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International Journal of Molecular... Nov 2023Perirenal adipose tissue (PRAT) surrounding the kidney is emerging as a player and novel independent risk factor in diabetic kidney disease (DKD); DKD is a complication...
Perirenal adipose tissue (PRAT) surrounding the kidney is emerging as a player and novel independent risk factor in diabetic kidney disease (DKD); DKD is a complication of diabetes and is a major cause of increased cardiovascular (CV) risk and CV mortality in affected patients. We determined the effect of diabetes induction on (i) kidney and CV damage and (ii) on the expression of proinflammatory and profibrotic factors in both the PRAT and the mesenteric adipose tissue (MAT) of Munich Wistar Frömter (MWF) rats. The 16-week-old male MWF rats (n = 10 rats/group) were fed standard chow (MWF-C) or a high-fat/high-sucrose diet for 6 weeks together with low-dose streptozotocin (15 mg/kg i.p.) at the start of dietary exposure (MWF-D). Phenotyping was performed at the end of treatment through determining water intake, urine excretion, and oral glucose tolerance; use of the homeostatic model assessment-insulin resistance index (HOMA-IR) evidenced the development of overt diabetes manifestation in MWF-D rats. The kidney damage markers and were significantly higher in MWF-D rats, as were the amounts of PRAT and MAT. A diabetes-induced upregulation in , , , and was observed in both the PRAT and the MAT. was increased in the PRAT but not in the MAT of MWF-D, whereas was lower and higher in the PRAT and the MAT, respectively. Urinary albumin excretion and blood pressure were not further increased by diabetes induction, while heart weight was higher in the MWF-D. In conclusion, our results show a proinflammatory and profibrotic in vivo environment in PRAT induced by diabetes which might be associated with kidney damage progression in the MWF strain.
Topics: Humans; Rats; Male; Animals; Rats, Wistar; Albuminuria; Up-Regulation; Kidney Diseases; Diabetes Mellitus; Inflammation; Collagen; Adipose Tissue
PubMed: 38069331
DOI: 10.3390/ijms242317008 -
Cureus Sep 2023Emphysematous pyelonephritis (EPN) is a suppurative necrotizing form of renal infection with abscess and gas formation in the renal parenchyma and perirenal tissue. EPN...
Emphysematous pyelonephritis (EPN) is a suppurative necrotizing form of renal infection with abscess and gas formation in the renal parenchyma and perirenal tissue. EPN with scrotal extension is rare; if not recognized and treated promptly, the clinical course can be severe and life-threatening. The most common causative organism is and association with diabetes mellitus has been found in almost all cases. Prompt control of blood sugar and intravenous antibiotics are essential steps in management. Here, we report a rare form of extensive EPN extending from the right kidney to the scrotum retroperitoneally in a 47-year-old male with uncontrolled blood sugar. The patient was managed with a right percutaneous perinephric drain with right double J (DJ) stenting. His blood sugar was controlled by subcutaneous insulin. The patient was discharged on day 7 in satisfactory general condition with right percutaneous drainage and right DJ stent in situ.
PubMed: 37842469
DOI: 10.7759/cureus.45065 -
Frontiers in Pediatrics 2021A 14-year-old girl noticed malodorous urine and experienced left flank pain. The patient was presented to our hospital with gradually increasing pain. She had no...
A 14-year-old girl noticed malodorous urine and experienced left flank pain. The patient was presented to our hospital with gradually increasing pain. She had no underlying disease but had a history of pain on micturition for several days. Hematologic examination indicated low white blood cell and platelet counts and a high serum lactate level. Computed tomography showed that a part of the parenchyma of the left kidney had poor contrast and was deteriorated, with fluid and gas retention from the perirenal region to the retroperitoneal cavity. A left hydroureter and large ureterocele were observed in the bladder. She was diagnosed with emphysematous pyelonephritis (EPN) with a giant congenital ureterocele. Vasopressors and blood transfusion failed to maintain normal circulatory dynamics, and an open left nephrectomy and transurethral ureterocele fenestration were performed. The excised outer portion of the left kidney was dissolved by the infection and replaced with blood clots and necrotic tissue. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry identified the inflammatory, gas-producing bacteria , and . Meropenem was administered for 4 days postoperatively and then de-escalated to sulbactam/ampicillin for another 10 days. The patient was discharged on day 17 of hospitalization, and the postoperative course remained favorable. EPN is extremely rare in pediatric patients, and it is believed that nephrectomy is sometimes necessary if the patient does not have normal circulatory dynamics despite the use of catecholamines.
