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BMC Medical Imaging Nov 2023Kidney volume is important in the management of renal diseases. Unfortunately, the currently available, semi-automated kidney volume determination is time-consuming and...
PURPOSE
Kidney volume is important in the management of renal diseases. Unfortunately, the currently available, semi-automated kidney volume determination is time-consuming and prone to errors. Recent advances in its automation are promising but mostly require contrast-enhanced computed tomography (CT) scans. This study aimed at establishing an automated estimation of kidney volume in non-contrast, low-dose CT scans of patients with suspected urolithiasis.
METHODS
The kidney segmentation process was automated with 2D Convolutional Neural Network (CNN) models trained on manually segmented 2D transverse images extracted from low-dose, unenhanced CT scans of 210 patients. The models' segmentation accuracy was assessed using Dice Similarity Coefficient (DSC), for the overlap with manually-generated masks on a set of images not used in the training. Next, the models were applied to 22 previously unseen cases to segment kidney regions. The volume of each kidney was calculated from the product of voxel number and their volume in each segmented mask. Kidney volume results were then validated against results semi-automatically obtained by radiologists.
RESULTS
The CNN-enabled kidney volume estimation took a mean of 32 s for both kidneys in a CT scan with an average of 1026 slices. The DSC was 0.91 and 0.86 and for left and right kidneys, respectively. Inter-rater variability had consistencies of ICC = 0.89 (right), 0.92 (left), and absolute agreements of ICC = 0.89 (right), 0.93 (left) between the CNN-enabled and semi-automated volume estimations.
CONCLUSION
In our work, we demonstrated that CNN-enabled kidney volume estimation is feasible and highly reproducible in low-dose, non-enhanced CT scans. Automatic segmentation can thereby quantitatively enhance radiological reports.
Topics: Humans; Neural Networks, Computer; Tomography, X-Ray Computed; Radionuclide Imaging; Kidney; Automation; Image Processing, Computer-Assisted
PubMed: 37968580
DOI: 10.1186/s12880-023-01142-y -
Canadian Journal of Surgery. Journal... 2022During kidney procurement, after ice removal, kidneys located in the retroperitoneum are at risk for rewarming owing to the time taken to retrieve other abdominal and...
BACKGROUND
During kidney procurement, after ice removal, kidneys located in the retroperitoneum are at risk for rewarming owing to the time taken to retrieve other abdominal and thoracic organs, which may lead to poorer outcomes. The purpose of this study was to evaluate the impact of prolonged kidney procurement time (PKP) on outcomes of kidney transplantation performed at the Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
METHODS
We retrospectively reviewed the cases of all adult (age ≥ 18 yr) patients who underwent kidney transplantation at the Queen Elizabeth II Health Sciences Centre between Jan. 1, 2010, and Dec. 31, 2015. We included all patients who received kidney transplants from deceased donors with a minimum follow-up period of 3 years. We defined PKP as more than 65 minutes from aortic cross-clamp to final organ extraction, and standard procurement time (SP) as 65 minutes or less.
RESULTS
Among the 455 transplantation procedures performed during the study period, we reviewed the cases of 145 patients who received kidneys from Nova Scotian donors and were followed in Nova Scotia. No statistically significant differences were seen in outcomes between kidney-only ( = 46) and multiorgan ( = 99) procurement, although more organs from kidney-only donors than multiorgan donors had a Kidney Donor Profile Index score greater than 50% (32 [69.6%] v. 48 [48.5%], < 0.01). Compared to the SP group ( = 115), the PKP group ( = 30) had a higher rate of 30-day graft loss (6.7% v. 0.0%, < 0.01), a higher incidence of de novo formation of donor-specific antibodies (3 [10.0%] v. 1 [0.9%], < 0.01) and a lower 5-year graft survival rate (90.0% v. 97.4%, = 0.03). Left kidneys remained 11 minutes longer on the donor than right kidneys when multiorgan procurement was performed ( < 0.01), and their 5-year survival rate was significantly lower than that of right kidneys ( = 0.03).
