Renal Sinus Research Articles

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.

Aneurysm of renal artery mimicking as a renal cyst: A case report

Background: Renal artery aneurysm is a dilated segment of renal artery that exceeds twice the diameter of a renal artery. Renal artery aneurysm is a rare condition and mostly asymptomatic. Most renal artery aneurysms diagnosed incidentally when imaging modality performed. We report a case of accessory renal artery aneurysm in a 48-year-old male mimicking as a renal cyst. Case Presentation: A rare case of renal artery aneurysm in a 48-year-old male is presented. Patient came with left flank pain. Abdominal CT scan showed renal cyst on subcapsular left kidney with size of 7 x 4.6 x 9.2 cm. Patient underwent retroperitoneal exploration and excision of the mass and blood clots were found inside. Conclusion: A renal artery aneurysm mimics the presentation of a renal cyst, clinically and radiologically. Therefore, renal artery aneurysm should be considered as a differential diagnosis, especially if the mass located near the renal sinus. Performing imaging such as CT angiography should be considered.

Obesity-Related Chronic Kidney Disease: Principal Mechanisms and New Approaches in Nutritional Management.

Obesity is the epidemic of our era and its incidence is supposed to increase by more than 30% by 2030. It is commonly defined as a chronic and metabolic disease with an excessive accumulation of body fat in relation to fat-free mass, both in terms of quantity and distribution at specific points on the body. The effects of obesity have an important impact on different clinical areas, particularly endocrinology, cardiology, and nephrology. Indeed, increased rates of obesity have been associated with increased risk of cardiovascular disease (CVD), cancer, type 2 diabetes (T2D), dyslipidemia, hypertension, renal diseases, and neurocognitive impairment. Obesity-related chronic kidney disease (CKD) has been ascribed to intrarenal fat accumulation along the proximal tubule, glomeruli, renal sinus, and around the kidney capsule, and to hemodynamic changes with hyperfiltration, albuminuria, and impaired glomerular filtration rate. In addition, hypertension, dyslipidemia, and diabetes, which arise as a consequence of overweight, contribute to amplifying renal dysfunction in both the native and transplanted kidney. Overall, several mechanisms are closely related to the onset and progression of CKD in the general population, including changes in renal hemodynamics, neurohumoral pathways, renal adiposity, local and systemic inflammation, dysbiosis of microbiota, insulin resistance, and fibrotic process. Unfortunately, there are no clinical practice guidelines for the management of patients with obesity-related CKD. Therefore, dietary management is based on the clinical practice guidelines for the nutritional care of adults with CKD, developed and published by the National Kidney Foundation, Kidney Disease Outcome Quality Initiative and common recommendations for the healthy population. Optimal nutritional management of these patients should follow the guidelines of the Mediterranean diet, which is known to be associated with a lower incidence of CVD and beneficial effects on chronic diseases such as diabetes, obesity, and cognitive health. Mediterranean-style diets are often unsuccessful in promoting efficient weight loss, especially in patients with altered glucose metabolism. For this purpose, this review also discusses the use of non-classical weight loss approaches in CKD, including intermittent fasting and ketogenic diet to contrast the onset and progression of obesity-related CKD.

Parapelvic Cysts: An Imaging Marker of Kidney Disease Potentially Leading to the Diagnosis of Treatable Rare Genetic Disorders? A Narrative Review of the Literature.

Simple renal cysts are a common finding during abdominal imaging assessment. The incidence increases with age and it is higher in male gender. Parapelvic cysts are a subset of simple cysts that arise within the renal parenchyma, adjacent to the renal sinus, characterized by being generally single, larger, and incompletely surrounded by renal parenchyma. Noteworthy, parapelvic cysts are a rare and understudied condition which, although considered clinically insignificant due to the absence of influence on renal function, still have a controversial aetiopathogenesis. On the other hand, urological management and differential diagnosis have been thoroughly investigated. The aim of our review is to provide an overall vision on this rare condition, usually misdiagnosed and underestimated, on the basis of more recent data. An accurate differential diagnosis of parapelvic cysts can lead to the identification of treatable conditions such as Fabry disease, autosomal dominant polycystic kidney disease, polycystic liver disease and tuberous sclerosis complex disease.

