Renal Ultrasound Research Articles

Clinical features of acute focal bacterial nephritis in adults

Acute focal bacterial nephritis (AFBN) is a localized bacterial infection of the kidneys presenting as an inflammatory mass that can develop into renal abscess. The current reports on AFBN mostly are among children and rarely described in adults. This study was aimed to analyze the clinical features of AFBN in adults and make a review for the disease to give the clinicians some clues to suspect and recognize it in adults. From January 2014 to December 2019, AFBN was diagnosed by contrast-enhanced computed tomography (CT) in 238 adults at the Department of Nephrology, the Second Hospital of Hebei Medical University, Shijiazhuang, China. We reviewed the clinical records of these patients and asked them about their post-discharge status via telephone follow-up. Of all the patients, 195 were female and 43 were male, the median age were 46.87 years. 86.13% presented with fever, 55.89% presented with lower urinary tract symptoms and 97.9% presented with pyuria. In renal ultrasonography, abdominal findings were seen only 22.69% patients. E.coli accounted for 74.73% of the isolated pathogen. After 4 weeks of treatment, the patients had no recurrence of symptoms. We recommend that when a patient presents clinically with acute pyelonephritis, but the fever persist longer after antimicrobial treatment (≥ 4 days in our study), AFBN should be suspected. For the diagnosis, contrast-enhanced CT is the “gold standard”, magnetic resonance imaging (MRI) may be a good option, but the ultrasonography is probably not satisfied. 3–4 weeks of antibiotic therapy may be appropriate for AFBN in adults.

MO122: Bleeding Complications after Allograft Kidney Biopsy and Role of Antiplatelet Therapy

Abstract BACKGROUND AND AIMS Percutaneous biopsy is an important tool for monitoring renal allograft and early diagnosis when dysfunction occurs. Bleeding is the most dangerous adverse event, even if it is rare (risk of 0.5%). Cardiovascular (CV) disease affects 2/3 of elderly with CKD and antiplatelet therapy is taken for primary and secondary prevention of CV events. A systematic review on aspirin discontinuation among 50 279 patients at risk for coronary disease shows a 3-fold risk of adverse CV event. The aim of this study is to compare bleeding complications of antiplatelet administration within 5 days from renal biopsy versus absence of therapy. METHOD We conducted a 10-year (2010–2020) single-centre retrospective study on 285 consecutive ultrasound assisted percutaneous allograft kidney biopsy. We collected information about demographic, laboratory (eGFR, platelets, haemoglobin pre/post biopsy, proteinuria) data, biopsy indication (elective/urgent), clinical presentation [acute kidney injury (AKI)/nephrotic syndrome], needle gauge, use of antiplatelet or anticoagulant, diagnosis and complications (categorized as minor and major, according to the need for intervention). We divided patients in two groups: antiplatelet therapy within 5 days versus therapy discontinuation or absence. Bivariate logistic regression was used to analyse possible risk factors associated with complications. RESULTS Among the 285 patients: 173 patients received antiplatelet agents (low-dose aspirin in >90% of cases) within 5 days from biopsy and 112 patients were not on antiplatelet therapy. Diastolic hypertension, AKI and proteinuria were statistically greater in the group without antiplatelet therapy. Histologic diagnoses were evenly present in the two groups, and no differences were observed in the rate of complications. Major complications were diagnosed in 0/112 patients without antiplatelet therapy and 1/173 patients with therapy within 5 days. Minor complications were documented in 14/112 and in 15/173 patients, respectively. There were no statistically significant differences in terms of complications between antiplatelet therapy within 5 days and absence of therapy (Table 1). Furthermore, there were no differences between taking antiplatelet within 48 h or stopping it within 48 h of the procedure (Table 2). No deaths were attributed to procedure and all events occurred within 24 h from biopsy, irrespective of their severity. The univariate logistic regression model (dependent variable: major complication) documented a lower BMI as a significant risk factor; indeed, this was not confirmed at multivariate regression. The analysis did not find a significant difference between 16-G and 18-G biopsy needle in terms of major/minor complications; however, the use of the latter was associated with a significant lower number of glomeruli in the sample. CONCLUSION Our study suggests that the use of antiplatelet agents within 5 days from procedure does not increase the bleeding risk, so it should be safe to continue the therapy in patients at risk for CV events. However, this is a weak evidence that needs prospective studies to be validated. Our data also suggest that 16-G biopsy needle may be safely used to obtain enough tissue for histologic diagnosis.