CONCLUSION
Procurement times longer than 65 minutes may be associated with poorer outcomes after kidney transplantation. Measures to reduce kidney exposure to rewarming during procurement may improve long-term outcomes.
Topics: Adult; Humans; Graft Survival; Kidney; Kidney Transplantation; Nova Scotia; Retrospective Studies; Tissue and Organ Procurement; Tissue Donors
PubMed: 36302131
DOI: 10.1503/cjs.005721 -
Medicine Sep 2020A supernumerary kidney is an extremely rare renal anomaly. Currently, <100 cases are reported in the literature. There are only 2 right unilateral supernumerary kidneys...
RATIONALE
A supernumerary kidney is an extremely rare renal anomaly. Currently, <100 cases are reported in the literature. There are only 2 right unilateral supernumerary kidneys reported in the literature thus far, but no confirmed cases of urothelial carcinoma in supernumerary kidneys. We report a case of a right supernumerary with urothelial carcinoma, which is, to the best of our knowledge, reported for the first time.
PATIENT CONCERNS
A 73-year-old female patient presented with intermittent, painless, whole course and gross hematuria for about 3 months. Her physical and laboratory examinations did not reveal any significant findings except positive occult blood in routine urine examination. Contrast-enhanced spiral computed tomography revealed a dysplastic supernumerary kidney under the normal right kidney.
DIAGNOSES
The ureteroscopy showed that the ureter was Y-shaped in the middle part. The medial ureter led to a normal kidney. The lateral ureter was just 2 cm and led to a small cavity in which there was a mass whose biopsy showed urothelial carcinoma. The patient was subsequently diagnosed with a right supernumerary kidney with urothelial carcinoma.
INTERVENTION
Nephroureterectomy, including the right normal and supernumerary kidneys, and partial cystectomy by laparoscopy were performed after the ureteroscopy. The patient then received 6 cycles of gemcitabine and cisplatin regimen chemotherapy and regular intravesical epirubicin chemotherapy.
OUTCOMES
No recurrence or metastasis was found on follow-up computed tomography performed 13 months postoperatively.
LESSONS
A supernumerary kidney is an extremely rare renal anomaly. Malignancy can occur in supernumerary kidneys.
Topics: Aged; Antineoplastic Agents; Carcinoma, Transitional Cell; Cisplatin; Deoxycytidine; Humans; Kidney; Kidney Neoplasms; Nephroureterectomy; Ureter; Gemcitabine
PubMed: 32957401
DOI: 10.1097/MD.0000000000022329 -
Prilozi (Makedonska Akademija Na... Apr 2021Multicystic dysplastic kidney is a rare congenital anomaly of the kidney and urinary tract. The association with the posterior urethral valve is also very rare. Here we...
Multicystic dysplastic kidney is a rare congenital anomaly of the kidney and urinary tract. The association with the posterior urethral valve is also very rare. Here we present a patient with both entities and prenatal resolution of the cysts.A 10-week old baby was referred for nephrourological work up due to prenatal diagnosis of the left multicystic kidney. He had serial US scans during the pregnancy. Immediately before delivery the cysts were not seen (prenatal resolution). There were no extrarenal anomalies. The first postnatal ultrasound scan revealed normal sized right kidney without dilatation of the pelvicalyceal system. The bladder had normal thickness of the wall. Technetium-99m dimercaptosuccinic acid scan showed no activity on the left side, and the right kidney appeared normal. At two months of age, a poor urinary steam was observed and additional urologic work up was indicated on clinical suspicion of PUV. Voiding urethrocystography revealed posterior urethral valve and the baby underwent cytoscopic valve resection.Conclusion: We present a rare association of two congenital anomalies of the kidney and urinary tract with prenatal involution of the multicystic dysplastic kidney that is extremely rare event as seen in our case. Presence of posterior urethral valve must be suspected in a male baby with a poor urinary stream even when his ultrasound scan of urinary system appears normal.
