Sample records for renal parenchymal involvement

  1. Preliminary report on digitalization of renal microangiograms used in analysing renal parenchymal diseases. (United States)

    Takahashi, M; Kaneko, M


    Glomerulography is a useful method for the angiographic diagnosis of various renal parenchymal diseases. A new system for digitalization of the glomerulogram has been developed using a high resolution television camera and a CT computer. We describe the fundamental procedures involved in the clinical application of digital glomerulography by applying this method to a renal microangiogram of a cow. This new method aids a clearer understanding of the detailed microvasculatures by providing better magnification and storage and allowing for further processing of the original analogue images. With a computer printout of any part of the glomerulogram also possible, an estimation of the glomerular counts and their distribution can now be given for any unit of cross-sectional area of the renal cortex.

  2. Renal parenchymal oxygenation and hypoxia adaptation in acute kidney injury. (United States)

    Rosenberger, Christian; Rosen, Seymour; Heyman, Samuel N


    The pathogenesis of acute kidney injury (AKI), formally termed acute tubular necrosis, is complex and, phenotypically, may range from functional dysregulation without overt morphological features to literal tubular destruction. Hypoxia results from imbalanced oxygen supply and consumption. Increasing evidence supports the view that regional renal hypoxia occurs in AKI irrespective of the underlying condition, even under circumstances basically believed to reflect 'direct' tubulotoxicity. However, at present, it is remains unclear whether hypoxia per se or, rather, re-oxygenation (possibly through reactive oxygen species) causes AKI. Data regarding renal hypoxia in the clinical situation of AKI are lacking and our current concepts regarding renal oxygenation during acute renal failure are presumptive and largely derived from experimental studies. There is robust experimental evidence that AKI is often associated with altered intrarenal microcirculation and oxygenation. Furthermore, renal parenchymal oxygen deprivation seems to participate in the pathogenesis of experimental AKI, induced by exogenous nephrotoxins (such as contrast media, non-steroidal anti-inflammatory drugs or amphotericin), sepsis, pigment and obstructive nephropathies. Sub-lethal cellular hypoxia engenders adaptational responses through hypoxia-inducible factors (HIF). Forthcoming technologies to modulate the HIF system form a novel potential therapeutic approach for AKI.

  3. Is Imaging Time Between two Tc 99m DMSA Scans Sufficient for Reporting as Renal Parenchymal Scarring? Healed Parenchymal Renal Defect After 6 Years

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    Erdem Sürücü


    Full Text Available We aimed to report a healed renal parenchymal defect after 6 years in a 9-year-old girl who was being followed for recurrent urinary tract infection (UTI. The first UTI was at the age of two. She was being followed with ultrasonography, urine analysis and urine culture since the first UTI. Technetium-99m dimercaptosuccinic acid (DMSA scintigraphy was repeated four times up to the present day. She had a renal parenchymal defect reported as parenchymal scarring, which healed 6 years after the first DMSA scintigraphy.

  4. Sonographic Renal Parenchymal Measurements for the Evaluation and Management of Ureteropelvic Junction Obstruction in Children

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    Jeremy C Kelley


    Full Text Available Purpose: To correlate sonographic renal parenchymal measurements among patients with ureteropelvic junction obstruction (UPJO labeled Society of Fetal Urology (SFU hydronephrosis grades 1 to 4 and to examine whether sonographic renal parenchymal measurements could be used to differentiate conservative versus surgical management.Materials and Methods: Retrospective chart review and sonographic renal parenchymal measurements (renal length, medullary pyramid thickness, and renal parenchymal thickness were performed in patients with SFU grades 1 to 4 hydronephrosis secondary to UPJO managed between 2009 and 2014. Exclusion criteria included other concomitant genitourinary pathology or incomplete follow-up. Anterior-posterior renal pelvic diameter (APRPD and radionuclide renography were also evaluated when available. Results: 104 patient with ureteropelvic junction obstruction underwent 244 RBUS (1,464 sonographic renal parenchymal measurements in 488 kidneys. Medullary pyramid thickness and renal parenchymal thickness progressively decreased from SFU grades 1 to 4 (p<0.05. A similar trend was appreciated when comparing SFU grades 1 and 2 vs. 3 and 4, as well as SFU grades 3 vs. 4 (p<0.05. SFU grade 3 and 4 patients who underwent pyeloplasty had longer renal length in comparison to those who were managed conservatively (p<0.02.Conclusions: This is the first study that evaluates these objective, quantifiable sonographic renal parenchymal measurements in children with unilateral UPJO. These sonographic renal parenchymal measurements correlate closely with worsening of hydronephrosis graded by the SFU and APRPD classification systems. Prospective studies are needed to elucidate the role of sonographic renal parenchymal measurements in the management of children with UPJO.□


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    V. B. Matvee


    Full Text Available Objective: to assess the advisability and safety of transperitoneal laparoscopic nephrectomy for renal parenchymal tumors.Subjects and methods. The investigation enrolled 163 patents with clinically localized renal parenchymal tumors that had been resected through laparoscopic (n = 81 (49.7 % and open (n = 82 (50.3 % accesses. The groups of patients operated on via laparoscopic and laparotomic accesses were matched for demographic characteristics, somatic status, baseline renal function, and nephrometric signs of tumor nodules, except the involved side (7 patients in the laparoscopic group had bilateral renal tumors. Renal resection was carried out in all the patients; a contralateral kidney tumor was also removed in 7 patients with a bilateral lesion (nephrectomy and kidney resection were done in 3 and 4 patients, respectively. Histological examination verified benign tumors in 15 (9.2 % cases, renal cell carcinoma in 148 (90.8 %, including all bilateral renal tumors [рТ1а (n = 135 (91.2 % cases; рТ1b (n = 4 (2.7 %; рТ3а (n = 9 (6.1 %]; according to the pT category, the distribution of patients in the laparoscopic and open resection groups was even (p = 0.586. No additional treatment was performed in any case. The median follow-up was 48.2 ± 11.8 months.Results. The use of the laparoscopic access significantly increased the frequency of intraoperative complications (6.1 and 16.0 %; p = 0.037, but failed to affect that of postoperative complications (13.0 and 18.3 %, respectively; p = 0.291 versus the open access. Laparoscopic versus conventional techniques did not cause any reduction in 5-year overall, specific, and relapse-free survival rates (93.3, 100.0, 80.0 % and 97.1, 100.0, 98.5 %, respectively; р > 0.05 for all. The rate of acute renal dysfunction and its distribution by the RIFLE classes, the rate and level of a decrease in glomerular filtration rate in the late postoperative period did not depend on the surgical access (p


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    V. B. Matvee


    Full Text Available Objective: to assess the advisability and safety of transperitoneal laparoscopic nephrectomy for renal parenchymal tumors.Subjects and methods. The investigation enrolled 163 patents with clinically localized renal parenchymal tumors that had been resected through laparoscopic (n = 81 (49.7 % and open (n = 82 (50.3 % accesses. The groups of patients operated on via laparoscopic and laparotomic accesses were matched for demographic characteristics, somatic status, baseline renal function, and nephrometric signs of tumor nodules, except the involved side (7 patients in the laparoscopic group had bilateral renal tumors. Renal resection was carried out in all the patients; a contralateral kidney tumor was also removed in 7 patients with a bilateral lesion (nephrectomy and kidney resection were done in 3 and 4 patients, respectively. Histological examination verified benign tumors in 15 (9.2 % cases, renal cell carcinoma in 148 (90.8 %, including all bilateral renal tumors [рТ1а (n = 135 (91.2 % cases; рТ1b (n = 4 (2.7 %; рТ3а (n = 9 (6.1 %]; according to the pT category, the distribution of patients in the laparoscopic and open resection groups was even (p = 0.586. No additional treatment was performed in any case. The median follow-up was 48.2 ± 11.8 months.Results. The use of the laparoscopic access significantly increased the frequency of intraoperative complications (6.1 and 16.0 %; p = 0.037, but failed to affect that of postoperative complications (13.0 and 18.3 %, respectively; p = 0.291 versus the open access. Laparoscopic versus conventional techniques did not cause any reduction in 5-year overall, specific, and relapse-free survival rates (93.3, 100.0, 80.0 % and 97.1, 100.0, 98.5 %, respectively; р > 0.05 for all. The rate of acute renal dysfunction and its distribution by the RIFLE classes, the rate and level of a decrease in glomerular filtration rate in the late postoperative period did not depend on the surgical access (p

  7. Changes of renal sinus fat and renal parenchymal fat during an 18-month randomized weight loss trial. (United States)

    Zelicha, Hila; Schwarzfuchs, Dan; Shelef, Ilan; Gepner, Yftach; Tsaban, Gal; Tene, Lilac; Yaskolka Meir, Anat; Bilitzky, Avital; Komy, Oded; Cohen, Noa; Bril, Nitzan; Rein, Michal; Serfaty, Dana; Kenigsbuch, Shira; Chassidim, Yoash; Sarusi, Benjamin; Thiery, Joachim; Ceglarek, Uta; Stumvoll, Michael; Blüher, Matthias; Haviv, Yosef S; Stampfer, Meir J; Rudich, Assaf; Shai, Iris


    Data regarding the role of kidney adiposity, its clinical implications, and its dynamics during weight-loss are sparse. We investigated the effect of long-term weight-loss induced intervention diets on dynamics of renal-sinus-fat, an ectopic fat depot, and %renal-parenchymal-fat, lipid accumulation within the renal parenchyma. We randomized 278 participants with abdominal obesity/dyslipidemia to low-fat or Mediterranean/low-carbohydrate diets, with or without exercise. We quantified renal-sinus-fat and %renal-parenchymal-fat by whole body magnetic-resonance-imaging. Participants (age = 48 years; 89% men; body-mass-index = 31 kg/m(2)) had 86% retention to the trial after 18 months. Both increased renal-sinus-fat and %renal-parenchymal-fat were directly associated with hypertension, and with higher abdominal deep-subcutaneous-adipose-tissue and visceral-adipose-tissue (p of trend fat was associated with lower estimated-glomerular-filtration-rate and with higher microalbuminuria and %HbA1C beyond body weight. After 18 months of intervention, overall renal-sinus-fat (-9%; p fat (-1.7%; p = 0.13 vs. baseline) significantly decreased, and similarly across the intervention groups. Renal-sinus-fat and %renal-parenchymal-fat changes were correlated with weight-loss per-se (p fat associated with decreased pancreatic, hepatic and cardiac fats (p fat, after adjustment for 18 months weight-loss (β = 0.15; p = 0.026) and hypertension (β = 0.14; p = 0.04). Renal-sinus-fat and renal-parenchymal-fat are fairly related to weight-loss. Decreased renal-sinus-fat is associated with improved hepatic parameters, independent of changes in weight or hepatic fat, rather than with improved renal function or blood pressure parameters. CLINICALTRIALS. NCT01530724. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  8. Renal parenchymal histopathology predicts life-threatening chronic kidney disease as a result of radical nephrectomy. (United States)

    Sejima, Takehiro; Honda, Masashi; Takenaka, Atsushi


    The preoperative prediction of post-radical nephrectomy renal insufficiency plays an important role in the decision-making process regarding renal surgery options. Furthermore, the prediction of both postoperative renal insufficiency and postoperative cardiovascular disease occurrence, which is suggested to be an adverse consequence caused by renal insufficiency, contributes to the preoperative policy decision as well as the precise informed consent for a renal cell carcinoma patient. Preoperative nomograms for the prediction of post-radical nephrectomy renal insufficiency, calculated using patient backgrounds, are advocated. The use of these nomograms together with other types of nomograms predicting oncological outcome is beneficial. Post-radical nephrectomy attending physicians can predict renal insufficiency based on the normal renal parenchymal pathology in addition to preoperative patient characteristics. It is suggested that a high level of global glomerulosclerosis in nephrectomized normal renal parenchyma is closely associated with severe renal insufficiency. Some studies showed that post-radical nephrectomy severe renal insufficiency might have an association with increased mortality as a result of cardiovascular disease. Therefore, such pathophysiology should be recognized as life-threatening, surgically-related chronic kidney disease. On the contrary, the investigation of the prediction of mild post-radical nephrectomy renal insufficiency, which is not related to adverse consequences in the postoperative long-term period, is also promising because the prediction of mild renal insufficiency might be the basis for the substitution of radical nephrectomy for nephron-sparing surgery in technically difficult or compromised cases. The deterioration of quality of life caused by post-radical nephrectomy renal insufficiency should be investigated in conjunction with life-threatening matters.

  9. Reduced cilia frequencies in human renal cell carcinomas versus neighboring parenchymal tissue

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    Basten Sander G


    Full Text Available Abstract Background Cilia are essential organelles in multiple organ systems, including the kidney where they serve as important regulators of renal homeostasis. Renal nephron cilia emanate from the apical membrane of epithelia, extending into the lumen where they function in flow-sensing and ligand-dependent signaling cascades. Ciliary dysfunction underlies renal cyst formation that is in part caused by deregulation of planar cell polarity and canonical Wnt signaling. Renal cancer pathologies occur sporadically or in heritable syndromes caused by germline mutations in tumor suppressor genes including VHL. Importantly, Von Hippel-Lindau (VHL patients frequently develop complex renal cysts that can be considered a premalignant stage. One of the well-characterized molecular functions of VHL is its requirement for the maintenance of cilia. In this study, tissue from 110 renal cancer patients who underwent nephrectomy was analyzed to determine if lower ciliary frequency is a common hallmark of renal tumorigenesis by comparing cilia frequencies in both tumor and adjacent parenchymal tissue biopsies from the same kidney. Methods We stained sections of human renal material using markers for cilia. Preliminary staining was performed using an immunofluorescent approach and a combination of acetylated-α-tubulin and pericentrin antibodies and DAPI. After validation of an alternative, higher throughput approach using acetylated-α-tubulin immunohistochemistry, we continued to manually quantify cilia in all tissues. Nuclei were separately counted in an automated fashion in order to determine ciliary frequencies. Similar staining and scoring for Ki67 positive cells was performed to exclude that proliferation obscures cilia formation potential. Results Samples from renal cell carcinoma patients deposited in our hospital tissue bank were previously used to compose a tissue microarray containing three cores of both tumor and parenchymal tissue per patient

  10. Reliability of DMSA for the diagnosis of renal parenchymal abnormality in children

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    Craig, J.C. [Centre for Kidney Research, New Children' s Hospital, Sydney (Australia); Dept. of Public Health and Community Medicine, Univ. of Sydney (Australia); Dept. of Paediatrics and Child Health, University of Sydney, Sydney (Australia); Irwig, L. [Centre for Kidney Research, New Children' s Hospital, Sydney (Australia); Dept. of Public Health and Community Medicine, Univ. of Sydney (Australia); Ford, M.; Uren, R.F. [Dept. of Nuclear Medicine, New Children' s Hospital, Sydney (Australia); Willis, N.S. [Centre for Kidney Research, New Children' s Hospital, Sydney (Australia); Howman-Giles, R.B. [Dept. of Nuclear Medicine, New Children' s Hospital, Sydney (Australia); Rossleigh, M.A. [Dept. of Nuclear Medicine, Sydney Children' s Hospital, Sydney (Australia); Grunewald, S. [Dept. of Nuclear Medicine and Diagnostic Ultrasound, Westmead Hospital, Sydney (Australia)


    The objective of this study was to evaluate the variability of technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy interpretation by four nuclear medicine physicians for the diagnosis of renal parenchymal abnormality in children, and to compare variability among three different DMSA methods in clinical use: planar alone, single-photon emission tomography (SPET) alone, and planar with SPET. One hundred consecutive DMSA studies were independently interpreted 3 times by four participating nuclear medicine specialists from different departments and in random order. All scans were classified by the presence or absence of renal parenchymal abnormality using the modified four-level grading system of Goldraich. Indices of agreement were the percentage of agreement and the kappa statistic. Disagreement was analysed using children, kidneys and kidney zones (three zones per kidney). Using patients as the unit of analysis, agreement for planar and planar with SPET methods was 87%-88% (kappa 0.74) for the normal-abnormal scan classification. The corresponding agreement value for the SPET alone method was 78% (kappa 0.56). Similarly, substantial disagreement (disagreement {>=}2 categories) occurred in 2.5% and 1.3% of comparisons between observers for planar alone and planar with SPET, respectively, but in 5.2% of comparisons for SPET alone. These results did not vary appreciably whether interpretation of patients, kidneys or kidney zones was compared. It is concluded that the four experienced nuclear medicine physicians showed substantial agreement in the interpretation of planar alone and planar with SPET DMSA scintigraphic images. Interpretation of SPET DMSA images, without planar images, was significantly more variable than interpretation using the two other methods, disagreement occurring in more than 20% of comparisons. SPET DMSA scintigraphy, when used without planar images, does not provide a firm basis for clinical decision making in the care of children who may

  11. A Comparative Study of Sonographic Grading of Renal Parenchymal Changes and Estimated Glomerular Filtration Rate (eGFR) using Modified Diet in Renal Disease Formula (United States)

    Shivalli, Siddharudha; Pai, B.H. Santhosh; Acharya, Koteshwara Devadasa; Gopalakrishnan, Ravichandra; Srikanth, Vivek; Reddy, Vishwanath; Haris, Arafat


    Introduction The sonographic findings are of help in evaluating the nephrological diseases. Glomerular filtration rate is another parameter for assessing the reserved renal function and an indicator of prognosis. In clinical practice GFR estimation (eGFR) is done by using a mathematical formula. In our study, we compared the sonographic grading of renal parenchymal changes with eGFR calculated using Modified Diet in Renal Diseases formula based on serum creatinine, age, gender and ethnicity. Aim To evaluate the relevance of sonographic grading of renal parenchymal changes in assessing the severity of the renal disease and comparing it to the eGFR calculated using MDRD formula based on the age, gender and serum creatinine value of the patient. Materials and Methods The adult patients with suspected kidney disease referred for sonography of abdomen were our study participants. As per our study design following strict inclusion and exclusion criteria, patients were selected as study participants and for each of the patient’s renal parenchymal status, serum creatinine, age, gender and ethnicity were documented. Results A total of 70 patients were our study participants, out of which 67.1% were males and 32.9% were females. Our study showed a linear correlation between sonographic grading of renal parenchymal changes with eGFR. Conclusion We conclude that by evaluating the kidneys with sonography and calculating eGFR using MDRD formula the renal status will be more accurately interpreted. PMID:27042555

  12. Intra-Parenchymal Renal Resistive Index Variation (IRRIV) Describes Renal Functional Reserve (RFR): Pilot Study in Healthy Volunteers. (United States)

    Samoni, Sara; Nalesso, Federico; Meola, Mario; Villa, Gianluca; De Cal, Massimo; De Rosa, Silvia; Petrucci, Ilaria; Brendolan, Alessandra; Rosner, Mitchell H; Ronco, Claudio


    An increase of glomerular filtration rate after protein load represents renal functional reserve (RFR) and is due to afferent arteriolar vasodilation. Lack of RFR may be a risk factor for acute kidney injury (AKI), but is cumbersome to measure. We sought to develop a non-invasive, bedside method that would indirectly measure RFR. Mechanical abdominal pressure, through compression of renal vessels, decreases blood flow and activates the auto-regulatory mechanism which can be measured by a fall in renal resistive index (RRI). The study aims at elucidating the relationship between intra-parenchymal renal resistive index variation (IRRIV) during abdominal pressure and RFR. In healthy volunteers, pressure was applied by a weight on the abdomen (fluid-bag 10% of subject's body weight) while RFR was measured through a protein loading test. We recorded RRI in an interlobular artery after application of pressure using ultrasound. The maximum percentage reduction of RRI from baseline was compared in the same subject to RFR. We enrolled 14 male and 16 female subjects (mean age 38 ± 14 years). Mean creatinine clearance was 106.2 ± 16.4 ml/min/1.73 m(2). RFR ranged between -1.9 and 59.7 with a mean value of 28.9 ± 13.1 ml/min/1.73 m(2). Mean baseline RRI was 0.61 ± 0.05, compared to 0.49 ± 0.06 during abdominal pressure; IRRIV was 19.6 ± 6.7%, ranging between 3.1% and 29.2%. Pearson's coefficient between RFR and IRRIV was 74.16% (p renal susceptibility to different exposures and the consequent risk for AKI.

  13. Renal involvement in antiphospholipid syndrome. (United States)

    Pons-Estel, Guillermo J; Cervera, Ricard


    Renal involvement can be a serious problem for patients with antiphospholipid syndrome (APS). However, this complication has been poorly recognized and studied. It can be present in patients who have either primary or systemic lupus erythematosus-associated APS. Clinical and laboratory features of renal involvement in APS include hypertension, hematuria, acute renal failure, and progressive chronic renal insufficiency with mild levels of proteinuria that can progress to nephrotic-range proteinuria. The main lesions are renal artery stenosis, venous renal thrombosis, and glomerular lesions (APS nephropathy) that may be acute (thrombotic microangiopathy) and/or chronic (arteriosclerosis, arterial fibrous intimal hyperplasia, tubular thyroidization, arteriolar occlusions, and focal cortical atrophy). APS can also cause end-stage renal disease and allograft vascular thrombosis. This article reviews the range of renal abnormalities associated with APS, and their diagnosis and treatment options.

  14. The relationships between clinical variables and renal parenchymal disease in pediatric clinically suspected urinary tract infection

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    Jung Lim Byun


    Full Text Available Purpose : To evaluate the significance of clinical signs and laboratory findings as predictors of renal parenchymal lesions and vesicoureteral reflux (VUR in childhood urinary tract infection (UTI. Methods : From July 2005 to July 2008, 180 patients admitted with a first febrile UTI at the Pediatric Department of Konkuk University Hospital were included in this study. The following were the clinical variables: leukocytosis, elevated C-reactive protein (CRP, positive urine nitrite, positive urine culture, and fever duration both before and after treatment. We evaluated the relationships between clinical variables and dimercaptosuccinic acid (DMSA scan and voiding cystourethrography (VCUG results. Results : VCUG was performed in 148 patients; of them, 37 (25.0% had VUR: 18 (12.2% had low-grade (I-II VUR, and 19 (10.5% had high-grade (III-V VUR. Of the 95 patients who underwent DMSA scanning, 29 (30.5% had cortical defects, of which 21 (63.6% had VUR: 10 (30.3%, low-grade (I-II VUR; and 11 (33.3%, high-grade VUR. Of the 57 patients who were normal on DMSA scan, 8 (14.0% had low-grade VUR and 6 (10.5% had high-grade VUR. The sensitivity, specificity, and positive and negative predictive values of the DMSA scan in predicting high-grade VUR were 64.7%, 69.9%, 33.3%, and 89.5%, respectively. Leukocytosis, elevated CRP, and prolonged fever (?#243;6 hours after treatment were significantly correlated with the cortical defects on DMSA scans and high-grade VUR. Conclusion : Clinical signs, including prolonged fever after treatment, elevated CRP, and leukocytosis, are positive predictors of acute pyelonephritis and high-grade VUR.

  15. Can MRI replace DMSA in the detection of renal parenchymal defects in children with urinary tract infections?

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    Kavanagh, Eoin C.; Ryan, Stephanie; McCourbrey, Siobhan; O' Connor, Rachel; Donoghue, Veronica [Children' s University Hospital, Department of Radiology, Dublin (Ireland); Awan, Atif [Children' s University Hospital, Department of Paediatrics, Dublin (Ireland)


    Renal parenchymal defects may be a consequence of urinary tract infections (UTI) in childhood. MRI is a non-radiation imaging modality compared with DMSA scanning. To compare DMSA with MRI for the detection of renal parenchymal defects in children presenting for radiological investigation after a first UTI. Both DMSA and MRI were performed at the same appointment in 37 children (aged 4 months-13 years; mean 4.5 years) with a history of UTI. Both planar and SPECT DMSA were performed. MRI of the kidneys employed axial and coronal T1-, T2- and fat-saturated T1-weighted (T1-W) sequences. Some children had imaging after IV contrast medium. The coronal fat-saturated T1-W sequence was the best sequence and it detected all the findings on MRI. MRI had a sensitivity of 77% and a specificity of 87% for the detection of a scarred kidney using DMSA as the gold standard. MRI diagnosed pyelonephritis in two children that had been interpreted as scarring on DMSA. Renal MRI using a single, coronal, fat-saturated T1-W sequence is a rapid, accurate and minimally invasive technique for the detection of renal scarring that does not employ ionizing radiation. (orig.)

  16. Renal involvement in antiphospholipid syndrome. (United States)

    Sciascia, Savino; Cuadrado, Maria José; Khamashta, Munther; Roccatello, Dario


    Antiphospholipid syndrome (APS) is an autoimmune disease defined by the presence of arterial or venous thrombotic events and/or pregnancy morbidity in patients who test positive for antiphospholipid antibodies (aPLs). APS can be isolated (known as primary APS) or associated with other autoimmune diseases, such as systemic lupus erythematosus (SLE; known as secondary APS). The kidney is a major target organ in APS and renal thrombosis can occur at any level within the vasculature of the kidney (renal arteries, intrarenal arteries, glomerular capillaries and renal veins); events reflect the site and size of the involved vessels. Histological findings vary widely, including ischaemic glomeruli and thrombotic lesions without glomerular or arterial immune deposits on immunofluorescence. Renal prognosis is affected by the presence of aPLs in patients with lupus nephritis and can be poor. In patients with SLE and aPLs, biopsy should be performed because inflammatory and thrombotic lesions require different therapeutic approaches. Renal involvement in patients with definite APS is treated by anticoagulation with long-term warfarin. The range of renal manifestations associated with APS is broadening and, therefore, aPLs have increasing relevance in end-stage renal disease, transplantation and pregnancy.

  17. Renal and perirenal space involvement in acute pancreatitis: An MRI study

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    Li, Xing Hui, E-mail: [Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Zhang, Xiao Ming, E-mail: [Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Ji, Yi Fan, E-mail: [Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Jing, Zong Lin, E-mail: [Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Huang, Xiao Hua, E-mail: [Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Yang, Lin, E-mail: [Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Zhai, Zhao Hua, E-mail: [Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China)


    Objectives: To study the prevalence and characteristics of renal and perirenal space involvement and its relation to the severity of acute pancreatitis (AP) using MRI. Methods: 115 patients with AP who underwent MRI with the clinical kidney function test were retrospectively analyzed in this study. MRI sequences included conventional and diffusion weighted imaging (DWI) sequences. The renal and perirenal space involvement in AP was noted on MRI. The renal apparent diffusion coefficient (ADC) on DWI was measured for each kidney. The severity of AP on MRI was graded using MR severity index (MRSI). The relationships among the renal and perirenal space involvement on MRI, the renal ADC, MRSI and the results of the kidney function test were analyzed. Results: In the 115 patients with AP, the renal and perirenal space abnormalities detected included renal parenchymal abnormalities (0.8%), abnormalities of the renal collecting system (2.6%), renal vascular abnormalities (1.7%), thickened renal fascia (99%), perirenal stranding (62%) and perirenal fluid collection (40%). The prevalence of perirenal space abnormalities was correlated with the severity of AP based on MRSI (P < 0.05). The renal ADC values were lower in patients with abnormal kidney function than in those without kidney injury (P < 0.05). The prevalence of kidney function abnormalities was 9.4%, 32% and 100% in mild, moderate, and severe AP cases, respectively (P = 0.00). Conclusion: Perirenal space involvement is much more than renal parenchymal involvement in AP. The prevalence of perirenal space involvement in AP on MRI has a positive correlation with the severity of AP according to MRSI.

