A next generation physiologically-based kinetic model for quantitative in vitro to in vivo extrapolation of cisplatin-induced nephrotoxicity in humans.

The use of kidneys from small pediatric donors (< 5 years) for single kidney transplantation (SKT) may expand the donor pool. In recent years, many national allocation policies have given priority to pediatric recipients. However, comparative studies involving pediatric and adult recipients of single kidney transplants from small pediatric donors are limited. All patients who underwent SKT from small pediatric donors aged < 5 years at our center between January 1, 2015 and June 30, 2024 were included in this study. The outcomes included graft survival, patient survival, and post-transplant complications, which were compared between pediatric and adult recipients. The patient cohort included 83 adult recipients and 55 pediatric recipients from 48 and 40 small pediatric donors (aged < 5 years), respectively. Three-year death-censored graft survival and patient survival in pediatric recipients were 81.7% and 100%, respectively, which were not significantly different from those in adult recipients (89.0% and 95.8%). The leading cause of graft loss was vascular thrombosis (6 cases), followed by rejection (5 cases). No significant differences were observed between pediatric and adult recipients regarding primary nonfunction, the incidence of proteinuria, vascular and urinary complications, or the cumulative incidence of acute rejection. However, adult recipients experienced a significantly higher incidence of delayed graft function than pediatric recipients. SKT from small pediatric donors achieved comparable outcomes in adult and pediatric recipients, validating that current policies prioritizing pediatric recipients are clinically appropriate. Addressing risks of vascular thrombosis and rejection may further improve outcomes.

Objectives The disparity between kidney demand and supply necessitates the expansion of the donor pool. This study evaluates the long-term outcomes of single kidney transplantation guided by histological and clinical parameters. Methods We retrospectively analyzed 1,024 adult recipients of deceased-donor kidney transplants from January 2011 to December 2020. Graft and patient survival were assessed using Kaplan-Meier analysis, and independent risk factors were identified through Cox regression models. Donor kidney histological specimens were evaluated using the Remuzzi score. Results A Remuzzi score of 4 emerged as a critical threshold for safe single kidney transplantation. Recipients were divided into three groups based on Remuzzi score (0–3, 4, and >4). Those with a score of 4 had similar 10-year graft survival to those with score 0–3 (92.0% vs. 92.0%, p = 0.984), whereas grafts with score >4 had poorer outcomes (82.0%, p = 0.033). The 10-year patient survival for recipients with a score of 4 was comparable to those with scores 0–3 (90.0% vs. 94.0%, p = 0.122), while score >4 trended toward worse survival (81.0%, p = 0.067). In subgroup analyses of high Remuzzi scores (>4, n = 105), the Kidney Donor Profile Index (KDPI) and donor terminal creatinine were identified as independent risk factors for graft loss. Conclusions Single kidney transplantation is safe for grafts with Remuzzi scores ≤4. Even some kidneys from high-score donors demonstrated favorable graft prognosis when allocated based on KDPI and donor terminal creatinine.

Midterm Performance of Bridging Stent-grafts Used for Visceral Branches in Fenestrated Endovascular Aneurysm Repair.

