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Heliyon Jan 2024Clear cell renal cell carcinoma (ccRCC) is corelated with tumor-associated material (TAM), coagulation system and adipocyte tissue, but the relationships between them...
BACKGROUND
Clear cell renal cell carcinoma (ccRCC) is corelated with tumor-associated material (TAM), coagulation system and adipocyte tissue, but the relationships between them have been inconsistent. Our study aimed to explore the cut-off intervals of variables that are non-linearly related to ccRCC pathological T stage for providing clues to understand these discrepancies, and to effectively preoperative risk stratification.
METHODS
This retrospective analysis included 218 ccRCC patients with a clear pathological T stage between January 1st, 2014, and November 30th, 2021. The patients were categorized into two cohorts based on their pathological T stage: low T stage (T1 and T2) and high T stage (T3 and T4). Abdominal and perirenal fat variables were measured based on preoperative CT images. Blood biochemical indexes from the last time before surgery were also collected. The generalized sum model was used to identify cut-off intervals for nonlinear variables.
RESULTS
In specific intervals, fibrinogen levels (FIB) (2.63-4.06 g/L) and platelet (PLT) counts (>200.34 × 10/L) were significantly positively correlated with T stage, while PLT counts (<200.34 × 10/L) were significantly negatively correlated with T stage. Additionally, tumor-associated material exhibited varying degrees of positive correlation with T stage at different cut-off intervals (cut-off value: 90.556 U/mL).
CONCLUSION
Preoperative PLT, FIB and TAM are nonlinearly related to pathological T stage. This study is the first to provide specific cut-off intervals for preoperative variables that are nonlinearly related to ccRCC T stage. These intervals can aid in the risk stratification of ccRCC patients before surgery, allowing for developing a more personalized treatment planning.
PubMed: 38268833
DOI: 10.1016/j.heliyon.2024.e24456 -
Urologic Oncology Jan 2024To determine the optimal cut-off value of Ki-67 for predicting the survival of patients with clear cell renal cell carcinoma (ccRCC) and tumor thrombus and to explore...
PURPOSE
To determine the optimal cut-off value of Ki-67 for predicting the survival of patients with clear cell renal cell carcinoma (ccRCC) and tumor thrombus and to explore the correlation between Ki-67 expression and pathological features.
PATIENTS AND METHODS
We retrospectively analyzed Ki-67 immunohistochemical staining of ccRCC and tumor thrombus resected from February 2006 to February 2022. The survival rate was evaluated using the Kaplan-Meier method. The optimal cut-off value of the Ki-67 expression for predicting survival was determined by the minimum P-value method. Clinicopathological data were compared based on Ki-67 status (low versus high expression). Univariate and multivariate Cox regression analysis was used to explore independent predictors.
RESULTS
A total of 202 patients (median age, 58 years [IQR, 52-65 years], 147 men) with ccRCC and tumor thrombus were included in the study. The optimal cut-off value of Ki-67 for predicting survival was 30%. 159 (78.7%) and 43 (21.3%) patients were included in the low-expression and high-expression groups. Patients with Ki-67 high expression had significantly worse recurrence-free survival (P < 0.001) and cancer-specific survival (P < 0.001). Ki-67 high expression was associated with adverse pathological features, including tumor necrosis, ISUP nuclear grade, sarcomatoid differentiation, perirenal fat invasion, renal pelvis invasion, and inferior vena cava wall invasion (all P < 0.050). Ki-67 expression ≥ 30% (P = 0.016), tumor side (P = 0.003), diabetes (P = 0.040), blood loss (P = 0.016), inferior vena cava wall invasion (P = 0.016), and sarcomatoid differentiation (P = 0.014) were independent predictors of cancer-specific survival.
CONCLUSION
The optimal cut-off level of Ki-67 in predicting the prognosis of ccRCC and tumor thrombus was 30%. The high expression of Ki-67 was associated with the aggressive pathological phenotype and poor prognosis.