  18. Normal values for renal parenchymal volume and kidney length as measured by non-enhanced multidetector spiral computed tomography

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    Gao, Fei; Wu, Xiao Hou (Dept. of Urology, The First Affiliated Hospital of Chongqing Medical Univ., Chongqing (China)), email:; Yang, Mei (Inst. of Neuroscience, Chongqing Medical Univ., Chongqing (China)); Luo, Chun Li (Dept. of Laboratory Medicine, Chongqing Medical Univ., Chongqing (China)); Pang, Hua (Dept. of Radiology, The First Affiliated Hospital of Chongqing Medical Univ., Chongqing (China))


    Background: Renal parenchymal volume (RPV) is considered an important index for clinical decisions. However, normal values have not been established, which hinders the clinical application of RPV. Purpose: To test the accuracy and reproducibility of RPV and to investigate the normal values of RPV and kidney length as measured by non-enhanced multidetector computed tomography (CT). Material and Methods: An animal model study was performed to test the accuracy and repeatability of RPV measured by CT. RPV of porcine kidneys was measured by water displacement (actual values) and non-enhanced multidetector CT. Individual RPV and kidney length were measured by non-enhanced CT in patients with no clinical history of renal disease (n 722). Patient height, age, weight, body surface area (BSA), and body mass index (BMI) were assessed before each patient's CT examination was performed. Results: RPV obtained by the CT method was within 2% of the RPV determined by the water displacement method. The normal values of RPV (M +- 1.96 standard deviation [SD]) were 145.72 +- 54.37 mL for men and 132.46 +- 41.94 mL for women. The normal values of kidney length (M +- 1.96 SD) were 10.27 +- 1.98 cm for men and 9.93 +- 1.58 cm for women. RPV did not significantly correlate with BSA or weight in women, but correlated significantly with height and age in both men and women. Of the assessed factors age, weight, height, BSA, and BMI, age, and height were the independent factors that best reflected RPV, in both men and women. Conclusion: The present animal study results showed that non-enhanced multidetector CT findings accurately reflect the RPV. The subsequent study performed in humans showed that the RPV of the presently sampled Chinese population was lower than the commonly quoted reference values obtained from Western populations

  19. Doença parenquimatosa renal: correlação histológico-sonográfica Renal parenchymal disease: histopathologic-sonographic correlation

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    Nordeval Cavalcante Araújo


    Full Text Available OBJETIVO: Este estudo foi planejado para avaliar a correlação da ecografia do rim com as lesões histológicas e com os achados clínico-laboratoriais na doença parenquimatosa renal, por análise de regressão logística multivariada. MÉTODOS: Os dados clínicos, laboratoriais, ecográficos e as biópsias foram avaliados em 154 pacientes. A ecogenicidade cortical foi graduada como menor que grau zero, igual a grau um ou maior que grau dois a do parênquima hepático ou esplênico. As lesões histológicas - proliferação mesangial (PM, permeação leucocitária (PL, crescente e necrose fibrinóide (CNF, infiltrado inflamatório intersticial (II, esclerose glomerular segmentar (ES, obsolescência glomerular (OG, atrofia tubular (AT, fibrose intersticial (FI e edema intersticial (EI - foram graduadas de acordo com a extensão, em normal (0%, leve (25% 50%. RESULTADOS: a II, FI, ES, EI e creatinina elevada ocorreram menos no grau 0 de ecogenicidade cortical; b PM, hipertensão arterial e espessura normal do parênquima foram preditores do grau 1 de ecogenicidade cortical; c FI, EI, creatinina elevada e parênquima fino foram preditores do grau 2 de ecogenicidade cortical; d Excluindos os obesos, em jovens com hematócrito baixo, a pirâmide proeminente foi mais comum; e Creatinina elevada e OG foram preditores de rins pequenos. CONCLUSÃO: A ecogenicidade cortical foi um sensível marcador de doença parenquimatosa renal. Lesões distintas mais do que o grau de severidade da lesão contribuiram para o aumento da ecogenicidade cortical. O EI aumenta exponencialmente o efeito da FI na ecogenicidade cortical.PURPOSE: This study was designed to address the correlation between sonography of a kidney with histological lesions and clinical findings in patients with renal parenchymal disease based on a multivariate logistic regression analysis. METHODS: Clinical and laboratory data, sonograms and renal biopsies were evaluated in 154 patients. Cortical

  20. Clinical and Prognostic Factors for Renal Parenchymal, Pelvis, and Ureter Cancers in SEER Registries: Collaborative Stage Data Collection System, Version 2 (United States)

    Altekruse, Sean F.; Dickie, Lois; Wu, Xiao-Cheng; Hsieh, Mei-Chin; Wu, Manxia; Lee, Richard; Delacroix, Scott


    BACKGROUND The American Joint Committee on Cancer’s (AJCC) 7th edition cancer staging manual reflects recent changes in cancer care practices. This report assesses changes from the AJCC 6th to the AJCC 7th edition stage distributions and the quality of site-specific factors (SSFs). METHODS Incidence data for renal parenchyma and pelvis and ureter cancers from 18 Surveillance, Epidemiology, and End Results (SEER) registries were examined, including staging trends during 2004–2010, stage distribution changes between the AJCC 6th and 7th editions, and SSF completeness for cases diagnosed in 2010. RESULTS From 2004 to 2010, the percentage of stage I renal parenchyma cancers increased from 50% to 58%, whereas stage IV and unknown stage cases decreased (18% to 15%, and 10% to 6%, respectively). During this period, the percentage of stage 0a renal pelvis and ureter cancers increased from 21% to 25%, and stage IV and unknown stage tumors decreased (20% to 18%, and 7% to 5%, respectively). Stage distributions under the AJCC 6th and 7th editions were about the same. For renal parenchymal cancers, 71%–90% of cases had known values for 6 required SSFs. For renal pelvis and ureter cancers, 74% of cases were coded as known for SSF1 (WHO/ISUP grade) and 47% as known for SSF2 (depth of renal parenchymal invasion). SSF values were known for larger proportions of cases with reported resections. CONCLUSIONS Stage distributions between the AJCC 6th and 7th editions were similar. SSFs were known for more than two-thirds of cases, providing more detail in the SEER database relevant to prognosis. PMID:25412394

  1. Initial evidence demonstrating the association between the vascular status in surgically resected renal parenchymal pathology and sexual function. (United States)

    Sejima, T; Iwamoto, H; Masago, T; Morizane, S; Yao, A; Umekita, Y; Honda, M; Takenaka, A


    Our goal is to evaluate the association between histopathology of glomerulosclerosis (GS) and atherosclerosis (AS) in the nephrectomized normal parenchyma together with patients' background, and erectile dysfunction (ED) of patients treated with radical nephrectomy (RN) for renal cell carcinoma (RCC). ED was assessed with the International Index of Erectile Function in 65 patients who were less than age 70 years at the time of questionnaire. Glomeruli status was assessed by the extent of global GS. AS was graded based on lumen occlusion and frequency of involvement. Patients' backgrounds included any comorbidities, post-RN renal insufficiency, tumor pathology, demographics and social status. The presence of diabetes mellitus and lack of a spouse were independent predictors for severe ED, whereas G0/1 AS was an independent predictor for mild/no ED. The extent of global GS was significantly lower in patients with mild/no ED than in other patients. Our study represents the first report identifying healthy arterial status in the renal parenchyma as a significant indicator of favorable erectile function and that the evaluation of AS severity is not a superior indicator of severe ED in the presence of comorbidities or social status among patients treated with RN.

  2. Parenchymal injury in remnant-kidney model may be linked to apoptosis of renal cells mediated by nitric oxide. (United States)

    Hruby, Zbigniew; Rosinski, Maciej; Tyran, Bronislaw


    The importance of apoptotic cell death in the pathogenesis of progressive renal sclerosis has been well established. While activity of vasorelaxant nitric oxide is conceivable in the remnant hyperfiltrating kidney and nitric oxide has been reported to cause apoptosis, we postulated that this mechanism of cell death may be operating in progressive renal fibrosis. The intensity of apoptosis in glomerular and tubular cells was assessed (light microscopy, TUNEL method) in the remnant-kidney model of progressive renal fibrosis in rats undergoing 5/6 nephrectomy. Numbers of apoptotic cells were correlated with expression of mRNA for inducible nitric oxide synthase (iNOS; RT-PCR in situ), generation of nitrite in renal tissue, an index of glomerulosclerosis, proteinuria and creatinine clearance. A control group of 5/6 nephrectomized rats received an iNOS inhibitor, L-NAME, in drinking water during the 4 weeks after nephrectomy. Number of apoptotic cells gradually increased in experimental rats both in glomeruli and tubules, until termination of the study 3 months after 5/6 nephrectomy. At 3 months postinduction, the intensity of tubular cell apoptosis was significantly correlated with creatinine clearance (p<0.05), while glomerular cell apoptosis was correlated with the index of glomerulosclerosis, also at 3 months (p<0.0025). Along with the apoptosis, the levels of iNOS mRNA for, and generation of, nitrite in renal tissue had risen until termination of the study. The generation of nitrites correlated with the number of apoptotic glomerular cells (p<0.025). Treatment with the iNOS inhibitor resulted in a significant reduction in number of apoptotic cells (p<0.01). Apoptotic depletion of renal tubular and glomerular cells linked to activity of iNOS may contribute to progression of chronic kidney tissue injury in the 5/6 nephrectomy model.

  3. Renal involvement in primary antiphospholipid syndrome. (United States)

    Marcantoni, Carmelita; Emmanuele, Carmela; Scolari, Francesco


    Antiphospholipid syndrome is an autoimmune disorder characterized by recurrent venous or arterial thrombosis and/or pregnancy-related problems associated with persistently elevated levels of antiphospholipid antibodies. The kidney is a major target organ in both primary and secondary antiphospholipid syndrome. This review describes several aspects of the renal involvement in the primary form of the syndrome, in particular the histological pattern of the so-called antiphospholipid syndrome nephropathy (APSN). APSN is a vascular nephropathy characterized by small vessel vaso-occlusive lesions associated with fibrous intimal hyperplasia of interlobular arteries, recanalizing thrombi in arteries and arterioles, and focal atrophy, a constellation of morphological lesions suggestive of primary antiphospholipid syndrome.

  4. An open-label, randomized, controlled, 4-week comparative clinical trial of barnidipine hydrochloride, a calcium-channel blocker, and benazepril, an angiotensin-converting enzyme inhibitor, in Chinese patients with renal parenchymal hypertension. (United States)

    Chen, X; Zheng, F; Chen, P; Tang, L; Wei, R; Yu, Y; Su, Y; Kikkawa, T; Yamamoto, M


    This study compared barnidipine, a calcium-channel blocker, and benazepril, an angiotensin-converting enzyme inhibitor, in 85 Chinese patients with renal parenchymal hypertension (diastolic blood pressure range 95 - 110 mmHg). Patients were randomly assigned to receive either 10 mg barnidipine or 10 mg benazepril orally daily for 4 weeks. In patients with diastolic blood pressure > 90 mmHg after 2 weeks of treatment, the dose of barnidipine or benazepril was increased by 5 or 10 mg, respectively. Both the barnidipine-treated group (n = 43) and the benazepril-treated group (n = 42) showed significant mean reductions from baseline in sitting systolic and diastolic blood pressures. The decrease in diastolic blood pressure with benazepril was significantly greater than with barnidipine treatment. Sitting heart rate was not changed by either drug. There was no significant difference in adverse events between the two groups. Barnidipine is similar to benazepril for the treatment of renal parenchymal hypertension.

  5. Tyrosine kinase inhibitors improve parenchymal findings of liver cirrhosis in a patient exhibiting concomitant hepatocellular carcinoma and renal cell cancer (United States)



    Hepatocellular carcinoma (HCC) and renal cell cancer (RCC) are malignancies, which are chemotherapy resistant and fatal at the advanced stages. Previously developed tyrosine kinase inhibitors are used in the treatment of advanced stage disease. In the present case study, a patient using sunitinib for stage IV RCC presented with HCC following 2 years of treatment. A patient who exhibited Child-Pugh class C cirrhosis initially, exhibited a marked improvement of hepatocellular parenchyma findings following treatment with sunitinib. Sunitinib is suggested to have preventive effects on the pathogenesis of liver fibrosis and cirrhosis in vitro, via an anti-vascular endothelial growth factor and anti-platelet-derived growth factor mechanism. However, no clinical supportive study has been performed until now. Improvement of liver functions may be explained in this manner. Therefore, investigations are required with different doses of sunitinib and other tyrosine kinase inhibitors in order to evaluate the efficacy on treatment of cirrhosis progression. PMID:26893877

  6. Renal Involvement in Idiopathic Inflammatory Myopathies. (United States)

    Cucchiari, David; Angelini, Claudio


    Renal involvement in idiopathic inflammatory myopathies is not as uncommon as was previously thought, as it develops in about one fifth of patients. Clinical presentation includes either acute kidney injury or chronic glomerulonephritis. The former usually develops abruptly during acute phases of rhabdomyolysis: in this case, kidney injury is caused by the toxic effects that myoglobinuria has on the kidney tubules, including cast formation and iron-induced oxidative stress and the development of a third space into the injured muscles. The latter instead has an autoimmune nature, a pleomorphic histological picture, and a more indolent course, with the exception of crescentic glomerulonephritis. Accurate diagnosis and management is crucial for these patients, as timely evaluation and treatment can prevent most of the complications. In the setting of rhabdomyolysis-induced acute kidney injury, the necessity of dialysis can be avoided through aggressive hydration and alkalinization, in order to force diuresis and avoid acidosis and hyperkalemia. In immune-mediated glomerulonephritis, renal biopsy is of undoubtedly value in the diagnostic process and can add prognostic and therapeutic information. In these forms, the development of chronic kidney disease can be prevented or at least delayed by the institution or modification of immunosuppressive treatment. Moreover, the use of drugs that inhibit the renin-angiotensin-aldosterone system and some lifestyle modifications, such as smoking cessation, weight loss, and salt restriction have also value in reducing proteinuria and the progression of kidney damage. In this review, we have summarized the currently available evidence and the different case series in an attempt to provide the readers with the most complete and practical notions that are needed to handle these delicate patients.

  7. Wegener's granulomatosis with renal involvement: patient survival and correlations between initial renal function, renal histology, therapy and renal outcome. (United States)

    Andrassy, K; Erb, A; Koderisch, J; Waldherr, R; Ritz, E


    Patient survival and renal outcome were followed in 25 patients with biopsy confirmed Wegener's granulomatosis and renal involvement. Fourteen out of 25 patients required dialysis on admission, 11/25 patients did not. All patients were treated with a novel protocol comprising methylprednisolone and cyclophosphamide. The median follow-up observation was 36 months (12-113 months). With the exception of 1 patient (who died from causes not related to Wegener's granulomatosis) all patients are alive. Among the patients initially requiring dialysis (n = 14) 4 are in terminal renal failure after 0, 7, 21 and 38 months respectively. In the nondialysis group (n = 11) only 1 patient subsequently required chronic dialysis 30 months after clinical admission. Renal failure was due to non-compliance with immunosuppressive therapy in at least 2 patients. Percentage of obsolescent glomeruli and the degree of tubulointerstitial lesions, but not active glomerular lesions (crescents, necroses) predicted renal outcome. The major cause of renal functional impairment was relapse of Wegener's granulomatosis usually within 2 years after clinical remission. Therefore prolonged treatment with cyclophosphamide for at least 2 years after clinical remission is recommended. Two patients with initially negative immunohistology had a second renal biopsy which revealed de novo appearance of mesangial IgA deposits.

  8. Assessment of pathologically diagnosed patients with Castleman's disease associated with diffuse parenchymal lung involvement using the diagnostic criteria for IgG4-related disease. (United States)

    Ogoshi, Takaaki; Kido, Takashi; Yatera, Kazuhiro; Oda, Keishi; Kawanami, Toshinori; Ishimoto, Hiroshi; Sakamoto, Noriho; Sano, Arisa; Yoshii, Chiharu; Shimajiri, Shohei; Mukae, Hiroshi


    IgG4-related disease (IgG4RD) is a recently recognized disease entity. Differentiating IgG4RD from plasma cell type Castleman's disease (PCD) is important but also difficult using only pathological findings. In addition, little is known about the association between these two diseases with diffuse parenchymal lung involvement. We analyzed the serum IgG4 levels and the ratio of IgG4/IgG-positive plasmacytes in the lung and lymph node specimens of eight patients previously pathologically diagnosed of PCD with diffuse parenchymal lung involvement (DL-PCD). We also compared the clinical and laboratory findings observed in these patients. Six of the eight patients exhibited abundant IgG4-positive plasmacytes in the lung and lymph node tissues and elevated serum IgG4 levels, thereby fulfilling the diagnostic criteria of IgG4RD with DL (DL-IgG4RD) in addition to having obstructive phlebitis and massive lymphoplasmacytic infiltration with fibrosis. However, three of these six patients exhibited higher levels of serum interleukin-6 and were still diagnosed with DL-PCD. Accordingly, three of these eight patients were considered as IgG4RD with DL (DL-IgG4RD), and the other five patients were ultimately given a diagnosis of DL-PCD. These two diseases have different characteristics in terms of age, symptoms, serum levels of C-reactive protein, and IgA, complicating allergic disorders, response to corticosteroids, and prognosis. This is the first report to show a high prevalence of DL-IgG4RD in DL-PCD patients, although additional large investigations are necessary. Clinical and laboratory findings are important for distinguishing between these two diseases in other organs, as previously described.

  9. Levamisole-Induced Vasculitis with Renal Involvement. (United States)

    Chawdhary, Karan; Parke, Ann


    A significant amount of cocaine used in the United States today is adulterated with levamisole. In some instances, prolonged use of contaminated cocaine is associated with the development of levamisole-induced vasculitis (LIV) with features of cutaneous vasculitis and agranulocytosis along with other constitutional symptoms and arthritis. We describe a case of a crack cocaine user with LIV, who developed significant renal disease secondary to crescentic glomerulonephritis, confirmed on renal biopsy. Renal vasculitis is an uncommon feature of LIV and significantly affects clinical course and management.

  10. Renal involvement in dogs with babesiosis

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    R.G. Lobetti


    Full Text Available Proteinuria, and renal tubular casts and epithelial cells in urine sediment, are commonly observed in both complicated and uncomplicated babesiosis, but do not necessarily reflect or predict renal failure. This study investigated the presence and degree of renal damage in canine babesiosis. Renal function and integrity were evaluated using serum urea and creatinine, serum electrolytes (sodium and potassium, fractional clearance of sodium (FcNa and potassium (FcK, urine enzyme activity of gamma-glutamyl transpeptidase and alkaline phosphatase, urine protein:creatinine ratio, and urinalysis. One control group (n =10 and 3 groups of babesiosis cases were studied: mild uncomplicated (n =10, severe uncomplicated (n = 11, and complicated (n = 9. All babesiosis groups showed well-concentrated urine. Mean serum urea was elevated in the severe and complicated groups, and was significantly different from the control group. There was no statistically significant difference between the groups for creatinine, although the complicated group had a mean value above the normal reference range. Hypokalaemia was uncommon in all the groups. Hyperkalaemia was present in only 2 dogs in the complicated group. Marginal hyponatraemia was present in a minority of dogs in all groups. The serumelectrolytes were not significantly different between groups. There was no overall elevation, nor any statistically significant difference in both the FcNa and FcK between the groups. Only 1 dog, in the complicated group, showed marked enzymuria. Proteinuria was a common finding and was significantly different between the severe and complicated groups and the control group. Some dogs in all groups had renal tubular epithelial cells in the urinary sediment, which increased in severity from the mild to the complicated groups and was significantly different from the control group. This study demonstrated that minimal renal damage occurs more often in canine babesiosis than significant


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    N Ataei


    Full Text Available "nUrinary tract infection (UTI may lead to irreversible changes in renal parenchyma. Early diagnosis using scintigraphy with technetium-99m-labeled dimercaptosuccinic acid (DMSA scan and early treatment may decrease or prevent development of renal parenchymal lesions. The aim of this study was to assess the occurrence of renal parenchymal lesion in children admitted with a first-time symptomatic UTI and to evaluate the relation between renal parenchymal damage and severity of vesicoureteral reflux (VUR. A total of 102 children with first time acute pyelonephritis (APN were enrolled in the study. All children studied with DMSA scan and ultrasonography (US. Voiding cystourethrography (VCUG was performed in 98 children when urine culture became negative. Changes on the DMSA scan and US were found in 178 (88% and 5 (2.4% out of 203 renal units during the acute phase, respectively. All abnormal renal units on US showed severe parenchymal involvement on DMSA. We also found significant correlation between severity of VUR and abnormal US results on kidneys. Of 40 kidneys with reflux, 38 (95% were found to have abnormal renal scan. Among 155 kidneys with non-refluxing ureters 132 (85.2% revealed parenchymal changes on renal cortical scintigraphy. Kidneys with moderate to severe reflux were more likely to have severe renal involvement. We found a high incidence of renal parenchymal changes in children with APN. Additionally, renal involvement was significantly higher in children with moderate to severe reflux. When there are high-grade VUR and female gender, the risk of renal parenchymal involvement is higher.

  12. Multiple vascular anomalies involving renal, testicular and suprarenal arteries

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    Suresh Rao


    Full Text Available Knowledge of variations of blood vessels of the abdomen is important during operative, diagnostic and endovascular pro- cedures. During routine dissection of the abdominal cavity, we came across multiple vascular anomalies involving renal, suprarenal and testicular arteries. The left kidney was supplied by two renal arteries originating together from the abdomi- nal aorta, and the right kidney was supplied by two accessory renal arteries, one of which was arising from the right renal artery and the other one from the aorta (about 2 inches below the origin of the renal artery. Accessory renal veins were present on both sides. The right testicular artery was arising from the lower accessory renal artery. The left testicular artery was looping around the inferior tributary of the left renal vein, whereby forming a sharp kink. The left middle suprarenal artery was diving into three small branches; the upper two branches were supplying the left suprarenal gland, whereas the lower branch was supplying the left kidney. Furthermore, detailed literature and the clinical and surgical importance of the case are discussed. [Arch Clin Exp Surg 2015; 4(3.000: 168-171

  13. Carcinoid tumor with bilateral renal involvement in a child. (United States)

    Warrier, Raj P; Varma, Aditi Vian; Chauhan, Aman; Ward, Ken; Craver, Randal


    Carcinoid tumors are uncommon in children. Kidneys are rarely involved as they do not possess neuro-endocrine cells. Work up of painless hematuria after abdominal trauma in a 10-year-old boy revealed primary carcinoid tumors with metastasis to both kidneys. We were unable to find any previous reports of renal involvement by carcinoid tumor in children.

  14. Renal involvement in non-Hodgkin lymphoma: proven by renal biopsy. (United States)

    Li, Shi-Jun; Chen, Hui-Ping; Chen, Ying-Hua; Zhang, Li-hua; Tu, Yuan-Mao; Liu, Zhi-hong


    To determine the spectrum of renal lesions in patients with kidney involvement in non-Hodgkin's lymphoma (NHL) by renal biopsy. The clinical features and histological findings at the time of the renal biopsy were assessed for each patient. We identified 20 patients with NHL and renal involvement, and the diagnosis of NHL was established following the kidney biopsy in 18 (90%) patients. The types of NHL include the following: chronic lymphocytic leukemia/small lymphocytic lymphoma (n = 8), diffuse large B-cell lymphoma (n = 4), T/NK cell lymphoma (n = 3), lymphoplasmacytic lymphoma (n = 2), cutaneous T-cell lymphoma (n = 1), mucosa-associated lymphoid tissue lymphoma (n = 1) and mantle cell lymphoma (n = 1). All presented with proteinuria, and 15 patients had impaired renal function. The pathological findings included (1) membranoproliferative glomerulonephritis-like pattern in seven patients; (2) crescent glomerulonephritis in four; (3) minimal-change disease in three, and glomeruli without specific pathological abnormalities in three; (4) intraglomerular large B-cell lymphoma in one; (5) intracapillary monoclonal IgM deposits in one; (6) primary diffuse large B-cell lymphoma of the kidneys in one; and (7) lymphoma infiltration of the kidney in eight patients. A wide spectrum of renal lesions can be observed in patients with NHL, and NHL may be first proven by renal biopsies for evaluation of kidney injury or proteinuria. Renal biopsy is necessary to establish the underlying cause of renal involvement in NHL.

  15. The spectrum of renal involvement in patients with inflammatory myopathies. (United States)

    Couvrat-Desvergnes, Grégoire; Masseau, Agathe; Benveniste, Olivier; Bruel, Alexandra; Hervier, Baptiste; Mussini, Jean-Marie; Buob, David; Hachulla, Eric; Rémy, Philippe; Azar, Raymond; Mac Namara, Evelyne; MacGregor, Brigitte; Daniel, Laurent; Lacraz, Adeline; De Broucker, Thomas; Rouvier, Philippe; Carli, Philippe; Laville, Maurice; Dantan, Etienne; Hamidou, Mohamed; Moreau, Anne; Fakhouri, Fadi


    Data regarding the incidence and outcome of renal involvement in patients with inflammatory myopathies (IM) remain scarce. We assessed the incidence and causes of acute kidney injury (AKI) and chronic kidney disease (CKD) in 150 patients with dermatomyositis, polymyositis, and antisynthetase syndrome followed in 3 French referral centers. Renal involvement occurred in 35 (23.3%) patients: AKI in 16 (10.7%), and CKD in 31 (20.7%) patients. The main cause of AKI was drug or myoglobinuria-induced acute tubular necrosis. Male sex, cardiovascular risk factors, cardiac involvement, and initial proteinuria >0.3 g/d were associated with the occurrence of AKI. The outcome of patients with AKI was poor: 13 (81%) progressed to CKD and 2 (12.5%) reached end-stage renal disease. In multivariate survival analysis, age at IM onset, male sex, a history of cardiovascular events, and a previous episode of AKI were associated with the risk of CKD. We also identified 14 IM patients who underwent a kidney biopsy in 10 nephrology centers. Renal pathology disclosed a wide range of renal disorders, mainly immune-complex glomerulonephritis. We identified in 5 patients a peculiar pattern of severe acute renal vascular damage consisting mainly of edematous thickening of the intima of arterioles. We found that AKI and CKD are frequent in patients with IM. Prevention of AKI is crucial in these patients, as AKI is a major contributor to their relatively high risk of CKD. A peculiar pattern of acute vascular damage is part of the spectrum of renal diseases associated with IM.

  16. IgG4-related inflammatory pseudotumor of the renal pelvis involving renal parenchyma, mimicking malignancy. (United States)

    Park, Ho Gyun; Kim, Kyoung Min


    IgG4-related disease is a recently recognized systemic disease characterized by storiform fibrosis with infiltration of IgG4-positive plasma cells. In rare incidences, IgG4-related renal disease can present as a solitary mass lesion at renal pelvis and can pose a diagnostic challenge since these lesions mimic malignancy. Herein, we present a rare case of IgG4-related disease presenting as inflammatory pseudotumor lesion, involving the renal pelvis and also neighboring renal parenchyma. A 75-year-old man with no history of IgG4-related disease underwent computed tomography (CT) scan for evaluation of prostatic cancer. The CT scan incidentally revealed a mass lesion located at the right renal pelvis. Radiologic findings were highly suggestive of malignancy. Therefore, the patient underwent right nephroureterectomy. Microscopically, the mass lesion showed storiform fibrosis with diffuse and intense inflammatory cell infiltration. Infiltrating cells were mainly histiocytes and plasma cells. Tubulointerstitium adjacent to the lesion also showed fibrosis with abundant plasmacytic infiltration. Immunohistochemical staining revealed the presence of IgG4-positive plasma cells in both the mass lesion and tubulointerstitium (mean of 94/HPF per field). Considering these findings, we diagnosed the mass lesion as IgG4-related inflammatory pseudotumor of the renal pelvis. In patients with renal pelvic masses, IgG4-related inflammatory pesudotumor should be considered in the differential diagnosis to avoid unnecessary surgical intervention.

  17. Diabetes mellitus and renal involvement in chronic viral liver disease. (United States)

    Iovanescu, V F; Streba, C T; Ionescu, M; Constantinescu, A F; Vere, C C; Rogoveanu, I; Moța, E


    Chronic viral liver disease is often associated with other conditions. Diabetes mellitus (DM) is frequently reported in this context and may play a role in the progression of the liver disease to hepatocellular carcinoma (HCC). Renal disease is also an important extrahepatic manifestation of hepatitis viral infection and its presence is associated with poor prognosis and management issues. Our study had multiple purposes: to determine the frequency of the association between chronic viral liver disease and diabetes mellitus, evaluate the potential of diabetes mellitus as a risk factor for HCC and assess an eventual renal involvement. We included in our study a number of 246 patients with chronic liver disease, from whom 136 were diagnosed with chronic viral hepatitis and 110 with viral liver cirrhosis. These patients were assessed by using a clinical examination and a series of tests, including serum transaminase levels, serum bilirubin, serum albumin, markers of cholestasis, fasting plasma glucose levels, serum creatinine, urea, albuminuria, Addis-Hamburger test, electrophoresis of urinary proteins, abdominal ultrasound and, in some cases, CT examination. We obtained the following results: diabetes mellitus is often associated with chronic liver disease of viral etiology, having been identified in 18.29% of the patients in our study. Age above 60 in patients with chronic hepatitis (p=0.013diabetes mellitus. Renal disease was present in 13.4% of the patients with chronic liver disease and it was especially associated with liver cirrhosis and hepatitis C virus. The most common form of renal injury was glomerulonephritis. Acute kidney injury was diagnosed only in cirrhotic patients as hepatorenal syndrome, occurring in 7.27% of the subjects, while chronic kidney disease was identified only in two cases of chronic viral hepatitis. Four patients in our study were diagnosed with HCC and none of them presented diabetes mellitus. Our study revealed that there is a

  18. Diffuse parenchymal lung disease

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    Sara Tomassetti


    Full Text Available Between September 2015 and August 2016 there were >1500 publications in the field of diffuse parenchymal lung diseases (DPLDs. For the Clinical Year in Review session at the European Respiratory Society Congress that was held in London, UK, in September 2016, we selected only five articles. This selection, made from the enormous number of published papers, does not include all the relevant studies that will significantly impact our knowledge in the field of DPLDs in the near future. This review article provides our personal view on the following topics: early diagnosis of idiopathic pulmonary fibrosis, current knowledge on the multidisciplinary team diagnosis of DPLDs and the diagnostic role of transbronchial cryobiopsy in this diagnostic setting, insights on the new entity of interstitial pneumonia with autoimmune features, and new therapeutic approaches for scleroderma-related interstitial lung disease.

  19. Allograft and prostatic involvement in a renal transplant recipient with disseminated tuberculosis. (United States)

    Sreejith, P; Jha, V; Kohli, H S; Rathi, M; Gupta, K L; Sakhuja, V


    Tuberculosis is a serious opportunistic infection in renal transplant recipients and is disseminated in nature in one-third of patients. Genito urinary tuberculosis is rare in renal transplant recipients. We report a patient presenting 5 years after renal transplantation with disseminated tuberculosis and allograft and prostatic involvement.

  20. Bone marrow involvement by lymphoproliferative disorders after renal transplantation: PTLD. Int. Survey

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    Morteza Izadi


    Conclusions: Renal recipients with BM PTLD represent worse outcome and more unfavorable histopathological phenomenon than in other organ involvements. Moreover, a concomitant PTLD involvement site in liver was found which necessitates full hepatic evaluation for a potential complication by the disease in renal recipients whose BM is involved.

  1. Pathogenesis of Alcoholic Liver Disease: Interactions between parenchymal and non-parenchymal cells (United States)

    Cohen, Jessica I.; Nagy, Laura E.


