Malrotation of Kidney Ectopia and Spontaneous Renal Vein Thrombosis

Abstract Introduction Penile vasculopathy leading to erectile dysfunction can be an early indicator of systemic disease. Despite rising popularity of penile implants, these devices are not well understood by non-urologists. Traditionally, reservoirs are placed on the right side in the retropubic space, near where a transplant renal vein anastomosis would be located. Renal vein thrombosis is a surgical emergency occurring in 1% of renal transplant recipients. Doppler Ultrasound is diagnostic; showing an enlarged kidney with absent venous flow, a thrombus-filled renal vein, and prolonged plateauing of flow on power doppler due to reversal of arterial flow in diastole. Objective We present a case of management of transplant renal vein thrombosis secondary to refilling of the IPP reservoir post-operatively. This is a 69-year-old male who presented for simultaneous liver-kidney transplant (SLK). The patient’s past medical history is relevant for end stage liver disease due to nonalcoholic steatohepatitis with hepatocellular carcinoma (T2), CKD stage 5, diabetes and erectile dysfunction. He had undergone placement of a penile prosthesis in 2015 with reservoir placement in the left retropubic space. In a post-operative discussion, the patient reported occasional auto-inflation of his IPP when lying supine. The transplant kidney was placed in the left iliac fossa in the area of the patient’s IPP reservoir. On POD1, the patient deflated the penile prosthesis. On POD2, he developed hematuria associated with decreased urine output, and rising creatinine. A transplant renal ultrasound showed renal vein thrombosis. He was taken to the operating room for emergent renal vein thrombectomy. It was at this time that the inflated reservoir was noted to be abutting the renal vein anastomosis. Methods Urology was consulted intraoperatively due to renal vein thrombosis with suspicion for the IPP reservoir as the cause. We discussed with the patient’s wife removal of the reservoir vs. repositioning of the reservoir. The transplant team did not feel comfortable with significant dissection around the transplant. All parties agreed to remove the reservoir only and pass the tubing into the scrotum to facilitate replacement of the reservoir at a future date. The reservoir capsule was dissected free and the reservoir was removed. The prosthesis was drained and the reservoir tubing was clipped with hemolok and metal clips before being passed back into the scrotum. The capsule was closed to ensure the prosthesis remained in a separate compartment to decrease infection risk. Copious antibiotic irrigation was used throughout the procedure. Results Following renal vein thrombectomy and reservoir explant the patient and the renal allograft function improved. He was discharged home on POD5 following his renal vein thrombectomy. Conclusions We present a case of transplant renal vein thrombosis in a patient with a penile prosthesis. This is a rare complication that can be hard to predict for non-urologists. Future considerations could include involving urologists in pre-transplant care of these patients, in order to assess the reservoir position and whether it presents a risk for renal vasculature. Repositioning or explant of the reservoir are viable strategies to manage this complication and require discussion with the patient or their partner. Disclosure No

Graft versus host disease (GvHD) is a common complication of allogeneic hematopoietic stem cell transplantation (HSCT). While the skin, eyes, mouth, and liver are the most commonly affected organs in chronic GvHD, there is increasing recognition of less typical sites of involvement. Emerging evidence suggests that the kidney may also be affected; however, current data remain limited and largely derived from small retrospective studies or case series. We examined a cohort of 1441 patients transplanted and identified 12 patients (0.8%) presenting with nephrotic syndrome that had renal biopsies consistent with membranous nephropathy (MN). None of the patients had pre-existing renal disease. All patients had nephrotic range proteinuria (median 6.6 g/24 h, range 4.1-17.8) at presentation. The median time to diagnosis of glomerular disease was 1.8 years (range 0.6-4.3 years) after HSCT. The median time to diagnosis of nephrotic syndrome was 407 days (range 95-1415 days) after an initial diagnosis of chronic GvHD. Three patients had features of renal vein thrombosis at presentation. All patients showed typical pathologic features of MN with additional mild microangiopathic features on ultrastructural examination, and nine tested were PLA2R negative. All patients received immunosuppressive therapy. Seven had a complete response to treatment, four achieved a partial response, and one did not respond. Herein, we describe their clinical characteristics, disease course, and clinical outcomes. None of our patients developed irreversible renal impairment, outlining the importance of rapid intervention with appropriate immunosuppression. In the absence of effective biomarkers, the management of suspected renal GvHD presenting with proteinuria should include renal biopsy to identify and appropriately classify the lesion.

