Renal Sinus Fat Research Articles

Prognostic impact of renal sinus fat accumulation in patients with chronic kidney disease.

Obesity is associated with the development and progression of chronic kidney disease (CKD). In the general population, the amount of renal sinus fat was associated with hypertension and renal impairment. However, its impact upon those with CKD remains uncertain. We prospectively included CKD patients who underwent renal biopsy and simultaneously measured their renal sinus fat volume. The association between the percentage of renal sinus fat volume, which was adjusted by kidney volume, and renal outcomes was investigated. A total of 56 patients (median 55years old, 35 men) were included. Among baseline characteristics, age and visceral fat volume were positively correlated with the percentage of renal sinus fat volume (p < 0.05). The percentage of renal sinus fat volume was associated with hypertension (p < 0.01) and tended to be associated with max glomerular diameter (p = 0.078) and urine angiotensinogen creatinine ratio (p = 0.064) after adjustment with several clinical factors. The percentage of renal sinus fat volume was significantly associated with a future > 50% decline in estimated glomerular filtration rate (p < 0.05). Among those with CKD who required renal biopsy, the amount of renal sinus fat was associated with poor renal outcomes accompanied by systemic hypertension.

MP41-08 PROGNOSTIC SIGNIFICANCE OF PT3A STAGING SUBCLASSIFICATIONS IN NON-CLEAR CELL RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 Apr 2023MP41-08 PROGNOSTIC SIGNIFICANCE OF PT3A STAGING SUBCLASSIFICATIONS IN NON-CLEAR CELL RENAL CELL CARCINOMA Michael Rezaee, Maximilian Pallauf, Roy Elias, Sean Fletcher, Christian Pavlovich, Ezra Baraban, Yasser Ged, and Nirmish Singla Michael RezaeeMichael Rezaee More articles by this author , Maximilian PallaufMaximilian Pallauf More articles by this author , Roy EliasRoy Elias More articles by this author , Sean FletcherSean Fletcher More articles by this author , Christian PavlovichChristian Pavlovich More articles by this author , Ezra BarabanEzra Baraban More articles by this author , Yasser GedYasser Ged More articles by this author , and Nirmish SinglaNirmish Singla More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003279.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior studies in clear cell renal cell carcinoma (RCC) have suggested that the pT3a staging subclassification based on perinephric fat, renal sinus fat, and renal vein invasion may represent an overly heterogenous group of patients with varying survival trajectories. A similar evaluation has not yet been performed in patients with non-clear cell pathology. Therefore, we examined the prognostic significance of perinephric fat, renal sinus fat, and renal vein invasion in pT3a non-clear cell RCC (nccRCC) patients. METHODS: A population-based retrospective cohort study of patients with pT3aN0M0 nccRCC was performed using Surveillance, Epidemiology, and End Results (SEER) data for the years 2010 through 2019. Patients were grouped by pT3a subclassification: perinephric fat, renal sinus fat, and segmental or renal vein invasion. Cox proportional hazards models were used to examine the relationship between pT3a subclassification groups and cancer-specific survival, overall and by histological subtype (papillary, chromophobe, and other nccRCC tumors). RESULTS: The final analysis sample consisted of 1,640 pT3aN0M0 nccRCC patients with a median follow up of 4 years. Compared to perinephric fat invasion, segmental or renal vein invasion was associated with significantly worse cancer-specific survival (hazard ratio [HR] 3.0, 95% CI: 2.1 – 4.3, Figure 1) overall. Of these patients, 51.1%, 38.4%, and 10.5% had papillary, chromophobe, and other nccRRC tumors, respectively. Among patients with papillary (HR 4.8, 95% CI: 2.8 – 8.3) and chromophobe (HR 2.9, 95% CI: 1.1 – 7.9) pT3a tumors, segmental or renal vein invasion was associated with significantly worse cancer-specific survival compared to perinephric fat invasion. No difference was observed in cancer-specific survival by pT3a subgroups for other nccRCC tumors. Patients with two pT3a characteristics had significantly worse cancer-specific survival compared to those with only one (HR 2.1, 95% CI: 1.5 to 3.1). CONCLUSIONS: Cancer-specific survival is significantly worse in pT3a nccRCC patients with segmental or renal involvement, particularly in those with papillary and chromophobe tumors. Current RCC staging guidelines may underestimate the prognostic value of segmental or renal vein involvement relative to other pT3a criteria. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e557 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Rezaee More articles by this author Maximilian Pallauf More articles by this author Roy Elias More articles by this author Sean Fletcher More articles by this author Christian Pavlovich More articles by this author Ezra Baraban More articles by this author Yasser Ged More articles by this author Nirmish Singla More articles by this author Expand All Advertisement PDF downloadLoading ...

