Solitary Kidney Research Articles

Ultrasound‐guided embolization for renal artery pseudoaneurysm in solitary kidney

IntroductionRenal artery pseudoaneurysm is a rare yet serious complication following percutaneous nephrolithotomy, especially in patients with solitary kidneys. Effective management is crucial to prevent further renal damage.Case presentationWe report a case of a 41‐year‐old male with a solitary kidney who experienced gross hematuria and renal insufficiency 3 months after percutaneous nephrolithotomy. Due to the patient's renal insufficiency and the risks associated with arterial catheterization, ultrasound‐guided embolization was chosen as the treatment approach. Initial angiographic attempts were impeded by renal vessel spasms, delaying intervention. However, successful direct percutaneous embolization was subsequently performed using ultrasound and digital subtraction angiography.ConclusionThe patient's recovery was uneventful, and follow‐up assessments showed no recurrence of renal artery pseudoaneurysm. This case highlights the effectiveness of ultrasound‐guided embolization as a viable treatment option for post‐percutaneous nephrolithotomy renal artery pseudoaneurysm, particularly in patients with solitary kidneys.

Efficacy of flexible ureterorenoscopy in treating multiple renal stones: a cohort study.

While the efficacy of flexibleureterorenoscopy (URS) in managing solitary kidney stones (KSs) is widely acknowledged, its effectiveness intreating multiple stones has scarcely been investigated. This study aims to assess the effectiveness and safety of retrogradeintrarenal surgery (RIRS) utilizing flexible URS and laser lithotripsy in the management of multiple KSs. Methods: This study was a single-group cohort study conducted on patients with multiple KSs who underwent treatment withRIRS using flexible URS and laser lithotripsy. Stone-free status was considered as the lack of residual stone fragments or anyresidual stone of any size. The first follow-up appointment was arranged 3-4 weeks following the procedure. If significant residualstones were present, patients underwent reintervention within 2-4 weeks. A total of 110 patients with multiple KSs were included. The mean stone burden was 27.5 ± 7.9 mm, and the mean duration of the operation was 54.9 ± 19.7 minutes. Seven cases(6.3%) experienced intraoperative complications, while postoperative complications were found in eight cases (7.3%). Afterfour weeks, a stone-free rate (SFR) was documented in 80.9% of the cases, and this rate increased to 93.6% after three months.The SFR after three months was significant with Guy's stone score (p < 0.001); however, it did not reach a significant level with any other parameters. Conclusions: The RIRS with flexible URS may be an effective and potentially safe procedure for treating multiple KSs. It mayyield a favorable SFR with an acceptable complication rate.

Non-dilated obstructive nephropathy.

Obstructive nephropathy (ON) is a common and reversible cause of post-renal acute kidney injury (AKI) and may be caused by a variety of conditions. It occurs when both the upper urinary tracts are obstructed, or when one tract is obstructed in patients with a solitary kidney. ON is suspected whenever there is evidence of hydronephrosis at imaging. However, not all patients with obstruction develop hydronephrosis and significant obstruction can be present in the absence of hydronephrosis. This syndrome is called non-dilated obstructive uropathy (NDOU). It accounts for about 5% of cases of urinary obstruction and the diagnosis can be challenging. The current paper provides an overview of the literature aiming to identify the main causes of NDOU and its clinical presentation, in order to clarify when to suspect it among AKI cases. A narrative review was performed due to the overall low quality of the available evidence. Only patients with post-renal AKI and a non-dilated or minimal dilation of the intrarenal collecting system were included. As evidenced by our review, NDOU is most prevalent in the fifth and sixth decades of life and affects mainly the male gender. On hospital admission serum creatinine levels are usually very high. Among the most common clinical presentations are oliguria/anuria, abdominal pain, signs of retention such as oedema or pleural effusion, and nausea/vomiting. About three out of four cases of NDOU are due to an ab-extrinsic compression of the ureters caused by retroperitoneal fibrosis or malignant disease. An effective and minimally invasive urinary diversion is obtained with ureteric stenting or a percutaneous nephrostomy. A correct diagnosis of NDOU may be challenging but it is of paramount importance as it can lead to a prompt management with a potential complete resolution of both obstruction and acute renal failure.