Background. To describe the case of a patient with polymyalgia rheumatica (PMR) and suboptimal response to steroid therapy with the incidental finding of hyperphosphaturic hypophosphatemia, suspected for tumor-induced osteomalacia (TIO), to highlight the importance of a multidisciplinary approach and targeted diagnostic laboratory and instrumental workup. Materials and Methods. Male patient, 76 years old, with a functionally single kidney following nephrectomy of an ectopic kidney at age 33, medical history of arterial hypertension, dyslipidemia, OSAS, subcritical stenosis of the supraaortic trunks, and polyglobulia (JAK2 mutation negative, endogenous EPO within normal limits); on chronic therapy with NSAIDs as needed, antihypertensives, ASA 100 mg/day, statins, and benzodiazepines for anxiety-depressive syndrome. Symptom onset approximately 3 months prior with arthralgias of the shoulder and pelvic girdles, prolonged morning stiffness &gt;2 h, functional limitation, and elevation of inflammatory markers. Underwent initial treatment with prednisone 37.5 mg/day with tapering as indicated by the general practitioner. Subsequent relapse upon discontinuation and therefore referred for urgent rheumatology evaluation with reintroduction of PDN 18.75 mg/day and slow tapering and initiation of antiresorptive therapy with risedronate, calcium, and vitamin D supplementation. Results. At 3-month rheumatology follow-up visit, reported recurrence of arthralgias and morning stiffness upon reduction of prednisone below 7.5 mg/day. Laboratory tests revealed CRP 2.1 mg/dL; serum calcium 9.9 mg/dL; serum phosphorus 2.0 mg/dL (normal range 2.7-5.1); serum magnesium 2.1 mg/dL; spot urine phosphorus 49.9 mg/dL; plasma creatinine 1.01 mg/dL; TmPO4/GFR 1.42 mg/dL (normal range &gt;2.7). Given suspicion of TIO, intact and C-terminal FGF23 assays were requested, with values resulting inappropriately normal in relation to serum phosphorus levels. Systematic monitoring of serum phosphorus was concurrently initiated, with IV supplementation of fructose-1,6-diphosphate and oral potassium phosphate as needed, and introduction of calcitriol up to 0.5 µg/day. Gallium-DOTAPEPTIDE PET/CT extended to the appendicular skeleton was also requested, with results not yet available at the time of publication. Conclusions. Tumor-induced osteomalacia represents a rare cause of renal hyperphosphaturia and severe hypophosphatemia, frequently masked by nonspecific musculoskeletal symptoms in elderly patients; this case highlights the need to integrate clinical suspicion of PMR with complete biochemical investigations, including serum phosphate and TmPO4/GFR calculation, and to employ advanced imaging techniques for localization of FGF23-secreting neoplasms, in order to promptly direct the patient toward specific surgical or medical therapy and improve functional and metabolic outcome. Currently, burosumab, a recombinant human monoclonal antibody (IgG1) directed against FGF23, is approved in both children and adults for the treatment of FGF23-related hypophosphatemia secondary to phosphaturic mesenchymal tumors that cannot be curatively resected or localized.

A man in his 50s presented with persistent left flank pain, imaging revealed a non-functioning hydronephrotic left kidney with multiple calculi and thinning of the renal parenchyma, prompting a radical nephrectomy. Histopathological examination unexpectedly identified two distinct neoplasms-a type 1 papillary renal cell carcinoma (PRCC) and primary mucinous adenocarcinoma arising from the pelvicalyceal system. Immunohistochemistry confirmed their separate epithelial origins. Neither tumour had metastasised. Chronic irritation from nephrolithiasis and hydronephrosis may have promoted the development of the mucinous adenocarcinoma, while sporadic genetic alterations likely underpinned the PRCC. This case highlights the need for thorough pathological assessment and, specifically, to consider multiple primary tumours in patients with chronic renal pathology. Early surgical intervention and careful histopathological evaluation are crucial for accurate diagnosis, informing disease management and potentially improving patient outcomes.

