Renal Size Research Articles

MO362: Braunschweig Body Composition, Butterfly Sonography and Drug Dosing in AKI Study (B3 D2 AKI––Study)

Abstract BACKGROUND AND AIMS In-hospital AKI is associated with increased morbidity and mortality. AKI Alert systems are frequently used to allow time detection of AKI patients based on changes in creatinine. We aimed to examine the hydration status, medication errors and prior existing CKD in a series of AKI 3 patients in a tertiary care hospital. METHOD Prospective single centre cohort study. Study was approved by the local IRB. Hydration status was assessed by Bioimpedance using the body composition monitor (Fresenius Medical Care). Renal size and exclusion of postrenal failure were accomplished using a point of care ultrasound system (Butterfly Network Inc.). Pharmacotherapy was entered into the Federal Medication Plan of Germany (Bundesmedikationsplan). RESULTS A total of 101 patients with AKI 3 were identified based on changes in creatinine only. The median (IQR) age was 74.0 (64.7–82.0) years with a BMI of 27.8 (23.5–34.2) kg/m2. The baseline creatinine of the patients was 1.53 (0.92–2.85) mg/dL. At the time of AKI 3 diagnosis the median [IQR] 4.1 (1.9–5.9) L. Systolic blood pressure was 116 (100–140) mmHg (Fig. 1). Median (IQR) kidney length was 10.4 (9.2–11.7) cm. Polypharmacy (> 5 drugs) was seen in 89.7% of all patients. Almost half of the patients (48.3%) received 10 or more drugs. A total of 38% of patients receiving an antibiotic received an inadequately high dose, followed by 7.8% receiving an inadequate dosing of oral antidiabetic drugs. CONCLUSION Patients detected by an AKI alert in a tertiary care hospital did mostly neither exhibit low blood pressure nor volume depletion. Postrenal AKI was undetected in 1 out of 101 patients. Medication dosing errors were frequently seen, especially in the dosing of antibiotics. A joined nephron-pharmacological approach seems to be important in patients with hospital acquired AKI 3.

MP50-14 SINGLE PORT VS MULTI PORT ROBOTIC RENAL SURGERY: ANALYSIS OF PERIOPERATIVE OUTCOMES FOR EXCISION OF HIGH AND LOW COMPLEXITY RENAL MASSES

You have accessJournal of UrologyCME1 May 2022MP50-14 SINGLE PORT VS MULTI PORT ROBOTIC RENAL SURGERY: ANALYSIS OF PERIOPERATIVE OUTCOMES FOR EXCISION OF HIGH AND LOW COMPLEXITY RENAL MASSES Grant Henning, Joel Vetter, Nicholas Pickersgill, Arjun Sivaraman, R. Sherburne Figenshau, and Eric Kim Grant HenningGrant Henning More articles by this author , Joel VetterJoel Vetter More articles by this author , Nicholas PickersgillNicholas Pickersgill More articles by this author , Arjun SivaramanArjun Sivaraman More articles by this author , R. Sherburne FigenshauR. Sherburne Figenshau More articles by this author , and Eric KimEric Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002625.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is limited data on the safety and feasibility of the da Vinci Single Port (SP)® robotic surgical system (Intuitive Surgical, Sunnyvale, CA) as a minimally invasive alternative to robotic platforms requiring multiple ports. We sought to compare perioperative outcomes between SP and multi-port (MP) robotic approaches for excision of high and low complexity renal masses. METHODS: Retrospective chart review was performed for all patients undergoing robotic partial or radical nephrectomy using the SP surgical system (N=23) at our institution between its adoption in November 2019 and November 2021. Patient demographics, preoperative imaging, operative approaches, and perioperative outcomes were recorded. Renal masses were categorized into high (7+) and low complexity groups (4-6) using the RENAL nephrometry scoring system (RNS). Patients were matched using an institutionally maintained MP database by patient BMI, renal mass size, renal mass complexity, and partial or radical nephrectomy in a 2:1 (MP:SP) ratio. Perioperative outcomes were compared. RESULTS: For high complexity tumors (N=12), SP renal surgery was associated with a significantly longer average operative time compared to MP surgery (248.4 ± 75.0 min vs 188.1 ± 61.0 min, p=0.02), and tended towards higher average estimated blood loss (410.0 ± 669.9 mL vs 171.2 ± 136.0 mL, p=0.62) and a higher positive surgical margin rate (25.0% vs 12.5%, p=0.38). For low complexity tumors (N=11), there was no significant difference in operative time (177.7 ± 53.9 min vs 161.4 ± 41.9 min, p=0.53), average estimated blood loss (69.6.0 ± 33.0 mL vs 142.0 ± 168.6 mL, p=0.62) or positive margins (9.1% vs 4.5%, p=1.00) between SP and MP approaches and all patients underwent successful partial nephrectomy using the SP system. Increasing nephrometry score was associated with a greater relative increase in operative time for SP compared to MP renal surgery (p=0.07) using best of fit linear modeling (Figure 1). CONCLUSIONS: SP nephron-sparing surgery is safe and feasible for low complexity renal masses. For excision of high complexity renal masses, the SP system is associated with a significantly longer operative time when compared to a MP approach. Careful selection should be performed when planning operative approach. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e870 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Grant Henning More articles by this author Joel Vetter More articles by this author Nicholas Pickersgill More articles by this author Arjun Sivaraman More articles by this author R. Sherburne Figenshau More articles by this author Eric Kim More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP24-01 RACE BASED EQUATIONS FOR ESTIMATING KIDNEY FUNCTION MAY CONTRIBUTE TO RACIAL DISPARITIES IN PARTIAL NEPHRECTOMY UTILIZATION AMONG BLACK PATIENTS WITH KIDNEY TUMORS