MP47-17 SINGLE CENTER COMPARISON OF RADIOGRAPHIC AND MORPHOMETRIC CHARACTERISTICS AND OUTCOMES IN T3A PATHOLOGICALLY UPSTAGED AND NON-UPSTAGED RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 Apr 2023MP47-17 SINGLE CENTER COMPARISON OF RADIOGRAPHIC AND MORPHOMETRIC CHARACTERISTICS AND OUTCOMES IN T3A PATHOLOGICALLY UPSTAGED AND NON-UPSTAGED RENAL CELL CARCINOMA Saeed Ghassemzadeh, Aastha Shah, Dhruv Puri, Luke Wang, Franklin Liu, Sohail Dhanji, Kevin Hakimi, Mimi Nguyen, Ryan Nasseri, Margaret Meagher, Clara Cerrato, Juan Javier-Desloges, and Ithaar Derweesh Saeed GhassemzadehSaeed Ghassemzadeh More articles by this author , Aastha ShahAastha Shah More articles by this author , Dhruv PuriDhruv Puri More articles by this author , Luke WangLuke Wang More articles by this author , Franklin LiuFranklin Liu More articles by this author , Sohail DhanjiSohail Dhanji More articles by this author , Kevin HakimiKevin Hakimi More articles by this author , Mimi NguyenMimi Nguyen More articles by this author , Ryan NasseriRyan Nasseri More articles by this author , Margaret MeagherMargaret Meagher More articles by this author , Clara CerratoClara Cerrato More articles by this author , Juan Javier-DeslogesJuan Javier-Desloges More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A significant portion of patients presenting with Stage 1-2 Renal Cell Carcinoma (RCC) are pathologically upstaged to Stage 3 following surgery. This is due to previously undetected extension into the renal venous system, perirenal or renal sinus fat, or collecting system. Improved detection of potential T3 upstaging may prompt changes in disease management and may impact patient survival. We sought to compare pathologically upstaged and non-upstaged T3a RCC cases to identify characteristics of upstaged masses, predictors of T3a disease, and impact on oncological outcomes. METHODS: We conducted a single center retrospective analysis of patients with pathologic T3a RCC who underwent surgical intervention. The cohort was divided into a group of patients with masses which were upstaged, (cT1-cT2/pT3a) and a group with masses preoperatively identified as cT3a (non-upstaged, cT3a/pT3a) for descriptive and outcomes analyses. We sought to delineate proportion of underdiagnosed pT3a RCC, location of upstaged disease, and predictors of upstaging. Outcomes were overall survival (OS) and recurrence-free survival (RFS). Multivariate analyses (MVA) were performed to identify predictors of T3a invasion site and outcomes. Kaplan Meier survival analyses (KMA) were performed to compare survival outcomes. RESULTS: We analyzed 185 patients, of which 120 (64.9%) were upstaged and 65 (35.1%) were non-upstaged. When compared to non-upstaged masses, upstaged masses were significant for smaller size (6.8 cm vs 8.2 cm, p=0.008), lower RENAL score (8.7 vs 9.9, p<0.001), less hilar involvement (29.2% vs 86.2%, p<0.001), and increased exophyticity (41.7% vs 23.1%, p=0.011). On pathology, upstaged masses had greater proportions of perirenal fat invasion (53.3% vs 33.8%, p=0.011), but less venous system (44.2% vs 78.5%, p<0.001) and sinus fat invasion (35.8% vs 63.1%, p<0.001) compared to non-upstaged masses. RENAL domains R, E, and L were independent predictors for T3a disease foci (OR=0.053-7.70, p=0.001-0.042). MVA demonstrated that non upstaged cT3a RCC had a higher risk of recurrence (HR=2.01, p=0.043). KMA noted better RFS in upstaged patients compared to non-upstaged patients (80.8% vs 75.4%, p=0.002). CONCLUSIONS: Pathologically upstaged T3a RCC is associated with distinct morphology and invasion patterns, and improved recurrence free survival when compared to non-upstaged T3a RCC. RENAL domains can aid in identifying masses with upstaging potential. Source of Funding: UC San Diego Summer Research Fellowship © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e651 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Saeed Ghassemzadeh More articles by this author Aastha Shah More articles by this author Dhruv Puri More articles by this author Luke Wang More articles by this author Franklin Liu More articles by this author Sohail Dhanji More articles by this author Kevin Hakimi More articles by this author Mimi Nguyen More articles by this author Ryan Nasseri More articles by this author Margaret Meagher More articles by this author Clara Cerrato More articles by this author Juan Javier-Desloges More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...

An Extremely Rare Masquerader – A Case of Chronic Allograft Dysfunction

47 year old lady who was detected to have hypertension at the age of 25 years, with renal dysfunction (Creatinine – 2.5 mg/dl), progressed to End stage renal disease requiring hemodialysis at the age of 31 years. She was on maintenance hemodialysis for the next 18 months and underwent a deceased donor renal transplant in 2009. Her post transplant period was uneventful and her creatinine was 1.2 until September 2021. Her creatinine showed a gradual rise to 1.9 mg/dl with increased requirement of anti hypertensives and increasing proteinuria with protein estimation showing 3950 mg/day. She underwent an allograft biopsy which showed duplication of the glomerular basement membranes and glomerulitis with c4d negative on immunofluorescence. She was treated with intravenous immunoglobulin and Rituximab for the same with not much improvement. However, an ultrasound of the transplant kidney showed bulky and echogenic transplant kidney with mild hydronephrosis and prominent renal sinus fat. MR Urogram showed extensive lymphangiectasia around the transplant kidney and ureter with markedly enlarged and edematous kidney. The collecting system and ureter are encased by the lymphangiectasia. After the treatment of CABMR her creatinine improved to 1.7 mg/dl and proteinuria reduced to 2100 mg/day. However her lymphangiectasia persisted and is being managed conservatively with no intervention planned. There are very few reported cases of Lymphangiectasia post renal transplant.

