Renal Vascularization Research Articles

Morphometry and skeletopy of kidneys and renal vessels in marmoset (Callithrix spp.).

Marmosets, Callithrix spp, are small New World monkeys that have gained importance as an experimental animal model for human. Despite its use, information on its renal morphometry, vascularization, and location are limited. Therefore, this study will supply basic anatomy for applied studies and for comparative anatomy. Fifty cadavers of Callithrix spp were collected on highways from the Atlantic Forest biome, identified and injected with a 10% formaldehyde solution. Later, the specimens were dissected and the measurements and topography of the kidneys and renal vessels were recorded. Both left and right kidneys were significantly larger in females. In the specimens studied, the average body length was 20.00 ± 2.46 cm in males and 20.50 ± 1.98 cm in females (p = .43). The kidneys of the Callithrix spp. were symmetrical in shape and resembled a "bean." They were also pale brown with a smooth surface. In males, the most frequent location of the right kidney was at the L1-L2 level (92%), while the location of the left kidney was between L2 and L3 (76%). In females, the most frequent location of the right kidney was at the L1-L2 level (56%), while the location of the left kidney was between L2 and L3 (32%) (Table1). However, in seven (28%) males and nine (36%) females, the kidneys were at the same level. In both sexes, there was a positive and significant linear correlation between body length and kidney length. Regardless of the variable location of the kidneys in both sides and in either sexe, the right kidney was always located more cranially than the left, similar to observations in other non-human primates.

Toll-like receptor 4 mutation mitigates gut microbiota-mediated hypertensive kidney injury

Hypertension-associated dysbiosis is linked to several clinical complications, including inflammation and possible kidney dysfunction. Inflammation and TLR4 activation during hypertension result from gut dysbiosis-related impairment of intestinal integrity. However, the contribution of TLR4 in kidney dysfunction during hypertension-induced gut dysbiosis is unclear. We designed this study to address this knowledge gap by utilizing TLR4 normal (TLR4N) and TLR4 mutant (TLR4M) mice. These mice were infused with high doses of Angiotensin-II for four weeks to induce hypertension. Results suggest that Ang-II significantly increased renal arterial resistive index (RI), decreased renal vascularity, and renal function (GFR) in TLR4N mice compared to TLR4M. 16 S rRNA sequencing analysis of gut microbiome revealed that Ang-II-induced hypertension resulted in alteration of Firmicutes: Bacteroidetes ratio in the gut of both TLR4N and TLR4M mice; however, it was not comparably rather differentially. Additionally, Ang-II-hypertension decreased the expression of tight junction proteins and increased gut permeability, which were more prominent in TLR4N mice than in TLR4M mice. Concomitant with gut hyperpermeability, an increased bacterial component translocation to the kidney was observed in TLR4N mice treated with Ang-II compared to TLR4N plus saline. Interestingly, microbiota translocation was mitigated in Ang-II-hypertensive TLR4M mice. Furthermore, Ang-II altered the expression of inflammatory (IL-1β, IL-6) and anti-inflammatory IL-10) markers, and extracellular matrix proteins, including MMP-2, −9, −14, and TIMP-2 in the kidney of TLR4N mice, which were blunted in TLR4M mice. Our data demonstrate that ablation of TLR4 attenuates hypertension-induced gut dysbiosis resulting in preventing gut hyperpermeability, bacterial translocation, mitigation of renal inflammation and alleviation of kidney dysfunction.

Unraveling Renal Arteries Morphogenesis from Tridimensional Human Embryos Reconstruction