You have accessJournal of UrologyCME1 May 2022MP24-01 RACE BASED EQUATIONS FOR ESTIMATING KIDNEY FUNCTION MAY CONTRIBUTE TO RACIAL DISPARITIES IN PARTIAL NEPHRECTOMY UTILIZATION AMONG BLACK PATIENTS WITH KIDNEY TUMORS Nour Abdallah, Tarik Benidir, Martin Hofmann, Eiftu Haile, Diego Aguilar Palacios, Venkatesh Krishnamurthi, Samuel Haywood, Mohamed Eltemamy, Jihad Kaouk, Robert Abouassaly, Steven Campbell, and Christopher Weight Nour AbdallahNour Abdallah More articles by this author , Tarik BenidirTarik Benidir More articles by this author , Martin HofmannMartin Hofmann More articles by this author , Eiftu HaileEiftu Haile More articles by this author , Diego Aguilar PalaciosDiego Aguilar Palacios More articles by this author , Venkatesh KrishnamurthiVenkatesh Krishnamurthi More articles by this author , Samuel HaywoodSamuel Haywood More articles by this author , Mohamed EltemamyMohamed Eltemamy More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Robert AbouassalyRobert Abouassaly More articles by this author , Steven CampbellSteven Campbell More articles by this author , and Christopher WeightChristopher Weight More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002563.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Population based studies have found that black Americans with renal tumors are less likely to undergo a partial nephrectomy (PN) compared to non-black Americans despite their increased risk for chronic kidney disease (CKD). Guidelines suggest assessment of renal function, tumor size and location to determine whether to perform a PN or radical nephrectomy (RN). However, commonly used equations to predict renal function are racialized and estimate a 15-20% higher glomerular filtration rate (eGFR) if the patient is black compared to non-black patients. We hypothesize that these racialized estimates of eGFR may contribute to the lower utilization of PN in blacks. METHODS: From 2005 to 2020, we included 6476 consecutive patients undergoing either PN or RN with known self-reported race and preoperative (preop) creatinine at Cleveland Clinic. Data was dichotomized into Black (n=668) and non-Black patients (n=5808) and compared across preop variables and surgery types. Multivariable regression analysis was used to identify predictors of PN. We also stratified PN rates across CKD stages for blacks and non-blacks. RESULTS: The cohorts’ preop variables are listed in Table 1. Black patients had higher rates of diabetes, hypertension, had higher comorbidity scores and lower baseline eGFR. On multivariable logistic regression analysis, black patients were less likely to be treated via PN (Odds Ratio (OR)=0.75, Confidence interval (CI)=[0.63-0.89], p=0.001), even when controlling for body mass index, age-adjusted Charlson comorbidity index, hypertension, preop eGFR, tumor size and complexity. When comparing PN rates across CKD stages, PN utilization was similar for all stages except stage 1, where the odds of getting a PN were 39% lower for black patients compared to non-blacks (OR 0.61, [0.46-0.82], p=0.01). CONCLUSIONS: Black patients were less likely to undergo PN, despite lower baseline kidney function and higher comorbidity rates. This disparity was most marked in patients with high estimated renal function. Racialized kidney function equations may contribute, along with access and other unknown factors to the disparity seen in the use of kidney preservation strategies for black patients with renal masses. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e392 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nour Abdallah More articles by this author Tarik Benidir More articles by this author Martin Hofmann More articles by this author Eiftu Haile More articles by this author Diego Aguilar Palacios More articles by this author Venkatesh Krishnamurthi More articles by this author Samuel Haywood More articles by this author Mohamed Eltemamy More articles by this author Jihad Kaouk More articles by this author Robert Abouassaly More articles by this author Steven Campbell More articles by this author Christopher Weight More articles by this author Expand All Advertisement PDF downloadLoading ...