Topics: Female; Humans; Infant; Kidney; Male; Multicystic Dysplastic Kidney; Pregnancy; Prenatal Diagnosis; Ultrasonography
PubMed: 33894118
DOI: 10.2478/prilozi-2021-0006 -
Biomedical Papers of the Medical... Sep 2022Antenatal hydronephrosis, dilatation of the upper urinary tract (UUTD), is a common finding on prenatal ultrasound. One of the most common causes is ureteropelvic... (Review)
Review
Antenatal hydronephrosis, dilatation of the upper urinary tract (UUTD), is a common finding on prenatal ultrasound. One of the most common causes is ureteropelvic junction (UPJ) obstruction. Although such prenatally diagnosed UUTD resolves spontaneously in most newborns, further examination of these children is advocated to prevent possible irreversible kidney damage, and ultrasound is mainly used for this. If the dilatation persists or becomes symptomatic, it is necessary to proceed to other relatively demanding and invasive diagnostic examinations for these small patients, where the question of the right timing of indications for possible surgical solutions is still unclear. For this reason, various biomarkers have been investigated in a number of clinical trials as potential mini-invasive diagnostic tools for determining when upper urinary tract dilatation in such children poses a threat to the developing kidneys and they should be operated on, and vice versa, when to proceed conservatively. The aim of this article is to review the findings on and current issues with the use of biomarkers in the diagnosis and treatment of UPJ obstruction in children.
Topics: Biomarkers; Child; Female; Humans; Hydronephrosis; Infant, Newborn; Kidney; Pregnancy; Ureteral Obstruction; Urinary Tract
PubMed: 35147136
DOI: 10.5507/bp.2022.002 -
Technology in Cancer Research &... Aug 2017The minimally invasive treatment of small renal masses with cryoablation has become increasingly widespread during the past 15 years. Studies with long-term follow-up...
INTRODUCTION
The minimally invasive treatment of small renal masses with cryoablation has become increasingly widespread during the past 15 years. Studies with long-term follow-up are beginning to emerge, showing good oncological control, however, tumors with a central and endophytic location seem to possess an increased risk of treatment failure. Such tumors are likely to be subjected to a high volume of blood giving thermal protection to the cancerous cells. Arterial clamping during freezing might reduce this effect but at the same time subject the kidney to ischemia. The aim of this study was to evaluate the effect of renal artery clamping during cryoablation in a porcine survival model.
METHODS
Ten Danish Landrace pigs (approximately 40 kg) underwent bilateral laparoscopic cryoablation with clamping of the right renal artery during freezing. The cryoablation consisted of a standard double-freeze cycle of 10-minute freeze followed by 8 minutes of thaw. Arterial clamping subjected the right kidney to 2 cycles of ischemia (10 minutes) with perfusion in between. After surgery, the animals were housed for 14 days prior to computed tomography perfusions scans, radioisotope renography, and bilateral nephrectomy.
RESULTS
No perioperative or postoperative complications were experienced. Mean differential renal function was 44% (95% confidence interval: 42-46) in the clamped right kidney group and 56% (95% confidence interval: 54-58) in the nonclamped left kidney group, P < .05. The ±5% technical inaccuracy is not accounted for in the results. Mean maximum temperature between freeze cycles was 5.13°C (95% confidence interval: -0.1 to 10.3) in the clamped right kidney group and 22.7°C (95% confidence interval: -16.6 to 28.8) in the nonclamped left kidney group, P < .05. Mean cryolesion volume, estimated on computed tomography perfusion, was 12.4 mL (95% confidence interval: 10.35-14.4) in the clamped right kidney group and 6.85 mL (95% confidence interval: 5.57-8.14) in the nonclamped left kidney group, P < .05. Pathological examination shows a higher degree of vital cells in the intermediate zone of the cryolesions in the nonclamped left kidneys when compared with the clamped right kidneys.
CONCLUSION
Arterial clamping increases cryolesion size by approximately 80%, and pathologic examinations suggest a decreased risk of vital cells in the intermediate zone. The clamped kidneys showed no sign of injury from the limited ischemic insult. This study was limited by being a nontumor model.