MO030: Familial clustering of a rare UMOD variant in undiagnosed hereditary nephropathy suggests the presence of a common ancestral founder mutation

Abstract BACKGROUND AND AIMS ADTKD–UMOD (Autosomal dominant tubulointerstitial kidney disease–UMOD) is a rare genetic disease due to a heterozygous mutation in the UMOD gene encoding uromodulin. It is classically characterized by minimal proteinuria, slowly progressive CKD, hyperuricemia and early-onset gout. With increasing awareness and testing, pathogenic variants in UMOD are being identified more frequently although the nonspecific nature of most symptoms makes clinical diagnosis difficult. We report the surprising finding of a rare UMOD variant in 11 seemingly unrelated families referred to Sheffield or Nottingham renal genetics services over a 15-year period with undiagnosed hereditary kidney disease. METHOD The probands identified were initially referred to renal genetics services based in Sheffield and Nottingham between 2006 and 2021, where they underwent genetic testing and a comprehensive renal workup. All had a family history of ESRD. A pathogenic variant of UMOD, c.278_289delinsCCGCCTCCT was identified in 11 probands by gene or panel-based sequencing. Family members of the affected probands were invited for genetic testing and clinical follow-up. A retrospective review of all patients screened or with ESRD at both renal genetic clinics was conducted. Molecular modeling of the variant was performed using in-silico tools. RESULTS Clinical data from 60 members (11 pedigrees) was obtained. All individuals were born in the United Kingdom and of White British ethnicity. A total of 37 tested positive for the variant, 3 were negative and 19 were not tested due to being deceased (n = 13) and for unknown reasons (n = 6). The median age of ESRD was 52 (range 32, 76) years. More females had ESRD comprising 67% (20/30). Of patients with available data, 68% (30/44) had hypertension, 7.3% (3/41) had proteinuria >30 mg/g and 18% (7/40) had mild hematuria. A total of 11% (6/57) had experienced ≥1 episode of gout with a median onset of 42.5 (range 29–61) years. Only one patient had asymptomatic renal calculi. All patients with CKD who carried the UMOD mutation (n = 22) had hypertension, apart from two who had unknown hypertensive status (n = 1) or reflux nephropathy causing kidney scarring (n = 1). Renal histology where available (8) showed glomerulosclerosis and tubulointerstitial fibrosis. Ultrasound kidney lengths were normal or reduced and renal cysts were only occasionally detected. Molecular modeling of the variant showed structural changes in the cysteine-rich (C6) with EGFII-like Ca2+ binding domain of UMOD, predicted to disrupt disulfide-bond formation (fifth cysteine C94–sixth cysteine C106) as well as by altering the loop (93–97) between two β-sheets of EGFII domain (AlphaFold), possibly altering calcium ion binding (DeepFRI). This variant was initially reported as a recurrent mutation in four apparently unrelated families [1] and has since been noted in a further 11 families [2], all of White British ethnicity. CONCLUSION We have identified a rare pathogenic UMOD variant shared by 11 apparently unrelated families with familial ESRD within a contiguous geographical region of England. The nonspecific symptoms associated with this variant (especially the rarity of gout) were atypical from those with more classical UMOD variants leading to a delay in diagnosis. Our findings and those of others suggest that this is likely to represent a common ancestral variant rather than a recurrent variant within the UK population. 1. Smith GD, Robinson C, Stewart AP et al. Characterization of a recurrent in-frame UMOD indel mutation causing late-onset autosomal dominant end-stage renal failure. Clin J Am Soc Nephrol 2011; 6: 2766–2774. 2. Kidd K, Vylet'al P, Schaeffer C et al. Genetic and clinical predictors of age of ESKD in individuals with autosomal dominant tubulointerstitial kidney disease due to UMOD mutations. Kidney Int Rep 2020; 5:1472–1485.

MP40-01 COST AND DIAGNOSTIC YIELD OF UPPER TRACT IMAGING IN HIGH RISK MICROHEMATURIA; ARE WE STILL DOING TOO MUCH?

You have accessJournal of UrologyCME1 May 2022MP40-01 COST AND DIAGNOSTIC YIELD OF UPPER TRACT IMAGING IN HIGH RISK MICROHEMATURIA; ARE WE STILL DOING TOO MUCH? Clay Martin, Eric Macdonald, Ella Taubenfeld, and Simon Hall Clay MartinClay Martin More articles by this author , Eric MacdonaldEric Macdonald More articles by this author , Ella TaubenfeldElla Taubenfeld More articles by this author , and Simon HallSimon Hall More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002600.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The 2020 AUA guidelines have brought some cost and potentially morbidity-saving changes to the workup and treatment of microhematuria (MH). With these changes comes a call for validating evidence. Herein the new guidelines have been applied to 1,906 patients. METHODS: All patients diagnosed with MH (RBC ≥3/hpf) at a single institution between 2010 and 2019 were retrospectively analyzed. Those with a complete workup including cystoscopy and upper tract imaging within 1 year of diagnosis were included. The new 2020 risk stratification was applied and cancer detection rates by risk group were assessed. A basic cost analysis was performed using the Centers for Medicare & Medicaid Services Physician and Clinical Laboratory Fee Schedule for 2021. RESULTS: Of the total MH cohort (n=1906), 1010 patients were stratified as high risk according to the 2020 guidelines. 770 of the 1010 (76.3%) had cross sectional imaging as part of their workup. Overall, 28 neoplasms were diagnosed in this patient group which corresponds to a detection rate of 2.77%. Of the 28 neoplasms identified, 18 were bladder tumors, 2 were upper tract urothelial malignancies and 8 were solid renal neoplasms. Cross-sectional imaging identified a total of 10 upper tract neoplasms (urothelial and renal) which corresponds to a 1.30% (10/770) detection rate. Furthermore, of the 8 solid renal masses, only 3 were of sufficient radiologic concern to warrant upfront surgical treatment. Additionally, 3 of these 8 patients had renal US in addition to their CT, 2 out of these 3 identified the solid renal mass. Cost analysis suggests that replacement of CT urography with renal US could decrease cost of workup by 38% ($433.04 vs $703.43). CONCLUSIONS: Cross sectional imaging in 770 patients with High-risk MH by the 2020 AUA guidelines yielded a detection rate of only 1.30% for upper tract neoplasms. Only 2 of these were urothelial malignancies that may not have been picked up via renal ultrasonography. Assuming most significant solid renal lesions could be identified by renal US, the utility of cross-sectional imaging is a positive finding in less than 1% of CT scans in this population. These data suggest that cross-sectional imaging may be unnecessary in the workup of MH, even in high-risk patients. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e674 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Clay Martin More articles by this author Eric Macdonald More articles by this author Ella Taubenfeld More articles by this author Simon Hall More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP33-01 "THAT CAN'T BE A STONE!": PREDICTORS OF FALSE POSITIVITY FOR NEPHROLITHIASIS ON RADIOLOGIC REPORTS OF RENAL SONOGRAMS