    The development of alcoholic liver disease (ALD) is a complex process involving both the parenchymal and non-parenchymal cells in the liver. The impact of ethanol on hepatocytes can be characterized as a condition of “organelle stress” with multi-factorial changes in hepatocellular function accumulating during ethanol exposure. These changes include oxidative stress, mitochondrial dysfunction, decreased methylation capacity, endoplasmic reticulum stress, impaired vesicular trafficking and altered proteosome function. Injury to hepatocytes is attributed, in part, to ethanol metabolism by the hepatocytes. Changes in the structural integrety of hepatic sinusoidal endotheial cells, as well as enhanced inflammation in the liver during ethanol exposure are also important contributors to injury. Activation of hepatic stellate cells initiates the deposition of extracellular matrix proteins characteristic of fibrosis. Kupffer cells, the resident macrophages in liver, are particularly critical to the onset of ethanol-induced liver injury. Chronic ethanol exposure sensitizes Kupffer cells to activation by lipopolysaccharide via toll-like receptor 4. This sensitization enhances production of inflammatory mediators, such as tumor necrosis factor-α and reactive oxygen species, that contribute to hepatocyte dysfunction, necrosis and apoptosis of hepatocytes and generation of extracellular matrix proteins leading to fibrosis. In this review, we provide an overview of the complex interactions between parenchymal and non-parenchymal cells in the liver during the progression of ethanol-induced liver injury. PMID:21091930

  2. Reduced cyclooxygenase involvement in vascular endothelial function in rat renal transplantation

    NARCIS (Netherlands)

    Smit-Van Oosten, Annemieke; Boonstra, Arnold H.; Navis, Gerjan; Van Goor, Harry; Buikema, Hendrik


    Background: Cardiovascular disease is a major cause of death following renal transplantation. Mechanisms leading to vascular dysfunction outside the transplanted organ involve common risk factors such as hypertension, hypercholesterolemia, proteinuria, but immune-mediated factors may also be involve

  3. Reduced cyclooxygenase involvement in vascular endothelial function in rat renal transplantation

    NARCIS (Netherlands)

    Smit-Van Oosten, Annemieke; Boonstra, Arnold H.; Navis, Gerjan; Van Goor, Harry; Buikema, Hendrik


    Background: Cardiovascular disease is a major cause of death following renal transplantation. Mechanisms leading to vascular dysfunction outside the transplanted organ involve common risk factors such as hypertension, hypercholesterolemia, proteinuria, but immune-mediated factors may also be involve

  4. Expression profiles of genes involved in xenobiotic metabolism and disposition in human renal tissues and renal cell models

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    Van der Hauwaert, Cynthia; Savary, Grégoire [EA4483, Université de Lille 2, Faculté de Médecine de Lille, Pôle Recherche, 59045 Lille (France); Buob, David [Institut de Pathologie, Centre de Biologie Pathologie Génétique, Centre Hospitalier Régional Universitaire de Lille, 59037 Lille (France); Leroy, Xavier; Aubert, Sébastien [Institut de Pathologie, Centre de Biologie Pathologie Génétique, Centre Hospitalier Régional Universitaire de Lille, 59037 Lille (France); Institut National de la Santé et de la Recherche Médicale, UMR837, Centre de Recherche Jean-Pierre Aubert, Equipe 5, 59045 Lille (France); Flamand, Vincent [Service d' Urologie, Hôpital Huriez, Centre Hospitalier Régional Universitaire de Lille, 59037 Lille (France); Hennino, Marie-Flore [EA4483, Université de Lille 2, Faculté de Médecine de Lille, Pôle Recherche, 59045 Lille (France); Service de Néphrologie, Hôpital Huriez, Centre Hospitalier Régional Universitaire de Lille, 59037 Lille (France); Perrais, Michaël [Institut National de la Santé et de la Recherche Médicale, UMR837, Centre de Recherche Jean-Pierre Aubert, Equipe 5, 59045 Lille (France); and others


    Numerous xenobiotics have been shown to be harmful for the kidney. Thus, to improve our knowledge of the cellular processing of these nephrotoxic compounds, we evaluated, by real-time PCR, the mRNA expression level of 377 genes encoding xenobiotic-metabolizing enzymes (XMEs), transporters, as well as nuclear receptors and transcription factors that coordinate their expression in eight normal human renal cortical tissues. Additionally, since several renal in vitro models are commonly used in pharmacological and toxicological studies, we investigated their metabolic capacities and compared them with those of renal tissues. The same set of genes was thus investigated in HEK293 and HK2 immortalized cell lines in commercial primary cultures of epithelial renal cells and in proximal tubular cell primary cultures. Altogether, our data offers a comprehensive description of kidney ability to process xenobiotics. Moreover, by hierarchical clustering, we observed large variations in gene expression profiles between renal cell lines and renal tissues. Primary cultures of proximal tubular epithelial cells exhibited the highest similarities with renal tissue in terms of transcript profiling. Moreover, compared to other renal cell models, Tacrolimus dose dependent toxic effects were lower in proximal tubular cell primary cultures that display the highest metabolism and disposition capacity. Therefore, primary cultures appear to be the most relevant in vitro model for investigating the metabolism and bioactivation of nephrotoxic compounds and for toxicological and pharmacological studies. - Highlights: • Renal proximal tubular (PT) cells are highly sensitive to xenobiotics. • Expression of genes involved in xenobiotic disposition was measured. • PT cells exhibited the highest similarities with renal tissue.

  5. Obesity increases the risk of renal involvement in children with Henoch-Schönlein purpura. (United States)

    Zhao, Yong-Li; Liu, Zheng-Juan; Bai, Xue-Mei; Wang, Yu-Chuan; Li, Guo-Hua; Yan, Xue-Yan


    The main aim of this study was to evaluate the relationship between obesity and renal involvement in children with Henoch-Schönlein purpura (HSP). A retrospective study of 141 pediatric patients with HSP was conducted in our hospital. The clinical data of all patients were collected from the electronic medical record management system from January 2010 to June 2014. The possible risk factors of renal involvement, especially obesity, were analyzed using univariate and multivariate analyses. Renal involvement occurred in 45/141 of the patients. A univariate analysis showed that an age more than 7 years at onset, persistent purpura, obesity, time from symptoms onset to diagnosis more than 14 days, and decreased C3 all increased the risk of renal involvement in HSP. The forward stepwise logistic regression analysis indicated obesity (odds ratio (OR) 4.43, 95 % confidence interval (CI) 1.896 to 10.358), age more than 7 years at onset (OR 2.81, 95 % CI 1.142 to 6.907), and persistent purpura (OR 2.57, 95 % CI 1.119 to 5.909) were independent risk factors for renal involvement. Our results show that obesity can increase the hazard of renal involvement in children with HSP and reconfirm that older age at onset and persistent purpura are the independent risk factors for renal involvement. • There have been some reports that obesity was associated with the development of renal injury. • It is not clear whether obesity can increase the risk of renal involvement in children with HSP. What is New: • The main finding of this study is that obesity can increase the hazard of renal involvement in children with HSP.

  6. Signaling Pathways Involved in Renal Oxidative Injury: Role of the Vasoactive Peptides and the Renal Dopaminergic System

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    N. L. Rukavina Mikusic


    Full Text Available The physiological hydroelectrolytic balance and the redox steady state in the kidney are accomplished by an intricate interaction between signals from extrarenal and intrarenal sources and between antinatriuretic and natriuretic factors. Angiotensin II, atrial natriuretic peptide and intrarenal dopamine play a pivotal role in this interactive network. The balance between endogenous antioxidant agents like the renal dopaminergic system and atrial natriuretic peptide, by one side, and the prooxidant effect of the renin angiotensin system, by the other side, contributes to ensuring the normal function of the kidney. Different pathological scenarios, as nephrotic syndrome and hypertension, where renal sodium excretion is altered, are associated with an impaired interaction between two natriuretic systems as the renal dopaminergic system and atrial natriuretic peptide that may be involved in the pathogenesis of renal diseases. The aim of this review is to update and comment the most recent evidences about the intracellular pathways involved in the relationship between endogenous antioxidant agents like the renal dopaminergic system and atrial natriuretic peptide and the prooxidant effect of the renin angiotensin system in the pathogenesis of renal inflammation.

  7. Renal involvement following near-drowning in the sea. (United States)

    Oren, A; Etzion, Z; Broitman, D; Yagil, R


    1. The metabolic changes in rats following introduction of sea water directly into the stomach were studied. The results were compared with those of a human case report of acute renal failure following swallowing of sea water. 2. In both rats and man, acute renal failure appeared within the first 24 hr. A slight improvement was found five days later. 3. There was an acute hypocalcemia. This was supposedly due to the large magnesium content of the sea water. 4. It is probable that water entering the alimentary canal, dry drowning, affects the kidneys by the initial flow of water to the intestines. This results in hemo-concentration and reduced kidney function. The abnormality is a transient one and could be due to a partial anoxia due to shrinking of the erythrocytes. 5. It is concluded that an apparently uneventful swallowing of sea water can turn into secondary drowning with transient acute renal failure.

  8. Multiple Drug Transporters Are Involved in Renal Secretion of Entecavir. (United States)

    Yang, Xi; Ma, Zhiyuan; Zhou, Sisi; Weng, Yayun; Lei, Hongmei; Zeng, Su; Li, Liping; Jiang, Huidi


    Entecavir (ETV) is a first-line antiviral agent for the treatment of chronic hepatitis B virus infection. Renal excretion is the major elimination path of ETV, in which tubular secretion plays the key role. However, the secretion mechanism has not been clarified. We speculated that renal transporters mediated the secretion of ETV. Therefore, the aim of our study was to elucidate which transporters contribute to the renal disposition of ETV. Our results revealed that ETV (50 μM) remarkably reduced the accumulation of probe substrates in MDCK cells stably expressing human multidrug and toxin efflux extrusion proteins (hMATE1/2-K), organic cation transporter 2 (hOCT2), and carnitine/organic cation transporters (hOCTNs) and increased the substrate accumulation in cells transfected with multidrug resistance-associated protein 2 (hMRP2) or multidrug resistance protein 1 (hMDR1). Moreover, ETV was proved to be a substrate of the above-described transporters. In transwell studies, the transport of ETV in MDCK-hOCT2-hMATE1 showed a distinct directionality from BL (hOCT2) to AP (hMATE1), and the cellular accumulation of ETV in cells expressing hMATE1 was dramatically lower than that of the mock-treated cells. The accumulation of ETV in mouse primary renal tubular cells was obviously affected by inhibitors of organic anion transporter 1/3 (Oat1/3), Oct2, Octn1/2, and Mrp2. Therefore, the renal uptake of ETV is likely mediated by OAT1/3 and OCT2 while the efflux is mediated by MATEs, MDR1, and MRP2, and OCTN1/2 may participate in both renal secretion and reabsorption. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

  9. New syndrome with ocular, skeletal and renal involvement

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    Cirillo Silengo, M.; Lopez Bell, G.; Biagioli, M.; Guala, A.; Franceschini, P.; Porcellini, G.


    A patient with retinitis pigmentosa, hypertension with interstitial nephropathy, short limb dwarfism with Madelung deformity of the forearms and an unclassified type of brachydactyly is described. Such bone dysplasia has never been reported to date either as a single entity or associated with renal and retinal diseases.

  10. Assessment of renal involvement in patients with familial Mediterranean fever: a clinical study from Ardabil, Iran. (United States)

    Bashardoust, B; Maleki, N


    Familial Mediterranean fever (FMF) is an autosomal recessive disease characterised by recurrent episodes of painful inflammation in the abdomen, chest or joints. The association between FMF and non-amyloid glomerulopathies are unusual. In this study, we describe our experiences and observations about renal involvement in patients with FMF. A total of 108 patients with FMF was enrolled in the study. Twelve patients with FMF were referred to the Nephrology Service, for evaluation and assessment of the degree of renal involvement. All the 12 patients underwent percutaneous ultrasound-guided renal biopsies and genetic analysis. On microscopic examination of the kidney specimens, six patients were found to have amyloidosis, five focal segmental glomerulosclerosis and one patient membranoproliferative glomerulonephritis. It seems that in patients with FMF and renal amyloidosis, the response to treatment with colchicine is excellent, but in patients with FMF and focal segmental glomerulosclerosis, the response to treatment with colchicine is poor. We present an evidence-based algorithm, constructed based on literature review, to aid decision making in management of renal involvement in patients with FMF. The results of our study suggest that in patients with FMF and renal involvement, non-amyloid renal lesions should be considered in the differential diagnosis in addition to amyloidosis. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

  11. Disseminated zygomycosis with renal involvement simulating malignancy in a diabetic patient

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    Deepak Khandelwal


    Full Text Available Zygomycosis or mucormycosis refers to a group of uncommon but frequently fatal mycoses caused by fungi of the class Zygomycetes. The disease is usually an opportunistic infection in patients with diabetes, immunosuppression, trauma, burn wounds and other chronic debilitating diseases. Isolated renal involvement is rare although involvement of kidneys in disseminated mucormycosis is not uncommon. Clinical awareness and thorough appropriate investigations are required for an early diagnosis and successful treatment. We herein report a case of disseminated zygomycosis presenting as renal mass with pulmonary lesions, which was initially suspected to be disseminated renal cell carcinoma before a tissue diagnosis was obtained.


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    Musso CG


    Full Text Available Designer drugs or synthetic drugs are manufactured from modifying the chemical structure of certain natural products or drugs, with psychotropic effect. The clinical picture is characterized by producing altered mental status associated with mydriasis, tachycardia, hypertension, nausea, chills, sweating, tremor and hyperthermia. Given the importance that the acute renal failure has among complications induced by these drugs, they are detailed in this paper: fall in renal blood flow, acute parenchymal damage, urinary obstruction, and mixed mechanism. For this reason, the renal treatment to be implemented depends on the correct assessment and understanding of the mechanisms involved in the renal patient alteration.

  13. Disseminated mucormycosis with myocardial involvement in a renal transplant recipient. (United States)

    Nam, Y; Jung, J; Park, S S; Kim, S J; Shin, S J; Choi, J H; Kim, M; Yoon, H E


    We report the case of a renal transplant recipient with pulmonary and splenic mucormycosis whose demise was accelerated by a myocardial abscess. Once pulmonary and splenic mucormycosis was diagnosed, liposomal amphotericin B was started and immunosuppressant treatments were discontinued. The pulmonary cavities regressed during treatment, but new myocardial and peri-allograft abscesses developed. The myocardial abscess diffusely infiltrated the left ventricular wall and was associated with akinesia, which led to sudden cardiac arrest. This case demonstrates a rare manifestation of mucormycosis and highlights the fatality and invasiveness of this infection.

  14. Renal Involvement in AA Amyloidosis: Clinical Outcomes and Survival

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    Murvet Yilmaz


    Full Text Available Background: The natural history of AA amyloidosis is typically progressive, leading to multiple organ failure and death. We analyzed the etiology as well as clinical and laboratory features of patients with biopsy-proven AA amyloidosis and evaluated the ultimate outcome. Methods: Seventy-three patients (24 female; mean age 41.85±15.89 years were analyzed retrospectively. Demographic, clinical and laboratory features were studied and the outcome was assessed. Results: Familial Mediterranean Fever and tuberculosis were the most frequent causes of amyloidosis. Mean serum creatinine and proteinuria at diagnosis were 4.65±4.89 mg/dl and 8.04±6.09 g/day, respectively; and stage I, II, III, IV and V renal disease were present in 19.2%, 13.7%, 16.4%, 11%, and 39.7% of the patients, respectively. ESRD developed in 16 patients during the follow-up period. All of the ESRD patients started a dialysis programme. Thirty patients (41% died during the follow-up period; median patient survival was 35.9±6.12 months. Old age, tuberculosis etiology, advanced renal disease and low serum albumin levels were associated with a worse prognosis. Serum albumin was a predictor of mortality in logistic regression analysis. Conclusion: The ultimate outcome of the patients with AA amyloidosis is poor, possibly due to the late referral to the nephrology clinics. Early referral may be helpful to improve prognosis.

  15. Behcet's syndrome and renal involvement: a histological and immunofluorescent study of eleven renal biopsies. (United States)

    Herreman, G; Beaufils, H; Godeau, P; Cassou, B; Wechsler, B; Boujeau, J; Chomette, G


    The finding of focal glomerulonephritis in a patient with Behcet's syndrome led us to perform systematic renal biopsies in ten other patients with the disease. None of the patients had symptoms of renal disease. Proteinuria was found in five, two of whom had associated leukocyturia. By light microscopy mesangial and extramembranous glomerular deposits were observed in eight patients. Arterioles in ten patients showed subendothelial and medial hyaline deposits. A granular pattern of fluorescent staining identified the presence of the third component of complement in these deposits. Circulating immune deposits were sought and found in six out of seven patients. The finding of circulating immune complexes and deposition of complement in glomerular and arteriolar tissues supports an immune complex mediated nephropathy and is consistent with the hypothesis of an immunological pathogenesis in Behcet's syndrome.

  16. Visceral leishmaniasis due to Leishmania infantum with renal involvement in HIV-infected patients


    Vassallo, Matteo; Moranne, Olivier; Ambrosetti, Damien; Jeandel, Pierre-Yves; Pomares, Christelle; Cassuto, Elisabeth; Boscagli, Annick; Giraud, Guillaume; Montagne, Nathalie; Dentone, Chiara; Demacina, Ilaria; Villaggio, Barbara; Secondo, Giovanni; Ferrea, Giuseppe; Passeron, Corinne


    Background We describe histological, clinical findings and outcomes of renal involvement during Leishmania infantum infection in four HIV-infected patients in South France and North Italy hospital settings. Cases presentation Four HIV-infected Caucasian patients (age 24-49) performed renal biopsy during episodes of visceral leishmaniasis. They presented severe immunosuppression, frequent relapses of visceral leishmaniasis during a follow-up period of several years and partial or complete reco...

  17. Renal involvement in childhood-onset systemic lupus erythematosus in Egypt. (United States)

    Mahmoud, Samia Salah-El-Din; Bazaraa, Hafez Mahmoud; Lotfy, Hala Mohamed; Abd-El-Aziz, Doaa Mohamed


    Lupus nephritis has been described as the most serious complication of systemic lupus erythematosus (SLE) and the strongest predictor of poor outcome. While the incidence of childhood SLE is relatively low, renal involvement appears to be more common and more severe in childhood SLE. This study aims to characterize the features and outcome of renal involvement in childhood-onset SLE based on a study of 100 Egyptian patients (mean age at diagnosis 10.1 years, range 2-17 years). Initial data regarding disease manifestations and biopsy findings were reviewed. Disease activity was assessed using SLEDAI scores. Follow-up data (mean duration 6 years) were noted regarding specific treatment, response, complications and renal survival. Initial renal involvement was present in 78 patients, including 66 with hypertension and 23 with renal impairment. Pathologically, class IV nephropathy was found in 18 patients, class V in 9 and low-grade lesions (class II-III) in 49. Twenty patients required follow-up biopsy, and all transformations were observed. SLEDAI scores significantly decreased from initial (mean ± SD) of 21.4 ± 7.3 to 13.4 ± 7.8, in association with response to therapy (P < 0.0001). Poor response was associated with initial hypertension and renal impairment but not with initial SLEDAI score or pathological class. The projected renal survival was 82.4 and 64.7% 5 and 10 years from diagnosis. Early renal involvement in childhood SLE is common, serious and requires proper evaluation and management.

  18. Spectrum of fibrosing diffuse parenchymal lung disease. (United States)

    Morgenthau, Adam S; Padilla, Maria L


    The interstitial lung diseases are a heterogeneous group of disorders characterized by inflammation and/or fibrosis of the pulmonary interstitium. In 2002, the American Thoracic Society and the European Respiratory Society revised the classification of interstitial lung diseases and introduced the term diffuse parenchymal lung disease. The idiopathic interstitial pneumonias are a subtype of diffuse parenchymal lung disease. The idiopathic interstitial pneumonias are subdivided into usual interstitial pneumonia (with its clinical counterpart idiopathic interstitial pneumonia), nonspecific interstitial pneumonia, cryptogenic organizing pneumonia, acute interstitial pneumonia, desquamative interstitial pneumonia, respiratory bronchiolitis interstitial lung disease, and lymphocytic pneumonia. Sarcoidosis and hypersensitivity pneumonitis are the 2 most common granulomatous diffuse parenchymal lung diseases. Rheumatoid arthritis, systemic sclerosis, and dermatomyositis/polymyositis (causing antisynthetase syndrome) are diffuse parenchymal lung diseases of known association because these conditions are associated with connective tissue disease. Hermansky-Pudlak syndrome is a rare genetic diffuse parenchymal lung disease characterized by the clinical triad of pulmonary disease, oculocutaneous albinism, and bleeding diathesis. This review provides an overview of the chronic fibrosing diffuse parenchymal lung diseases. Its primary objective is to illuminate the clinical challenges encountered by clinicians who manage the diffuse parenchymal lung diseases regularly and to offer potential solutions to those challenges. Treatment for the diffuse parenchymal lung diseases is limited, and for many patients with end-stage disease, lung transplantation remains the best option. Although much has been learned about the diffuse parenchymal lung diseases during the past decade, research in these diseases is urgently needed.

  19. An update on renal involvement in hemophagocytic syndrome (macrophage activation syndrome). (United States)

    Esmaili, Haydarali; Mostafidi, Elmira; Mehramuz, Bahareh; Ardalan, Mohammadreza; Mohajel-Shoja, Mohammadali


    Hemophagocytic syndrome (HPS) is mainly characterized by massive infiltration of bone marrow by activated macrophages and often presents with pancytopenia. Thrombotic microangiopathy (TMA) is also present with thrombocytopenia and renal involvement. Both conditions could coexist with each other and complicate the condition. Directory of Open Access Journals (DOAJ), EMBASE, Google Scholar, PubMed, EBSCO, and Web of Science with keywords relevant to; Hemophagocytic syndrome, macrophage activation syndrome, interferon-gamma and thrombotic microangiopathy, have been searched. Viral infection, rheumatologic disease and malignancies are the main underlying causes for secondary HPS. calcineurin inhibitors and viral infections are also the main underlying causes of TMA in transplant recipients. In this review, we discussed a 39-year-old male who presented with pancytopenia and renal allograft dysfunction. With the diagnosis of HPS induced TMA his renal condition and pancytopenia improved after receiving intravenous immunoglobulin (IVIG) and plasmapheresis therapy. HPS is an increasingly recognized disorder in the realm of different medical specialties. Renal involvement complicates the clinical picture of the disease, and this condition even is more complex in renal transplant recipients. We should consider the possibility of HPS in any renal transplant recipient with pancytopenia and allograft dysfunction. The combination of HPS with TMA future increases the complexity of the situation.

  20. Comparison of renal ultrasonography and dimercaptosuccinic acid renal scintigraphy in febrile urinary tract infection. (United States)

    Ayazi, Parviz; Mahyar, Abolfazl; Noroozian, Elham; Esmailzadehha, Neda; Barikani, Ameneh


    Accurate and early diagnosis and appropriate treatment of patient with urinary tract infection (UTI) are essential for the prevention or restriction of permanent damage to the kidneys in children. The aim of this study was to compare renal ultrasonography (US) and dimercaptosuccinic acid (DMSA) renal scan in the diagnosis of patients with febrile urinary tract infection. This study involved the medical records of children with febrile urinary tract infection who were admitted to the children's hospital in Qazvin, Iran. Pyelonephritis was diagnosed on the basis of clinical symptoms, laboratory tests and abnormal DMSA renal scans. The criteria for abnormality of renal US were an increase or a decrease in diffuse or focal parenchymal echogenicity, loss of corticomedullary differentiation, kidney position irregularities, parenchymal reduction and increased kidney size. Of the 100 study patients, 23% had an abnormal US and 46% had an abnormal DMSA renal scan. Of the latter patients, 15 had concurrent abnormal US (P value ≤ 0.03, concordance rate: 18%). Renal US had a sensitivity of 32%, specificity of 85%, positive predictive value of 65% and negative predictive value of 60%. Of the 77 patients with normal US, 31 (40.2%) had an abnormal DMSA renal scan. Despite the benefits and accessibility of renal US, its value in the diagnosis of pyelonephritis is limited.

  1. A case of exorbitism in association with Wegener's granulomatosis with renal involvement. (United States)

    Beji, S; Fatma, L Ben; Chebbi, A; Rais, L; Krid, M; Smaoui, W; Maiz, H Ben; Zouaghi, K; Moussa, F Ben


    Wegener's granulomatosis (WG) is a necrotizing granulomatous vasculitis involving the nose, paranasal sinuses, lungs, and kidneys. Ocular involvement can occur in about 50% of cases. There are very few reports of WG with orbital inflammation and exorbitism. We report a case of a female patient who presented with exorbitism related to orbital inflammation secondary to WG, with renal involvement. A 29-year-old woman with a previous history of recurrent pan-sinusitis presented with bilateral exophthalmos and renal failure with rapidly progressive glomerulonephritis. Computed tomography showed extensive bilateral soft tissue in the retro-orbital area. Immunologic tests showed the presence of type-C anti-neutrophil cytoplasmic antibodies and renal biopsy revealed pauci immune crescentic glomerulonephritis. The patient was treated with corticosteroids and pulses of cyclophosphamide followed by azathioprine and trimethoprim-sulfamethoxazole. After a follow-up of 10 months, the renal outcome was favorable with improvement of renal function but there was persistence of exorbitism and loss of visual function. Our case suggests that WG should be considered in the differential diagnosis of persistent bilateral exophthalmos. Prompt recognition of this early manifestation is important for the institution of early treatment.

  2. A case of exorbitism in association with Wegener′s granulomatosis with renal involvement

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    S Beji


    Full Text Available Wegener′s granulomatosis (WG is a necrotizing granulomatous vasculitis invol-ving the nose, paranasal sinuses, lungs, and kidneys. Ocular involvement can occur in about 50% of cases. There are very few reports of WG with orbital inflammation and exorbitism. We report a case of a female patient who presented with exorbitism related to orbital inflammation secondary to WG, with renal involvement. A 29-year-old woman with a previous history of recurrent pan-sinusitis presented with bilateral exophthalmos and renal failure with rapidly progressive glo-merulonephritis. Computed tomography showed extensive bilateral soft tissue in the retro-orbital area. Immunologic tests showed the presence of type-C anti-neutrophil cytoplasmic antibodies and renal biopsy revealed pauci immune crescentic glomerulonephritis. The patient was treated with corticosteroids and pulses of cyclophosphamide followed by azathioprine and trimethoprim-sulfamethoxazole. After a follow-up of 10 months, the renal outcome was favorable with improvement of renal function but there was persistence of exorbitism and loss of visual function. Our case suggests that WG should be considered in the differential diagnosis of persistent bila-teral exophthalmos. Prompt recognition of this early manifestation is important for the institution of early treatment.

  3. Are calcium oxalate crystals involved in the mechanism of acute renal failure in ethylene glycol poisoning? (United States)

    McMartin, Kenneth


    Ethylene glycol (EG) poisoning often results in acute renal failure, particularly if treatment with fomepizole or ethanol is delayed because of late presentation or diagnosis. The mechanism has not been established but is thought to result from the production of a toxic metabolite. A literature review utilizing PubMed identified papers dealing with renal toxicity and EG or oxalate. The list of papers was culled to those relevant to the mechanism and treatment of the renal toxicity associated with either compound. ROLE OF METABOLITES: Although the "aldehyde" metabolites of EG, glycolaldehyde, and glyoxalate, have been suggested as the metabolites responsible, recent studies have shown definitively that the accumulation of calcium oxalate monohydrate (COM) crystals in kidney tissue produces renal tubular necrosis that leads to kidney failure. In vivo studies in EG-dosed rats have correlated the severity of renal damage with the total accumulation of COM crystals in kidney tissue. Studies in cultured kidney cells, including human proximal tubule (HPT) cells, have demonstrated that only COM crystals, not the oxalate ion, glycolaldehyde, or glyoxylate, produce a necrotic cell death at toxicologically relevant concentrations. COM CRYSTAL ACCUMULATION: In EG poisoning, COM crystals accumulate to high concentrations in the kidney through a process involving adherence to tubular cell membranes, followed by internalization of the crystals. MECHANISM OF TOXICITY: COM crystals have been shown to alter membrane structure and function, to increase reactive oxygen species and to produce mitochondrial dysfunction. These processes are likely to be involved in the mechanism of cell death. Accumulation of COM crystals in the kidney is responsible for producing the renal toxicity associated with EG poisoning. The development of a pharmacological approach to reduce COM crystal adherence to tubular cells and its cellular interactions would be valuable as this would decrease the renal

  4. TRPM6 forms the Mg2+ influx channel involved in intestinal and renal Mg2+ absorption.

    NARCIS (Netherlands)

    Voets, T.; Nilius, B.; Hoefs, S.J.G.; Kemp, J.W.C.M. van der; Droogmans, G.; Bindels, R.J.M.; Hoenderop, J.G.J.


    Mg2+ is an essential ion involved in a multitude of physiological and biochemical processes and a major constituent of bone tissue. Mg2+ homeostasis in mammals depends on the equilibrium between intestinal Mg2+ absorption and renal Mg2+ excretion, but little is known about the molecular nature of

  5. Leiomyosarcoma of inferior vena cava involving bilateral renal veins: Surgical challenges and reconstruction with upfront saphenous vein interposition graft for left renal vein outflow

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    Rishi Nayyar


    Full Text Available Leiomyosarcoma of inferior vena cava (IVC involving bilateral renal veins presents a surgical challenge. Herein, we report the successful management of two such cases using restoration of left renal venous outflow by saphenous vein interposition graft as first step of surgery. Then radical resection of tumor and right kidney was done. IVC was lastly reconstructed using Gore-Tex graft. This report highlights the surgical challenges to ensure radical resection. Furthermore, the importance of restoring left renal outflow in presence of concomitant right nephrectomy is discussed. Both the patients were disease free at six months with no loss of left renal glomerular filtration rate.

  6. Increased renal vascular reactivity to ANG II after unilateral nephrectomy in the rat involves 20-HETE. (United States)

    Joly, E; Seqqat, R; Flamion, B; Caron, N; Michel, A; Imig, J D; Kramp, R


    This study examined the role of intrarenal ANG II in the renal vascular reactivity changes occurring in the remaining kidney undergoing adaptation following contralateral nephrectomy. Renal blood flow responses to intrarenal injections of ANG II (0.25 to 5 ng) were measured in anesthetized euvolemic male Wistar rats 1, 4, 12, and 24 wk after uninephrectomy (UNX) or sham procedure (SHAM). At week 4, renal vasoconstriction induced by 2 ng ANG II was greater in UNX (69 +/- 5%) than in SHAM rats (50 +/- 3%; P < 0.01). This response was inhibited, by 50 and 66%, and by 20 and 25%, in SHAM and UNX rats, after combined injections of ANG II and losartan, or PD-123319 (P < 0.05), respectively. Characteristics of ANG II receptor binding in isolated preglomerular resistance vessels were similar in the two groups. After prostanoid inhibition with indomethacin, renal vasoconstriction was enhanced by 42 +/- 8% (P < 0.05), only in SHAM rats, whereas after 20-HETE inhibition with HET0016, it was reduced by 53 +/- 16% (P < 0.05), only in UNX rats. These differences vanished after concomitant prostanoid and 20-HETE inhibition in the two groups. After UNX, renal cortical protein expression of cytochrome P-450 2c23 isoform (CYP2c23) and cyclooxygenase-1 (COX-1) was unaltered, but it was decreased for CYP4a and increased for COX-2. In conclusion, renal vascular reactivity to ANG II was significantly increased in the postuninephrectomy adapted kidney, independently of protein expression, but presumably involving interactions between 20-HETE and COX in the renal microvasculature and changes in the paracrine activity of ANG II and 20-HETE.

