Unilateral Kidney Disease Research Articles

The role of nuclear medicine techniques; Tc-99m-labeled dimercaptosuccinic acid, diethylenetriaminepentaacetic acid, and mercaptoacetyltriglycine scintigraphies in pediatric surgery

The purpose of this review is to highlight the pivotal role of nuclear medicine in pediatric surgery, specifically in the diagnosis and management of nephro-urological conditions. This review focuses on the applications and advantages of three key nuclear medicine techniques: Tc-99m dimercaptosuccinic acid (DMSA), Tc-99m diethylenetriaminepentaacetic acid (DTPA), and Tc-99m mercaptoacetyltriglycine (MAG3) scintigraphies. These imaging modalities are crucial for providing detailed anatomical and functional information with minimal invasiveness, essential for evaluating congenital anomalies, urinary tract infections, and obstructive uropathies in children. DMSA Scintigraphy is established as the gold standard for detecting renal cortical scarring and assessing functional renal parenchymal damage. It offers superior sensitivity and specificity compared to other imaging techniques, making it indispensable for identifying renal scars from recurrent urinary tract infections or pyelonephritis. DTPA Scintigraphy is critical for measuring glomerular filtration rate (GFR) and analyzing renogram curves, providing quantitative assessments of renal function. It effectively evaluates renal perfusion and identifies perfusion defects and renal ischemia, essential for managing conditions like renal artery stenosis and unilateral kidney disease. MAG3 Scintigraphy excels in dynamic renal scintigraphy, particularly in patients with impaired renal function. It provides high-quality images and superior diagnostic capability, making it invaluable for assessing ureteropelvic junction obstruction and other obstructive uropathies in pediatric patients. The review concludes by emphasizing the integration of these scintigraphy techniques with SPECT/CT, enhancing diagnostic accuracy and providing comprehensive anatomical and functional insights. Despite concerns regarding radiation exposure, measures such as dose optimization and advanced imaging techniques ensure safety and efficacy in pediatric applications.

Colonic microflora and plasma metabolite-based comparative analysis of unilateral ureteral obstruction-induced chronic kidney disease after treatment with the Chinese medicine FuZhengHuaYuJiangZhuTongLuo and AST-120

BackgroundMany researchers have investigated the use of Chinese herbs to delay the progression of chronic kidney disease (CKD) through their effects on colonic microflora and microbiota-derived metabolites. However, whether FuZhengHuaYuJiangZhuTongLuo (FZHY) has effects that are similar to those of AST-120 on CKD needs to be elucidated. MethodsIn this study, we compared the effects of FZHY and AST-120 on the colonic microbiota and plasma metabolites in the CKD rat model. We developed a unilateral ureteral obstruction (UUO)-induced CKD rat model and then administered FZHY and AST-120 to these model rats. Non-targeted metabolomic LC-MS analysis, 16S rRNA sequencing, and histopathological staining were performed on plasma, stool, and kidney tissues, respectively, and the joint correlation between biomarkers and metabolites of candidate bacteria was analyzed. ResultsOur results showed that administering FZHY and AST-120 effectively ameliorated UUO-induced abnormal renal function and renal fibrosis and regulated the composition of microbiota and metabolites. Compared to the UUO model group, the p_Firmicutes and o_Peptostreptococcales_Tissierellales were increased, while 14 negative ion metabolites were upregulated and 21 were downregulated after FZHY treatment. Additionally, 40 positive ion metabolites were upregulated and 63 were downregulated. On the other hand, AST-120 treatment resulted in an increase in the levels of g_Prevotellaceae_NK3B31_group and f_Prevotellaceae, as well as 12 upregulated and 23 downregulated negative ion metabolites and 56 upregulated and 63 downregulated positive ion metabolites. Besides, FZHY increased the levels of candidate bacterial biomarkers that were found to be negatively correlated with some poisonous metabolites, such as 4-hydroxyretinoic acid, and positively correlated with beneficial metabolites, such as l-arginine. AST-120 increased the levels of candidate bacterial biomarkers that were negatively correlated with some toxic metabolites, such as glycoursodeoxycholic acid, 4-ethylphenol, and indole-3-acetic acid. ConclusionFZHY and AST-120 effectively reduced kidney damage, in which, the recovery of some dysregulated bacteria and metabolites are probably involved. As their mechanisms of regulation were different, FZHY might play a complementary role to AST-120 in treating CKD.