During human morphogenesis, the definitive kidneys derive from the metanephros during Carnegie Stage 14 to 23. The pronephros and the mesonephros develop previously and successively to finally lead to the formation of the urinary tract. Renal vascularization, first described in 1912 by Félix using a "ladder theory" model, is highly variable and current available morphogenesis descriptions do not explain all reported anatomical variations. The aim of this work was to study the morphogenesis of the human metanephros and its vascularization by three-dimensional reconstructions of human embryos. Histological sections of 23 human embryos from the Carnegie Collection and 5 human embryos from the French collection (Carnegie stages 14 to 23) were completely digitalized and reconstructed in three dimensions using specific softwares and then analyzed by descriptive method using manual annotation. In all studied embryos, the mesonephric arteries did not reach the metanephros irrespective to the position of the metanephros during its cranial ascent. Before the end of the cranial metanephros migration (15 embryos), at the level of the aorto-iliac bifurcation, a "primitive" vascularization was shown in 9 of them. The renal artery originated from the primitive iliac arteries for 8 embryos and from the inferior mesenteric artery in one embryo. Further, a capillary cluster emerging from the lateral wall of the aorta and extending toward the metanephros was found in 2 embryos (Carnegie stages 21 and 22). This may correspond to a phenomenon of neoangiogenesis responsible of the definitive renal artery. The present study reported the morphogenesis of human renal arteries between Carnegie stages 14 and 23 using an original method of tridimensional computerized reconstructions of historical human embryos. Some original findings, in contradiction with the original Felix's description, may explain the most frequently reported anatomical variations.

Unilateral Duplication of Renal Vessels: Exploring Anatomical, Clinical, and Surgical Insights

The classic description of renal vascularization typically refers to a renal artery and vein. Nevertheless, this vascular configuration exhibits numerous anatomical variations in terms of their number, origin, and course, primarily attributable to ontogenetic alterations. While performing standard abdominal dissections for medical students, we examined the kidneys and their vasculature observing variations in the morphological arrangements of the right renal artery and renal vein. This case report aims to shed light on these variations, thereby enhancing clinicians' awareness of the intricate blood supply to the kidney. Understanding the diverse patterns of renal artery variations holds significance for urologists, radiologists, and surgeons alike. Such insights can prove invaluable for practitioners engaged in invasive procedures and vascular surgeries. Keywords: renal artery, renal vein, vascular variation, anatomical variants, renal surgery

#281 AVF formation is a common complication of percutaneous ultrasound-guided renal biopsy: a single-center analysis of risk factors and clinical outcome

Abstract Background and Aims Percutaneous renal biopsy is a key procedure for the work-up of renal diseases. Among the possible complications of such procedure, prevalence, risk factors and clinical outcome of arterio-venous fistula (AVF) formation is unclear. We present here a single-center experience on renal biopsy-related complications with a focus on risk factors for AVFs formation and their management. Method We retrospectively analyzed all the kidney biopsies performed in our center between January 2012 and December 2022. All biopsies were conducted under real-time ultrasound (US) guidance by trained nephrologists. Kidney US and doppler mapping were performed routinely 6 and 24 hours post-procedure. In accordance with the description provided in the US report, AVFs were categorized into small, moderate, and high-flow rates. Patients’ comorbidities, histologic sample characteristics, blood tests results and the clinical course were recorded. Logistic regression was employed to investigate potential risk factors for complications. Results 1016 adult native renal biopsies were performed. The average age of patients was 55 ± 17 years, and 677/1016 (66.6%) were males. The histological sample was unsuitable in 29/1016 (2.9%) of the cases; moreover, prevalence of renal medulla and presence of large-caliber arteriole were observed in 88/1016 (8.7%) and 38/1016 (3.7%) of the samples, respectively. The most common complication was hematoma, detected by US in 175/1016 (17.2%), which was considered “complicated” in 21/1016 (2.1%) due to the association with macroscopic hematuria (n = 10), blood transfusion requirement (n = 8), or signs of active bleeding (n = 8), requiring embolization in 6/1016 patients (0.6%). AVFs were identified in 119/1016 (11.7%) biopsies; of these 20/119 (16.8%) required embolization after a median time of 16 days (IQR 5-65). Spontaneous resolution was documented in 65/119 (55%) of cases and occurred after a median of 27 days (IQR 15-49), with 50/55 (90.9%) of cases spontaneously resolving within the first month and the remaining cases no later than the fourth month (Fig. 1). High-flow AVFs more frequently necessitated angiographic intervention compared to moderate and small AVFs (75% vs 25% vs 7%), with a prolonged spontaneous resolution time (median 78 days; IQR 51-106) (Table 1). In the cases requiring embolization, the median creatinine level before and 6 months after procedure was respectively 1.7 mg/dL and 1.9 mg/dL (paired Wilcoxon signed-rank test: p = 0.908). In three cases post-embolization, a loss of renal vascularization at angiography higher than 30% was reported; however, even in these cases no differences in terms of renal function were observed at 6 months compared to the baseline. At multivariate logistic regression, hypertension (OR = 2,2; p = 0.003; 95% CI [1.3-3.7]), renal medulla prevalence (OR = 2,8; p = 0,001; 95% CI [1.6-4.8]), and large-caliber arteriole presence (OR = 2,9; p = 0,008; 95% CI [1.3-6.3]) were associated with a higher risk of AVFs, while obesity emerged as a protective factor (OR = 0,27; p = 0,013; 95% CI [0.1-0.8]). Conclusion AVF is a common complication following renal biopsy but therapeutic intervention is rarely required, as spontaneous resolution is typically observed within one month. In case of symptomatic or persistent AVFs, embolization may be required without an apparent impact on the renal function, at least in the short term. Hypertension and surrogate factors associated with a deeper penetration of the needle into the renal parenchyma are associated with an increased risk of AVF. Conversely, obesity was protective toward the risk of AVF development.