The Xanthogranulomatous pyelonephritis (XPN) is a rare type of pyelonephritis (found in 4.0% to 8.2% of kidneys with pyelonephritis), where the renal parenchyma is infiltrated by lipid-laden foamy macrophages resulting in renal parenchymal destruction. It is associated with urolithiasis, diabetes mellitus, urinary tract obstruction and infections. The inflammation and the fibrosis infiltrates into the surrounding tissues. However renal vein thrombosis extending into the inferior vena cava (IVC) as a result of inflammation is rare. We report a case of left renal XPN and renal vein thrombosis extending into the inferior vena cava (IVC). This was treated with radical nephrectomy and IVC tumour clearance.

Venous anastomosis in kidney transplan-tation can be technically demanding in patients with deep iliac vein or bulky psoas muscle, increasing the risk of renal vein kinking, thrombosis, and prolonged ischemia times. This study prospectively evaluated the safety and efficacy of a novel surgical technique, psoas muscle groove creation, to address this specific challenge. In this prospective case series, 20 consecutive living related kidney transplant recipients with preoperatively identified challenging venous anatomy (deep iliac vein, prominent psoas overhang) underwent venous anastomosis with the psoas groove technique between September 2017 and June 2025. The technique involved creating a shallow, hemostatic groove in the psoas major muscle by using limited electrocautery to accommodate the renal vein, preventing kinking and ensuring a tension-free course. Primary outcomes were venous anastomosis time and incidence of vascular complications. Secondary outcomes included cold ischemia time, operative duration, graft function, and 1-year patient and graft survival. All 20 procedures were successfully completed without conversion to an alternative technique. Mean venous anastomosis time was 12 ± 4 minutes, and mean cold ischemia time was 25 ± 6 minutes. No cases of renal vein thrombosis, kinking, or other major vascular complications occurred. Immediate graft function was achieved in 95% of patients. At 1-year follow-up, graft survival was 96.4% and patient survival was 96.4%, with mean estimated glomerular filtration rate of 89 mL/min/1.73 m². Postoperative complications were infrequent and not related to the groove creation. The psoas muscle groove technique is a safe, reproducible, and effective surgical innovation for managing challenging venous anastomosis during kidney transplant. By providing a protected channel for the renal vein, the technique facilitates a tension-free anastomosis, reduces operative and ischemia times, and prevents kinking, without adding procedural morbidity. This technique represents a valuable adjunct for transplant surgeons facing difficult iliac anatomy.

Radiogenomics offers a non-invasive approach to correlate imaging features with tumor molecular profiles. This study aims to identify computed tomography (CT) imaging characteristics associated with positive NIPA-like domain containing 4 (NIPAL4) expression in clear cell renal cell carcinoma (ccRCC) and to develop a radiogenomic predictive model to support personalized risk stratification. A retrospective analysis was conducted on 241 ccRCC patients from The Cancer Genome Atlas (TCGA) and The Cancer Imaging Archive (TCIA) databases. Clinical, pathological, and CT features were compared between NIPAL4-positive and NIPAL4-negative groups. A penalized logistic regression model was built to predict NIPAL4 expression, and its performance was assessed using Receiver Operating Characteristic (ROC) and Decision Curve Analysis (DCA). Additionally, unsupervised K-means clustering was used to identify radiologic phenotypes, and a nomogram was developed to enable individualized risk estimation. Among 241 ccRCC patients, 29 (12.03%) showed positive NIPAL4 expression. Compared to NIPAL4-negative cases, positive expression was significantly associated with larger tumor size (median 70.5 mm vs. 52 mm, p = 0.0371), ill-defined margins (61.5% vs. 32.4%, p = 0.0077), perinephric adipose tissue stranding (76.9% vs. 50.0%, p = 0.0114), renal vein thrombosis (24.0% vs. 4.7%, p = 0.021), Gerota's fascia thickening (61.5% vs. 35.2%, p = 0.0163), and collecting system invasion (52.0% vs. 26.5%, p = 0.0171). A multivariate penalized logistic regression model incorporating these features achieved an AUC of 0.973% and 92.1% accuracy in predicting NIPAL4 positivity. Positive NIPAL4 expression in ccRCC is significantly associated with aggressive CT features-particularly perinephric adipose tissue stranding, ill-defined margins, and renal vein thrombosis. A radiogenomic model based on these features achieved excellent predictive performance (AUC = 0.973), supporting its potential role in non-invasive risk stratification and personalized clinical decision-making.