This study aimed to contribute to the literature by investigating whether Retrograde Intrarenal Surgery (RIRC) performed with Thulium Fiber Laser Lithotripsy (TFLLT) can be an alternative to Percutaneous Nephrolithotomy (PNL), which is still considered the gold standard, for the treatment of kidney stones measuring 20-30 mm, a more invasive procedure. Between April 2022 and June 2024, patients with a single kidney stone (Guy stone score 1) located in the renal pelvis, lower pole, or middle pole, measuring between 20-30 mm, were randomized at the Urology Clinic of Atatürk University Research Hospital. A total of 86 patients were included in the study. 44 patients (51.1%) underwent RIRS with TFLLT, and 42 patients (48.8%) underwent PNL. The mean stone size was 24.7 ± 1.8 mm in the RIRS group and 24.8 ± 1.7 mm in the PNL group. There was no statistically significant difference in demographics and stone characteristics between the two groups (p0.05). Stone-free rates were statistically similar between the two groups (p=0.714). The mean operative time was longer in the RIRS group, while the mean hemoglobin decrease and hospital stay were longer in the PNL group (p0.001). No statistically significant difference was found in postoperative complications between the groups (p=0.806). In the treatment of kidney stones measuring 20-30 mm, RIRC with TFLLT provides advantages over PNL, including lower blood loss, shorter hospitalization, lower fluoroscopy time, less postoperative pain, and lower analgesic consumption. With similar complication and stone-free rates, thulium fiber laser lithotripsy (TFLLT) performed via retrograde intrarenal surgery (RIRS) may have the potential to be a safe and effective alternative to percutaneous nephrolithotomy (PNL). Further studies with larger patient series will contribute to the literature.

Objectives: Evaluate the agreement and interobserver variability between manual segmentation and the ellipsoid formula in estimating single kidney volume (SKV) in patients with autosomal dominant polycystic kidney disease (ADPKD). Methods: In this retrospective study, 130 unenhanced CT scans of ADPKD kidneys were analyzed. Three radiologists (one senior, two juniors) measured SKV using manual segmentation and the ellipsoid formula. Statistical analyses included intraclass correlation coefficient (ICC), Wilcoxon signed-rank test, Bland-Altman analysis, and paired t-tests to compare measurement values and computation times. Results: Both methods showed excellent interobserver agreement (ICC ≥ 0.977). No significant difference was observed in volume estimates between the two techniques (Wilcoxon p = 0.295). Bland-Altman analysis confirmed strong agreement between methods for the senior radiologist. The ellipsoid method was significantly faster for all readers (p < 0.05). Conclusions: The ellipsoid formula is a reliable, time-efficient alternative to manual segmentation for SKV estimation in ADPKD, offering comparable accuracy with reduced resource demands in clinical settings.

Disclosure: H. Oh: None. M. Jeon: None. C. Kim: None. W. Kim: None. W. Kim: None. J. Ryu: None. T. Kim: None.Background: Radioactive active iodine (RAI) treatment is the essential treatment for advanced differentiated thyroid cancer patient. However, unforeseen complications arising from thyroid hormone withdrawal (THW) can lead to the cancellation of scheduled treatments. We aimed to identify cases of treatment discontinuation during THW-RAI therapy due to THW-related complication and to explore preventable causes for improving patient management. Methods: Between 2012 and 2024, 4,174 patients underwent THW-RAI therapy in Asan Medical Center. Among them, 39 did not complete the planned treatment. After excluding cases canceled for reasons unrelated to THW, 11 patients with unexpected medical issues from THW were analyzed. Results: The median age of the included patients was 65 years (range: 31–72), with 10 being male. The reasons for discontinuation were hyponatremia (1 case), abnormal liver function (1 case), abnormal renal function (3 cases), and concurrent liver and renal dysfunction (6 cases). The patient with hyponatremia had a history of thiazide diuretic use. Most cases of liver dysfunction were associated with prior use of herbal medications, while renal dysfunction was linked to diuretic or non-steroidal anti-inflammatory drug use, pre-existing conditions such as single kidney and diabetic nephropathy, or inadequate oral intake during low-iodine preparation. Notably, two cases of combined liver and renal dysfunction were attributed to rhabdomyolysis following intense exercise or heavy workloads. Conclusions: Our analysis of 11 cases highlights avoidable factors that led to discontinuation of THW-RAI therapy. Enhanced patient education, comprehensive pre-treatment evaluations, and careful avoidance of high-risk medications are critical for minimizing disruptions in RAI therapy.Presentation: Saturday, July 12, 2025