Associations between MRI signs of kidney parenchymal changes and biomarkers of renal dysfunction in resistant hypertension

Objective. Resistant hypertension (RHT) is often associated with kidney injury and chronic kidney disease, especially in diabetic patients. Early detection of renal changes contributes to avoiding severe cardiovascular complications, but imaging characteristics of renal dysfunction in RHT remain unclear. The aim of the present study was to determine the relationships between the renal parenchyma volumes and biomarkers reflecting kidney function in a cohort of patients with RHT.Material and Methods. The study comprised 34 patients with RHT meeting the inclusion criteria. Evaluation of renal function was based on the measurements of estimated glomerular filtration rate (eGFR) and serum levels of creatinine and cystatin C. Renal sizes were assessed by MRI based on absolute and normalized parenchymal kidney volumes.Results. Primary MRI-based changes in renal parenchyma in patients with RHT demonstrated altered cortical surface, attenuated cortical thickness, lower renal volumes, and round shape of the kidneys compared with the reference characteristics. Positive correlation of moderate power was found between eGFR value and all parameters characterizing renal parenchyma. The strongest direct correlation was found between eGFR and bsa-TKV (r = 0.6166, p = 0.000); ht-TKV correlated with eGFR (r = 0.4751, p = 0.007) and creatinine (r = –0.4302, p = 0.016). According to linear regression analysis, ht-T-Cortex-V < 32.4 was a key element of MRI-presentation of renal dysfunction in patients with eGFR below 60 mL/min/1.73 m2 (sensitivity of 83.3%, specificity of 60.7%, p = 0.03).Conclusion. MRI study allowed to detect early renal parenchymal changes suggesting the presence of association between renal function and renal parenchymal volume in RHT patients. For the first time, the study revealed MRI-pattern of renal dysfunction in RHT.

Application of a new position in endoscopic combined intrarenal surgery: modified prone split-leg position

BackgroundEndoscopic combined intrarenal surgery (ECIRS) is well established as a minimally invasive procedure for the treatment of multiple urolithiasis. The position is the key to the perfect combination of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Galdakao-modified supine Valdivia (GMSV) and prone split-leg positions are widely used. However, both positions have their own advantages and disadvantages. This study aimed to evaluate the effect of ECIRS in the treatment of multiple urolithiasis in the modified prone split-leg position.Patients and methodsA total of 96 patients with multiple urolithiasis underwent ECIRS in modified prone split-leg position from September 2017 to January 2021. Relevant demographic and clinical data were analysed retrospectively. Clinical outcomes, such as the stone free rate, complications and postoperative hospital stay were evaluated. The chi-square test was used to compare categorical variables and Student’s t test was applied for continuous variables of the treatment groups.ResultsThe mean renal stone size was 32.5 ± 10.7 mm and renal stone surface area was 712.2 ± 264.8 mm2. The mean ureteral stones size was 24.8 ± 12.3 mm. The mean surgical time was 82.2 ± 38.3 min. The incidence of complications was 16.7%, and they were mainly grade 1 and grade 2. No complications occurred above grade 3. The stone was completely removed in 75 (78.1%) patients in a single operation. The risk factors affecting the stone-free rate of ECIRS were analysed, and only the number of involved calyces by stone was found to be significant (p = 0.01).ConclusionECIRS is safe and effective in the treatment of multiple renal calculi or multiple renal calculi with ipsilateral ureteral calculi in the modified prone split-leg position. The modification of the prone split-leg position makes the retrograde operation more convenient, which is conducive to the combination of RIRS and PCNL.

Comparison of Ultra-Mini Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery for Renal Stones: A Systematic Review and Meta-Analysis from the KSER Update Series.

Miniaturized percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for renal stones have been developed to overcome the invasive disadvantages of PCNL. We aimed to compare the therapeutic effect and safety of ultra-mini percutaneous nephrolithotomy (UMPCNL) and RIRS for renal stones using an updated systematic review and meta-analysis. We searched clinical trials comparing UMPCNL and RIRS for renal stones using the PubMed, EMBASE, Cochrane Library, and Google Scholar databases up to October 2021. Seven studies were included in the current study. The renal stone size was 10–20 mm in three studies, 10–25 mm in one study, 10–35 mm in two studies, and not specified in one study. The stone-free rate of UMPCNL was higher than that of RIRS (p = 0.02; odds ratio (OR) = 2.01; 95% confidence interval (CI) = 1.12, 3.61). The complication rate showed no significant difference between UMPCNL and RIRS (p = 0.48; OR = 1.20; 95% CI = 0.73, 1.98). Regarding the operative time, UMPCNL was shorter than RIRS (p = 0.005; weighted mean difference (WMD) = −15.63; 95% CI = −26.60, −4.67). The hospital stay of UMPCNL was longer than that of RIRS (p = 0.0004; WMD = 1.48; 95% CI = 0.66, 2.31). UMPCNL showed higher efficacy than RIRS and similar safety to RIRS. UMPCNL may be a useful therapeutic option for moderate-sized renal stones.