Solitary Kidney Seeks Potassium Alkali to Lower the Pressure.

Solitary Kidney Seeks Potassium Alkali to Lower the Pressure.

Comparison of supine and prone mini percutaneous nephrolithotomy in obese patients: a retrospective study.

To compare the safety and effectiveness of Mini Percutaneous Nephrolithotomy (m-PNL) operations performed in the supine and prone positions in obese patients. We retrospectively analysed data from obese patients (BMI ≥ 30) who underwent prone or supine mPCNL between January 2014 and June 2021 in our clinic. Kidney anomalies, coagulopathy, solitary kidney, skeletal deformity, and patients under 18 were excluded. Outcomes measures included operation time, fluoroscopy time, duration of hospitalisation, stone-free rate, and complications classified by Clavien-Dindo. Statistical analysis was performed using SPSS version 26. The study included 338 patients (100 supine, 238 prone). Supine mPCNL had a shorter mean operation time (89.6 vs. 100.3 minutes, p=0.001), fluoroscopy time, and duration of hospitalisation (60.7 vs. 112.0 hours, p=0.001). Overall complication rates were comparable, but major complications were higher in the prone group (p=0.041). Logistic regression identified stone size >25 mm and prone position as significant risk factors for major complications. Supine and prone mPCNL are both effective for treating kidney stones in obese patients. Supine mPCNL offers benefits, such as shorter operation time, reduced radiation exposure, and fewer major complications. Careful monitoring is recommended for patients with high CCI scores or larger stones due to increased complication risks.

Helsmoortel-Van der Aa syndrome in a 13-year-old girl with autistic spectrum disorder, dysmorphism, a right solitary kidney, and polycystic ovaries: a case report

BackgroundHelsmoortel-Van der Aa syndrome was officially documented in 2014. Helsmoortel-Van der Aa syndrome is an extremely rare complex neurodegenerative disorder characterized by reduced intellectual capacity, motor dysfunction, facial dysmorphism, impaired development, and an increased predisposition to autism spectrum disorder. In addition, many patients also present with neuropsychiatric disorders, including attention deficit hyperactivity disorder, anxiety disorders, and various behavioral abnormalities. Helsmoortel-Van der Aa syndrome is challenging to identify solely on the basis of symptoms, and genetic investigations, including exome sequencing, may facilitate diagnosis.Case presentationWe report a case of 13-year-old Saudi patient who presented with dysmorphic features as illustrated in Fig. 1, severe intellectual disability, autism spectrum disorder, and attention deficit hyperactivity disorder. Initial genetic testing was unremarkable; thus, a clinical exome analysis was performed to identify the genetic basis of the condition.ConclusionsClinical exome analysis indicated an autosomal dominant Helsmoortel-Van der Aa syndrome with a likely pathogenic de novo variant within the activity-dependent neuroprotector homeobox (ADNP) gene not previously reported in Helsmoortel-Van der Aa syndrome. The patient had a right-sided solitary kidney and polycystic ovaries, conditions that were not previously associated with HVDAS.

Salvage stereotactic ablative body radiotherapy after thermal ablation of primary kidney cancer.

