Single Kidney Research Articles

Structure and features of the dynamics of primary disability in the adult population of Ukraine as a result of non-oncological urological diseases

Background. The purpose of the work: to study the structure and features of the dynamics of primary disability among the adult population of Ukraine as a result of non-oncological urological diseases. Materials and methods. The reporting form No. 14 of the State Statistics Service of Ukraine, the statistical sources of the Ukrainian State Research Institute of Medical and Social Problems of Disability, documentation of regional centers for medical and social expertise are used. Results. There is a tendency to reduce the number of people recognized as disabled for the first time due to genitourinary diseases. It has been confirmed that prolonging temporary disability contributes to this. The official reporting of the causes of disability by the class of genitourinary diseases is presented only for chronic glomerulonephritis and chronic pyelonephritis; for 5 years, the incidence of the first nosology increased by 13.0 % (to 43.8 % among 1,549 registered), the second — decreased by 37.4 % (to 20.0 % in all regions except Kyiv). At the same time, there was a tendency to reduce the incidence of disability retirement for reasons classified as “others” (36.2 ± 2.0 % vs. 39.0 ± 1.8 % in 2016, and in the Central and Northeastern regions it reached 49.2 ± 2.8 % and 49.6 ± 4.7 %, respectively). Apart from the two above-mentioned pathologies, the structure of disability causes is as follows: the first three places belonged to urolithiasis, polycystic kidney disease, single kidney, the next three — hydronephrosis, congenital malformations and urethral stricture. With age, the incidence of urolithiasis, polycystic kidney disease, hydronephrosis, urethral stricture increases and the incidence of congenital malformations and a single kidney decreases. Over the years, the assignment of the second group of disability decreases (18.1 ± 3.1 % in 2020 vs. 20.4 ± 2.6 % in 2016), with an increase of the third group (67.8 ± 3.8 % vs. 65.3 ± 3.1 %), and stabilization of the first group (14.1 vs. 14.3 %). Conclusions. During the 5-year observation period, 12.9 % more patients avoided disability and 4.7 % less received groups I and II. A decrease by 37.4 % (to 20.0 %) in the share of chronic pyelonephritis as a cause of disability was observed in all regions except Kyiv. Structure of other causes of disability: urolithiasis — 45.0 %, polycystic kidney disease — 22.1 %, single kidney — 18.8 %, hydronephrosis — 15.4 %, congenital defects — 12.1 %, urethral stricture — 4.7 %. Against the background of the general increase in disability assignments with age, group III disability among others was more common (7.7 % — at the age of up to 39 years, 63.1 % — at pre-retirement age, 67.8 % — at retirement age).

Predictors of stone-free rate after a single-session extracorporeal shockwave lithotripsy for a single kidney stone measuring 10 to 20 mm: A private center experience.

Despite the continuous update of guidelines for the management of kidney stones, the ability to predict a successful response to extracorporeal shockwave lithotripsy (SWL) remains a topic of research. This is due to the need to refine the decision making in the context of technological advancements and current pandemics. This study aimed to determine the predictors of stone-free rate (SFR) after single-session SWL in adult patients with a single kidney stone 10 to 20 mm in diameter. A retrospective review of the records of patients with a single kidney stone 10 to 20 mm in diameter was performed at a private SWL center from December 2019 to February 2021. Univariate and multivariate analyses were performed for stone- and patient-related factors, using the Student t and Mann-Whitney U tests for the quantitative variables and the Fisher exact and Pearson correlation tests for the qualitative variables. A total of 138 patients were eligible for this study, including 92 men and 46 women. The mean age was 38.6 ± 12.4 years, and the mean body mass index (BMI) was 25.9 ± 3.4 kg/m2. Four weeks after SWL, 120 patients (87%) were free of stones, and 18 (13%) needed further treatment. Univariate analyses showed that SFR was negatively correlated with increased BMI (p = 0.0001), maximum stone length (p = 0.0001), transverse diameter of the stone (p = 0.0001), number of shocks per session (p = 0.052), and Hounsfield unit (HU) (p = 0.0001). Multivariate analysis revealed that HU (p = 0.009), maximum stone length (p = 0.01), BMI (p = 0.000), and presence of double-J stent (p = 0.034) were independent risk factors for failure of single-session SWL in the treatment of kidney stones 10 to 20 mm in diameter. The estimated average cost per case was USD 450.5. Increased HU, maximum stone length, BMI, and presence of double-J stents were independent risk factors for low SFR after single-session SWL for a kidney stone 10 to 20 mm in diameter. The cost of SWL remains an advantage in the private sector.