PubMed: 34900875
DOI: 10.3389/fped.2021.775468 -
Radiology Case Reports Jul 2024Renal cell carcinoma (RCC) is an extremely rare cancer in pediatric, accounting for 0.1% to 0.3% of all pediatric malignancies. Due to its low incidence in this age...
Renal cell carcinoma (RCC) is an extremely rare cancer in pediatric, accounting for 0.1% to 0.3% of all pediatric malignancies. Due to its low incidence in this age group, literature on pediatric RCC is limited. We present a case of localized RCC in pediatric patient treated with nephroureterectomy and lymphadenectomy. A 14-year-old girl with a 2-year history of red urine, blood clots, and left flank pain underwent physical examination, revealing left flank tenderness. Laboratory results showed anemia, leukocytosis, elevated LDH, and erythrocytes in urine. Imaging revealed a hyperechoic area in the left kidney's lower pole (4.0 × 2.8 cm). Contrast abdominal CT scan indicated a solid mass (5.4 × 3.8 × 3.2 cm) in left renal pelvis extending to the minor calyx and severe hydronephrosis. The patient was diagnosed with suspected cT3N0M0 left upper tract urothelial carcinoma and underwent cystoscopy, bladder cuff excision, and left radical nephroureterectomy with paraaortic lymph node dissection. Pathological analysis revealed clear cell type renal cell carcinoma, WHO ISUP grade IV, extending to the perirenal fat, with tumor-free ureteral resection margins, and no paraaortic lymph node metastasis. Follow-up on postoperative period showed a satisfactory outcome. In cases of pediatric localized RCC, surgical therapy, including radical nephrectomy or nephron-sparing surgery (NSS), can be a preferred treatment for small tumor volumes. This approach preserves kidney function and is generally considered safe for achieving tumor-free margins.
PubMed: 38721391
DOI: 10.1016/j.radcr.2024.03.022 -
Nutrients Oct 2020The objective of this study was to evaluate the influence of high-fat (HF) and cafeteria diet (CAF) diets and sex on the metabolism of important fatty acids in the liver...
The objective of this study was to evaluate the influence of high-fat (HF) and cafeteria diet (CAF) diets and sex on the metabolism of important fatty acids in the liver and perirenal fat tissue. Dietary treatments induced changes in the fatty acid profile in comparison to the untreated group, but the characteristic differences between treated groups were also observable. The HF diet induced an increase in the content of C16:1-7 and C18:1-7 in the liver phospholipids (PL) and triglycerides (TG) and perirenal fat tissue compared to the control and CAF diet. The CAF diet induced a more drastic decrease in both -3 and -6 polyunsaturated fatty acids (PUFA), including depletion of eicosapentaenoic acid (EPA). The CAF diet also increased the content of -6 docosapentaenoic acid (DPA-6) in the liver and decreased it in the perirenal fat. Sex also had a significant influence on the fatty acid profile, but the variables with the highest differences between the CAF and HF treatments were identical in the male and female rats. In this study, we have established that two dietary models of non-alcoholic fatty liver disease (NAFLD) led to characteristic changes in the hepatic and perirenal fat fatty acid profile, in contrast to the control diet and in comparison with each other. These differences could play an important role in the interpretation of the experimental results of nutritional studies.
Topics: Animals; Blood Glucose; Body Weight; Diet; Disease Models, Animal; Fasting; Fatty Acids, Monounsaturated; Fatty Acids, Unsaturated; Female; Fructose; Inflammation; Insulin Resistance; Liver; Male; Non-alcoholic Fatty Liver Disease; Phospholipids; Rats, Wistar; Sex Characteristics; Triglycerides
PubMed: 33143061
DOI: 10.3390/nu12113339 -
Journal of the Belgian Society of... Sep 2015Lymphangioleiomyomatosis (LAM) is a rare debilitating disease of unknown etiology, classically described as almost exclusively affecting women of childbearing age. The...