Topics: Male; Humans; Middle Aged; Carcinoma, Renal Cell; Kidney Neoplasms; Ki-67 Antigen; Retrospective Studies; Vena Cava, Inferior; Thrombosis; Prognosis; Neoplastic Processes; Carcinoma; Cell Proliferation; Nephrectomy
PubMed: 38030468
DOI: 10.1016/j.urolonc.2023.11.001 -
Journal of Community Hospital Internal... 2023Page kidney is a pathologic and rare occurrence caused by a compression of renal parenchyma leading to hypertension. When infiltrated or engulfed by extrinsic matter,...
Page kidney is a pathologic and rare occurrence caused by a compression of renal parenchyma leading to hypertension. When infiltrated or engulfed by extrinsic matter, the subcapsular region surrounding the renal tissue may cause blanket compression, leading to the activation of the renin-angiotensin-aldosterone system secondary to renal hypoperfusion. While most cases of Page kidney are secondary to blunt trauma to the costovertebral angle, herein we present a case of Page kidney due to renal parenchymal core needle biopsy. The rarity of our case is not due to the cause of such an incidence but because our case resulted in a hypertensive emergency treated with dual intravenous infusions.
PubMed: 38596547
DOI: 10.55729/2000-9666.1266 -
The American Journal of Case Reports Apr 2024BACKGROUND Wünderlich syndrome (WS) is a rare diagnosis of nontraumatic spontaneous renal hemorrhage into the subcapsular, perirenal, or pararenal spaces. Prompt and...
BACKGROUND Wünderlich syndrome (WS) is a rare diagnosis of nontraumatic spontaneous renal hemorrhage into the subcapsular, perirenal, or pararenal spaces. Prompt and effective intervention is necessary for an accurate pathological diagnosis and preservation of life. In the current literature, open surgery is the primary option when conservative treatment fails, but there can be serious trauma and corresponding consequences. Herein, we present 3 cases of Wünderlich syndrome managed by robot-assisted laparoscopic nephrectomy via a retroperitoneal approach. CASE REPORT Patient 1 was a 44-year-old woman with right flank pain for 6 h. Patient 2 was a 53-year-old woman with a history of diabetes who had pain in her right flank pain and nausea for 1 day. Patient 3 was a 45-year-old man with left flank pain for 1 day. All cases of WS were confirmed by CT. All 3 patients were treated with retroperitoneal robot-assisted nephrectomy after conservative treatment failed. Pathological examination confirmed that patient 1 had angiomyolipoma, and patients 2 and 3 had renal clear cell carcinoma. At the 9-month follow-up, renal function was good and no evidence of recurrence or metastasis has been detected. CONCLUSIONS These cases have highlighted the importance of the clinical history and imaging findings in the diagnosis of Wünderlich syndrome, and show that rapid management can be achieved using robot-assisted laparoscopic nephrectomy. However, it is crucial to have a skilled surgical team and adequate preoperative preparation.
Topics: Humans; Nephrectomy; Middle Aged; Robotic Surgical Procedures; Male; Laparoscopy; Female; Adult; Syndrome; Kidney Diseases; Hemorrhage; Kidney Neoplasms; Angiomyolipoma; Carcinoma, Renal Cell
PubMed: 38659203
DOI: 10.12659/AJCR.942826 -
Renal vein thrombosis in the course of non-operative treatment of kidney trauma: A rare case report.International Journal of Surgery Case... Mar 2024Venous thromboembolism is widely recognized as a life-threatening complication in trauma, yet renal vein thrombosis (RVT) following trauma is particularly rare.
INTRODUCTION
Venous thromboembolism is widely recognized as a life-threatening complication in trauma, yet renal vein thrombosis (RVT) following trauma is particularly rare.
PRESENTATION OF CASE
We report a case of a 67-year-old man who was brought to the emergency department after falling down a 14-step staircase at home which presented right kidney trauma (parenchyma laceration with a perirenal hematoma) on computed tomography, and hematuria. Considering the patient's hemodynamic stability, a non-operative treatment was initiated, and the patient was referred to the intensive care unit for close observation. On post-trauma day 3, a repeated CT revealed right renal vein thrombosis. After evaluation, it was decided to maintain prophylactic anticoagulation doses of enoxaparin (40 mg/day) due to the elevated risk of bleeding in high-grade renal trauma and planned an inferior vena cava (IVC) filter placement. In the following days, the hematuria resolved spontaneously and an IVC filter was placed. The patient progressed with no complaints, spontaneous diuresis, improvement in laboratory parameters, and cardiovascular stability, which led to his discharge on day 12 with rivaroxaban 10 mg/day. The patient was successfully treated with a non-operative approach, and the RVT disappeared after 35 days.