Abstract Background and Aims With an economic burden exceeding $140 billion annually, innovative and affordable diagnostic tools and therapeutic strategies are urgently needed to preserve kidney function and reduce societal costs. These tools should enable large-scale screening, address sex-specific treatment challenges, advance precision medicine, promote regenerative kidney research, and adhere to 3R principles to minimize animal use in preclinical studies. Traditional in vitro models, such as cell cultures and kidney organoids, are constrained by time, cost, and limited physiological complexity. Here, we present a cost-effective, time-efficient, and high-yield lectin-mediated flow sorting technique for isolating glomeruli and four distinct, morphologically and functionally intact nephron tubule segments from a single kidney. As a proof of concept, we employed a proteomic approach to investigate sex-specific differences in freshly sorted, functionally distinct nephron segments and aimed to establish an ex vivo 3D culture model. Method Five nephron segments were isolated from mouse kidneys using fluorophore-conjugated lectins and high-speed flow sorting (200 µm nozzle, 5 psi): glomeruli (Cy3-labeled Sambucus Nigra agglutinin, SNA-Cy3), proximal tubules (PT, fluorescein-labeled Lotus Tetragonolobus lectin, LTL-FITC), and distal convoluted tubules (DCT, Pacific Blue-labeled soybean agglutinin, SBA-PB). Connecting tubules and collecting ducts (CNT/CD) were identified by double-positive SBA-PB and SNA-Cy3 signals, while thick ascending limb (TAL) segments lacked labeling. Sorted segments were evaluated for RNA/protein yield, purity, and marker expression. A bottom-up proteomics approach was used to analyze sex-specific differences in PT, DCT, and TAL. For 3D cultures, PT or TAL segments embedded in gelatin or Matrigel were compared to conventional 2D cultures for morphology, viability, and gene expression at 4, 8, 24, and 48 hours. Results Flow sorting enabled rapid isolation of tubular nephron segments, yielding 37–521 ng of protein or 0.71–16.71 ng of RNA per second, depending on the segment. High purity was confirmed by a 96.1-fold median mRNA enrichment across 15 segment-specific marker genes (e.g., Nphs1, Lrp2, Slc12a1, Slc12a3, Calb1, Aqp2). Proteomic analysis revealed sex-specific protein expression in PT and DCT but not in TAL. Male PT and DCT segments showed higher levels of proteins related to lipid metabolism, peroxisomal activity, phase I drug metabolism (e.g., Ces2b, Ces1f, Cyp2e1), and organic anion transport (Oatp). Female PTs exhibited higher expression of phase II drug metabolism enzymes (e.g., Gsta4, Gsta5) and multidrug resistance proteins (e.g., Abcb1, Abcc4). In 3D culture experiments, PTs and TALs embedded in 30% Matrigel retained morphology and viability, as assessed by TMRE staining, longer than those in 7% gelatin, which lost viability within 24 hours. Marker gene analysis also confirmed the superiority of Matrigel over gelatin and 2D cultures in maintaining tubule-specific features, though marker expression declined after 24 hours across all conditions. Conclusion Our novel lectin-mediated flow sorting method offers a rapid, cost-effective, and scalable solution for isolating pure nephron segments while preserving morphology and ensuring high viability. Proteomic analysis suggests that males may be more vulnerable to oxidative stress-induced injury due to increased ROS production and reduced detoxification capacity. In contrast, females exhibit greater resilience to cellular stress, driven by enhanced detoxification and more efficient metabolite excretion. Understanding these sex-specific differences in nephron segment function, combined with advanced 3D culture systems, is essential for developing personalized CKD therapies. Optimizing these approaches holds great potential for therapeutic innovation, regenerative medicine, and reducing reliance on animal models, aligning with 3R principles.

