Renal Size Research Articles

Application of functional magnetic resonance imaging to evaluate renal structure and function in type 2 cardiorenal syndrome.

There is a lack of diagnostic non-invasive imaging technology for assessing the early structural and functional changes of the kidney in type 2 cardiorenal (CRS) patients. This study aims to explore the value of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for clinical application in type 2 CRS patients, to provide imaging markers for the assessment of kidney damage. This is a retrospective observational clinical study conducted in Nanjing, China. The clinical characteristics, including age, gender, medical history, laboratory results, and ultrasound and magnetic resonance imaging results were collected from the electronic medical record. Thirty-one patients with type 2 CRS, 20 patients with chronic heart failure (HF) and 20 healthy controls were enrolled and divided into type 2 CRS, HF and control groups. All the participants underwent magnetic resonance imaging (MRI) scanning. The apparent diffusion coefficient (ADC) value and IVIM-DWI parameters including true diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) were obtained. The correlation between estimated glomerular filtration rate (eGFR), renal size and imaging parameters was evaluated by Spearman correlation analysis. ADC and D of the renal cortex in patients with type 2 CRS were lower than those in the healthy control group. ADC and f in the HF group were lower than those in the control group. D was positively correlated with the length (r = 0.3752, P = 0.0013) and transverse diameter (r = 0.3258, P = 0.0056) of the kidney. ADC (r = 0.2964, P = 0.0121) and D (r = 0.3051, P = 0.0097) were positively correlated with eGFR. Renal cortical ADC and D values could distinguish type 2 CRS patients from the healthy controls with area under the curve (AUC) of 0.723 and 0.706, respectively. The ADC and D values were not only correlated with renal function, but also had lower levels in type 2 CRS. The IVIM-DWI parameter D was also related to kidney size, but further research is needed to determine whether it can be used as a novel imaging marker for type 2 CRS.

Impact of neoadjuvant therapy on prognosis in renal cell carcinoma with inferior vena cava thrombus

BackgroundThe standard treatment for non-metastatic renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus is complete surgical resection; however, this procedure is complex and carries high complication rates and perioperative mortality. Previous studies have explored preoperative multimodal therapy to reduce surgical difficulty, but limited evidence prevents guideline recommendations. This study aimed to investigate the impact of neoadjuvant therapy on the prognosis of patients with RCC and IVC thrombus without distant metastasis. MethodsData from 2006 to 2024 on RCC patients with IVC thrombus undergoing radical nephrectomy plus IVC thrombus resection were collected. Patients received neoadjuvant therapy, including tyrosine kinase inhibitors or immune checkpoint inhibitors, followed by surgery. Tumor size and thrombus height were assessed by computed tomography. Disease-free survival (DFS) and overall survival (OS) were calculated using Kaplan-Meier curves. Multivariate analysis was used to identify factors predicting DFS. ResultsThirty-one patients who did not receive neoadjuvant chemotherapy therapy (NAC-Naive group) and 19 patients who received neoadjuvant chemotherapy therapy (NAC group) were analyzed. The NAC group showed significant reductions in primary renal tumor size and neutrophil-to-lymphocyte ratio compared to the NAC-Naive group just before nephrectomy. The NAC group had significantly improved DFS and OS. Median DFS and OS were not reached in the NAC group compared to 26.3 months and 73.5 months, respectively, in the NAC-Naive group. The NAC group had a 2-year recurrence-free survival rate of 70.9% compared to 50.6% in the NAC-Naive group. Multivariate analysis identified a preoperative tumor size of 10 cm or larger and lack of neoadjuvant therapy as poor prognostic factors for DFS. ConclusionNeoadjuvant therapy significantly improves the prognosis of RCC patients with IVC thrombus. This therapy reduces surgical invasiveness and has a mid- to long-term preventive effect on recurrence. These findings support the potential benefit of neoadjuvant systemic therapy in improving outcomes for this patient population.

Everolimus on cystic kidney disease burden reduction in pediatric tuberous sclerosis complex patients: a case series

BackgroundTuberous Sclerosis complex (TSC) is a multisystemic neurocutaneous genetic condition with high rates of morbidity and mortality from subependymal giant cell astrocytoma (SEGA), renal angiomyolipoma, and renal cyst complications. Everolimus is an inhibitor for mTORC1 and is currently used to treat TSC for its main role in rapidly reducing SEGA volume and seizure burden, although mainly studied in the adult population. It has also been shown to stabilize estimated glomerular filtration rate and reduce renal angiomyolipoma size in the adult population.Case presentationThis case report illustrates three pediatric patients placed on everolimus for SEGA and seizure control with incidental findings of the disappearance of or decreased burden of cystic kidney disease after everolimus therapy. In one patient, the cyst burden remained stable even after the cessation of everolimus while the SEGA resumed growth.ConclusionsThis report demonstrates the utility of everolimus in not only renal angiomyolipomas but also cystic kidney disease particularly in pediatric patients with a promising role in preserving renal function and preventing long term sequelae such as hematuria and hemorrhage from larger renal cysts especially if used early on in disease course.