DISCUSSION
Post-traumatic renal vein thrombosis is a rare occurrence, and due to the infrequent nature of these events, specific management guidelines are not fully established, particularly when thrombosis is confirmed in an acutely injured patient.
CONCLUSION
Conservative therapy seems to play a meaningful role in trauma-related renal vein thrombosis treatment.
PubMed: 38401323
DOI: 10.1016/j.ijscr.2024.109433 -
BMJ Open Jan 2024In older patients, the diagnosis of acute pyelonephritis (APN) is challenging. The aim was to evaluate the added value of CT to history, physical examination and...
Added value of non-contrast CT for the diagnosis of acute pyelonephritis in older patients with suspected infection with an unknown focus: a retrospective diagnostic study.
OBJECTIVES
In older patients, the diagnosis of acute pyelonephritis (APN) is challenging. The aim was to evaluate the added value of CT to history, physical examination and urinalysis for the diagnosis of APN in older patients with suspected infection with an unknown focus.
DESIGN
Retrospective diagnostic study.
SETTING
Department of General Medicine in an acute care hospital in Japan.
PARTICIPANTS
Patients aged ≥65 years who underwent blood cultures, a urine culture, and chest and abdominal CT to detect the focus of infection were included.
PRIMARY OUTCOME MEASURES
Two radiologists independently reviewed four non-contrast CT signs: perirenal fat stranding, pelvicalyceal wall thickening, enlargement of the kidney and thickening of Gerota's fascia. Findings on contrast-enhanced CT could not be evaluated due to an insufficient number of patients in whom contrast-enhanced CT was performed. An expert panel was used as the reference standard for APN. The added value of CT findings was quantified by comparing the diagnostic performance between a model based on 10 predictors available before CT and an extended model including the CT findings.
RESULTS
Of 473 patients, 61 (14.8%) were diagnosed with APN. When the laterality of the CT findings was taken into account, the model fit was not improved by adding them. In the laterality-insensitive analysis, the model performance was significantly improved by adding the CT signs (likelihood-ratio test p=0.03; c-index 0.89 vs 0.91, p=0.03). However, their clinical utility was only to improve the classification of 11.5% of patients with APN.
CONCLUSIONS
The added value of non-contrast CT findings to history, physical examination and urinalysis was limited for the diagnosis of APN in older patients with a suspected infection with an unknown focus.
Topics: Humans; Aged; Retrospective Studies; Acute Disease; Tomography, X-Ray Computed; Pyelonephritis; Kidney
PubMed: 38171629
DOI: 10.1136/bmjopen-2023-076678 -
Archives of Toxicology Jul 2024Many fatal intoxications have been reported in connection with the consumption of newer, highly potent synthetic cannabinoids. Yet, a possible postmortem redistribution...
Does a postmortem redistribution affect the concentrations of the 7 azaindole-derived synthetic cannabinoid 5F-MDMB-P7AICA in tissues and body fluids following pulmonary administration to pigs?
Many fatal intoxications have been reported in connection with the consumption of newer, highly potent synthetic cannabinoids. Yet, a possible postmortem redistribution (PMR) might complicate reliable interpretation of analytical results. Thus, it is necessary to investigate the PMR-potential of new synthetic cannabinoids. The pig model has already proven to be suitable for this purpose. Hence, the aim of this study was to study the PMR of the synthetic cannabinoid 5F-MDMB-P7AICA and its main metabolite 5F-MDMB-P7AICA-dimethylbutanoic acid (DBA). 5F-MDMB-P7AICA (200 µg/kg body weight) was administered by inhalation to anesthetized and ventilated pigs. At the end of the experiment, the animals were euthanized and stored at room temperature for 3 days. Tissue and body fluid samples were taken daily. Specimens were analyzed after solid phase extraction using a standard addition method and LC-MS/MS, blood was quantified after protein precipitation using a validated method. In perimortem samples, 5F-MDMB-P7AICA was found mainly in adipose tissue, bile fluid, and duodenum contents. Small amounts of 5F-MDMB-P7AICA were found in blood, muscle, brain, liver, and lung. High concentrations of DBA were found primarily in bile fluid, duodenum contents, urine, and kidney/perirenal fat tissue. In the remaining tissues, rather low amounts could be found. In comparison to older synthetic cannabinoids, PMR of 5F-MDMB-P7AICA was less pronounced. Concentrations in blood also appear to remain relatively stable at a low level postmortem. Muscle, kidney, fat, and duodenum content are suitable alternative matrices for the detection of 5F-MDMB-P7AICA and DBA, if blood specimens are not available. In conclusion, concentrations of 5F-MDMB-P7AICA and its main metabolite DBA are not relevantly affected by PMR.