Abstract Background and Aims Standard ultrasound is the only imaging performed in most patients undergoing work-up for chronic kidney disease (CKD), but provides only coarse estimates of kidney volume, shape or appearance. Magnetic Resonance Imaging (MRI) provides detailed anatomical images that allow measurement of total kidney volume (TKV) and can be further analysed for quantitative radiomics features such as kidney shape, texture and heterogeneity. The relationship of these MRI features to CKD aetiology and kidney function is not well described. Method We analysed baseline data from the AFiRM study, a UK multi-centre prospective study of renal MRI in people with CKD, to describe TKV and shape features across a range of eGFR and CKD aetiologies. All participants underwent a comprehensive renal multiparametric MRI protocol, which included a T2-weighted anatomical image (Fig. 1a). Each kidney was segmented using a machine learning U-Net, followed by visual assessment and manual correction if required. Normalised kidney volumes and radiomics shape descriptors were computed (14 3D features for each kidney and kidney asymmetry (left-right)) along with summed volume, surface area and surface area/volume, resulting in 45 shape features. Clinical and biochemical data were collected at time of MRI, and primary renal diagnoses were categorised into: diabetic kidney disease (DKD), non-DKD glomerular disease, tubular disease, ischaemic nephropathy, CKD of unknown cause, and other. Those with ADPKD or with single kidneys were not eligible for this study. Descriptive statistics were used to compare radiomics features between diagnostic categories. The relationship of eGFR with MRI metrics were explored using linear and quadratic terms including BSA as a covariable, with the quadratic term retained where the model fit significantly improved at the 10% level. Results From a cohort of 420 participants, 411 participants had complete data and were included in this analysis. Mean age was 55.1 years (standard deviation (sd) = 12.8 years) with 63.7% male. Mean eGFR was 42.7 (sd = 18.7) ml/min/1.73m2 and most (86.2%) were in CKD stages G3-4. The most common diagnostic category was glomerular disease (42.0%), followed by CKD of unknown cause (19.2%), DKD (13.6%), tubular disease (12.2%), ischaemic nephropathy (4.9%) and other (8.0%). A total of 218 (53%) had primary renal diagnosis based on kidney biopsy. A number of MRI shape and volume features differed across diagnostic categories, with differences in the number and strength of associations between MRI variables and eGFR, as shown in Table 1. For instance, DKD had highest kidney volumes and other features relating to kidney size, including surface area, long and short axis, equivalent diameter, moment of inertia (Fig. 1b and c). Conclusion We show that there are clear associations between quantitative MRI measures of kidney volume and shape with eGFR, as well as differences between CKD aetiology categories. This demonstrates substantial potential for these MRI measures to be used in prediction modelling to further explore the interplay among these measures to determine potential mechanistic (i.e., causal) understanding relevant to CKD progression. These analyses will be augmented with the addition of T2-weighted radiomics measures of texture and heterogeneity and quantitative T1 and T2 metrics.

Abstract Background and Aims Despite significant progress in modern immunosuppression, kidney transplant recipients remain at high risk of adverse outcomes including fractures. The reported fracture risk after kidney transplantation vary, with most studies focusing on major osteoporotic fractures (MOF). This study investigated the risk of any fracture in contemporary kidney transplant recipients, with trends over the past 20 years. Method This was a retrospective cohort study utilizing national health registries. The study population was defined using the Danish Renal Registry and included all adult patients receiving a first single kidney transplant in Denmark between 2000–2022. Hospital diagnoses derived from the Danish National Patient Registry were used to identify all fracture events after kidney transplantation. Fractures and comorbidity before the time of transplantation was based on diagnosis in the registry up to 10 years prior to transplantation. MOF was defined as spine, hip, proximal humerus or forearm fracture. The incidence rate was computed as the number of events divided by people at risk during follow-up. To examine temporal trends the follow-up was restricted to five years and incidence rates were estimated for separate time periods as crude and as age- and sex-standardized to the earliest calendar period. Cumulative incidence (risk) of any fracture or MOF was computed treating death as a competing risk. Results A total of 3997 first kidney transplantations were identified. Median age at transplant was 50 yr, 37% were female, and 22% had diabetes mellitus. A fracture prior to transplantation was noted for 17% of patients, with 4% having had a MOF. During a median follow-up of 5.9 years (IQR 2.6–10.8), 909 patients (23%) sustained any post-transplant fracture. Of all first fracture events, 87% occurred in patients who still had kidney graft function. The crude incidence rate was 31.8/1000 person years (95% CI 29.8–33.9) for any fracture and 9.2/1000 person years (95% CI 8.2–10.3) for a MOF. The 5-year risk for any fracture was 15% (95% CI 14–16%) and the 10-year risk was 25% (95% CI 23–26%). The annual risk was highest during the first five years after which it declined. During the study period crude incidence rates of any fracture remained stable and this did not change after standardization (Fig. 1). Patients who sustained a fracture were more likely to be female, have diabetes and a history of previous fracture, and a longer dialysis vintage. Post-transplant fractures were primarily located at the distal skeleton, with fractures of the foot, hand, lower leg and forearm comprising 59% of all first fractures, while MOF comprised 35% (Fig. 2). Conclusion Contemporary kidney transplant recipients have high fracture rates, and despite improvements in post-transplant care, fracture rates are unchanged over the past 20 years. The majority of fractures are located at the distal skeleton and the definition of MOF captures only 1/3 of post-transplant fractures. Further efforts are needed to characterize fracture risk factors post-transplant, particularly related to transplant-specific factors such as mineral metabolism disturbances.