Ultrasound Correlates Highly With Cross Sectional Imaging for Small Renal Masses in a Contemporary Cohort

ObjectiveTo determine the correlation between ultrasound (US), cross-sectional imaging, and pathological renal mass sizes. MethodsBetween January 2011 and January 2021, a cohort of patients from 14 academic institutions who had an US and cross-sectional imaging within 8 weeks of each other and within 6 months of surgery were identified. A second cohort of patients with small renal masses (≤4 cm) who had US and cross-sectional imaging within 8 weeks of each other were also examined, regardless of their treatment modality. Correlation coefficients, Bland-Altman plots, and sensitivity tables were generated. ResultsA total of 1464 patients were included in the surgical cohort and 1582 patients (1921 imaging pairs) were included in the small renal mass (SRM) cohort. Pearson correlation coefficients between computed tomography (CT)/magnetic resonance imaging (MRI) and pathologic size was 0.93 (P <.0001) and between US and pathological size was 0.90 (P <.0001). The correlation between US and CT/MRI was 0.93 (P <.0001). Bland-Altman plots demonstrated a greater agreement for smaller renal masses. For the SRM cohort when comparing US to CT/MRI, 1441 (75%) SRM measurements were within 0.5 cm and only 149 (7.8%) were greater than 1 cm in difference. Subgroup analysis demonstrated that correlation between US and CT/MRI for SRMs were higher in patients with lower body mass index. ConclusionThere is a strong correlation between US and cross-sectional imaging in 75% of patients at baseline imaging. Our study provides support for utilization of US for active surveillance.

Phase 2 study of neoadjuvant cabozantinib in patients with locally advanced non-metastatic clear cell renal cell carcinoma.

340 Background: Cabozantinib is a small molecule inhibitor of the tyrosine kinases c-Met, AXL and VEGFR2 that has been shown to reduce tumor growth, metastasis, and angiogenesis. After the promising results from the METEOR, CABOSUN and Checkmate-9ER trials, cabozantinib was approved for use in patients with advanced renal cell carcinoma (RCC). The increased response rates with cabozantinib in metastatic RCC, along with the other neoadjuvant TKI data, support an expanded role for cabozantinib in the neoadjuvant setting. Methods: Patients with clinical stage ≥ T3Nx or TanyN+ or deemed unresectable by the surgeon with biopsy-proven clear cell RCC were eligible for this study, and received cabozantinib at a starting dose of 60 mg daily for 12 weeks. The primary outcome was objective response rate per RECIST v1.1 (complete and partial responses) at week 12 after the administration of cabozantinib as determined by independent radiologist review. Secondary outcomes included safety, tolerability, clinical outcome (DFS, OS), surgical outcome and quality of life. Results: As of 20 September 2021, 16 biopsy-proven clear cell RCC patients were treated with neoadjuvant cabozantinib. The median age was 56 years (range: 41-84 years) and 81.2% male. All patients completed 12 weeks of treatment, and 15 of them underwent surgery as planned without any delay after completion of 4 weeks wash-out. One patient refused to undergo surgery due to personal reasons and received further systemic treatment. Five patients (31.2%) experienced a partial response, and 11 patients had stable disease. There was no progression of disease while on cabozantinib. Median reduction of primary renal tumor size was 24% (range: 6-45%). The one patient who was deemed to be unresectable became resectable at the end of treatment. Two patients were converted from radical to partial nephrectomy. The most common AEs were diarrhea, nausea, fatigue, hypertension, anorexia, and palmar-plantar erythrodysesthesia syndrome. Intraoperatively, we did not experience any immediate complications. Postoperatively, no surgical complications related to the drug were noted. No treatment related grade 4 or 5 AEs related to cabozantinib or surgery occurred. Two patients had died at the time of analysis (1 due to COVID and 1 unknown cause). Conclusions: Cabozantinib was clinically active and safe in the neoadjuvant setting in patients with locally advanced non-metastatic clear cell RCC. Additional data will be reported including long term outcomes, correlative studies, quality of life, and frailty/sarcopenia indices. Clinical trial information: NCT04022343.

Renal Artery Dimensions and Variation on Computed Tomography Angiogram: A Cross-sectional Study.

