium dichloroacetate (DCA), mitigated apoptosis, attributable to the reduction of PDHE1α phosphorylation levels as well as normalized mitochondrial morphology and function. DCA treatment lessened oxidative stress and decreased the production of inflammatory markers following IR-induced AKI or hypoxia-reoxygenation injury. Conclusion: Restoration of mitochondrial function by DCA effectively alleviated renal injury by decreasing ROS production and inflammation, highlighting its critical role in IR-mediated damage. These results suggest another potential target for renal protection during AKI; therefore, the prevention of acute kidney injury through the inhibition of PDK could be a promising therapeutic approach for treating Diabetic Kidney Disease (DKD). Presentation: 6/1/2024

8563 Pheochromocytoma Screening In A Patient With Neurofibromatosis Type I And Medication-Resistant Hypertension

Abstract Disclosure: E. Mora: None. A. Bolduc, MD: None. G. Elshimy: None. Title: Pheochromocytoma Screening in a Patient With Neurofibromatosis Type I and Medication-Resistant Hypertension Background: Patients with neurofibromatosis type I (NF1) have a higher risk of pheochromocytoma and it may be missed if no screening done, thus placing the patient at risk of stroke and/or myocardial infarction. The prevalence of pheochromocytoma in patients with NF1 is 2.9% according to a retrospective cohort study by Gruber et al. We present a case of biochemically silent pheochromocytoma in a patient with NF1 and resistant hypertension Clinical case: A 74-year woman with NF1 presented with episodic headaches and labile systolic blood pressure (BP) in the 170-200s mm Hg on three different antihypertensives consistent with pheochromocytoma. Initial tests for renal artery stenosis and pheochromocytoma showed normal plasma MN (0.43 nmol/L, n< 0.50 nmol/L) and NM (0.86 nmol/L, n< 0.90 nmol/L), and normal flow in both renal hila by color Doppler and no large suprarenal masses identified on retroperitoneal US. Duplex imaging of the bilateral kidneys showed no evidence of renal artery stenosis. CT of abdomen/pelvis with and without IV contrast showed a 1.6 cm nodule on Right (RT) adrenal gland that measured 36 HU on unenhanced phase with an absolute washout of 67%. No discrete nodule in Lt adrenal gland. Dotatate PET/CT revealed a Rt adrenal nodule with elevated asymmetric activity (measured 28.1 standardized uptake values (SUV), n for liver: max 12.3, spleen: max 23.5) relative to the normal physiologic activity of the Leftt adrenal gland, which is concerning for pheochromocytoma. The patient was then referred to our endocrine clinic for further evaluation 6 months after the initial presentation. Labs showed normal aldosterone (5.8 ng/dL, n≤39.2 ng/dL), cortisol (7.66 mcg/dL, n: 3.09-22.40 mcg/dL), ACTH (20 pg/mL, n: 7.2-63 (AM collection), and DHEA-S (28 mcg/dL, n:5.3-124 mcg/dL). Normal repeat plasma MN (0.38 nmol/L, n< 0.50 nmol/L) and NM (0.46 nmol/L, n< 0.90 nmol/L). Repeat CT adrenal washout redemonstrated 1.4 cm Rt adrenal nodule that measured 39 HU on non- contrast image with an absolute washout of 68%. Patient will have a surgical resection of the Rt adrenal biochemically silent pheochromocytoma next week and she has been receiving an alpha-blocker prior to surgery to decrease risk for labile BP. Discussion and Conclusion: This case illustrates how CT and DOtatate scan findings can alert providers to the presence of a pheochromocytoma, even in biochemically negative patients. We recommend pheochromocytoma screening in all patients with NF1 to prevent delayed diagnosis and complications of untreated pheochromocytoma. Presentation: 6/1/2024

Which lymphadenectomy for adrenocortical carcinoma?