V05-08 KIDNEY TUMORS WITH RENAL VEIN BRANCH EXTENSION: INITIAL EXPERIENCE ON T3A SUB CLASSIFICATION IN UPSTAGED T1A MASSES

You have accessJournal of UrologyCME1 Apr 2023V05-08 KIDNEY TUMORS WITH RENAL VEIN BRANCH EXTENSION: INITIAL EXPERIENCE ON T3A SUB CLASSIFICATION IN UPSTAGED T1A MASSES Laura Zuluaga, Burak Ucpinar, Kennedy Okhawere, Jordan Rich, Indu saini, Josh Levieddin, Antony Deluxe, and Ketan Badani Laura ZuluagaLaura Zuluaga More articles by this author , Burak UcpinarBurak Ucpinar More articles by this author , Kennedy OkhawereKennedy Okhawere More articles by this author , Jordan RichJordan Rich More articles by this author , Indu saini Indu saini More articles by this author , Josh LevieddinJosh Levieddin More articles by this author , Antony DeluxeAntony Deluxe More articles by this author , and Ketan BadaniKetan Badani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003263.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Much has been written about the prognosis of Renal Cell Carcinoma (RCC) patients upstaged from cT1a to pT3a. However, the nature of the pT3a stage is diverse according to the current TNM (Tumor Node Metastasis) including perinephric fat invasion (PFI), renal sinus fat invasion (SFI), and renal vein branch extension (RVBE) and the prognosis of <4 cm tumors staged T3a due to the intraoperative finding of thrombus has never been explored. We aim to analyze the descriptive data in patients after Partial Nephrectomy (PN) with stage cT1a renal cell carcinoma (RCC) who were upstaged to stage T3a due to intraoperative finding of thrombus in the renal vein branches. METHODS: A retrospective descriptive analysis of our single center kidney cancer database was performed, which identified T1a RCC patients upstaged to T3a due to thrombotic intraoperative finding after PN between 2013 and 2022. Categorical variables were presented using frequency and percentage. Continuous variables presented with median and inter-quartile range. RESULTS: A total of 20 patients were included. Median age was 63.1±11.8. 11 (55%) were male, and 9 (45%) were female. The mean BMI was 28.2±4.1 and median Charlson Comorbidity Index was 4 (IQR: 3, 5). The median renal score was 7, the mean tumor size was 3.2±1.1 and 70% of tumors were left lateral tumors. Median operative time was 120 minutes (IQR 111, 138), and ischemia time was 10 minutes (IQR 11, 13). EBL was 50 ml (IQR 50, 75) and length of stay was 1 day (IQR 1, 1). Two (10%) patients had post-operative complications. Most common tumor histology was clear cell RCC (60%), and no patients had positive surgical margins. At the median follow-up of 11.4 (3.7, 36.2) months, no patient had experienced recurrence. CONCLUSIONS: No studies have described the recurrence characteristics of pT3a RCC with RVB. The treatment outcomes of patients with cT1a RCC upstaged to pT3a after PN remains controversial. Comparative studies are needed to provide conclusions on recurrence data and guidance in terms of follow-up and further treatment for these patients. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e426 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Zuluaga More articles by this author Burak Ucpinar More articles by this author Kennedy Okhawere More articles by this author Jordan Rich More articles by this author Indu saini More articles by this author Josh Levieddin More articles by this author Antony Deluxe More articles by this author Ketan Badani More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract No. 89 Safety, Technical Success, and Clinical Outcomes of Percutaneous Cryoablation of Central Renal Tumors without Pyeloperfusion in 94 Patients

To assess the safety, technical success, and clinical outcomes of percutaneous cryoablation (PCA) without pyeloperfusion in 94 patients with central renal tumors. A single-center retrospective review of all adult patients with a central renal tumor treated by interventional radiology using PCA without pyeloperfusion was approved by the local IRB. Central tumors were defined as those involving the renal sinus fat on pre-procedural cross-sectional imaging. Patient demographics and baseline tumor characteristics including maximal tumor diameter, tumor stage, RENAL nephrometry score, and distance to the nearest critical structure was recorded. Details of the PCA procedure, primary and secondary technical success, rates of local recurrence, adverse events (AEs), cancer-specific survival (CSS), and overall survival (OS) were compiled. Aes were categorized according to SIR criteria. 94 patients (48 females (51%); mean age: 68.2 (range:38-87)) with 94 central renal tumors were included. The mean BMI and Charlson co-morbidity index of the cohort were 33.7 (range:20-56) and 6.9 (range:2-12), respectively. Mean maximal tumor diameter, mean RENAL nephrometry score, and mean distance to the nearest critical structure were 37 mm (range:15-67), 8 (range:4-11), and 9 mm (range:0-29), respectively. 59 tumors (63%) and 35 tumors (37%) were classified as T1a and T1b tumors, respectively. Five patients (5%) underwent embolization of the primary mass prior to PCA. The mean number of probes used during PCA was 2.9 (range:1-8). Primary technical success was achieved in 94% (n = 88) of procedures. Of those that did not achieve primary technical success, three underwent successful repeat PCA (secondary technical success: 97%; n = 91/94). The other three patients were surveilled for residual disease. 24 patients (26%) required hydrodissection during PCA. Six patients (6%) experienced major Aes after PCA including hemorrhage requiring embolization (n = 3), hemorrhage requiring transfusions with admission (n = 2), and perinephric abscess necessitating drain placement (n = 1). 22 patients (23%) experienced minor Aes. Nine patients (10%) experienced local recurrence during the follow-up period. OS was 94% (n = 88/94) while CSS was 98% (n = 92/94). PCA of central renal tumors can achieve high rates of technical and oncologic success with major AE and local recurrence rates comparable to published outcomes of PCA for non-central renal tumors, even without the use of pyeloperfusion.

A comparison of radiographic and morphometric characteristics and outcomes in T3a pathologically upstaged and non-upstaged renal cell carcinoma.