Introduction A knowledge of renal artery dimension is necessary for characterizing the physiological change as well as pathological process undergoing in the renal artery likely stenosis, ectasia, or aneurysm. This study aims to explore the anatomy of the renal artery with regards to its dimension, relation, and branching and identify the common anatomical variation. Materials and Methods The study was a retrospective hospital record-based study conducted during the period of one year from 2019 January to 2019 December. All abdominal CT angiograms were reviewed for renal artery anatomy and variation. Abnormal Abdominal CT angiograms were excluded from the study. Normal anatomy, dimensions, and variation of renal vasculature were assessed. ResultsA total of 110 patients included the inclusion criteria and was included in the study. The renal length and size of the renal artery were significantly larger on the left side. The renal artery diameter showed positive correlation with renal length (r= 0.432; p&lt;0.001). No variation of the renal size of renal artery diameter was however noted with sex. Supernumerary arteries were seen in 33(30%) patients. The optimum cut-off value of renal artery diameter for predicting accessory renal artery was 5.35 or less which yielded a sensitivity of 75% and specificity of 70%. (AUC-0.79; p&lt;0.001). When 4.15 mm was taken as cut-off, the specificity increased to 96% with a marked reduction in sensitivity to 3.6%. Conclusion Renal artery diameter is dependent on laterality, kidney size, and presence of accessory artery and independent of sex.

The Relationship Between Renal Stones and Primary Aldosteronism.

IntroductionThe association between primary aldosteronism (PA) and nephrolithiasis is still unclear. The hypercalciuria and hypocitraturia of PA patients might be the reason leading to recurrent calcium nephrolithiasis. This study aimed to evaluate the relationship between PA and renal stones, including stone size and density.Materials and MethodsFrom February 2010 to March 2021, we retrospectively collected 610 patients who presented to our medical center with hypertension history, and all these patients, suspicious of PA, had PA data survey. In total, 147 patients had kidney stone and were divided into 44 patients with essential hypertension as group 1 and 103 patients with PA as group 2. Pearson χ2 test and independent Student’s t-test were performed to examine the differences among variables.ResultsThe mean age was 54.4 ± 12.0 years in group 1 and 53.0 ± 11.1 years in group 2. The incidence rate of renal stones in the PA group was around 24%. No significant differences between the two groups were found for gender, systolic/diastolic blood pressure, duration of hypertension, diabetes mellitus history, and laterality of kidney stone; however, mean stone size was 4.0 ± 3.3 mm in group 1 and 6.5 ± 7.2 mm in group 2, with a significantly larger renal stone size noted in the PA group than that in the essential hypertension group (p = 0.004). Hounsfield unit (HU) density was higher in the PA group vis-à-vis the essential hypertension cohort, although this did not reach a significant difference (p = 0.204).ConclusionsOur study revealed that PA patients had a higher incidence rate of renal stones compared to that of the general population. Besides, the PA-related renal stones also presented as larger and harder than those of the essential hypertension group. Further investigation concerning the association between PA and renal stones is warranted.

Extracorporeal shock wave lithotripsy for the treatment of urinary lithiasis in children

Introduction: Extracorporeal shock wave lithotripsy (ESWL) is an option for the treatment of urinary lithiasis.&#x0D; Objective: To describe the outcomes of ESWL for the treatment of urinary lithiasis in children.&#x0D; Methods: A descriptive and retrospective study of 51 patients with urinary lithiasis that underwent ESWL from 2014 to 2019.&#x0D; Results: Males and 15–18-year-old patients prevailed; 27.4% had prior surgery; 10-20 mm lithiasis of renal location and density between 400-799 HU were the most common; a double J stent was the most utilized urinary derivation prior to lithotripsy treatment; 7.8% required retreatment; 13.7% additional interventions; the stone-free rate was 74.5% at one month and 92.2% at three months. The size of the lithiasis was associated with the success of the treatment (p&lt;0.023). The most frequent complication was steinstrasse; endourologic procedures were the most utilized, grade III b (Clavien-Dindo) prevailed and were associated to older patients (p=0.04), renal lithiasis localization (p=0.017), larger size (p=0.08), and density(p=0.036).&#x0D; Conclusions: ESWL is effective and safe for treating urinary lithiasis in children. Its success was significantly associated to smaller stone size and its complications to patients of older age, larger stone size, density and renal localization of the lithiasis.

Characterizing seasonal transitions: Breeding-like morphology and behavior during the late non-breeding season in green anole lizards

Seasonally breeding animals, such as green anole lizards (Anolis carolinensis), allow for the examination of the control of reproduction during different reproductive states. During the breeding season, the gonads are large and reproductively active. Following the breeding season, gonads regress and become less active, and the lizards enter a refractory period where breeding is inhibited. After this stage, a post-refractory period occurs during which the lizards are still in a non-breeding state, but environmental changes can trigger the onset of breeding. However, it is unclear what causes these changes in reproductive state and we hypothesized that this may be due to alterations in gonadotropin-releasing hormone (GnRH) signaling. The present study aimed to identify morphological and behavioral differences in GnRH- and saline-injected refractory and post-refractory male anoles when housed under the same non-breeding environmental conditions. We found that post-refractory anoles had increased testicular weight, recrudescence, sperm presence, and reproductive behavior, with no impact of GnRH injection. Renal sex segment size and steroidogenic acute regulatory protein (StAR) mRNA levels did not differ among groups, indicating that testosterone levels likely had not increased in post-refractory lizards. Post-refractory anoles in this study were beginning to transition towards a breeding state without exposure to changing environmental conditions, and GnRH was not necessary for these changes. These data reveal a complex interaction between the activation of breeding, changing environmental conditions, and the underlying physiology regulating reproduction in seasonally breeding lizards. Future studies are needed to further elucidate the mechanisms that regulate this relationship.

