-
Life Sciences Apr 2024Hypertension, a prevalent global cardiovascular disease, affects approximately 45.4 % of adults worldwide. Despite advances in therapy, hypertension continues to pose a... (Review)
Review
Hypertension, a prevalent global cardiovascular disease, affects approximately 45.4 % of adults worldwide. Despite advances in therapy, hypertension continues to pose a significant health risk due to inadequate management. It has been established that excessive adiposity contributes majorly to hypertension, accounting for 65 to 75 % of primary cases. Fat depots can be categorised into subcutaneous and visceral adipose tissue based on anatomical and physiological characteristics. The metabolic impact and the risk of hypertension are determined more significantly by visceral fat. Perirenal adipose tissue (PRAT), a viscera enveloping the kidney, is known for its superior vascularisation and abundant innervation. Although traditionally deemed as a mechanical support tissue, recent studies have indicated its contributing potential to hypertension. Hypertensive patients tend to have increased PRAT thickness compared to those without, and there is a positive correlation between PRAT thickness and elevated systolic blood pressure. This review encapsulates the anatomical characteristics and biogenesis of PRAT. We provide an overview of the potential mechanisms where PRAT may modulate blood pressure, including physical compression, paracrine effects, and neurogenic regulation. PRAT has become a promising target for hypertension management, and continuous effort is required to further explore the underlying mechanisms.
Topics: Adult; Humans; Hypertension; Adipose Tissue; Obesity; Adiposity; Kidney
PubMed: 38387699
DOI: 10.1016/j.lfs.2024.122511 -
International Journal of... 2019The aim of this study was to discuss the clinical significance of perirenal puncture and drainage with urokinase treatment of perirenal hematoma complicated by infection...
The aim of this study was to discuss the clinical significance of perirenal puncture and drainage with urokinase treatment of perirenal hematoma complicated by infection following surgery for upper urinary tract calculi. Two cases of perirenal hematoma complicated by infection following surgery for upper urinary tract calculi in 2017, and later received perirenal puncture and drainage of perirenal hematoma with urokinase treatment were selected. Puncture and drainage of perirenal hematoma with urokinase treatment were performed without the occurrence of severe complications such as sepsis, septic shock, or secondary bleeding. Both the renal morphology and functions were well restored. Puncture and drainage with urokinase treatment had definite efficacy in the treatment of perirenal hematoma complicated by infection.
Topics: Anti-Bacterial Agents; Gentamicins; Hematoma; Humans; Kidney; Kidney Calculi; Paracentesis; Shock, Septic; Urinary Tract Infections; Urokinase-Type Plasminogen Activator
PubMed: 31238742
DOI: 10.1177/2058738419859696 -
Investigative and Clinical Urology Jan 2021To compare the treatment success rate and safety of reduced (30 shocks/min, 1,200 shocks/session) versus standard (60 shocks/min, 2,400 shocks/session) extracorporeal... (Comparative Study)
Comparative Study
PURPOSE
To compare the treatment success rate and safety of reduced (30 shocks/min, 1,200 shocks/session) versus standard (60 shocks/min, 2,400 shocks/session) extracorporeal shockwave lithotripsy for the management of renal stones.
MATERIALS AND METHODS
We retrospectively analyzed 404 patients who underwent extracorporeal shockwave lithotripsy for 5-20-mm renal stones between April 2011 and March 2019. Patients selected the reduced or standard protocol (group R and S) after explaining the potential benefits and disadvantages. The primary outcome was treatment success within 12 weeks, which was defined as no residual fragment or fragments <4 mm on ultrasonography and plain radiograph.
RESULTS
In total, 94 and 310 patients underwent shockwave lithotripsy with a reduced and standard protocol, respectively. The background characteristics of the participants did not significantly differ. The treatment success within 12 weeks was achieved in 78 (83.0%) patients in group R and 259 (83.5%) in group S (p=0.88). The median number of the session was 3 (interquartile range, 2-4) in both groups (p=0.53). The total complication rates were 5.4% in group R and 6.1% in group S. Three (1.0%) patients in group S experienced perirenal hematoma, which was conservatively treated. The reduced protocol was not associated with treatment success in the multivariate analysis adjusted for potential confounders (odds ratio, 0.91; 95% confidence interval, 0.46-1.80; p=0.78).
CONCLUSIONS
The new treatment amendment with a slower delivery rate successfully reduced the total number of shocks need to fragment renal stones <20 mm without compromising the stone-free rate.
Topics: Aged; Asymptomatic Diseases; Female; Hematoma; Humans; Kidney Calculi; Lithotripsy; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 33314807
DOI: 10.4111/icu.20200285 -
Communications Biology Oct 2021Reindeer (Rangifer tarandus) are semi-domesticated animals adapted to the challenging conditions of northern Eurasia. Adipose tissues play a crucial role in northern...