Vascularization of kidney organoids: different strategies and perspectives

Kidney diseases such as glomerulopathy and nephron dysfunction are estimated to grow to more than 900 million cases by 2030, in 45% of which kidney transplantation will be required, representing a major challenge for biomedicine. A wealth of progress has been made to model human diseases using induced pluripotent stem cells (iPSCs) in vitro differentiated to a variety of organoids, including kidney organoids, and in developing various microfluidics-based organ-on-a-chip (OoC) systems based on them. With the combination of targeted gene editing capacities, relevant polymorphic genetic variants can be established in such organoid models to advance evidence-based medicine. However, the major drawback of the current organoid disease models is the lack of functional endothelial vasculature, which especially concerns the kidney, the function of which is strongly associated with blood flow. The design of novel medical devices using tissue engineering approaches such as kidney organoids is also strongly dependent on the understanding of the fundamental principles of nephrogenesis and the vascularization of organs and tissues. Developmental vascularization of the kidney has been an area of intense research for decades. However, there is still no consensus among researchers on how exactly the vascularization of the kidney occurs in normal and pathological conditions. This lack of consensus is partly due to the lack of an appropriate model system to study renal vascularization during nephrogenesis. In this review, we will describe recent progress in the areas of kidney vasculature development, kidney organoids in general and assembled on microfluidic devices in particular. We will focus on the in vitro vasculature of kidney organoids in microfluidic OoC model systems to study kidney diseases and on the perspectives of tissue engineering for the modeling of kidney diseases and the design of bioartificial medical devices. We also aim to summarize the information related to the key mechanisms of intercellular communication during nephrogenesis and the formation of the renal vasculature in an OoC setup.

Renal vascular disparities among kidney donors presented at renal transplant unit- A single centre study

Renal vasculature has been reported to show anatomical variations, which may lead to surgical complications. The pattern of renal vascular variations in Pakistani population is not well reported. Thus, this study was designed to assess the renal vascularity among kidney donors and correlate with age, gender and site of vessels. A total of 223 healthy volunteers underwent evaluation for kidney donation at the Radiology Department, DOW University Hospital, Karachi, Pakistan from January 2020 to July 2022 were included. The assessment of renal vasculature was done on computed (CT) angiogram. Renal vascular variations were found in 112 (50.2%), 59.8% were seen in males and 40.2% in females. On right side 50% vascular anomalies were found followed by left side with 27% and 22% on both sides. The arterial variants included accessory renal artery seen in 76 (67.8%) individuals, out of which 13.2% had in upper polar, 26.3% in hilum, 36.8% in lower polar, while 23.7% of early branching was observed. Ten retro-aortic, fourteen accessory renal veins and six bifurcation renal veins, along with six early branching renal veins, were present. Patient who received donor nephrectomy, the outcomes of the operation were completely consistent with the results of the CTA. According to this study, Pakistani population have differences in their renal venous and arterial anatomy, which can significantly influence surgical procedures.

Anatomic Variations of Renal Arteries as an Important Factor in the Effectiveness of Renal Denervation in Resistant Hypertension.