You have accessJournal of UrologyCME1 May 2022MP33-01 "THAT CAN'T BE A STONE!": PREDICTORS OF FALSE POSITIVITY FOR NEPHROLITHIASIS ON RADIOLOGIC REPORTS OF RENAL SONOGRAMS Dylan Z. Taylor, Garrett E. Smith, and Scott V. Wiener Dylan Z. TaylorDylan Z. Taylor More articles by this author , Garrett E. SmithGarrett E. Smith More articles by this author , and Scott V. WienerScott V. Wiener More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002587.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Standard of care for diagnosing nephrolithiasis is shifting from computed tomography (CT) to Ultrasonography (US). Identifying a stone on US may lead to a CT scan, however if no stone is identified on CT, the patient will have been exposed to unnecessary radiation. We hypothesize that sonographic and patient factors predict true positivity (TP) and false positivity (FP) for nephrolithiasis on US vs. CT. METHODS: To avoid repeated measures, patients with one stone documented in the radiological report of renal US who had a CT within 24 hours in 2019, were included retrospectively at one institution. Stones were categorized as TP or FP by correlating US and CT images (as reviewed by the researchers) according to a novel stone likelihood scoring system (US-SLS, Figure 1) including stone location (collecting system or parenchyma) and size. Patient and sonographic variables were incorporated into a binary logistic regression to predict FP. RESULTS: 449 patients had an US followed by CT; 139 (30.10%) US reports documented “stones", of which 90 (20.04%) were solitary stones. There were 56 TP’s and 34 FP’s, thus the PPV for US was 62%. Univariate predictors of FP were (Table 1): no prior stones (OR 3.41, CI 1.32-8.85, p=0.011), age (OR 1.024, CI 1.001–1.024, p=0.042), and a US-SLS of 1 (OR 9.09, CI 2.67–31.25, p <0.001). Adjusting for these variables, a low US-SLS (OR: 8.70, CI: 2.42–31.25, p=0.001) was the only significant predictor of FP findings of “stones” within radiology reports on multivariate analysis. Non-significant variables included: US gain, twinkling, shadowing, depth to stone, hydronephrosis, hematuria, flank pain, BMI, and medical history. CONCLUSIONS: Our US-SLS identifies clinically relevant stones on subsequent CT better than other criteria such as shadowing or twinkling. Providers should consider utilizing this US-SLS prior to ordering a CT in response to a radiological report documenting “stones”, as it may limit patient exposure to unnecessary radiation. Further study will prospectively validate these scores among surgical cohorts. Source of Funding: This research received no funding. SVW reports equity in Applaud Medical and a consulting agreement with Time Therapeutics LLC. DZT and GES have no conflicts of interest to disclose © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e569 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dylan Z. Taylor More articles by this author Garrett E. Smith More articles by this author Scott V. Wiener More articles by this author Expand All Advertisement PDF DownloadLoading ...

Study on the Mechanism of Bu-Shen-He-Mai Granules in Improving Renal Damage of Ageing Spontaneously Hypertensive Rats by Regulating Th17 Cell/Tregs Balance.

Methods Blood pressure and urine biochemical indices were recorded. Renal blood flow was evaluated by renal ultrasonography. Transmission electron microscopy (TEM) and HE staining were used to assess kidney and spleen morphology. Renal fibrosis was assessed using Masson staining. Serum levels of IL-6, IL-10, and IL-17A were measured using ELISAs. The density of RORγ and Foxp3 in the spleen was observed by immunofluorescence staining. The levels of Th17 cells and Tregs in blood were detected via flow cytometry. Transcriptome sequencing was performed to screen the targets of BSHM granules in hypertensive kidneys. Results BSHM granules decreased SBP by 21.2 mm·Hg and DBP by 8.8 mm·Hg in ageing SHRs (P < 0.05), decreased the levels of urine mALB, β2-Mg, and NAG (P < 0.01), and improved renal blood flow and arteriosclerosis. BSHM granules increased IL-10 expression (P < 0.05) while decreasing IL-6 (P < 0.01) and IL-17A (P < 0.05) levels. BSHM granules improved Foxp3 density and the number of Tregs (P < 0.01) and reduced RORγt density and the number of Th17 cells (P < 0.01). Transcriptome sequencing identified 747 differentially expressed (DE) mRNAs in kidneys after BSHM treatment. GO analysis suggested that BSHM granules act through immunoregulation. Conclusions BSHM granules attenuated hypertensive renal damage in ageing SHRs, by significantly increasing Tregs and decreasing Th17 cells.