A Case Report of Renal Replacement Lipomatosis

Replacement lipomatosis of the kidney (RLK) is an advanced form of renal sinus lipomatosis, in which infection, renal calculi and long-standing hydronephrosis are accompanied by renal parenchymal atrophy. The kidneys are usually poor or non-functioning. We present CT and MRI findings of an unusual focal RLK of a 52-year-old male, who was examined with the suspicion of renal malignancy.

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 < 0.05), perirenal (1.7 and 2.0-fold; P < 0.01) and paranephric (1.5 and 1.6-folds; P < 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 < 0.001, physiological (25 µU/mL) and supraphysiological (1000 µU/mL) both 1.3-fold higher; P < 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 < 0.01 and ***P < 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 < 0.05, **P < 0.01.

PD40-10 FORMAL VALIDATION AT FINAL PATHOLOGY AFTER RADICAL NEHRECTOMY OF NEPHROMETRY SCORES: DISCORDANCE RATES AND OVERTREATMENT RISK

PD40-10 FORMAL VALIDATION AT FINAL PATHOLOGY AFTER RADICAL NEHRECTOMY OF NEPHROMETRY SCORES: DISCORDANCE RATES AND OVERTREATMENT RISK

Symptom of renal pelvic “pseudodissection” with computed tomography as a sign of pyelosinus reflux and urine extravasation

The purpose of the study . To find typical computed tomographic signs of pyelosinus reflux with a small amount of extravasation of urine. Material and methods . Eight observations were analyzed in which there was extravasation of urine into the renal sinus detected by CT. Results . In six cases, the changes were on the right, in two – on the left side. The cause of acute urinary tract obstruction in four cases were ureteral stones, in two cases there was compression of the ureter from the outside by a pelvic tumor. In two cases, a day after the relief of renal obstruction, the contrasted urine outside the pelvic was not determined. Additional findings were: flection of the ureter in two cases, renal sinus cysts – in four observations. In four observations an unusual “pseudodissection” of the renal pelvis in the excretory phase was revealed, which consisted in the presence of a thin non-contrasting layer "dividing" the contrasted contents of the pelvis into two parts. Conclusions . 1. Identification of the pattern of “pseudodissection” of the pelvis is practically a pathognomonic computed tomographic symptom of extravasation of urine as a result of pyelosinus reflux and rupture of renal calices. 2. Resolution of ureteral obstruction can lead to complete normalization of the computed tomographic picture during the day. 3. Inflection of the ureter, cysts of the sinus of the kidney, may be provoking factors of extravasation of urine in acute ureteral obstruction, but this requires further study.

Extranodal Rosai-Dorfman-Destombes disease mimicking renal cell carcinoma: a case report and review of literature

Rosai-Dorfman-Destombes disease (RDD) is an uncommon histiocytic disorder of unknown aetiology. Extranodal involvement occurs in a significant proportion of patients but involvement of the kidney is rare. Here we present a case report of extranodal RDD of the kidney. Imaging revealed a heterogeneously enhancing solid mass lesion in left renal hilum infiltrating renal medulla and deeper layers of renal cortex. With the clinical diagnosis of suspected left renal cell cancer, laparoscopic left radical nephrectomy was performed. Macroscopic examination showed specimen covered with Gerota’s fascia and perinephric pad of fat. Renal capsule could be easily split off. On cut section, ill circumscribed solid lesion having variegated appearance with areas of necrosis and haemorrhage, involving middle and lower pole, was noted. Renal sinus appeared to be involved. Microscopic examination showed sheets of histiocytes with abundant eosinophilic to vacuolated cytoplasm. There was emperipolesis of intact lymphocytes. Also, seen were sheets of plasma cells, lymphocytes with intervening dense hyalinised stroma. Retro peritoneal lymph nodes and para-aortic lymph nodes also showed similar histological picture. Immunohistochemistry showed that the histiocytes were positive for S100 and CD68. IgG4-positive plasma cells were not seen. These findings showed that the lesion represented and extranodal RDD of the kidney. Although rare, extranodal RDD should also be included in the differential diagnosis of a renal mass and frozen section be advised whenever feasible.