Abstract Background and Aims The limited availability of donor kidneys represents a major obstacle to accessing kidney transplantation. Procurement biopsies are frequently utilized to assess donor kidney quality, but they are associated with high discard rates, especially for marginal donors. This raises concerns that some potentially viable kidneys may be discarded due to limitations in current evaluation methods. We have developed ComPRePS (Computational Renal Pathology Suite), an open-source, end-to-end, cloud-based platform designed for AI/ML-driven analysis of kidney biopsies. Using this platform, we aimed to establish a computational model that integrates donor pathological and clinical data to enhance the prediction of post-transplant graft function and mitigate organ discard rates. Method Our analysis focused on 213 harvest core needle biopsies from kidneys of 152 deceased donors: 139 cases from 110 donors were allocated for single kidney transplantation, while 74 cases from 42 donors were discarded due to biopsy findings. The tissue samples were processed using a rapid Formalin-Fixed Paraffin-Embedded method, with tissue sections prepared at a thickness of 2–3 μm and stained with Periodic Acid–Schiff. The slides were then digitized using a brightfield microscopy whole-slide scanner at 40× magnification. We collected a complete set of clinical data for both donors and recipients, including the glomerular filtration rate at different time points. Our computational pipeline automatically segment glomeruli, tubules, arteries, and arterioles followed by a comprehensive extraction of 73 quantitative pathomic features from these regions: measures of distance, color, texture, morphology, and summary statistics. Additionally, separate pre-trained convolutional neural networks assessed the degree of arterial fibrointimal thickening, interstitial fibrosis, and tubular atrophy (IFTA). A penalized LASSO Cox regression machine learning model was employed to identify the most significant predictors of the 12-month post-transplant eGFR outcome. Finally, we developed a computational Remuzzi score using ComPRePS and compared it to the original on-call pathologist assessment to evaluate the potential reduction in organ discard rates. Results Our regression model included 24 variables to predict the 12-month eGFR: donor variables (age and last eGFR), arterial fibrointimal thickening, IFTA and 20 pathomic features. This model demonstrated excellent performance, with an area under the curve of 0.85 (95% CI, 0.78 to 0.91) for predicting an estimated glomerular filtration rate (eGFR) ≥55 ml/min/1.73 m2 at 12 months post-transplantation compared to 0.70 (95% CI, 0.61 to 0.79) of the Kidney Donor Profile Index, and 0.57 (95% CI, 0.47 to 0.67) for the initial on-call Pathologist Remuzzi score (Fig. 1). Additionally, our analysis revealed that the combined computational Remuzzi score would have deemed 42.4% of previously discarded kidneys as suitable for transplantation (Computational Remuzzi score &amp;lt;4). Based on our eGFR prediction model, 18.2% of these kidneys would have been expected to have an eGFR ≥55 mL/min/1.73 m2 or greater at 12 months post-transplantation. Conclusion This study highlights the potential of integrating pathological and clinical data from deceased kidney donors using ML analysis. Our computational model outperformed existing methods in predicting post-transplant graft function and has demonstrated the potential to reduce organ discard rates.