Prevalence of canine renal insufficiency: A decade-long retrospective study in and around Patna, Bihar

This retrospective study investigates the prevalence and epidemiological factors associated with renal insufficiency in dogs within Patna, Bihar, India. Out of 5,700 dogs with various illnesses, 317 were diagnosed with renal insufficiency, identified by serum creatinine levels exceeding 5 mg/dL. The study assessed the incidence of renal insufficiency across different demographics, including age, sex, breed, and season. The highest incidence was observed in dogs aged 8-10 years, with males showing a higher prevalence than females. Pomeranians (32.18%), Labrador Retrievers (25.55%), and German Shepherds (20.82%) were the most affected breeds. Seasonally, the post-monsoon period (September-November) exhibited the highest incidence (37.85%) of renal disorders. Laboratory investigations revealed significant haematological and biochemical alterations in affected dogs, including lower haemoglobin, total erythrocyte count, and packed cell volume, alongside elevated serum levels of blood urea nitrogen (BUN), creatinine, potassium, and phosphorus. Ultrasonography indicated decreased renal size and increased echogenicity in dogs with renal insufficiency. The study concludes that renal insufficiency in dogs is most prevalent in older males and certain breeds, particularly during the post-monsoon season. Regular monitoring of serum BUN and creatinine levels is recommended for early diagnosis and management of this condition.

Ultrasonographic estimation of kidney size in adult Bangladeshi population without known renal disease: a preliminary report

Background: The kidney size of a patient is a valuable diagnostic parameter in clinical practice. Renal size varies with age, gender, body mass index (BMI), pregnancy, race and co-morbid conditions like diabetes mellitus (DM) and hypertension (HTN). Measurements of renal dimensions can be carried out by using different modern techniques like ultrasonography (USG), computed tomography (CT) scan and magnetic resonance imaging (MRI). Out of these modalities USG is choice because of its simplicity, inexpensive, easily available, non-invasive and easy reproducibility. There is no established nomogram for renal size in the Bangladeshi population. Aim of the study was to determine the ultrasonographic renal size in adult Bangladeshi population with no known renal disease and to correlate renal size with age, gender and BMI. In addition, we assess whether hypertension and diabetes mellitus affect renal size. Methods: This cross-sectional study was done in BIRDEM General Hospital and included 55 patients with age >18 years over 6 month period. Study population were not known to have renal disease documented by urine routine microscopy, spot urine for albumin creatinine ratio (ACR), serum creatinine and USG. Their body weight, height and BMI were calculated along with duration of DM and HTN. Analysis was done for differences due to age, gender and laterality. The correlation of renal dimensions with anthropometric parameters were also done. Results: A total of 55 patients were analyzed. There were 19 (34.5%) male and 36 (65.5%) female. The mean age was 46±.10 years. There mean weight, height and BMI were 61 ± 11 kg, 1.54±.069 meter, 25.7 ± 4.8 kg/m2 respectively. In total population 34.5% (19) were diabetic and 32.5% (18) were hypertensive. The means of length, width and parenchymal thickness (PT) of right kidneys (RK) were 10.1 ± 0.87, 4.2 ± 0.67 and 1.4± 0.32 cm respectively. The means of length, width and PT of left kidneys (LK) were 10.3 ± 0.89, 4.5 ± 0.49 and 1.5 ± 0.32 cm respectively. Measurements were significantly higher in LK than those of RK respectively (p=.003, p<.001 and p=.041). There were significant differences in kidney length and PT between sex and age. There were also significant differences in kidney length and PT between subjects of higher BMI, long duration of DM and HTN. The correlation between renal length and weight showed a positive correlation (r = 0.16, p < 0.023). Conclusion: The variation of parameters of both kidneys varies on gender, age, obesity, comorbidity like DM & HTN and with their duration. Length of both kidneys depends on body weight. Further study needed with large samples. BIRDEM Med J 2024; 14(3): 151-157

Oridonin Attenuates Diabetes‑induced Renal Fibrosis via the Inhibition of TXNIP/NLRP3 and NF‑κB Pathways by Activating PPARγ in Rats.