Incidence and resolution of de novo hydronephrosis after pediatric robot-assisted laparoscopic extravesical ureteral reimplantation for primary vesicoureteral reflux

With the advent of robot-assisted laparoscopic ureteral reimplantation (RALUR) for primary vesicoureteral reflux (VUR), understanding and minimizing its complications continues to be critical. Incidence of de novo hydronephrosis after RALUR could be indicative of an outcome that needs further study or could be a benign transient finding. In the present study, we hypothesized that the incidence of de novo hydronephrosis after RALUR is low and resolves spontaneously. An IRB-approved prospective single-institutional registry was utilized to identify all patients undergoing RALUR via an extravesical approach from 2012 to 2020. Patients with primary VUR and minimal (Grade I SFU) or no hydronephrosis prior to surgery were included. Patients who had other associated pathology or underwent concomitant procedures were excluded. Preoperative characteristics including VUR and hydronephrosis grades as well as post-operative clinical details and hydronephrosis grades were aggregated and analyzed. 86/172 (50%) patients (133 ureters), with median reflux grade of 3 (IQR: G2, G3) met the inclusion criteria. Patients underwent RALUR at a median age of 5.7 years (IQR: 3.4, 8.7) with median 36.2 months (IQR: 19.6, 63.6) follow-up. Renal ultrasound at 4-6 weeks post-op showed de novo hydronephrosis in 18 (13.5%) ureters; the complete resolution was seen in 13 ureters (72%) at a median of 4.5 months from surgery. Among the 5 with non-resolved hydronephrosis (SFU G2:4, G3:1), 2 patients (3 ureters) underwent subsequent interventions. The present study evaluating the natural history of de novo hydronephrosis after RALUR-EV performed for primary VUR, is to our knowledge the largest cohort of patients undergoing RALUR that this has been studied in. In our cohort, the incidence of de novo hydronephrosis after RALUR was 13.5%, similar to rates reported in two OUR cohorts, and significantly lower than reported incidence rates of 22-26% in several OUR cohorts, and 30% in a RALUR cohort. In the present cohort, hydronephrosis resolved spontaneously in more than 72% of cases. The median time from surgery until resolution of hydronephrosis was 4.5 (1.6, 10.5) months, which is shorter in comparison to the average time to resolution of 7.6 months, reported by Kim etal. in an earlier study. De novo hydronephrosis after RALUR can be followed with serial renal ultrasounds. The majority of de novo hydronephrosis post-RALUR is transient and resolves spontaneously within a year of surgery with a very low re-intervention rate.

Postoperative JJ stent is not necessary after balloon high-pressure endoscopic dilatation of primary obstructive megaureter

A wide range of surgical interventions have been described for the management of primary obstructive megaureter (POM). Endoscopic balloon dilatation has been developed through last decades as a minimally invasive alternative to classic surgery. To assess the need for placement of a double J stent after endoscopic balloon dilatation procedure, by comparing the post-operative related outcomes with and without double J placement. Secondary outcome was the success rate, considering the need for further procedure after endoscopic balloon dilatation and the improvement of the ureteral diameter in the two groups. Historical retrospective comparison of children treated by endoscopic dilatation for POM, with post-operative JJ stent left in place (2012-2014) or without ureteral JJ stent (since 2015). Post-operative complications were reported following Clavien-Dindo grading system and compared between the two groups. Success rate was defined as absence of need for further surgical reimplantation. Ureteral diameters on preoperative and postoperative renal ultrasounds were compared. Endoscopic dilatations were performed in 42 patients for 46 renal units during the study period. There was a significantly higher rate of post-operative complications in the group with JJ stenting compared to the group without double J stenting regarding all Clavien-Dindo grades (56% vs 15%, p=0.014) and Clavien-Dindo grade III only (31% vs 0%, p=0,0051) (Figure). The success rate was similar in the JJ group (75%, F-up: 70 months [13-101]) and the no JJ group (81%, F-up: 26 months [12-95]). There was a significant improvement of US renal pelvis and ureter dilatation in both groups, with a median follow-up of 35.5 months [12-101]. The overall rate of complications was slightly higher than in other reports and higher in the JJ group regarding Clavien-Dindo grade III complications. The success rate was comparable to previous studies reviewing endoscopic dilatations and equivalent in the two groups. In our study, the omission of postoperative ureteral drainage by a JJ stent after endoscopic balloon dilatation of POM did not increase post-operative complications rate without demonstrable impact on the success rate.