To evaluate the effectiveness and safety of salvage stereotactic ablative body radiotherapy (SABR) for recurrent renal cell carcinoma (RCC) after thermal ablation (TA). This study was a multi-institutional retrospective analysis of patients with recurrent RCC following TA who received SABR between 2016 and 2020. The primary study outcome was freedom from local failure, evaluated radiographically based on Response Evaluation Criteria in Solid Tumours (RECIST) v1.1. Distant failure, cancer-specific survival (CSS), overall survival (OS), treatment-related toxicity and renal function changes following SABR were the secondary outcomes. The Kaplan-Meier method was used to estimate freedom from local and distant failure, CSS and OS. Seventeen patients with 18 biopsy-confirmed RCCs were included, with a median (interquartile range [IQR]) age at time of SABR of 75.2 (72.6-68.7) years, a median (IQR) tumour size of 3.5 (1.9-4.1) cm and follow-up (reverse Kaplan-Meier method) of 3.36 (95% confidence interval [CI] 1.6-4.1) years. Six of the 17 patients had a solitary kidney. Five patients had failed repeat TA prior to SABR. The median (IQR) time from TA procedure to SABR was 3.03 (1.5-5.1) years. No patient experienced local progression, with a local control rate of 100%. Four patients, two with baseline metastatic disease, experienced distant progression. The distant progression-free survival, CSS and OS at 3 years were 72.1% (95% CI 51.9%-100%), 92.3% (95% CI 78.9%-100%) and 82.1% (95% CI 62.1%-100%), respectively. The median (IQR) glomerular filtration rate before SABR was 58 (40-71) mL/min, and at last follow-up, it was 48 (33-57) mL/min. No patient experienced grade 3+ toxicity or went on to develop end-stage renal disease. The results showed that SABR appears to be an effective and safe salvage strategy in patients with recurrent RCC following TA.

23 Pre-surgical visceral adipose tissue may be a novel pre-surgical risk factor for acute kidney injury among clear cell renal cell cancer patients undergoing radical nephrectomy

Abstract Background Patients with renal cancer undergoing partial (PN) or radical nephrectomy (RN) are at risk for acute kidney injury (AKI). Established risk factor for AKI include baseline comorbidities (e.g., obesity, hypertension), normal renal parenchymal loss, and ischemia-reperfusion injury. Pre-surgical body composition may be an overlooked modifiable patient characteristic that influences risk of AKI. We hypothesized that patients with higher visceral adipose tissue quantity or lower skeletal muscle quantity would have a higher risk of AKI. Methods The RESOLVE study at Memorial Sloan Kettering Cancer Center is a retrospective study of 1239 patients with stage I-III clear cell renal cell carcinoma (ccRCC) undergoing PN or RN from 2000 to 2020. We excluded from analysis patients with solitary kidney, those without preoperative serum creatinine (sCr) measurements, and those without a sCr measurement within seven days following nephrectomy, yielding a study population of 1,200 ccRCC patients with longitudinal sCr assessment (n=754 PN; n=446 PN). AKI was defined as a binary variable using the Kidney Disease – Improving Global Outcomes (KDIGO) criteria, based on a threshold of either a 1.5x relative or 0.3 mg/dl absolute increase in sCr within seven days. The cross-sectional areas and radiodensities of visceral adipose and skeletal muscle tissues were determined from pre-surgical computed tomography (CT) scans at the third lumbar vertebrae using Automatica software. We used generalized linear models with a binomial family and identity link to estimate seven-day risk differences (RD) and 95% confidence intervals in subgroups defined by surgery type. Results AKI was more frequent among patients undergoing RN (66% vs 26% among PN). Male patients, those with higher eGFR prior to surgery, those with lower stage/smaller tumors, and those with a history of hyperlipidemia more frequently experienced AKI in the post-operative period. No associations were observed with other reported comorbidities (diabetes, hypertension). While no association was observed between BMI and risk of AKI, visceral adipose and skeletal muscle variables were significantly associated with risk of AKI in univariate models. After adjustment for age, sex, comorbidities, and other body composition variables, only higher visceral adipose tissue quantity remained significantly associated with increased risk of AKI [RD per 40 unit increase (95% CI): 5.2 (1.3, 9.2)]. Muscle characteristics were not associated with AKI in multivariable models. Among patients undergoing PN, we observed a higher frequency of AKI among male patients, those with higher stage/larger tumors, and those with longer ischemia times. No significant associations were observed with comorbidity histories. In univariate models, visceral adipose tissue quantity and quality as well as skeletal muscle quantity were associated with AKI risk; however, after adjustment for age, sex, comorbidities, and other body composition variables, we observed no significant associations between any body composition feature and AKI in patients undergoing PN. Conclusions Associations between pre-surgical body composition and risk of AKI vary by surgery type. Visceral adipose tissue quantity was associated with risk of AKI among patients undergoing RN, but not PN. This finding may be relevant for patient counseling, consideration for nephron-sparing surgery, and development of interventions to lower visceral adipose tissue quantity. Future studies should evaluate the impact of both pre-surgical and post-surgical change in body composition in relation on chronic kidney disease after nephrectomy.