Topics: Animals; Constriction; Cryosurgery; Female; Kidney; Kidney Neoplasms; Laparoscopy; Nephrectomy; Renal Artery; Sus scrofa; Treatment Outcome
PubMed: 27566799
DOI: 10.1177/1533034616663365 -
JSLS : Journal of the Society of... 2021Laparoscopic living donor nephrectomy (LLDN) of the right kidney is currently considered as part of standard of care; however, dealing with the renal hilum when...
BACKGROUND/OBJECTIVES
Laparoscopic living donor nephrectomy (LLDN) of the right kidney is currently considered as part of standard of care; however, dealing with the renal hilum when performing ligation/division of its renal vessels is still a main concern. Here, we describe a simple-to-perform technique, i.e., flipping the fully mobilized right kidney to the midline so that the renal artery becomes anteriorly, which offers better visualization and easier dissection of the renal vessels (achieving maximized lengths) when performing hand-assisted LLDN of the right kidney.
METHODS
Living donors who underwent hand-assisted LLDN of the right kidney, along with their respective renal transplant recipients, were included in this report. Donor characteristics included renal artery and vein lengths; recipient characteristics included creatinine at months 12 - 36. Graft vein and arterial anastomosis data were also reported.
RESULTS
Nineteen living donors and 19 recipients, with median donor and recipient ages being 39 (24 - 60) and 53 (3 - 81) years, respectively, were included. None of the 38 patients had intra- or postoperative complications. Donor renal vein was anastomosed to the right external iliac vein (n = 16), right common iliac vein (n = 2), and inferior vena cava (n = 1). Gonadal vein (n = 1) and deceased donor iliac vein (n = 2) were used to increase the right renal vein length in 3 cases. Four donor kidneys had 2 arteries reconstructed side by side. None of the recipients developed any vascular or urological complications.
CONCLUSIONS
The laparoscopic technique described is safe and allows better visualization of the right hilum, mainly the renal artery, and helps in stapling the renal vein and renal artery.
Topics: Adult; Female; Hand-Assisted Laparoscopy; Humans; Kidney; Kidney Transplantation; Living Donors; Male; Middle Aged; Nephrectomy; Renal Artery; Renal Veins; Rotation; Tissue and Organ Harvesting; Treatment Outcome; Young Adult
PubMed: 34248334
DOI: 10.4293/JSLS.2021.00018 -
American Journal of Veterinary Research Jan 2023To evaluate the sedative effect of a combination of butorphanol and midazolam on 2-D shear wave elastography (SWE) of the kidneys and pancreas in dogs.
OBJECTIVE
To evaluate the sedative effect of a combination of butorphanol and midazolam on 2-D shear wave elastography (SWE) of the kidneys and pancreas in dogs.
ANIMALS
8 clinically healthy dogs.
PROCEDURES
We conducted a 2-D SWE examination of the bilateral kidneys and the pancreas before and after IV of 0.2 mg/kg butorphanol and 0.1 mg/kg midazolam in each dog. We performed 2-D SWE on the left kidney via a subcostal approach with the dog in right lateral recumbency, on the right kidney via the intercostal approach with the dog in left lateral recumbency, and on the right lobe of the pancreas via the subcostal approach. Subsequently, the pancreas and kidney shear wave velocities (SWV) pre- and postsedation were compared.
RESULTS
On qualitative evaluation using color mapping, the pancreas and kidneys showed a homogeneous blue-to-green color in pre- and post-sedation 2-D SWE. There was no significant difference in SWV pre- and post-sedation in the pancreas and kidneys.
CLINICAL RELEVANCE
Intravenous administration of a combination of 0.2 mg/kg butorphanol and 0.1 mg/kg midazolam did not change the 2-D SWE of the pancreas and kidneys significantly. The combination of butorphanol and midazolam can be used in healthy dogs for 2-D SWE evaluation of the pancreas and kidneys, especially when the patient is uncooperative during the examination.