IntroductionChronic kidney disease (CKD) affects 1 in 10 people worldwide and can progress towards kidney failure, which is best predicted by the severity of kidney fibrosis. Currently, kidney fibrosis can only be detected by invasive kidney biopsy which carries procedural risks with limitations on repeat testing. MRI techniques have emerged as potential surrogate markers for kidney fibrosis, though data remain limited. To date, no studies have examined postgadolinium contrast T1 mapping in kidney fibrosis despite its proven utility in assessing myocardial fibrosis. This study aims to develop a multiparametric MRI biomarker including postcontrast imaging to quantify kidney fibrosis in individuals with CKD.Methods and analysisIn this observational cohort study, a control group of 20 healthy adult volunteers will establish healthy kidney MRI parameters. Two adult non-dialysis CKD cohorts (each n=24) who have undergone kidney biopsy within the last month will derive and validate the MRI models, respectively. Tubulointerstitial fibrosis on kidney biopsy will be assessed by Masson trichrome staining and quantified based on the percentage of cortex affected by blinded pathologists. All participants will undergo a single multiparametric kidney MRI including kidney volumetry, T1 mapping (pre-low-dose and post-low-dose contrast), T2 mapping, T2* mapping, diffusion weighted imaging and phase-contrast MRI of renal artery flow. The primary outcome will be the association between a composite multiparametric MRI marker and tubulointerstitial fibrosis with a minimum variance of 50%. The association between the multiparametric MRI marker and individual MRI variables, and tubulointerstitial fibrosis, estimated glomerular filtration rate and albuminuria will also be studied.Ethics and disseminationEthics approval has been obtained by the Northern Sydney Local Health District Human Research Ethics Committee (2022/ETH00972). Results will be disseminated in relevant peer-reviewed journals and presented at academic conferences.Trial registration numberACTRN12622000855729p (Pre-results).

metastasis of kidney cancer occurs to the bones in 30% of cases, and to the liver in 60%. One of the radiation methods for detecting metastatic lesions of the skeleton and liver is radionuclide. Osteoscintigraphy is a specific study in the diagnosis of bone metastases, mainly of the osteoblastic type. For the diagnosis of liver metastases, radionuclide methods are used "in vivo" and "in vitro". Static hepatoscintigraphy, compared to ultrasound, computed tomography and magnetic resonance imaging, is less informative in finding secondary lesions. One of the most sensitive methods for detecting secondary liver damage is radioimmunoassay of specific tumor markers. The main ones are alpha-fetoprotein, carcinoembryonic antigen and carbohydrate antigen 19-9. Their concentration in the blood serum increases tenfold when the malignant process spreads to the liver. In the radionuclide department of the KMCL No. 18, which is located at the Department of Radiology and Radiation Medicine of the O.O. Bogomolets National Medical University, patient S., 62 years old, with right-sided renal cell carcinoma of stage II (T2N0M0), underwent radionuclide studies of the skeleton, liver, function of the single left kidney (after right-sided nephrectomy), and tumor markers. The reason for this was the absence of secondary lesions of these organs on X-ray computed tomograms in the presence of pain syndrome in the lower back and heaviness in the right hypochondrium. Radionuclide examination of the skeleton revealed slight hyperfixation of the radiopharmaceutical (up to 150%) from L1 to L5, which did not confirm the presence of secondary spinal lesions. The functional capacity of the left kidney was reduced. The absence of drug accumulation on hepatoscintigram was not detected, but a diffuse-uneven decrease in its uptake by cells of the reticuloendothelial system was observed, which is characteristic of hepatitis. However, the levels of tumor markers characteristic of focal liver damage significantly exceeded the norm. Based on which a conclusion was made regarding metastatic damage to this organ. Thus, patients with hepatocellular kidney cancer are recommended to undergo a comprehensive radiation examination with the inclusion of radionuclide methods both "in vivo" and "in vitro" to determine tumor markers specific for secondary liver damage.