Is Fat Deposition of Renal Sinus a Concomitant Finding to Fatty Liver Disease? The First Study Regarding the Relationship Between Kidney and Liver Fat Content with Non-Contrast Computed Tomography.

INTRODUCTIONIt has been established that abnormal fat deposits are associated with fat deposition in other abdominal regions and linked to obesity, diabetes mellitus, hypertension, vascular and metabolic diseases. This study aimed to determine whether there was a relationship between fat deposition of the renal (i.e., kidney) sinus (FRS) and fatty liver disease (FLD) in a sample of adults. The authors hypothesized that FRS could be a diagnostic finding associated with Hepatosteatosis (HS) in a sample of younger patients. This study was the first apparent investigation of this possible phenomenon.METHODSA convenience sample of 92 adult patients of which 19 (20.7%) were females and 73 (79.3%) were males, and with a mean age of 30.19 (SD = 6.00) were included. The authors calculated Hounsfield Units (HU) (i.e., relative quantitative measurement of radio density) of patients’ livers and spleens on non-contrast computed tomography (CT). Liver and spleen differences < 10 HU were considered steatosis (FLD). The authors stratified sample patients into two analytic subgroups according to the presence of FLD or not and compared them based on their FRS widths.RESULTSIn the FLD subgroup (N = 48), the difference of HU values between liver and spleen was -5.19 (SD = 11.32), with a range of -38 - 8 HU, while, in the non-steatosis subgroup (N = 44), the mean difference was 16.36 (SD = 3.90), range of 11 - 26 HU. The average diameter of FRS width was 12.5 mm in those patients with steatosis (FLD subgroup) although 9.3 mm in non-FLD patients. (p = 0.02)CONCLUSIONSBased on these results, FRS may be able to be used by radiologists as an ancillary method in the detection of hepatic steatosis in younger adults. The effectiveness of premedical processes (e.g., exercise and diet modification) can also be increased by non-radiologists after detection of lower-grade HS.

A deep learning system for automated kidney stone detection and volumetric segmentation on noncontrast CT scans.

Early detection and size quantification of renal calculi are important for optimizing treatment and preventing severe kidney stone disease. Prior work has shown that volumetric measurements of kidney stones are more informative and reproducible than linear measurements. Deep learning-based systems that use abdominal noncontrast computed tomography (CT) scans may assist in detection and reduce workload by removing the need for manual stone volume measurement. Prior to this work, no such system had been developed for use on noisy low-dose CT or tested on a large-scale externaldataset. We used a dataset of 91 CT colonography (CTC) scans with manually marked kidney stones combined with 89 CTC scans without kidney stones. To compare with a prior work half the data was used for training and half for testing. A set of CTC scans from 6185 patients from a separate institution with patient-level labels were used as an external validation set. A 3D U-Net model was employed to segment the kidneys, followed by gradient-based anisotropic denoising, thresholding, and region growing. A 13 layer convolutional neural network classifier was then applied to distinguish kidney stones from false positiveregions. The system achieved a sensitivity of 0.86 at 0.5 false positives per scan on a challenging test set of low-dose CT with many small stones, an improvement over an earlier work that obtained a sensitivity of 0.52. The stone volume measurements correlated well with manual measurements ( ). For patient-level classification, the system achieved an area under the receiver-operating characteristic of 0.95 on an external validation set (sensitivity = 0.88, specificity = 0.91 at the Youden point). A common cause of false positives were small atherosclerotic plaques in the renal sinus that simulated kidneystones. Our deep-learning-based system showed improvements over a previously developed system that did not use deep learning, with even higher performance on an external validationset.