Reindeer (Rangifer tarandus) are semi-domesticated animals adapted to the challenging conditions of northern Eurasia. Adipose tissues play a crucial role in northern animals by altering gene expression in their tissues to regulate energy homoeostasis and thermogenic activity. Here, we perform transcriptome profiling by RNA sequencing of adipose tissues from three different anatomical depots: metacarpal (bone marrow), perirenal, and prescapular fat in Finnish and Even reindeer (in Sakha) during spring and winter. A total of 16,212 genes are expressed in our data. Gene expression profiles in metacarpal tissue are distinct from perirenal and prescapular adipose tissues. Notably, metacarpal adipose tissue appears to have a significant role in the regulation of the energy metabolism of reindeer in spring when their nutritional condition is poor after winter. During spring, genes associated with the immune system are upregulated in the perirenal and prescapular adipose tissue. Blood and tissue parameters reflecting general physiological and metabolic status show less seasonal variation in Even reindeer than in Finnish reindeer. This study identifies candidate genes potentially involved in immune response, fat deposition, and energy metabolism and provides new information on the mechanisms by which reindeer adapt to harsh arctic conditions.
Topics: Adaptation, Biological; Adipose Tissue; Animals; Arctic Regions; Finland; Reindeer; Seasons; Siberia; Transcriptome
PubMed: 34620965
DOI: 10.1038/s42003-021-02703-z -
BMC Cardiovascular Disorders Sep 2015Renal sinus fat (RSF) has been recognized as a risk factor for arterial hypertension. This study was addressed to examine whether also para- and perirenal fat...
BACKGROUND
Renal sinus fat (RSF) has been recognized as a risk factor for arterial hypertension. This study was addressed to examine whether also para- and perirenal fat accumulation is associated to higher 24-h mean systolic (SBP) and/or diastolic blood pressure (DBP) levels in overweight and obese subjects.
METHODS
A cohort of 42 overweight and obese patients, 29 women and 13 men, aged 25-55 years, not treated with any kind of drug, was examined. Body mass index (BMI), waist circumference (WC), fasting insulin and glucose serum levels, insulin resistance (assessed by using the homeostasis model assessment [HOMAIR]), and 24-h aldosterone urine levels were measured. Ambulatory blood pressure monitoring (ABPM) was measured with 15 min intervals from 7.0 a.m. to 11.0 a.m. and with 30 min intervals from 23.0 to 7.0 for consecutive 24 h, starting from 8:30 AM. Measurement of para- and perirenal fat thickness was performed by ultrasounds by a duplex Doppler apparatus.
RESULTS
Para- and perirenal ultrasonographic fat thickness (PUFT) was significantly and positively correlated with WC (p < 0.01), insulin (p < 0.01), HOMAIR (p < 0.01), and 24-h mean DBP levels (p < 0.05). 24-h mean DBP was also significantly and positively correlated with 24-h aldosterone urine concentrations (p < 0.001). A multivariate analysis by multiple linear regression was performed; the final model showed that the association of 24-h mean DBP as dependent variable with PUFT (multiple R = 0.34; p = 0.026) and daily aldosterone production (multiple R = 0.59; p = 0.001) was independent of other anthropometric, hormone and metabolic parameters.
DISCUSSION AND CONCLUSIONS
This study shows a positive independent association between PUFT and mean 24-h diastolic blood pressure levels in overweight and obese subjects, suggesting a possible direct role of PUFT in increasing daily diastolic blood pressure.