Oridonin possesses remarkable anti-inflammatory, immunoregulatory properties. However, the renoprotective effects of oridonin and the underlying molecular mechanisms in diabetic nephropathy (DN). We hypothesized that oridonin could ameliorate diabetes‑induced renal fibrosis. Streptozocin (STZ)-induced diabetic rats were provided with a high-fat diet to establish a type 2 diabetes mellitus (T2DM) animal model, and then treated with Oridonin (10, 20 mg/kg/day) for two weeks. Kidney function and renal fibrosis were assessed. High glucose-induced human renal proximal tubule epithelial cells (HK-2) were also treated with oridonin. The expression of inflammatory factors and fibrotic markers were analyzed. Oridonin treatment preserved kidney function and markedly limited the renal fibrosis size in diabetic rats. The renal fibrotic markers were inhibited in the oridonin 10 mg/kg/day and 20 mg/kg/day groups compared to the T2DM group. The expression of thioredoxin-interacting proteins/ nod-like receptor protein-3 (TXNIP/NLRP3) and nuclear factor (NF)‑κB pathway decreased, while that of peroxisome proliferator-activated receptor-gamma (PPARγ) increased in the oridonin treatment group compared to the non-treated group. In vitro, PPARγ intervention could significantly regulate the effect of oridonin on the high glucose-induced inflammatory changes in HK-2 cells. Oridonin reduces renal fibrosis and preserves kidney function via the inhibition of TXNIP/NLRP3 and NF‑κB pathways by activating PPARγ in rat T2DM model, which indicates potential effect of oridonin in the treatment of DN.

Effects of semaglutide, empagliflozin and their combination on renal diffusion-weighted MRI and total kidney volume in patients with type 2 diabetes: a post hoc analysis from a 32 week randomised trial

Aims/hypothesisThe apparent diffusion coefficient (ADC) derived from diffusion-weighted MRI (DWI-MRI) has been proposed as a measure of changes in kidney microstructure, including kidney fibrosis. In advanced kidney disease, the kidneys often become atrophic; however, in the initial phase of type 2 diabetes, there is an increase in renal size. Glucagon-like peptide-1 receptor agonists and sodium–glucose cotransporter 2 inhibitors both provide protection against progression of kidney disease in diabetes. However, the mechanisms are incompletely understood. To explore this, we examined the effects of semaglutide, empagliflozin and their combination on renal ADC and total kidney volume (TKV).MethodsThis was a substudy of a randomised clinical trial on the effects of semaglutide and empagliflozin alone or in combination. Eighty patients with type 2 diabetes and high risk of CVD were randomised into four groups (n=20 in each) receiving either tablet placebo, empagliflozin, a combination of semaglutide and tablet placebo (herein referred to as the ‘semaglutide’ group), or the combination of semaglutide and empagliflozin (referred to as the ‘combination-therapy’ group). The semaglutide and the combination-therapy group had semaglutide treatment for 16 weeks and then had either tablet placebo or empagliflozin added to the treatment, respectively, for a further 16 weeks; the placebo and empagliflozin groups were treated with the respective monotherapy for 32 weeks. We analysed the effects of treatment on changes in ADC (cortical, medullary and the cortico–medullary difference [ΔADC; medullary ADC subtracted from cortical ADC]), as well as TKV measured by MRI.ResultsBoth semaglutide and empagliflozin decreased cortical ADC significantly compared with placebo (semaglutide: −0.20×10−3 mm2/s [95% CI −0.30, −0.10], p<0.001; empagliflozin: −0.15×10−3 mm2/s [95% CI −0.26, −0.04], p=0.01). No significant change was observed in the combination-therapy group (−0.05×10−3 mm2/s [95%CI −0.15, 0.05]; p=0.29 vs placebo). The changes in cortical ADC were not associated with changes in GFR, albuminuria, TKV or markers of inflammation. Further, there were no changes in medullary ADC in any of the groups compared with placebo. Only treatment with semaglutide changed ΔADC significantly from placebo, showing a decrease of −0.13×10−3 mm2/s (95% CI −0.22, −0.04; p=0.01). Compared with placebo, TKV decreased by −3% (95% CI −5%, −0.3%; p=0.04), −3% (95% CI −5%, −0.4%; p=0.02) and −5% (95% CI −8%, −2%; p<0.001) in the semaglutide, empagliflozin and combination-therapy group, respectively. The changes in TKV were associated with changes in GFR, albuminuria and HbA1c.Conclusions/interpretationIn a population with type 2 diabetes and high risk of CVD, semaglutide and empagliflozin significantly reduced cortical ADC compared with placebo, indicating microstructural changes in the kidneys. These changes were not associated with changes in GFR, albuminuria or inflammation. Further, we found a decrease in TKV in all active treatment groups, which was possibly mediated by a reduction in hyperfiltration. Our findings suggest that DWI-MRI may serve as a promising tool for investigating the underlying mechanisms of medical interventions in individuals with type 2 diabetes but may reflect effects not related to fibrosis.Trial registrationEuropean Union Drug Regulating Authorities Clinical Trials Database (EudraCT) 2019-000781-38Graphical

Radiologic evaluation of the kidney transplant donor and recipient.