CT imaging findings of renal epithelioid lipid-poor angiomyolipoma.

To identify specific imaging and clinicopathological features of a rare potentially malignant epithelioid variant of renal lipid-poor angiomyolipoma (E-lpAML). A total of 20 patients with E-lpAML and 43 patients with other lpAML were retrospectively included. Multiphase computed tomography (CT) imaging features and clinicopathological findings were recorded. Independent predictors for E-lpAML were identified using multivariate logistic regression and were used to construct a diagnostic score for differentiation of E-lpAML from other lpAML. The E-lpAML group consisted of 6 men and 14 women (age median ± SD: 39.45 ± 15.70, range: 16.0-68.0years). E-lpAML tended to appear as hyperdense mass lesions located at the renal sinus (n = 8, 40%) or at the renal cortex (n = 12, 60%), with a "fast-in and slow-out" enhancement pattern (n = 20, 100%), cystic degeneration (n = 18, 90%), "eyeball" sign (n = 11, 55%), and tumor neo-vasculature (n = 15, 75%) on CT. Multivariate logistic regression analysis showed that the independent predictors for diagnosing E-lpAML were cystic degeneration on CT imaging and CT value of the tumor in corticomedullary phase of enhancement. A predictive model was built with the two predictors, achieving an area under the curve (AUC) of 93.5% (95% confidence interval (95%CI): 84.3-98.2%) with a sensitivity of 95.0% (95%CI: 75.1-99.9%) and a specificity of 83.72% (95%CI: 69.3-93.2%). We identified specific CT imaging features and predictors that could contribute to the correct diagnosis of E-lpAML. Our findings should be helpful for clinical management of E-lpAML which could potentially be malignant and may require nephron-sparing surgery while other lpAML tumors which are benign require no intervention. • It is important to differentiate renal epithelioid lipid-poor angiomyolipoma (E-lpAML) from other lpAML because of differences in clinical management. • E-lpAML tumors tend to be large hyperdense tumors in the renal sinus with cystic degeneration and "fast-in and slow-out" pattern of enhancement. • Our CT imaging-based predictive model was robust in its performance for predicting E-lpAML from other lpAML tumors.

Integrative Analysis of Peripheral Blood Indices for the Renal Sinus Invasion Prediction of T1 Renal Cell Carcinoma: An Ensemble Study Using Machine Learning-Assisted Decision-Support Models.

PurposeRenal sinus invasion is an attributive factor affecting the prognosis of renal cell carcinoma (RCC). This study aimed to construct a risk prediction model that could stratify patients with RCC and predict renal sinus invasion with the help of a machine learning (ML) algorithm.Patients and MethodsWe retrospectively recruited 1229 patients diagnosed with T1 stage RCC at the Baotou Cancer Hospital between November 2013 and August 2021. Iterative analysis was used to screen out predictors related to renal sinus invasion, after which ML-based models were developed to predict renal sinus invasion in patients with T1 stage RCC. The receiver operating characteristic curve (ROC), decision curve analysis (DCA), and clinical impact curve (CIC) were performed to evaluate the robustness and clinical practicability of each model.ResultsA total of 21 candidate variables were shortlisted for model building. Iterative analysis screened that neutrophil to albumin ratio (NAR), hemoglobin level * albumin level * lymphocyte count/platelet count ratio (HALP), prognostic nutrition index (PNI), body mass index*serum albumin/neutrophil-lymphocyte ratio (AKI), NAR, and fibrinogen (FIB) concentration (NARFIB), platelet to lymphocyte ratio (PLR), and R.E.N.A.L score was related to renal sinus invasion and contributed significantly to ML-based algorithm. The areas under the ROC curve (AUCs) of the random forest classifier (RFC) model, support vector machine (SVM), eXtreme gradient boosting (XGBoost), artificial neural network (ANN), and decision tree (DT) ranged from 0.797 to 0.924. The optimal risk probability of renal sinus invasion predicted was RFC (AUC = 0.924, 95% confidence interval [CI]: 0.414–1.434), which showed robust discrimination for identifying high-risk patients.ConclusionWe successfully develop practical models for renal sinus invasion prediction, particularly the RFC, which could contribute to early detection via integrating systemic inflammatory factors and nutritional parameters.

