Authors: Marcelo Langer Wroclawski, Guilherme Andrade Peixoto, Marcio Covas Moschovas...

INTRODUCTION

Renal ptosis is defined as the renal descent when there is a change from supine to orthostatic position, usually with a change of two vertebral bodies or more than five cm apart. Although rare, it is one of the causes of chronic flank pain or of upper abdomen. The typical patient of renal ptosis is young, female, thin, with complaint of pain when in an upright position (1, 2).

OBJECTIVE

Demonstrate a robot-assisted nephropexy technique in a young woman diagnosed with symptomatic renal ptosis on the right kidney, confirmed by imaging tests.

MATERIALS AND METHODS

A 29-year-old female patient with a history of chronic right-sided pain and palpable renal mobility on physical examination. The diagnosis of renal ptosis was confirmed by ultrasound imaging, excretory urography (Figure -1), and renal scintigraphy with 99mTc-DTPA (Figure-2). She was submitted to a robotic-assisted right nephropexy with a polypropylene mesh fixing the right kidney to the ipsilateral psoas muscle fascia.

RESULT

We reported a 96-minute surgical time. The patient was discharged in the first postoperative day. At the one-month follow-up, there was an important improvement of the symptoms, with normality renal function and imaging tests describing adequate renal positioning.

CONCLUSIONS

Robotic-assisted nephropexy is feasible and can be an excellent minimally invasive alternative technique for the proposed surgery. We reported a shorter hospital stay and a faster postoperative recovery compared with the opened procedure.

Topics: Adult; Female; Humans; Kidney; Robotic Surgical Procedures; Treatment Outcome; Urologic Surgical Procedures

PubMed: 29211400
DOI: 10.1590/S1677-5538.IBJU.2017.0390

Review

Authors: Kelly Lambert, Robert Gardos, Helen Coolican...

Polycystic kidney disease (PKD) is a chronic, progressive hereditary condition characterized by abnormal development and growth of cysts in the kidneys and other organs. There is increasing interest in exploring whether dietary modifications may prevent or slow the disease course in people with PKD. Although vasopressin-receptor agonists have emerged as a novel drug treatment in advancing care for people with PKD, several recent landmark trials and clinical discoveries also have provided new insights into potential dietary-related therapeutic strategies. In this review, we summarize the current evidence pertaining to nutrients, foods, dietary patterns, cyst growth, and progression of PKD. We also describe existing evidence-based dietary care for people with PKD and outline the potential implications for advancing evidence-based dietary interventions. Semin Nephrol 43:x-xx © 2023 Elsevier Inc. All rights reserved.

Topics: Humans; Polycystic Kidney Diseases; Kidney; Diet; Nutrients

PubMed: 37542985
DOI: 10.1016/j.semnephrol.2023.151405

Authors: Ayu Ogawa, Shinji Kitamura, Kazunori Nakayama...

Topics: Branchio-Oto-Renal Syndrome; Ear, Inner; Female; Humans; Kidney; Proteinuria; Tomography, X-Ray Computed; Young Adult

PubMed: 23064196
DOI: 10.1038/ki.2012.201

Authors: Misako Nakamura, Shoichiro Kanda, Yuko Kajiho...

Congenital anomalies of the kidney and urinary tract (CAKUT) are frequently associated with Mullerian anomalies. This can be explained by the fact that Mullerian duct elongation depends on the preformed Wolffian duct during embryogenesis. While CAKUT such as unilateral renal agenesis and multicystic dysplastic kidney are commonly identified prenatally by routine ultrasound, the diagnosis of Mullerian anomalies is often delayed, increasing the risk of complications such as endometriosis or pelvic inflammatory disease. Herein, we report a case of a premenarchal girl who had initially been diagnosed with right multicystic dysplastic kidney. She presented with continuous urinary incontinence at 4 years old and further evaluation by contrast-enhanced computed tomography, cystoscopy, colposcopy, ureterography, and hysterosalpingography led to the final diagnosis of right hypodysplastic kidney and ectopic ureter associated with bicornuate uterus. A strong family history of uterine malformations prompted the examination of the uterus. Genetic testing was suggested but the family declined. She is planned to be referred to a gynecologist at puberty for further assessment. The recognition and screening rate of concurrent Mullerian anomalies in CAKUT patients varies between institutions. Screening for Mullerian anomalies in prediagnosed CAKUT girls may enable to provide timely counseling and to prevent gynecological complications.