Hypertension remains the leading cause of death worldwide. Despite advances in drug-based treatment, many patients do not achieve target blood pressure. In recent years, there has been an increased interest in invasive hypertension treatment methods. Long-term effects and factors affecting renal denervation effectiveness are still under investigation. Some investigators found that the renal arteries' morphology is crucial in renal denervation effectiveness. Accessory renal arteries occur in 20-30% of the population and even more frequently in patients with resistant hypertension. Diversity in renal vascularization and innervation may complicate the renal denervation procedure and increase the number of people who will not benefit from treatment. Based on previous studies, it has been shown that the presence of accessory renal arteries, and in particular, the lack of their complete denervation, reduces the procedure's effectiveness. The following review presents the anatomical assessment of the renal arteries, emphasizing the importance of imaging tests. Examples of imaging and denervation methods to optimize the procedure are presented. The development of new-generation catheters and the advancement in knowledge of renal arteries anatomy may improve the effectiveness of treatment and reduce the number of patients who do not respond to treatment.

Anatomical study about the variations in renal vasculature.

Renal vascularization is classically described as a renal artery and vein. However, this vascular pattern presents numerous anatomical variations in terms of their number, origin and course due to ontogenetic alterations. The aim was to carry out a descriptive study of the renal vascular pattern observed during the dissection of cadavers intended for teaching purposes. A descriptive and observational study of renal vascular anatomy was carried out by dissecting 16 renal blocks from 8 cadavers donated to science and used for teaching at the Faculty of Medicine of the University of Zaragoza. The prevalence of arterial variations was 75% (56.3% for polar renal arteries, 12.5% for pre-hilar branching and 6.25% for double communicating arterial arch) and venous was 62.5% (12.5% for polar renal veins, 25% for late venous confluence, 6.25% for triple renal vein and 18.75% for double circumaortic renal vein). We conclude that the renal vascular anomalies occur with high frequency; for this reason, knowledge of these anomalies is extremely important for the correct planning of numerous medical-surgical activities.

Additional value of microvascular flow imaging inthe assessment of cystic and solid renal lesions.

Contrast enhanced ultrasound (CEUS) is increasingly used in the evaluation of renal lesions, however, its availability remains limited. Thus, sensitive noncontrast ultrasound evaluation of renal lesion vascularity is an unmet need. In this single-center, retrospective study we assessed microvascular flow imaging (MV-flow) compared to CEUS in the evaluation of complex renal cysts and solid lesions. Out of 92 patients 28 were evaluated with both CEUS and MV-flow. Color Doppler, CEUS, and MV-flow was performed in 13 cases, whilst MV-flow, CEUS, and contrast-enhanced MV-flow (CE-MV-flow) was done in 16 cases. The CEUS diagnosis was considered gold standard. MV-flow showed a substantial agreement with the CEUS diagnosis (weighted Kappa = 0.806), excluding equivocal lesions (Bosniak 2F). MV-flow substantially outperformed color Doppler (weighted Kappa = 0.77 vs. 0.133). The agreement of CE-MV-flow and MV-flow was comparable (weighted Kappa = 0.79 vs. 0.69). MV-flow significantly improves evaluation of renal lesion vascularity compared to conventional techniques. However, the sensitivity is limited for equivocal lesions (e.g. Bosniak 2F cysts). Thus, MV-flow should be used as an ancillary technique, not as a substitute to CEUS. Current MV-flow presets are ill-suited for postcontrast imaging, therefore specific presets optimized for this purpose are needed to establish its potential.

Radiological and surgical correlation of pelviureteric junction obstruction in positional anomalies of the kidney in children.

Pelviureteric junction obstruction, also known as ureteropelvic junction obstruction, is a congenital narrowing of the urinary excretory tract at the junction between the renal pelvis and the ureter and is a common cause of congenital pelvicalyceal dilatation. The outcome is variable, from spontaneous resolution to renal parenchymal function loss in cases of untreated high-grade obstruction. Abnormalities in renal ascent, rotation and vascularity can be associated with pelviureteric junction obstruction and easily overlooked radiologically. In this pictorial review, we explore the anatomical, radiological and surgical correlations of pelviureteric junction obstruction in the context of a normal kidney and a spectrum of renal abnormalities, including hyper-rotation (also known as renal malrotation), failed renal ascent, fusion anomalies and accessory crossing renal vessels. For each scenario, we provide technical tips on how to identify the altered anatomy at the first ultrasound assessment and correlation with scintigraphic, cross-sectional and postoperative imaging where appropriate. A detailed ultrasound protocol specifically to assess and characterise pelviureteric junction obstruction in paediatric patients is also offered.