U-Net Modelling-Based Imaging MAP Score for Tl Stage Nephrectomy: An Exploratory Study.

We evaluate the stability of the clinical application of the MAP scoring system based on anatomical features of renal tumour images, explore the relevance of this scoring system to the choice of surgical procedure for patients with limited renal tumours, and investigate the effectiveness of automated segmentation and reconstruction 3D models of renal tumour images based on U-net for interpretative cognitive navigation during laparoscopy Tl stage radical renal tumour cancer surgery. A total of 5 000 kidney tumour images containing manual annotations were applied to the training set, and a stable and efficient full CNN algorithm model oriented to clinical needs was constructed to regionalism and multistructure and to finely automate segmentation of kidney tumour images, output modelling information in STL format, and apply a tablet computer to intraoperatively display the Tl stage kidney tumour model for cognitive navigation. Based on a training sample of MR images from 201 patients with stage Tl renal tumour cancer, an adaptation of the classical U-net allows individual segmentation of important structures such as renal tumours and 3D visualisation to visualise the structural relationships and the extent of tumour invasion at key surgical sites. The preoperative CT and clinical data of 225 patients with limited renal tumours treated surgically at our hospital from August 2011 to August 2012 were retrospectively analysed by three imaging physicians using the MAP scoring system for the total score and the variables R (maximum diameter), E (exogenous/endogenous), N (distance from the renal sinus), A (ventral/dorsal), L (relationship along the longitudinal axis of the kidney), and h (whether in contact with the renal hilum). The score for each variable (contact with the renal hilum) was statistically compared with each other for the three observers. Patients were divided into three groups according to the total score—low, medium, and high—and according to the surgical procedure—radical and partial resection. The correlation between the total score and the score of each variable and the choice of surgical procedure was analysed. The agreement rate of the total score and the score of each variable for all three observers was over 90% (P ≤ 0.001). The map scoring system based on the anatomical features of renal tumour imaging was well stabilized, and the scores were significantly correlated with the surgical approach.

Mixed Epithelial and Stromal Tumor Family of Kidney (Adult Cystic Nephroma, Mixed Epithelial and Stromal Tumor): Retrospective Clinicopathological Evaluation.

Tumors belonging to the mixed epithelial stromal tumor family (MESTF) are rare; thus clinicopathological experience about them are limited. Each epithelial and stromal component shows different patterns in these tumors. Clinicopathological features of 11 MESTF cases that were diagnosed between 2000 and 2021 at a single center were evaluated. Ten of the 11 patients were female (F:M = 10:1). The mean age of the females was 47 (31-63) years; the male patient was 45 years old. The mean tumor diameter was 6.7 (3.5-19) cm. All tumors had varying proportions of cystic and solid components. Eight cases were well circumscribed, and the others had distinct but irregular borders. Two of the tumors with irregular borders were bulging into the renal sinus. The epithelial component was dominant in most cases. In the epithelial component, macrocyst, microcyst, and tubules were the most common patterns and the most common types of lining epithelium were flat, cuboidal and hobnail. The stromal component was variable in most cases and included hypocellular (mostly collagenous) and cellular areas. In most cases, the cellular stroma had an ovarian-like appearance. Among the other features observed, hyalinization and dystrophic calcification were common. The positivity for estrogen and progesterone receptor in the stromal component was observed in almost all female cases. MESTF, which has distinctive features, should be considered in the differential diagnosis of cystic kidney tumors.