THE ROLE OF R.E.N.A.L NEPHROMETRY SCORE TO PREDICT PERIOPERATIVE OUTCOME FOLLOWING PARTIAL NEPHRECTOMY IN A NATIONAL REFERRAL HOSPITAL

Objective: This study aim to see the significance of R.E.N.A.L-NS in our center. Material & Methods: We retrospectively collected all the data of RCC patients that underwent partial nephrectomy (PN) in Cipto Mangunkusumo Hospital from January 2010-January 2018, with complete CT-scan examination. Patients with single kidney were excluded from our study. We evaluated intraoperative blood loss, length of operation, post operative length of stay, post operative kidney function, and complications as the perioperative parameters. Patients were categorized into 3 category based their complexity from RENAL-NS into: low (4-6), moderate (7-9), and high (10-12). Complications were based on Clavien-Dindo classification. Perioperative outcomes were analyzed based on the stratification of the patients and analyzed using ANOVA and chi-square. Results: We evaluated 25 partial nephrectomy cases which are suitable with inclusion and exclusion criteria. There were 8 (32%) low, 14 (56%) medium, and 3 (12%) high complexity cases. Median age of patients were 61 (46-71) years old, with mean tumor diameter 72.07 (+ 38.9) mm. Nine (36%) patients underwent open procedure and 16 (64%) underwent laparoscopic procedure. The laparoscopic procedure was tend to the lower complexity of R.E.N.A.L score (p=0.048). Higher complexity of R.E.N.A.L score correlated with higher blood loss (p<0.001), length of stay (p<0.001), complication rate (p<0.001), and length of operation (p=0.033). Conclusion: R.E.N.A.L-NS has a role for a selection of type of procedure and a prediction of perioperative outcome in partial nephrectomy. R.E.N.A.L-NS can be used in daily basis as it could determine the procedure and several outcomes of the partial nephrectomy procedure.

Сравнительный анализ влияния размера и объема конкремента на длительность тулиевой перкутанной нефролитотрипсии

The aim of the investigation was to determine the influence of such parametric characteristics of the stone such as size and volume on the duration of tulium laser disintegration of the urinary stone and to determine which of these parameters is more effective to use like prognostic criterion for the duration of the planned surgical intervention in the percutaneous nephrolithotripsy.Overall 52 patients (27 females and 25 males) with an average age of 56,9 (25-79) years participated in the present study. All patients underwent percutaneous nephrolithotripsy with disintegration of the kidney stone by thulium energy. Inclusion criteria were: stone size more or equal 2 cm, stone density >1100 HU. Exclusion criteria were: patients with a single kidney, urinary tract divertions, coagulopathy. The average operation time was 30 (15-100) minutes, with an average puncture time of 3.15 (1-10) minutes and lithotripsy time of 28 (14-98) minutes. To determine the volume we used the method of automatic lithometry according to CT data using the software: Vitrea ver. 4.1.52. The size of the stone was determined by the longest length in one of the plane. During the study it was found that the average size of the stone was 28.25 (20-58) mm and the average volume was 2579.4 (250-9990) mm3. To confirm our assumption, we decided to determine the dependence of the time of disintegration of the stone on the size and volume of the stone. For this purpose, we graphically presented the correlation of these parameters.We have drawn 2 graphs reflecting the dependence of lithotripsy time parameters on the size and volume characteristics of the stone. As a result of comparing these parameters we found that size is a prognostically less reliable predictor of lithotripsy time, and is not characterized by a linear distribution, in contrast to the stone volume.Thereby, the main stereoscopic characteristic of a stone is a volume, which should be the primary guide in selecting the preferred method of treatment as well as in predicting the operative time and associated risks.