Secondary Membranous Lupus Nephritis Presenting with Bilateral Renal Vein Thrombosis: A Diagnostic and Therapeutic Challenge

Advancements in imaging modalities for post-kidney transplant monitoring: A focus on contrast-enhanced ultrasound.

Catheter-directed aspiration thrombectomy of the IVC/renal vein for acute renal vein thrombosis in a patient with nephrotic syndrome: A Case Report

Endovascular Recanalization of Late Venous Thrombosis After Kidney Transplantation by Off-Label Application of Ultrasound Mechanical Thrombolysis (EKOS): A Case Report.

Background: Kidney transplantation is the treatment of choice for pediatric patients with end-stage kidney disease. However, transplantation in children weighing < 15 kg remains challenging due to limited donor availability and higher surgical and medical risks. We report our 35-year single-center experience in this population, focusing on perioperative and long-term outcomes. Methods: We retrospectively analyzed kidney transplants performed from 1987 to 2023 in children weighing < 15 kg. Data on demographics, donor type, complications, immunosuppression, and outcomes at 2, 5, and 10 years (including survival, graft function, rejection, infections, and urological issues) were collected. Outcomes were compared between deceased and living donors and between recipients weighing < 10 kg and ≥10 kg. Results: Ninety-six transplants were included (mean age 3.3 years; mean weight 11.1 kg), 80 from deceased and 16 from living donors. Most patients (69.8%) had been treated with peritoneal dialysis. Median follow-up was 120 months. Patient survival was 95.8%; graft survival was 78.1%. Eight grafts (8.3%) were lost to renal vein thrombosis, all in deceased-donor recipients (p = 0.60). Preserved renal function (eGFR > 60 mL/min/1.73 m2) declined from 80.4% at 2 years to 66.0% at 5 years and 18.0% at 10 years. Graft survival at 10 years was significantly lower in children < 10 kg vs. ≥10 kg (49.6% vs. 80.3%, p = 0.003). CAKUT was associated with higher urological complication rates (p = 0.017). No significant differences emerged between living and deceased donor groups. Conclusions: Transplantation in children < 15 kg is feasible with good outcomes, but those <10 kg present lower graft survival at 10 years. Multidisciplinary assessment and center experience are key to optimizing results.

To assess the accuracy of PVA+, a model integrating differential degree of enhancement (DOE) with parenchymal volume analysis (PVA), for predicting new baseline glomerular filtration rate (NBGFR) following radical nephrectomy (RN), and to assess PVA+ vs PVA alone in patients with hydronephrosis, where disruptions in the parenchymal volume/function relationship may impact prediction accuracy. A total of 485 RN patients (2006-2021) with preoperative contrast-enhanced computed tomography were included. The predicted NBGFR was estimated to be 1.25 (GFRpreRN x split renal function [SRF]contralateral), with 1.25 representing the average renal functional compensation following RN in adults. For PVA, SRF was determined with differential parenchymal volumes, whereas for PVA+ the differential DOE was also incorporated. Parenchymal volumes and DOE were measured using semi-automated software from the venous phase vs non-contrast images. The accuracy of predicted vs observed NBGFR was compared using a 15% threshold. Overall, PVA+ accurately predicted NBGFR for 76% (r = 0.86) of the cases, compared to 72% for PVA alone (r = 0.84, both P < 0.05). PVA+ was particularly advantageous in patients with hydronephrosis or renal vein thrombosis (RVT; 68% vs 50% accuracy for PVA+ vs PVA alone; P < 0.01). Similarly, PVA+ was superior in patients with infiltrative renal masses (IRMs) compared to PVA alone (55% vs 40%; P < 0.01). Accurate prediction of NBGFR following RN is essential for counselling patients for whom RN is being considered vs partial nephrectomy. PVA+ was superior to PVA alone for NBGFR prediction, particularly in patients with hydronephrosis, RVT and IRMs. Requiring only routine contrast-enhanced preoperative imaging, PVA+ improves peri-operative decision-making for patients with localised renal masses, particularly in cases where the parenchymal volume/function relationship might be distorted.