The kidney is the most common solid organ transplant globally and rates continue to climb, driven by the increasing prevalence of end stage renal disease (ESRD). Compounded by advancements in surgical techniques and immunosuppression leading to longer graft survival, radiologists evermore commonly evaluate kidney transplant patients and candidates, underscoring their role along the transplant process. Multiphase computed tomography (CT) with multiplanar and 3D reformatting is the primary method for evaluating renal donor candidates, detailing renal size, vascular/collecting system anatomy, and identifying significant pathologies such as renal vascular diseases and nephrolithiasis. Ultrasound is the preferred initial postoperative imaging modality for graft evaluation due to its low cost, accessibility, noninvasiveness, and lack of radiation. CT and magnetic resonance imaging (MRI) may be useful adjunctive imaging techniques in diagnosing transplant pathology when ultrasound alone is not diagnostic. Kidney transplant complications are categorized by an approximate timeline framework, aiding in differential diagnosis based on onset, duration, and severity and include perinephric fluid collections, graft compression, iatrogenic injuries, vascular compromise, graft rejection, and neoplastic processes. This review discusses imaging strategies and important findings along the transplant timeline, from donor assessment to long-term recipient complications.

Analysis of outcomes of robot-assisted laparoscopic pyeloplasty in children from a tertiary pediatric center in South India.

This study aims to analyze the outcomes of robot-assisted laparoscopic pyeloplasty (RALP) in children with pelvi-ureteric junction obstruction (PUJO) over a 10-year period at a tertiary care center in South India. This study provides a detailed analysis of prospectively acquired data from 2013 to 2023 of all children who underwent RALP at our institution. Pre- and post-operative renal ultrasound and isotope renography were used to assess outcomes. Detailed information on patient demographics, procedural duration, post-operative pain relief, operation steps, and post-surgical follow-up protocols has been provided. The analysis included all patients who completed a 1-year follow-up. Between 2013 and 2023, 201 children underwent RALP. Of these, 185 children completed at least 1 year of follow-up and were included in the analysis. The mean age of the cohort was 4.9 years (1 month to 17 years), with males comprising the majority (77.3%). Twenty-five children (13.5%) were younger than 1 year of age. Left-sided PUJO was found to be more common. The mean console time was 76.5 min (40-180 min), and the average hospital stay was 2.8 days (2-5). After surgery, the mean reduction in antero-posterior diameter of the renal pelvis was more than 50% of its pre-operative value and statistically significant (3.3 ± 0.3 to 1.9 ± 0.9 cm). At the end of 1 year, the overall reduction in renal size was also significant (9.7 ± 2.3 cm pre-operative to 8.9 ± 1.8 cm post-operative). The pre-operative Society of Fetal Urology (SFU) grade of hydronephrosis was compared to the post-operative SFU grade, and the improvement (resolution/downgrading) was found to be statistically significant. The median split renal function in this series was 39% pre-operative and 43% post-operative, and the overall functional improvement after RALP was significant. A successful outcome was observed in 181 children (97.8%). Four children experienced persistent severe hydronephrosis and underwent redo stenting and/or redo pyeloplasty (2.1% failure rate). Post-operative complications, according to the Clavien-Dindo classification, were classified as type 1 in three children and type 3b in two children. There were no conversions to open surgery in the series. RALP emerges as the minimally invasive procedure of choice for children with PUJO at our institution. It is safe, delivering consistently excellent results and minimal complications. Our outcomes are comparable to those of previously published series. We trust that our experience will serve as a roadmap for those centers (especially in South Asia) embarking on a pediatric robotic program.

Normal sonographic measurements for kidney dimensions in Saudi adult population: A cross-sectional prospective study.

The use of ultrasound-based measurements to determine renal size has proven valuable in the diagnosis of renal function and associated disorders. The dimensions of the abdominal organs are affected by an individual's body age, height, sex, and weight. The objective of this study was to establish the standard sonographic parameters for renal dimensions and to determine the correlation between body measurements and renal dimensions in a population of healthy adults residing in Jazan City, Saudi Arabia. The present study was a prospective study conducted at a single center located in Jazan City from February to August 2022. Ninety-five participants underwent abdominal ultrasonography. The process of measuring renal size through sonography entails the measurement of various dimensions of the kidney, such as renal length, width, and thickness. The demographic information of the participants, including their sex, age, height, and weight, was documented. All analyses were performed using Statistical Package for the Social Sciences v27 software. The dimensions of the right kidney, specifically the length, width, and thickness, had mean value of 9.79 centimeters (cm), 5.09 cm, and 4.10 cm, respectively. The left kidney had mean dimensions of 10.1 cm, 5.09 cm, and 4.10 cm for length, width, and thickness, respectively. The left kidney was larger than the right kidney. Furthermore, male participants exhibited larger kidney measurements than their female counterparts did. A noteworthy positive correlation was observed between the thickness of the left kidney and sex, whereas no significant correlations were found with age, weight, or height. The current study revealed that the kidney dimensions were observed to be larger in males as compared to females. The research findings indicate that there is no significant correlation between kidney dimensions and various demographic factors, such as age, height, weight, and sex. In addition, this study provides reference tables for further use.