  7. Magnetic resonance imaging in parenchymal neurocysticercosis

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    Just, M.; Higer, H.P.; Pfannenstiel, P.; Mergner, T.; Henne, W.


    MRI-findings in a case of parenchymal neurocysticercosis are presented. The changes of the lesions as a response to chemotherapy were monitored by MRI and CT. Problems of sensitivity (MRI vs. CT) and MRI differential diagnoses are discussed.

  8. Prevalence and patterns of renal involvement in imaging of malignant lymphoproliferative diseases

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    Bach, Andreas Gunter; Behrmann, Curd; Spielmann, Rolf Peter; Surov, Alexey (Dept. of Radiology, Martin-Luther-Univ. Halle-Wittenberg, Halle (Germany)), Email:; Holzhausen, Hans Jurgen (Dept. of Pathology, Martin-Luther-Univ. Halle-Wittenberg, Halle (Germany)); Katzer, Michaela (Dept. of Urology, Martin-Luther-Univ. Halle-Wittenberg, Halle (Germany)); Arnold, Dirk (Univ. Cancer Center Hamburg, Hamburg (Germany))


    Background: Renal involvement in patients with lymphoproliferative disease is an uncommon radiological finding. Purpose: To determine its prevalence and radiological appearances in a patient population. Material and Methods: All forms of lymphoproliferative disease (ICD: C81-C96) were considered. From January 2005 to January 2010, 668 consecutive patients with lymphoproliferative disease were identified with the help of the radiological database and patient records. Inclusion criteria were complete staging including appropriate CT scan and/or MRI. All stored images (initial staging and follow-up examinations) were reviewed. Results: Review of all stored images revealed renal infiltration in patients with non-Hodgkin lymphoma (11 of 364 = 3.0%; median age = 65 years, m:f = 6:5) but also multiple myeloma (2 of 162 = 1.2%; median age = 72 years; m:f = 1:1) and leukemia (5 of 101 4.9%; median age = 12 years; m:f = 2:3). There were no cases of renal infiltration in 41 patients with Hodgkin's disease. In total there were six patients with solitary lesions, five patients with diffuse renal enlargement, four patients with perirenal lesions, and two patients with direct invasion of the kidney. Conclusion: In leukemia the most common imaging pattern is diffuse enlargement. In the other subtypes of lymphoproliferative disease no specific correlation between typical CT patterns and subtype of lymphoproliferative disease can be found. The prevalence of renal involvement is in line with earlier studies. Contrary to earlier reports, multiple lesions were not found to be a common pattern

  9. Role of Epigenetic Histone Modifications in Diabetic Kidney Disease Involving Renal Fibrosis

    Directory of Open Access Journals (Sweden)

    Jing Sun


    Full Text Available One of the commonest causes of end-stage renal disease is diabetic kidney disease (DKD. Renal fibrosis, characterized by the accumulation of extracellular matrix (ECM proteins in glomerular basement membranes and the tubulointerstitium, is the final manifestation of DKD. The TGF-β pathway triggers epithelial-to-mesenchymal transition (EMT, which plays a key role in the accumulation of ECM proteins in DKD. DCCT/EDIC studies have shown that DKD often persists and progresses despite glycemic control in diabetes once DKD sets in due to prior exposure to hyperglycemia called “metabolic memory.” These imply that epigenetic factors modulate kidney gene expression. There is evidence to suggest that in diabetes and hyperglycemia, epigenetic histone modifications have a significant effect in modulating renal fibrotic and ECM gene expression induced by TGF-β1, as well as its downstream profibrotic genes. Histone modifications are also implicated in renal fibrosis through its ability to regulate the EMT process triggered by TGF-β signaling. In view of this, efforts are being made to develop HAT, HDAC, and HMT inhibitors to delay, stop, or even reverse DKD. In this review, we outline the latest advances that are being made to regulate histone modifications involved in DKD.

  10. Bilateral asynchronous renal cell carcinoma with metastatic involvement of the tongue. (United States)

    Ghazali, Naseem; Davis, Charlotte; Barrett, A W; Tighe, John V


    Renal cell carcinoma (RCC) has a propensity for distant organ metastasis and late recurrence, involving not only the ipsilateral but also contralateral kidney. Lingual metastasis by RCC is rare. We present an unusual case of bilateral asynchronous RCC. Involvement of the right kidney was discovered only after a metastatic tongue lesion was diagnosed. The original RCC had been treated by left nephrectomy 14 years previously. Due to end-stage primary pulmonary malignancy, and poor function of the remaining kidney, immunotherapy was unsuitable. Palliative local resection of the lingual metastasis alleviated functional difficulties and was preventative against airway obstruction, but the patient died five months later.

  11. Involvement of central alpha1-adrenoceptors on renal responses to central moxonidine and alpha-methylnoradrenaline. (United States)

    de Andrade, Carina A F; de Andrade, Glaucia M F; De Paula, Patricia M; De Luca, Laurival A; Menani, José V


    Moxonidine (alpha2-adrenoceptor/imidazoline receptor agonist) injected into the lateral ventricle induces diuresis, natriuresis and renal vasodilation. Moxonidine-induced diuresis and natriuresis depend on central imidazoline receptors, while central alpha1-adrenoceptors are involved in renal vasodilation. However, the involvement of central alpha1-adrenoceptors on diuresis and natriuresis to central moxonidine was not investigated yet. In the present study, the effects of moxonidine, alpha-methylnoradrenaline (alpha2-adrenoceptor agonist) or phenylephrine (alpha1-adrenoceptor agonist) alone or combined with previous injections of prazosin (alpha1-adrenoceptor antagonist), yohimbine or RX 821002 (alpha2-adrenoceptor antagonists) intracerebroventricularly (i.c.v.) on urinary sodium, potassium and volume were investigated. Male Holtzman rats (n = 5-18/group) with stainless steel cannula implanted into the lateral ventricle and submitted to gastric water load (10% of body weight) were used. Injections of moxonidine (20 nmol) or alpha-methylnoradrenaline (80 nmol) i.c.v. induced natriuresis (196 +/- 25 and 171 +/- 30, respectively, vs. vehicle: 101 +/- 9 microEq/2 h) and diuresis (9.0 +/- 0.4 and 12.3 +/- 1.6, respectively, vs. vehicle: 5.2 +/- 0.5 ml/2 h). Pre-treatment with prazosin (320 nmol) i.c.v. abolished the natriuresis (23 +/- 4 and 76 +/- 11 microEq/2 h, respectively) and diuresis (5 +/- 1 and 7.6 +/- 0.8 ml/2 h, respectively) produced by i.c.v. moxonidine or alpha-methylnoradrenaline. RX 821002 (320 nmol) i.c.v. abolished the natriuretic effect of alpha-methylnoradrenaline, however, yohimbine (320 nmol) did not change renal responses to moxonidine. Phenylephrine (80 nmol) i.c.v. induced natriuresis and kaliuresis that were blocked by prazosin. Therefore, the present data suggest that moxonidine and alpha-methylnoradrenaline acting on central imidazoline receptors and alpha2-adrenoceptors, respectively, activate central alpha1-adrenergic mechanisms to

  12. Relevant Networks involving the p53 Signalling Pathway in Renal Cell Carcinoma (United States)

    Villaamil, V. Medina; Gallego, G. Aparicio; Caínzos, I. Santamarina; Ruvira, L. Valbuena; Valladares-Ayerbes, M.; Aparicio, L. M. Antón


    Introduction: Renal cell carcinoma is the most common type of kidney cancer. A better understanding of the critical pathways and interactions associated with alterations in renal function and renal tumour properties is required. Our final goal is to combine the knowledge provided by a regulatory network with experimental observations provided by the dataset. Methods: In this study, a systems biology approach was used, integrating immunohistochemistry protein expression profiles and protein interaction information with the STRING and MeV bioinformatics tools. A group consisting of 80 patients with renal cell carcinoma was studied. The expression of selected markers was assessed using tissue microarray technology on immunohistochemically stained slides. The immunohistochemical data of the molecular factors studied were analysed using a parametric statistical test, Pearson’s correlation coefficient test. Results: Bioinformatics analysis of tumour samples resulted in 2 protein networks. The first network consists of proteins involved in the angiogenesis pathway and the apoptosis suppressor, BCL2, and includes both positive and negative correlations. The second network shows a negative interaction between the p53 tumour suppressor protein and the glucose transporter type 4. Conclusion: The comprehensive pathway network will help us to realise the cooperative behaviours among pathways. Regulation of metabolic pathways is an important role of p53. The pathway involving the tumour suppressor gene p53 could regulate tumour angiogenesis. Further investigation of the proteins that interact with this pathway in this type of tumour may provide new strategies for cancer therapies to specifically inhibit the molecules that play crucial roles in tumour progression. PMID:23675247

  13. Involvement of MEK/ERK pathway in cephaloridine-induced injury in rat renal cortical slices. (United States)

    Kohda, Yuka; Hiramatsu, Jun; Gemba, Munekazu


    We have previously reported that free radical-mediated injury induced by cephaloridine (CER) is enhanced by phorbol 12-myristate 13-acetate (PMA), a protein kinase C (PKC) activator, in rat renal cortical slices. We have also shown that PKC activation in mitochondria is involved in CER-induced nephrotoxicity in rats. We investigated the role of a downstream PKC pathway, a MEK/ERK pathway, in free radical-induced injury in rat renal cortical slices exposed to CER. Immediately after preparing slices from rat renal cortex, the slices were incubated in the medium containing MEK inhibitors. ERK1/2 activation was determined by Western blot analysis for phosphorylated ERK (pERK) 1/2 protein in nucleus fraction prepared from the slices exposed to CER. Prominently, CER caused not only increases in lipid peroxidation as an index of free radical generation and in LDH leakage as that of cell injury in the slices, but also marked activation of ERK1/2 in nucleus fraction. PD98059 and U0126, MEK1/2 inhibitors, significantly attenuated CER-induced increases in lipid peroxidation and LDH leakage in the slices. PD98059 also suppressed ERK1/2 activation in nucleus fraction prepared from the slices treated with CER. Inhibition of other MAP kinase pathways, p38 MAP kinase and c-Jun N-terminal kinase (JNK) had no effect on CER-induced increases in lipid peroxidation level and LDH leakage in the slices. The present results suggest that a MEK/ERK pathway down stream of a PKC pathway is probably involved in free radical-induced injury in rat renal cortical slices exposed to CER.

  14. Renal involvement in MELAS syndrome - a series of 5 cases and review of the literature. (United States)

    Seidowsky, Alexandre; Hoffmann, Maxime; Glowacki, François; Dhaenens, Claire-Marie; Devaux, Jean-Philippe; de Sainte Foy, Celia Lessore; Provot, François; Gheerbrant, Jean-Dominique; Hummel, Aurelie; Hazzan, Marc; Dracon, Michel; Dieux-Coeslier, Anne; Copin, Marie-Christine; Noël, Christian; Buob, David


    Renal dysfunction is increasingly recognized as a potential clinical feature of mitochondrial cytopathies such as mitochondrial encephalomyopathy, lacticacidosis and stroke-like episodes (MELAS) syndrome. Five cases of MELAS syndrome with renal involvement from 4 unrelated families are presented in this case series. Three of the 5 patients had a history of maternally-inherited diabetes and/or deafness. Focal and segmental glomerulosclerosis and arteriolar hyaline thickening were the most striking findings on renal biopsy. In addition to clinical presentation with the typical symptoms of MELAS syndrome, genetic testing in these patients identified the A3243G point mutation in the tRNALeu gene of the mitochondrial DNA (mtDNA). The diagnosis of MELAS syndrome was thus considered to be unequivocal. The incidence of kidney disease in MELAS syndrome may be underestimated although a study is required to investigate this hypothesis. As the A3243G mtDNA mutation leads to a progressive adult-onset form of focal segmental glomerulosclerosis (FSGS), screening for the MELAS A3243G mtDNA mutation should therefore be performed especially in patients with maternally-inherited diabetes or hearing loss presenting with FSGS.

  15. Papillary renal cell carcinoma with metastatic laparoscopic port site and vaginal involvement: a case report

    Directory of Open Access Journals (Sweden)

    Fong Kah


    Full Text Available Abstract Introduction Laparoscopic port-site metastasis is a rare but well recognized outcome following surgery in urological cancers, with its etiology not clearly understood. Additionally, vaginal metastasis in clear cell renal cell carcinoma is rare, and has not been previously reported in the setting of papillary renal cell carcinoma. Case presentation We present the case of a 71-year-old Chinese woman with metastatic type II papillary renal cell carcinoma with histologically verified vaginal involvement and a concurrent laparoscopic port-site metastasis. This was also associated with a unique constellation of widely disseminated metastatic sites, which include a local relapse, the peritoneum and the urethra. Conclusion Laparoscopic port-site metastases are associated with the presence of advanced cancer with multiple sites of metastasis. We hypothesize from the findings of our report and background data that this phenomenon is more likely to be related to tumor factors rather than operative factors. We also present what is, to the best of our knowledge, the first reported case in the literature of vaginal and urethral metastasis and the second reported case of laparoscopic port-site recurrence.

  16. Molecular clock is involved in predictive circadian adjustment of renal function. (United States)

    Zuber, Annie Mercier; Centeno, Gabriel; Pradervand, Sylvain; Nikolaeva, Svetlana; Maquelin, Lionel; Cardinaux, Léonard; Bonny, Olivier; Firsov, Dmitri


    Renal excretion of water and major electrolytes exhibits a significant circadian rhythm. This functional periodicity is believed to result, at least in part, from circadian changes in secretion/reabsorption capacities of the distal nephron and collecting ducts. Here, we studied the molecular mechanisms underlying circadian rhythms in the distal nephron segments, i.e., distal convoluted tubule (DCT) and connecting tubule (CNT) and the cortical collecting duct (CCD). Temporal expression analysis performed on microdissected mouse DCT/CNT or CCD revealed a marked circadian rhythmicity in the expression of a large number of genes crucially involved in various homeostatic functions of the kidney. This analysis also revealed that both DCT/CNT and CCD possess an intrinsic circadian timing system characterized by robust oscillations in the expression of circadian core clock genes (clock, bma11, npas2, per, cry, nr1d1) and clock-controlled Par bZip transcriptional factors dbp, hlf, and tef. The clock knockout mice or mice devoid of dbp/hlf/tef (triple knockout) exhibit significant changes in renal expression of several key regulators of water or sodium balance (vasopressin V2 receptor, aquaporin-2, aquaporin-4, alphaENaC). Functionally, the loss of clock leads to a complex phenotype characterized by partial diabetes insipidus, dysregulation of sodium excretion rhythms, and a significant decrease in blood pressure. Collectively, this study uncovers a major role of molecular clock in renal function.

  17. Megalin and cubilin are endocytic receptors involved in renal clearance of hemoglobin. (United States)

    Gburek, Jakub; Verroust, Pierre J; Willnow, Thomas E; Fyfe, John C; Nowacki, Wojciech; Jacobsen, Christian; Moestrup, Søren K; Christensen, Erik I


    The kidney is the main site of hemoglobin clearance and degradation in conditions of severe hemolysis. Herein it is reported that megalin and cubilin, two epithelial endocytic receptors, mediate the uptake of hemoglobin in renal proximal tubules. Both receptors were purified by use of hemoglobin-Sepharose affinity chromatography of solubilized renal brush-border membranes. Apparent dissociation constants of 1.7 microM for megalin and 4.1 microM for cubilin were determined by surface plasmon resonance analysis. The binding was calcium dependent in both cases. Uptake of fluorescence-labeled hemoglobin by BN-16 cells was inhibited by anti-megalin and anti-cubilin antibodies as well as by receptor-associated protein, a chaperone for LDL-receptor family proteins. Partial inhibition by myoglobin was observed, whereas bovine serum albumin, intrinsic factor-cobalamin complexes, and beta2-microglobulin did not affect the uptake. By use of immunohistochemistry, it was demonstrated that uptake of hemoglobin in proximal tubules of rat, mouse, and dog kidneys occurs under physiologic conditions. Studies on normal and megalin knockout mouse kidney sections showed that megalin is responsible for physiologic clearance of hemoglobin. Labeling intensities in kidneys from normal and cubilin-malexpressing dogs were similar, which suggests that, in the normal state, the role of cubilin in uptake of hemoglobin is rather limited. However, cubilin is likely to assist hemoglobin endocytosis in settings of hemoglobinuria. In conclusion, the study provides a molecular explanation for long-standing observations of hemoglobin uptake in renal proximal tubules that involve the endocytic receptors megalin and cubilin. The findings may prove to be essential for further research on the pathophysiology of hemoglobinuric acute renal failure and proteinuria-associated tubulointerstitial nephritis.

  18. Renal carbonic anhydrases are involved in the reabsorption of endogenous nitrite. (United States)

    Chobanyan-Jürgens, Kristine; Schwarz, Alexandra; Böhmer, Anke; Beckmann, Bibiana; Gutzki, Frank-Mathias; Michaelsen, Jan T; Stichtenoth, Dirk O; Tsikas, Dimitrios


    Nitrite (ONO(-)) exerts nitric oxide (NO)-related biological actions and its concentration in the circulation may be of particular importance. Nitrite is excreted in the urine. Hence, the kidney may play an important role in nitrite/NO homeostasis in the vasculature. We investigated a possible involvement of renal carbonic anhydrases (CAs) in endogenous nitrite reabsorption in the proximal tubule. The potent CA inhibitor acetazolamide was administered orally to six healthy volunteers (5 mg/kg) and nitrite was measured in spot urine samples before and after administration. Acetazolamide increased abruptly nitrite excretion in the urine, strongly suggesting that renal CAs are involved in nitrite reabsorption in healthy humans. Additional in vitro experiments support our hypothesis that nitrite reacts with CO(2), analogous to the reaction of peroxynitrite (ONOO(-)) with CO(2), to form acid-labile nitrito carbonate [ONOC(O)O(-)]. We assume that this reaction is catalyzed by CAs and that nitrito carbonate represents the nitrite form that is actively transported into the kidney. The significance of nitrite reabsorption in the kidney and the underlying mechanisms, notably a direct involvement of CAs in the reaction between nitrite and CO(2), remain to be elucidated.

  19. Successful treatment of malaria tropica with acute renal failure and cerebral involvement by plasmapheresis and hemodialysis. (United States)

    Stuby, U; Kaiser, W; Biesenbach, G; Zazgornik, J


    A non-immune, 31-year-old woman developed an acute infection with Plasmodium falciparum after travelling to Kenia. The parasites proved resistant to chloroquine and sulfadoxine/pyrimethamine. The course of the disease was complicated by acute renal failure, hepatocellular damage, disorders of blood coagulation, thrombocytopenia, hemolysis and cerebral involvement. Despite a very high level of parasitemia (50% parasitized erythrocytes) a rapid clinical improvement was achieved by plasmapheresis and hemodialysis. Our experience shows that plasmapheresis and hemodialysis are excellent additive methods which rapidly improve clinical symptoms and may reduce morbidity and mortality in severe malaria tropica.

  20. Immunopathologic effects of scorpion venom on hepato-renal tissues: Involvement of lipid derived inflammatory mediators. (United States)

    Lamraoui, Amal; Adi-Bessalem, Sonia; Laraba-Djebari, Fatima


    Scorpion venoms are known to cause different inflammatory disorders through complex mechanisms in various tissues. In the study here, the involvement of phospholipase A2 (PLA2) and cyclo-oxygenase (COX)-derived metabolites in hepatic and renal inflammation responses were examined. Mice were envenomed with Androctonus australis hector scorpion venom in the absence or presence of inhibitors that can interfere with lipid inflammatory mediator synthesis, i.e., dexamethasone (PLA2 inhibitor), indomethacin (non-selective COX-1/COX-2 inhibitor), or celecoxib (selective COX-2 inhibitor). The inflammatory response was assessed by evaluating vascular permeability changes, inflammatory cell infiltration, oxidative/nitrosative stress marker levels, and by histologic and functional analyses of the liver and kidney. Results revealed that the venom alone induced an inflammatory response in this tissues marked by increased microvascular permeability and inflammatory cell infiltration, increases in levels of nitric oxide and lipid peroxidation, and decreases in antioxidant defense. Moreover, significant alterations in the histological architecture of these organs were associated with increased serum levels of some metabolic enzymes, as well as urea and uric acid. Pre-treatment of mice with dexamethasone led to significant decreases of the inflammatory disorders in the hepatic parenchyma; celecoxib pre-treatment seemed to be more effective against renal inflammation. Indomethacin pre-treatment only slightly reduced the inflammatory disorders in the tissues. These results suggest that the induced inflammation response in liver was mediated mainly by PLA2 activation, while the renal inflammatory process was mediated by prostaglandin formation by COX-2. These findings provide additional insight toward the understanding of activated pathways and related mechanisms involved in scorpion envenoming syndrome.

  1. The Correlation Between the GFR and the Renal Dimensions in Glomerulopathy Patients: Comparison of 2D and 3D Ultrasound

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Gyoung Min [Seoul National University Hospital, Seoul (Korea, Republic of); Lee, Hak Jong; Hwang, Sung Il; Chin, Ho Jun [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)


    We wanted to determine the correlation between the renal length as measured on two dimensional (2D) ultrasonography (US) and the renal parenchymal volume as measured with a new three-dimensional (3D) volume probe ultrasound system. We also wanted to determine the correlation between the renal length or renal parenchymal volume and the glomerular filtration rate (GFR) in patients with glomerulopathy. From July 2007 to December 2007, 26 patients who were pathologically confirmed to have glomerulopathy by biopsy were enrolled. Renal length was measured with 2D US and the renal parenchymal volume was measured with 3D US just prior to biopsy. The GFR was obtained from the electronic medical records. Pearson's correlation coefficients were used to analyze the correlation between the renal length and the renal parenchymal volume, the correlation between the renal length and the GFR and the correlation between the renal parenchymal volume and the GFR. The renal length and the renal parenchymal volume showed strong positive correlation (r = 0.850, p = 0.0001). The correlation coefficient between the renal length and the GFR was 0.623 (p = 0.0007) and the correlation coefficient between the renal volume and the GFR was 0.590 (p = 0.0015). Both the renal length and renal parenchymal volume showed apparently positive correlations with the GFR in glomerulopathy patients. The renal length showed strong positive correlations with the renal parenchymal volume. Both the renal length and the renal parenchymal volume showed apparently positive correlations with the GFR in glomerulopathy patients. In glomerulopathy patients, the renal dimensions measured by ultrasound can reflect the status of the GFR, and the measurement of the 2D renal length could be sufficient for follow up. Further studies are needed to evaluate the role of 3D US for assessing patients with renal disease

  2. Value of comprehensive renal ultrasound in children with acute urinary tract infection for assessment of renal involvement: comparison with DMSA scintigraphy and final diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Brader, Peter; Riccabona, Michael [Medical University Graz, Division of Pediatric Radiology, Department of Radiology, Graz (Austria); Schwarz, Thomas [Medical University Graz, Division of Nuclear Medicine, Department of Radiology, Graz (Austria); Seebacher, Ursula [Medical University Graz, Department of Pediatric Surgery, Graz (Austria); Ring, Ekkehard [Medical University Graz, Department of Pediatrics, Graz (Austria)


    The aim of this study was to evaluate the value of comprehensive renal ultrasound (US), i.e., combining greyscale US and amplitude-coded color Doppler sonography (aCDS), for assessment of urinary tract infection (UTI) in infants and children, compared to (1) {sup 99m}Tc DMSA scintigraphy and (2) final diagnosis. Two hundred eighty-seven children with UTI underwent renal comprehensive US and DMSA scintigraphy. The results were compared with regard to their reliability to diagnose renal involvement, using (1) DMSA scintigraphy and (2) final diagnosis as the gold standard. Sixty-seven children clinically had renal involvement. Sensitivity increased from 84.1% using only aCDS to 92.1% for the combined US approach, using DMSA scintigraphy as the reference standard. When correlated with the final diagnosis, sensitivity for DMSA scintigraphy was 92.5%; sensitivity for comprehensive US was 94.0%. Our data demonstrate an increasing sensitivity using the combination of renal greyscale US supplemented by aCDS for differentiation of upper from lower UTI. Sensitivity for DMSA and comprehensive US was similar for both methods compared to the final diagnosis. Comprehensive US should gain a more important role in the imaging algorithm of children with acute UTI, thereby reducing the radiation burden. (orig.)

  3. Pediatric renal leukemia: spectrum of CT imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Hilmes, Melissa A. [University of Michigan Health System, C.S. Mott Children' s Hospital, Section of Pediatric Radiology, Ann Arbor, MI (United States); Vanderbilt University Children' s Hospital, Section of Pediatric Radiology, Nashville, TN (United States); Dillman, Jonathan R. [University of Michigan Health System, C.S. Mott Children' s Hospital, Section of Pediatric Radiology, Ann Arbor, MI (United States); University of Michigan Health System, Department of Radiology, Ann Arbor, MI (United States); Mody, Rajen J. [University of Michigan Health System, C.S. Mott Children' s Hospital, Division of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ann Arbor, MI (United States); Strouse, Peter J. [University of Michigan Health System, C.S. Mott Children' s Hospital, Section of Pediatric Radiology, Ann Arbor, MI (United States)


    The kidneys are a site of extramedullary leukemic disease that can be readily detected by CT. To demonstrate the spectrum of CT findings in children with renal leukemic involvement. Twelve children were identified retrospectively as having renal leukemic involvement by contrast-enhanced CT of the abdomen. Contrast-enhanced CT images through the kidneys of each patient were reviewed by two pediatric radiologists. Pertinent imaging findings and renal lengths were documented. The electronic medical record was accessed to obtain relevant clinical and pathologic information. Five patients with renal leukemic involvement presented with multiple bilateral low-attenuation masses, while three patients demonstrated large areas of wedge-shaped and geographic low attenuation. Four other patients presented with unique imaging findings, including a solitary unilateral low-attenuation mass, solitary bilateral low-attenuation masses, multiple bilateral low-attenuation masses including unilateral large conglomerate masses, and bilateral areas of ill-defined parenchymal low attenuation. Two patients showed unilateral nephromegaly, while eight other patients showed bilateral nephromegaly. Two patients had normal size kidneys. Two patients had elevated serum creatinine concentrations at the time of imaging. Renal leukemic involvement in children can present with a variety of CT imaging findings. Focal renal abnormalities as well as nephromegaly are frequently observed. Most commonly, renal leukemic involvement does not appear to impair renal function. (orig.)

  4. Downregulation of the tumor suppressor HSPB7, involved in the p53 pathway, in renal cell carcinoma by hypermethylation



    In order to identify genes involved in renal carcinogenesis, we analyzed the expression profile of renal cell carcinomas (RCCs) using microarrays consisting of 27,648 cDNA or ESTs, and found a small heat shock protein, HSPB7, to be significantly and commonly downregulated in RCC. Subsequent quantitative PCR (qPCR) and immunohistochemical (IHC) analyses confirmed the downregulation of HSPB7 in RCC tissues and cancer cell lines in both transcriptional and protein levels. Bisulfite sequencing of...

  5. Gastrointestinal involvement of recurrent renal cell carcinoma: CT findings and clinicpathologic features

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hyo Jung; Kim, Hyun Jin; Park, Seung Ho; Lee, Jong Seok; Kim, Ah Young [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Ha, Hyun Kwon [Dept. of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung (Korea, Republic of)


    To retrospectively evaluate the CT findings and clinicopathologic features in patients with gastrointestinal (GI) involvement of recurrent renal cell carcinoma (RCC). The medical records were reviewed for 15 patients with 19 pathologically proven GI tract metastases of RCC. The CT findings were analyzed to determine the involved sites and type of involvement; lesion size, morphology, and contrast enhancement pattern; and occurrence of lymphadenopathy, ascites and other complications. The most common presentation was GI bleeding (66.7%). The average interval between nephrectomy and the detection of GI involvement was 30.4 ± 37.4 months. GI lesions were most commonly found in the ileum (36.8%) and duodenum (31.6%). A distant metastasis (80%) was more common than a direct invasion from metastatic lesions. The mean lesion size was 34.1 ± 15.0 mm. Intraluminal polypoid masses (63.2%) with hyperenhancement (78.9%) and heterogeneous enhancement (63.2%) were the most common findings. No patients had regional lymphadenopathy. Complications occurred in four patients, with one each of bowel obstruction, intussusception, bile duct dilatation, and pancreatic duct dilatation. GI involvement of recurrent RCC could be included in the differential diagnosis of patients with heterogeneous, hyperenhanced intraluminal polypoid masses in the small bowel on CT scans along with a relative paucity of lymphadenopathy.

  6. The potential role of regucalcin in kidney cell regulation: Involvement in renal failure (Review). (United States)

    Yamaguchi, Masayoshi


    The kidneys play a physiologic role in the regulation of urine formation and nutrient reabsorption in the proximal tubule epithelial cells. Kidney development has been shown to be regulated through calcium (Ca2+) signaling processes that are present through numerous steps of tubulogenesis and nephron induction during embryonic development of the kidneys. Ca2+-binding proteins, such as calbindin-D28k and regucalcin are important proteins that are commonly used as biomarkers in pronephric tubules, and the ureteric bud and metanephric mesenchyme. Previous research on regucalcin focused on Ca2+ sensors that are involved in renal organogenesis and the link between Ca2+-dependent signals and polycystins. Moreover, regucalcin has been highlighted to play a multifunctional role in kidney cell regulation. The regucalcin gene, which is localized on the X chromosome, is regulated through various transcription factors. Regucalcin has been found to regulate intracellular Ca2+ homeostasis in kidney proximal tubule epithelial cells. Regucalcin has been demonstrated to regulate the activity of various enzymes that are involved in intracellular signaling pathways. It has been noted that regucalcin suppresses DNA synthesis and regulates the gene expression of various proteins related to mineral transport, transcription factors, cell proliferation and apoptosis. The overexpression of regucalcin has been shown to exert suppressive effects on cell proliferation and apoptotic cell death, which are stimulated by various stimulatory factors. Moreover, regucalcin gene expression was found to to be involved in various pathophysiological states, including renal failure. This review discusses recent findings concerning the potential role of regucalcin as a regulatory protein in the kidney proximal tubule epithelial cells.