615 Background: A significant portion of patients presenting with clinically localized stage 1-2 renal cell carcinoma are pathologically upstaged to Stage 3 following surgical intervention. This is due to previously undetected extension into the renal venous system, perirenal or renal sinus fat, or collecting system. Improved detection of potential T3 upstaging may prompt changes in disease management, which may impact patient survival. We sought to compare pathologically upstaged and non-upstaged T3a RCC cases to identify characteristics of upstaged masses, predictors of T3a disease, and impact on oncological outcomes. Methods: We conducted a single center retrospective analysis of patients with pathologic T3a RCC who underwent surgical intervention. The cohort was divided into a group of patients with masses not preoperatively identified as cT3a (upstaged, cT1-cT2/pT3a) and a group of patients with masses preoperatively identified as cT3a (non-upstaged, cT3a/pT3a) for descriptive and outcomes analyses. We sought to delineate proportion of under-diagnosed pT3a RCC, location of upstaged disease, and predictors of upstaging. Primary outcome was overall survival (OS) and secondary outcome was recurrence-free survival (RFS). Multivariate analyses (MVA) were performed to identify predictors of T3a invasion site and outcomes. Kaplan Meier survival analyses (KMA) were performed to compare survival outcomes. Results: We analyzed 185 patients, of which 120 (64.9%) were upstaged and 65 (35.1%) were non-upstaged. When compared to non-upstaged masses, upstaged masses were significant for smaller size (6.8 vs 8.2 cm, p=0.008), lower RENAL score (8.7 vs 9.9, p&lt;0.001), less hilar involvement (29.2% vs 86.2%, p&lt;0.001), and increased exophyticity (41.7% vs 23.1%, p=0.011). On pathology, upstaged masses had greater proportions of perirenal fat invasion (53.3% vs 33.8%, p=0.011), but less venous system (44.2% vs 78.5%, p&lt;0.001) and sinus fat invasion (35.8% vs 63.1%, p&lt;0.001) compared to non-upstaged masses. RENAL domains R (OR=2.30-2.49, p=0.037-0.042), E (OR=0.39-2.32, p=0.003-0.009), and L (OR=0.53-7.70, p=0.001-0.031) were independent predictors for T3a disease foci. MVA demonstrated an association between non-upstaged status and recurrence (HR=2.01, p=0.043) but not overall mortality (HR=1.27, p=0.581). KMA noted better RFS in upstaged patients compared to non-upstaged patients (80.8% vs 75.4%, p=0.002), but no OS differences between upstaged and non-upstaged patients (74.2% vs 83.1%, p=0.209). Conclusions: Pathologically upstaged T3a RCC is associated with distinct morphology and invasion patterns and higher recurrence-free survival outcomes compared to non-upstaged T3a RCC. RENAL domains can assist in identifying masses with upstaging potential, predicting their invasion site, and performing preoperative risk stratification.

Case of the Month from the Peter MacCallum Cancer Centre, Melbourne, Australia: combination of stereotactic ablative body radiotherapy and radical nephrectomy for synchronous bilateral primary renal cell carcinoma.

Case of the Month from the Peter MacCallum Cancer Centre, Melbourne, Australia: combination of stereotactic ablative body radiotherapy and radical nephrectomy for synchronous bilateral primary renal cell carcinoma.

Renal cell carcinoma T staging: Diagnostic accuracy of preoperative contrast-enhanced computed tomography.

Renal cell carcinoma (RCC) accounts for 1-2% of all malignancies and is the most common renal tumor in adults. Imaging studies are used for diagnosis and staging. Tumor-Node-Metastasis staging strongly affects prognosis and management, while contrast-enhanced computed tomography (CECT) is regarded as a standard imaging technique for local and distant staging. The present study aimed to evaluate the accuracy of CECT for the preoperative staging of RCC by using surgical and pathological staging as the reference methods. This single-center prospective study was conducted between October 2019 and November 2021. The preoperative abdominal CT scans of patients suspected of having RCC were reviewed. Imaging data were collected, including tumor side and size, and perinephric fat invasion. Intraoperative notes were recorded, including the operation type, perinephric fat invasion, renal vein (RV) or inferior vena cava (IVC) tumor extension, and surrounding organ invasion. pathological data were collected on tumor size, RCC type, presence of clear margins, presence of renal capsule or perinephric fat invasion, renal sinus or pelvicalyceal system (PCS) invasion, segmental or main RV extension, and the involvement of Gerota's fascia and nearby organs. Preoperative CECT revealed that 42 out of 59 tumors had a greater maximum diameter than the pathological specimen, with an overall disparity of 0.25 cm. The specificity of CT for the detection of tumor invasion of the perinephric and renal sinus fat and PCS was 95%, and the sensitivity ranged from 80 to 88%. CT had an 83% sensitivity and a 95 specificity in detecting T4 stage cancer, with a 100% specificity for adrenal invasion. The concordance between radiographic and histological results for RV and IVC involvement was high, with specificities of 94 and 98%, and sensitivities of 80 and 100%, respectively. Overall accuracy for correct T staging was 80%. In conclusion, CECT is accurate in the local T staging of RCC, with high sensitivity and specificity for estimating tumor size and detecting extension to nearby structures and venous invasion.