Acoustic comfort in pediatric noninvasive exam: A study of bedside renal sonography for children

Pediatric renal sonography is a non-radiation exposure and non-invasive procedure to evaluate kidneys and urinary tract structures. It is frequently performed in clinics and wards. Although there is no physical discomfort during ultrasounds, children would still experience agitation or crying due to unfamiliarity with medical environment. To provide comfortable medical experience and improve the quality of healthcare, we design a renal sonography process integrated with acoustic components specific for children. Patients under 7 years old are divided into three groups, under the age of 1, 1–3, and above 3. Pre-recorded music with nursery rhymes and fairy tales is played. Two time points are designed to evaluate acoustic integrated effect, along with preparing phase or real time of sonography starting. Data are collected from three timeframes: before, during, and after the exam. Physiological data will include heart rate, respiratory rate, and O2 saturation. Emotional behavior, such as agitation, crying, and smiling, will be recorded. This study will establish specific acoustic components and suitable intervention timeframe for children of different age groups. By having acoustic comfort, we hope children will have good experiences during sonography exam. As a result, the quality of medical examination and children wellbeing can be achieved.

Nutcracker Syndrome with Thin Basement Membrane Disease: A Case Report

Nutcracker syndrome is caused by external compression of the left renal vein and is characterized by various symptoms, such as hematuria and left flank pain. However, long-standing gross hematuria is uncommon. We report the case of a 23-year-old woman who had had painless gross hematuria for several months. Kidney biopsy revealed thin basement membrane disease, but this did not explain the gross hematuria with proteinuria. Renal venography and Doppler ultrasonography showed increased diameter and velocity ratios between the left renal vein and inferior vena cava. Cystoscopy revealed that the hematuria originated from the left ureteral orifice. These results indicate coexisting Nutcracker syndrome. Nutcracker syndrome with thin basement membrane disease should be considered in the differential diagnosis of a patient who has long-standing gross hematuria.

Motion-capture technique-based interface screen displaying real-time probe position and angle in kidney ultrasonography.

Professional skill is required to reproduce ultrasound images of the kidney as an optimal cross-section is easily lost with slight deviation in scanning location or angle of the probe. We developed a motion-capture technique-based interface screen that displays the real-time probe position and angle to overlap those provided beforehand. When a professional operator captured the approximate kidney image, our system recorded the relative spatial relationship between the subject and the probe. Next, an amateur operator who had no experience of clinical practice manipulated the probe only with the aid of the interface until the probe position and angle coincided with the professional ones. Eventually, amateur operators could place the probe with a deviation of distance of (x = 2.7 ± 1.2mm, y = 3.0 ± 1.7mm, z = 6.6 ± 1.8mm) and angle of (Rx = 1.5 ± 0.3 degrees, Ry = 2.6 ± 1.1 degrees, Rz = 1.1 ± 0.3 degrees) from the professional goal to produce very similar cross-sectional kidney images (N = 8). Also, motion-capture technique-based evaluation of relative locations of the probe and subject body revealed difficulty in reproducing those without the interface screen navigation. In summary, our motion-capture technique-based ultrasound guide system provides operators with the opportunity to handle the probe just as another operator would beforehand. This could help in medical procedures wherein the same cross-sectional image should be repeatedly obtained. Moreover, it requires no conventional probe training for beginners and could even shift the paradigm for ultrasound probe handling.

Long-term follow-up of patients after acute kidney injury in the neonatal period: abnormal ambulatory blood pressure findings

BackgroundData on the long-term effects of neonatal acute kidney injury (AKI) are limited.MethodsWe invited 302 children who had neonatal AKI and survived to hospital discharge; out of 95 patients who agreed to participate in the study, 23 cases were excluded due to primary kidney, cardiac, or metabolic diseases. KDIGO definition was used to define AKI. When a newborn had no previous serum creatinine, AKI was defined as serum creatinine above the mean plus two standard deviations (SD) (or above 97.5th percentile) according to gestational age, weight, and postnatal age. Clinical and laboratory features in the neonatal AKI period were recorded for 72 cases; at long-term evaluation (2–12 years), kidney function tests with glomerular filtration rate (eGFR) by the Schwartz formula, microalbuminuria, office and 24-h ambulatory blood pressure monitoring (ABPM), and kidney ultrasonography were performed.ResultsForty-two patients (58%) had stage I AKI during the neonatal period. Mean age at long-term evaluation was 6.8 ± 2.9 years (range: 2.3–12.0); mean eGFR was 152.3 ± 26.5 ml/min/1.73 m2. Office hypertension (systolic and/or diastolic BP ≥ 95th percentile), microalbuminuria (> 30 mg/g creatinine), and hyperfiltration (> 187 ml/min/1.73 m2) were present in 13.0%, 12.7%, and 9.7% of patients, respectively. ABPM was performed on 27 patients, 18.5% had hypertension, and 40.7% were non-dippers; 48.1% had abnormal findings. Female sex was associated with microalbuminuria; low birth weight (< 1,500 g) and low gestational age (< 32 weeks) were associated with hypertension by ABPM. Twenty-three patients (33.8%) had at least one sign of microalbuminuria, office hypertension, or hyperfiltration. Among 27 patients who had ABPM, 16 (59.3%) had at least one sign of microalbuminuria, abnormal ABPM (hypertension and/or non-dipping), or hyperfiltration.ConclusionEven children who experienced stage 1 and 2 neonatal AKI are at risk for subclinical kidney dysfunction. Non-dipping is seen in four out of 10 children. Long-term follow-up of these patients is necessary.