BackgroundLymph node dissection improves adrenocortical carcinoma staging, but remains anatomically poorly defined. This ambiguity stems from limited knowledge of the adrenals lymphatic network. This work aims to define lymph node dissection for adrenocortical carcinoma through a systematic review and anatomical study. MethodFirst, an anatomical study was conducted on fresh cadavers by injecting blue dye into each adrenal gland before dissection. Concurrently, a systematic review of anatomical and clinical studies was performed, focusing on adrenals lymphatic network, lymph node dissection, and location of invaded lymph nodes in surgical series. ResultsTwelve adrenals from 6 cadavers were resected en bloc with a median of 3 lymph nodes (1.5–6) removed. Screening of 6,506 studies revealed (1) 18 anatomical studies on cadavers detailing a 3-stage compartmentalized adrenals lymphatic network with distinct right/left lymph nodes relays; (2) 4 clinical studies highlighting discrepancies in lymph node involvement in adrenocortical carcinoma patients compared with anatomical description of adrenals lymphatic network, notably: lower implication of celiac lymph node, preponderance of ipsilateral renal hilum lymph nodes, potential contralateral involvement; (3) 21 series of adrenocortical carcinoma surgery demonstrating the heterogeneity of lymph node dissection practice (22% ± 4% lymph node dissection rate), with an average of 2.7 ± 0.6 lymph nodes removed, already fewer than in our cadaveric study. ConclusionSynthesis of anatomical and clinical studies suggest the following lymph node dissection protocol during adrenocortical carcinoma resection: capsular, renal hilum, para-cava, and inter-aortic-cava lymph nodes (right adrenocortical carcinoma); and capsular, renal hilum, para-aortic, and inter-aortic-cava lymph nodes (left adrenocortical carcinoma).

Sivelestat Sodium Alleviates Ischemia-Reperfusion-Induced Acute Kidney Injury via Suppressing TLR4/Myd88/NF-κB Signaling Pathway in Mice.

We aim to detect the effects of sivelestat on renal ischemia-reperfusion associated with AKI and also explore the underlying mechanism. Mice, aged between 8 and 12weeks, were randomly allocated among four distinct groups, respectively normal saline sham group(C), normal saline surgery group(I), sivelestat (50 mg/kg) sham group(S), sivelestat (50 mg/kg) surgery group(SI) (n=6, each group). In the surgical groups, the renal pedicles of mice were clamped withnon-traumatic micro-aneurysm clamps, resulting in ischemia of the kidneys for 45minutes. This was followed by a period of reperfusion lasting 24hours. Sham group mice underwent the identical surgery produced without clamping renal pedicles. Mice blood was obtained from eyeballs, and Serum creatinine and blood urea nitrogen levels were measured. After a 24-hour period of reperfusion, the mice were euthanized, and their kidneys were gathered for various analyses, including Western Blot (WB) analysis, RT-PCR, immunofluorescence (IF), hematoxylin and eosin (H&E) staining, and Tunel assay. Pretreatments with sivelestat decreased renal Neutrophil elastase (NE), serum creatinine, and blood urea nitrogen levels after renal ischemia-reperfusion. Sivelestat also reduced histological damage and cell apoptosis in kidneys following ischemia-reperfusion injury (IRI). In addition, thesivelestat administrationdiminished the levels of mRNA expression of interleukin 6 (IL-6), Macrophage inflammatory protein-2 (MIP-2), monocyte chemoattractant protein-1 (MCP-1), and tumor necrosis factor (TNF)-α in the kidneys during IRI.The kidney tissues of the SI group had significantly mitigated TLR4, Myd88, and NF-κB p-p65 protein expression levels compared to the I group (all P<0.05). We demonstrated a previously unidentified mechanism that sivelestat effectively attenuates AKI-induced renal dysfunction, possibly through suppressing the TLR4/Myd88/ NF-κB pathway.

A subset of image-defined risk factors predict completeness of resection in children with high-risk neuroblastoma: An international multicenter study.