The influence of systemic and ectopic fat depots on the state of kidney function

Objective: To assess renal function and renal hemodynamics in obese individuals at various stages of the cardiometabolic continuum, including metabolically healthy abdominal obesity (MНАО) without metabolic syndrome (MS), MS, and type 2 diabetes mellitus (DM).Materials and methods: The sample (n = 156) consisting of individuals with abdominal obesity (AO) aged 18-45 years. Study methods included anthropometric measurements, laboratory (total cholesterol, triglycerides, HDL, LDL, uric acid, creatinine, cystatin C, glucose, insulin, with calculation of HOMA-IR, adiponectin, leptin, glomerular filtration rate) and instrumental examinations (renal ultrasound and renal artery duplex scaning, CT with determination of fat depots).Results: Renal function (GFR) and renal blood flow were to be strongly related to fat depot sizes, both systemic (intraabdominal fat) and local (perirenal fat and renal sinus fat) depot. In persons with MHAO, there is a slight decrease in GFR compared to healthy persons and an increase in the pulse index (PI), which indicates an increase in peripheral vascular resistance to blood flow. In individuals with MS and type 2 DM, these changes are even more pronounced.Conclusions: Thus, the identification of renal hemodynamic disorders at the early stages of the cardiometabolic continuum will allow highlighting persons with high renal and cardiovascular risk

Associations of renal sinus fat with blood pressure and ectopic fat in a diverse cohort of adults

BackgroundRenal sinus fat (RSF) is an ectopic fat depot shown to be associated with visceral adiposity and hypertension in predominantly white populations. The purpose of this analysis is to investigate RSF and associations between RSF and blood pressure in a cohort of African American (AA) and European American (EA) adults. A secondary purpose was to explore risk factors associated with RSF. MethodsParticipants were 116 A A and EA adult men and women. Ectopic fat depots were assessed with MRI: RSF, intraabdominal adipose tissue (IAAT), intermuscular adipose tissue (IMAT), perimuscular adipose tissue (PMAT), and liver fat. Cardiovascular measures included diastolic blood pressure (DBP), systolic blood pressure (SBP), pulse pressure, mean arterial pressure, and flow mediated dilation. Matsuda index was calculated for insulin sensitivity. Pearson correlations were used to investigate associations of RSF with cardiovascular measures. Multiple linear regression was used to evaluate contributions of RSF on SBP and DBP and to explore factors associated with RSF. ResultsNo difference was observed in RSF between AA and EA participants. RSF was positively associated with DBP in AA participants, but this was not independent of age and sex. Age, male sex, and total body fat were positively associated with RSF in AA participants. Insulin sensitivity was inversely and IAAT and PMAT were positively associated with RSF in EA participants. ConclusionsDifferential associations of RSF with age, insulin sensitivity, and adipose depots among AA and EA adults suggest unique pathophysiological mechanisms influence RSF deposition, which may contribute to chronic disease etiology and progression.

Rhabdoid Melanoma Solitary Metastasis to Kidney with Renal Vein Invasion Mimicking Renal Cell Carcinoma

Abstract Introduction/Objective 83 percent of malignant melanoma cases present as localized skin lesions. However, a small percentage of patients present with concurrent metastatic disease or experience late metastasis. Metastatic melanoma has highly variable presentation and morphology, frequently mimicking other tumors. The most common metastatic sites in order of frequency are skin and subcutaneous tissue, lungs, liver, bones, and brain. While rare, metastasis to the kidney can occur and typically takes the form of multiple micrometastases. Methods/Case Report Here we present an unusual case of a late, purely rhabdoid large solitary renal metastatic melanoma with renal vein invasion, mimicking rhabdoid renal cell carcinoma. The patient is an 84 year old male with a remote history (30 years) of cutaneous malignant melanoma who was referred with a CT scan demonstrating 7.9 x 5.7 x 5.7 mass in the lower pole of the left kidney with a tumor thrombus in the renal vein hhighly suspicious radiographically for renal cell carcinoma. The patient underwent a radical nephrectomy. Macroscopically there was a solitary 7.7 x 6.3 x 5.5 cm tan-grey mass in the lower pole with gross invasion into the renal sinus fat and renal vein resembling the macroscopic appearance of a renal cell carcinoma. Microscopic examination demonstrated pleomorphic tumor cells with pure rhabdoid morphology, extensive necrosis and Lymphovascular invasion. No pigment was identified. No classic clear cell areas were identified. Immunohistochemical stains were positive for S100, SOX10 Melan-A, HMB45 and vimentin and negative for AE1/3, CK7, CAIX, PAX8, P63, CD117 and AMACR. Multiple resected lymph nodes were negative for metastasis Results (if a Case Study enter NA) NA. Conclusion This case is a rare and unusual presentation of melanoma, and it’s important to keep this diagnosis in consideration in the setting of unusual morphology of renal tumors.

Association between decreased ipsilateral renal function and aggressive behavior in renal cell carcinoma

BackgroundTo assess prognostic value of pre-operative ipsilateral split renal function (SRF) on disease-free survival (DFS) and its association with aggressive pathological features in renal cell carcinoma (RCC) patients. MethodsWe examined patients registered in SNUG-RCC-Nx who underwent partial or radical nephrectomy at Seoul National University Hospital between January 1, 2010 and December 31, 2020. Patients with the following criteria were excluded from the study. 1) non-kidney origin cancer or benign renal tumor, 2) no pre-operative Tc 99 m-DTPA renal scan, 3) single kidney status or previous partial or radical nephrectomy, and 4) bilateral renal mass. Finally, 1,078 patients were included.ResultsAmong 1,078 patients, 899 (83.4%) showed maintained ipsilateral SRF on DTPA renal scan; 179 patients (16.6%) showed decreased SRF. The decreased SRF group showed significantly large tumor size (maintained vs. decreased SRF; 3.31 ± 2.15 vs. 6.85 ± 3.25, p < 0.001), high Fuhrman grade (grade 3–4) (41.7% vs. 55.6%, p < 0.001), and high T stage (T stage 3–4) (9.0% vs. 20.1%, p < 0.001). Pathological invasive features, including invasion of the renal capsule, perirenal fat, renal sinus fat, vein, and collecting duct system, were associated with low SRF of the ipsilateral kidney. Univariate Cox regression analysis identified higher SSIGN (The stage, size, grade, and necrosis) score and decreased ipsilateral SRF as significant risk factors, while multivariate analysis showed SSIGN (5–7) (hazard ratio [HR] 11.9, p < 0.001) and SSIGN (8–10) (HR 69.2, p < 0.001) were significantly associated with shortened DFS, while decreased ipsilateral SRF (HR 1.75, p = 0.065) showed borderline significance. Kaplan–Meier analysis showed that decreased ipsilateral SRF (< 45%) group had shorter DFS than the other group (median DFS: 90.3 months vs. not reached, p < 0.001).ConclusionsAmong unilateral RCC patients, those with low ipsilateral SRF showed poor prognosis with pathologically invasive features. Our novel approach may facilitate risk stratification in RCC patients, helping formulate a treatment strategy.