Abstract P320: Transgenic Cre Drivers For Harvesting Podocytes And Endothelial Cells From Dahl Salt-sensitive Rats

Complex phenotypes such as blood pressure regulation involve multiple organ systems, tissues, and specific cell types. Transgenic rodent models with the expression of fluorescent proteins under the control of tissue- and cell-type-specific promoters are powerful tools for identifying and isolating specific cells but have been primarily limited to mice. Our long-term goal is to establish a Cre-driver rat resource for conditional and physiologically predictive rat models of human diseases. We developed two Cre-driver transgenic strains of rats (SS/PodocinCreERT2 and SS/VECadCre) capable of activating a second Cre-sensitive tdTomato reporter transgene integrated into the rat Rosa26 locus in the Dahl salt-sensitive hypertension model background. Cells with reporter activation were identified under fluorescence microscopy or harvested using fluorescence-activated cell sorting (FACS). A tamoxifen-inducible Cre transgene under the control of the Nphs2 (podocin) gene promoter was used to harvest fluorescently labeled podocytes after tamoxifen injection. A constitutive Cre under the control of the Cdh5 (VE-Cadherin) gene promoter was used for the isolation of endothelial cells. Correspondingly, tens to hundreds of thousands of podocytes or endothelial cells were isolated from a single kidney or mesenteric artery. Isolated cells were enriched for specific marker genes and could be used in downstream assays including single-cell transcriptional profiling. These new Cre/reporter dual transgenic rat models provide a much-needed resource for the biomedical research community to study the role of these cell types in a broad range of health and disease modeling studies.

P8.034: Single Port Robotic Versus Open Kidney Transplantation: A Comparison of Outcomes

P8.034: Single Port Robotic Versus Open Kidney Transplantation: A Comparison of Outcomes

316.1: Incidence and Effect on Survival of Delayed Graft Function in Donor-Deceased Kidney Transplants in Argentina: A Multicenter Analysis

Introduction: Delayed graft function (DGF) is a manifestation of acute kidney injury with attributes unique to the transplant process. DGF is associated with negative outcomes such as higher incidence of acute rejection, worse graft function and lower grafts and patients´ survival. Although the worldwide incidence of DGF is variable, a previous study showed that the incidence in Argentina is higher than the US and most countries in Europe. Therefore, the aim of our study was to identify the risk factors associated with DGF in Argentina and to evaluate the impact of DGF on grafts´ and patients´ survival. Methods: Retrospective multicenter cohort study of deceased-donor kidney transplant from 33 transplant centers in Argentina between 2015 and 2017. Demographic data and donor and recipient related variables were analyzed at baseline and at 3 and 5 years of follow-up. Data were obtained from SINTRA/ INCUCAI, the Argentinian procurement organization and from the transplant centers. Results: Between 2015 and 2017, 1886 single kidney transplants were performed in 33 centers. Recipient and donor characteristics are shown in Table 1. In the current study, the incidence of DGF was 62%. Univariate analysis demonstrated that higher donor creatinine, donor age, recipient time on dialysis, donor BMI, absence of induction and cold ischemia time were risk factors associated with DGF. Multiple organ donation and cause of death other than stroke were associated with reduced risk DGF. In the multivariable analysis donor age (0.02), higher donor creatinine (0.02), recipient time on dialysis (<0.01), cold ischemia time (<0.01), monorganic donor (<0.01)) were risk factors of DGF. Renal function was significatively better in patients without DGF throughout the 5 years follow -up (p<0.05). Patients with DGF had higher incidence of acute rejection in the first three months of follow-up, with T-cell mediated rejection being the most frequent. At 3 and 5 years of follow up there was no increased risk of rejection when both groups were compared. Graft survival and patient survival were lower in the group that developed DGF at 1, 3 and 5 years of follow-up (<0.01) (Figure 1). Conclusion: We confirmed the high incidence of DGF in our country. Furthermore, the analysis on the risk factors associated with DGF were not as much as different as in other countries where the incidence of DGF were lower. Further studies should be done to unravel the cause of this high incidence of DGF in Argentina. Heads of Transplant Centers: WalterJ, Raffaele P, Ciappa M, Paladini J, De la Fuente J, Novoa P, Soler Pujol G, Toselli L, Suso E, Ferreyra M, Fragale G, Reinoso S, Acosta F, Sgrosso J, Arriola M, Maldonado R, Acosta M, Prado R, Sedevich A, Martinez I, Di Pietrantonio S, Oddino J, Trimarchi H, Raimondi C, Gómez M, Dorado E, Palti G, Mele P, Maggiora E, Papaginovic Leiva M. Kidney Commitee: Ibañez J, Benitez ML, Leon L, Mesias M, Osella F.