In response to the article "The relationship between renal sinus lipomatosis detected at abdominal computed tomography and abdominal visceral and subcutaneous fat accumulation and metabolic risk factors". Pol J Radiol 2020; 85: e62-e66.

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Aggarwal A, Bagri N. In response to the article “The relationship between renal sinus lipomatosis detected at abdominal computed tomography and abdominal visceral and subcutaneous fat accumulation and metabolic risk factors”. Pol J Radiol 2020; 85: e62-e66. Polish Journal of Radiology. 2022;87(1):232-232. doi:10.5114/pjr.2022.115807. APA Aggarwal, A., & Bagri, N. (2022). In response to the article “The relationship between renal sinus lipomatosis detected at abdominal computed tomography and abdominal visceral and subcutaneous fat accumulation and metabolic risk factors”. Pol J Radiol 2020; 85: e62-e66. Polish Journal of Radiology, 87(1), 232-232. https://doi.org/10.5114/pjr.2022.115807 Chicago Aggarwal, Ankita, and Neha Bagri. 2022. "In response to the article “The relationship between renal sinus lipomatosis detected at abdominal computed tomography and abdominal visceral and subcutaneous fat accumulation and metabolic risk factors”. Pol J Radiol 2020; 85: e62-e66". Polish Journal of Radiology 87 (1): 232-232. doi:10.5114/pjr.2022.115807. Harvard Aggarwal, A., and Bagri, N. (2022). In response to the article “The relationship between renal sinus lipomatosis detected at abdominal computed tomography and abdominal visceral and subcutaneous fat accumulation and metabolic risk factors”. Pol J Radiol 2020; 85: e62-e66. Polish Journal of Radiology, 87(1), pp.232-232. https://doi.org/10.5114/pjr.2022.115807 MLA Aggarwal, Ankita et al. "In response to the article “The relationship between renal sinus lipomatosis detected at abdominal computed tomography and abdominal visceral and subcutaneous fat accumulation and metabolic risk factors”. Pol J Radiol 2020; 85: e62-e66." Polish Journal of Radiology, vol. 87, no. 1, 2022, pp. 232-232. doi:10.5114/pjr.2022.115807. Vancouver Aggarwal A, Bagri N. In response to the article “The relationship between renal sinus lipomatosis detected at abdominal computed tomography and abdominal visceral and subcutaneous fat accumulation and metabolic risk factors”. Pol J Radiol 2020; 85: e62-e66. Polish Journal of Radiology. 2022;87(1):232-232. doi:10.5114/pjr.2022.115807.

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.

THE COMPARATIVE STUDY TO DETECT RENAL &amp; URINARY TRACT CALCULI (NEPHROLITHIASIS AND UROLITHIASIS) ON ULTRASOUND AND CT.

Background: Ultrasound is a non-invasive imaging modality, and it is cost effective while CT in invasive that uses ionizing radiations, yet it is difficult on ultrasound to diagnose calculi in ureter hence for evaluation of ureteric calculi CT scan is gold standard modality.&#x0D; Objective: To compare the detection of renal&amp; urinary tract calculi (nephrolithiasis &amp; urolithiasis) on ultrasound and CT.&#x0D; Material and methods: The data bases PubMed, ProQuest, and Google scholar and research gate were searched with the key words: nephrolithiasis on ultrasound and CT, sensitivity, specificity, from 2010 to 2021. For inclusion and exclusion of studies independently screened the titles and abstracts of full and related articles. Articles that had information about nephrolithiasis, urolithiasis at ultrasound and CT and its sensitivity and specificity were included.&#x0D; Results: In total, 28 studies were found on renal &amp; urinary tract calculi at ultrasound and computed tomography. This literature review demonstrates that computed tomography is characterized by high sensitivity and specificity in diagnosing renal, ureteric calculi while ultrasound has low sensitivity and specificity.&#x0D; Conclusions: Ultrasound is the best modality for imaging calculi within the kidney, a well hyper echoic mass with posterior acoustic shadow is identified as stone on gray scale, color Doppler can be used for demarcation of stone. At Color Doppler twinkling artifact appears around the calculi hence it can be differentiated by hyper echoic renal sinuses but this is crucially dependant on the size and anatomical position of the stone. The ultrasonic evaluation either overestimates or misinterprets the calculi size while CT gives an exact measurement, position with authentic sensitivity and specificity. Hence, CT is the gold standard for detection of renal calculi.&#x0D; Recommendation: Ultrasound is a non-invasive imaging modality and it is cost effective while CT in invasive that uses ionizing radiations, yet it is difficult on ultrasound to diagnose calculi in ureter hence for evaluation of ureteric calculi CT scan is gold standard modality.