Renal Abscess – A Case Report

Introduction. Renal abscesses can be the result of haematogenous spread or as a rare complication of upper UTI particularly in the setting of renal stones or diabetes. Classically it may present as loin pain, fever, rigors, and tenderness in the costovertebral angle, but may simply manifest as a pyrexia of unknown origin and a raised acute phase response. Case report. We report the case of a 73-year-old female patient with type 2 diabetes mellitus, who presented for abdominal pain, chills, confusion and deterioration of general condition with progressive aggravation of the symptoms, the clinical examination revealed a respiratory rate of 14 breaths per minute, blood oxygen saturation of 98%, heart rate 82 beats per minute, blood pressure 137/75 mmHg and no fever. She had peripheral cyanosis and peripheral pulses were weak in the lower limbs; diuresis was present on the urinary catheter the laboratory and imaging investigations showed inflammatory syndrome ( CRP=255 mg/l ) and the CT showed both kidneys with normal position, a bilateral reduction in renal size, bilateral dilated pyelocaliceal system grade I developed a left renal abscess as a complication of acute pyelonephritis. The primary pathogen identified was Escherichia Coli. Computed tomography revealed a well-defined mass on the left kidney with low attenuation in contact with the renal fascia. Broad spectrum antibiotics and haemodialysis were used as part of conservative management regimen. The patient achieved clinical improvement after 3 weeks and was discharged.Conclusions. The particularities of the case are represented by the fulminant evolution of the infection in a patient with poorly controlled diabetes, the acute kidney injury caused by urosepsis and the progression of pyelonephritis towards the development of a renal abscess. Diabetes mellitus is a disease with a significant prevalence, the incidence of which increases with age and which develops multiple complications. In addition to vascular lesions, diabetic neuropathy or nephropathy, patients have a high risk of developing an infection, the most common being those of the upper urinary tract, which evolve aggressively. The renal abscess is a rare complication of pyelonephritis, but it is to be considered in patients with persistent inflammatory state in despite of the right management.

Renal Volume Nomogram on Computed Tomography in North Indian Population Correlated with Age, Gender and Height

Introduction: Assessment of renal size is a difficult task in view of the complex shape of kidney. Among different imaging modalities Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) owing to their 3 Dimensional reconstructional ability are quite helpful in assessment of kidney size. A relationship between renal size and anthropometric parameters is an issue of interest. Aim: To assess kidney size in North Indian adult population using CT and to assess its relationship with age, sex and height. Materials and Methods: This was a cross-sectional study done over a period of two years (January 2018 to December 2019) in which a total of 300 adults aged between 20-90 years with normal renal function were enrolled. Age and sex of subjects was noted and their heights were measured. All the subjects underwent computed tomographic assessment for kidney size using 384 Slice Somatom Force, Seimens Corp. Multidetected CT machine. Contrast enhanced abdominal CT was performed to visualise the kidneys. Linear renal dimensions (length, lateral diameter, anteriorposterior diameter) were measured and renal volume was calculated using the ellipsoid volume formula. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 21.0 software. Independent samples t-test, paired t-test, Analysis of Variance (ANOVA) and Pearson coefficient constants were calculated. Results: A total of 300 subjects were included, with the mean age of subjects were 41.12 years. Exactly half (50%) were males. Mean kidney size was 94.62 (95% CI: 90.27-98.97) cm3 for right side and 119.84 (95% CI=113.40-126.29) cm3 for left side. Average kidney size was 107.23 (95% CI=102.66-111.80) cm3. For both the sides, males had significantly larger kidney as compared to that of females (p-value &lt;0.01). With increasing age, a significant decline in kidney size was observed (p-value &lt;0.001). With increasing height, a significant increase in kidney size was observed (p-value &lt;0.001). Height showed a significant positive correlation with both right and left side of kidney size (r=0.588, p-value &lt;0.05). Conclusion: The present study provided the normal range for kidney size among North Indian adults using CT. The findings showed an age, gender and height dependence of kidney size in present study population.