Topics: Adipose Tissue; Adult; Aldosterone; Blood Glucose; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Body Mass Index; Female; Humans; Insulin; Insulin Resistance; Kidney; Male; Middle Aged; Obesity; Overweight; Risk Factors; Ultrasonography; Waist Circumference
PubMed: 26419359
DOI: 10.1186/s12872-015-0101-6 -
Beijing Da Xue Xue Bao. Yi Xue Ban =... Aug 2017Lymphangioma is a rare, benign mesenchymal neoplasm, which is characterized by numerous intercommunicating cystic spaces containing lymphatic fluid. It is considered a... (Review)
Review
Lymphangioma is a rare, benign mesenchymal neoplasm, which is characterized by numerous intercommunicating cystic spaces containing lymphatic fluid. It is considered a congenital disease resulting from the obstruction of regional lymph drainage during the developmental period. Lymphangioma frequently occurs in the cervical neck and axilla, also in the retroperitoneum, mediastinum, mesentery, omentum, colon, and pelvis, rarely in the perirenal space. These tumors usually present in childhood, but infrequently, these also present in adults. Patients often complain of hematuria, flank pain, or abdominal pain. Complications of lymphangioma have been reported to include infection, ruputure, or hemorrhage. There are three types of lymphangioma commonly identified: capillary, cavernous, and cystic. Cystic type is the one commonly found intra-abdominally or retroperitoneally, and may be uniloculated or multiloculated. All these perirenal tumors have a very low incidence, make it difficult to diagnose. Differential diagnosis must be performed with the primary renal lymphoma, urinoma, polycystic kidney, teratoma, both benign and malignant tumors, etc. Endoscopic ultrasound guided fine needle aspiration is recommended in some literatures, which may help make diagnosis and further guide subsequent therapeutic strategy. Regarding treatment, surgical excision can be performed via either laparotomy or laparoscopy. And injection of sclerosants into lympahgioma has been described in the literature in nonsurgical candidates. The optimal definitive treatment is total surgical excision. Despite being rare, the tumor has an excellent prognosis. Here, we report a case of a 48-year-old woman with a left renal mass found in an abdominal ultrasonography during a health checkup. In the case presented, abdominal ultrasonography and magnetic resonance urography (MRU) revealed an approximately 11.3 cm×10.6 cm×12.8 cm multilocular cystic mass in the left perirenal space. There was no history of bowel or bladder complaint, either previous illness episodes. Full blood count and kidney function tests were within normal limits. Laparoscopic surgical removal of the cyst was accomplished without incident. A benign cystic perirenal lymphangioma was diagnosed on histology and confirmed with immunohistochemical stains. One month after the surgery the ureteral stent was removed. The patient was free of disease after a 3-month follow-up period. We report the case and discuss the management of perirenal lymphangiomatosis with a literature review.
Topics: Adult; Child; Female; Humans; Kidney Neoplasms; Lymphangioma, Cystic; Mesentery; Middle Aged; Omentum; Retroperitoneal Space
PubMed: 28816297
DOI: No ID Found -
Oncology Letters Sep 2022Primary retroperitoneal perirenal CIC rearrangement sarcoma is rare. The current case report presents a 69-year-old male patient with this pathology, including the...
Primary retroperitoneal perirenal CIC rearrangement sarcoma is rare. The current case report presents a 69-year-old male patient with this pathology, including the clinical features, pathomorphology and immunohistochemistry, and CIC gene rupture detected by fluorescence hybridization (FISH). Furthermore, the relevant literature was reviewed. Histologically, the tumor was composed of diffuse nests of small- to medium-sized juvenile round blue cells with hyperchromatic nuclei, prominent nucleoli and occasional mitotic signs. The tumor involved adipose tissue with no obvious hemorrhagic necrotic foci. Immunohistochemistry indicated scattered expression of CD99 in tumor cells. FISH examination suggested that the CIC gene was fragmented and translocated.
PubMed: 35949589
DOI: 10.3892/ol.2022.13442 -
Acta Radiologica (Stockholm, Sweden :... Feb 2016Exophytic renal angiomyolipoma and liposarcoma are two representative tumors in the retroperitoneum with fatty components that have potential to be misdiagnosed with...
BACKGROUND
Exophytic renal angiomyolipoma and liposarcoma are two representative tumors in the retroperitoneum with fatty components that have potential to be misdiagnosed with each other.
PURPOSE
To compare the computed tomography (CT) findings of exophytic renal angiomyolipoma and perirenal liposarcoma.
MATERIAL AND METHODS
Fourteen and 16 cases with histologically-proven exophytic renal angiomyolipoma and perirenal liposarcoma, respectively, with preoperative CT from January 2000 to December 2013 were reviewed by two radiologists blinded to the clinical and pathological findings for an array of CT findings. These findings were compared between exophytic renal angiomyolipoma and perirenal liposarcoma using the Student t-test and Fisher's exact test.
RESULTS
Patients with exophytic renal angiomyolipoma were younger (P = 0.001) without differences in sex (P = 1.000). Exophytic renal angiomyolipomas were smaller (P = 0.004) and more commonly showed the following findings: renal parenchymal defect (P < 0.001), multiple linear vessels (P = 0.026), aneurysmal dilatation of intratumoral vessels (P = 0.024), renal parenchymal vascular pedicle (P < 0.001), hemorrhage (P = 0.037), encapsulated margin (P = 0.001), and other intrarenal fatty lesions (P = 0.037). No significant difference was seen in laterality, renal hilar vascular pedicle, non-fatty soft tissue nodule, calcification, or kidney displacement (P = 0.236-1.000).