Perfused boundary region as biomarker for endothelial integrity in former preterms in adolescence.

Extremely low birth weight (ELBW) survivors have microvascular structural differences already described in kidney and retina, suggesting changes in endothelial integrity. A biomarker of endothelial integrity is perfused boundary region (PBR), which measures glycocalycal thickness. The endothelial glycocalyx is a complex, highly versatile structure with essential roles in vascular integrity and function. We explored PBR patterns together with other microvascular markers in healthy controls and former ELBW children. In the PREMATCH cohort (87 healthy controls, 93 ELBW survivors), we assessed endothelial integrity by calculating PBR (sidestream dark-field imaging), several microvascular markers (blood pressure, estimated glomerular filtration rate (eGFRcysC)), and retinal imaging in early adolescence. We explored differences between both groups, and searched for perinatal determinants of PBR and correlations between different microvascular markers. We provided reference values for PBR (average 1.90 µm, SD 0.30) in children. PBR was not different from ELBW survivors during early adolescence, despite their higher blood pressure, lower eGFRcysC, and different retinal vessel width and tortuosity. We generated reference values for PBR in early adolescence. Despite some correlations between microvascular parameters, there seem to be numerous confounders to propose PBR as a marker for endothelial integrity in ELBW survivors. The endothelial glycocalyx is a complex and versatile structure. Changes in blood pressure and retinal and renal vascularization suggest a disturbance of its integrity in extremely low birth weight (ELBW) survivors. Its thickness can be measured by calculating perfused boundary region (PBR) using sidestream dark-field imaging, with a higher PBR indicating a thinner glycocalyx. We generated reference values for PBR in healthy adolescents. These values were not different in former ELBW children. Despite some correlations of PBR with other microvascular biomarkers, these are not strong enough to describe endothelial integrity and its covariates in former ELBW children.

Systematic Review and Meta‐analysis of the Anatomical Variants in Renal Vascularization and their Clinical Implication using Anatomical Quality Assurance (AQUA) checklist

IntroductionAnatomically, the vascularization and venous drainage of the kidney is provided by the renal artery and vein. Generally, the kidney consists of a renal artery originating in the abdominal aorta, which later divides into an anterior and posterior branch, however it is not uncommon to find more than one emerging from the abdominal part of the aorta, in addition to some iliac artery or rarely originating from the lower thoracic aorta or mesenteric arteries. On the other hand, the renal veins drain on the inferior vena cava, but the left renal vein a longer course, crossing the midline anterior to the abdominal aorta and posterior to the superior mesenteric artery.Materials and methodsWe considered specific scientific articles and books of human anatomy, written in Spanish or English, published between 2000 and 2021. The search process was carried out in the following databases: MEDLINE, SCIELO, WOS, CINHAL, SCOPUS and GOOGLE SCHOLAR, using as search terms “renal artery ”, “anatomical variation”, “renal veins”, “” and “renal vascularization” for which the following Boolean connectors “AND”, “OR” and “NOT” were used, also to see the bias was used The Anatomical Quality Assurance (AQUA) checklist.ResultsRegarding the incidence of the variants in renal vascularization, these are reported as follows; variants only of the renal artery, variants only of the renal vein and finally variants of both the artery and the renal vein. For the variants of the origin of the renal artery, four studies with an N greater than 1 in their sample, reported variation in the origin of the renal artery where this artery has two branches that originate from the aorta artery, one that is polar superior or lower and the other is directed towards the renal hilum. In these studies, the incidence varied between 16.66% and 31% with a mean of 25.54% and a cumulative n of 1594 patients. For the variant of the origin of Renal artery in studies with N equal to 1, three studies were presented, of which two presented an accessory inferior polar artery, while one study presented origin of the renal artery at the level of the thoracic aorta. Regarding the incidence of variation in the trajectory of the renal artery, eight studies were found, which reported variations in the trajectory of the renal artery, which were mainly multiple renal arteries that bifurcated laterally to their origin in the abdominal aorta artery. While one study showed multiple renal artery surrounding the abdominal aorta artery, the incidence of these variations fluctuated between 6.7% and 100% with a mean of 62.45% with a total accumulated N of 879 in the sample of the included studies.ConclusionsThe amount of variations in renal vascularization is very wide, so the knowledge of professionals who treat pathological conditions of the abdominal region becomes crucial, since ignoring these variations could lead to complications in the surgical approach or in the diagnosis. We also believe that future studies that associate these variations with some pathologies would also be important.