45. Undiagnosed OHVIRA Presenting as Tubo-ovarian Abscess Managed With Interval Vaginal and Abdominal Drainage

<h3>Background</h3> Obstructed hemi-vagina and ipsilateral renal anomaly (OHVIRA) typically presents with pelvic pain after menarche due to outflow obstruction. We present a case of a 17-year-old girl with history of renal anomaly who developed fever and pain and was found to have a tubo-ovarian abscess (TOA) and OHVIRA, treated with antibiotics and vaginal and intra-abdominal drainage. <h3>Case</h3> A 17-year-old female presented with fevers, abdominal pain, vomiting and diarrhea. She had menarche at age 11, and history of obesity, hearing loss, and right nephrectomy for unilateral congenital kidney disease. She denied prior sexual activity. At an outside hospital, she was diagnosed with rhinovirus and had a white blood cell count (WBC) of 27 × 10(3)/mcL. On exam, she had abdominal tenderness and a suspected oblique vaginal septum. MRI imaging confirmed the diagnosis of OHVIRA with 12 × 7 × 5 cm tubo-ovarian abscess and she was transferred to our tertiary care pediatric hospital. She was started on doxycycline, metronidazole, and piperacillin-tazobactam, but had persistent pain and was taken to the operating room for exam under anesthesia and drainage. We noted purulent vaginal discharge and a palpable right vaginal wall bulge which was incised, revealing purulent fluid. A 24 French Malecot drain was placed through the vaginal septum incision. She continued to have pain and WBC of 20 × 10(3)/mcL. Interventional radiology performed ultrasound-guided drainage and placed two transabdominal pigtail catheters into the TOA. Both vaginal and abdominal catheters drained purulent fluid, with gram negative and positive rods on gram stain, no growth on culture. Due to persistent pain and high WBC, she then underwent diagnostic laparoscopy/washout which showed uterine didelphys, normal left fallopian tube and ovary, and persistent right tubo-ovarian abscess, which was copiously irrigated and suctioned. Postoperatively, pain resolved and WBC normalized. Abdominal drains were removed and she was discharged home with norethindrone for menstrual suppression and oral doxycycline and metronidazole, followed by prophylactic doxycycline until definitive vaginal septum resection. <h3>Comments</h3> Obstructed hemi-vagina and ipsilateral renal anomaly (OHVIRA) is a Mullerian anomaly typically presenting with worsening dysmenorrhea +/- a pelvic mass. This patient had never been sexually active, had negative STI testing, and had menstruated for six years. We suspect she may have had microperforation in her septum allowing for both a path for ascending infection and delayed presentation of OHVIRA due to menstrual outflow. While patients with OHIVRA often undergo vaginoplasty at time of diagnosis, she required staged intervention due to elevated risk of infectious complications.