Are renal stone protocol computed tomography reports giving us enough information?

Non-contrast computed tomography (CT) is the gold-standard diagnostic test for urolithiasis. Little is published regarding which information needs to be included in the report for it to be most useful to the healthcare team for efficient triage and high-quality patient care. This study aimed to assess the quality and variability of CT scan reporting at a single Canadian tertiary academic medical center. We completed a retrospective review of 100 consecutive renal colic CT scans. Descriptive statistics were used to report the frequency with which specific elements commonly used by urologists to triage and treat patients were included in radiology reports. Our sample had a mean age of 51.4±13.1 years. Stone size was universally reported for obstructing stones but was less frequently reported for non-obstructing stones (100% vs. 86.8%). A similar trend was observed for the exact stone number (100% vs. 93.4%). Non-obstructing stones were more likely than obstructing stones to be reported in one dimension (77.5% vs. 47%). Obstructing stones were reported in three dimensions 27% of the time. CT reports commonly include the presence or absence of hydronephrosis status (98%) but are less likely to include renal size (32%) and periureteral stranding (16%). Hounsfield units (HU) were reported in 3% of the reports, but skin-to-stone distance (SSD) and radiation dose were never reported. Reports routinely included assessments of stone size, location, and number (although not uniformly). HU, SSD, and radiation dose were rarely reported. This provides insight into opportunities for standardized reporting to optimize knowledge transfer that may result in clinical efficiency and improved quality of patient care.

Comparative Analysis of Standard Percutaneous Nephrolithotomy (PCNL) and Mini-Percutaneous Nephrolithotomy (Mini-PCNL) for Renal Stones Larger Than 2 cm at a Rural Hospital: A Study Protocol.

Background Percutaneous nephrolithotomy (PCNL) is considered a standard treatment option for large-size renal stones but is associated with drawbacks such as bleeding and prolonged recovery. Mini-PCNL offers a less invasive alternative, but its efficacy compared to standardPCNLfor renal stones larger than 2 cm remains under debate. This study aims to compare the efficacy and safety of standard PCNLversus mini-PCNLfor renal stone sizes more than2 cm. Methods This single-centre prospective interventional study willbe conductedat Acharya Vinoba Bhave Rural Hospital (AVBRH). The study will include patients 18 to 70 years of age undergoing unilateralPCNLfor renal calculi. Patients with renal stones larger than 2 cm will be enrolled. Data on stone-free rate (SFR), operative duration, hospital stay time, surgical site infection, haemoglobin (Hb) drop, need for blood transfusion, and post-surgery fever will be collected and compared between the two procedures.Statistical analysis of data willbe performedusingdescriptive and analytical statistics. Results The study aims to enrol a total of 32 patients.Data analysis willbe doneusing IBM SPSS Statistics for Windows, Version 24 (Released 2016; IBM Corp., Armonk, New York). Conclusion This study will provide valuable insights into thecomparative outcomein terms ofefficacy and safety of standard PCNL and mini-PCNLfor kidney stoneslarger than 2 cm.

Long-term outcome of retroperitoneoscopic one-trocar-assisted pyeloplasty: a single-center and single-surgeon experience.

The aim of this study was to assess the long-term outcomes of retroperitoneoscopic one-trocar-assisted pyeloplasty (OTAP) for ureteropelvic junction obstruction (UPJO) in children. This retrospective analysis included 70 pediatric cases, all under the age of 5, diagnosed with UPJO and treated with the OTAP technique between May 2011 and June 2013 by a single surgeon. A single 10mm operative scope with a 5mm working channel was utilized to mobilize the ureteropelvic junction (UPJ) and exteriorize it through the trocar insertion site. Subsequently, conventional Anderson-Hynes dismembered pyeloplasty was conducted extracorporeally. Patient's demographics, operative time, hospital stay, complications, and success rate were evaluated. Seventy pediatric patients (65 males and 5 females) underwent OTAP, with ages at the time of operation ranging from 1month to 5years (mean = 22.6 ± 18.6months). The mean operative time was 74.8 ± 15.2min. There was a significant reduction in the mean renal pelvis size from 34.3 ± 8.1mm preoperatively to 13.8 ± 4.7mm postoperatively (p < 0.05). Moreover, the mean differential renal function (DRF) increased from 47.9 ± 9.8% preoperatively to 51.2 ± 5.9% postoperatively (p < 0.05). All patients experienced an uneventful postoperative recovery, with a median hospital stay of 3.4days. The success rate was 95.7%, with a median follow-up time of 75months (range: 6-125months). OTAP is a safe and feasible minimally invasive technique to correct ureteropelvic junction obstruction in children. It could be considered as a treatment of choice for children under the age of 5 as it combines the advantages of open and retroperitoneoscopic pyeloplasty and presents excellent long-term outcomes. NCT06349161 April 4th, 2024, retrospectively registered.