Ultrasound shear wave elastography cannot discriminate between low- and high-pressure neurogenic bladders

Patients with neurogenic bladders are monitored with renal bladder ultrasounds and video urodynamics studies (VUDS) to assess upper urinary tractinjury. Ultrasound shear wave elastography (US-SWE) can assess tissue stiffness. If bladder compliance is affected by bladder wall fibrosis and stiffening, then high-pressure bladders may be detectable by US-SWE therefore reducing the need for VUDS in some patients. To determine if US-SWE can differentiate between low- and high-pressure bladders and hence be used for noninvasive assessment of neurogenic bladder in children. Prospective study of patients with neurogenic bladder undergoing clinically indicated VUDS between February and July of 2017. During VUDS, bladder wall US-SWE was measured at different filling percentages of estimated bladder capacity (EBC). The bladders were divided into cohorts according to the detrusor muscle pressure (Pdet) reached at the maximum bladder capacity: normal (1 to <15 cmH2O) and abnormal (≥15 cmH2O) pressure. T-test was used to compare elastography values at different bladder volumes and Pdet; (statistical significance set at p<0.05). 30/31 enrolled children completed the protocol. With an empty bladder, as well as at all other bladder volumes, no relationship was observed between Pdet and mean SWE of the anterior or posterior bladder wall. At maximum bladder capacity, there was no difference between mean SWE values of the anterior or posterior bladder walls in those with normal pressure, 2.97m/s (SD±0.82) and 1.96m/s (SD±0.75), compared to those with abnormal pressures 3.08m/s (SD±0.84) and 2.39m/s (SD±0.96), p = 0.75 and p=0.2, respectively. We found no difference between SWE values of either the anterior or posterior bladder wall in neurogenic bladders with normal and abnormal filling pressures measured during VUDS. Our study differs from previously reported studies with morepositive results in that our cut-off for abnormal bladder pressure was (Pdet ≥15 cmH2O). This is lower than the more commonly used leak point pressure of 40 cmH2O because our practice isto intervene earlier. Moreover, SWE would be most useful if it can identify changes before the bladder has reached such severe conditions, to allow for early intervention. Additional differences between ours and other studies include US manufacturer and younger age of the participating children. US-SWE, while feasible, was not able to discriminate between low- and high-pressure bladders. Moreover, US-SWE did not show significant correlation with the current gold standard, VUDS.

Artificial intelligence in glomerular diseases.

In this narrative review, we focus on the application of artificial intelligence in the clinical history of patients with glomerular disease, digital pathology in kidney biopsy, renal ultrasonography imaging, and prediction of chronic kidney disease (CKD). With the development of natural language processing, the clinical history of a patient can be used to identify a computable phenotype. In kidney pathology, digital imaging has adopted innovative deep learning algorithms (DLAs) that can improve the predictive capability of the examined lesions. However, at this time, these applications can only be used in research because there is no recognized validation to replace the conventional diagnostic applications. Kidney ultrasonography, used in the clinical examination of patients, provides information about the progression of kidney damage. Machine learning algorithms (MLAs) with promising results for the early detection of CKD have been proposed, but, still, they are not solid enough to be incorporated into the clinical practice. A few tools for glomerulonephritis, based on MLAs, are available in clinical practice. They can be downloaded on computers and cellular phones but can only be applied to uniracial cohorts of patients. To improve their performance, it is necessary to organize large consortia with multiracial cohorts. Finally, in many studies MLA development has been carried out using retrospective cohorts. The performance of the models might differ in retrospective cohorts compared to real-world data. Therefore, the models should be validated in prospective external large cohorts.

Renal Venous Stasis Index Reflects Renal Congestion and Predicts Adverse Outcomes in Patients With Heart Failure.

BackgroundIt has been recently reported that the renal venous stasis index (RVSI) assessed by renal Doppler ultrasonography provides information to stratify pulmonary hypertension that can lead to right-sided heart failure (HF). However, the clinical significance of RVSI in HF patients has not been sufficiently examined. We aimed to examine the associations of RVSI with parameters of cardiac function and right heart catheterization (RHC), as well as with prognosis, in patients with HF.MethodsWe performed renal Doppler ultrasonography, echocardiography and RHC in hospitalized patients with HF (n = 388). RVSI was calculated as follows: RVSI = (cardiac cycle time-venous flow time)/cardiac cycle time. The patients were classified to three groups based on RVSI: control group (RVSI = 0, n = 260, 67%), low RVSI group (0 < RVSI ≤ 0.21, n = 63, 16%) and high RVSI group (RVSI > 0.21, n = 65, 17%). We examined associations of RVSI with parameters of cardiac function and RHC, and followed up for cardiac events defined as cardiac death or worsening HF.ResultsThere were significant correlations of RVSI with mean right atrial pressure (mRAP; R = 0.253, P < 0.001), right atrial area (R = 0.327, P < 0.001) and inferior vena cava diameter (R = 0.327, P < 0.001), but not with cardiac index (R = −0.019, P = 0.769). During the follow-up period (median 412 days), cardiac events occurred in 60 patients. In the Kaplan–Meier analysis, the cumulative cardiac event rate increased with increasing RVSI (log-rank, P = 0.001). In the multivariate Cox proportional hazard analysis, the cardiac event rate was independently associated with RVSI (high RVSI group vs. control group: hazard ratio, 1.908; 95% confidence interval, 1.046–3.479, P = 0.035).ConclusionRVSI assessed by renal Doppler ultrasonography reflects right-sided overload and is associated with adverse prognosis in HF patients.