417.4: Outcomes of Single Kidney Transplantation From Pediatric Donors With Acute Kidney Injury Into Pediatric Recipients

417.4: Outcomes of Single Kidney Transplantation From Pediatric Donors With Acute Kidney Injury Into Pediatric Recipients

232.3: Longitudinal Analysis of Donor-derived Cell-Free DNA (Dd-cfDNA) in En-bloc Kidney Transplantation

Introduction: The longitudinal dd-cfDNA patterns in en-bloc kidney transplant recipients have not been studied. It is unknown how the initial smaller mass of thetwo pediatric organs impacts dd-cfDNA early post-transplant or if the dd-cfDNA rises over time as the organs enlarge. We analyzed dd-cfDNA scores over thefirst 12 months in recipients of pediatric en-bloc kidneys enrolled in the Kidney allograft Outcomes AlloSure Registry (KOAR, NCT03326076). Methods: 16 recipients of pediatric en-bloc kidneys with donors aged ≤7 years old were identified and compared with 931 single, non en-bloc deceased donorrecipients. Patients with rejection were excluded. Results: Of the 16 en-bloc recipients, 56.2% were male with median donor age of 1.4 years and median cold ischemia time (CIT) of 20 hours. None of the en-bloc transplants had delayed graft function. Aside from KDPI, donor age, and recipient age, no other differences were observed between groups (Table 1). Higher median dd-cfDNA values were seen in the en-bloc cohort compared to not en-bloc at month 1 (M1, 1.4% vs 0.4%) and month 2 (0.58% vs 0.23%) aftertransplant (p<0.001) (Figure 1a). Median dd-cfDNA values were comparable for month 3 (0.21% vs 0.16%, p = 0.07) and all subsequent time points (Figure 1a, 1b). Among 8 patients with M1 dd-cfDNA results, there was no significant association between M1 dd-cfDNA and either CIT (r=0.33, p=0.419) or KDPI (r=0.23,p=0.589) (Figure 2). Conclusion: Our results demonstrate higher early post-transplant dd-cfDNA values among en-bloc kidney compared to single kidney recipients however, nodifference or upward trend is observed beyond month 2 and out to 12 months.

Long-term Outcome Reporting in Older Kidney Transplant Recipients and the Limitations of Conventional Survival Metrics

The kidney transplant recipient population in the United States is aging rapidly, which may exacerbate some of the limitations of conventional outcome metrics. Using data from the Scientific Registry of Transplant Recipients (SRTR), age-stratified unadjusted Kaplan-Meier and competing risk survival analyses were performed on a cohort of 238,123 adult recipients of a first-time single kidney transplant between 2000 and 2017. These were compared with a multistate model incorporating 5 post-transplant states (alive with functioning graft, death with functioning graft, graft failed (alive), retransplanted, and death after graft failure). Kaplan-Meier resulted in an age-dependent overestimation of the risks of graft failure and death with functioning graft, compared with competing risk or multistate models. In elderly (≥75 years old) recipients, the absolute overestimation of the risk of death with functioning graft was 4-fold higher than in those younger than 55 years. The multistate model demonstrated that for patients transplanted at age 55 years and older, the probability of being back on dialysis was never more than 4% at any point post-transplant. The underlying reasons were low graft failure rates and high mortality after resuming dialysis as follows: 2-year mortality after graft failure was 38%, 54%, and 67% in recipients aged from 55 to 64 years, from 65 to 74 years, and those aged 75 years and older, versus 20% in those younger than 55 years. Multistate models provide an accurate and comprehensive assessment of the life course of kidney transplant recipients. This may be particularly relevant in older recipients, who are more prone to event rate overestimation and for whom outcomes after graft failure are substantially worse than for younger recipients.