CONCLUSION
Several CT findings were significantly different between exophytic renal angiomyolipoma and perirenal liposarcoma and may be helpful for differentiating between the two entities when confronting a fatty mass in the perirenal space.
Topics: Adult; Aged; Aged, 80 and over; Angiomyolipoma; Diagnosis, Differential; Female; Humans; Kidney; Kidney Neoplasms; Liposarcoma; Male; Middle Aged; Observer Variation; Reproducibility of Results; Retroperitoneal Neoplasms; Retroperitoneal Space; Retrospective Studies; Tomography, X-Ray Computed; Young Adult
PubMed: 25722461
DOI: 10.1177/0284185115574543 -
Equine Veterinary Journal Mar 2021Surgical approaches to the kidneys and perirenal structures are uncommonly performed in horses and several complications have been described with the current procedures.
BACKGROUND
Surgical approaches to the kidneys and perirenal structures are uncommonly performed in horses and several complications have been described with the current procedures.
OBJECTIVE
To describe the anatomy of the retroperitoneal perirenal space and investigate a retroperitoneal minimally invasive approach to access the kidney and perirenal structures in horses.
STUDY DESIGN
Descriptive, cadaveric study.
METHODS
Anatomical description of the retroperitoneal space was performed on three equine cadavers and the surgical approach was developed based on these dissections. Ten cadaveric horses underwent a retroperitoneoscopy. Five horses were placed in a right lateral recumbency position to explore the left retroperitoneal space and five horses were placed in a standing position to explore both left and right sides. Anatomical landmarks, working space and access to the renal hilus and perirenal structures were evaluated.
RESULTS
Dissections revealed that kidneys are surrounded by a renal fascia which delimits two spaces: a perirenal space between the kidney and the renal fascia, and a pararenal space between the renal fascia and psoas muscles or peritoneum. The retroperitoneoscopic portal was placed at the level of the dorsal aspect of the tuber coxae, 3 cm caudal to the last rib for the left side and 2 cm caudal to the last rib for the right side. Retroperitoneal access and working space were successfully established in all horses. The standing position allowed an easier dissection than lateral recumbency. Division of the perirenal fat allowed access to the kidney and adrenal glands as well as individualisation of renal vessels and ureter in the renal hilus.
MAIN LIMITATIONS
Study of cadavers precluded appreciation of haemorrhage or use the pulsating vessels as landmarks.
CONCLUSIONS
This study provides a description of the retroperitoneal perirenal space and describes a new surgical approach to access kidneys and perirenal structures in horses.
Topics: Animals; Cadaver; Hemorrhage; Horse Diseases; Horses; Retroperitoneal Space
PubMed: 32473613
DOI: 10.1111/evj.13293 -
International Journal of Surgery Case... Oct 2021Emphysematous pyelonephritis (EPN) is an uncommon suppurative infection of renal parenchyma and perirenal tissue characterized by production of gas within renal...
INTRODUCTION
Emphysematous pyelonephritis (EPN) is an uncommon suppurative infection of renal parenchyma and perirenal tissue characterized by production of gas within renal parenchyma, collecting system or perinephric tissue.
CASE PRESENTATION
We report a case of young non diabetic female with past history of extracorporeal shock wave lithotripsy (ESWL) who presented with intermittent lower abdominal pain, dysuria and left lower limb swelling. Abdomen examination was notable for tenderness at left iliac fossa and fullness at left renal angle. Blood investigation showed leukocytosis and deranged creatinine levels. Urine analysis showed pyuria. Transabdominal ultrasound revealed left nephrolithiasis with moderate hydronephrosis, vesical calculus and double J (DJ) stent in situ. Patient was diagnosed as acute pyelonephritis and started on intravenous antibiotics. Despite on medical management, the condition deteriorated and progressed to septic shock. Computed tomography of kidneys, ureters and bladder (CT KUB) showed air fluid level in calyceal system with perinephric collection and confirmed diagnosis as emphysematous pyelonephritis. Patient underwent surgical drainage to control the sepsis. Few days later after control of sepsis and optimization, left nephrectomy and removal of retained DJ stent was done.
CLINICAL DISCUSSION
This case report highlights the need to consider emphysematous pyelonephritis as a possible diagnosis in patients harbouring DJ stents even in young non diabetics. Early aggressive medical management coupled with urological intervention is a valuable alternative to upfront emergent nephrectomy. However, surgery should not be delayed in patient with fulminant infection at presentation or who failed on conservative management.
CONCLUSION
Emphysematous pyelonephritis warrants high index of suspicion for timely diagnosis and can be fatal if not recognized early and promptly treated.
PubMed: 34534814
DOI: 10.1016/j.ijscr.2021.106405