P0117DOSE ESCALATING TOXICOLOGY STUDY OF ELP-VEGF, A NOVEL BIOLOGIC FOR RENAL THERAPEUTIC ANGIOGENESIS

Abstract Background and Aims Chronic renal disease, irrespective of the etiology, is hallmarked by renal microvascular rarefaction. This rarefaction is associated with a reduced bioavailability of the pro-angiogenic cytokine vascular endothelial growth factor (VEGF). Recently, we developed a therapeutic intervention for ischemic renal conditions using therapeutic angiogenesis – supplementing renal VEGF levels. This was achieved by administration of a biopolymer-stabilized form of VEGF using a fusion protein between human VEGF-A121 and an elastin-like polypeptide carrier protein (ELP-VEGF). ELP-VEGF induced microvascular remodeling and increased microvascular density when administered intra-renally in swine models of unilateral renovascular disease (RVD) and chronic kidney disease (CKD), which was associated with improved renal function, reduced renal inflammation, and reduced renal fibrosis. Also, ELP-VEGF targeted the kidney when administered systemically and induced similar beneficial effects on renal function and renal vascular density. The therapeutic dose of ELP-VEGF in the swine models was 0.1 mg/kg when administered intra-renally and 1.0 mg/kg when administered intravenously. The aims of the present study were to determine the maximum tolerated dose of ELP-VEGF and assess its dose-related toxicity. We hypothesize that ELP-VEGF will not exhibit toxicity at therapeutic doses. Method A dose escalating toxicology experiment was performed in Sprague Dawley. Female rats were instrumented with either carotid catheters or carotid artery telemeters for blood pressure monitoring. After a recovery period, a baseline 24-hour urine sample was collected, and baseline glomerular filtration rate (GFR) was measured by monitoring FITC-sinistrin clearance via transdermal fluorescence. A single injection of saline control or ELP-VEGF (0.1, 1, 10, 100, or 200 mg/kg) was administered, and blood pressure was monitored by telemetry or by direct carotid arterial pressure measurements. Body weights were monitored daily throughout the study, and 24-hour urine collections and GFR measurements were repeated 7 and 14 days after protein injection. On day 14 after injection, blood was collected, one kidney was collected and fixed for histological examination, and the second kidney was perfused with Microfil vascular contrast agent for quantification of renal vascular density by micro-CT. Results ELP-VEGF caused no significant changes in body weight at any dose. At the highest doses there was an acute drop in blood pressure (20 – 30 mm Hg at 100 and 200 mg/kg dose, respectively) for approximately twenty minutes post-injection which then normalized. GFR was unchanged by ELP-VEGF at doses up to 100 mg/kg. However, GFR was significantly increased 14 days after treatment with 200 mg/kg ELP-VEGF (1.5 +/- 0.3 versus 2.7 +/- 0.3 mL/min/100 g body weight, p=0.0021). Plasma toxicology revealed no changes in markers of liver or kidney toxicity (AST, ALT, BUN, creatinine, LDH, bilirubin) at any dose or time point. Renal vascular density was unaffected by ELP-VEGF at doses up to 10 mg/kg. However, at 200 mg/kg ELP-VEGF, renal vascular density was significantly decreased for small (0 – 100 micron, p=0.0007) and intermediate (100 – 200 micron, p=0.028) sized vessels Conclusion ELP-VEGF has a proven therapeutic potential for treatment of RVD and CKD at therapeutic doses ranging from 0.1 – 1.0 mg/kg in swine models. Dose escalating toxicity assessment in rats found no effect of ELP-VEGF on body weight, blood pressure, plasma markers of liver and renal toxicity, GFR, or renal vascular density at these therapeutic doses. ELP-VEGF doses of 100 – 200 mg/kg caused transient hypotension immediately after the injection and were associated with increased GFR and loss of renal vascular density, possibly indicating renal damage at ultra-high doses. We conclude that the therapeutic window for ELP-VEGF is 100 – 1,000 times the effective therapeutic dose.

Evaluation of Renal Function in Obstructed Ureter Model Using 99mTc-DMSA.

Urinary obstruction is a condition of impaired urinary drainage, which may result in progressive renal deterioration. This study applied 99mTc-labeled dimercaptosuccinic acid (99mTc-DMSA) renal scintigraphy to a rabbit model of right ureter obstruction and evaluated its utility in studying obstructive renal diseases. Complete unilateral ureter obstruction in rabbits was generated by complete ligation of the right ureter. Renal function was investigated during a 4-week post-obstruction period by obtaining planar images of 99mTc-DMSA activity following ear vein injection. Renal blood perfusion was evaluated by non-invasive scintigraphy in conjunction with parallel histological and hematological examinations. Renal perfusion was remarkably and rapidly reduced in the ureter-obstructed kidneys. During the experimental period, the size of left kidney appeared normal in the scintigraphic images, but the ureter-obstructed right kidney progressively became larger. Histopathological examination showed flattening and atrophy of tubules, enlargement of interstitial areas, accumulation of extracellular martices and infiltration of inflammatory cells in the obstreucted kidney. 99mTc-DMSA scintigraphy is a sensitive, non-invasive method to assess renal function in unilateral kidney diseases.