Solitary kidney functional damage due to caesarean ureteric injury monitored for 2 years after acute management: A case report

Caesarean section with associated ureteric injuries that damage kidney function is uncommon. Such injury in women with a solitary kidney has far-reaching effects if the diagnosis is delayed. The case report describes the successful acute management with stenting of ureteric damage after caesarean section in a woman with a solitary kidney.A 29-year-old woman presented with anuria, hypertension (174/101 mmHg) and flank pain 3 days after caesarean section. Physical examination was significant for peri-orbital oedema, left flank tenderness, pallor and delirium. A diagnosis of acute kidney injury was confirmed by elevated blood urea and creatinine levels. An ultrasound scan revealed a solitary hydronephrotic left kidney. She had successful acute management at a resource-deprived facility, with normal renal function at a 2-year follow-up. Proteinuria lasted for about three months after surgery.Recovery of solitary kidney function with acute kidney injury due to caesarean section ureteric injury may be associated with prolonged proteinuria without evidence of further functional deterioration.

Cancer risk in living kidney donors

Living kidney donors are screened for transmissible diseases including cancer. Outcomes following donation are excellent, but concern exists regarding development of chronic kidney disease, and cancer risk is unknown. We used linked transplant and cancer registry data to identify incident cancers among 84,357 kidney donors in the United States (1995–2017). We compared risk with the general population using standardized incidence ratios (SIRs). For selected cancers, we used Poisson regression to compare donors with 47,451 Adventist Health Study 2 (AHS-2) participants, who typically have healthy lifestyles. During follow-up, 2843 cancers were diagnosed in donors, representing an overall deficit (SIR 0.79, 95%CI 0.76–0.82). None of 46 specified cancer sites occurred in excess relative to the general population, and 15 showed significant deficits (SIR < 1.00). Compared with AHS-2 participants, donors had similar incidence of liver cancer, melanoma, breast cancer, and non-Hodgkin lymphoma but, starting 7 years after donation, elevated incidence of colorectal cancer (adjusted incidence rate ratio 2.07, 95%CI 1.54–2.79) and kidney cancer (2.97, 1.58–5.58, accounting for the presence of a single kidney in donors). Elevated kidney cancer incidence may reflect adverse processes in donors’ remaining kidney. Nonetheless, cancer risk is lower than in the general population, suggesting that enhanced screening is unnecessary.

Expanded Criteria Donors.

The expanded criteria donor is any donor over the age of 60 years or a donor over the age of 50 years with 2 of the following 3 items: (1) history of high blood pressure, (2) serum creatinine ≥1.5 mg/dL, and (3) death due to stroke. To accept an expanded criteria donor kidney may significantly decrease the amount of time a person waits for transplant but requires written informed consent from the recipient. Although expanded criteria donor kidneys have predictably shorter outcomes than standard criteria donors, the exact risk is unknown. At 5 years follow-up, 50% of expanded criteria donor kidneys are still working. Regardless of donor status of these kidneys as expanded criteria or standard criteria, the transplant recipients have higher survival rates compared with candidates who remain on the wait list. The success rate may be increased when a perfusion pump is used to preserve the kidneys. Sometimes the function of a single kidney from an expanded criteria donor is deemed insufficient. In this situation, a pair of marginally functioning kidneys may be transplanted as a dual-kidney transplant. This dual transplant option offers acceptable outcomes as good as a single-kidney transplant with normal function and can effectively address the shortage of donor organs. The use of a perfusion pump allows the clinician to decide whether or not to use a particular expanded criteria donor kidney. Expanded criteria donors may be justified by meticulous selection of each donor for recipients, along with more sophisticated surgical techniques to maximize the kidney donor pool.