The Landscape of Stereotactic Ablative Radiotherapy (SABR) for Renal Cell Cancer (RCC).

Renal cell cancer (RCC) has traditionally been considered radioresistant. Because of this, conventional radiotherapy (RT) has been predominantly relegated to the palliation of symptomatic metastatic disease. The implementation of stereotactic ablative radiotherapy (SABR) has made it possible to deliver higher ablative doses safely, shifting the renal radioresistance paradigm. SABR has increasingly been adopted into the multidisciplinary framework for the treatment of locally recurrent, oligoprogressive, and oligometastatic disease. Furthermore, there is growing evidence of SABR as a non-invasive definitive therapy in patients with primary RCC who are medically inoperable or who decline surgery, unsuited to invasive ablation (surgery or percutaneous techniques), or at high-risk of requiring post-operative dialysis. Encouraging outcomes have even been reported in cases of solitary kidney or pre-existing chronic disease (poor eGFR), with a high likelihood of preserving renal function. A review of clinical evidence supporting the use of ablative radiotherapy (SABR) in primary, recurrent, and metastatic RCC has been conducted. Given the potential immunogenic effect of the high RT doses, we also explore emerging opportunities to combine SABR with systemic treatments. In addition, we explore future directions and ongoing clinical trials in the evolving landscape of this disease.

Bilateral simultaneous partial nephrectomy

Introduction. Partial nephrectomy is the treatment of choice for small renal tumors. There are other indications include tumors in a solitary kidney, multiple and bilateral tumors.Сase presentation. A 67-year-old male presented with left flank pain and lower urinary tract symptoms. Computed tomography for abdominal and pelvis showed bilateral renal masses. After doing the essential laboratory tests and investigations, he underwent bilateral open simultaneous partial nephrectomies. After two days, he was discharged with no complains. Follow-up after three months showed no recurrence and acceptable renal function.Discussion. Partial nephrectomy is increasingly used for the management of renal masses. The preservation of renal function with reduced morbidity and equivalent oncologic outcomes led to a paradigm shift away from radical nephrectomy.Conclusion. Bilateral partial nephrectomy is feasible with both clinical and oncological good results.

Stereotactic Body Radiation Therapy for Primary Renal Cell Carcinoma: A Case-Based Radiosurgery Society Practice Guide

Traditionally, renal cell carcinoma (RCC) was considered a radioresistant tumor, thereby limiting definitive radiation therapy management options. However, several recent studies have demonstrated that stereotactic body radiation therapy (SBRT) can achieve high rates of local control for the treatment of primary RCC. In the setting of expanding use of SBRT for primary RCC, it is crucial to provide guidance on practical considerations such as patient selection, fractionation, target delineation, and response assessment. This is particularly important in challenging scenarios where a paucity of evidence exists, such as in patients with a solitary kidney, bulky tumors, or tumor thrombus. The Radiosurgery Society endorses this case-based guide to provide a practical framework for delivering SBRT to primary RCC, exemplified by 3 cases. This article explores topics of tumor size and dose fractionation, impact on renal function and treatment in the setting of a solitary kidney, and radiation's role in the management of inferior vena cava tumor thrombus. Additionally, we review existing evidence and expert opinion on target delineation, advanced techniques such as magnetic resonance imaging guided SBRT, and SBRT response assessment.