Comparison between Tubeless Mini-Percutaneous Nephrolithotomy Versus Retrograde Intrarenal Surgery for the Treatment of 2 to 3Cm Renal Lithiasis

Purpose: To assess the outcome and safety of tubeless mini-percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) to treat patients with renal and upper ureteral stones between 2 and 3 cm. Materials and Methods: Between July 2017 and June 2020, 140 patients underwent tubeless mini-PCNL and RIRS for renal stone size between 2 and 3 cm were enrolled in this study. The outcome was determined immediately after operation on plain radiograph kidney, ureter, and bladder and sonography. Various patient and stone characteristics including perioperative outcomes and complications were evaluated. SPSS version 16. Institutional Review Board of Ditmanson Medical Foundation Chia-Yi Christian Hospital, approval number 2021037. Results: Stone-free rates after the procedure were achieved in 78.4% of patients for the tubeless mini-PCNL and 36.4% of patients for the RIRS Group (P &lt; 0.001). However, the stone-free rates at 3 months after surgery were 78.4% for the tubeless mini-PCNL and 68.2% of the RIRS Group (P = 0.172). The mean operative time per patient was 88.6 ± 27.4 min in the tubeless mini-PCNL group, and it was 129.1 ± 44.8 min in the RIRS groups (P &lt; 0.001). The average hospital stay is 3.4 ± 2.0 days in the tubeless mini-PCNL group and 1.9 ± 1.8 days in the RIRS group (P &lt; 0.001). The postoperative infection rates for the tubeless mini-PCNL and RIRS groups were 9.5% and 6.1%, respectively (P = 0.456). Blood transfusions were needed in one patient in the tubeless mini-PCNL group. Conclusion: Tubeless mini-PCNL and RIRS are safe and effective methods for medium-sized renal calculi. Tubeless mini-PCNL compared to RIRS offers the better outcome of higher stone-free rate and lower operation time, but with longer hospital stay and stone-free rate (3-month postoperative).

Outcome Analysis of Reduction and Nonreduction Dismembered Pyeloplasty in Ureteropelvic Junction Obstruction: A Randomized, Prospective, Comparative Study.

Objectives:The objective of this study is to compare the changes in renal function and drainage following open dismembered pyeloplasty with and without renal pelvis reduction.Materials and Methods:Randomized prospective study of children with ureteropelvic junction obstruction undergoing pyeloplasty with (Group 1) and without (Group 2) pelvis reduction over an 18-month period. Postoperative function and drainage were assessed by ethylene dicysteine (EC) scan and intravenous urography (IVU) and renal pelvis size by ultrasonography.Results:Forty-two patients (2 months-11 years) participated. The mean preoperative EC scan function was Group 1: 45.88% ± 14.42% (5%–80%) and Group 2: 39.22% ± 9.75% (21%–53%). (P = 0.117). The mean postoperative EC scan function of Group 1 was 42.64% ± 9.62% (17%–54%) and 43.75% ± 9.88% (17%–58%) and of Group 2 was 44.77% ± 12.82% (20%–68%) and 42.25% ± 8.56% (23%–58%) at 3 months (P = 0.584) and ≥ 1year (P = 0.385), respectively, with no significant difference. None required re-do pyeloplasty. The number of patients with slow drainage, especially at 3 months and also at ≥1-year postoperative period on EC scan was slightly higher in Group 2 compared to Group 1 but did not attain statistical significance. There was postoperative improvement in function and drainage on IVU with no significant difference between the two groups, (P = 0.214; P = 0.99, respectively). At a mean follow-up of 45.5 months, Group 2 also showed significant reduction in pelvis size on ultrasound (P = 0.011).Conclusion:Postoperative function remained stable in both groups. More number of patients achieved unobstructed drainage by 3 mo postoperative after reduction pyeloplasty but drainage patterns were mostly similar between reduction and nonreduction of pelvis group in late follow-up.

Superiority of magnetic resonance imaging in small renal mass diagnosis where image reports mismatches between computed tomography and magnetic resonance imaging.

To analyze malignancy of computed tomography (CT) and magnetic resonance imaging (MRI) results in the same renal mass. We retrospectively reviewed 1,216 patients who underwent partial nephrectomy from January 2017 to December 2021 in our institute. Patients who had both CT and MRI reports prior to surgery were included. We compared the diagnostic accuracy between the CT and the MRI. The patients were divided into two groups according to the consistency of reports: the 'Consistent group' and the 'Inconsistent group'. The Inconsistent group was further divided into two subgroups. Group 1 is the case that showed benign findings on CT but malignancy on MRI. Group 2 is the cases of malignancy on CT but benign on MRI. 410 patients were identified. Benign lesion was identified in 68 cases (16.6%). The sensitivity, specificity and diagnostic accuracy of MRI was 91.2%, 36.8%, and 82.2% respectively, whereas that of CT was 84.8%, 41.2%, and 77.6% respectively. Consistent group were 335 cases (81.7%) and inconsistent group were 75 cases (18.3%). The mean mass size was significantly smaller in the inconsistent group compared to the consistent group (consistent group vs. inconsistent group: 2.31±0.84 cm vs.1.84±0.75 cm, p<0.001). Also, the Group 1 had higher odds of malignancy compared to Group 2 in the renal mass size 2-4 cm (odds ratio, 5.62 [1.02-30.90]). Smaller mass size affects the discrepancy of CT and MRI reports. In addition, MRI showed better diagnostic performance in mismatch cases in the small renal masses.