Monosodium glutamate altered renal architecture and modulated expression of NMDA-R, eNOS, and nNOS in normotensive and hypertensive rats

Monosodium glutamate (MSG) administration has been shown to pronounce hypertension and oxidative status with increased renal blood flow (RBF), however, the precise mechanisms of action have never been demonstrated. This study aimed to investigate the MSG action by studying the alteration in renal architecture and specific protein expression in 2-kidney-1-clip hypertensive comparing to sham operative normotensive rats. The administered doses of MSG were 80, 160, or 320 mg/kg BW daily for 8 weeks. Using routine chemical staining, the congestion of glomerular capillaries, a lesser renal corpuscles and glomeruli size, a widen Bowman capsule's space, an increase in mesangial cell proliferation and mesangial matrix, renal interstitial fibrosis, focal cloudy swelling of renal tubular epithelial cells were observed. Immunological study revealed an increase in the expression of N-methyl-D-aspartate receptor (NMDA-R) and endothelial nitric oxide synthase (eNOS) but a decrease in neuronal NOS (nNOS). It is suggested that MSG may upregulate the NMDA-R levels which responsible for the oxidative stress, glomerular injury, and renal interstitial fibrosis. The NMDA-R may also stimulate eNOS overexpression which resulted in renal microvascular dilatation, a raise in RBF and GFR, and natriuresis and diuresis promotion. Long-term exposure of MSG may trigger adaptation of tubuloglomerular feedback through nNOS downregulation.

#1029 Factors associated with chronic kidney disease in patients with recurrent kidney stones: a case-control study

Abstract Background and Aims Kidney stones have been described in multiple studies as an independent risk factor for chronic kidney disease (CKD). However, this relationship remains partially understood, and there is limited local, regional, and national information available. While common factors contribute to both kidney stones and CKD development, other factors favoring CKD occurrence in patients with recurrent renal lithiasis have been reported. This study aimed to identify factors associated with chronic kidney disease in patients with recurrent renal lithiasis in the city of Cartagena, Colombia. Method This was an observational nested case-control study within a cohort, where cases were patients diagnosed with recurrent kidney stones who developed CKD during follow-up, and controls were patients with recurrent kidney stones without CKD during follow-up. The cohort comprised all adult patients with recurrent kidney stones between 2010 and 2019, without an initial diagnosis of CKD, and with a minimum follow-up period of two years or more. Data on demographic variables (age, gender, type of insurance), clinical factors (overweight, history of hyperuricemia, diabetes mellitus, hypertension, dyslipidemia, alcohol consumption, smoking, exercise habits), and variables related to recurrent kidney stones (course of kidney stones, onset time of CKD, metabolic disorders, history of renal colic, stone localization, number, and size) were collected. Variables associated with the development of chronic kidney disease were identified using association measures via the chi-square test. Variables of clinical and statistical significance were further analyzed for association using multivariable logistic regression. Results The study included 31 cases and 39 controls, with mean ages of 65.2±11.5 and 51.8±14.6 years, respectively (p=0.00002). The duration of recurrent kidney stones was 174.7±148.6 and 163.3±129.5 months for cases and controls (p=0.738). The onset time of CKD was 61.1±35.4 months. Among cases, 93.5% were men, 77.4% were hypertensive, and 67.9% had dyslipidemia, significantly differing from the controls (see Table 1). There were no differences between cases and controls concerning the duration of recurrent kidney stones, type of health insurance, overweight status, hyperuricemia, diabetes mellitus, exercise habits, metabolic study alterations, history of renal colic, renal stone localization, number, and size. The difference was borderline for alcohol consumption and smoking habits. Multivariable logistic regression, incorporating variables with statistical significance (age, gender, hypertension, alcohol consumption, smoking habit) into the model, revealed that higher age corresponds to a greater risk of CKD (Odds ratio 1.052; 95% CI, 1.003 to 1.103). Furthermore, the male gender exhibited a 5.5 times higher likelihood of suffering from CKD (Odds ratio 5.5; 95% CI, 1.2 to 26.5). Conclusion In patients with recurrent kidney stones, higher age, and male gender were identified as factors associated with the development of CKD.