Fibromyxoid Nephrogenic Adenoma: A Series of 43 Cases Reassessing Predisposing Conditions, Clinical Presentation, and Morphology.

Nephrogenic adenoma is a benign epithelial lesion of the genitourinary tract that arises from the reimplantation and proliferation of shed renal tubular cells in areas of urothelial injury and denudation. Fibromyxoid nephrogenic adenoma is a rare variant that consists of compressed spindle-shaped renal epithelial cells in a fibromyxoid background. Only 14 observations of this variant are reported in the literature. We performed a retrospective analysis of fibromyxoid nephrogenic adenomas from 3 large reference centers. We identified 43 lesions in 6 women and 36 men (2 in 1 man) with a median age of 72 years (range, 31 to 94y). Median lesion size was 0.7cm (range, 0.2 to 5cm). Nephrogenic adenomas were in the bladder (n=15), prostate/prostatic urethra (n=14), kidney (n=7), ureter (n=3), penile urethra (n=3), and urethral diverticulum (n=1). One of the kidney lesions developed in an end-stage kidney and radiologically mimicked cancer. Of 37 patients with information, 36 had predisposing conditions including prior biopsy, transurethral resection of bladder tumor, resection, Foley catheter, BCG treatment, urinary stones, (chemo)radiation, or diverticulum. Only 4/37 (10.8%) had a history of prior irradiation. Fifteen lesions had pure fibromyxoid morphology and 28 were admixed classic and fibromyxoid patterns. Three nephrogenic adenomas involved prostatic stroma, 3 renal sinus fat, 2 muscularis propria (1 bladder, 1 renal pelvis), 1 perinephric fat, and 1 corpus spongiosum. Ten fibromyxoid nephrogenic adenomas were intermixed with urothelial carcinoma, 1 with prostate adenocarcinoma, and 1 with malignant melanoma. By immunohistochemistry, PAX8 was positive in all the examined lesions (n=31). Napsin A was negative in all examined fibromyxoid nephrogenic adenomas (n=30). Twenty of them had classic nephrogenic adenoma component which was positive for napsin A. Similar to classic nephrogenic adenoma, fibromyxoid nephrogenic adenoma can occur anywhere along the urinary tract and is associated with a prior history that causes urothelial injury. In nearly a quarter of the cases, fibromyxoid nephrogenic adenoma extended beyond the lamina propria. Unlike previously suggested, fibromyxoid nephrogenic adenoma is not specifically related to prior radiation therapy. Awareness of this variant is important to avoid misdiagnosis and overtreatment.

Measurement of the Surface Area of the Renal Sinus Fat Using MDCT: Correlation with Presence and Severity of Essential Hypertension and Body Mass Index.

Objectives:Essential hypertension remains a major modifiable risk factor for cardiovascular disease. Excess visceral adipose tissue is associated with the presence of adverse metabolic risk factors. Our study aims to measure the surface area of the renal sinus fat using MDCT and correlate the renal sinus surface area with the presence and grading of essential hypertension as well as body mass index.Materials and Methods:This cross-sectional study included two groups; the patients’ group including 40 cases presented with a history of primary essential hypertension and the control group including 40 cases. The average of the surface area of the two kidneys as well as the average of the surface area of sinus fat was measured in the control and patient subgroups and was correlated with the presence and grading of essential hypertension as well as body mass index.Results:There was a significant correlation between the presence and grading of essential hypertension with prominent renal sinus fat. There was a significant correlation between the average surface area of kidneys and surface area of sinus fat in overweight and obese groups than in the control group (P < 0.01).Conclusion:Obesity is now recognized as a risk factor for the development of renal dysfunction. There was a significant correlation between the surface area of renal sinus fat measured using MDCT and the presence as well as grading of essential hypertension, suggesting that renal sinus fat may promote cardiovascular events.

Sonographic Measurement of Renal Sinus Fat to Renal Cortical Thickness Ratio Is a Better Predictor of Chronic Kidney Disease Than Cortical Thickness Alone

Objective: The aim was to determine if the renal sinus fat-to-cortical thickness ratio was a better predictor of chronic kidney disease (CKD) than cortical thickness alone. Materials and Methods: A total of 199 patients were included in the study. Renal fat, parenchyma, and cortical thicknesses were evaluated by sonography retrospectively. Same day serum glomerular filtration rate (GFR) values were obtained and correlated. Results: The study patients had an average fat-to-cortical thickness ratio &lt;0.4 and had a 63% probability of developing renal failure. The probability increased almost linearly from 65% to 85% for patients with a ratio between 0.4 and 0.5, and then plateaued at 85% probability for a ratio &gt;0.5. Additionally, the average fat-to-cortical thickness ratio was statistically significant ( P-value = .02) in predicting progression to renal failure, compared to a cortical thickness alone ( P-value = .12 and P-value = .39 for the left and right kidney, respectively). However, when evaluating individual kidneys for the average fat-to-cortical thickness ratio, only the left kidney showed a statistical significance ( P-value = .02 and P-value = .08 on the left and right, respectively). Conclusion: The renal sinus fat-to-cortical thickness ratio has a significant negative correlation to GFR, specifically for the left kidney. The probability of developing renal failure increases with higher ratios. The renal sinus fat-to-cortical thickness ratio may also be better than cortical thickness alone in predicting progression toward CKD and it acts as an internal control for differences in body size.