Renal function after ureteral reconstruction surgery in patients with solitary kidney.

Ureteral strictures (US) could lead to impaired kidney function, which was alleviated by ureteral reconstruction surgery. However, solitary kidney (SK) patients with US were more complicated to treat. This study aimed to evaluate the impact of reconstruction surgery on renal function based on estimated glomerular filtration rate (eGFR) in patients with SK. We retrospectively enrolled patients who underwent reconstruction surgery between April 2014 to March 2022. eGFR was measured pre- and postoperatively. The 'static renal function' was defined as a change in eGFR of 20% or less at the last follow-up, and the 'worsening renal function group' was defined as a decrease of greater than 20%. A total of 61 SK patients were involved. The success rate of ureteral reconstruction surgery was 90.16% (55/61). The median follow-up time was 20.8 months (range, 3.7-109.2 months). The median eGFR was 65.5 (range, 15.1-99.9) and 65.3 (range, 3.8-123.4) mL/min/1.73 m2 at the baseline and the last follow-up. No statistically significant difference in eGFR was observed between the preoperative baseline and last follow-up visits (P=0.58). However, in patients with baseline renal dysfunction [chronic kidney disease (CKD) stage 3-5], the eGFR significantly improved at the last follow-up compared to the baseline (P=0.02). Three patients developed a 'worsening renal function' (4.92%). Besides, the systolic blood pressures (SBP) at follow-up significantly reduced compared to the preoperative baseline (P=0.002). Ureteral reconstruction surgery is an effective treatment to preserve renal function, which also achieves a high success rate and is associated with the reduction of SBP for SK patients with US.

Case Study: Co-existing Isolated Internal Iliac Artery Aneurysm and Solitary Kidney

Purpose: The purpose of this case study is to report on an isolated internal iliac artery aneurysm (IIIAA) with solitary kidney found during cadaveric dissection and to discuss potential clinical implications of such a variation. Methods: IIIAA and solitary kidney were discovered during cadaveric dissection performed by six nursing graduate students at Samford University in Birmingham, Alabama. Upon discovery, a literature review was performed to consider clinical implications, patient presentation, and management strategies associated with IIIAA and solitary kidney. This is the first time the pairing of these variations has been reported and thus it is difficult to speculate whether or not this person had symptoms associated with either of these conditions. Results: IIIAA is independently associated with bladder, ureter, rectal, iliac vein, and sciatic nerve symptoms. Solitary kidney is associated with hypertension and end-stage renal disease. Conclusion: As this variation was discovered post-mortem, it is unknown whether this condition was symptomatic.

Correlation of Ablation Volume with Renal Function Loss after Cryoablation in Solitary Functioning Kidneys

PurposeTo determine the degree of renal function deterioration after renal cryoablation in patients with a solitary functioning kidney on the basis of ablation volume. Materials and MethodsOver a 15-year period, 81 percutaneous cryoablations were performed in solitary functioning kidneys. After exclusion of patients with baseline end-stage renal disease (ESRD) and insufficient follow-up, analysis was performed on 65 procedures in 52 patients (40 men; mean age, 63.5 years). The postcryoablation renal function was based on the lowest serum creatinine within 6 months after procedure. Renal function change was defined as percentage glomerular filtration rate (GFR) change. Volumetric analysis was performed on the target lesion, renal parenchyma, and ablation zone. ResultsThe median tumor diameter was 2.0 cm (range, 0.8–4.7 cm). The median baseline GFR decreased from 56.4 mL/min/1.73 m2 (range, 17.5–89.7 mL/min/1.73 m2) to 46.9 mL/min/1.73 m2 (range, 16.5–89.7 mL/min/1.73 m2) at median of 95 days (P < .001), equating to a −7.9% median renal function change (range, −45.0% to +30.7%). All patients had Stage 2 or worse chronic kidney disease, and baseline function did not correlate with renal function change. The median volume of ablated parenchyma was 19.7 mL (range, 2.4–87.3 mL), equating to 8.1% (range, 0.7%–37.2%) of total parenchyma. The volume of parenchymal volume ablated correlated significantly with renal function loss, whereas age, hypertension, and diabetes mellitus did not. No patient developed ESRD within 1 year after cryoablation. ConclusionsCryoablation in solitary functioning kidneys resulted in a modest reduction in renal function, even in patients with chronic kidney disease and ablations of up to 20% of renal parenchymal volume.