  7. Detection of parenchymal abnormalities in experimentally induced acute pyelonephritis in rabbits using contrast-enhanced ultrasonography, CT, and MRI

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    Ryu, Jeong Ah; Kim, Bo Hyun; Kim, Seung Kwon; Seo, Jin Won [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Jong Sung [Laboratory Animal Research Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)


    We evaluated the efficacy of contrast-enhanced ultrasonography (CEUS) in detecting acute pyelonephritis (APN) using the rabbit kidney model and compared it with CT and MRI. This study was approved by the Institutional Review Board. In a total of 20 New Zealand White rabbits, APN was induced experimentally. CEUS, CT, and MRI were performed on the first, third, and seventh postoperative days. After imaging studies, the subjects were sacrificed and the pathological diagnosis of APN was confirmed in each animal by a pathologist. Imaging studies were obtained in eight animals, including eight CEUS, four computed tomography (CT), and four magnetic resonance imaging (MRI) images. CEUS depicted diffuse renal enlargement (7), diffuse heterogeneous parenchymal enhancement (6), and focal areas of decreased parenchymal enhancement (6). These findings were well correlated with the CT and MRI findings in five cases in which these studies were available. CT and MRI showed diffuse renal enlargement, diffuse heterogeneous parenchymal enhancement, focal areas of decreased parenchymal enhancement, focal contour bulging, and the finding of perinephric spread of infection. In a rabbit model, CEUS could depict the parenchymal lesions of APN similar to CT or MRI; however, it was limited in depicting the perinephric extension of inflammation.

  8. Biopsy-proven renal involvement and prognosis in 13 hispanic patients with primary Sjögren syndrome. (United States)

    Carrillo-Pérez, Diego Luis; Tejeda-Maldonado, Javier; Garza-García, Carlos; Soto-Abraham, Virgilia; Hernández-Molina, Gabriela; Molina-Paredes, Giovanni Arnoldo; Uribe-Uribe, Norma O; Morales-Buenrostro, Luis E


    The aim of this study was to describe a case series of 13 Hispanic patients with primary Sjögren syndrome (pSS) and biopsy-proven renal involvement. We describe the clinical, serological and histological characteristics as well as the prognosis in a group of patients with pSS and biopsy-proven renal involvement, treated in 2 referral nephrology units in Mexico City. Thirteen patients with pSS underwent kidney biopsy (KB) over a period of 27 years. The median duration from pSS diagnosis to KB was 13.9 months. Seven patients (54%) had glomerulonephritis and 6 patients (46%) had tubulointerstitial nephritis. All patients were treated with corticosteroids and/or immunosuppressants. Eight patients (62%) remained stable or their renal function improved after a median follow-up of 12 months. This case series reflects the broad spectrum of renal involvement in pSS. We observed that in our Hispanic population, glomerular involvement was the most frequent abnormality, mainly membranous glomerulopathy, followed by tubulointerstitial disease. Tubular atrophy and interstitial fibrosis were also common biopsy findings. Treatment with corticosteroids or other immunosuppressive agents appear to slow renal disease progression. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  9. Idiopathic retroperitoneal fibrosis involving a unilateral renal sinus: A case report and literature review

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    Lee, Seul Bi; Yoon, Jung Hee; Kim, Seung Ho; Lee, Ye Daum; Kim, Suk Jung; Lim, Yun Jung; Jung, Hyun Kyung; Lee, Jin Soo [Dept. of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)


    Idiopathic retroperitoneal fibrosis (RPF) is a rare disease entity and its etiology is uncertain. We report two similar cases which showed an uncommon presentation of idiopathic RPF. A 66-year-old woman and an 80-year-old man presented with incidental findings of left renal pelvic mass-like lesions. Computed tomography revealed a soft tissue density mass replacing the left renal pelvis, which was suspicious for renal pelvic cancer, and the diagnosis of idiopathic RPF was surgically confirmed. To the best of our knowledge, a few cases of idiopathic RPF presenting with features of a localized unilateral renal pelvic mass mimicking renal pelvic cancer have been reported.

  10. MR findings of degenerating parenchymal neurocysticercosis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yul; Chung, Eun A; Yang, Ik; Park, Hae Jung; Chung, Soo Young [Hallym Univ. Kangnam Sungshim Hospital, Seoul (Korea, Republic of)


    To evaluate MR imaging findings of degenerating parenchymal neurocysticercosis and to determine the characteristics which distinguish it from other brain diseases. MR imagings of 19 patients (56 lesions) of degenerating parenchymal neurocysticercosis were retrospectively evaluated, focusing on the size and location of lesions signal intensity patterns of cyst fluid and wall, the extent of the surrounding edema and features of contrast enhancement. Degenerating parenchymal neurocysticercosis was located in gray or subcortical while matter in 89.3% of 56 lesions (50/56) ; most of these (98.2%) were smaller than 2 cm in diameter. Cyst fluid signal was hyperintense relative to CSF on T1 and proton density weighted images (92.9%). A hypointense signal rim of the cyst wall was noted in the lesions on proton density (92.9%) and T2 weighted (98.2%) images, Surrounding edema was mostly mild. Peripheral rim enhancement was noted in all lesions, and this was frequently irregular and lobulated (67.9%) with a focal defect in the enhancing rim(41.1%). Findings which could be helpful in distinguishing degenerating parencymal neurocysticercosis from other brain diseases are as follows : small, superficial lesions ; hyperintense signal of the cyst fluid on T1 and proton density weighted images ; hypointense signal of the cyst wall on proton density and T2 weighted images ; relatively mild extent of surrounding edema, and peripheral rim enhancement which is frequently irregular and lobulated with a focal defect in the enhancing rim.

  11. Ultrasonography in chronic renal failure

    Energy Technology Data Exchange (ETDEWEB)

    Buturovic-Ponikvar, Jadranka E-mail:; Visnar-Perovic, Alenka


    Many chronic renal diseases lead to the final common state of decrease in renal size, parenchymal atrophy, sclerosis and fibrosis. The ultrasound image show a smaller kidney, thinning of the parenchyma and its hyperechogenicity (reflecting sclerosis and fibrosis). The frequency of renal cysts increases with the progression of the disease. Ultrasound generally does not allow for the exact diagnosis of an underlying chronic disease (renal biopsy is usually required), but it can help to determine an irreversible disease, assess prognosis and avoid unnecessary diagnostic or therapeutic procedures. The main exception in which the ultrasound image does not show a smaller kidney with parenchymal atrophy is diabetic nephropathy, the leading cause of chronic and end-stage renal failure in developed countries in recent years. In this case, both renal size and parenchymal thickness are preserved until end-stage renal failure. Doppler study of intrarenal vessels can provide additional information about microvascular and parenchymal lesions, which is helpful in deciding for or against therapeutic intervention and timely planning for optimal renal replacement therapy option.

  12. Renal involvement in type 1 (IDDM) diabetes in Spain. ESTUDIO DIAMANTE. (United States)


    Diabetic nephropathy (DN) is a major complication of diabetes with a significant repercussion in health care with few epidemiological data available in Spain. The aim of this multicenter cross-sectional study was to establish the prevalence of renal involvement in a large group of patients with type 1 (insulin-dependent) diabetes and evaluate several risk factors related to its development. One thousand eight hundred twenty-two patients (921 males, mean age: 30.5 +/- 9.7 years, diabetes duration 14.1 +/- 9.2 years) from the Endocrinology Units of 18 Spanish hospitals were included in this study. Urinary albumin excretion (UAE), plasma creatinine, lipid profile, HbA1c, and family history of hypertension and nephropathy, smoking, arterial blood pressure and BMI were evaluated. The prevalence of microalbuminuria, established nephropathy (patients with macroalbuminuria and those with renal failure) and hypertension was 14.1, 8.5 and 11.3%, respectively. On logistic regression analysis, using the presence or absence of established nephropathy as variable, smoking (P = 0.0005), years of diabetes evolution (P < 0.00005), diastolic blood pressure (P < 0.00005), HbA1c (P < 0.00005) and triglycerides (P = 0.0008) were included in the model. When analyzing patients with microalbuminuria vs those with normoalbuminuria the variables included were smoking (P = 0.005), diastolic blood pressure (P = 0.0026), years of diabetes evolution (P < 0.00005) and HbA1c (P < 0.00005). prevalence of diabetic nephropathy DN in type 1 (insulin-dependent) diabetes in Spain is similar to that observed ther European countries. The association between diabetic nephropathy DN and hypertension, lipid disorders and metabolic control is confirmed and smoking appears to be an additional risk factor to be considered in diabetic care.

  13. Fibroadenomatosis involving bilateral breasts and axillary accessory breast tissues in a renal transplant recipient given cyclosporin A. (United States)

    Bulakci, Mesut; Gocmez, Ahmet; Demir, Ali Aslan; Salmaslioglu, Artur; Tukenmez, Mustafa; Yavuz, Ekrem; Acunas, Gulden


    We present the mammographic and sonographic findings in a case of fibroadenomatosis involving both breasts and axillae in a renal transplant patient after 16 years of treatment with cyclosporin A. Awareness of the fact that cyclosporin A may induce the formation of fibroadenomas, including in accessory breast tissue, is important for correct diagnosis and preventing unnecessary intervention. © 2014 Wiley Periodicals, Inc.

  14. Prognosis of microscopic polyangiitis with renal involvement: report of 60 Chinese patients

    Institute of Scientific and Technical Information of China (English)

    HU Wei-xin; LIU Zhi-hong; LIU Chun-bei; TANG Zheng; WANG Qing-wen; CHEN Hui-ping; LI Lei-shi


    @@ With the widespread clinical application of renal biopsy and serum antineutrophil cytoplasmic antibody (ANCA) testing, the percentage of renal injuries caused by systemic small vessel vasculitis (SVV) including microscopic polyangiitis (MPA)and Wegener's granulomatosis (WG) is on the rise in China.

  15. Induction of Apoptosis by Luteolin Involving Akt Inactivation in Human 786-O Renal Cell Carcinoma Cells

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    Yen-Chuan Ou


    Full Text Available There is a growing interest in the health-promoting effects of natural substances obtained from plants. Although luteolin has been identified as a potential therapeutic and preventive agent for cancer because of its potent cancer cell-killing activity, the molecular mechanisms have not been well elucidated. This study provides evidence of an alternative target for luteolin and sheds light on the mechanism of its physiological benefits. Treatment of 786-O renal cell carcinoma (RCC cells (as well as A498 and ACHN with luteolin caused cell apoptosis and death. This cytotoxicity was caused by the downregulation of Akt and resultant upregulation of apoptosis signal-regulating kinase-1 (Ask1, p38, and c-Jun N-terminal kinase (JNK activities, probably via protein phosphatase 2A (PP2A activation. In addition to being a concurrent substrate of caspases and event of cell death, heat shock protein-90 (HSP90 cleavage might also play a role in driving further cellular alterations and cell death, at least in part, involving an Akt-related mechanism. Due to the high expression of HSP90 and Akt-related molecules in RCC and other cancer cells, our findings suggest that PP2A activation might work in concert with HSP90 cleavage to inactivate Akt and lead to a vicious caspase-dependent apoptotic cycle in luteolin-treated 786-O cells.

  16. Involvement of caspase-12-dependent apoptotic pathway in ionic radiocontrast urografin-induced renal tubular cell injury

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Cheng Tien [Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan (China); Weng, Te I. [Department of Forensic Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (China); Chen, Li Ping [Department of Dentistry, Chang Gang Memorial Hospital, Chang Gang University, Taoyuan, Taiwan (China); Chiang, Chih Kang [Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (China); Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (China); Liu, Shing Hwa, E-mail: [Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan (China); Department of Urology, National Taiwan University Hospital, Taipei, Taiwan (China)


    Contrast medium (CM) induces a direct toxic effect on renal tubular cells. This toxic effect subjects in the disorder of CM-induced nephropathy. Our previous work has demonstrated that CM shows to activate the endoplasmic reticulum (ER)-related adaptive unfolding protein response (UPR) activators. Glucose-regulated protein 78 (GRP78)/eukaryotic initiation factor 2α (eIF2α)-related pathways play a protective role during the urografin (an ionic CM)-induced renal tubular injury. However, the involvement of ER stress-related apoptotic signals in the urografin-induced renal tubular cell injury remains unclear. Here, we examined by the in vivo and in vitro experiments to explore whether ER stress-regulated pro-apoptotic activators participate in urografin-induced renal injury. Urografin induced renal tubular dilation, tubular cells detachment, and necrosis in the kidneys of rats. The tubular apoptosis, ER stress-related pro-apoptotic transcriptional factors, and kidney injury marker-1 (kim-1) were also conspicuously up-regulated in urografin-treated rats. Furthermore, treatment of normal rat kidney (NRK)-52E tubular cells with urografin augmented the expressions of activating transcription factor-6 (ATF-6), C/EBP homologous protein (CHOP), Bax, caspase-12, JNK, and inositol-requiring enzyme (IRE) 1 signals. Urografin-induced renal tubular cell apoptosis was not reversed by the inhibitors of ATF-6, JNK signals or CHOP siRNA transfection, but it could be partially reversed by the inhibitor of caspase-12. Taken together, the present results and our previous findings suggest that exposure of CM/urografin activates the ER stress-regulated survival- and apoptosis-related signaling pathways in renal tubular cells. Caspase-12-dependent apoptotic pathway may be partially involved in the urografin-induced nephropathy. -- Highlights: ► Ionic contrast medium-urografin induces renal tubular cell apoptosis. ► Urografin induces the ER stress-regulated survival and apoptosis

  17. Angiotensin-Converting Enzyme Inhibitor (ACEI-Mediated Amelioration in Renal Fibrosis Involves Suppression of Mast Cell Degranulation

    Directory of Open Access Journals (Sweden)

    Nan Sun


    Full Text Available Background/Aims: The mechanism by which angiotensin-converting enzyme inhibitors (ACEIs attenuate renal fibrosis has not been fully uncovered. Methods: Renal fibrosis in rats was triggered by unilateral ureteral obstruction (UUO and treated with Enalapril. Results: Enalapril attenuated renal fibrosis, as evidenced by the fibrosis scores (1.07±0.73 versus 2.18±0.75 for 200 mg/ml Enalapril versus control, pwsh/wsh mice developing renal fibrosis. We detected lower levels of transforming growth factor β (TGF-β and alpha-smooth muscle actin (α-SMA, a fibroblast activation marker in the kidney tissue of Enalapril-treated UUO rats relative to the control UUO rats. Enalapril-treated UUO rats exhibited far fewer mast cells infiltrating per area in the kidney tissue than the control UUO rats (8.00±0.65 versus 29.00±0.57, pin vivo. Conclusion: Enalapril attenuated renal fibrosis in UUO rats, possibly by a mechanism involving the suppression of mast cell degranulation.

  18. Automated classification of parenchymal patterns in mammograms

    Energy Technology Data Exchange (ETDEWEB)

    Karssemeijer, N. [University Hospital Nijmegen, Department of Radiology, PO Box 9101, 6500 HB Nijmegen (Netherlands)


    A method for automated determination of parenchymal patterns in mammograms has been developed that is insensitive to changes in the mammographic imaging technique. The method was designed to study the relation between breast cancer risk and changes of mammographic density. It includes a new method for automatic segmentation of the pectoral muscle in oblique mammograms, based on application of the Hough transform. The technique developed for classification of parenchymal patterns is based on a distance transform that subdivides the breast tissue area into regions in which distance to the skin line is approximately equal. Features are calculated from grey level histograms computed in these regions. In this way, dependency on varying tissue thickness in the peripheral zone of the breast is minimized. Additional features represent differences between tissue projected in pectoral and breast area. Robustness and classification performance were studied on a test set of 615 digitized mammograms, applying a kNN classifier and leave-one-out for training. Using four density categories in 67% of the cases an exact agreement was obtained with a subjective classification made by a radiologist. The number of cases for which classifications of the radiologist and the program differed by more that one category was only 2%. For more recent mammograms, recorded after 1991, an exact agreement of 80% was obtained. (author)

  19. Involvement of activation of NADPH oxidase and extracellular signal-regulated kinase (ERK) in renal cell injury induced by zinc. (United States)

    Matsunaga, Yoshiko; Kawai, Yoshiko; Kohda, Yuka; Gemba, Munekazu


    Zinc is employed as a supplement; however, zinc-related nephropathy is not generally known. In this study, we investigated zinc-induced renal cell injury using a pig kidney-derived cultured renal epithelial cell line, LLC-PK(1), with proximal kidney tubule-like features, and examined the involvement of free radicals and extracellular signal-regulated kinase (ERK) in the cell injury. The LLC-PK(1) cells showed early uptake of zinc (30 microM), and the release of lactate dehydrogenase (LDH), an index of cell injury, was observed 24 hr after uptake. Three hours after zinc exposure, generation of reactive oxygen species (ROS) was increased. An antioxidant, N, N'-diphenyl-p-phenylenediamine (DPPD), inhibited a zinc-related increase in ROS generation and zinc-induced renal cell injury. An NADPH oxidase inhibitor, diphenyleneiodonium (DPI), inhibited a zinc-related increase in ROS generation and cell injury. We investigated translocation from the cytosol fraction of the p67(phox) subunit, which is involved in the activation of NADPH oxidase, to the membrane fraction, and translocation was induced 3 hr after zinc exposure. We examined the involvement of ERK1/2 in the deterioration of zinc-induced renal cell injury, and the association between ERK1/2 and an increase in ROS generation. Six hours after zinc exposure, the activation (phosphorylation) of ERK1/2 was observed. An antioxidant, DPPD, inhibited the zinc-related activation of ERK1/2. An MAPK/ERK kinase (MEK1/2) inhibitor, U0126, almost completely inhibited zinc-related cell injury (the release of LDH), but did not influence ROS generation. These results suggest that early intracellular uptake of zinc by LLC-PK(1) cells causes the activation of NADPH oxidase, and that ROS generation by the activation of the enzyme leads to the deterioration of renal cell injury via the activation of ERK1/2.

  20. Erdheim Chester disease with appendicular skeletal, renal and pleural involvement responding to Zelboraf (BRAF inhibitor) treatment: case report

    Energy Technology Data Exchange (ETDEWEB)

    Borys, Dariusz [Loyola University Medical Center Chicago, Department of Pathology, Maywood, IL (United States); Loyola University Medical Center Chicago, Departmet of Orthopaedic Surgery, Maywood, IL (United States); Loyola University Medical Center, Maywood, IL (United States); Nystrom, Lucas [Loyola University Medical Center Chicago, Departmet of Orthopaedic Surgery, Maywood, IL (United States); Song, Albert [Loyola University Medical Center Chicago, Department of Radiology, Maywood, IL (United States); Lomasney, Laurie M. [Loyola University Medical Center Chicago, Departmet of Orthopaedic Surgery, Maywood, IL (United States); Loyola University Medical Center Chicago, Department of Radiology, Maywood, IL (United States)


    Erdheim Chester disease is a rare non-Langerhans cell histiocytosis which may involve multiple organs including bone, soft tissue, lungs, cardiovascular system, kidneys (retroperitoneum), skin, and central nervous system. Bone involvement is most common followed by other organs. This case report describes a 58-year-old man who presented with progressive renal dysfunction presumed due to obstruction. The patient failed multiple urinary tract interventions, and clinical course was complicated by recurrent low-grade fevers, and bilateral knee pain. Advanced imaging and histopathological features on bone biopsy were consistent with Erdheim Chester disease. Molecular studies of tissue showed BRAF V600 mutation. This patient was treated with Zelboraf (vemurafenib) BRAF inhibitor with subsequent improvement in renal and pleural dysfunction as well as decreased histiocytic soft tissue masses on CT. (orig.)

  1. Imaging features of gray-scale and contrast-enhanced color doppler US for the differentiation of transient renal arterial ischemia and arterial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Park, Byung Kwan; Kim Seung Hyup [Seoul National University Hospital, Seoul (Korea, Republic of); Moon, Min Hwan; Jung, Sung Il [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)


    To characterize the imaging features on gray-scale and contrast-enhanced color Doppler US images which differentiate renal ischemia from renal infarction. The segmental renal arteries of eight healthy rabbits were surgically ligated. In four of these rabbits, the ligated renal artery was released 60 minutes after arterial occlusion to cause transient ischemia. In the remaining four rabbits, the arterial ligation was retained to cause a permanent infarction. The gray-scale and contrast-enhanced color Doppler US imaging features of the involved renal parenchymal of both ischemia and infarction groups were compared with respect to the presence or absence of parenchymal swelling, echogenicity changes, tissue loss and perfusion defects. Parenchyma swelling, echogenic changes, tissue loss and perfusion defects were found to be more extensive in the infarction than the ischemia group. The hyperechoic areas reperfused with blood flow recovered normal echogenicity and perfusion, whereas the hyperechoic areas without reperfusion became renal infarcts. Gray-scale and contrast-enhanced color Doppler US showed that the hyperechoic areas with reperfusion may reverse to normal parenchyma and allow the differentiation of renal ischemia from renal infarction.

  2. Renal involvement in prolonged salmonella bacteremia: the role of schistosomal glomerulopathy Envolvimento renal na salmonelose septicêmica prolongada: papel da glomerulopatia esquistossomótica

    Directory of Open Access Journals (Sweden)

    Reinaldo Martinelli


    Full Text Available Renal involvement has been well documented in patients with hepatosplenic schistosomiasis and in patients with prolonged salmonella bacteremia (PSB. Whether there is a specific renal lesion related to PSB or the chronic bacterial infection aggravates a pre-existing schistosomal glomerulopathy has been a matter of controversy. To analyze the clinical manifestations and histopathological findings of the renal involvement, 8 patients with hepatosplenic schistosomiasis and PSB (group I were compared with 8 patients with schistosomal glomerulopathy (group II matched by sex and glomerular disease. The mean age in group I was 17.7 years. All patients presented with hematuria, in 4 cases associated with non-nephrotic proteinuria. In group II the mean age was 23 years; nephrotic syndrome was the clinical presentation in 7 of the 8 patients in the group. All patients in group I experienced remission of the clinical and laboratory abnormalities as the salmonella infection was cured; in group II the patients had persistent, steroid-resistant, nephrotic syndrome. On histological examination, no difference was noted between the two groups, except for pronounced glomerular hypercellularity and interstitial mononuclear cell infiltration in group I. These observations strongly suggest that PSB exacerbates a pre-existing sub-clinical schistosomal glomerulopathy by the addition of active lesions directly related to the prolonged bacteremiaEnvolvimento renal tern sido documentado em pacientes com o diagnóstico de salmonelose septicêmica prolongada (SSP. Entretanto, ainda é controversa a existência de uma glomerulopatia especificamente relacionada a SSP ou se a infecção bacteriana prolongada agrava a glomerulopatia esquistossomótica pré-existente. Com o objetivo de analisar as manifestações clínicas e histológicas do envolvimento renal, 8 pacientes com o diagnostico de SSP foram estudados e comparados com 8 pacientes portadores de glomerulopatia

  3. Leiomyosarcoma of the inferior vena cava level II involvement: curative resection and reconstruction of renal veins

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    Wang Quan


    Full Text Available Abstract Leiomyosarcoma of the inferior vena cava (IVCL is a rare retroperitoneal tumor. We report two cases of level II (middle level, renal veins to hepatic veins IVCL, who underwent en bloc resection with reconstruction of bilateral or left renal venous return using prosthetic grafts. In our cases, IVCL is documented to be occluded preoperatively, therefore, radical resection of tumor and/or right kidney was performed and the distal end of inferior vena cava was resected and without caval reconstruction. None of the patients developed edema or acute renal failure postoperatively. After surgical resection, adjuvant radiation therapy was administrated. The patients have been free of recurrence 2 years and 3 months, 9 months after surgery, respectively, indicating the complete surgical resection and radiotherapy contribute to the better survival. The reconstruction of inferior vena cava was not considered mandatory in level II IVCL, if the retroperitoneal venous collateral pathways have been established. In addition to the curative resection of IVCL, the renal vascular reconstruction minimized the risks of procedure-related acute renal failure, and was more physiologically preferable. This concept was reflected in the treatment of the two patients reported on.

  4. Propofol attenuation of renal ischemia/reperfusion injury involves heme oxygenase-1

    Institute of Scientific and Technical Information of China (English)

    Hui-hua WANG; Hai-yan ZHOU; Cong-cong CHEN; Xiu-lai ZHANG; Gang CHENG


    Aim: To examine the protective effect of propofol in renal ischemia/reperfusion (I/R) injury and the role of heme oxygenase-1 (HO-1) in this process. Methods:-Sprague-Dawley rats were randomly divided into 3 groups: (i) sham-operated group; (ii) I/R group; and (iii) propofol group. Bilateral renal warm ischemia for 45 rain was performed. After 2, 6, and 24 h reperfusion, blood samples and kidneys were collected for assessment of renal injury, and HO-1 expressions were ana-lyzed by immunohistochemical analysis, RT-PCR and Western blotting. Results: Blood urea nitrogen and serum creatinine levels in the propofol group were sig-nificantly lower than that in the UR group at 24 h after reperfusion. The mean histological score by Paller's standard showed that propofol significantly attenu-ated renal I/R injury after 6 h reperfusion. Propofol increased HO-1 mRNA and protein levels 2 h after repeffusion, whereas HO-1 expressions were present at exceedingly low levels in the I/R group and the sham-operated group at same time point. Propofol also markedly increased HO- 1 mRNA and protein levels than I/R at 6 and 24 h after reperfusion. Conclusion: These results suggest that propofol mitigates renal I/R injury in rats. This protection may be partly through the induc-tion of the HO- 1 expression.

  5. Collecting Duct Renal Cell Carcinoma Found to Involve the Collecting System During Partial Nephrectomy: A Case Report

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    Andrew C Harbin


    Full Text Available Collecting duct carcinoma (CDC is a rare and aggressive form of renal cell carcinoma (RCC arising from the principal cells of the collecting duct.  One third of cases present with metastatic disease, but many present in a manner similar to conventional RCC or urothelial carcinoma (UC.  We discuss a case of CDC which presented as a small mass at the cortico-medullary junction, and was discovered at robotic partial nephrectomy (RPN to be grossly involving the collecting system. A 62-year-old man presented with a small renal mass suspicious for RCC, which was found on computed tomography (CT after an episode of gross hematuria.  After thorough workup, RPN was attempted; however, intraoperatively the mass was found to be involving the collecting system.  Radical nephroureterectomy was performed, and the pathology report revealed CDC.  CDC is a rare and aggressive form of RCC.  While many cases are metastatic at diagnosis, most patients present with the incidental finding of a small renal mass.  There are no reports of a CDC involving the collecting system at RPN after negative ureteroscopy preoperatively.  The adjuvant therapeutic options for CDC are limited, and long term survival is poor.    

  6. Ureteral Involvement Within an Incarcerated Inguinal Hernia in a Patient With Crossed-fused Renal Ectopia

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    Udit Singhal


    Full Text Available Crossed-fused renal ectopy is an uncommon abnormality of the genitourinary tract that results from errors during embryological development. Ureteral herniation represents another rare anatomic event and can often occur from spontaneous, postoperative, and congenital causes (Allam, Johnson, Grewal & Johnson 2015; Pollack, Popky & Blumberg 1975. Here, we discuss the complex clinical course of a patient with crossed-fused renal ectopia who presents with symptoms due to ureteroinguinal herniation and provide a brief overview of the literature. We highlight the clinical considerations in the management of this patient and provide a potential anatomical and embryological explanation for his presentation.

  7. Prevalence of anemia in type 2 diabetes and role of renal involvement. (United States)

    Bonakdaran, Shokoufeh; Gharebaghi, Mohammad; Vahedian, Mohammad


    Anemia is more common and more severe in diabetics compared to nondiabetic chronic kidney disease patients. This study was undertaken to determine the prevalence of anemia and the contribution of level of nephropathy to anemia in type 2 diabetic patients. A total of 1,962 patients with type 2 diabetes were evaluated for anemia and biochemical profile. 19.6% of the patients had anemia. 38.1% of patients had albuminuria, 8.1% had moderate (creatinine clearance (CrCl) renal impairment. Diabetic patients with moderate renal impairment had significantly more anemia than diabetics with mild renal failure (30% vs. 9%, P = 0.000 Albuminuria was also associated with anemia (8.4% vs. 5.7%, P = 0.000). Cardiovascular disease and retinopathy were also more frequent in diabetic patients with anemia (P = 0.01 and 0.001, respectively). In conclusion, anemia is a highly prevalent finding in Iranian type 2 diabetic patients. Any degree of renal impairment and albuminuria are the greatest risk factors for anemia in these patients.

  8. Prevalence of anemia in type 2 diabetes and role of renal involvement

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    Shokoufeh Bonakdaran


    Full Text Available Anemia is more common and more severe in diabetics compared to nondiabetic chronic kidney disease patients. This study was undertaken to determine the prevalence of anemia and the contribution of level of nephropathy to anemia in type 2 diabetic patients. A total of 1,962 patients with type 2 diabetes were evaluated for anemia and biochemical profile. 19.6% of the pa-tients had anemia. 38.1% of patients had albuminuria, 8.1% had moderate (creatinine clearance (CrCl <60 mL/min/1.73 m 2 and 31.4% had mild (CrCl = 60-90 mL/min renal impairment. Dia-betic patients with moderate renal impairment had significantly more anemia than diabetics with mild renal failure (30% vs. 9%, P = 0.000 Albuminuria was also associated with anemia (8.4% vs. 5.7%, P = 0.000. Cardiovascular disease and retinopathy were also more frequent in diabetic patients with anemia (P = 0.01 and 0.001, respectively. In conclusion, anemia is a highly prevalent finding in Iranian type 2 diabetic patients. Any degree of renal impairment and albumi-uria are the greatest risk factors for anemia in these patients.