Utility of renal scintigraphy in diagnosis of multicystic dysplastic kidney.

To compare the prevalence of vesicoureteral reflux (VUR), febrile urinary tract infection (fUTI), and chronic kidney disease (CKD) among patients with multicystic dysplastic kidney (MCDK) diagnosed by renal scintigraphy (RS) versus follow-up renal ultrasound (RUS) alone. This was a retrospective review of patients seen at a tertiary care center from 2010 to 2020 with MCDK diagnosed by RS or follow-up RUS. Differences in the prevalence of VUR, fUTI, and CKD by cohort were assessed using logistic regression analysis, Pearson X2 , and Fisher's Exact tests. Temporal trends in diagnostic methods used (RUS versus RUS + RS) were evaluated using the Cochran-Armitage trend test. One-hundred seventy-two patients were included: 50% (n=86) underwent RUS + RS and 50% (n=86) underwent RUS alone to diagnose MCDK. Prevalence of VUR, fUTI, and CKD did not significantly vary between groups. Among patients who had a VCUG, 4.4% had contralateral VUR (1.7% RUS + RS group; 7.4% RUS group; p=0.19) and 14.5% had at least one fUTI (16.3% RUS + RS group; 12.8% RUS group; p=0.52). Females were significantly more likely to have at least one fUTI (p=0.04). Four patients (2.3%) developed CKD, all in the RUS + RS cohort (p=0.12). Diagnosis of MCDK by RUS versus RUS + RS did not significantly vary over time (p=0.17). Patients with unilateral MCDK confirmed by RS versus RUS alone do not significantly vary in the prevalence of VUR, fUTI, or CKD. Renal scintigraphy studies may not be necessary in unilateral MCDK diagnosis but continue to be used.

Efficacy of corticosteroids in reducing the renal scarring in acute pyelonephritis in children

Abstract Background: Renal scarring is a serious and chronic consequence of acute pyelonephritis in children, which may cause late complications in young adults, such as hypertension, chronic renal failure, and preeclampsia. Urinary tract infection is the most common serious infection in childhood, accounts for 5% to 14% of all pediatric emergency centers. This study aimed to evaluate the effect of dexamethasone in reducing or preventing renal scarring in children who were treated with antibiotics for acute urinary tract infection. Methods: This is a multicenter, randomized, placebo-controlled, double-blind clinical trial, which evaluates the efficacy of dexamethasone in preventing or reducing renal scarring in febrile children (2 months to 14 years) with a first-diagnosed urinary tract infection. A total of 120 participants will be enrolled over a 3-year period from 6 sites in Qatar. Participants will be randomized into a therapy arm and a placebo arm; each arm will comprise 60 participants. Participants were allocated to the therapy arm and received dexamethasone, while those who were allocated to the placebo arm received a placebo, orally in the same regime, twice daily for 3 days. Blood and urine investigations will be performed at presentation and after 3 days from beginning antibiotics, renal ultrasonography will be performed over the first month and DMSA scan will be performed 6 months after enrolment. Study medication will be administered in the first 48 hours of starting antibiotics. The DMSA scan for all participants will be read by 3 reference radiologists without knowledge of clinical features or trial arms. Discussion: The formation of renal scarring will be compared between participants in both arms, the severity of renal scars and all adverse events of the therapy is determined. Trial registration: This trial has been registered at ClinicalTrials.gov: NCT04654507 (December 4, 2020), https://clinicaltrials.gov/ct2/show/NCT04654507.