Matrix calculi in systemic lupus erythematosus complicated by distal renal tubular acidosis in a solitary kidney

Matrix calculi in systemic lupus erythematosus complicated by distal renal tubular acidosis in a solitary kidney

COMPARISON OF SUCCESS OF EXTRACORPOREAL LITHOTRIPSY (ESWL) AND LASER URETERORENOSCOPY IN PROXIMAL URETERIC STONES

Managing ureteral stones to achieve complete stone clearance with minimal patient morbidity involves several therapeutic approaches. The commonly used methods include extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS), percutaneous nephrolithotripsy, laparoscopic ureterolithotomy, and open ureterolithotomy. However, definitive evidence-based options for managing large proximal ureteral stones are lacking. Objective: To compare extracorporeal shock wave lithotripsy (ESWL) and laser ureterorenoscopy (URS) success rates in treating proximal ureteric stones. Methods: This randomized controlled trial was conducted in the Department of Urology &amp; Renal Transplantation at Bahawal Victoria Hospital, Bahawalpur, from January 1, 2020, to May 31, 2021. One hundred four patients, aged 20 to 60, with single proximal ureteric stones measuring 8-15 mm, were included. Patients with pyonephrosis, sepsis, bleeding disorders, solitary kidney, previous open ureterolithotomy, chronic renal failure, proteinuria, recurrent urinary tract infections, congenital urinary tract obstruction, bladder outflow obstruction, chronic liver disease, or a history of chronic drug usage were excluded. Patients were randomized into two groups: Group A underwent URS lithotripsy with DJ stent placement, while Group B underwent ESWL with DJ stent placement. A single surgeon performed all procedures. Pre-operative antibiotics and analgesics were administered to all patients. Stone clearance was assessed two weeks post-procedure. Statistical analysis was performed using appropriate methods, with a p-value ≤ 0.05 considered significant. Results: The mean age of patients in Group A was 37.52 ± 11.20 years, and in Group B was 36.73 ± 10.57 years. Most patients (75, 72.12%) were between 20 and 40. Out of the 104 patients, 63 (60.58%) were male, and 41 (39.42%) were female, with a male-to-female ratio of 1.7:1. Complete stone clearance was achieved in 44 (84.62%) patients in Group A (URS group) and 30 (57.69%) patients in Group B (ESWL group), with a statistically significant p-value of 0.002. The study concluded that the stone clearance rate after laser ureterorenoscopy (URS) is significantly higher than extracorporeal shock wave lithotripsy (ESWL) for proximal ureteric stones.

#2575 GFR in onco-nephrology: the innovative use of measured GFR in the management of oncological solitary kidney