  9. Involvement of the chromosomal region 11q13 in renal oncocytoma : Case report and literature review

    NARCIS (Netherlands)

    Neuhaus, C; Dijkhuizen, T; vandenBerg, E; Storkel, S; Stockle, M; Mensch, B; Huber, C; Decker, HJ

    Renal oncocytomas comprise a cytogenetically heterogeneous group of tumors consisting potentially of cytogenetic distinguishable subgroups. Review of the literature revealed loss of chromosome 1 and Y as a possible anomaly for at least one subset of oncocytomas. The frequent finding of

  10. Megalin and cubilin are endocytic receptors involved in renal clearance of hemoglobin

    DEFF Research Database (Denmark)

    Gburek, Jakub; Verroust, Pierre J; Willnow, Thomas E


    The kidney is the main site of hemoglobin clearance and degradation in conditions of severe hemolysis. Herein it is reported that megalin and cubilin, two epithelial endocytic receptors, mediate the uptake of hemoglobin in renal proximal tubules. Both receptors were purified by use of hemoglobin......-Sepharose affinity chromatography of solubilized renal brush-border membranes. Apparent dissociation constants of 1.7 microM for megalin and 4.1 microM for cubilin were determined by surface plasmon resonance analysis. The binding was calcium dependent in both cases. Uptake of fluorescence-labeled hemoglobin by BN...... not affect the uptake. By use of immunohistochemistry, it was demonstrated that uptake of hemoglobin in proximal tubules of rat, mouse, and dog kidneys occurs under physiologic conditions. Studies on normal and megalin knockout mouse kidney sections showed that megalin is responsible for physiologic...


    Directory of Open Access Journals (Sweden)

    Praffulla Chandra


    Full Text Available BACKGROUND Primary carcinoma of vagina is a rare entity in Gynaecological oncology. A tumour should be considered as a primary vaginal carcinoma when cervix is uninvolved. Here we are reporting a case of primary vaginal adenocarcinoma with a rare uterine malformation, right renal agenesis and enlarged left kidney. This case was confirmed by meticulous physical examination, histopathology and relevant radiological investigations which excluded the possibility of carcinoma cervix, endometrium and ovary. This patient was treated solely by chemotherapy

  12. US Features of Experimentally-induced Transient Ischemia and Infarct of Renal Segmental Artery of Rabbits

    Energy Technology Data Exchange (ETDEWEB)

    Park, Byung Kwan [Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Seung Hyup; Moon, Min Hoan [Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul (Korea, Republic of)


    The goal of this study was to analyze and compare the changes in renal parenchymal morphology and cortical perfusion following transient arterial ischemia and infarct in rabbits using ultrasonography (US). Six rabbits were divided into the ischemia (n=3) and infarct groups (n=3). In the ischemia group, a lower polar branch of the left renal artery was surgically ligated for a duration of 60 minutes and then released, in order to induce transient renal ischemia and reperfusion. In the infarct group, a lower polar branch of the left renal artery was permanently ligated without release, in order to induce renal infarction. Gray-scale and contrast-enhanced color/power Doppler US were performed in the two groups at specific times, namely before ligation, immediately after release or ligation (for the ischemia and infarct groups, respectively?), and on the 1st, 3rd, 7th, 14th and 28th postoperative days. The left kidneys of all rabbits were harvested after the last US, for the purpose of evaluating the pathologic correlations. In the US images, swelling, hypo- or hyperechoic areas of the involved parenchyma, tissue loss and perfusion defects were more predominant in the infarct group than in the ischemia group. In successive images, hyperechoic renal parenchyma with no reperfusion changed into renal infarct, while that with reperfusion became normal tissue. In the pathologic analysis, the specimens obtained from the ischemia group revealed mild parenchymal infarct with interstitial fibrosis, whereas those from the infarct group revealed extensive tissue loss and scarring in the involved area of the lower pole. Gray-scale and contrast-enhanced color/power Doppler US can demonstrate the morphological and hemodynamic changes in cases of renal ischemia and infarct

  13. Measurement of renal cortical thickness using spiral CT in early diabetic nephropathy

    Energy Technology Data Exchange (ETDEWEB)

    Koo, Bong Sig; Chung, Won Jung; Park, Byeong Ho; Choi, Jong Cheol; Nam, Kyung Jin; Lee, Yung Il; Chung, Duk Hwan [Donga Univ. College of Medicine, Pusan (Korea, Republic of)


    To compare the ratio of renal cortical thickness to renal parenchymal thickness in early diabetic nephropathy and in normal control group. We performed spiral CT in 17 patients suffering from diabetic nephropathy without renal failure or renal atrophy. The normal control group consisted of 19 persons who were normal on renal function test and did not show any abnormality of the kidney. Renal cortical and parenchymal thicknesses were measured at renal hilum level perpendicular to the renal surface by electronic caliper on contrast-enhanced transverse scan demonstrating the cortical nephrogram phase. Using student's test, the difference in renal parenchymal and cortical thickness between the two groups was tested for statistical significance. There was no significant difference in renal parenchymal thickness between the two groups (p>0.05);the patient group had a thicker renal cortex than the normal control group however (p<0.05). The ratio of renal cortical thickness to parenchymal thickness in early diabetic nephropathy patients (Rt.:0.041{+-}0.051, Lt.:0.382{+-}0.053) was significantly higher than in the normal control group (Rt.:0.331{+-}0.067, Lt.:0.323{+-}0.064). The kidney of early diabetic nephropathy patients had a thicker renal cortex than normal kidney.

  14. Focal parenchymal lesions in community-acquired bacterial meningitis in adults: a clinico-radiological study

    Energy Technology Data Exchange (ETDEWEB)

    Katchanov, Juri [Campus Charite Mitte, Charite, Department of Neurology, Berlin (Germany); University Hospital Charite, Campus Benjamin Franklin, Department of Neurology, Berlin (Germany); Siebert, Eberhard; Klingebiel, Randolf [Campus Charite Mitte, Charite, Department of Neuroradiology, Berlin (Germany); Endres, Matthias [Campus Charite Mitte, Charite, Department of Neurology, Berlin (Germany); Charite-Universitaetsmedizin Berlin, Center for Stroke Research Berlin, Berlin (Germany)


    Here, we analyzed the frequency, morphological pattern, and imaging characteristics of focal lesions as a consequence of community-acquired bacterial meningitis. We hypothesized that diffusion-weighted imaging combined with contrast-enhanced imaging, serial scanning, and multimodal vascular studies would provide further insight into the pathological basis of such parenchymal lesions in bacterial meningitis. We reviewed clinical and imaging data (i.e., magnetic resonance tomography, magnetic resonance angiography, computed tomography angiography, digital subtraction angiography) of 68 adult patients admitted to our neurological intensive care unit between March 1998 and February 2009 with the diagnosis of community-acquired bacterial meningitis. We identified seven patients with parenchymal lesions. These lesions could be attributed to four morphological patterns: (1) territorial cerebral ischemia, (2) perforating vessels ischemia, (3) ischemia of presumed cardiac origin, and (4) isolated cortical lesions. Whereas the patterns (1) and (2) were associated with vasculopathy of large- and medium-sized vessels (as shown by cerebral vascular imaging), vessel imaging in (3) and (4) did not show abnormal findings. Our study implies that parenchymal lesions in acute bacterial meningitis are mainly ischemic and due to involvement of large-, medium-, and small-sized arteries of the brain. Diffusion-weighted imaging combined with conventional, CT-, or MR-based cerebral angiography revealed the underlying pathophysiological mechanisms in the majority of patients. Furthermore, we detected two patients with isolated bilateral cortical involvement and normal vessel imaging. These lesions might represent ischemia due to the involvement of small pial and intracortical arteries. (orig.)

  15. Risk Factors Associated with Renal Involvement in Childhood Henoch-Schönlein Purpura: A Meta-Analysis (United States)

    Chan, Han; Tang, Yan-Ling; Lv, Xiao-Hang; Zhang, Gao-Fu; Wang, Mo; Yang, Hai-Ping; Li, Qiu


    Background and objective Henoch-Schönlein purpura (HSP) is an important cause of chronic kidney disease in children. This meta-analysis identified risk factors associated with renal involvement in childhood HSP. Methods PubMed, Embase, and Web of Science were searched. The quality of all eligible studies was assessed using the Newcastle-Ottawa scale criteria. An analysis of possible risk factors was conducted to report the odds ratio (OR) and weighted mean difference (WMD). Results Thirteen studies (2398 children) revealed 20 possible and 13 significant risk factors associated with renal involvement in HSP, with the following meta-analysis estimates of OR and WMD, with 95% confidence intervals: older age (0.90, 0.61–1.19); age > 10 y (3.13, 1.39–7.07); male gender (1.36, 1.07–1.74); abdominal pain (1.94,1.24–3.04); gastrointestinal bleeding (1.86, 1.30–2.65); severe bowel angina (3.38, 1.17–9.80); persistent purpura (4.02, 1.22–13.25); relapse (4.70, 2.42–9.14); WBC > 15 × 109/L (2.42, 1.39–4.22); platelets > 500 × 109/L (2.98, 1.22–7.25); elevated antistreptolysin O (ASO) (2.17, 1.29–3.64); and decreased complement component 3 (C3) (3.13, 1.62–6.05). Factors not significantly associated with renal involvement were: blood pressure; orchitis; elevated C-reactive protein; elevated erythrocyte sedimentation rate (ESR); and elevated serum IgA/IgE or IgG. Arthritis/arthralgia may be a risk factor according to the criteria of the American College of Rheumatology (1.41, 1.01–1.96). Conclusion The following are associated with renal involvement in pediatric HSP: male gender; > 10 y old; severe gastrointestinal symptoms (abdominal pain, gastrointestinal bleeding, and severe bowel angina); arthritis/arthralgia; persistent purpura or relapse; WBC > 15 × 109/L; platelets > 500 × 109/L; elevated ASO; and low C3. Relevant clinical interventions for these risk factors may exert positive effects on the prevention of kidney disease during the early

  16. The Natural History and Outcomes of the Patients with Carcinosarcoma Involving Kidney and Renal Pelvis

    Directory of Open Access Journals (Sweden)

    Jue Wang


    Full Text Available Background. The objective of this paper was to examine the epidemiology, natural history, and prognostic factors of carcinosarcoma of the kidney and renal pelvis (CSKP using population-based registry. Patients and Methods. Forty-three patients with CSKP, diagnosed between January 1973 and December 2007, were identified from the national Surveillance, Epidemiology, and End Results (SEER database and reviewed. Results. 79% of all patients with known SEER stage were classified as having regional or distant stage; almost all the patients with known histology grade had poorly or undifferentiated histology. The median cancer specific survival was 6 months (95% CI 4–9. The 1-year cancer-specific survival rate for entire cohort was 30.2%. There were no differences in terms of age at diagnosis, histological grade, tumor stage on presentation, and frequency of nephrectomy between carcinosarcoma of kidney (CSK or renal pelvis (CSP. In multivariate analysis, age at diagnosis, tumor stage, and year of diagnosis were found to be significant predictors for cancer-specific survival. Conclusion. CSKP commonly presented as high-grade, advanced stage disease, and was associated with a poor prognosis regardless of location.

  17. Akt2 is involved in loss of epithelial cells and renal fibrosis following unilateral ureteral obstruction.

    Directory of Open Access Journals (Sweden)

    Aiping Lan

    Full Text Available Obstructive nephropathy is an aggressive form of chronic kidney disease (CKD, which is characterized by an epithelial-to-mesenchymal transition (EMT and interstitial fibrosis. However, the molecular mechanisms of EMT and fibrosis are complex and not fully understood. In this study, we investigated the contribution of Akt2 to experimental renal EMT and fibrosis using the well-established model of unilateral ureteral obstruction (UUO. We found that Akt2 and phosphor (p-Akt protein levels were increased in the obstructed kidneys. UUO induced activation of transforming growth factor-β1 (TGF-β1 signaling. Importantly, knockout of Akt2 suppressed UUO-induced EMT, kidney fibrosis, increased GSK3β activity, and decreased expression of Snail and β-catenin. Inhibition of GSK3β with LiCl (the inhibitor of GSK3β increased the expression of Snail and β-catenin in cultured kidney epithelial cells. Our findings suggest that Akt2 partially contributes to interstitial fibrosis following UUO and that inhibition of this signaling pathway may provide a novel approach of prevent progression of renal fibrosis.

  18. Functional involvement of VAMP/synaptobrevin-2 in cAMP-stimulated aquaporin 2 translocation in renal collecting duct cells. (United States)

    Gouraud, Sabine; Laera, Antonia; Calamita, Giuseppe; Carmosino, Monica; Procino, Giuseppe; Rossetto, Ornella; Mannucci, Roberta; Rosenthal, Walter; Svelto, Maria; Valenti, Giovanna


    The involvement of soluble N-ethylmaleimide sensitive factor-attachment protein receptor (SNARE) proteins in the cAMP-induced exocytosis of aquaporin 2 (AQP2)-containing vesicles was investigated in AQP2-transfected renal CD8 cells. RT-PCR and western blot analysis confirmed the presence of the SNARE homologs VAMP/synaptobrevin-2, syntaxin-1, syntaxin-4 and SNAP-23 in CD8 cells. Tetanus neurotoxin (TeNT) was efficient in cleaving synaptobrevin-like protein both in vitro and in intact CD8 cells incubated with the toxin. TeNT treatment in intact CD8 cells completely abolished cAMP-stimulated AQP2 targeting to the plasma membrane, as assessed by quantification of cell-surface immunoreactivity to an anti-AQP2 antibody raised against a peptide reproducing the extracellular AQP2 C-loop. These results represent the first evidence for the functional involvement of VAMP-2 in cAMP-induced AQP2 exocytosis in renal cells.

  19. Pyelonephritis, renal scarring, and reflux nephropathy: a pediatric urologist's perspective

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Edwin A. [Emory University School of Medicine, Department of Urology, Atlanta, GA (United States)


    Imaging of children with a clinical diagnosis of pyelonephritis is performed to characterize the extent of the infection, to identify associated renal injury and to uncover risk factors for future infections and renal damage. Although there is general agreement regarding the need for parenchymal imaging and the need to exclude processes that are either functionally or anatomically obstructive, there is controversy regarding the need for routine cystography, especially when parenchymal involvement has not been documented. A protocol that limits the use of cystography for evaluation of urinary tract infections must assume that the diagnosis of reflux is at least of variable clinical significance. It is now clear that vesicoureteral reflux and reflux nephropathy represent a diverse population that includes both congenital and acquired processes. MR imaging will improve our understanding of vesicoureteral reflux, pyelonephritis and renal scarring and might help us to identify and manage those patients most at risk for recurrent infections and renal injury. To recognize the potential contributions of this newer imaging technique it is helpful to look at our understanding of the pathophysiology of pyelonephritis, reflux and reflux nephropathy. (orig.)

  20. Plasma Cell Type of Castleman's Disease Involving Renal Parenchyma and Sinus with Cardiac Tamponade: Case Report and Literature Review

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Un; Kim, Suk; Lee, Jun Woo; Lee, Nam Kyung; Jeon, Ung Bae; Ha, Hong Gu; Shin, Dong Hoon [Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan (Korea, Republic of)


    Castleman's disease is an uncommon disorder characterized by benign proliferation of the lymphoid tissue that occurs most commonly in the mediastinum. Although unusual locations and manifestations have been reported, involvement of the renal parenchyma and sinus, and moreover, manifestations as cardiac tamponade are extremely rare. Here, we present a rare case of Castleman's disease in the renal parenchyma and sinus that also accompanied cardiac tamponade.

  1. Renal lesions associated with autoimmune pancreatitis: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Triantopoulou, Charikleia; Maniatis, Petros; Siafas, Ioannis; Papailiou, John (CT and Radiology Dept., ' Konstantopouleion' General Hospital, Athens (Greece)), e-mail:; Malachias, George; Anastopoulos, John (Radiology Dept., ' Sismanogleio' General Hospital, Athens (Greece))


    Background: Autoimmune pancreatitis (AIP) is a chronic inflammatory condition characterized by IgG4-positive plasma cells. Recent evidence suggests that it is a systemic disease affecting various organs. Tubulointerstitial nephritis has been reported in association with AIP. Purpose: To investigate the incidence and types of renal involvement in patients with AIP. Material and Methods: Eighteen patients with no history of renal disease and a diagnosis of AIP (on the basis of histopathologic findings or a combination of characteristic imaging features, increased serum IgG4 levels, and response to steroid treatment) were included. All patients underwent computed tomography (CT) imaging and follow-up ranged from 6 months to 2 years. CT images were reviewed for the presence of renal lesions. Results: Seven patients had renal involvement (38.8%). None of the lesions was visible on non-contrast-enhanced CT scan. Parenchymal lesions appeared as multiple nodules showing decreased enhancement (four cases). Pyelonephritis, lymphoma, and metastases were considered in the differential diagnosis. An ill-defined low-attenuation mass-like lesion was found in one patient, while diffuse thickening of the renal pelvis wall was evident in the last two cases. Renal lesions regressed in all patients after steroid treatment, the larger one leaving a fibrous cortical scar. Conclusion: Different types of renal lesions in patients with AIP are relatively common, appearing as multiple nodules with decreased enhancement. These findings support the proposed concept of an IgG4-related systemic disease. Autoimmune disease should be suspected in cases of renal involvement in association with pancreatic focal or diffuse enlargement.

  2. A case of treatment in a patient with synchronous bilateral renal cell carcinoma and simultaneous metastatic involvement of both adrenal glands: Clinical observation

    Directory of Open Access Journals (Sweden)

    V. R. Latypov


    Full Text Available Synchronous bilateral renal cell carcinoma occurs in 1.4 % of cases. The probability of bilateral adrenal metastases from renal cell carcinoma is less than 0.5 %. The clinical observation presents a case of synchronous bilateral renal cell carcinoma and simultaneous metastatic involvement of both adrenal glands. A 55‑year-old male patient was adm tted with the signs of hematuria and anemia to the Unit of Urology, Clinic of General Surgery, Siberian State Medical University. He was found to have synchronous bilateral renal cell carcinoma and simultaneous bilateral adrenal involvement. Sequential surgical treatment – radical nephrectomy (with adrenal gland removal on the right side and, after 3 months, adrenalectomy and kidney resection on the left side were performed. All the organs removed displayed tumors that proved to be renal cell carcinomas (a clear cell variant. There were lymph node metastases in the right-sided renal portal. Postoperatively, the investigators performed hormone replacement therapy for adrenal insufficiency, an immunotherapy cycle, three cycles of targeted therapy withsorafenib and sunitinib (at an interval of 0.5–2 years, and insulin therapy for new-onset diabetes mellitus. The duration of a follow-up was 6.2 years. When describing the case, the patient was alive and showed a generalized tumorous process with extensive tumor involvement of the solitary kidney. Sunitinib therapy was used.

  3. Alveolar septal patterning during compensatory lung growth: Part II the effect of parenchymal pressure gradients. (United States)

    Haber, Shimon; Weisbord, Michal; Mentzer, Steven J; Tsuda, Akira


    In most mammals, compensatory lung growth occurs after the removal of one lung (pneumonectomy). Although the mechanism of alveolar growth is unknown, the patterning of complex alveolar geometry over organ-sized length scales is a central question in regenerative lung biology. Because shear forces appear capable of signaling the differentiation of important cells involved in neoalveolarization (fibroblasts and myofibroblasts), interstitial fluid mechanics provide a potential mechanism for the patterning of alveolar growth. The movement of interstitial fluid is created by two basic mechanisms: 1) the non-uniform motion of the boundary walls, and 2) parenchymal pressure gradients external to the interstitial fluid. In a previous study (Haber et al., Journal of Theoretical Biology 400: 118-128, 2016), we investigated the effects of non-uniform stretching of the primary septum (associated with its heterogeneous mechanical properties) during breathing on generating non-uniform Stokes flow in the interstitial space. In the present study, we analyzed the effect of parenchymal pressure gradients on interstitial flow. Dependent upon lung microarchitecture and physiologic conditions, parenchymal pressure gradients had a significant effect on the shear stress distribution in the interstitial space of primary septa. A dimensionless parameter δ described the ratio between the effects of a pressure gradient and the influence of non-uniform primary septal wall motion. Assuming that secondary septa are formed where shear stresses were the largest, it is shown that the geometry of the newly generated secondary septa was governed by the value of δ. For δ smaller than 0.26, the alveolus size was halved while for higher values its original size was unaltered. We conclude that the movement of interstitial fluid, governed by parenchymal pressure gradients and non-uniform primary septa wall motion, provides a plausible mechanism for the patterning of alveolar growth. Copyright © 2017

  4. Computerized breast parenchymal analysis on DCE-MRI (United States)

    Li, Hui; Giger, Maryellen L.; Yuan, Yading; Jansen, Sanaz A.; Lan, Li; Bhooshan, Neha; Newstead, Gillian M.


    Breast density has been shown to be associated with the risk of developing breast cancer, and MRI has been recommended for high-risk women screening, however, it is still unknown how the breast parenchymal enhancement on DCE-MRI is associated with breast density and breast cancer risk. Ninety-two DCE-MRI exams of asymptomatic women with normal MR findings were included in this study. The 3D breast volume was automatically segmented using a volume-growing based algorithm. The extracted breast volume was classified into fibroglandular and fatty regions based on the discriminant analysis method. The parenchymal kinetic curves within the breast fibroglandular region were extracted and categorized by use of fuzzy c-means clustering, and various parenchymal kinetic characteristics were extracted from the most enhancing voxels. Correlation analysis between the computer-extracted percent dense measures and radiologist-noted BIRADS density ratings yielded a correlation coefficient of 0.76 (pBIRADS 3 and 4) were found to have more parenchymal enhancement at their peak time point (Ep) with an average Ep of 116.5% while those women with fatty breasts (BIRADS 1 and 2) demonstrated an average Ep of 62.0%. In conclusion, breast parenchymal enhancement may be associated with breast density and may be potential useful as an additional characteristic for assessing breast cancer risk.

  5. Surgical resection of a renal cell carcinoma involving the inferior vena cava: the role of the cardiothoracic surgeon

    LENUS (Irish Health Repository)

    Parissis, Haralabos


    Abstract Background The techniques for the resection of renal tumors with IVC extension are based on the experience of individual units. We attempt to provide a logical approach of the surgical strategies in a stepwise fashion. Methods Over 6-years 9 patients with renal cell carcinoma invading the IVC, underwent surgery. There were 6 males. The extension was at level IV in 4 and III in 5 cases. CPB used in 8 and hypothermia and circulatory arrest in all patients with level IV disease. The results and an algorithm of the plan of action, as per level of extension are presented. Results Plan of action: For level I-II disease: No Cardiothoracic involvement, For level III: Cardiopulmonary Bypass (CPB) & control of the cavo-atrial junction. For level IV: use of brief periods of Circulatory Arrest & repair of the Cavotomy with a pericardial patch. Postoperative morbidity: prolonged ICU stay, 3 patients (33.3%); tracheostomy, 1 (11.1%); Sepsis, 2 (22.2%); CVA 1, (11.1%). Mortality: 2 patients (22.2%) Conclusions Total clearance of the IVC from an adherent tumor is important, therefore extensive level IV disease presents a surgical challenge. We recommend CPB for level III and brief periods of Total Circulatory Arrest (TCA) for level IV disease.

  6. Involvement of the histaminergic system in renal sympathetic and cardiovascular responses to leptin and ghrelin. (United States)

    Tanida, Mamoru; Kaneko, Hidekazu; Shen, Jiao; Nagai, Katsuya


    Previous studies have demonstrated that histamine affects blood pressure (BP) in anesthetized rats. Here, we examined the effects of lateral cerebral ventricular (LCV) injection of various doses of histamine on renal sympathetic nerve activity (RSNA) and BP in anesthetized rats. LCV injection of a low dose of histamine (0.0001nmol) suppressed RSNA and BP. Conversely, a high dose of histamine (100nmol) elevated both RSNA and BP. Moreover, inhibiting effects of a low dose of histamine were eliminated by LCV pre-injection of thioperamide, an antagonist of histaminergic H3-receptor, and accelerating effects of a high dose of histamine were abolished by LCV pre-injection of diphenhydramine, an antagonist of histaminergic H1-receptor. Thus, these evidences suggest that central histamine affects RSNA and BP via histaminergic receptors. In addition, we examined a role for histaminergic system in cardiovascular modulators such as leptin and ghrelin. The LCV pre-injection of thioperamide clearly blocked suppressing effects of ghrelin on RSNA and BP. The LCV pre-injection of diphenhydramine also blocked elevating effects of leptin. Therefore, these results suggest that leptin and ghrelin might affect RSNA and BP by mediating central histaminegic H1- and H3-receptors, respectively.

  7. Involvement of endoplasmic reticulum stress in albuminuria induced inflammasome activation in renal proximal tubular cells.

    Directory of Open Access Journals (Sweden)

    Li Fang

    Full Text Available Albuminuria contributes to the progression of tubulointerstitial fibrosis. Although it has been demonstrated that ongoing albuminuria leads to tubular injury manifested by the overexpression of numerous proinflammatory cytokines, the mechanism remains largely unknown. In this study, we found that the inflammasome activation which has been recognized as one of the cornerstones of intracellular surveillance system was associated with the severity of albuminuria in the renal biopsies specimens. In vitro, bovine serum albumin (BSA could also induce the activation of NLRP3 inflammasome in the cultured kidney epithelial cells (NRK-52E. Since there was a significant overlap of NLRP3 with the ER marker calreticulin, the ER stress provoked by BSA seemed to play a crucial role in the activation of inflammasome. Here, we demonstrated that the chemical chaperone taurine-conjugated ursodeoxycholic acid (TUDCA which was proved to be an enhancer for the adaptive capacity of ER could attenuate the inflammasome activation induced by albuminuria not only in vitro but also in diabetic nephropathy. Taken together, these data suggested that ER stress seemed to play an important role in albuminuria-induced inflammasome activation, elimination of ER stress via TUDCA might hold promise as a novel avenue for preventing inflammasome activation ameliorating kidney epithelial cells injury induced by albuminuria.

  8. The normal renal size of Korean children. Radiologic estimation

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Young Tae; Hyun, Jae Suk; Kim, Young Sun; Kim, Kyung Do [Chungang University College of Medicine, Chinju (Korea, Republic of)


    A nephropathy following urinary tract infection is usually referred to as renal scarring. The main radiologic features are an overall reduction in the size of the kidney, with coarse scar, deformity of calyxes and indentation of the surface. If adequately treated, the progressive renal scarring by urinary tract infection could be prevented. Therefore, the early radiologic detection of renal damage following urinary tract infection or vesicoureteral reflux is great importance for the evaluation of the pathogenesis of renal scarring and for the planning of the therapy. To evaluate the renal damage, we must have the normal data of the kidneys. Many reports discussed the renal size in normal children, but there are no reports in the Korean children. We estimate the renal length, width, several focal parenchymal thicknesses for renal size evaluation and segmental lumbar vertebral length at the intravenous paleography in the normal Korean children. And the linear equations are obtained by the regression analysis between the various renal parameters and segmental vertebral length. Thereafter we make out the nomogram by the obtained equations. The renal length and width are highly correlated to the segmental lumbar vertebral length than various renal parenchymal thicknesses. These results suggest that the renal length and width are reliable parameters for normal renal size evaluation in growing kidney. And then the obtained equations and nomograms might be useful in the diagnosis of parenchymal loss in early scarring and follow-up. (author)

  9. Serum ferritin level correlates with SLEDAI scores and renal involvement in SLE. (United States)

    Tripathy, R; Panda, A K; Das, B K


    Ferritin is an acute-phase reactant that is elevated in various autoimmune disorders. Serum ferritin levels have been positively correlated with disease activity scores of rheumatoid arthritis and systemic lupus erythematosus (SLE). Further, enhanced levels of ferritin have also been reported in lupus nephritis. However, there are no reports from the Indian subcontinent. Seventy-six female SLE patients, diagnosed on the basis of revised ACR criteria, and 50 healthy females, age matched from similar geographical areas, were enrolled in the present study. Serum levels of ferritin, IFN-α and IL-6 were quantified by enzyme-linked immunosorbent assay (ELISA). Clinical, biochemical, serological and other markers of disease activity (C3, C4 and anti-dsDNA) were measured by standard laboratory procedure. Serum ferritin levels were significantly higher in SLE patients compared to healthy controls (p Ferritin levels positively correlated with SLE Disease Activity Index (SLEDAI) (p = 0.001, r = 0.35), anti-dsDNA (p = 0.001, r = 0.35), IFN-α (p serum levels of ferritin were positively associated with proteinuria (p = 0.001, r = 0.36), serum urea (p = 0.0004, r = 0.39) and serum creatinine (p = 0.0006, r = 0.38). Serum ferritin is an excellent marker of disease activity and renal dysfunction in SLE. © The Author(s) 2014 Reprints and permissions:

  10. Sonographic Findings in Fetal Renal Vein Thrombosis. (United States)

    Gerber, Rebecca E; Bromley, Bryann; Benson, Carol B; Frates, Mary C


    We present the sonographic findings of fetal renal vein thrombosis in a series of 6 patients. The mean gestational age at diagnosis was 31.2 weeks. Four cases were unilateral, and 2 were bilateral. The most common findings were renal enlargement and intrarenal vascular calcifications, followed by increased renal parenchymal echogenicity. Inferior vena cava thrombosis was found in 4 patients and common iliac vein thrombosis in 2. Fetal renal vein thrombosis is an uncommon diagnosis with characteristic sonographic findings. The presence of these findings should prompt Doppler interrogation of the renal vein and inferior vena cava to confirm the diagnosis.