Image-defined risk factors (IDRFs) were promulgated for predicting the feasibility and safety of complete primary tumor resection in children with neuroblastoma (NB). There is limited understanding of the impact of individual IDRFs on resectability of the primary tumor or patient outcomes. A multicenter database of patients with high-risk NB was interrogated to answer this question. Patients with high-risk NB (age <20years) were eligible if cross-sectional imaging was performed at least twice prior to resection. IDRFs and primary tumor measurements were recorded for each imaging study. Extent of resection was determined from operative reports. There were 211 of 229 patients with IDRFs at diagnosis, and 171 patients with IDRFs present pre-surgery. A ≥90% resection was significantly more likely in the absence of tumor invading or encasing the porta hepatis, hepatoduodenal ligament, superior mesenteric artery (SMA), renal pedicles, abdominal aorta/inferior vena cava (IVC), iliac vessels, and/or diaphragm at diagnosis or an overlapping subset of IDRFs (except diaphragm) at pre-surgery. There were no significant differences in event-free survival (EFS) and overall survival (OS) when patients were stratified by the presence versus absence of any IDRF either at diagnosis or pre-surgery. Two distinct but overlapping subsets of IDRFs present either at diagnosis or after induction chemotherapy significantly influence the probability of a complete resection in children with high-risk NB. The presence of IDRFs was not associated with significant differences in OS or EFS in this cohort.

The Potential Renoprotective Effect of Fedratinib in Renal Ischemia Reperfusion Injury in Male Rat Model

Renal Ischemia Reperfusion Injury (RIRI) is a serious condition that arises following kidney transplantation or other circumstances that result in decreased blood supply to the kidneys, these conditions cause a harm to the renal tissue. Gaining insight into the fundamental mechanisms of RIRI, including inflammation, cell death pathways, is essential for the development of successful therapeutic approaches. Objective: This study aimed to assess the effects of Fedratinib, a JAK2 inhibitor, in reducing RIRI in a rat model. The study involved rats divided into four groups: Sham group, control group, vehicle group, and Fedratinib group. Rats underwent anaesthesia and midline incision to expose renal pedicles, with blood flow halted using microvascular clamps. The wound was stitched, and the animals were left for 90 minutes to allow reperfusion. Blood samples were collected from the heart apex to assess serum urea and creatinine, and renal slices were used for PCR to detect the jak2/stat3 pathway. The Elisa was used to evaluate TNF, IL-6, NF-κB, Bax, Bcl2, and HMGB levels. Results: IL-6 and TNF-α, and HMGB1 were identified to have a role in the development of RIRI, inhibition of JAK2/STAT3 pathway by Fedratinib significantly decrease their concentration and minimizing RIRI. Suppression of JAK2/STAT3 pathway led to a significant inhibition in NF-κB and apoptosis. Conclusion: Fedratinib has a potential preventive effect against RIRI through their activity as JAK2 inhibitor and inhibition of the following downstream inflammatory pathways.

Nephronsparing surgery for retroperitoneal sarcomas

Objective: to clarify the indications for the use of nephron-sparing technologies in surgical treatment of patients with retroperitoneal sarcomas. Material and Methods. The study included 64 patients with primary retroperitoneal sarcomas with kidney and renal pedicle invasion, who underwent surgical treatment in the Thoracic-abdominal Department of the P.A. Herzen Moscow Oncology Research Institute from 2010 to 2021. Twenty-one patients underwent nephrectomies, and 43 patients underwent nephron-sparing surgery. The morphological profile of sarcomas, age and gender of the patients, feasibility of using nephron-sparing technologies, postoperative complications, and long-term outcomes in patients of both groups were analyzed. Results. Forty-three patients with primary retroperitoneal sarcomas with invasion of the renal parenchyma, ureter, and renal pedicle underwent nephron-sparing surgery (precision mobilization of the kidney, ureter and vascular structures of the kidney from tumor tissue, kidney resection, ureteral stenting, resection of the renal vein orifices, resection of the ureters, and kidney autotransplantation). Postoperative complications were observed in 19.0 % of nephrectomy group patients (4 pts: II, IIIB, IV and V types according to Clavien–Dindo) and in 30.2 % of nephron-sparing group patients (15 pts: types II – 8, IIIA – 1, IIIB – 3, IV – 1). No statistical differences in the relapse-free period and survival time between two groups were observed. The 1-, 3- and 5-year survival rates were 84.1 %, 65.9 %, and 51.4 %, respectively. Multifactorial analysis showed that mortality increased significantly in patients over 64 years of age and was associated with both disease recurrence and concomitant pathology (p=0.009). There was also a trend toward decreased survival in patients with leiomyosarcoma (p=0.066). Conclusion. In retroperitoneal sarcomas, tumor resection with preservation of organs and structures not directly invaded by the tumor is the optimal surgical strategy. Nephron-sparing technologies do not worsen both immediate and long-term treatment outcomes. For leiomyosarcoma, tumor resection with nephrectomy is the most suitable approach.