Percutaneous methods for the treatment of urothelial tumors of the pyelocaliceal system (case report and literature review)

Urothelial carcinoma is one of the most common solid malignancies. Moreover, urothelial cancer of the ureter of a single kidney is a rare entity that requires nephron-sparing treatment and carries a high risk of postoperative recurrence. An analysis of the literature on this disease was conducted using the databases of PubMed, Scopus, and Web of Science for the period from 2011 to 2022. A clinical case of recurrence of urothelial cancer of the pyelocaliceal system of the kidney in a 73-year-old patient was presented. For the primary tumor, the patient underwent percutaneous laser en bloc resection on the narrow base of the tumor. In case of recurrence, given the acute angle of attack and the wide tumor base, bipolar loop resection became necessary. This clinical observation demonstrates the need for logistical equipment with laser, mono- and bipolar energy sources, and flexible nephroscopes for the most effective and personalized treatment.

Dosing Limitation for Intra-Renal Arterial Infusion of Mesenchymal Stromal Cells.

The immunomodulatory and regenerative properties of mesenchymal stromal cells (MSCs) make MSC therapy a promising therapeutic strategy in kidney disease. A targeted MSC administration via the renal artery offers an efficient delivery method with limited spillover to other organs. Although local administration alleviates safety issues with MSCs in systemic circulation, it introduces new safety concerns in the kidneys. In a porcine model, we employed intra-renal arterial infusion of ten million allogenic adipose tissue-derived MSCs. In order to trigger any potential adverse events, a higher dose (hundred million MSCs) was also included. The kidney function was studied by magnetic resonance imaging after the MSC infusion and again at two weeks post-treatment. The kidneys were assessed by single kidney glomerular filtration rate (skGFR) measurements, histology and inflammation, and fibrosis-related gene expression. None of the measured parameters were affected immediately after the administration of ten million MSCs, but the administration of one hundred million MSCs induced severe adverse events. Renal perfusion was reduced immediately after MSC administration which coincided with the presence of microthrombi in the glomeruli and signs of an instant blood-mediated inflammatory reaction. At two weeks post-treatment, the kidneys that were treated with one hundred million MSCs showed reduced skGFR, signs of tissue inflammation, and glomerular and tubular damage. In conclusions, the intra-renal administration of ten million MSCs is well-tolerated by the porcine kidney. However, higher concentrations (one hundred million MSCs) caused severe kidney damage, implying that very high doses of intra-renally administered MSCs should be undertaken with caution.

Flank-Free Modified Supine vs Prone Ultra-Mini-Percutaneous Nephrolithotomy in Treatment of Medium-Sized Renal Pelvic Stone: A Randomized Clinical Trial.

Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) is the standard treatment of renal stone >2 cm. Ultra-mini-percutaneous nephrolithotomy (UMP) had emerged in the past decade as a new technique in treating renal stones <2 cm. In this study we compared between the outcome of UMP in prone position with the outcome of UMP in modified flank free supine position (FFSP). Materials and Methods: A prospective randomized study was conducted between January 2016 and April 2020, including 122 patients, divided into two matched groups. Group A included 61 patients who underwent UMP in FFSP, and Group B included 61 patients who underwent UMP in a prone position. All patients had a single renal pelvic stone 1-2 cm. Patients with a single kidney, renal anomalies, body mass index ≥40 kg/m2, history of ipsilateral renal surgery, and age <18 years were excluded. In both groups, the dilatation was done up to 13F; a holmium laser was used through a 9F ureteroscope for fragmentation. Nephrostomy tube and ureteral stent were used only when indicated. Results: In total, 122 patients were divided into two groups. The mean age was 40.09 ± 13.63 and 39.67 ± 13.80 years in both groups, respectively. The operative time was 63.64 ± 9.22 and 78.48 ± 9.55 minutes in Groups A and B, respectively (p = 0.0001). The fluoroscopy time was 3.47 ± 0.56 and 4.45 ± 0.39 minutes in Groups A and B, respectively (p = 0.0001). No significant difference was shown between both groups regarding operative and postoperative complications. Shift to mini-PCNL was needed in one patient in Group A and four patients in Group B because of impaired vision. The hospital stay was 25.36 ± 4.23 and 26.13 ± 4.76 hours in both groups, respectively. The initial stone-free rate was 95.1% and 91.8% in both groups, respectively. Conclusions: UMP in modified supine position shows comparable results with UMP in the prone position regarding stone-free rate, hospital stay, and perioperative complication, with significantly shorter operative and fluoroscopy time.