PubMed: 38955864
DOI: 10.1007/s00204-024-03815-1 -
IJU Case Reports Mar 2024Parenchymal renal rupture due to a ureteric calculus is extremely rare and an emergency.
INTRODUCTION
Parenchymal renal rupture due to a ureteric calculus is extremely rare and an emergency.
CASE PRESENTATION
A 54-year-old man was brought to the emergency room with left back pain without trauma. Computed tomography showed left parenchymal renal rupture with an incompletely duplicated renal pelvis, ureter, and an 11-mm ureteric calculus in the ureterovesical junction. A ureteral stent was placed, and the patient was treated conservatively as his vital signs were stable. We performed transurethral lithotripsy after resolution of the perirenal hematoma.
CONCLUSION
To best of our knowledge, this report is the first to present a case of parenchymal renal rupture due to a ureteric calculus in an incompletely duplicated renal pelvis and ureter. Ureteric calculus within an incompletely duplicated renal pelvis and ureter is at risk of parenchymal renal rupture. Therefore, the aggressive treatment of ureteric calculus could be important.
PubMed: 38440706
DOI: 10.1002/iju5.12697 -
Radiology Case Reports Jun 2024Extramedullary hematopoiesis represents a clinical compensatory condition characterized by the growth of hematopoietic tissue outside the bone marrow. It can mainly...
Extramedullary hematopoiesis represents a clinical compensatory condition characterized by the growth of hematopoietic tissue outside the bone marrow. It can mainly occur in patient with myeloproliferative disorders where alteration or neoplastic invasion of the bone marrow causes ineffective production of blood cells with the recruitment of progenitrix blood cells in non-hematopoietic organs, including kidneys. Renal extramedullary hematopoiesis is a rare condition manifesting as parenchymal or perirenal soft tissue masses with different patterns mimicking neoplasms, infectious or vascular diseases. We describe a unique case of a patient affected by primary myelofibrosis underwent ultrasound and magnetic resonance examinations showing bilateral perirenal alterations to be related to hemopoietic tissue. We also focused on the pathophysiology of this condition with imaging correlation. The case we present emphasises the importance of recognising the main radiological features of renal extramedullary hematopoiesis. MR examination should become part of the diagnostic pathway of the patient with primary myelofibrosis.
PubMed: 38559653
DOI: 10.1016/j.radcr.2024.02.083 -
Environmental Toxicology and... Jun 2024This study aimed to explore whether there is an association between environmental exposure to POPs and kidney tumor induction, and whether blood POP concentrations...
This study aimed to explore whether there is an association between environmental exposure to POPs and kidney tumor induction, and whether blood POP concentrations reflect kidney tissue concentrations. POP derivatives were determined in blood, tumor tissue, tumor surrounding tissue, and perirenal fat tissue samples taken from patients who underwent surgery for renal tumors. A voluntary control group was recruited for blood and urine samples as well. Urinary excretions of o,o'-dityrosine, chlorotyrosine, nitrotyrosine, and 8-OHdG were measured in the same patients. The possible role of genetic polymorphisms in CYP1A1, GST isozymes P, M, and T, and hOGG1 genes on the predisposition to renal cancer was investigated. Some POPs have been found to be associated with kidney cancer, as evidenced by their significantly high ORs. 8-OHdG levels were significantly higher compared to the control group. The GSTT1 null polymorphism can be a risk factor for malignant but not for benign kidney tumors.
PubMed: 38950873
DOI: 10.1016/j.etap.2024.104495