  11. Upregulation of Interleukin-33 in obstructive renal injury

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Wei-Yu, E-mail: [Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (China); Chang, Ya-Jen [Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan (China); Su, Chia-Hao [Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (China); Tsai, Tzu-Hsien [Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (China); Chen, Shang-Der [Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (China); Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan (China); Hsing, Chung-Hsi [Department of Anesthesiology, Chi-Mei Medical Center, Tainan, Taiwan (China); Yang, Jenq-Lin, E-mail: [Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (China)


    Interstitial fibrosis and loss of parenchymal tubular cells are the common outcomes of progressive renal diseases. Pro-inflammatory cytokines have been known contributing to the damage of tubular cells and fibrosis responses after renal injury. Interleukin (IL)-33 is a tissue-derived nucleus alarmin that drives inflammatory responses. The regulation and function of IL-33 in renal injury, however, is not well understood. To investigate the involvement of cytokines in the pathogenesis of renal injury and fibrosis, we performed the mouse renal injury model induced by unilateral urinary obstruction (UUO) and analyze the differentially upregulated genes between the obstructed and the contralateral unobstructed kidneys using RNA sequencing (RNAseq). Our RNAseq data identified IL33 and its receptor ST2 were upregulated in the UUO kidney. Quantitative analysis confirmed that transcripts of IL33 and ST2 were upregulated in the obstructed kidneys. Immunofluorescent staining revealed that IL-33 was upregulated in Vimentin- and alpha-SMA-positive interstitial cells. By using genetically knockout mice, deletion of IL33 reduced UUO-induced renal fibrosis. Moreover, in combination with BrdU labeling technique, we observed that the numbers of proliferating tubular epithelial cells were increased in the UUO kidneys from IL33-or ST2-deficient mice compared to wild type mice. Collectively, our study demonstrated the upregulation of IL-33/ST2 signaling in the obstructed kidney may promote tubular cell injury and interstitial fibrosis. IL-33 may serve as a biomarker to detect renal injury and that IL-33/ST2 signaling may represent a novel target for treating renal diseases. -- Highlights: •Interleukin (IL)-33 was upregulated in obstructed kidneys. •Interstitial myofibroblasts expressed IL-33 after UUO-induced renal injury. •Deficiency of IL33 reduced interstitial fibrosis and promoted tubular cell proliferation.

  12. Value of renal cortical thickness as a predictor of renal function impairment in chronic renal disease patients

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    Samia Rafael Yamashita


    Full Text Available Objective: To determine the presence of linear relationship between renal cortical thickness, bipolar length, and parenchymal thickness in chronic kidney disease patients presenting with different estimated glomerular filtration rates (GFRs and to assess the reproducibility of these measurements using ultrasonography. Materials and Methods: Ultrasonography was performed in 54 chronic renal failure patients. The scans were performed by two independent and blinded radiologists. The estimated GFR was calculated using the Cockcroft-Gault equation. Interobserver agreement was calculated and a linear correlation coefficient (r was determined in order to establish the relationship between the different renal measurements and estimated GFR. Results: The correlation between GFR and measurements of renal cortical thickness, bipolar length, and parenchymal thickness was, respectively, moderate (r = 0.478; p < 0.001, poor (r = 0.380; p = 0.004, and poor (r = 0.277; p = 0.116. The interobserver agreement was considered excellent (0.754 for measurements of cortical thickness and bipolar length (0.833, and satisfactory for parenchymal thickness (0.523. Conclusion: The interobserver reproducibility for renal measurements obtained was good. A moderate correlation was observed between estimated GFR and cortical thickness, but bipolar length and parenchymal thickness were poorly correlated.

  13. MR imaging findings of renal infarction induced by renal artery

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jun Woo; Kim, Suck; Kim, Yong Woo; Hu, Jin Sam; Choi, Sang Yoel; Moon, Tae Yong; Lee, Suck Hong; Kim, Byung Su; Lee, Chang Hun [Pusan National Univ., Pusan (Korea, Repulic of). Coll. of Medicine


    To assess the usefulness of diffusion-weighted imaging (DWI) in evaluating serial parenchymal changes in renal infarction induced by renal artery ligation, by comparing this with the conventional spin echo technique and correlating the results with the histopathological findings. In 22 rabbits, renal infarction was induced by ligation of the renal artery. Spin-echo T1-weighted imaging (T1WI), turbo spin-echo (TSE) T2-weighted imaging (T2WI), and DWI were performed, using a 1.5-T superconductive unit, at 30 minutes, 1 hour, 2,3,6, 12 and 24 hours, and 2, 3, 7 and 20 days after left renal artery ligation. Changes in signal intensity on T1WI, T2WI, and DWI were correlated with histopathologic findings. Diffusion-weighted imaging is useful for the detection of hyperacute renal infarction, and the apparent diffusion coefficient may provide additional information concerning its evolution. (author). 21 refs., 9 figs.

  14. Towards quantitative magnetic resonance assessment in parenchymal liver disease

    NARCIS (Netherlands)

    Runge, J.H.


    In this thesis several advanced magnetic resonance (MR) techniques for quantitative measurements in parenchymal liver disease are studied. In particular, certain important hallmarks of liver disease such as steatosis, fibrosis, iron overload and inflammation are studied. Steatosis or fatty liver dis

  15. The Renal Parenchyma Evaluation: MAG3 vs. DMSA


    Smokvina, Aleksandar; Grbac-Ivanković, Svjetlana; Girotto, Neva; Subat Dežulović, Mirna; Saina, Giordano; Miletić Barković, Marina


    Scintigraphy with Tc-99m dimercaptosuccinic acid (DMSA) is considered a reference method for assessment of parenchymal lesions and estimation of differential kidney function. The aim of study was to evaluate Tc-99m mercaptoacetyltriglycine (MAG3) dynamic renal scintigraphy for the same purpose. 188 patients, submitted to both studies within three months, were divided in two groups. In the first, 83 DMSA images were compared to parenchymal phase of MAG3 scintigraphy. Kidney morphology was i...

  16. IL22 in Egyptian SLE patients, could it reflect disease activity, skin or renal involvement or is it only an expensive ESR?

    Directory of Open Access Journals (Sweden)

    Iman Ibrahim El-Gazzar


    Conclusion: Our data suggest that increased serum IL-22 may contribute to the pathogenesis of SLE. Its elevated serum level allows discrimination between patients with different clinical and laboratory measures and indicates the potential of IL-22 as an additional tool for assessment of activity in SLE. IL22 in serum seems to be a significant index reflecting skin and renal involvement in SLE.

  17. Advances in the pathogenesis of renal involvement in pre-eclampsia%先兆子痫肾损害发病机制的研究进展

    Institute of Scientific and Technical Information of China (English)

    刘翔; 任红旗


    The exact pathogenesis of renal involvement in pre-eclampsia is unclear. The majority of the literature suggests that placental trophoblast invasion, immune system abnormalities are major factors of renal involvement in pre-eclampsia. In recent years, with the advances in molecular biology, the pathogenesisa of renal involvement in pre-eclampsia has made considerable progress. This paper reviewed the progress on pathogenesis of renal involvement in pre-eclampsia.%先兆子痫肾损害确切发病机制尚不清楚,多数文献认为胎盘滋养层细胞侵入、免疫系统异常等是先兆子痫肾损害的主要因素。近年来,随着分子生物学的进展,先兆子痫肾损害发病机制研究取得了长足的进展。因而,本文结合文献对先兆子痫肾损害发病机制的进展进行综述。


    Directory of Open Access Journals (Sweden)

    Elizabeth De Francesco DAHER


    Full Text Available SUMMARY Introduction: We present a fatal case of disseminated cryptococcosis in a young man whose diagnosis of HIV infection was made at the time of admission to the emergency room. Case report: The patient was a twenty-three-year-old man, with a history of daily fever during one month associated with diarrhea, weight loss, headache, vomiting and generalized seizures. He also had a history of diabetes mellitus, alcoholism and drug addiction. Upon physical examination the patient was pale, disoriented and had periods of agitation. White blood cells count was 3,440/mm3 (5% lymphocytes, hemoglobin was 10g/dL, platelets were 83,000/ mm3. Creatinine was 0.7 mg/dL; urea 19 mg/dL; Na, K, and liver enzymes were within normal limits. Lactic dehydrogenase was 494 IU/L. Cerebrospinal fluid (CSF analysis revealed 10 white blood cells/mm3 (58% neutrophils, 31% lymphocytes, 11% monocytes and 2 red blood cells/mm3. India ink test revealed six Cryptococcus yeasts/mm3. CSF glucose was 122 mg/dL and protein was 36 mg/ dL. VDRL test was negative and anti-HIV test was positive. Intravenous hydration, insulin, phenytoin, fluconazole, pyrimethamine, sulfadiazine, folinic acid, and amphotericin B were started. The patient did not improve and became obtunded and hypotensive. He was intubated and put on mechanical respiration. He received vasoactive drugs and died less than 24 hours after admission. A postmortem examination was performed and revealed disseminated cryptococcosis, with severe involvement of the kidneys. Conclusion: Cryptococcosis, as a rule, is a systemic disease that affects mostly immunocompromised individuals, especially patients with AIDS. When diagnosed late in its course it has a very high mortality.

  19. Reversible Renal Insufficiency Secondary to Extrinsic Splenic Compression of the Kidney in a Patient with Chronic Lymphocytic Leukemia

    Directory of Open Access Journals (Sweden)

    Miriam Hadj-Moussa


    Full Text Available While increased renal venous and direct renal parenchymal pressure may cause renal insufficiency, there are no prior reports of hypersplenism secondary to chronic lymphocytic leukemia (CLL doing so. This first report of massive splenomegaly leading to marked compression of the left kidney associated with renal insufficiency that resolved after splenectomy illustrates that profound extrinsic renal compression from splenomegaly may significantly compromise left renal function and splenectomy should be considered in this situation.

  20. Sarcoidosis with Renal Involvement: A Case Report and Review of Literature%结节病肾损害1例并文献复习

    Institute of Scientific and Technical Information of China (English)

    许小毛; 孙铁英; 杨菁菁


    Objective: To highlight the sarcoidosis with renal involvement. Methods: We analyzed the clinical feature and therapy about a patient with renal sarcoidosis. The literature concerning sarcoidosis with renal involvement was reviewed. Results: Patient presented with hypercalcemia and chronic renal failure initially. She was diagnosed sarcoidosis through lymph node biopsy. Hypercalcemia and renal failure improved after treated with corticosteroids and immunosuppressor. Conclusion: The diagnosis of sarcoidosis with renal involvement often delay. Corticosteroids should be first line of treatment. If it didn' t work well, combine with immunosuppressor may be a choice.%目的:通过分析结节病累及肾脏患者的临床资料,旨在提高结节病肾损害诊断和治疗水平.方法:回顾性分析1例女性结节病肾损害患者的临床表现、实验室检查及疗效,结合文献复习,总结结节病肾损害的诊治经验.结果:患者以不明原因的高钙血症、慢性肾功能不全为首发症状,1 年后经淋巴结活检诊断为结节病,给予糖皮质激素和免疫抑制剂治疗,肾功能、高钙血症好转.结论:结节病肾损害常常延误诊断,明确诊断后治疗首选糖皮质激素治疗,疗效欠佳时可联合应用免疫抑制剂.

  1. AQP2 exocytosis in the renal collecting duct -- involvement of SNARE isoforms and the regulatory role of Munc18b.

    NARCIS (Netherlands)

    Procino, G.; Barbieri, C.; Tamma, G.; Benedictis, L De; Pessin, J.E.; Svelto, M.; Valenti, G.


    Vasopressin regulates the fusion of the water channel aquaporin 2 (AQP2) to the apical membrane of the renal collecting-duct principal cells and several lines of evidence indicate that SNARE proteins mediate this process. In this work MCD4 renal cells were used to investigate the functional role of

  2. Complement Activation Is Involved in Renal Damage in Human Antineutrophil Cytoplasmic Autoantibody Associated Pauci-Immune Vasculitis

    NARCIS (Netherlands)

    Xing, Guang-qun; Chen, Min; Liu, Gang; Heeringa, Peter; Zhang, Jun-jun; Zheng, Xin; Jie, E.; Kallenberg, Cees G. M.; Zhao, Ming-hui


    This study was to investigate the evidence for complement activation in renal biopsy specimens of patients with myeloperoxidase (MPO)-antineutrophil cytoplasmic autoantibody (ANCA)-associated pauci-immune vasculitis. Renal biopsy specimens from seven patients with MPO-ANCA positive pauci-immune necr

  3. Nonreciprocal chromosomal translocations in renal cancer involve multiple DSBs and NHEJ associated with breakpoint inversion but not necessarily with transcription. (United States)

    Ali, Hanif; Daser, Angelika; Dear, Paul; Wood, Henry; Rabbitts, Pamela; Rabbitts, Terence


    Chromosomal translocations and other abnormalities are central to the initiation of cancer in all cell types. Understanding the mechanism is therefore important to evaluate the evolution of cancer from the cancer initiating events to overt disease. Recent work has concentrated on model systems to develop an understanding of the molecular mechanisms of translocations but naturally occurring events are more ideal case studies since biological selection is absent from model systems. In solid tumours, nonreciprocal translocations are most commonly found, and accordingly we have investigated the recurrent nonreciprocal t(3;5) chromosomal translocations in renal carcinoma to better understand the mechanism of these naturally occurring translocations in cancer. Unexpectedly, the junctions of these translocations can be associated with site-specific, intrachromosomal inversion involving at least two double strand breaks (DSB) in cis and rejoining by nonhomologous end joining or micro-homology end joining. However, these translocations are not necessarily associated with transcribed regions questioning accessibility per se in controlling these events. In addition, intrachromosomal deletions also occur. We conclude these naturally occurring, nonreciprocal t(3;5) chromosomal translocations occur after complex and multiple unresolved intrachromosomal DSBs leading to aberrant joining with concurrent interstitial inversion and that clonal selection of cells is the critical element in cancer development emerging from a plethora of DSBs that may not always be pathogenic.

  4. Involvement of Raf-1/MEK/ERK1/2 signaling pathway in zinc-induced injury in rat renal cortical slices. (United States)

    Kohda, Yuka; Matsunaga, Yoshiko; Shiota, Ryugo; Satoh, Tomohiko; Kishi, Yuko; Kawai, Yoshiko; Gemba, Munekazu


    Zinc is an essential nutrient that can also be toxic. We have previously reported that zinc-related renal toxicity is due, in part, to free radical generation in the renal epithelial cell line, LLC-PK(1) cells. We have also shown that an MEK1/2 inhibitor, U0126, markedly inhibits zinc-induced renal cell injury. In this study, we investigated the role of an upstream MEK/ERK pathway, Raf-1 kinase pathway, and the transcription factor and ERK substrate Elk-1, in rat renal cortical slices exposed to zinc. Immediately after preparing slices from rat renal cortex, the slices were incubated in medium containing Raf-1 and MEK inhibitors. ERK1/2 and Elk-1 activation were determined by Western blot analysis for phosphorylated ERK (pERK) 1/2 and phosphorylated Elk-1 (pElk-1) in nuclear fractions prepared from slices exposed to zinc. Zinc caused not only increases in 4-hydroxynonenal (4-HNE) modified protein and lipid peroxidation, as an index of oxidant stress, and decreases in PAH accumulation, as that of renal cell injury in the slices. Zinc also induced a rapid increase in ERK/Elk-1 activity accompanied by increased expressions of pERK and pElk-1 in the nuclear fraction. A Raf-1 kinase inhibitor and an MEK1/2 inhibitor U0126 significantly attenuated zinc-induced decreases PAH accumulation in the slices. The Raf-1 kinase inhibitor and U0126 also suppressed ERK1/2 activation in nuclear fractions prepared from slices treated with zinc. The present results suggest that a Raf-1/MEK/ERK1/2 pathway and the ERK substrate Elk-1 are involved in free radical-induced injury in rat renal cortical slices exposed to zinc.

  5. Multidetector Computed Tomography Features in Differentiating Exophytic Renal Angiomyolipoma from Retroperitoneal Liposarcoma (United States)

    Wang, Qiushi; Juan, Yu-Hsiang; Li, Yong; Xie, Jia-Jun; Liu, Hui; Huang, Hongfei; Liu, Zaiyi; Zheng, Junhui; Saboo, Ujwala S.; Saboo, Sachin S.; Liang, Changhong


    Abstract This study aims to evaluate the multidetector computed tomography (CT) imaging features in differentiating exophytic renal angiomyolipoma (AML) from retroperitoneal liposarcoma. We retrospectively enrolled 42 patients with confirmed exophytic renal AML (31 patients) or retroperitoneal liposarcoma (11 patients) during 8 years period to assess: renal parenchymal defect at site of tumor contact, supply from branches of renal artery, tumoral vessel extending through the renal parenchyma, dilated intratumoral vessels, hemorrhage, non–fat-containing intratumoral nodules with postcontrast enhancement, calcification, renal sinus enlargement, anterior displacement of kidneys, and other associated AML. Renal parenchymal defect, renal arterial blood supply, tumoral vessel through the renal parenchyma, dilated intratumoral vessels, intratumoral/perirenal hemorrhage, renal sinus enlargement, and associated AML were seen only or mainly in exophytic renal AML (all P value < 0.05); however, non–fat-attenuating enhancing intratumoral nodules, intratumoral calcification, and anterior displacement of the kidney were more common in liposarcoma (all P value < 0.05). AMLs reveal renal parenchymal defect at the site of tumor contact, supply from renal artery, tumoral vessel extending through the renal parenchyma, dilated intratumoral vessels, intratumoral and/or perirenal hemorrhage, renal sinus enlargement, and associated AML. Non–fat-attenuating enhancing intratumoral nodules, intratumoral calcifications, and anterior displacement of kidney were more commonly seen in liposarcoma. PMID:26376398

  6. Nuclear receptor atlas of female mouse liver parenchymal, endothelial, and Kupffer cells. (United States)

    Li, Zhaosha; Kruijt, J Kar; van der Sluis, Ronald J; Van Berkel, Theo J C; Hoekstra, Menno


    The liver consists of different cell types that together synchronize crucial roles in liver homeostasis. Since nuclear receptors constitute an important class of drug targets that are involved in a wide variety of physiological processes, we have composed the hepatic cell type-specific expression profile of nuclear receptors to uncover the pharmacological potential of liver-enriched nuclear receptors. Parenchymal liver cells (hepatocytes) and liver endothelial and Kupffer cells were isolated from virgin female C57BL/6 wild-type mice using collagenase perfusion and counterflow centrifugal elutriation. The hepatic expression pattern of 49 nuclear receptors was generated by real-time quantitative PCR using the NUclear Receptor Signaling Atlas (NURSA) program resources. Thirty-six nuclear receptors were expressed in total liver. FXR-α, EAR2, LXR-α, HNF4-α, and CAR were the most abundantly expressed nuclear receptors in liver parenchymal cells. In contrast, NUR77, COUP-TFII, LXR-α/β, FXR-α, and EAR2 were the most highly expressed nuclear receptors in endothelial and Kupffer cells. Interestingly, members of orphan receptor COUP-TF family showed a distinct expression pattern. EAR2 was highly and exclusively expressed in parenchymal cells, while COUP-TFII was moderately and exclusively expressed in endothelial and Kupffer cells. Of interest, the orphan receptor TR4 showed a similar expression pattern as the established lipid sensor PPAR-γ. In conclusion, our study provides the most complete quantitative assessment of the nuclear receptor distribution in liver reported to date. Our gene expression catalog suggests that orphan nuclear receptors such as COUP-TFII, EAR2, and TR4 may be of significant importance as novel targets for pharmaceutical interventions in liver.

  7. Clinical presentation and outcome prediction of clinical, serological, and histopathological classification schemes in ANCA-associated vasculitis with renal involvement. (United States)

    Córdova-Sánchez, Bertha M; Mejía-Vilet, Juan M; Morales-Buenrostro, Luis E; Loyola-Rodríguez, Georgina; Uribe-Uribe, Norma O; Correa-Rotter, Ricardo


    Several classification schemes have been developed for anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), with actual debate focusing on their clinical and prognostic performance. Sixty-two patients with renal biopsy-proven AAV from a single center in Mexico City diagnosed between 2004 and 2013 were analyzed and classified under clinical (granulomatosis with polyangiitis [GPA], microscopic polyangiitis [MPA], renal limited vasculitis [RLV]), serological (proteinase 3 anti-neutrophil cytoplasmic antibodies [PR3-ANCA], myeloperoxidase anti-neutrophil cytoplasmic antibodies [MPO-ANCA], ANCA negative), and histopathological (focal, crescenteric, mixed-type, sclerosing) categories. Clinical presentation parameters were compared at baseline between classification groups, and the predictive value of different classification categories for disease and renal remission, relapse, renal, and patient survival was analyzed. Serological classification predicted relapse rate (PR3-ANCA hazard ratio for relapse 2.93, 1.20-7.17, p = 0.019). There were no differences in disease or renal remission, renal, or patient survival between clinical and serological categories. Histopathological classification predicted response to therapy, with a poorer renal remission rate for sclerosing group and those with less than 25 % normal glomeruli; in addition, it adequately delimited 24-month glomerular filtration rate (eGFR) evolution, but it did not predict renal nor patient survival. On multivariate models, renal replacement therapy (RRT) requirement (HR 8.07, CI 1.75-37.4, p = 0.008) and proteinuria (HR 1.49, CI 1.03-2.14, p = 0.034) at presentation predicted renal survival, while age (HR 1.10, CI 1.01-1.21, p = 0.041) and infective events during the induction phase (HR 4.72, 1.01-22.1, p = 0.049) negatively influenced patient survival. At present, ANCA-based serological classification may predict AAV relapses, but neither clinical nor serological

  8. Interventricular low-grade oligodendroglioma with multiple parenchymal relapse. (United States)

    Akhavan, Ali; Binesh, Fariba; Rakhsha, Afshin; Navabii, Hossein


    Oligodendrogliomas can be found anywhere oligodendrocytes exist; however, they mostly occur in frontal lobes. Although intra- and extra central nervous system dissemination of anaplastic oligodendroglioma is a well-known property of this tumour, low-grade oligodendroglioma with intracranial relapse is a very uncommon finding. In this case report, a 37-year-old man with grade II oligodendroglioma relapsed after 18 months with multiple parenchymal masses is presented.

  9. Light-chain nephropathy in patient with renal carcinoma.


    Enia, G.; Maringhini, S; L'Abbate, A; Zoccali, C.; Maggiore, Q


    Paraneoplastic syndromes are often associated with renal parenchymal tumours. This report describes a case of renal-cell carcinoma with kappa-chain nephropathy. The patient, a 60-year-old man, had renal tubular dysfunction, shown by low serum concentrations of urate and phosphate. Kappa-chains were found in both serum and urine, but no lambda-chains were found. Investigations showed a clear-cell carcinoma, and the patient underwent a radical nephrectomy. Two years after operation serum phosph...

  10. Quantitative Assessment of Breast Parenchymal Uptake on 18F-FDG PET/CT: Correlation with Age, Background Parenchymal Enhancement, and Amount of Fibroglandular Tissue on MRI. (United States)

    Leithner, Doris; Baltzer, Pascal A; Magometschnigg, Heinrich F; Wengert, Georg J; Karanikas, Georgios; Helbich, Thomas H; Weber, Michael; Wadsak, Wolfgang; Pinker, Katja


    Background parenchymal enhancement (BPE), and the amount of fibroglandular tissue (FGT) assessed with MRI have been implicated as sensitive imaging biomarkers for breast cancer. The purpose of this study was to quantitatively assess breast parenchymal uptake (BPU) on (18)F-FDG PET/CT as another valuable imaging biomarker and examine its correlation with BPE, FGT, and age.

  11. Effect of Hachimijiogan against Renal Dysfunction and Involvement of Hypoxia-Inducible Factor-1α in the Remnant Kidney Model

    Directory of Open Access Journals (Sweden)

    Hiroshi Oka


    Full Text Available In chronic renal failure, hypoxia of renal tissue is thought to be the common final pathway leading to end-stage renal failure. In this study the effects of hachimijiogan, a Kampo formula, were studied with respect to hypoxia-inducible factor (HIF. Using remnant kidney rats, we studied the effects of hachimijiogan on renal function in comparison with angiotensin II receptor blocker. The result showed that oral administration of hachimijiogan for seven days suppressed urinary protein excretion and urinary 8-OHdG, a marker of antioxidant activity, equally as well as oral administration of candesartan cilexetil. In contrast, the protein volume of HIF-1α in the renal cortex was not increased in the candesartan cilexetil group, but that in the hachimijiogan group was increased. In immunohistochemical studies as well, the expression of HIF-1α of the high-dose hachimijiogan group increased compared to that of the control group. Vascular endothelial growth factor and glucose transporter 1, target genes of HIF-1α, were also increased in the hachimijiogan group. These results suggest that hachimijiogan produces a protective effect by a mechanism different from that of candesartan cilexetil.

  12. Quantification of Hepatic Vascular and Parenchymal Regeneration in Mice (United States)

    Xie, Chichi; Schwen, Lars Ole; Wei, Weiwei; Schenk, Andrea; Zafarnia, Sara; Gremse, Felix; Dahmen, Uta


    Background Liver regeneration consists of cellular proliferation leading to parenchymal and vascular growth. This study complements previous studies on cellular proliferation and weight recovery by (1) quantitatively describing parenchymal and vascular regeneration, and (2) determining their relationship. Both together are needed to (3) characterize the underlying growth pattern. Methods Specimens were created by injecting a polymerizing contrast agent in either portal or hepatic vein in normal or regenerating livers after 70% partial hepatectomy. 3D image data were obtained through micro-CT scanning. Parenchymal growth was assessed by determining weight and volume of the regenerating liver. Vascular growth was described by manually determined circumscribed parameters (maximal vessel length and radius of right inferior portal/hepatic vein), automatically determined cumulative parameters (total edge length and total vascular volume), and parameters describing vascular density (total edge length/volume, vascular volume fraction). The growth pattern was explored by comparing the relative increase of these parameters to the increase expected in case of isotropic expansion. Results Liver volume recovery paralleled weight recovery and reached 90% of the original liver volume within 7 days. Comparing radius-related vascular parameters immediately after surgical resection and after virtual resection in-silico revealed a slight increase, possibly reflecting the effect of resection-induced portal hyperperfusion. Comparing length-related parameters between post-operative day 7 and after virtual resection showed similar vascular growth in both vascular systems investigated. In contrast, radius-related parameters increased slightly more in the portal vein. Despite the seemingly homogeneous 3D growth, the observed vascular parameters were not compatible with the hypothesis of isotropic expansion of liver parenchyma and vascular structures. Conclusion We present an approach for

  13. Multiphoton imaging of renal tissues in vitro. (United States)

    Peti-Peterdi, János


    The highly inhomogeneous and light-scattering structure of living renal tissue makes the application of conventional imaging techniques more difficult compared with other parenchymal organs. On the other hand, key physiological processes of the kidney, such as regulation of glomerular filtration, hemodynamics, concentration, and dilution, involve complex interactions between multiple cell types and otherwise inaccessible structures that necessitate visual approaches. An ideal solution is multiphoton excitation fluorescence microscopy, a state-of-the-art imaging technique superior for deep optical sectioning of living tissue samples. Here, we review the basics and advantages of multiphoton microscopy and provide examples for its application in renal physiology using dissected cortical and medullary tissues in vitro. In combination with microperfusion techniques, the major functions of the juxtaglomerular apparatus, tubuloglomerular feedback and renin release, can be studied with high spatial and temporal resolution. Salt-dependent changes in macula densa cell volume, vasoconstriction of the afferent arteriole, and activity of an intraglomerular precapillary sphincter composed of renin granular cells are visualized in real time. Release and tissue activity of renin can be studied on the individual granule level. Imaging of the living inner medulla shows how interstitial cells interconnect cells of the vasa recta, loop of Henle, and collecting duct. In summary, multiphoton microscopy is an exciting new optical sectioning technique that has great potential for numerous future developments and is ideal for applications that require deep optical sectioning of living tissue samples.

  14. Pathophysiology of Pulmonary Hypertension in Chronic Parenchymal Lung Disease. (United States)

    Singh, Inderjit; Ma, Kevin Cong; Berlin, David Adam


    Pulmonary hypertension commonly complicates chronic obstructive pulmonary disease and interstitial lung disease. The association of chronic lung disease and pulmonary hypertension portends a worse prognosis. The pathophysiology of pulmonary hypertension differs in the presence or absence of lung disease. We describe the physiological determinants of the normal pulmonary circulation to better understand the pathophysiological factors implicated in chronic parenchymal lung disease-associated pulmonary hypertension. This review will focus on the pathophysiology of 3 forms of chronic lung disease-associated pulmonary hypertension: idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease, and sarcoidosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Renal allograft rejection: sonography and scintigraphy

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    Singh, A.; Cohen, W.N.


    A total of 30 renal allograft patients who had sonographic B scanning and radionuclide studies of the transplant was studied as to whether: (1) the allograft rejection was associated with any consistent and reliable sonographic features and (2) the sonograms complemented the radionuclide studies. Focal areas of decreased parenchymal echogenicity were the most striking and consistent sonographic finding in chymal echogenicity were the most striking and consistens sonographic finding in allograft rejection. This was observed in most of the patients exhibiting moderate or severe rejection, but was frequently absent with mild rejection. Areas of decreased parenchymal echogenicity were not seen during episodes of acute tubular necrosis. Therefore, sonography showing zones of decreased parenchymal echogenicity was complementary to radionuclide studies in the diagnosis of allograft rejection versus acute tubular necrosis. Corticomedullary demarcation was difficult to interpret because of technical variables, and was inconsistently related to rejection in this series.

  16. Elucidation of the distal convoluted tubule transcriptome identifies new candidate genes involved in renal Mg2+ handling.

    NARCIS (Netherlands)

    Baaij, J.H.F. de; Groot Koerkamp, M.J.; Lavrijsen, M.; Zeeland, F. van; Meijer, H.; Holstege, F.C.; Bindels, R.J.M.; Hoenderop, J.G.J.