Abstract Background and Aims A reliable assessment of renal function in onco-nephrology and especially in oncological solitary kidney (SK) is of paramount importance. Nowadays, the use of estimated GFR is predominant in clinical practice because it is fast, easy and cost-effective. However, eGFR harbours a significant error in comparison to gold standards methods using exogenous molecules such as iohexol or iothalamate (mGFR). Aim of this study was to determine the extent of the error of eGFR compared to the mGFR in onco-nephrological patients with a solitary kidney (SK) after nephrectomy (RN). Method A total consecutive cohort of 200 SK who previous underwent RN for renal cancer was enrolled in a single tertiary institution from 2017 to 2023 to compare the most used eGFR formulas (MDRD, CKD-EPI crea 2012, CKD-EPI 2021 crea, CKD-EPI cyst 2012, CKD-EPI Cyst 2021, CKD-EPI cyst/creat, Cockroft-Gault) with a mGFR method using Iohexol Plasma Clearance. Clinical and laboratory data were reported for each patient. True positives (TP) and False positives, (FP) were classified in CKD stages based on eGFR and mGFR. Comparisons between groups were performed using Wilcoxon ranks sum test for numerical variables and Pearson's Chi square test for categorical ones. Results Overall median age was 67 years (IQR: 56.75), median BMI 24.8 (IQR: 22.8; 27.7), Male: 74.9%,F: 25.1% Diabetes: 10.9% Hypertension: 53.8%, CKD stage I: 3.7%, II: 25.5%, IIIA:28,IIIB: 27.5%, IV: 13.4%, V: 1.74%, mean Creatinine:1,46 mg/dl (1.16-1,84), cystatin: 1.23 (0.95-1.56). Surprisingly, SK cohort harboured a non-negligible errors in each CKD class with a huge discrepancy between the eGFR formulas and the gold standard method (Figs 1 and 2), suggesting the great relevance of mGFR in the clinical decision making algorithm. Conclusion The use of mGFR in nephrectomized patients for RC remains fundamental to avoid misleading evaluations and to perform correct personalized pharmacological therapies.

#2071 The metabolic syndrome impact in the onco-nephrological scenario of renal cancer: when comorbidities beat surgery

Abstract Background and Aims Metabolic syndrome (MS) represents a pathological state in which many risk factors for CKD including obesity, hyperglycemia, hypertension and dyslipidemia co-occur within individuals. In the past decade different lines of evidence underlined the relationship between MS and CKD, two increasing worldwide serious threat to life. With the rise of onco-nephrology, there is a strong need to define the role of MS in the nephrological management of oncological patients. Our study aimed to assess the impact of metabolic syndrome on renal function in patients undergoing partial nephrectomy (PN) for renal cancer (RC). Method We retrospectively analyzed data from 1,112 patients undergoing PN at a tertiary referral center between 2000 and 2023. Patients with metastatic disease, hereditary cancer or a solitary kidney were excluded. Renal function was evaluated with eGFR values using CKD-EPI 2021 formula. AKI and CKD onset were defined using K-DIGO 2012 criteria. MS was defined as at least 3 of the following conditions: obesity, insulin resistance, dyslipidemia and hypertension. Multivariable analyses (MA) were used to determine the impact of MS on preoperative eGFR impairment and post-operative AKI. Covariates were intraoperative blood loss, surgical experience, pT stage, type of surgery (open vs minimally invasive), pre-existing CKD, age, and comorbidities (defined as Charlson Comorbidity Index&amp;gt;3). Results Overall, the rate of MS was 9% (n = 100). The median follow-up was 60 months (IQR 28-68). Patients with MS had lower preoperative eGFR (78 ml/min vs. 87 ml/min), higher estimated blood loss (500 ml vs. 300 ml) and higher rate of complications (38% vs. 29%) relative to non-MS counterparts (all p &amp;lt; 0.001). Additionally, the rate of AKI was 25% (n = 25) vs 18% (n = 182) for metabolic vs non-MS patients (p = 0.01), respectively. At MVA, MS was an independent predictor for both lower preoperative eGFR (OR 1.07, 95% CI 1.01-1.14, p = 0.01) and higher risk of AKI (OR 2.1, 95% CI 1.3-4.1, p = 0.01). MS patients had a worse kidney function at baseline, had higher risk of AKI immediately after surgery and a higher risk of CKD onset over time, with a steep reduction of eGFR even at long term follow-up (Fig. 1). Conclusion Renal cancer patients diagnosed with MS harbored an increased risk of both AKI and CKD even with a partial nephrectomy. Therefore, the role of onco-nephrologists and nutritionists remains a cornerstone in the management of such cohort of patients, before and after surgery.

#2665 Acute kidney injury (AKI) and chronic kidney disease (CKD) in living kidney donors (LKD): time for a new “surgical” classification system?