Topics: Dogs; Animals; Hypnotics and Sedatives; Midazolam; Butorphanol; Elasticity Imaging Techniques; Kidney; Pancreas
PubMed: 36662605
DOI: 10.2460/ajvr.22.10.0187 -
International Urology and Nephrology Jan 2023To evaluate renal function damage in children with duplex kidneys.
PURPOSE
To evaluate renal function damage in children with duplex kidneys.
METHODS
A total of 355 duplex kidneys, 110 urinary tract infection (UTI) kidneys without abnormalities, and 104 kidneys with primary unilateral vesicoureteral reflux (VUR) were reviewed. Clinical data including age at diagnosis, body weight, history of UTI, ureteroceles, ectopic ureteral opening, VUR grade, serum creatinine level, cystatin C level, renal scarring, split renal function in dimercaptosuccinic acid scans, and effective renal plasma flow (ERPF) were analyzed.
RESULTS
Duplex kidneys had a higher grade of VUR and renal scarring. Split renal function in unilateral duplex kidneys (45.58 ± 12.85%) was much lower than that in contralateral duplex kidneys (56.33 ± 11.90%) and controls (50.00 ± 11.38%) (P < 0.001 and P = 0.014, respectively). Both left and right split renal functions in bilateral duplex kidneys were similar to those ipsilateral to the controls (P = 0.906 and P = 0.932, respectively). However, the total ERPFs in the left, right, and bilateral duplex kidneys were significantly lower than that in the control group (P = 0.003, P = 0.001, and P = 0.003, respectively). The total ERPFs in the left and right unilateral duplex kidneys were similar. ERPF in unilateral duplex kidneys (106.70 ± 48.05 mL/min/m) was significantly lower than that in contralateral duplex kidneys (150.18 ± 49.01 mL/min/m) or those ipsilateral to controls (145.98 ± 41.16 mL/min/m) (P < 0.001 and P < 0.001, respectively).
CONCLUSION
Duplex kidneys are usually accompanied by a higher grade of VUR, more severe renal scarring, and renal function impairment. Split renal function in duplex kidneys often declines significantly. Notably, the evaluation of split renal function in bilateral duplex kidneys should be performed cautiously.
Topics: Child; Humans; Infant; Cicatrix; Vesico-Ureteral Reflux; Kidney; Kidney Diseases; Urinary Tract Infections; Renal Insufficiency; Retrospective Studies
PubMed: 36103043
DOI: 10.1007/s11255-022-03337-8 -
JSLS : Journal of the Society of... 2014We present our initial experience and long-term results with transperitoneal laparoscopic nephropexy with nonabsorbable polymer clips.
BACKGROUND AND OBJECTIVES
We present our initial experience and long-term results with transperitoneal laparoscopic nephropexy with nonabsorbable polymer clips.
METHODS
Seven patients aged 34 to 47 years previously diagnosed with mobile kidney presented with chronic pain refractory to analgesics and underwent a transperitoneal laparoscopic nephropexy procedure with nonabsorbable polymer clips by fixing the perirenal tissue to the transversus abdominis fascia and triangular ligament.
RESULTS
Mean operation time was 20 minutes. All patients were discharged after 24 hours. Follow-up intravenous pyelogram (IVP) at 60 and 150 days showed the right kidneys in a more cephalad position, and showed pelvicaliceal dilatations and that the ureteral kinks seemed to be resolved. On days 15, 60, 90, and 150 of the first- and second-year follow-ups, severity of pain was 1 of 10 on the visual analog scale.
CONCLUSION
We believe that the technique of transperitoneal laparascopic nephropexy with nonabsorbable polymer clips on patients with symptomatic mobile kidney is safe and easy to perform and shows successful long-term results.
Topics: Adult; Equipment Design; Fasciotomy; Female; Follow-Up Studies; Humans; Kidney; Kidney Diseases; Laparoscopy; Middle Aged; Peritoneum; Polymers; Retrospective Studies; Surgical Instruments; Suture Techniques; Treatment Outcome
PubMed: 24680153
DOI: 10.4293/108680813X13693422519235