Topics: Female; Humans; Child, Preschool; Ureter; Multicystic Dysplastic Kidney; Bicornuate Uterus; Vagina; Kidney; Ureteral Obstruction

PubMed: 36056295
DOI: 10.1007/s13730-022-00730-1

Authors: Cassandra Eibl, Sonja Franz

BACKGROUND

The ultrasonographic examination technique is a well-established, non-invasive diagnostic tool for diverse conditions in humans and different animal species. The purpose of our study was to describe ultrasonographic localisation, sonographic appearance and dimensions of the kidneys and spleen of clinically healthy llamas and alpacas. Differences between llamas and alpacas and the influence of sex and ages were investigated. Results of this study may aid veterinarians performing ultrasonography in diseased animals and the technique can be used for routine protocol screening.

RESULTS

Ultrasonography was performed in 135 clinically healthy, non-sedated llamas and alpacas. Screening was performed with a 6.6 MHz curve linear transducer with only alcohol as contact medium between the probe and unclipped skin. The kidneys could be imaged from the paralumbar region. The right kidney only was visualized when scanning from the right and the left kidney only from the left. While the left kidney appeared in sagittal view as an oval shape in most llamas and alpacas, in one third of animals the left kidney had a triangular shape. The L-shaped base of the spleen, with its homogeneous, echoic pattern, could be seen craniolateral to the left kidney. Anechoic areas displaying vessels inside the spleen and a thin echoic capsule surrounding the splenic tissue could be differentiated. While sonographic appearances of the examined organs showed no differences between llamas and alpacas, selected dimensions of both of kidney and spleen showed significant differences between species. In terms of age and sex, significant differences in respect of kidney size could be found only in alpacas. Sex seemed to have no influence on kidney and spleen sizes in llamas.

CONCLUSIONS

The present study provides species-specific information on ultrasonographic appearance and reference values for kidney and spleen dimensions of clinically healthy llamas and alpacas. Results show differences in organ sizes between llamas and alpacas and in alpacas of different sex and age. The results of this study can be used as references for veterinarians performing ultrasound examinations in diseased animals.

Topics: Animals; Camelids, New World; Female; Kidney; Male; Reference Values; Species Specificity; Spleen; Ultrasonography

PubMed: 33478520
DOI: 10.1186/s13028-021-00571-5

Authors: F Conti-Ramsden, R Hill, M Rutherford...

AIM

To report the morphology of maternal kidneys captured on fetal magnetic resonance imaging (MRI) including kidney length, volume, renal pelvis diameter, and corticomedullary differentiation in pregnancy.

MATERIALS AND METHODS

A retrospective study of maternal kidney morphology captured incidentally on fetal MRI. Women without chronic kidney disease, with a complete view of both kidneys and a singleton pregnancy were included. Kidney length, maximal renal pelvis diameter, kidney volume, and corticomedullary differentiation ratio were measured independently in duplicate. Associations with maternal and pregnancy variables were explored using linear regression.

RESULTS

MRI images from 42 women were performed at 22-32 weeks' gestation. Serum creatinine concentrations are not checked routinely during pregnancy and were available for 15 (36%) women, with a median creatinine of 57 μmol/l (IQR: 50-63 μmol/l). Mean interpolar lengths were 10.9 and 10.4 cm for the left and right kidneys and varied with height. Mean maximal renal pelvis diameters were 9 mm and 12 mm, with upper reference intervals of 17 and 25 mm for the left and right kidneys, respectively. Renal volume in pregnancy was within the non-pregnant reference interval and varied with height and gestation.

CONCLUSIONS

Maternal kidney length and volume in pregnancy are within the normal reference intervals for non-pregnant women. Renal pelvis diameter in pregnancy measured using MRI is substantially higher than described previously by ultrasound, with implications for routine reporting.

Topics: Female; Gestational Age; Humans; Kidney; Magnetic Resonance Imaging; Male; Pregnancy; Retrospective Studies; Ultrasonography; Ultrasonography, Prenatal

PubMed: 35570156
DOI: 10.1016/j.crad.2022.03.019

Authors: David Csonka, Károly Kalmár Nagy, Péter Szakály...

INTRODUCTION

In the circulatory system, the vessel branching angle may have hemodynamic consequences. We hypothesized that there is a hemodynamically optimal range for the renal artery's branching angle.