Evaluation of Split Renal Function for Children with Kidney Diseases by Renal and Vascular Color Ultrasonography

Renal dynamic imaging and radionuclide renography use radioactivity to evaluate split renal function. We aimed to investigate the use of renal vascular color Doppler ultrasonography for evaluation of split renal function in children. Thirty-five children with unilateral kidney diseases were enrolled. For patients with unilateral renal tumor, peak systolic velocity (Vmax = 113.04 ± 13.59 cm/s) and resistance index (RI = 0.73 ± 0.02) were higher on abnormal compared with normal sides (Vmax = 86.03 ± 6.49 cm/s, RI = 0.62 ± 0.01), and blood perfusion was good, indicating compensatory enhancement in split renal function. For unilateral renal cyst, Vmax (58.20 ± 7.38 cm/s) was lower on the abnormal compared with the normal (87.71 ± 14.83 cm/s) size, and perfusion was poor. For unilateral hydronephrosis and renal atrophy, the parameters were similar to those of renal cyst, suggesting a weakening of renal function. For unilateral renal agenesis, Vmax (106.07 ± 13.07 cm/s) and RI (0.71 ± 0.05) were higher, and perfusion was good. Renal vascular color Doppler ultrasonography was superior in the evaluation of split renal function in children, without being invasive or radioactive.

Long-term Follow Up of a Boy with Unilateral Autosomal Dominant Polycystic Kidney Disease and Contralateral Renal Agenesis

In patients with autosomal dominant polycystic kidney disease (ADPKD) coexisting abnormalities of the urinary tract are considered rare. Only a few patients with ADPKD and congenital abnormalities of the kidney and urinary tract- renal agenesis, hypoplasia, aplasia, horseshoe kidney, ectopic multicystic dysplasic kidney, or subpelvic junction obstruction were reported. Renal agenesis occurs in approximately 1 in 1.500.000-3.000.000 patients with ADPKD. We report a boy with ADPKD and renal agenesis diagnosed at the age of 12 years. ADPKD was diagnosed in some other members of the family. Additionally to kidney changes, mitral valve prolapse was found on echocardiography. At the age of 18 years high normal blood pressure was recognized and laboratory tests demonstrated: serum creatinine 1.0 mg/dl, glomerular filtrate rate 97.9 ml/min/1.73m2, isotopic creatinine clearance (Tc-99mDTPA) 99 ml/min/1.73m2, normal urinalysis, no microalbuminuria.ConclusionsIn children with positive family history of ADPKD, screening ultrasonography of the kidney performed at the request of the family, allows the early diagnosis of sporadic present abnormalities of the kidney and urinary tract.

Renal surgery in the dog and cat

Nephrectomy is the complete removal of the kidney and ipsilateral ureter and usually it is performed through a midline laparotomy for the treatment of end stage unilateral kidney disease. Indications for performing nephrectomy may include: renal and ureteral neoplasms, persistent renal haematuria, serious renal trauma associated with or without avulsion of renal pedicle, end-stage hydronephrosis, single renal cysts associated with renal disease, polycystic kidney disease associated with pyelonephritis, renal parasites, renal or perirenal abscessation, chronic end-stage pyelonephritis and renal disease associated with ectopic ureter. Normal function of the contralateral kidney is a prerequisite for performing nephrectomy. The presence of azotaemia or persistent isosthenuria is a contraindication for nephrectomy. Nephrectomy for pyelonephritis may not consistently resolve the infection in the remaining kidney. Preoperative evaluation of renal function in animals undergoing nephrectomy would ideally include determination of glomerular filtration rate using renal nuclear scintigraphy. However, in clinical practice, excretory urography is performed for the assessment of renal function. Nephrotomy is a limited surgical incision through the dorsal renal surface to remove nephroliths, to explore the pelvis for polyps and neoplasms and to identify causes of renal haematuria. Nephrotomy is reported not to significantly affect renal function in normal dogs and cats. Indications for nephrotomy associated with the presence of nephroliths may include hydronephrosis and hydroureter associated with renal pelvic obstruction, recurrent infection resistant to conservative treatment, progressive nephrolith enlargement and deterioration of renal function. Pyelolithotomy for calculus removal may only be used when the renal pelvis and the proximal ureter are markedly dilated.