Kidney infarction in patient with covid-19: clinical case

Abstract Description: A 50-year-old male who was admitted to intensive care with a Coronavirus-19 diagnosis for strict handling requiring oxygen therapy. He presented distention and abdominal pain, for which an abdomen-pelvic tomography was requested, reporting lack of filling in the right renal artery and renal infarcts requiring angioplasty and double antiplatelet therapy. The evolution was favorable, and the patient was discharged. Currently, a renal Doppler reports adequate vascularization. The patient presents proper renal function. Clinical Significance: The coronavirus disease is a contagious and life-threatening infection caused by the severe acute respiratory syndrome coronavirus 2. It can lead patients to arterial and venous thrombosis. However, acute renal artery occlusion is considered a rare disease. Clinical Implications: Prompt diagnosis and treatment are important to prevent permanent kidney damage or permanent loss of kidney function. Conclusion: The underlying etiology of renal infarcts remains largely unknown at present, but it may include direct viral cytopathic effects on endothelial cells. Most patients are managed conservatively. Some cases undergo angioplasty successfully. The patient in this case received earlier treatment with doses of anticoagulant enoxaparin, and his glomerular filtration remained stable, although complementary treatment was required.

Review of Renal Artery Stenosis and Hypertension: Diagnosis, Management, and Recent Randomized Control Trials.

Renal artery stenosis is one of the most common causes of secondary hypertension (HTN). Renal artery stenosis-induced HTN can occur in the presence of unilateral or bilateral narrowing and a solitary kidney with stenotic artery, which may subsequently lead to renal insufficiency (e.g., ischemic kidney disease) or pulmonary edema. Renal artery stenosis can be diagnosed using multiple modalities, including Doppler ultrasound, computed tomography angiography, magnetic resonance angiography, or selective angiogram. Although atherosclerotic renal artery stenosis management in patients with HTN has been greatly controversial, it is inevitable in the treatment of some selected cases. These cases can be treated by either percutaneous angioplasty (with or without stenting) or less common, open surgical approach revascularization, both of which have excellent primary patency rates. Generally, several trials on renal artery angioplasty or stenting in patients with atherosclerotic disease have shown that the long-term benefits in terms of blood pressure control and renal function over pharmacological management is not substantial. Furthermore, studies could not demonstrate a prolongation of event-free survival after renal vascularization. Moreover, endovascular procedures have substantial risks. Careful patient selection is required when considering revascularization, for including those with refractory HTN or progressive renal failure, to maximize the potential benefits. This paper discusses the epidemiology of atherosclerotic renal artery stenosis and its clinical presentation, diagnosis, treatment, prognosis, and future perspectives.

Duplex doppler evaluation of distal intrarenal arteries in urinary tract diseases of dogs

The study was performed on 38 dogs to evaluate the utility of renal Doppler in the diagnosis of urinary tract affections. The dogs were divided into three groups viz., group I (healthy dogs), group II (dogs with renal failure) and group III (dogs with urinary obstruction). In all the dogs B-mode and Doppler ultrasonography were performed and in group II dogs ultrasound guided renal biopsy was also obtained to reach at final diagnosis. In group II, USG showed 100% sensitivity but very low specificity (14.28%), whereas in group III both sensitivity and specificity were 100%. There was no difference in the mean RI and PI of left and right kidneys. Renal cortical vascularity was reduced in group II, whereas there was no change in renal cortical vascularity in group III. The mean RI and PI of arcuate or interlobar vessels of group II dogs were significantly higher than that of groups III and I. The study concluded that both RI and PI increased in non-obstructive renal diseases; however, these indices had limited value in urinary obstruction in dogs.