TUMOR IN HORSESHOE KIDNEYS: A CASE REPORT AND LITERATURE REVIEW

Objective: This study aims to report a renal tumor in a horseshoe kidney successfully treated with an open left nephrectomy. Case(s) Presentation: A 3 years old girl with a lump in the left abdomen and intermittent hematuria was referred to our hospital. Whole abdominal contrast CT scan showed the presence of a left renal mass in a horseshoe kidney that infiltrates the left renal artery and is attached to the spleen. The patient underwent preoperative chemotherapy followed by surgical resection. Discussion: In a horseshoe kidney, renal tumors are uncommon. The limited kidney mobilization and access to the renal hilum and the abnormal and highly variable vasculature make surgical treatment of a tumor in a horseshoe kidney extremely difficult. Conclusion: Open surgery continues to be the treatment of choice for horseshoe kidney tumors due to their anatomical complexity, particularly in cases where the tumor is difficult to eradicate. Keywords: Renal tumor, horseshoe kidney, surgical management.

Concomitant circumaortic and retro-aortic left renal veins associated with fenestrated renal artery.

Variations of the left renal vein can be in the form of circumaortic vein or renal collar, retro-aortic vein, additional renal vein, or multiple primary tributaries. We report a unique complex venous pattern of concomitant circumaortic and retro-aortic left renal veins associated with a fenestrated left renal artery. Two renal veins, anterior and posterior to the renal artery, originated from the renal hilum. The anterior vein was further divided into two branches. One branch passed through the fenestrated renal artery to continue as the anterior limb of the circumaortic vein. It received the suprarenal and gonadal veins and drained into the inferior vena cava. The other branch coursed posterior to the fenestrated renal artery and joined the posterior renal vein. The posterior renal vein was divided into two branches: one forming the posterior limb of the circumaortic vein, and the other continued obliquely downwards as the retro-aortic vein. Variations in the left renal vein have been implicated in several clinical conditions, such as varicocele and pelvic varices. It also plays a crucial role in renal transplantation, as the left kidney is often used as the donor organ. Even though many reports have been published on circumaortic and retro-aortic veins, the complex venous pattern associated with a fenestrated renal artery has not been reported previously.

Retrocolic Fascia-An Anatomical and Multidetector Computed Tomographic Angiography (MDCTA) Morphometric Analysis in Patients with Right Colon Cancer.

This study aims to delineate anatomical landmarks crucial for complete mesocolic excision, focusing on Gerota's fascia, which guides surgical dissection in right-sided colon cancer, forming the posterior limit. Employing a multimodal approach, the research aims to understand the fascial anatomy and its variations under pathological conditions. Three methods were applied: a pilot dissection on an embalmed cadaver for clear anatomical presentation of prerenal fascia, Mimics segmentation of the fascia and its relationship with the colon, and a retrospective analysis of MDCTA scans from 196 patients (mean age 65.73 y, 118 F/78 M). Systematic measurements of fascial thickness were taken at key renal levels-upper pole, hilum, lower pole, and infra-renal. Covariates analyzed included Body Mass Index, age, and sex. The pilot dissection revealed the renal fascia of Gerota as the only true retrocolic compact connective tissue and the fusion fascia of Toldt as a mesh of strands of loose connective tissue and fat lobules. MDCTA showed clearer visualization of Gerota's fascia at the hilum and inferior renal pole, predominantly on the left. There were significant differences in fascial thickness between sides (1.30 mm on the right and 1.34 mm on the left) and a positive correlation with BMI, whereas age and sex showed no significant effects. Gerota's fascia is a critical anatomical landmark in CME for right colon cancer. This study highlights the fascia's structural integrity, unaffected by the tumor, underscoring its importance in surgical navigation.