Unilateral glomerulocystic kidney disease associated with tuberous sclerosis complex in a neonate

We report a case of glomerular cystic kidney disease (GCKD) associated with tuberous sclerosis complex (TSC) in a neonate. The patient displayed progressive abdominal enlargement attributed to GCKD associated with TSC. After birth, the right kidney was resected because it compressed his liver and right lung, and possible malignancy could not be excluded. Macroscopically, the resected kidney was markedly enlarged, and histologically the kidney had numerous glomerular cysts accompanied by papillary epithelial growth. Notably, a small area of normal parenchyma was observed at the lower pole. The epithelial cells of the cysts displaying a papillary growth pattern were positive for mTOR, phosphorylated mTOR, and phosphorylated S6 ribosomal protein (p-S6). The morphologically noncystic, normal-looking tubular epithelium was also positive for p-S6. These results imply that one more molecular event might be necessary for cyst formation in GCKD associated with TSC, in addition to the activation of mTOR signaling.

Fetal multicystic kidney disease: Outcome and follow up

Congenital fetal anomalies are the great problem and one of the main causes of increased perinatal mortality and morbidity. The aim of this study is to determine the outcome of prenataly detected multicystic dysplastic kidney and to point to the necessity of postnatal diagnostic procedures. The retrospective-prospective study encompasses 38 cases of the prenatally diagnosed unilateral fetal multicystic dysplastic kidney. The associated anomalies were revealed either by autopsy findings when the pregnancy was terminated, or when the pregnancy continued, by clinical and operative findings the newborns. The autopsy finding revealed bilateral multicystic displastic kidney or unilateral mylticystic displastic kidney and the agenesis of the contralateral kidney. The postnatal evaluation of the newborns with unilateral multicistic disease revealed that 84.3% of them had some concomitant anomaly of the urinary tract, most of them had an anomaly of the contralateral kidney (31.4%). The surgery was performed in 73.6% of children, in 17% of children the kidney function deteriorated after the surgery. The findings of bilateral multicystic kidney disease and unilateral multicystic kidney disease and amnion are the indication to terminate the pregnancy. The finding of an isolated unilateral multicystic dysplastic kidney require thorough examination, both prenatally and postnatally. We propose obligatory serial prenatal ultrasound examinations, followed by postnatal ultrasound, isotope scan, and urinary cystourethography.