The texture analysis of computed tomography studies in clear cell renal cell carcinoma: reproducibility of 2D and 3D segmentation

Background: Differentiation of tumor grade at the preoperative stage is of utmost importance for the modification of the treatment strategy and the extent of operation. However, the routine analysis of computed tomography (CT) data in clear cell renal cell carcinoma (ccRCC) does not allow for reliable determination of the tumor grade.&#x0D; Aim: To assess the reproducibility of the results of 2D and 3D segmentation of a kidney tumor in the cortico-medullary and nephrographic phases of CT studies, as well as the reproducibility of the first order texture parameters for 2D and 3D tumor segmentation in patients with verified ccRCC.&#x0D; Materials and methods: This retrospective study included the CT data of 50 patients with morphologically verified ccRCC obtained before their surgical treatment. The first patient group included the patients with the renal tumor size in the axial plane of ≥ 4 cm (28 patients, 29 CT studies), and the second patient group included those with the renal tumor size in axial plane of 4 cm (22 patients, 23 CT studies). Two radiologists independently performed segmentation of the renal tumor in the cortico-medullary and nephrographic phases of CT procedures done under a standard protocol with the bolus intravenous contrast enhancement. A two-dimensional region of interest (2D ROI) was selected by the investigators on a subjectively selected axial slice, where the tumor had the largest size. When forming a three-dimensional region of interest (3D ROI), the entire tumor volume was segmented. Next, the statistical analysis of the segmentation results and the results of calculation of the first order texture indices was performed with calculation of the intra-class correlation coefficient (ICC) to assess the strength of the data correlation. The ICC of ≥ 0.75 demonstrated the reproducibility of the segmentation results and the first order texture indices.&#x0D; Results: The 3D segmentation method for ccRCC demonstrated the best ROI reproducibility results, regardless of the tumor size and the phase of contrast enhancement, with the ICC values of 0.961 (95% confidence interval: 0.946–0.971) for the cortico-medullary phase and 0.969 (95% CI: 0.958–0.977) for the nephrographic phase. The 2D tumor segmentation method showed unsatisfactory ROI reproducibility, with the ICC values of ≤ 0.058; however, the unsatisfactory reproducibility of the segmentation results in the patients with ccRCC tumor size of ≥ 4 cm did not significantly affect the reproducibility of the Entropy and Energy texture indices (good to excellent correlation). With the 3D segmentation of ccRCC, most first-order texture metrics were reproducible, with the exception of the Kurtosis parameter. The Entropy and Energy scores in both patient groups demonstrated a high degree of reproducibility. In the 2D tumor segmentation, high reproducibility of the first order texture metrics was obtained for the Entropy and Energy indices.&#x0D; Conclusion: The 3D segmentation of the CT data for ccRCC has high reproducibility, the most first-order textural features were excellently reproducible when segmentations were performed in 3D. The 2D CT data segmentation method for ccRCC demonstrated low reproducibility; however, some of the first order texture indices were reproducible. Both segmentation methods can be used for the texture analysis of CT images.

Long-term outcome of pediatric renal transplantation with donors younger than 6 years.

Renal transplantation is currently the best treatment option for patients with end-stage renal disease. However, the use of kidneys from donors under 6 years of age as a possibility to increase the organ pool in pediatric recipients remains a controversial matter. We aimed to investigate whether donor age is associated to the long-term functionality of the renal graft. Likewise, we analyzed the adaptation of the graft to the ascending functional requirements in the pediatric patient. Retrospective study of the results obtained in pediatric recipients transplanted with grafts from donors between 3 and 6 years of age, comparing them with those of grafts from donors older than 6 years. Among the variables compared are cumulative graft survival, renal size, need for antiproteinuric therapy, GFR, incidence of rejection, pyelonephritis, renal failure and surgical or tumor complications. A total of 43 transplants were performed with donors aged 3-6 years, and 42 transplants with donors older than 6 years. Cumulative graft survival at 5 years was 81% for the younger donor group compared to 98% for the older donor group (p < .05). At 8 years, cumulative graft survival for donors <6 years was 74%. As for the mean estimated graft survival, it was 11.52 years for the younger donor group and 14.51 years for older donors. During follow-up, the younger donor group presented greater renal enlargement and need for antiproteinuric therapy. The older donors group had a higher GFR during the first year of follow-up, which then equalized in both groups. There were no statistically significant differences in the incidence of acute or chronic rejection, acute pyelonephritis, acute renal failure or surgical or tumor complications. Renal transplants of grafts equal to or less than 6 years old have good short-term and acceptable long-term results in pediatric patients.