Abstract P145: The Biological Effects of Cross-Sex Hormone Therapy in the Male Rat Does Not Enhance Renal Risk in Young Adulthood

Transgender females ( TGFs ) are born male but identify as female. Gender-affirming hormone therapy ( GAHT ) is used to treat gender dysphoria. In TGFs, GAHT includes 17β-estradiol ( E2 ) combined with an anti-androgen or surgical intervention. Whether renal function is decreased in TGFs on GAHT compared to cis-gender controls is unknown. Thus, we tested the hypothesis that glomerular filtration rate ( GFR ) is reduced and that renal susceptibility to acute renal ischemia is enhanced in male rats that undergo cross-sex hormone therapy ( CSHT ) in young adulthood. Male Sprague Dawley rats were randomly assigned to Control ( CON ) or E2 [5 mg/day, silastic capsule s.c. replaced every 3 weeks] starting at 13 weeks of age (adulthood) followed by castration ( CTX ) two weeks later. At 25 weeks of age, rats in each group were randomly subdivided to undergo Sham or renal Ischemia/Reperfusion ( I/R , 18 minute occlusion renal pedicles) (n=8-11/grp). Metabolic studies were conducted two days prior, then 1, 7, and 21 days after Sham or I/R with GFR measured (direct method of FITC-sinistrin) at end of study. Two-way ANOVA with Tukey’s post hoc analysis, P &lt;0.05 considered significant. Results ( Table ): Body weight and lean mass (EchoMRI) were significantly decreased in E2+CTX vs. CONs (* P &lt;0.0001). At 1-day post-surgery, proteinuria was decreased in E2+CTX vs. CONs († P &lt;0.05); yet, 3 weeks post-surgery, proteinuria was only reduced in E2+CTX I/R vs. CON Sham († P&lt; 0.05). GFR did not differ but urinary creatinine, which may reflect lean mass, was decreased in both E2+CTX vs. CONs (* P &lt;0.0001). These data suggest that the biological effect of CSHT in the male does not enhance renal risk in young adulthood.

Renal sinus adipose tissue: exploratory study of metabolic features and transcriptome compared with omental and subcutaneous adipose tissue.

The objective was to study metabolic characteristics and transcriptome of renal sinus adipose tissue (RSAT) located around renal arteries and veins. Adipose tissue biopsies from RSAT, omental (OAT), and subcutaneous (SAT) depots were obtained from healthy kidney donors (20 female, 20 male). Adipocyte glucose uptake rate and cell size were measured, and gene expression analyses using transcriptomics were performed. RSAT adipocytes were significantly smaller, with a higher basal glucose uptake rate, than adipocytes from SAT and OAT. Transcriptomic analyses revealed 29 differentially expressed genes between RSAT and OAT (RSAT: 23 lower, 6 higher) and 1214 differentially expressed genes between RSAT and SAT (RSAT: 859 lower, 355 higher). RSAT demonstrated molecular resemblance to OAT, both exhibiting lower metabolic gene expression and higher expression of immune-related pathways, including IL-17, TNFα, and NF-κB signaling than SAT. Weighted gene coexpression network analysis associated RSAT with immune response and nucleic acid transport processes. Despite its location near the renal hilum, RSAT closely resembled OAT and there was a lack of expression in the classical brown adipose tissue genes. Gene enrichment analyses suggest an inflammatory environment in RSAT compared with SAT and, to some extent, OAT. The findings suggest specific RSAT functions that could impact renal function and, possibly, the development of renal and cardiometabolic disorders.

Laparoscopic removal of retroperitoneal schwannoma in renal hilum: a case report

BackgroundSchwannomas in the renal hilum are rare among retroperitoneal tumors. However, the possibility of malignant findings cannot be ruled out, and surgery is often indicated. This case was expected to be difficult to remove laparoscopically because the tumor was sandwiched between the arteriovenous veins of the renal portal. Sometimes, the tumor should be resected with a conservative approach to the kidney to preserve the renal function.Case presentationOur patient was a 51-year-old Asian-Japanese man who was referred to our department for a retroperitoneal tumor in the renal hilum. Since malignancy could not be ruled out due to its size (45 × 48 × 55 mm) on imaging, the tumor was excised laparoscopically. Histopathology revealed schwannoma.ConclusionsWe herein report a case in which a renal hilar tumor between renal arteriovenous vessels was successfully resected laparoscopically.