Unilateral renal cystic disease

Unilateral renal cystic disease of kidney is a non-familial and non-progressive disorder, characterized by replacement of the renal parenchyma by a cluster of multiple cysts with a normal contralateral kidney. This rare condition is not related to autosomal dominant polycystic kidney disease; as such, hepatic and pancreatic cysts are not seen. We report a case of unilateral renal cystic disease in an elderly male documented by CT and serial ultrasound examinations. An elderly asymptomatic male (with normal renal function tests and urine examination) was found to have multiple cysts in left kidney during a routine ultrasound examination with thinned out intervening parenchyma; the right renal parenchyma was normal in size and echotexture. There was no evidence of hepatic or pancreatic cysts. Screening of family members did not reveal any evidence of autosomal dominant polycystic kidney disease. Contrast enhanced CT revealed multiple clustered cysts in left kidney, with normal enhancement of the intervening parenchyma [Figure 1]. The right kidney was normal without any cyst. Unilateral renal cystic disease was presumed, and patient put on follow-up. Serial ultrasounds over two years have documented the stability of the left renal cystic lesions, confirming the diagnosis. Figure 1 CECT abdomen shows multiple simple cysts replacing the left renal parenchyma with normally enhancing intervening parenchyma. Radiological picture was stable on follow-up Unilateral renal cystic disease, also called unilateral polycystic kidney disease, localized cystic disease of kidney, and segmental polycystic kidney, is characterized by replacement of renal parenchyma, either total or localized to a portion of kidney, by multiple cysts.[1–4] This is distinct from ADPKD, which is bilateral with involvement of both cortex and medulla. In children, ADPKD can have asymmetric onset; in these cases long term follow-up and screening of family members can make the distinction from unilateral cystic disease. The extrarenal manifestations of ADPKD (hepatic and pancreatic cysts, cerebral aneurysms) are not seen in unilateral renal cystic disease. Nephrolithiasis and hyperattenuating cysts are also generally seen in ADPKD.[4,5] When unilateral cystic disease of kidney is focal, it may be confused with a cystic neoplasm like multilocular cystic nephroma or cystic RCC. Careful analysis of multiple sequential images reveal a continuum of cysts in localized cystic disease of kidney with normal intervening parenchyma as compared to focal encapsulated mass in case of cystic neoplasms with compression of adjacent renal parenchyma.[1,4] The renal function is preserved with near normal concentration of contrast by the affected kidney. This allows distinction from multicystic dysplastic kidney (an entity seen in infants and children) in which the intercystic parenchyma is dysplastic and non functional; the dysplastic core in MCDK may show some enhancement, but has a different appearance from the normal renal tissue.[1–5]

Kidney Function and Volume Progression in Unilateral Autosomal Dominant Polycystic Kidney Disease With Contralateral Renal Agenesis or Hypoplasia: A Case Series

The occurrence of unilateral autosomal dominant polycystic kidney disease (ADPKD) with absence of the contralateral kidney has been described only rarely in the literature. Whether unilateral ADPKD is associated with faster disease progression is not known. Case series. In a prospective cohort of 182 patients with ADPKD, we identified 3 patients with ADPKD and unilateral renal agenesis (2 patients) or severe hypoplasia (1 patient). Genetic analysis of the PKD1 and PKD2 genes was performed for all 3 patients. Serum creatinine levels and kidney volumes based on magnetic resonance imaging were determined twice, with a 6-month interval between measurements. Characteristics of the 3 patients were compared with age- and sex-matched controls from the full cohort. Genotyping of the 3 patients indicated that each had a different [corrected] mutation in the PKD1 gene that is predicted to cause frameshift and/or truncation of the protein product. [corrected] All 3 patients with unilateral ADPKD had renal volumes and progression rates greater than the mean values of their matched control groups. However, their glomerular filtration rates were well preserved, with estimated single-kidney creatinine clearances much greater than their controls. The number of cases in this study is small and time of follow-up was limited. Unilateral renal agenesis or hypoplasia in patients with ADPKD might not be as rare as previously thought. Glomerular filtration rate was preserved despite unilateral renal absence, suggesting that renal compensatory mechanisms are well conserved in patients with ADPKD.

Association of fetal unilateral multicystic kidney disease with other urinary tract anomalies