Renal Sinus Fat Is Expanded in Patients with Obesity and/or Hypertension and Reduced by Bariatric Surgery Associated with Hypertension Remission.

Renal sinus fat is a fat depot at the renal hilum. Because of its location around the renal artery, vein, and lymphatic vessels, an expanded renal sinus fat mass may have hemodynamic and renal implications. We studied whether renal sinus fat area (RSF) associates with hypertension and whether following bariatric surgery a decrease in RSF associates with improvement of hypertension. A total of 74 severely obese and 46 lean controls were studied with whole-body magnetic resonance imaging (MRI). A total of 42 obese subjects were re-studied six months after bariatric surgery. RSF was assessed by two independent researchers using sliceOmatic. Glomerular filtration rate (eGFR) was estimated according to the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). Patients with obesity accumulated more RSF compared to lean controls (2.3 [1.7–3.1] vs. 1.8 [1.4–2.5] cm2, p = 0.03). Patients with hypertension (N = 36) had a larger RSF depot compared to normotensive subjects (2.6 [2.0–3.3] vs. 2.0 [1.4–2.5] cm2, p = 0.0007) also after accounting for body mass index (BMI). In the pooled data, RSF was negatively associated with eGFR (r = −0.20, p = 0.03), whereas there was no association with systolic or diastolic blood pressure. Following bariatric surgery, RSF was reduced (1.6 [1.3–2.3] vs. 2.3 [1.7–3.1] cm2, p = 0.03) along with other markers of adiposity. A total of 9/27 of patients achieved remission from hypertension. The remission was associated with a larger decrease in RSF, compared to patients who remained hypertensive (−0.68 [−0.74 to −0.44] vs. −0.28 [−0.59 to 0] cm2, p = 0.009). The accumulation of RSF seems to be involved in the pathogenesis of hypertension in obesity. Following bariatric surgery, loss of RSF was associated with remission from hypertension.

FC028: Characterization of Adipocyte Size and Glucose Uptake in Adipose Tissue with Focus on Different Perirenal Fat Depots

Abstract BACKGROUND AND AIMS Previous studies have suggested that the anatomical location of adipose tissue, and the characteristics of the adipocytes regulating adipose tissue function may be of importance for normal renal function and disease. However, in humans, the adipocyte size and metabolism of the fat depots surrounding the kidney have not been thoroughly characterized. The aim of this study was therefore to characterize adipocyte size and glucose uptake in human perirenal, renal sinus and paranephric adipose tissue. SUBJECTS AND METHODS A total of 25 healthy kidney donors [13 (50%) men, age 48 ± 11 years and BMI 25.7 ± 3.1 kg/m2] were included. Perirenal, renal sinus, paranephric, omental and subcutaneous adipose tissue were collected during laparoscopic unilateral nephrectomy. Adipocyte diameter, basal glucose uptake (no insulin) and insulin-stimulated glucose uptake (25 and 1000 µU/mL) were measured in isolated adipocytes from the different tissues. RESULTS The mean adipocyte cell diameters in the renal fat depots (perirenal, renal sinus and paranephric) were smaller than those in omental and subcutaneous tissue (mean ± sd; 69.3 ± 15.5, 65.5 ± 13.5 and 75.9 ± 16.5 versus 80.3 ± 20.5 and 85.5 ± 16.7 µm, respectively) with adipocytes from the renal sinus fat depot having the smallest cell diameter. Detailed data are displayed in Fig. 1. There were no significant gender differences in cell size and adipocyte size from the different depots did not correlate with body mass index (BMI). Insulin resistance index (HOMA-IR) correlated positively and significantly to adipocyte size in the omental (r = 0.607; P = 0.008), perirenal (r = 0.443; P = 0.027) and paranephric (r = 0.479; P = 0.015) depots. Insulin (both with 25 and 1000 µU/mL) significantly up-regulated glucose uptake in subcutaneous (1.6 and 1.9-fold; P &amp;lt; 0.05), perirenal (1.7 and 2.0-fold; P &amp;lt; 0.01) and paranephric (1.5 and 1.6-folds; P &amp;lt; 0.01) adipocytes, compared with basal (no insulin) as shown in Fig. 2. Interestingly, glucose uptake per cell surface was higher in renal sinus than omental adipocytes (basal (no insulin) 1.2-fold; P &amp;lt; 0.001, physiological (25 µU/mL) and supraphysiological (1000 µU/mL) both 1.3-fold higher; P &amp;lt; 0.001) than omental adipocytes (comparison not shown). CONCLUSION This study in healthy kidney donors indicate differences in different fat depots surrounding the kidney that may be of importance for renal function and disease. The fat depot in the renal sinus, with the smallest adipocytes and potentially a higher glucose uptake, is of specific interest. Detailed metabolic characterization of these fat depots is ongoing. Comparison of adipocyte diameter between the different adipose tissue depots: subcutaneous (n = 24), omental (n = 18), perirenal (n = 25), renal sinus (n = 21) and paranephric adipose tissue (n = 25); Values are mean with SEM as data were normally distributed. **P &amp;lt; 0.01 and ***P &amp;lt; 0.001. Physiological and supraphysiological effect of insulin (25 and 1000 µU/mL) on glucose uptake compared with basal (no insulin) by cell surface in adipocytes isolated from subcutaneous (n = 6), omental (n = 3), perirenal (n = 21), renal sinus (n = 4) and paranephric (n = 18) adipose tissue depots, respectively. Values are median and interquartile range as data were not normally distributed. *P &amp;lt; 0.05, **P &amp;lt; 0.01.