Acute kidney injury (AKI) resulting from acute renal vein thrombosis (ARVT) is uncommon, yet it can progress swiftly, requiring prompt diagnosis and intervention. This study aimed to investigate the various multimodal ultrasound techniques, specifically conventional ultrasound (CUS), microvascular flow imaging (MFI), contrast-enhanced ultrasound (CEUS), and shear wave elastography (SWE), in conjunction with radiomics for early diagnosis and assessment of AKI resulting from ARVT using a rabbit model. Twenty healthy adult New Zealand white rabbits with 40 kidneys were included in this study. The left kidneys were designated as the experimental group (n = 20), whereas the right kidneys served as the control group(n = 20). Throughout the study, multimodal ultrasound techniques were employed for image acquisition and analysis. The ultrasound images underwent processing, segmentation, feature extraction, and model construction. The dataset was randomly divided in a 7:3 ratio, and the performance of models was assessed through the Receiver Operating Characteristic Curve (ROC) analysis along with key performance metrics. In CUS images, the experimental group showed notable increases in renal volume, cortical thickness, and enhanced cortical echogenicity (p < 0.001, p = 0.032, p < 0.001). In the CDFI, MFI, and CEUS, the experimental group exhibited significant reductions in blood flow perfusion (p < 0.001). In SWE, Young's modulus values for the cortex, medulla, and sinus were significantly elevated in the experimental group (p < 0.001). The strongest correlations were found for creatinine, renal volume, peak systolic velocity of the arcuate artery, time from peak to half-value of sinus, and Young's modulus value for cortex minimum, with Area Under the Curve(AUC) values of 0.600, 0.868, 0.560, 0.503, and 0.982, respectively. The CUS, CDFI, MFI, CEUS, SWE, and CUS+CDFI+MFI+CEUS+SWE radiomics models demonstrated stronger performance, achieving AUC values of 0.899, 0.861, 0.899, 0.833, 0.861, and 0.734, respectively. Multimodal ultrasound combined with radiomics can significantly improve early diagnosis of AKI following ARVT, providing valuable insights for clinical research.

Venous Thromboembolism in Unusual Locations.

We conducted this systematic review to evaluate outcomes of thrombolysis followed by anticoagulation vs anticoagulation alone in pediatric patients with venous thromboembolism (VTE). This systematic review addresses mortality, VTE resolution, recurrence, bleeding, and organ-specific outcomes in 5 PICO (population, intervention, comparison, outcomes) questions on thrombolysis across pulmonary embolism (PE), extremity deep vein thrombosis (DVT), right atrial thrombosis (RAT), cerebral sinus venous thrombosis (CSVT), and renal vein thrombosis (RVT). Meta-analysis reported risk ratios or differences (95% confidence intervals [CIs]), and absolute effects per 1000 patients. Certainty of evidence was assessed using GRADE (Grading of recommendation, assessment, Development, and Evaluation) guidelines. Thirteen nonrandomized studies were included and no randomized clinical trials addressed these questions. Thrombolysis might be associated with a higher risk of major bleeding, clinically relevant nonmajor bleeding, or unspecified bleeding with risk differences of 0.09 (95% CI, -0.06 to 0.23), 0.06 (95% CI, -0.11 to 0.22), and 0.09 (95% CI, -0.04 to 0.23), respectively. In PE with hemodynamic compromise, thrombolysis might be associated with a lower risk of mortality but conclusions on PE progression were uncertain in submassive PE. In DVT, thrombolysis may have little to no effect on mortality or thrombus resolution but might be associated with lower risk of postthrombotic syndrome. In RAT, thrombolysis might have little to no effect on thrombus resolution but a higher risk of major bleeding and mortality. For CSVT and RVT, the evidence was very limited. These findings were based on very-low-certainty evidence because of confounding and imprecision from small sample sizes. This systematic review highlights key challenges in developing recommendations for thrombolysis in children with VTE.