METHODS

Data on the posttransplant kinetics of estimated glomerular filtration rate (eGFR) were analyzed according to the donor and implant sides (right-to-right and left-to-right position; n = 46). The renal artery branching angle from the aorta of a randomly selected population was measured using an X-ray angiogram (n = 44). Computational fluid dynamics simulation was used to elucidate the hemodynamic effects of angulation.

RESULTS AND DISCUSSION

Renal transplant patients receiving a right donor kidney to the right side showed faster adaptation and higher eGFR values than those receiving a left donor kidney to the right side (eGFR: 65 ± 7 vs. 56 ± 6 mL/min/1.73 m2; p < 0.01). The average branching angle on the left side was 78° and that on the right side was 66°. Simulation results showed that the pressure, volume flow, and velocity were relatively constant between 58° and 88°, indicating that this range is optimal for the kidneys. The turbulent kinetic energy does not change significantly between 58° and 78°.

CONCLUSION

The results suggest that there is an optimal range for the renal artery's branching angle from the aorta where hemodynamic vulnerability caused by the degree of angulation is the lowest, which should be considered during kidney transplantations.

Topics: Humans; Renal Artery; Kidney; Aorta; Kidney Transplantation; Hemodynamics

PubMed: 36940678
DOI: 10.1159/000530169

Authors: Hyeong-Joon Lim, Seok Hwa Choi

BACKGROUND/AIM

This study performed Tc-MAG renal scintigraphy on rabbit kidneys and evaluated its ability to identify obstructive or non-obstructive kidneys.

MATERIALS AND METHODS

Renal function was assessed during a four-week post-obstruction period by obtaining planar images of Tc-MAG activity following an ear vein injection. The individual renal function was evaluated by renal scintigraphy in conjunction with histopathological and morphological examinations.

RESULTS

The renal perfusion of Tc-MAG in the right kidney with a ureteral obstruction decreased with time. The width, height, and cortical thickness of the obstructed right kidney were significantly larger than those of the left kidney. A histopathological examination four weeks after the ureteral obstruction revealed a typical pattern of urinary tract obstruction, including multiple tubules, enlargement of the interstitial area, and cytoplasmic vacuoles.

CONCLUSION

Tc-MAG renal scintigraphy provides the kidney shape and size and can identify potential obstructive and non-obstructive kidneys in rabbits.

Topics: Animals; Kidney; Rabbits; Radioisotope Renography; Radiopharmaceuticals; Technetium Tc 99m Mertiatide; Ureteral Obstruction

PubMed: 34972716
DOI: 10.21873/invivo.12692

Observational Study

Authors: F T Akinlade, O M Akinlade, A A Aremu...

PURPOSE

Figures can sometimes be difficult to handle when considering whether the ultrasound dimensions of the liver, spleen, and kidneys of children are within normal limits in a typical clinical setting. Therefore, it is imperative to think of a simple measure that can be easily adopted when the question of whether these organs are enlarged or reduced in size is to be answered by a sonologist. We hypothesize that the liver-right kidney ratio and spleen-left kidney ratio are constant, regardless of age and sex among children, provided that the reference organ is not diseased.

METHODS

This observational, cross-sectional study was carried out in public primary schools in the Ogbomoso metropolis. A total of 1000 apparently healthy children aged 5-13 were subjected to abdominal sonography from July 2016 to December 2016. The length of the liver, spleen, and both kidneys as well as the anthropometric parameters of each subject were obtained and correlated. Data were analyzed using SPSS version 20.

RESULTS

The SPL:LKL (spleen to left kidney length) ratio varies with age, and this is statistically significant in female subjects (p = 0.042), but not in males (p = 0.360). The RLL:RKL (right lobe of the liver to right kidney length) ratio of 1.19 ± 0.18 does not significantly vary with age or sex (p = 0.337).

CONCLUSION

The SPL:LKL ratio of 1.11 ± 0.18 can be only used as a measure of normality of organ dimensions in males. On the contrary, the RLL:RKL of 1.19 ± 0.18 can be used in all children, regardless of sex, provided that the reference organ is normal.

Topics: Child; Cross-Sectional Studies; Female; Humans; Kidney; Liver; Male; Nigeria; Organ Size; Reference Values; Spleen; Ultrasonography

PubMed: 32915401
DOI: 10.1007/s40477-020-00521-3

Authors: Peter G Stock, Krista L Lentine

Topics: Humans; Kidney; Tissue and Organ Procurement

PubMed: 34327810
DOI: 10.1111/ajt.16771