This widening disparity between demand and supply necessitates innovative approaches to augment the pool of potential donors. Utilizing en bloc kidneys (EBKT) from newborns and small pediatric donors represents one promising strategy. Despite their smaller size, these kidneys have demonstrated considerable success in transplantation. A retrospective cohort analysis of the SRTR database was done for kidney transplants that were performed en bloc or single from donors younger than 5 years old in the United States from 1987 to 2023. After considering the inclusions and exclusion criteria, a total of 7355 kidney transplantation cases were included in the final study analysis, in which 4546 cases have received en bloc allografts and 2809 cases have had single kidney transplantation (SKT). The data analysis showed the higher 5-year patient survival rate in the EBKT group in comparison to the SKT group (87% vs. 81%, p value < 0.001); also, the 5-year allograft survival rate in the EBKT group is significantly higher than the SKT group (85% vs. 77%, p value < 0.001). As expected, delayed graft function (DGF) has increased the chance of graft failure in both EBKT and SKT groups (HR: 4.86 [3.69-6.39] vs. HR: 2.13 [1.56-2.89], respectively); also, the patient survival rate was lower when the patients had DGF in both EBKT and SKT groups (HR: 2.29 [1.50-3.48] vs. HR: 1.71 [1.12-2.59], respectively). Our study supports the use of EBKT as a promising option for kidney transplantation from pediatric donors under 5 years old. The higher patient and graft survival rates observed in the EBKT group highlight the potential benefits of this approach in expanding the donor pool and improving transplantation outcomes.

To evaluate the multi-institutional experience of performing robotic-assisted laparoscopic pyeloplasty (RALP) for ureteropelvic junction obstruction (UPJO) in the pediatric population. Beginning in 2016, all children with UPJO, including complex cases, uniformly underwent RALP instead of the previously used laparoscopic or open surgical approaches. This study is a multicenter retrospective chart review. It includes an analysis of demographic data, preoperative, intraoperative, and postoperative parameters, complications, and outcomes. During an 8-year period, 199 children (76% boys and 24% girls) underwent RALP. This group constitutes the study cohort. Challenging cases included: 24 cases with a weight less than 6 kg, 21 redo RALP procedures following previous open surgery failures, 7 cases of UPJO in the lower pole of a double collecting system, 7 children who underwent simultaneous nephrolithotomy, 7 cases of bilateral UPJO, 3 horseshoe kidneys, 3 single kidneys, and one case of giant hydronephrosis crossing the midline. The median age was 15 months (IQR, 5-43 months) and the median weight was 8.3 kg (IQR, 7-17 kg). The median operative time was 80 minutes (IQR, 64-107 minutes). No significant intraoperative complications were reported, although there was one case of conversion to open surgery due to lack of progress. The median length of hospitalization was 1.4 days (IQR, 1-4 days), with one-third of the children being discharged within 24 hours of the operation. In 18 cases, Clavien-Dindo grade II complications were noted, predominantly postoperative urinary tract infections. At a median follow-up of 20 months (IQR, 15.5-32.5 months), the success rate was 98%, with 4 patients requiring additional procedures due to persistent obstruction. Robotic-assisted pyeloplasty in children is a safe and effective procedure with a high success rate. RALP can be performed at all ages, including in complex cases. It has become the gold standard at our institutions.

Kidney Volume after Endovascular Exclusion of Abdominal Aortic Aneurysms by EVAR and FEVAR.

Kidney Transplantation and Donor Artery Grafts.

Single vs. En Bloc Kidney Transplantation from Donors ≤5 Years of Age in the United States: An Analysis of the Scientific Registry of Transplant Recipients (SRTR) from 1987 to 2023