Differentiating the clinical and computed tomography imaging features of mixed epithelial and stromal tumors of the kidney to establish a treatment plan.

ObjectiveTo differentiate the clinical features and computed tomography imaging features in the two types of mixed epithelial and stromal tumor of the kidney (MESTK) and to establish a treatment plan for the MESTK types.MethodsSeventeen patients who underwent multidetector computed tomography (MDCT) before surgery and had a pathological diagnosis of MESTK were enrolled. Their clinical information (R.E.N.A.L. nephrometry score (R.E.N.A.L.‐NS), radical nephrectomy (RN), partial nephrectomy (PN), etc.) were collected. The radiological features included renal sinus fat invagination (SFI), maximal diameter (MD), capsule and septa of the tumor, etc., were also analyzed. They were divided into two types according to the MDsolid/MDtumor ratio (solid type with >60%; cystic type with ≤60%). An independent‐sample t‐test and Fisher exact test were used to assess the differences between the two groups.ResultsMESTKs demonstrated a variable multi‐septate cystic and solid components with a delayed enhancement. There were nine patients for solid type and eight patients for cystic type. Compared with solid type, the lesions in cystic type have larger MD (81.00 ± 37.91 vs. 41.22 ± 24.19, p = 0.020), higher R.E.N.A.L.‐NS (10.03 ± 0.50 vs. 8.95 ± 1.26, p < 0.001), higher RN (75.00% vs. 22.22%, p = 0.015), larger SFI (87.5% vs. 33.3%, p = 0.05), more septa (100% vs. 0%, p < 0.001), and more capsule (100% vs. 11.1%, p < 0.001).ConclusionCystic type MESTK has more hazardous features (such as larger MD, higher R.E.N.A.L.‐NS, more RN, greater SFI, multiple septa) compared with solid type, suggesting that RN is more suitable for cystic type and PN for solid type.

Fibroblast growth factor 21 and adipose tissue distribution in young adult with abdominal obesity

Abstract Introduction Fibroblast growth factor 21 (FGF-21) is a hormone-like protein that is involved in the regulation of glucose and lipid homeostasis. Several studies have reported the association of FGF21 with visceral fat, epicardial fat, and pericardial fat. However, there is limited information about distribution of FGF21 levels in young adults with different metabolic status and its relationship to different body fat. Objective The main aim of study was to investigate the association between subcutaneous (SF), visceral (VF), periaortic (PF), epicardial (EF), perirenal (PRF), renal sinus (RSF) fat and fibroblast growth factor 21 (FGF21) in young adult with abdominal obesity (AO), or with metabolic syndrome (MS). Purpose To assess the level of FGF21 in blood serum in young people with AO and compare it with the distribution of adipose tissue. Methods There were 132 adult 18–45 y.o. in the study. We formed 3 groups: health (n=16, M - 43,8%, av.age 32 [27; 35]); AO plus 1 or less sing of MS (AO) (n=46, men (M) – 37,0%, av.age 40 [34; 43]), and MS (n=70, M – 81,4%, av.age 40 [35; 44]). Height, weight, BMI, waist circumference, blood tests (fast glucose (FG) and glucose tolerance (GT), lipid profile, insulin, adiponectin (ELISA, Mediagnost), leptin (ELISA, DBC), FGF21 (ELISA KIT, BCM Diagnostics) were measured. MS was defined as AO (cut-off of &amp;gt;80cm in women (W) and &amp;gt;94cm in M) plus &amp;gt;1 sign: HDL&amp;lt;1,30(w)/1,04(m)mmol/l; triglycerides&amp;gt;1,7mmol/l; FG&amp;gt;5,6mmol/l; violation GT; BP&amp;gt;140/90mmHg. SF, VF, PF, EF, PRF, RSF (range: −150 to −30 HU) was measured by computed tomography. We calculated ratio subcutaneous to visceral fat (RSV). 24-hour blood pressure monitoring was performed. Results The clinical characteristics of the groups are presented in table 1. We didn't find any difference of level FGF 21 between groups AO (294,4 pg / ml [110,0; 583,5]) and MS (245,7 pg/ml [129,2; 474,8]). But in health group (110,2 pg/ml [62,2; 221,9] it was significant lower (p=0,05). We found significant week relationship FGF 21 with VF (r=0,02, p&amp;lt;0,05) and SF (r=0,02, p&amp;lt;0,05), and insignificant association with PF (r=0,11 p&amp;gt;0,05), EF (r=0,04 p&amp;gt;0,05), PRF (r=−0,17 p&amp;gt;0,05), RSF (r=−0,02 p&amp;gt;0,05). Also, we checked association with other parameters (insulin (r=0,15 p&amp;gt;0,05), adiponectin (r=0,00 p&amp;gt;0,05), glucose (r=0,12 p&amp;gt;0,05)) and found a statistically significant association FGF21 with leptin (r=0,24, p&amp;lt;0,01). Conclusions Young adults with abdominal obesity had elevated level of FGF21. And it was associated with visceral, subcutaneous fat depots and leptin. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health of Russian Federation Table 1. Clinical characteristics of the groups