Lymphangioleiomyomatosis (LAM) is a rare debilitating disease of unknown etiology, classically described as almost exclusively affecting women of childbearing age. The disease most commonly involves the lungs and is characterized by hamartomatous smooth muscle cell proliferations along blood vessels, airways and lymphatics. Most patients present with pulmonary symptoms, including shortness of breath, recurrent pneumothorax and pleural effusions. Extrapulmonary manifestations of LAM as the initial presentation of the disease are highly unusual. We present the case of a patient in whom LAM was incidentally discovered when the patient presented with retroperitoneal hemorrhage from a ruptured renal angiomyolipoma.
PubMed: 30039066
DOI: 10.5334/jbr-btr.836 -
Kidney Diseases (Basel, Switzerland) Feb 2024Perirenal fat is a pad that fills the retroperitoneal space outside the kidney, which affects kidney function in various ways. However, the association between perirenal...
INTRODUCTION
Perirenal fat is a pad that fills the retroperitoneal space outside the kidney, which affects kidney function in various ways. However, the association between perirenal fat and IgA nephropathy (IgAN) has not yet been elucidated. This study aimed to investigate the role of perirenal fat in predicting IgAN progression.
METHODS
A total of 473 patients with biopsy-proven IgAN and follow-up information were recruited, and perirenal fat thickness (PFT) was measured using color Doppler ultrasonography at renal biopsy. Patients were divided into two groups according to the median PFT: the low-PFT group (PFT ≤1.34 cm, = 239) and the high PFT group (PFT >1.35 cm, = 234). A total of 473 healthy participants were included in the control group. Basic clinical characteristics were assessed at the time of renal biopsy, and the relationship between PFT and combined endpoints was analyzed. The renal composite endpoints were defined as a two-fold increase in blood creatinine level, end-stage renal disease (dialysis over 3 months). Kaplan-Meier survival analysis was used to explore the role of PFT in the progression of IgAN. Three clinicopathological models of multivariate Cox regression analysis were established to evaluate the association between PFT and renal prognosis in patients with IgAN.
RESULTS
Compared to healthy subjects, patients with IgAN showed significantly higher PFT. After a median follow-up of 50 months, 75 of 473 patients (15.9%) with IgAN reached renal composite endpoints. Among those, 13 of 239 patients (5.4%) were in the low PFT group, and 62 of 234 patients (26.5%) were in the high PFT group ( < 0.001). The results of three Cox regression models (including demographics, pathological and clinical indicators, and PFT) demonstrated that a higher PFT was significantly associated with a higher risk of reaching renal composite endpoints in patients with IgAN.
CONCLUSION
This study indicated a positive relationship between PFT at renal biopsy and renal progression in patients with IgAN, suggesting that perirenal fat might act as a marker of poor prognosis in patients with IgAN.
PubMed: 38322631
DOI: 10.1159/000533507 -
International Braz J Urol : Official... 2015To describe the surgical technique and initial experience with a single-port retroperitoneal renal biopsy (SPRRB).
OBJECTIVE
To describe the surgical technique and initial experience with a single-port retroperitoneal renal biopsy (SPRRB).
MATERIALS AND METHODS
Between January and April 2013, five children underwent SPRRB in our hospital. A single 1.5 cm incision was performed under the 12th rib at mid-axillary line, and an 11 mm trocar was inserted. A nephroscope was used to identify the kidney and dissect the perirenal fat. After lower pole exposure, a laparoscopic biopsy forceps was introduced through the nephroscope working channel to collect a renal tissue sample.
RESULTS
SPRRB was successfully performed in five children. The mean operative time was 32 minutes, and mean estimated blood loss was less than 10 mL. The hospital stay of all patients was two days because they were discharged in the second postoperative day, after remaining at strict bed rest for 24 hours after the procedure. The average number of glomeruli present in the specimen was 31.
CONCLUSION
SPRRB is a simple, safe and reliable alternative to open and videolaparoscopic approaches to surgical renal biopsy.
Topics: Blood Loss, Surgical; Child; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Female; Humans; Kidney; Laparoscopy; Length of Stay; Male; Operative Time; Reproducibility of Results; Retroperitoneal Space; Time Factors
PubMed: 25928523
DOI: 10.1590/S1677-5538.IBJU.2015.01.22 -
BioMed Research International 2021Percutaneous tumor ablation is usually performed using computed tomography (CT) or ultrasound (US) guidance, although reliable visualization of the target tumor could be...
OBJECTIVE
Percutaneous tumor ablation is usually performed using computed tomography (CT) or ultrasound (US) guidance, although reliable visualization of the target tumor could be challenging. Magnetic resonance- (MR-) guided ablation provides more reliable visualization of the target tumors and allows multiplanar imaging of the treatment process, making it the modality of choice, in particular if lesions are small.