ABSTRACTThis case report presents a scenario of pulmonary embolism (PE) and renal vein thrombosis (RVT) in a young patient with a recent diagnosis of nephrotic syndrome (NS). The presence of a clinical condition characterised by a marked non‐selective proteinuria, which may correlate with reduced drug concentration, has raised doubts about the most appropriate anticoagulant therapeutic choice. A 34‐year‐old male patient presented to the emergency department with dyspnea, chest pain and hypotension. Two days prior, the patient had undergone a renal biopsy for a recent NS finding. An urgent CT scan revealed a right pulmonary embolism and inferior left renal vein thrombus, prompting immediate anticoagulant therapy. The patient was discharged on rivaroxaban. The presence of NS and the consequent concern regarding potential decreased drug concentration led us to monitor rivaroxaban plasma concentrations during the treatment period. Monitoring showed a strong correlation between the extent of proteinuria and the drug concentration. At the 4‐month follow‐up after discharge from the hospital, the patient was performing normal daily activities without limitations, and angio‐CT showed complete resolution of renal and pulmonary thrombotic formations. In this clinical case, pulmonary embolism associated with renal vein thrombosis in a patient with a recent diagnosis of NS was managed with rivaroxaban with a good clinical outcome.

Objective. To analyze the data of patients with kidney cancer complicated by tumor venous thrombosis of the renal vein and inferior vena cava of levels 1–2 who underwent laparotomic and laparoscopic surgical treatment. Materials and methods. A study of 100 patients diagnosed with kidney cancer complicated by tumor venous thrombosis of the renal vein and inferior vena cava of levels 1–2 was conducted at Russian Research Center for Radiology and Surgical Technologies named after Academician A.M. Granov in the period from 2007–2024. 50 (n = 50) patients underwent open surgery, and the rest 50 (n = 50) patients underwent laparoscopic surgery. In the group of patients with laparoscopic surgery, in 8 (n = 8) patients, conversion of approach was performed which resulted in tumor thrombus invasion into the inferior vena cava (IVC) wall; adhesive disease; uncontrolled bleeding. Results. The median duration of laparoscopic surgery was 127.5 (115–155) min and surgery with laparotomy approach –132.5 (110–155) min, p = 0.4006. The median volume of blood loss in endoscopic approach was 200 (150–300) ml, in laparotomy – 250 (200–350) ml, p = 0.0105. Postoperative complications of the first class according to the Clavien–Dindo classification were observed in 20 patients (20 %), those of the second class were in 8 patients (8 %), 3 patients (3 %) had the third-class severity and the 4th class severity was noted in 2 patients (2 %). The median duration of hospital stay was 9 days for open surgery (8–10) and 7 days in laparoscopy (7–8), p 0.001. Conclusions. The data of the conducted study demonstrate the effectiveness of classical nephrectomy with thrombectomy for patients diagnosed with kidney cancer complicated by tumor venous thrombosis of the renal vein and inferior vena cava of levels 1–2. Conventional laparotomic nephrectomy with thrombectomy is the gold standard for the treatment of locally advanced renal cell cancer in stage pT3a and pT3b, but laparoscopic approach acts as an effective alternative. The above study clearly demonstrates it.

Antiphospholipid syndrome (APS) can affect the kidneys, leading to renal artery and vein thrombosis, allograft loss following transplantation, and microvascular damage referred to as aPL-nephropathy (aPL-N). APL-N is a complex and frequently underdiagnosed condition characterized by an incomplete understanding of its etiopathogenesis and associated with unfavorable renal outcomes. The 2023 ACR/EULAR classification criteria for APS included aPL-N within the microvascular domain. The gold standard for aPL-N is the biopsy, revealing lesions associated with acute thrombotic microangiopathy and chronic vascular changes. Nevertheless, reluctance for biopsies due to anticoagulation and thrombocytopenia underscores the need for noninvasive diagnostics. Common clinical features include hypertension, microscopic hematuria, proteinuria, and renal insufficiency. Antiphospholipid antibodies seem crucial to kidney damage through thrombotic and inflammatory processes. Studies and experimental models of thrombotic microangiopathy lesions suggest the involvement of the complement cascade, tissue factor, and mammalian target of the rapamycin complex activation pathway. Currently, the management of aPL-N is based mainly on expert opinion, with limited evidence supporting the use of anticoagulants, leading to controversy in their application. Treatment may include heparin, intravenous immunoglobulin, plasma exchange, and targeted therapies tailored to aPL-N mechanisms. Future multicenter studies are essential to clarify their roles. The goal of this review is to inform clinicians and create a research agenda to address the unmet needs in diagnosing and managing APL-N.