O029 Long term outcomes of renal transplants in kidneys with multiple arteries

Abstract Introduction Variations in kidney arterial anatomy may affect decisions regarding implantation, and in some cases require multiple anastomoses or reconstruction. We aimed to assess the effect of multiple arteries on transplant outcomes. Methods We performed a registry analysis of UK kidney transplants from 2000–2018. Univariate and Multi-variate analyses were performed to assess the effect of multiple arteries on graft outcomes including graft function and the incidence of DGF and vascular thrombosis. Results 13240 living donor (LD) and 28095 deceased donor (DD) transplants were analysed. Warm ischaemic times in single artery kidneys was lower than kidneys with multiple arteries (LD 42 vs 45mins, p=0.025, DD 40 vs 43mins, p&amp;lt;0.001). Donor characteristics were similar between both groups. When adjusted for age, sex, diabetes, cold and warm ischaemic time, there was no difference in mean creatinine at 3, 12 or 60 months in LD and DD with single or multiple arteries. There was an increased incidence in vascular thrombosis seen in LDs with multiple arteries (2.2% vs 4.5%, p=0.008), but not in DDs (3.7% vs 4.0%, p=0.584). There was no difference in DGF or PNF. In LDs, multiple arteries had no effect on transplant survival time (p=0.473), but DDs with multiple arteries had poorer survival (5493 vs 5649 days, p=0.007). Conclusion While multiple arteries may pose technical challenges and are associated with longer warm ischaemic times, the clinical implications of this are minimal. The increased risk of graft thrombosis in LDs is clinically relevant but long-term graft survival and graft outcomes remain excellent. Take-home message Kidneys with multiple arteries can make transplantation more technically challenging, but this has minimal effects on long term graft outcomes.

A clinical case of surgical treatment of a 10-year-old girl with megaureter of the single kidney

Editrial comment. The described long-term multi-stage surgical treatment – performed at the child's place of residence was not adequate and was the threat of losing the only kidney. Management of patients with a non-reflexing form of megaureter, especially in the neonatal period, requires the assessment of not only the state of the kidney and ureter, but also the state of the bladder, in order to exclude the bladder-dependent form of megaureter. Proximal ureterocuteniostomy, especially of a single kidney, should not be used without a preliminary, full-fledged urological examination. Children with complex malformations of the urinary system should be promptly consulted in specialized medical institutions. Introduction. Among congenital malformations of the urinary system, one of the most common is megaureter. The recently developed surgical techniques and, namely, minimally invasive ones for megaureter treatment, in some cases prevent or delay surgical intervention. However, if deterioration of the renal function is seen, especially in patients with the only functioning kidney, radical surgery has to be performed in a timely manner, before the formation of irreversible changes in the renal parenchyma leading to nephrosclerosis. Purpose. To illustrate a successful surgical outcome in a patient with megaureter in the only functioning kidney when surgeons had to consider all anatomical features after ineffective previous surgical corrections. Material and methods. The authors present a clinical observation and management of a 10-year-old patient with megaureter in the only kidney after previous ineffective surgical corrections when both open traditional methods and long-term endovesical stentings were performed but without taking into account the anatomical localization of the ureteral junction. The patient also developed a latent course of urinary tract infection and chronic kidney disease stage 3 by classification of the National Kidney Foundation (NKF), and the working group on improving outcomes of kidney diseases, Kidney Disease Outcomes Quality Initiative (KDOQI). Results. Despite the existing problems – deficit in the ureter length caused by previous surgeries, impossible endovideosurgical laparoscopy because of metabolic disorders – the performed treatment was successful. The surgeons formed ureterocystoanastomosis by Cohen technique with extra-bladder mobilization of the ureter. Dynamic follow-up after surgical treatment lasted for 2 years. During the observation period, urodynamics of the upper urinary tract was restored and, one could see the elimination of leukocyturia, improvement of blood flow in the parenchyma of the only functioning kidney as well as stabilization of nitrogen metabolic parameters and glomerular filtration rate. Conclusion. While choosing surgical management, surgeons should consider anatomical features of the ureterovesical junction. Such an approach has promoted good results in the discussed case.