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

Papillary Renal Cell Carcinoma With Microcystic Architecture Is Strongly Associated With Extrarenal Invasion and Metastatic Disease.

Papillary renal cell carcinoma (PRCC) is well-recognized as a morphologically and molecularly heterogenous group of kidney tumors with variable clinical behavior. Our goal was to analyze a unique histologic pattern of PRCC we have observed in routine practice to evaluate for potential clinical significance or distinct molecular signature. We identified 42 cases of PRCC showing a morphologically distinct architecture characterized by numerous epithelial-lined cysts containing the papillary tumor (herein called "microcysts"), which are typically separated by fibrous stroma. Of the initial 42 case test set with microcystic features, 23 (55%) were stage pT3a or higher. Most tumors had strong and diffuse cytoplasmic immunoreactivity for CK7 (93%, 37/40) and AMACR (100%, 40/40). Fumarate hydratase staining was retained in all cases tested (39/39). We performed next-generation sequencing on 15 of these cases with available tissue and identified chromosomal alterations commonly reported in historically "type 1" PRCC, notably multiple chromosomal gains, particularly of chromosomes 7 and 17, and MET alterations. However, alterations in pathways associated with more aggressive behavior (including SETD2, CDKN2A, and members of the NRF pathway) were also identified in 6 of 15 cases tested (40%). Given this molecular and immunophenotypic data, we subsequently reviewed an additional group of 60 consecutive pT2b-pT3 PRCCs to allow for comparisons between cases with and without microcysts, to assess for potential associations with other recently described histologic patterns (ie, "unfavorable architecture": micropapillary, solid, and hobnail), and to assess interobserver reproducibility for diagnosing architectural patterns and grade. Of the total combined 102 PRCCs, 67 (66%) had microcystic architecture within the intrarenal component but were commonly admixed with other patterns (39% had micropapillary, 31% solid, and 31% hobnail). Twenty-seven cases (26%) had metastatic disease, and 24 of these 27 (89%) had microcystic architecture in the intrarenal tumor. Within the pT3 subset, 21 of 22 cases with metastases (95%) had extrarenal invasion as either individual microcysts in renal sinus fat or aggregates of microcysts bulging beyond the confines of the capsule. Backward elimination and stepwise regression methods to detect features significantly associated with adverse outcome identified solid architecture (hazard ratio [HR]: 6.3; confidence interval [CI]: 2.1-18.8; P=0.001), hobnail architecture (HR: 5.3; CI: 1.7-16.7; P=0.004), and microcystic architecture at the tumor-stromal interface (HR: 4.2; CI: 1.1-16.7; P=0.036) as strongest. Of architectural patterns and grade, the microcystic pattern had a substantial interobserver agreement (κ score=0.795) that was highest among the 6 observers. In summary, PRCCs with microcystic architecture represents a subset of historically "type 1" PRCC with a predilection for morphologically distinctive extrarenal involvement and metastatic disease. Microcysts co-vary with other "unfavorable" architectural patterns also associated with higher risk for aggressive disease (ie, micropapillary, hobnail, and solid), but microcysts were more common and have superior interobserver reproducibility. These findings suggest that microcystic PRCC should be recognized as a potentially aggressive histologic pattern of growth in PRCC.