Objective: To investigate the clinicopathological characteristics and diagnosis of high-grade succinate dehydrogenase-deficient renal cell carcinoma (SDH-RCC). Methods: Three cases of high-grade SDH-RCC diagnosed by immunohistochemical staining and/or molecular testing were collected from Affiliated Hospital of Qingdao University and 971 Hospital of Navy of Chinese People's Liberation Army from January 2015 to December 2023. The clinicopathological characteristics and immunohistochemical features were summarized using light microscopy. Two cases were tested for gene mutations by next-generation sequencing. Results: Of the 3 cases, 2 were male and 1 was female. The ages were 49, 61, and 53 years, respectively. Gross examination revealed that all tumors were single nodules with diameters of 7.0, 4.5, and 5.2 cm, respectively, grayish white in color with irregular borders. Cases 1 and 2 exhibited solid cut sections, whereas case 3 had cystic and solid cut sections. Microscopically, all cases had high WHO/ISUP nuclear grade (3 or 4) and overt invasion. Case 1 exhibited a solid, sheet-like growth pattern with numerous scattered glandular ducts or acinar structures. Case 2 displayed a diffusely growth pattern reminiscent of sarcoma. Case 3 demonstrated intracystic papillary and nodular infiltrative growth patterns. Large clear cytoplasmic vacuoles could be observed in the focal areas of case 1 and case 3. Prominent peritumoral lymphocytes in stroma were noted in case 1. Case 1 was diagnosed with regional lymph node metastasis, and case 2 was diagnosed with renal vein thrombosis. Immunohistochemical staining revealed that SDHB and SDHA were deficiently expressed in 3 cases, while PAX8, FH, and INI-1 exhibited diffuse expression. CD10 (1/3), CA9 (1/3), and CK20 (1/3) were occasionally expressed. The Ki-67 proliferation index ranged from 10% to 50%. Two cases underwent next-generation sequencing and were both found to harbor pathogenic mutations in SDHA (case 2 had a frameshift mutation, and case 3 had a splice site mutation). All 3 cases were followed up for 11 to 112 months. Case 2 died 11 months post-operation, while case 1 and case 3 survived for 19 and 112 months, respectively, without any recurrence or metastasis. Conclusions: High-grade SDH-RCC is a rare subtype of SDH-RCC. The tumor exhibits various architectural patterns and is often misdiagnosed as other types of renal cell carcinoma. The presence of cytoplasmic vacuoles may be indicative for diagnosis. Compared to typical SDH-RCC, the high-grade subtype generally shows a larger tumor size, higher TNM stage, greater invasive potential, and poorer prognosis. For high-grade SDH-RCC, routine SDHB immunohistochemical staining may be necessary. The occurrence of high-grade SDH-RCC may be associated with mutations in SDHA.

This study compares recurrence-free survival (RFS) and overall survival (OS) in patients with non-clear cell (nccRCC) and clear cell renal cell carcinoma (ccRCC) undergoing surgical nephrectomy with thrombectomy (SNTx) for RCC with venous thrombus. Data from patients who underwent SNTx at two tertiary centers (June 1990–December 2022) were retrospectively reviewed. Patients were grouped as ccRCC or nccRCC and stratified by metastasis status at surgery. Primary endpoints were RFS and OS for metastasis-naive RCC and OS for the entire cohort, including both metastasis-naive and metastatic RCC. Kaplan–Meier analysis with log-rank tests and adjusted multivariable Cox proportional hazards models were performed, with TN adjustments for the metastasis-naive group and TNM adjustments for the entire population. Among 604 patients, 504 (83.5%) were ccRCC. In nccRCC, 44 (44.0%) were papillary, 17 (17.0%) were chromophobe, and 39 (39.0%) were rare subtypes, most commonly TFE3 rearranged RCC, followed by the RCC not otherwise specified subtype (according to the 2022 World Health Organization Classification of RCC). Median OS was 85.8 months for ccRCC, 37.7 for papillary, 90.2 for chromophobe, and 16.9 for rare subtypes. Rare RCC histology was significantly associated with worse RFS (HR 1.63, p = 0.038) and OS (HR 1.82, p = 0.039) in metastasis-naive RCC. For the entire cohort including metastatic diseases, rare subtypes had worse OS (HR 2.20, p < 0.001), while other nccRCC subtypes did not differ significantly from ccRCC in OS. In patients with RCC with venous thrombosis, rare nccRCC subtypes exhibited poorer survival outcomes, even after adjustment for TN(M) stage.