Multicystic dysplastic kidney represents a disorder in the fetus development presented prenatally of postnatally, this deserving special attention due to a risk of additional anomalies in children with this disorder. The aim of this study was to determine the incidence and type of common anomalies of the urinary system in the prenatal diagnosis of unilateral multicystic dysplastic kidney, and point out the necessity of postnatal diagnostic procedures in order to evaluate the state of the urinary system. This retrospective-prospective study encompassed 38 cases of prenatally diagnosed unilateral fetal multicystic dysplastic kidney, presented to the Council for Fetal Anomalies from the Institute for Gynecology and Obstetrics of the Clinical Centre of Serbia and the University Children's Clinic within a three-year period. Associated anomalies were revealed by autopsy findings when pregnancy was terminated, ie resumed with clinical and operative findings of born children. In every case of terminated pregnancy and death after birth the autopsy revealed additional renal or exstrarenal anomaly which were not prenataly detected. Postnatal evaluation of survived children with unilateral multicistic disease revealed that 31.4% of them have an anomaly of the contralateral kidney, 26.3% anomaly of the ipsilateral side, 13.2% anomaly of the lower portions of the urinary system and the same percent an additional extrarenal anomaly. The surgery was performed in 73.6% of children, more than half of the interventions were related to extrarenal anomaly. In 17% of children the kidney function was deteriorated after surgery. Children suffering from unilateral multicystic dysplastic kidney have a greater chance of exhibiting an anomaly of the contralateral kidney and the urinary system in general. Therefore, they require thorough examination, both prenatally and postnatally. We propose obligatory serial professional prenatal ultrasound examinations, followed by postnatal ultrasound, isotope scan, and we especially emphasize the need for performing urinary cystouretherography, bearing in mind the high incidence of the vesicoureteral reflux of the contralateral kidney. In addition to nephrectomy, cytoscopy and colposcopy also need to be performed for the purpose of discovering possible hidden anomalies of the urogenital system.

Left‐ and Right‐Sided Laparoscopic‐Assisted Nephrectomy in Standing Horses with Unilateral Renal Disease

To describe a technique for, and outcome after, left- or right-sided laparoscopic-assisted nephrectomy in standing horses with unilateral renal disease. Clinical report. Horses (n=3) with unilateral renal disease. Horses were sedated with detomidine (0.01 mg/kg intravenously [IV]) and levomethadone (0.05 mg/kg IV). Paravertebral anesthesia and infiltration-anesthesia with 2% lidocaine were used to create a surgical field incorporating the 17th intercostal space and paralumbar fossa. Two separate, ipsilateral portals and a mini-laparotomy were used. The perirenal peritoneum was horizontally incised (10-15 cm) using endoscissors and the incision digitally enlarged for manual dissection of the perirenal fat and kidney mobilization. The renal vessels and ureter were individually dissected, ligated, and transected under laparoscopic observation and the kidney removed. The perirenal and laparotomy peritoneal defects were not closed; and the laparotomy was closed in a multilayered fashion. The transverse abdominal muscle was apposed in a continuous pattern using 1 polyglactin 910, the subcutaneous tissue (simple continuous pattern) and skin (simple interrupted pattern) with 2-0 polyglactin 910. Left (2) and right (1) sided laparoscopic-assisted nephrectomy (1 nephrolithiasis, 2 hydronephrosis) was performed successfully. Sedation and local anesthesia was adequate for intraoperative immobilization and analgesia. No intraoperative complications occurred. Incisional seroma formation and fever occurred on days 3 and 4 in 1 horse and resolved with medical management. Laparoscopic-assisted nephrectomy can be used for removal of the left or right kidney in standing horses with unilateral kidney disease. To avoid risks associated with general anesthesia and to reduce surgical trauma, laparoscopic-assisted nephrectomy can be performed in the standing sedated horse using a 2 portal technique and a mini-laparotomy.

Unilateral and segmental localised polycystic kidney disease.

Unilateral and segmental localised polycystic disease is a rare type of cystic disease of the kidney. It takes the form of a segmental cystic abnormality in one kidney morphologically identical...

99mTc-2GAM: A tracer for renal imaging

We propose a renal imaging agent, the 99mTc complex of the bidentate- N,S chelate N-(mercaptoacetyl) glycine ( 99mTc-2GAM), with the imaging characteristics of 99mTc-DMSA but a faster kidney uptake; chemical evidence supports the formulation of 99mTc-2GAM as [Tc V(O)(GAM) 2] −. After biodistribution and toxicity studies in animals, 99mTc-2GAM was evaluated in five normal volunteers. 99mTc-2GAM is rapidly cleared from the blood ( t 1 2 = 9 min ) and 50% of the ID is excreted in the urine in the first 2 h. Dynamic data show a rapid renal uptake that increases up to 1 h with no significant wash-out between 1 and 8 h. The uptake in each kidney ranges from 11.3% to 20.7% ID. Low, stable liver uptake is observed. No significant activity is detected in other organs. We showed no differences between 99mTc-2GAM and 99mTc-DMSA compared in three patients with unilateral kidney disease. We conclude that 99mTc-2GAM has good practical and dosimetric features for renal imaging.