Patient-Specific Analysis of Renal Artery Hemodynamics After EVAR with Fenestrated or Branched Versus Parallel Stent-Graft Techniques for Renal Vascularization

Patient-Specific Analysis of Renal Artery Hemodynamics After EVAR with Fenestrated or Branched Versus Parallel Stent-Graft Techniques for Renal Vascularization

Description of an atypical vascular arch in the renal parenchyma

Introduction: Variability in renal vascularization occurs with a frequency of around 30%. During the routine dissection of one cadaver without renal pathology, we revealed the presence of one. Material and Methods: Dissection of a cadaver carried out in the practicing room of School of Medicine. Results: During the routine dissection of one cadaver without renal pathology, we revealed the presence of an early bifurcation of the renal artery on the left side, and the presence of two polar arteries – superior and inferior -, the latter presenting an anterior and posterior vascular arch to the renal pelvis in the parenchyma, which anastomoses the pre- and retro-pyelic branches of the renal artery with the pre- and retro-pyelic branches of the inferior accessory polar artery. In addition, the presence of an accessory polar artery was observed in the right kidney. Discussion and Conclusion: For vascular surgeons, knowledge of this anatomical variation is of real clinical relevance in cases such as fenestrated endografting in order to preserve the function of the entire kidney.

MP61-02 DIFFERENTIATION OF RENAL MASS HISTOLOGY AND GRADE UTILIZING DUAL-ENERGY COMPUTED TOMOGRAPHY

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance III (MP61)1 Sep 2021MP61-02 DIFFERENTIATION OF RENAL MASS HISTOLOGY AND GRADE UTILIZING DUAL-ENERGY COMPUTED TOMOGRAPHY Rishi Sekar, Giuseppe Toia, Achille Mileto, and George Schade Rishi SekarRishi Sekar More articles by this author , Giuseppe ToiaGiuseppe Toia More articles by this author , Achille MiletoAchille Mileto More articles by this author , and George SchadeGeorge Schade More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002101.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Dual-Energy Computed Tomography (DECT) has been shown to more accurately characterize renal mass vascularity, however its ability to differentiate tumor subtypes remains unclear. Herein, we investigate the role of DECT and iodine concentration as a derived imaging biomarker in predicting tumor histology and Fuhrman Nuclear Grade (FNG). METHODS: Our institutional database was queried for patients who underwent contrast enhanced DECT to characterize renal masses with subsequent pathologic diagnosis within our institution from 2018 to present. Tumor histology and FNG were obtained from internal pathologic evaluation. Tumor enhancement was measured in Hounsfield Units (HU) using standard techniques. Tumor iodine concentration (mg/mL) was calculated from the maximally enhancing region within each tumor in the nephrogenic phase. Mean enhancement (ME) and mean iodine concentration (MIC) were stratified by histology, and across FNG for clear cell renal cell carcinoma (ccRCC) and compared between groups using Student’s t-test. RESULTS: Our study cohort consisted of 39 separate renal solid enhancing masses. Diagnosis was ccRCC in 22 (56.4%), non-ccRCC in 12 (30.8%), and oncocytoma in 5 (12.8%). Among RCCs, both ME and MIC were statistically significantly higher for ccRCCs versus non-ccRCCs (ME: 116.0 vs. 65.9 HU, p=0.02; MIC: 5.5 vs 3.8 mg/mL, p=0.02).Among ccRCCs, ME was lower for high grade (FNG 3 and 4) versus low grade (FNG 1 and 2) tumors (86.2 vs. 145.9 HU, p=0.1), while MIC was higher (5.7 vs 5.4 mg/mL, p=0.7), however these relationships did not reach statistical significance. Further, ME was higher for chromophobe RCC versus oncocytoma (115 vs. 104.4 HU), while MIC was lower (5.3 vs 6.7 mg/mL, no statistical analysis performed due to small sample size). CONCLUSIONS: DECT imaging with tumor MIC may improve the diagnostic ability to differentiate between renal mass histologies compared to standard contrast enhanced CT imaging. Our preliminary data shows a trend towards higher iodine concentration in high grade ccRCCs compared to low grade tumors and benign histologies. Further investigation with larger cohorts is needed to delineate diagnostic thresholds and allow correlation with oncologic outcomes that could lead to improved prognostic tools. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1083-e1083 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rishi Sekar More articles by this author Giuseppe Toia More articles by this author Achille Mileto More articles by this author George Schade More articles by this author Expand All Advertisement Loading ...