Role of Renal Sonography in the Diagnosis of Chronic Kidney Disease

Aim: to use sonographic imaging in grading CKD and assess the serum creatinine, renal longitudinal size,parenchymal thickness and compare these parameters based upon ultrasonographic grade.Material and Methods: Present cross-sectional; study was conducted at the Department of Radiology, Tertiary Care Teaching Institute of India for the duration of 1 year. There are 120 participants with CKD in the research.All patients received a questionnaire, and a thorough clinical examination was done. Each participant underwent sector curved array transducer of 3.5–5 MHz ultrasound images of their liver and kidneys. Low tissue harmonic and speckle reduction imaging techniques are used to measure the echogenicity of the kidney and liver while reducing interobserver bias. In all the participants, the mean values of both the kidneys renal longitudinal size and parenchymal thickness were calculated. Renal cortical echogenicity was compared and graded with the echogenicity of the liver and renal medulla.Results: The mean age of the CKD patients was found to be 45.23 ± 06.05 years. It was found that 50 patientshad Grade 1, 40 patients had Grade 2, 20 patients had Grade 3 and 10 patients had Grade 4. The results showed that, when the comparison was done, serum creatinine was found to be significant among echogenicity grades with ANOVA. when the comparison was done; the mean longitudinal size was found to be significant among echogenicity. On comparison was found to be mean Parenchymal thickness was found to be significant among echogenicity grades.Conclusion: Renal cortical echogenicity and its grading in relation to longitudinal length, parenchymal thickness, and cortical thickness in CKD patients are the best sonographic parameters that correlate with blood creatinine. It is possible to use renal cortical echogenicity as a metric of renal function since it has the benefit of being irreversible in compared to serum creatinine levels.

IJCM_169A: Correlation of sonographic renal dimensions with anthropometric measurements among individuals without renal disorders

Background: Normal kidney dimensions are suggestive of normal kidney function. Degree of kidney function has a positive correlation with ultrasonic renal measurements. Co-morbid conditions affect the renal size. Therefore it becomes necessary to establish normal values of kidney dimensions for the diagnosis, prognosis and also as an early indication of renal diseases in order to prevent them. Objectives: To study the renal dimensions and association with socio- demographic conditions among the outpatient attendees in the study hospital. Methodology: This was a descriptive cross-sectional study done among the attendees of KMC Hospitals, Mangalore. Data extraction sheet included the socio-demographic details, Anthropometric measurements, personal history, history of comorbidities and sonographic dimensions of Kidney and laboratory findings of Renal Function Test. Data was entered and analyzed by using statistical software Statistical Package for Social Sciences (SPSS) Version 29.0. Results: Out of 194 participants, 118(60.8%) were males. The difference between corresponding kidney lengths of males and females is found to be statistically significant. The length and anteroposterior dimension of left kidney is greater than right kidney and the difference is statistically significant. When the kidney lengths and the heights of the individual were correlated a positive correlation was obtained, (0.278) in case of right kidney and (0.245) in case of left kidney. Conclusion: Kidney length had positive correlation with height and BMI. Female kidney length was significantly smaller than the male kidney length. There was significant variation between right and left kidney lengths.

Studies on Echostructural Pattern of Urinary System in Adult Female Goats

Background: Ultrasonography is a second most commonly used diagnostic imaging technique in veterinary practice after radiography. The ultrasonographic examination of clinically healthy animals provides relevant information about anatomical location, echo texture, size and shape of organs. In the present study, the echo-structural pattern of urinary system of adult female goats were evaluated to find the normal structural pattern of various constituents of urinary system. Methods: B-mode ultrasonographic study of urinary system was performed in 20 healthy adult female Jamunapari goats. Mean±S.E. values of body weight and age of selected animals were 27.49±0.79 kg and 2.77±0.10 years, respectively. All twenty animals were subjected to sonographic examination after clipping the hairs from desired sites to scan the various organs of urinary system in standing position under physical restraint without using any anesthetic agent. The values of various clinico-physiological parameters including rectal temperature, heart rate, respiration rate, colour of mucous membranes were recorded to examine the health status prior to sonography. The left and right kidneys were scanned from right dorsal flank by paravertebral approach using a transcutaneous micro-convex probe at 5 MHz and a convex probe at 2.8-6 MHz frequency. A dual frequency (5-9 MHz) micro-curved array cavity probe was used to scan bladder and urethra per rectally. The renal parenchyma in healthy goats was distinctly divided into hypoechoic outer cortex and anechoic inner medulla. The hyperechoic renal sinus complex was present in center of the kidney and renal pelvis was anechoic. The renal capsule was seen as hyperechoic fine line surrounding the renal parenchyma. Pulsed wave renal color doppler ultrasound was performed in 3 healthy goats with the aim to generate reference images of renal vasculature. Result: The Mean±SE values of renal length, renal height, horizontal diameter of renal sinus, vertical diameter of renal sinus and diameter of renal pelvis for right kidney were 6.11±0.09, 3.26±0.08, 3.01±0.11, 1.32±0.03, 1.05±0.03, respectively while for left kidney these values were 6.02±0.09 and 3.35±0.07, 2.67±0.12, 1.14±0.06, 1.10±0.07 cm. The ureters could not be visualized in any of the goats. The distended bladder was seen as anechoic circular structure surrounded by a smooth echogenic wall with a mean thickness of 1.65±0.06 mm. No significant difference was observed in the measurements of both kidneys except in dimensions of renal sinus. Positive correlation was found between renal size and body weight of goats. It was concluded that ultrasound is an easy, rapid and non-invasive method to evaluate echotexture and morphometry of structures of urinary system.