Doppler studies in normal kidneys of healthy children.

Despite the widespread use of Doppler ultrasound in kidney diseases of adults and children, there are only a few, partially contradictory reports of normal values of resistance index (RI) and pulsatility index (PI) of renal perfusion in a healthy pediatric population. This study was carried out to determine normal values for these parameters in a larger group of probands. For the RI correlation with age was most pronounced in the right renal artery, with children over 6 years having a significantly lower RI than younger children. The PI was relatively independent of side and age. These results are somewhat different to previous reports. These differences may influence future Doppler sonographic investigations of acute and symmetrically affected kidneys (nephrological diseases). Our data suggest that the RI of the right renal artery might be most useful. In chronical or unilateral kidney diseases (unilateral ureteral obstruction, reflux, or operation) investigation of the PI in addition to the RI may aid diagnosis.

Experimental partial ureteric obstruction in newborn rats. VIII. Contralateral kidney weight after release of the obstruction.

In unilateral kidney disease, it has been suggested that the ipsilateral state could be estimated by measuring contralateral kidney size; thus, a contralateral increase should reflect an ipsilateral impairment and vice versa. This could easily be performed using ultrasound. In our experiments with partial obstruction of one ureter (created in 1- to 3-day-old rats), a consistent and stable contralateral kidney hypertrophy occurred. However, after unobstruction, the hypertrophy persisted for at least a 6-week observation period, despite the disappearance of hydronephrosis and presence of a normal weight of the ipsilateral kidney. This would undeniably hamper the diagnostic utility of kidney size determination. To find out whether or not the hypertrophy ever disappears, we have performed studies after 6, 9 and 15 weeks. (1) The weight of the unobstructed kidney was found normal except after 15 weeks. The microstructure was normal except for some minor changes. (2) The contralateral kidney was significantly heavier than controls at all checkpoints (+10, +13 and +6%). No significant regression occurred over the observation period. (3) Furthermore, the weights of both kidneys were interrelated, but the slopes were positive; thus, the contralateral hypertrophy was not greater the lesser the ipsilateral kidney weight. The reasons for the persistence of contralateral hypertrophy are discussed. The present findings do not support the idea of documenting improvement by measuring contralateral kidney size. However, repeat studies in the same individual may prove to be more sensitive and are therefore recommended until further notice.

Nephropathy in Remnant Kidneys: Pathological Proteinuria After Unilateral Nephrectomy

It is a matter of dispute as to whether and to what extent hyperfiltrative nephropathy occurs in a contralateral remnant kidney after unilateral nephrectomy. This question was investigated in a retrospective progress observation using urinary electrophoresis among other methods. Of 106 patients who underwent nephrectomy between 1963 and 1984 because of unilateral kidney diseases, only 39 fulfilled all of the requisite criteria for a followup examination 2 to 23 years later. Whereas there was arterial hypertension or decreased kidney function in 4 cases (10.3%), pathological proteinuria was found in 32 of the remnant kidneys (82.1%): tubular in 13 (40.6%) and glomerular in 19 (59.4%). In contrast to that of arterial hypertension or decreased kidney function, this incidence is far greater than the expected risk in the normal population, which in our opinion indicates that hyperfiltrative nephropathy occurs in the contralateral remnant kidney after unilateral nephrectomy without causing relevant restriction of kidney function or increasing the arterial pressure.

Fetal renal artery blood velocimetry in multicystic kidney disease

Color flow mapping and Doppler velocimetry were used to measure impedance to flow in both renal arteries of 11 fetuses with unilateral multicystic kidney disease at 19-34 (mean = 26) weeks' gestation. In all cases, the pulsatility index in the renal artery of the multicystic kidney was higher than that of the contralateral normal kidney; the mean pulsatility index in the arteries of the affected kidneys was significantly higher than the normal mean for gestation.