Characteristics of Abdominal Fat Based on CT Measurements to Predict Early Recurrence After Initial Surgery of NMIBC in Stage Ta/T1

IntroductionThis study aimed to assess the predictive value of abdominal fat characteristics measured by computed tomography (CT) in identifying early recurrence within one year post-initial transurethral resection of bladder tumor (TURBT) in patients with nonmuscle-invasive bladder cancer (NMIBC). A predictive model integrating fat features and clinical factors was developed to guide individualized treatment. Materials and MethodsA retrospective analysis of 203 NMIBC patients from two medical centers was conducted. Abdominal CT images were analyzed using 3D Slicer software. Spearman correlation, logistic regression, and the Lasso algorithm were employed for data analysis. Predictive efficacy was assessed using the area under the curve (AUC) of receiver operating characteristic (ROC) and decision curve analysis (DCA). Calibration was evaluated using the Hosmer-Lemeshow test. ResultsSignificant differences in abdominal fat characteristics were found between the recurrence and nonrecurrence groups. All fat features positively correlated with body mass index (BMI), with bilateral perirenal fat thickness (PrFT) showing superior predictive performance. Multivariate logistic regression identified independent predictors of early recurrence, including tumor number, early perfusion chemotherapy, left and right PrFT, and visceral fat area (VFA) at umbilical and renal hilum levels. The Lasso-based model achieved an AUC of 0.904, outperforming existing models. ConclusionAbdominal fat characteristics, especially bilateral PrFT, strongly correlate with early recurrence in NMIBC. The Lasso-based model, integrating fat and clinical factors, offers superior predictive efficacy and could improve individualized treatment strategies.

Acidic preconditioning induced intracellular acid adaptation to protect renal injury via dynamic phosphorylation of focal adhesion kinase-dependent activation of sodium hydrogen exchanger 1

BackgroundDisruptions in intracellular pH (pHi) homeostasis, causing deviations from the physiological range, can damage renal epithelial cells. However, the existence of an adaptive mechanism to restore pHi to normalcy remains unclear. Early research identified H+ as a critical mediator of ischemic preconditioning (IPC), leading to the concept of acidic preconditioning (AP). This concept proposes that short-term, repetitive acidic stimulation can enhance a cell’s capacity to withstand subsequent adverse stress. While AP has demonstrated protective effects in various ischemia-reperfusion (I/R) injury models, its application in kidney injury remains largely unexplored.MethodsAn AP model was established in human kidney (HK2) cells by treating them with an acidic medium for 12 h, followed by a recovery period with a normal medium for 6 h. To induce hypoxia/reoxygenation (H/R) injury, HK2 cells were subjected to hypoxia for 24 h and reoxygenation for 1 h. In vivo, a mouse model of IPC was established by clamping the bilateral renal pedicles for 15 min, followed by reperfusion for 4 days. Conversely, the I/R model involved clamping the bilateral renal pedicles for 35 min and reperfusion for 24 h. Western blotting was employed to evaluate the expression levels of cleaved caspase 3, cleaved caspase 9, NHE1, KIM1, FAK, and NOX4. A pH-sensitive fluorescent probe was used to measure pHi, while a Hemin/CNF microelectrode monitored kidney tissue pH. Immunofluorescence staining was performed to visualize the localization of NHE1, NOX4, and FAK, along with the actin cytoskeleton structure in HK2 cells. Cell adhesion and scratch assays were conducted to assess cell motility.ResultsOur findings demonstrated that AP could effectively mitigate H/R injury in HK2 cells. This protective effect and the maintenance of pHi homeostasis by AP involved the upregulation of Na+/H+ exchanger 1 (NHE1) expression and activity. The activity of NHE1 was regulated by dynamic changes in pHi-dependent phosphorylation of Focal Adhesion Kinase (FAK) at Y397. This process was associated with NOX4-mediated reactive oxygen species (ROS) production. Furthermore, AP induced the co-localization of FAK, NOX4, and NHE1 in focal adhesions, promoting cytoskeletal remodeling and enhancing cell adhesion and migration capabilities.ConclusionsThis study provides compelling evidence that AP maintains pHi homeostasis and promotes cytoskeletal remodeling through FAK/NOX4/NHE1 signaling. This signaling pathway ultimately contributes to alleviated H/R injury in HK2 cells.