PD16-04 A PILOT STUDY INVESTIGATING THE FEASIBILITY OF USING A FULLY AUTOMATIC SOFTWARE TO ASSESS THE RENAL AND PADUA SCORE

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II (PD16)1 Sep 2021PD16-04 A PILOT STUDY INVESTIGATING THE FEASIBILITY OF USING A FULLY AUTOMATIC SOFTWARE TO ASSESS THE RENAL AND PADUA SCORE Mathieu Carlier, Fabien Lareyre, Cédric Adam, Marion Carrier, Matthieu Durand, and Juliette Raffort Mathieu CarlierMathieu Carlier More articles by this author , Fabien LareyreFabien Lareyre More articles by this author , Cédric AdamCédric Adam More articles by this author , Marion CarrierMarion Carrier More articles by this author , Matthieu DurandMatthieu Durand More articles by this author , and Juliette RaffortJuliette Raffort More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001998.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Minimally invasive approaches have demonstrated their interest to improve the peri-operative outcomes during partial nephrectomy for renal cell carcinoma (RCC). Several image-based morphometric scoring systems such as the RENAL and the PADUA scores have been developed to evaluate the complexity of the procedure. Artificial intelligence (AI) has brought new insights in medical imaging analysis, offering the opportunity to perform complex tasks and to develop pattern recognition. We aimed to develop a new imaging software based on AI-techniques to enable an automatic detection and a 3D visualization of RCC from CT scans. This pilot study addressed the feasibility to use it to evaluate the anatomical features included in the RENAL and the PADUA scores. METHODS: The study included patients with RCC who underwent robot-assisted nephrectomy at the University Hospital of Nice between January 2015 and December 2018. Diagnosis of RCC was based on CTA and confirmed by post-operative histopathological examination. Clinical characteristics were collected using manual and electronic medical records. Imaging data were extracted in DICOM format. The pipeline to enable an automatic visualization of RCC consisted in 4 sequential steps: image pre-processing, detection of the kidney using the active contour method, segmentation of the renal vascularization using a hybrid approach combing expert system with deep learning and 3D-viusalization of the tumor kidney. RENAL and PADUA scores were assessed by a trained operator on a semi-automatic commercialized software to serve as a ground truth. Concordance of the staging obtained with the automatic software were blindly assessed by the same operator. RESULTS: In total, 41 CTA from patients with RCC were analysed, with a median age of 66 years (57-70) and 80.5% of men. The median PADUA score assessed with the commercialized software was 9 (7-11) and the renal score was 8 (5.5-9). The automatic pipeline enabled to automatically detect the tumoral kidney and provided a 3D-visualization in all cases, with a computational time less than 20 seconds. Compared to the ground truth, concordances for staging the anatomical features of the RENAL scores were respectively: 87.8% for radius, 85.4% for exophytic rate, 82.9% for location to the polar lines and 92.7% for the antero-posterior location. For the PADUA scores, concordances were 90.2% for tumor size, 85.4% for exophytic rate, 87.8% for polar location and 100% for renal rim. CONCLUSIONS: The automatic software allowed to accurately detect and provide a 3D-visualization of the tumoral kidney in all cases, with a good concordance with the ground truth to assess the RENAL and PADUA scores. By adding further algorithms, this software could be trained to automatically calculate morphometric scores, saving time and improving reproducibility for clinicians. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e279-e279 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mathieu Carlier More articles by this author Fabien Lareyre More articles by this author Cédric Adam More articles by this author Marion Carrier More articles by this author Matthieu Durand More articles by this author Juliette Raffort More articles by this author Expand All Advertisement Loading ...