METHODS
From March 2016 to January 2018, 32 patients scheduled for percutaneous treatment of T1 RCC underwent MR-guided MWA. Complications were classified according to the Clavien grade. Kaplan-Meier survival estimates were calculated to evaluate progression-free survival (PFS).
RESULTS
Technical success was achieved in all lesions. The mean energy and procedure duration were 61.6 ± 8.7 kJ and 118.2 ± 26.7 min, respectively. The glomerular filtration rate (GFR) dropped rapidly after 1 month of treatment and slowly recovered within three months ( < 0.05). Postoperative pain and fever were the most common adverse events after treatment. Perirenal hematoma, thermal injury of the psoas muscle, and abdominal distension were common complications after MWA, and the incidence rates were 9.4% (3/32), 6.3% (2/32), and 6.3% (2/32), respectively. According to the Clavien grade classification, serious complications include hydrothorax, bowel injury, and renal failure, all of which have a probability of 3.1%. Of note, the three serious complications occurred in one patient. The 1-, 2-, and 3-year PFS rates were 96.9%, 93.8%, and 83.9%, respectively. The mean PFS rates were 33.972 months (95% CI: 33.045, 35.900).
CONCLUSION
Microwave ablation is feasible under MR guidance and provides effective treatment of RCC in one session.
Topics: Adult; Aged; Carcinoma, Renal Cell; Female; Glomerular Filtration Rate; Hematoma; Humans; Hydrothorax; Kidney Neoplasms; Male; Microwaves; Middle Aged; Psoas Muscles; Radiofrequency Ablation; Renal Insufficiency; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography
PubMed: 34055980
DOI: 10.1155/2021/5537192 -
Chinese Medical Journal Sep 2016Percutaneous nephrolithotomy (PCNL) is the most widely recommended treatment for calyceal diverticular calculi, providing excellent stone-free results. However, its...
BACKGROUND
Percutaneous nephrolithotomy (PCNL) is the most widely recommended treatment for calyceal diverticular calculi, providing excellent stone-free results. However, its invasiveness is not negligible considering its major complication rates. Flexible ureteroscopy (FURS) is currently used to treat calyceal diverticula. However, the greatest drawback of FURS is locating the diverticulum since its neck is narrow and concealed. In such a case, the FURS procedure must be converted to PCNL. The aim of this study was to evaluate ultrasound-guided flexible ureteroscopy (UFURS) identifying diverticulum and the management of calyceal diverticular calculi.
METHODS
A retrospective analysis was conducted on 24 patients who had calyceal diverticular calculi. In all 12 patients in the UFURS group, direct FURS failed to find evidence of calyceal diverticula but were confirmed with imaging. The other 12 patients in the PCNL group received PCNL plus fulguration of the diverticular walls.
RESULTS
Puncture of calyceal diverticulum was successful in all 12 UFURS patients. Two patients in this group had postoperative residual calculi and two patients developed fever. In the PCNL group, percutaneous renal access and lithotomy were successful in all 12 patients. One patient in this group had residual calculi, one had perirenal hematoma, and two patients developed fever. No significant difference was found in the operating time (UFURS vs. PCNL, 91.8 ± 24.2 vs. 86.3 ± 18.7 min), stone-free rate (UFURS vs. PCNL, 9/12 vs. 10/12), and rate of successful lithotripsy (UFURS vs. PCNL, 10/12 vs. 11/12) between the two groups (all P> 0.05). Postoperative pain scores in the FURS group were significantly lower than that in the PCNL group (2.7 ± 1.2 vs. 6.2 ± 1.5, P< 0.05). Hospital stay in the UFURS group was significantly shorter than that in the PCNL group (3.4 ± 0.8 vs. 5.4 ± 1.0 days, P< 0.05). All patients were symptom-free following surgery (UFURS vs. PCNL, 10/10 vs. 12/12).
CONCLUSION
Ultrasound-guided puncture facilitates identification of calyceal diverticula during FURS and improves the success rate of FURS surgery.
Topics: Adult; Diverticulum; Female; Humans; Kidney Calculi; Male; Middle Aged; Retrospective Studies; Ultrasonography; Ureteroscopes; Ureteroscopy
PubMed: 27569233
DOI: 10.4103/0366-6999.189060