Evaluation of Normal Renal Size and its Influencing Factors: A Cross-Sectional Study on the Adult Population of Mashhad.

Background:The normal range of kidney size is a controversial issue among different populations given to its impressibility by multiple factors, therefore, this study aimed to provide valid reference ranges for kidney dimensions in the adult population of Mashhad. Also, we assessed the association of kidney size characteristics with some personal predisposing factors.Methods:This cross-sectional study was conducted on 938 healthy individuals. Ultrasound measurement, physical examination, and laboratory analysis were performed. Demographic, dietary, and anthropometric data were obtained. The variables were categorized into 5 groups each, and data analysis were performed using the following statistical tests: Pearson correlation test, variance analysis, t-test, and chi-square test. A value of p<0.05 was considered statistically significant.Results:Weight had the most association with kidney size followed to a lesser extent by height and age. Even after adjustment for other confounding variables, weight remained as an independent factor, while this effect was resolved for height and age. Also, all values for renal function, body bio-impedance, blood pressure components, and water intake were notably correlated with kidney size.Conclusion:This study determined the normal kidney size in healthy adults. We also declared the normal range of kidney size is a dynamic concept and should be assessed for each individual separately according to their personal determinative factors.

Factors Affecting Robotic Partial Nephrectomy Conversion to Radical Nephrectomy: A Retrospective Multi-Institutional Analysis in the Michigan Urologic Surgery Improvement Collaborative (MUSIC).

Objective: To identify factors related to the conversion of robot-assisted partial nephrectomy (RPN) to robot-assisted radical nephrectomy (RRN) based on data collected by a statewide database in Michigan.Methods: Using the Michigan Urological Surgery Improvement Collaborative-Kidney mass: Identifying and Defining Necessary Evaluation and therapY (MUSIC-KIDNEY) database we identified 574 patients for whom RPN was planned. Patient and tumor characteristics were obtained including body mass index (BMI), Charlson comorbidity index (CCI), RENAL nephrometry score, tumor size, and pathologic staging. Treating centers were subdivided by annualized case volume and academic status. Bivariate and multivariate analyses were performed to assess the impact of these factors on the risk of conversion to RRN from RPN.Results: The conversion rate of RPN to RN was 5.75% (33/574). The difference in RENAL nephrometry score, tumor stage, and size reached statistical significance on bivariate analysis (p<0.001). The tumor stage also reached statistical significance on multivariate analysis [odds ratio (OR); 95%CI (8.97; 3.93-20.48) p<0.001]. The conversion rate was lower among high-volume versus low-volume practices; however, statistical significance was not reached [5.2% (27/520) vs.11% (6/54); p=0.11].Conclusions: Patient factors such as tumor size and renal nephrometry score are likely related to the conversion of RPN to RRN decisions. The data shows that Michigan urologists appear to appropriately assess intra-operative findings and convert to RRN in cases of more advanced kidney tumors. Lower volume centers appear to trend towards a higher conversion rate. Continued quality improvement tracking analysis may further clarify this relationship.

Identification of of a PAX2 mutation from maternal mosaicism causes recurrent renal disorder in siblings

BackgroundPAX2-related disorder is an autosomal dominant disorder characterized by renal and eye abnormalities. Some patients may present with isolated renal abnormalities without obvious ocular abnormalities. It is associated with mutations in paired box gene 2 (PAX2), which is one of the families of paired box transcription factor genes. Studies on mosaicism have been limited in PAX2-related disorder, as only three families with mosaic PAX2 mutations have been reported in the literature. MethodsThe proband with multicystic dysplastic kidneys from a Chinese family was recruited in our study. Detailed clinical symptoms were enquired. Trio-based whole exome sequencing (WES), SNP array, sanger sequencing and droplet digital PCR (ddPCR) were used to characterize etiology in the proband. Prenatal diagnosis was performed through amniocentesis and prenatal ultrasound when the proband's mother was further pregnant at 20 weeks. ResultsA heterozygous missense mutation in PAX2 (c.194 T > C) was identified in the proband. His asymptomatic mother has the same mutation with somatic mosaicism ratio of 22%. The mutation was also detected in the fetus. Prenatal ultrasound showed that bilateral hyperechogenic kidneys with decrease of renal size. ConclusionsThis is the first report on PAX2 mosaicism in a Chinese family. Identifying PAX2 mosaicism provides more evidence for estimating recurrence risk. Our findings have important implications on genetic counseling for patients with PAX2-related disorder and provide an effective diagnostic technology for mosaicism.