Abstract MP72: Renal Artery Stenosis Screening Among Women With Hypertensive Disorders Of Pregnancy And Associations With Pregnancy Outcomes

Introduction: Patients with hypertensive disorders of pregnancy (HDoP) have increased prevalence of renal artery stenosis due to fibromuscular dysplasia (FMD) that is usually diagnosed years post-partum. Because renal artery FMD is a treatable cause of hypertension, earlier diagnosis has potential to decrease maternal risk and improve pregnancy outcomes. We sought to characterize utilization of renal artery duplex screening among women with HDoP and associations with pregnancy outcomes. Hypothesis: We hypothesize that renal artery duplex screening for renal artery stenosis among women with HDoP will be low. Methods: Women diagnosed with HDoP treated at a single academic medical center from 2016-2021 were identified using ICD-9&amp;10 codes for hypertension of pregnancy, pre-eclampsia, eclampsia, and HELLP syndrome. Screening for renal artery FMD was categorized based on performance of at least one renal duplex ultrasounds during the study period. Associations with maternal demographic factors and pregnancy outcomes based on screening status were explored using descriptive statistics and categorical tests. Results: 11,564 women diagnosed with HDoP were identified. Mean age was 37.1±8.5 years. Race was categorized as 17% African American, 5% Asian, and 73% white; 4% of women had Hispanic or Latino ethnicity. 33% of patients were current or former smokers. Renal artery stenosis screening was performed on 72 women (0.6%). No significant differences in age, race, or ethnicity were identified between screened versus unscreened patients. Renal artery duplex results were abnormal in 14/72 (19%) of women screened, and an additional 3 women were diagnosed with FMD at a non-renal anatomic location based on imaging studies other than renal artery duplex. Women screened for renal artery stenosis for 44/8386 pregnancies (0.5%) associated with HDoP during the study period and had higher rates of preterm delivery (53% versus 20%; P&lt;0.001). Conclusions: Renal artery stenosis screening is uncommon among women with HDoP, but identified abnormal findings in a significant proportion of studies. Associations between screening and preterm delivery may reflect selection bias based on severity of HDoP symptoms and related risks. Renal artery stenosis screening may be under-utilized among women with HDoP, and expanded screening has potential to reduce both short- and long-term maternal risk and improve pregnancy outcomes.

Prevalence of reflux nephropathy in Iranian children with solitary kidney: results of a multi-center study

BackgroundGiven the importance of the function of the remnant kidney in children with unilateral renal agenesis and the significance of timely diagnosis and treatment of reflux nephropathy to prevent further damage to the remaining kidney, we aimed to determine the prevalence of reflux nephropathy in this subgroup of pediatric patients.MethodsIn general, 274 children referred to pediatric nephrologists in different parts of Iran were evaluated, of whom 199 had solitary kidney and were included in this cross-sectional study. The reasons for referral included urinary tract infection (UTI), abnormal renal ultrasonography, being symptomatic, and incidental screening. Demographic characteristics, including age and gender were recorded. History of UTI and presence of vesicoureteral reflux (VUR) were evaluated.ResultsOf the 274 children evaluated in this study with the mean age (SD) of 4.71 (4.24) years, 199 (72.6%) had solitary kidney. Among these, 118 (59.3%) were male and 81 (60.7%) were female, 21.1% had a history of UTI, and VUR was present in 23.1%. The most common cause of referral was abnormal renal ultrasonography (40.2%), followed by incidental screening (21.1%), being symptomatic (14.1%), and UTI (5.5%). In 116 children (58.3%), the right kidneys and in 83 (41.7%) the left kidneys were absent. Besides, 14.6% of the participants had consanguineous parents and 3% had a family history of solitary kidney. Upon DMSA scan, the single kidney was scarred in 13.1%, of which only 7.5% were associated with VUR. In addition, proteinuria and hematuria were observed in 6.5% and 1.5% of children, respectively.ConclusionsThe prevalence of reflux nephropathy was 7.5% in children with solitary kidney with a male predominance. Given the relatively high prevalence of reflux nephropathy in these children, screening for VUR in the remnant kidney appears to be essential in this population.

Early Renal Ultrasound in Patients with Congenital Solitary Kidney Can Guide Follow-Up Strategy Reducing Costs While Keeping Long-Term Prognostic Information.

We aimed to evaluate the prognostic value of renal length (RL) > 2 standard deviation scores (SDS) measured by renal ultrasound (RUS), across infancy, childhood and adolescence, in identifying which patients with congenital solitary functioning kidney (CSFK) are at lower risk of developing kidney injury (KI). We also estimated the cost saving of integrating the current follow-up protocols with an early RUS algorithm (ERUSA). Fifty-six CSFK adult patients who were 1–3 months old at first observation of undergoing RUS were enrolled. KI was defined by hypertension and/or proteinuria and/or declined renal function. ERUSA was assessed by early (at 1–3 months of life) RUS and was retrospectively tested in our patients. ERUSA establishes that patients with RL > 2SDS at early RUS do not undergo further follow-ups. The others undergo another RUS at 1 year of age along with follow-ups according with current protocols, with the exception of RUS which could be no longer performed. Direct and indirect costs were calculated for each analysed protocol and the cost saving of applying ERUSA was calculated. None of the patients with early RL > 2SDS presented KI in adulthood. A RL > 2SDS was predictive of absence of KI only at 1–3 months (OR = infinity) and 1 year of age (OR = 0.13; 95%CI: 0.03–0.66; p = 0.01). ERUSA provided a total cost-sparing ranging from 38.6% to 55.3% among the analysed follow-up protocols. With ERUSA, no patients developing KI in adulthood were missed. In conclusion, only a RL > 2SDS at 1–3 months and 1 year of age predicted good prognosis in young adulthood. ERUSA can guide a cost-sparing follow-up strategy in CSFK patients while maintaining important long-term information.