Kidney Transplantation From Deceased Donors With Vaccine-induced Immune Thrombocytopenia and Thrombosis: An Updated Analysis of the UK Experience.

The emergence and attendant mortality of vaccine-induced immune thrombocytopenia and thrombosis (VITT) as a consequence of vaccination against severe acute respiratory syndrome coronavirus 2 have resulted in some patients with VITT being considered as deceased organ donors. Outcomes after kidney transplantation in this context are poorly described. Because the disease seems to be mediated by antiplatelet factor 4 antibodies, there is a theoretical risk of transmission via passenger leukocytes within the allograft. We analyzed the experience of kidney transplantation from donors with VITT in the United Kingdom between January and June 2021. We followed-up all recipients of kidney-only transplants from donors with VITT to detect major postoperative complications or features of disease transmission and assess graft survival and function. There were 16 kidney donors and 30 single kidney transplant recipients in our study period. Of 11 preimplantation biopsies, 4 showed widespread glomerular microthrombi. After a median of 5 mo, patient and graft survival were 97% and 90%, respectively. The median 3-mo estimated glomerular filtration rate was 51 mL/min/1.73 m 2 . Two recipients had detectable antiplatelet factor 4 antibodies but no evidence of clinical disease after transplantation. Major hemorrhagic complications occurred in 3 recipients, all of whom had independent risk factors for bleeding, resulting in the loss of 2 grafts. The involvement of VITT could not be completely excluded in one of these cases. The UK experience to date shows that favorable outcomes are possible after kidney transplantation from donors with VITT but highlights the need for ongoing vigilance for donor-related complications in these patients.

ОСТРЫЙ ГНОЙНЫЙ ПИЕЛОНЕФРИТ ЕДИНСТВЕННОЙ ПОЧКИ

Background. One of the life-threatening diseases among patients with a single kidney is acute purulent pyelonephritis (APP). The disease is accompanied by oliguria or anuria and in many cases comes with the development of multiple organ dysfunction. Objectives. To present the features of the clinical manifestations of APP of a solitary kidney, the results of clinical and laboratory examination, the role of kidney imaging methods (USG, MRI and contrast-enhanced CT) in identifying foci of purulent destruction in the parenchyma, and the immediate results of treatment of patients with APP of a solitary kidney. Material and methods. 10 patients with APP of a solitary kidney were observed. The role of imaging methods (USG, CT and MRI) of the kidney in the detection of purulent destruction in parenchyma is shown. Methods of treating patients are considered: open organ-preserving surgery, nephrectomy; installation of an internal ureteral stent followed by antibiotic therapy and puncture nephrostomy followed by antibiotic therapy. Results. The best immediate results were noted in the group of patients who underwent open organ-preserving surgery in the volume of decapsulation of the kidney, excision of carbuncles, opening of abscesses and drainage of the calices-pelvis system of the kidney with nephrostomy. 3 out of 10 patients needed hemodialysis. Conclusion. Open organ-preserving surgery remains a reliable adequate method of surgical treatment of APP of a solitary kidney. In case of a single focus of destruction in the kidney parenchyma up to 3 cm in diameter or with signs of apostematous pyelonephritis, an effective method of treatment is the installation of an internal ureteral stent followed by antibiotic therapy. 30% of patients with APP need hemodialysis treatment.