Abstract Background and Aims Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD) represent two significant complications in patients who undergo radical (RN) nephrectomy in oncological patients. However, Living kidney donors (LKD) undergo a similar surgery, but kidney dysfunctions are rare. Our study aimed to investigate the incidence of AKI and CKD in a consecutive cohort of LKD. Method This multi-institutional study involved 256 kidney donors who performed RN between 2014 and 2021 in four tertiary care hospitals. Clinical and laboratory data were collected at baseline pre-surgery, six months after surgery, and then every 12 months for a five-year follow-up. eGFR was calculated with the CKD-EPI equation. Statistical analysis was performed using descriptive statistics and logistic regression. Results Descriptive analysis is reported in Table 1. Of note, the rate of AKI was high (85%), even though it was 100% of stage 1. At 12 months, LKD missed 27.9 ± 19.67 ml/min/1.73 m2, persisting stable at 60 months. 26% of patients developed CKD stage GIII, and 10% of patients lost about 30 ml/min/1.73 m2 from the baseline eGFR (Fig. 1 and Tables 1 and 2). The multivariate analysis (logistic regression) showed that age had a direct correlation with the risk of AKI (OR 1.057, p = 0.019), while the female sex was inversely correlated (OR 0.180, p = 0.006); on the other hand, age had a direct correlation with the risk of CKD (OR 1.15, p = 0.001), as well as eGFR before the surgery (OR 1,053, p = 0.027). Conclusion AKI and CKD affected a non-negligible percentage of LKD. However, it is remarkable that most LKD had a medium final eGFR &amp;gt;60 ml/min/1.73 m2 due to a healthy solitary kidney that worked properly, increasing its function by about 30% of its baseline capacity.

Rate of Post Obstructive Diuresis in Rapid Versus Gradual Bladder Decompression in Patients with Chronic Urinary Retention

Background: Post-obstructive diuresis (POD) is a polyuric state in which copious amounts of salt and water are eliminated after the relief of a urinary tract obstruction. POD is a clinical diagnosis based on urine output exceeding 200 mL per hour for two or more consecutives hours or 3L in 24 hours after decompressing an obstructed bladder, bilateral ureteric obstruction or unilateral ureteric obstruction in a solitary kidney. Methodology: This was a prospective, randomized study in which patients with chronic urinary retention were randomized into two groups: A and B. Group A had rapid urinary decompression with 18Fr urethral catheter attached to a urine bag, while group B had gradual decompression using a urethral catheter attached to an intravenous fluid giving set which was then attached to urine bag. Post obstructive diuresis in each group were assessed at designated times. Data Analysis and Result Presentation: Data was analyzed using the Statistical Package for Social Sciences (IBM) SPSS version 21. Data was summarized by descriptive statistics. The two arms were compared for similarities in demographic variables. Continuous and categorical variables were compared using student t- test and Pearsons‘ Chi – square respectively. Significant p value was 0.05. Result: Sixty patients were recruited into the study and randomized into group A (rapid urinary decompression) and B (gradual urinary decompression) with 30 patients in each group. Thirteen patients (43.33%) had post obstructive diuresis in group A compared to 15 patients (50%) in group B. p value of 0.584. Diuresis resolved within 24 hours in 9 patients (30%) in group A and 11 patients (36.7%) in group B. p value of 0.999. The mean reduction in systolic blood pressure was 8.21 ± 2.63mmHg in group A and 7.63 ± 2.14mmHg in group B. p value of 0.583. The mean reduction diastolic blood pressure was 3.84 ± 1.31mmHg in group A and 3.41 ± 1.16mmHg in group B. P value of 0.624. No patient in both groups developed hypotension (BP of &amp;lt;90/60). Conclusion: There was no statistically significant different in post obstructive diuresis. However, over 46.7% of patients had diuresis in both groups without any one developing hypotension. This may be due to routine prophylactic fluid and electrolyte replacement using normal saline.