    The kidney plays a key role in the maintenance of Mg(2+) homeostasis. Specifically, the distal convoluted tubule (DCT) is instrumental in the fine-tuning of renal Mg(2+) handling. In recent years, hereditary Mg(2+) transport disorders have helped to identify important players in DCT Mg(2+) homeostas

  17. Bronchoscopic cryobiopsy for the diagnosis of diffuse parenchymal lung disease.

    Directory of Open Access Journals (Sweden)

    Jonathan A Kropski

    Full Text Available BACKGROUND: Although in some cases clinical and radiographic features may be sufficient to establish a diagnosis of diffuse parenchymal lung disease (DPLD, surgical lung biopsy is frequently required. Recently a new technique for bronchoscopic lung biopsy has been developed using flexible cryo-probes. In this study we describe our clinical experience using bronchoscopic cryobiopsy for diagnosis of diffuse lung disease. METHODS: A retrospective study of subjects who had undergone bronchoscopic cryobiopsy for evaluation of DPLD at an academic tertiary care center from January 1, 2012 through January 15, 2013 was performed. The procedure was performed using a flexible bronchoscope to acquire biopsies of lung parenchyma. H&E stained biopsies were reviewed by an expert lung pathologist. RESULTS: Twenty-five eligible subjects were identified. With a mean area of 64.2 mm(2, cryobiopsies were larger than that typically encountered with traditional transbronchial forceps biopsy. In 19 of the 25 subjects, a specific diagnosis was obtained. In one additional subject, biopsies demonstrating normal parenchyma were felt sufficient to exclude diffuse lung disease as a cause of dyspnea. The overall diagnostic yield of bronchoscopic cryobiopsy was 80% (20/25. The most frequent diagnosis was usual interstitial pneumonia (UIP (n = 7. Three of the 25 subjects ultimately required surgical lung biopsy. There were no significant complications. CONCLUSION: In patients with suspected diffuse parenchymal lung disease, bronchoscopic cryobiopsy is a promising and minimally invasive approach to obtain lung tissue with high diagnostic yield.

  18. Characterization of systemic disease in primary Sjögren's syndrome: EULAR-SS Task Force recommendations for articular, cutaneous, pulmonary and renal involvements. (United States)

    Ramos-Casals, Manuel; Brito-Zerón, Pilar; Seror, Raphaèle; Bootsma, Hendrika; Bowman, Simon J; Dörner, Thomas; Gottenberg, Jacques-Eric; Mariette, Xavier; Theander, Elke; Bombardieri, Stefano; De Vita, Salvatore; Mandl, Thomas; Ng, Wan-Fai; Kruize, Aike; Tzioufas, Athanasios; Vitali, Claudio


    To reach a European consensus on the definition and characterization of the main organ-specific extraglandular manifestations in primary SS. The EULAR-SS Task Force Group steering committee agreed to approach SS-related systemic involvement according to the EULAR SS Disease Activity Index (ESSDAI) classification and proposed the preparation of four separate manuscripts: articular, cutaneous, pulmonary and renal ESSDAI involvement; muscular, peripheral nervous system, CNS and haematological ESSDAI involvement; organs not included in the ESSDAI classification; and lymphoproliferative disease. Currently available evidence was obtained by a systematic literature review focused on SS-related systemic features. The following information was summarized for articular, cutaneous, pulmonary and renal involvement: a clear, consensual definition of the clinical feature, a brief epidemiological description including an estimate of the prevalence reported in the main clinical series and a brief list of the key clinical and diagnostic features that could help physicians clearly identify these features. Unfortunately we found that the body of evidence relied predominantly on information retrieved from individual cases, and the scientific information provided was heterogeneous. The analysis of types of involvement was biased due to the unbalanced reporting of severe cases over non-severe cases, although the main sources of bias were the heterogeneous definitions of organ involvement (or even the lack of definition in some studies) and the heterogeneous diagnostic approach used in studies to investigate involvment of each organ. The proposals included in this article are a first step to developing an optimal diagnostic approach to systemic involvement in primary SS and may pave the way for further development of evidence-based diagnostic and therapeutic guidelines. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights

  19. Can we routinely measure patient involvement in treatment decision-making in chronic kidney care? A service evaluation in 27 renal units in the UK. (United States)

    Durand, Marie-Anne; Bekker, Hilary L; Casula, Anna; Elias, Robert; Ferraro, Alastair; Lloyd, Amy; van der Veer, Sabine N; Metcalfe, Wendy; Mooney, Andrew; Thomson, Richard G; Tomson, Charles R V


    Shared decision making is considered an important aspect of chronic disease management. We explored the feasibility of routinely measuring kidney patients' involvement in making decisions about renal replacement therapy (RRT) in National Health Service settings. We disseminated a 17-item paper questionnaire on involvement in decision-making among adult patients with established kidney failure who made a decision about RRT in the previous 90 days (Phase 1) and patients who had been receiving RRT for 90-180 days (Phase 2). Recruitment rates were calculated as the ratio between the number of included and expected eligible patients (I : E ratio). We assessed our sample's representativeness by comparing demographics between participants and incident patients in the UK Renal Registry. Three hundred and five (Phase 1) and 187 (Phase 2) patients were included. For Phase 1, the I : E ratio was 0.44 (range, 0.08-2.80) compared with 0.27 (range, 0.04-1.05) in Phase 2. Study participants were more likely to be white compared with incident RRT patients (88 versus 77%; P measurement of patient involvement in established kidney disease treatment decisions is feasible, but there are challenges in selecting the measure needed to capture experience of involvement, reducing variation in response rate by service and identifying when to capture experience in a service managing people's chronic disease over time.

  20. AQP2 exocytosis in the renal collecting duct -- involvement of SNARE isoforms and the regulatory role of Munc18b. (United States)

    Procino, Giuseppe; Barbieri, Claudia; Tamma, Grazia; De Benedictis, Leonarda; Pessin, Jeffrey E; Svelto, Maria; Valenti, Giovanna


    Vasopressin regulates the fusion of the water channel aquaporin 2 (AQP2) to the apical membrane of the renal collecting-duct principal cells and several lines of evidence indicate that SNARE proteins mediate this process. In this work MCD4 renal cells were used to investigate the functional role of a set of Q- and R-SNAREs, together with that of Munc18b as a negative regulator of the formation of the SNARE complex. Both VAMP2 and VAMP3 were associated with immunoisolated AQP2 vesicles, whereas syntaxin 3 (Stx3), SNAP23 and Munc18 were associated with the apical plasma membrane. Co-immunoprecipitation experiments indicated that Stx3 forms complexes with VAMP2, VAMP3, SNAP23 and Munc18b. Protein knockdown coupled to apical surface biotinylation demonstrated that reduced levels of the R-SNAREs VAMP2 and VAMP3, and the Q-SNAREs Stx3 and SNAP23 strongly inhibited AQP2 fusion at the apical membrane. In addition, knockdown of Munc18b promoted a sevenfold increase of AQP2 fused at the plasma membrane without forskolin stimulation. Taken together these findings propose VAMP2, VAMP3, Stx3 and SNAP23 as the complementary set of SNAREs responsible for AQP2-vesicle fusion into the apical membrane, and Munc18b as a negative regulator of SNARE-complex formation in renal collecting-duct principal cells.

  1. Prognostic Factors for Renal Cell Carcinoma Subtypes Diagnosed According to the 2016 WHO Renal Tumor Classification: a Study Involving 928 Patients. (United States)

    Kuthi, Levente; Jenei, Alex; Hajdu, Adrienn; Németh, István; Varga, Zoltán; Bajory, Zoltán; Pajor, László; Iványi, Béla


    The morphotype and grade of renal cell carcinoma (RCC) in 928 nephrectomies were reclassified according to the 2016 WHO classification in order to analyze the distribution and outcomes of RCC subtypes in Hungary, to assess whether microscopic tumor necrosis is an independent prognostic factor in clear cell RCC, and to study whether a two-tiered grading (low/high) for clear cell and papillary RCC provides similar prognostic information to that of the four-tiered ISUP grading system. 83.4% of the cohort were clear cell, 6.9% papillary, 4.5% chromophobe, 2.3% unclassified, 1.1% Xp11 translocation, 1.1% clear cell papillary, 0.3% collecting duct and 0.1% mucinous tubular and spindle cell RCCs. RCC occurred in 16 patients with end-stage kidney disease and none of them displayed features of acquired cystic kidney disease-associated RCC. The 5-year survival rates were as follows: chromophobe 100%, clear cell papillary 100%, clear cell low-grade 96%, papillary type 1 92%, clear cell high-grade 63%, papillary type 2 65%, unclassified 46%, Xp11 translocation 20%, and collecting duct 0%. The 5-year survival rates in low-grade and high-grade papillary RCC were 95% and 59%, respectively. In clear cell RCC, only the grade, the stage and the positive surgical margin proved to be independent prognostic factors statistically. Overall, papillary RCC occurred relatively infrequently; microscopic tumor necrosis in clear cell RCC did not predict the outcome independently of the tumor grading; and the assignment of clear cell and papillary RCCs into low-grade or high-grade tumors was in terms of survival no worse than the ISUP grading.

  2. Factors influencing recoverability of renal function after urinary diversion through percutaneous nephrostomy

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    Umesh Sharma


    Conclusions: CT, parenchymal echogenicity, CMD, pre-PCN creatinine, and status of c/l kidney are the only independent variables which can predict the renal function while other variables like renal size, urine output, infection, hydronephrosis lost their statistical significance in multivariate analysis. Furthermore, IPP measured before PCN directly correlated with daily urine output and diff. %CrCl.

  3. Late lung parenchymal changes on HRCT in children with mycoplasma pneumonia

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    Lee, Soo Hyeon; Kim, Joung Sook; Yoon, Jung Hee; Hur, Gham; Kim, Chang Gun [Inje Univ. Sanggye Paik Hospital, Seoul (Korea, Republic of)


    To evaluate late lung parenchymal change, as seen on high-resolution CT(HRCT) in children with mycoplasma pneumonia. Twenty-three patients [15 boys and 8 girls aged two to 13 (mean, 6) years] with mycoplasma pneumonia underwent HRCT four to 39 (mean, 10) months after initial infection. Using increased mycoplasma antibody titer( > 1;640) mycoplasma pneumonia was diagnosed, and patients were divided into two groups : high titer group (antibody titer > 1:5120), and lower titer group ( < 1:5120). CT scans were performed using 2mm collimation and 5-10mm interval from apex to diaphragm. In seven patients who were cooperative, both inspiratory scans were obtained at a window width of 1600 HU and level of 700. HRCT findings of mosaic low attenuations and changes in bronchioles and bronchial walls were assessed by three radiologists and correlated with initial chest radiographic findings. On HRCT, 17 of 23 patients (74%) demonstrated abnormal findings. These included mosaic attenuation of lung density alone in 11 of 17 patients (65%), mosaic attenuation associated with bronchiectasis in five(29%), and bronchiectasis only in one(6%). Mosaic attenuation was more accentuated on expiratory scans than on inspiratory. These findings were obtained in 10 of 12 high titer group and in 7 of 11 in the lower titer group. In 15 of 23 patients(65%), involved areas seen on HRCT exactly corresponded with initially involved areas seen on chest radiographs (CXR). Two patients in whom findings on initial CXR were normal showed mosaic attenuation on HRCT. Six patients in whom such findings were abnormal showed normal findings on HRCT, a fact which reflected their complete recovery. The most common late parenchymal change in mycoplasma pneumonia, as seen on HRCT, was mosaic attenuation of lung density followed by bronchiectasis. The latter is presumably due to bronchiolitis obliterans, a well-known complication. We believe that HRCT is very useful for the evaluation of long-term sequelae of

  4. Acute dialysis and continuous renal replacement: the emergence of new technology involving the nephrologist in the intensive care setting. (United States)

    Yagi, N; Paganini, E P


    The emergence of dialytic support for patients with reversible renal failure was one of the most significant advances in critical care medicine. Supporting a patient with a failed organ till organ recovery has not had the same success with other organ failures. Despite the indispensable nature of the support, dialysis was intermittent at best, and carried its own morbidity. The emergence of a "continuous" dialysis delivery system, originally through an arteriovenous access and later through veno-venous methodology, began to simulate the continuity of the natural kidney, and lifted much of the fluid and drug restrictions imposed by the intermittent nature of standard dialytic therapies. Components of the system were next reviewed for improvement and biocompatability. Differences in patient outcome were documented with various component comparisons, and disparate patient tolerance of delivery modality was also clearly proven. The hemodynamic stability of continuous treatment created utilization to be focused on the more unstable, the more severely compromised patient group. In this context, comparative studies with intermittent delivery methods showed improved hemodynamic stability among patients treated with continuous renal replacement therapies (CRRT), but no clear difference in patient mortality. Patient characteristics and severity scoring have recently been undertaken to better describe the population, and attempts at dialysis dosing is currently being developed for ARF dialysis recipients. Early results seem to point toward a dialysis dose effect on mortality in certain groups of ICU acute renal failure patients. However, the dialytic process is only depurative and artificial. Plastic membrane bio-incompatibility, human physiological responses to foreign material exposure, either in the circuit material itself or introduced from therapy methodology, pose practical and theoretical problems. Recent advances in the field of bio-artificial technology have allowed

  5. [Arterial reconstructive surgery of a coarctation of the abdominal aorta with involvement of renal and visceral arteries. Clinical and imagiologic evaluation 26 years after the operation]. (United States)

    Dinis da Gama, A


    The clinical case of a 13 years old female is reported, with the diagnosis of congenital coarctation of the abdominal aorta, with involvement of renal and visceral arteries, causing arterial hypertension and a systolic bruit in the auscultation of the epigastric and umbilical areas. Conventional angiography disclosed a stenotic process of the upper abdominal aorta, with concomitant ostial stenosis of the renal and digestive arteries, and post-stenotic dilatation of the celiac axis and superior mesenteric artery. The physical development of the patient, close to the adult pattern, allowed the performance of a complex revascularization procedure,accomplished in May 1984, consisting in the implantation of an aorto-aortic bypass graft, through the diaphragm, followed by visceral and renal revascularization, by means of independent prosthesis taken from the aortic bypass. The post-operative course was uneventful and blood pressure returned immediately to normal levels. Reviewed recently, the patient was found in good clinical condition,asymptomatic and with normal blood pressure, developing a normal family, social and Professional life. An Angio-CT evaluation, performed in February 2010, almost 26 years after the operation, revealed the complex revascularization procedure patent and working in excellent condition. To our knowledge, this seems to be the longest follow up of such a procedure employed successfully in a very rare clinical entity, thus justifying its presentation and divulgation.

  6. Severe renal bleeding caused by a ruptured renal sheath: case report of a rare complication of percutaneous nephrolithotomy

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    Gunes Ali


    Full Text Available Abstract Background Percutaneous nephrolithotomy is a minimally invasive intervention for renal stone disease. Complications, which are rare and usually presented as case reports, are diversified as the utilization of the procedure is expanded. The procedure causes less blood loss and less morbidity when compared to open surgical procedures. Yet, there are some reports involving severe bleeding and relevant morbidity during surgery. These are usually related with the surgical technique or experience of the surgeon. Renal sheaths are designed to cause minimal trauma inside the kidney and, to our knowledge, there are no reports presenting the rupture of a sheath causing severe bleeding during the procedure. Case report We present an adult patient who had severe bleeding during percutaneous nephrolithotomy due to parenchymal injury caused by a ruptured renal sheath. During retrieval, due probably to rough handling of the equipment, a piece of stone with serrated edges ruptured the tip of the sheath, and this tip caused damage inside the kidney. The operation was terminated and measures were taken to control bleeding. The patient was transfused with a total of 1600 ml of blood, and the stones were cleared in a second look operation. Conclusion Although considered to be a minimally invasive procedure, some unexpected complications may arise during percutaneous nephrolithotomy. After being fragmanted, stone pieces may damage surgical equipment, causing acute and severe harm to the kidney. Surgeons must manipulate the equipment with fine and careful movements in order to prevent this situation.

  7. Clinical significance of parenchymal excretion delay of unilateral graft on hepatobiliary scintigraphy after dual grafts living donors liver transplantation

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    Yang, Y. J.; Kim, J. S.; Lee, S. K.; Hwang, S.; Park, G. M.; Lee, Y. J.; Moon, D. H. [Asan Medical Center, Seoul (Korea, Republic of)


    Clinical significance of unilateral graft parenchymal excretion delay (UED) after dual grafts living donors liver transplantation (DLDLT) on hepatobiliary scintigraphy (HBS) may be different from that of liver transplantation with single graft considering the immune reaction and surgical techniques. The purpose of this study was to evaluate the clinical significance of UED after DLDLT. Clinicopathologic findings of 136 patients (48{+-}9 yrs; M/F=119/17) who underwent HBS using Tc-99m DISIDA after DLDLT were retrospectively evaluated. UED was considered when HBS showed delayed parenchymal excretion of unilateral graft with normal contralateral graft and HBS findings of UED were further classified into biliary obstructive (BO) or non-biliary obstructive (NBO) pattern according to biliary to enteric transit time. The etiology and outcome of UED were determined by clinical and pathologic findings. Of 136 patients, 18 showed UED (Rt/Lt=11/7) within 1 mo (1.6{+-}1.4 wk) after transplantation and 18 (Rt/Lt=6/12) after 1 mo (7.7{+-}5.0 mo). Of 18 patients with UED within 1 mo, 16 resulted from the early postoperative graft dysfunction (EGD) which showed NBO pattern in all but three (81%), and 2 resulted from biliary stenosis of anastomotic site. After 1 mo, 9 of 18 UED resulted from biliary stenosis and parenchymal dysfunction due to unknown but non-biliary etiology in 7, acute rejection in 1, and vascular insufficiency in 1. Four of 9 UED with biliary stenosis showed BO pattern on HBS and 6 of 9 UED with parenchymal dysfunction showed NBO pattern. UED due to EGD was spontaneously resolved and longterm outcome of the involved graft were not different from the contralateral normal graft. Most of unilateral graft parenchymal excretion delay within 1 mo after DLDLT showed NBO pattern on HBS and resulted from transient EGD without longterm prognostic value. UED after 1 mo resulted from variable etiology and needed further diagnostic work-up regardless of scintigraphic pattern.

  8. Need for a nomogram of renal sizes in the Indian population- findings from a single centre sonographic study

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    Prakash Muthusami


    Full Text Available Background & objectives: Renal size is an important parameter used in the diagnosis and follow up of renal diseases. However, while making decisions, clinicians must be aware of the dependence of these dimensions on the ethnicity of the individual, independent of anthropometric indices. There is no established nomogram for renal sizes in the Indian population. The aim of this study was to assess the applicability of oft-quoted ranges of normal renal sizes in our population. Methods: Renal dimensions including length, width and parenchymal thickness were sonographically measured in 140 individuals with no renal disease. Analysis was done for differences due to age, gender and laterality. The correlation of renal dimensions with anthropometric parameters like weight, height, body mass index (BMI and body surface area (BSA was analyzed. Results: The means of length, width and parenchymal thickness of all 280 kidneys of 140 patients were 9.65 ± 0.63, 4.5 ± 0.42 and 2.04 ± 0.2 cm, respectively. There was a significant difference in parenchymal thickness between the right and left kidneys, while there was no significant right-left difference in length or width. Gender-wise analysis showed significant differences between male and female renal breadths but not length and parenchymal thickness. Age group-wise analysis showed significant decrease in renal length and parenchymal thickness beyond the seventh decade. There was a moderate positive correlation of bilateral renal length with body weight and BSA, and a weak positive correlation with body height and BMI. Interpretation & conclusions: Renal sizes in our population are in contrast to commonly quoted normal values in literature. Conclusions about renal sizes need to be made with reference to nomograms and should not be based upon data from other populations. We also present formulae whereby to derive renal sizes from anthropometric indices in our population.

  9. Renal malignant solitary fibrous tumor with single lymph node involvement: report of unusual metastasis and review of the literature

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    Mearini E


    Full Text Available Ettore Mearini,1 Giovanni Cochetti,1 Francesco Barillaro,1 Sonia Fatigoni,2 Fausto Roila2 1Department of Medical-Surgical Specialties and Public Health, Division of Urological Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy; 2Medical Oncology, S Maria Hospital, Terni, Italy Abstract: Solitary fibrous tumors are rare mesenchymal spindle cell neoplasms that are usually found in the pleura. The kidneys are an uncommon site and only few cases of renal solitary fibrous tumor exhibit malignant behavior metastasizing to the liver, lung, and bone through the hematogenous pathway. Purpose: To describe the first case of lymph node metastasis from renal solitary fibrous tumor in order to increase the knowledge about the malignant behavior of these tumors. Patients and methods: A 19-year-old female patient had intermittent hematuria for several months without flank pain or other symptoms. A chest and abdomen CT scan was performed and showed a multi-lobed bulky solid mass of 170 × 98 × 120 mm in the left kidney. One day before the surgery, the left renal artery was catheterized and the kidney embolization was performed using a Haemostatic Absorbable Gelatin Sponge and polyvinyl alcohol. We then performed a radical nephrectomy with hilar, para-aortic, and inter-aortocaval lymphadenectomy. Results: Estimated intraoperative blood loss was 200 mL and the operative time was 100 minutes. No postoperative complications occurred. The hospital stay was 7 days long. The histological examination was malignant solitary fibrous tumor of the kidney. Cancerous tissue showed cellular atypia, with an increased mitotic index (up to 7 × 10 hpf. Immunohistochemical analysis showed positive results for CD34, BCL2, partial expression of HBME1, and occasionally of synaptophysin. Histological evaluation confirmed the presence of metastasis in one hilar node. The patient did not receive any other therapy. At 30-month follow-up, the

  10. Renal cell carcinoma with inferior vena cava involvement: Prognostic effect of tumor thrombus consistency on cancer specific survival. (United States)

    Mager, Rene; Daneshmand, Siamak; Evans, Christopher P; Palou, Joan; Martínez-Salamanca, Juan I; Master, Viraj A; McKiernan, James M; Libertino, John A; Haferkamp, Axel; Haferkamp, Axel; Capitanio, Umberto; Carballido, Joaquín A; Chantada, Venancio; Chromecki, Thomas; Ciancio, Gaetano; Daneshmand, Siamak; Evans, Christopher P; Gontero, Paolo; González, Javier; Hohenfellner, Markus; Huang, William C; Koppie, Theresa M; Libertino, John A; Espinós, Estefanía Linares; Lorentz, Adam; Martínez-Salamanca, Juan I; Master, Viraj A; McKiernan, James M; Montorsi, Francesco; Novara, Giacomo; O'Malley, Padraic; Pahernik, Sascha; Palou, Joan; Moreno, José Luis Pontones; Pruthi, Raj S; Faba, Oscar Rodriguez; Russo, Paul; Scherr, Douglas S; Shariat, Shahrokh F; Spahn, Martin; Terrone, Carlo; Tilki, Derya; Vázquez-Martul, Dario; Donoso, Cesar Vera; Vergho, Daniel; Wallen, Eric M; Zigeuner, Richard


    Renal cell carcinoma forming a venous tumor thrombus (VTT) in the inferior vena cava (IVC) has a poor prognosis. Recent investigations have been focused on prognostic markers of survival. Thrombus consistency (TC) has been proposed to be of significant value but yet there are conflicting data. The aim of this study is to test the effect of IVC VTT consistency on cancer specific survival (CSS) in a multi-institutional cohort. The records of 413 patients collected by the International Renal Cell Carcinoma-Venous Thrombus Consortium were retrospectively analyzed. All patients underwent radical nephrectomy and tumor thrombectomy. Kaplan-Meier estimate and Cox regression analyses investigated the impact of TC on CSS in addition to established clinicopathological predictors. VTT was solid in 225 patients and friable in 188 patients. Median CSS was 50 months in solid and 45 months in friable VTT. TC showed no significant association with metastatic spread, pT stage, perinephric fat invasion, and higher Fuhrman grade. Survival analysis and Cox regression rejected TC as prognostic marker for CSS. In the largest cohort published so far, TC seems not to be independently associated with survival in RCC patients and should therefore not be included in risk stratification models. J. Surg. Oncol. 2016;114:764-768. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  11. Isolated Renal Hydatidosis Presenting as Renal Mass: A Diagnostic Dilemma

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    Datteswar Hota


    Full Text Available Hydatid disease is a parasitic infestation by larval form of Echinococcus granulosus. Isolated renal involvement is extremely rare. There are no specific signs and symptoms of renal hydatidosis. However it may present as palpable mass, flank pain, hematuria, malaise, fever, and hydatiduria or as a complication of it such as infection, abscess, hemorrhage, necrosis and pelviureteric junction obstruction, renal failure etc. Except hydatiduria, none are pathognomonic for renal hydatidosis. There is no literature on renal hydatidosis presenting as renal mass we report 2 cases of isolated renal hydatidosis, which mimicked a renal mass on imaging study.

  12. Calcineurin inhibitor-induced and Ras-mediated overexpression of VEGF in renal cancer cells involves mTOR through the regulation of PRAS40.

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    Aninda Basu

    Full Text Available Malignancy is a major problem in patients treated with immunosuppressive agents. We have demonstrated that treatment with calcineurin inhibitors (CNIs can induce the activation of proto-oncogenic Ras, and may promote a rapid progression of human renal cancer through the overexpression of vascular endothelial growth factor (VEGF. Interestingly, we found that CNI-induced VEGF overexpression and cancer cell proliferation was inhibited by rapamycin treatment, indicating potential involvement of the mammalian target of rapamycin (mTOR pathway in this tumorigenic process. Here, we examined the role of mTOR pathway in mediating CNI- and Ras-induced overexpression of VEGF in human renal cancer cells (786-0 and Caki-1. We found that the knockdown of raptor (using siRNA significantly decreased CNI-induced VEGF promoter activity as observed by promoter-luciferase assay, suggesting the role of mTOR complex1 (mTORC1 in CNI-induced VEGF transcription. It is known that mTOR becomes activated following phosphorylation of its negative regulator PRAS40, which is a part of mTORC1. We observed that CNI treatment and activation of H-Ras (through transfection of an active H-Ras plasmid markedly increased the phosphorylation of PRAS40, and the transfection of cells using a dominant-negative plasmid of Ras, significantly decreased PRAS40 phosphorylation. Protein kinase C (PKC-ζ and PKC-δ, which are critical intermediary signaling molecules for CNI-induced tumorigenic pathway, formed complex with PRAS40; and we found that the CNI treatment increased the complex formation between PRAS40 and PKC, particularly (PKC-ζ. Inhibition of PKC activity using pharmacological inhibitor markedly decreased H-Ras-induced phosphorylation of PRAS40. The overexpression of PRAS40 in renal cancer cells significantly down-regulated CNI- and H-Ras-induced VEGF transcriptional activation. Finally, it was observed that CNI treatment increased the expression of phosho-PRAS40 in renal tumor

  13. Quantitative scintigraphic parameters for the assessment of renal transplant patients

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    El Maghraby, T.A.F.; Eck-Smit, B.L.F. van; Pauwels, E.K.J. [Department of Radiology, Division of Nuclear Medicine, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden (Netherlands); Fijter, J.W. de [Department of Nephrology, Leiden University Medical Centre, Leiden (Netherlands)


    Radionuclide renal diagnostic studies play an important role in assessing renal allograft function especially in the early post transplant period. In the last two decades various quantitative parameters have been derived from the radionuclide renogram to facilitate and confirm the changes in perfusion and/or function of the kidney allograft. In this review article we discuss the quantitative parameters that have been used to assess graft condition with emphasis on the early post-operative period. These quantitative methods were divided into parameters used for assessing renal graft perfusion and parameters used for evaluating parenchymal function. The blood flow in renal transplants can be quantified by measuring (a) the rate of activity appearance in the kidney graft; (b) the ratio of the integral activity under the transplanted kidney and arterial curves e.g. Hilson's perfusion index and Kircher's kidney/aortic ratio; (c) calculating the renal vascular transit time by deconvolution analysis. The literature overview on these parameters showed us that they have some practical disadvantages of requiring high quality bolus injection and numerical variations related to changes in the site and size of regions of interest. In addition, the perfusion parameter values suffer from significant overlap when various graft pathologies coexist. Quantitative evaluation of the graft parenchymal extraction and excretion was assessed by parameters derived from {sup 123}I/{sup 131}I-OIH,{sup 99m}Tc-DTPA or {sup 99m}Tc-MAG3 renograms. We review in this article a number of parenchymal parameters which include (1) plasma clearance methods like glomerular filtration rate (GFR) and effective renal plasma flow (ERPF); (2) renal transit times such as parenchymal mean transit time, T{sub max}, T{sub 1/2}; (3) parenchymal uptake and excretion indices as the accumulation index, graft uptake capacity at 2 and 10 min, excretion index and elimination index. These indices, however, are

  14. Peeping into human renal calcium oxalate stone matrix: characterization of novel proteins involved in the intricate mechanism of urolithiasis.

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    Kanu Priya Aggarwal

    Full Text Available BACKGROUND: The increasing number of patients suffering from urolithiasis represents one of the major challenges which nephrologists face worldwide today. For enhancing therapeutic outcomes of this disease, the pathogenic basis for the formation of renal stones is the need of hour. Proteins are found as major component in human renal stone matrix and are considered to have a potential role in crystal-membrane interaction, crystal growth and stone formation but their role in urolithiasis still remains obscure. METHODS: Proteins were isolated from the matrix of human CaOx containing kidney stones. Proteins having MW>3 kDa were subjected to anion exchange chromatography followed by molecular-sieve chromatography. The effect of these purified proteins was tested against CaOx nucleation and growth and on oxalate injured Madin-Darby Canine Kidney (MDCK renal epithelial cells for their activity. Proteins were identified by Matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF MS followed by database search with MASCOT server. In silico molecular interaction studies with CaOx crystals were also investigated. RESULTS: Five proteins were identified from the matrix of calcium oxalate kidney stones by MALDI-TOF MS followed by database search with MASCOT server with the competence to control the stone formation process. Out of which two proteins were promoters, two were inhibitors and one protein had a dual activity of both inhibition and promotion towards CaOx nucleation and growth. Further molecular modelling calculations revealed the mode of interaction of these proteins with CaOx at the molecular level. CONCLUSIONS: We identified and characterized Ethanolamine-phosphate cytidylyltransferase, Ras GTPase-activating-like protein, UDP-glucose:glycoprotein glucosyltransferase 2, RIMS-binding protein 3A, Macrophage-capping protein as novel proteins from the matrix of human calcium oxalate stone which play a critical role in kidney stone

  15. Seven-year survival after pancreaticoduodenectomy for early recurrent renal cell carcinoma involving the duodenum A case report. (United States)

    Cannistra', Marco; Ruggiero, Michele; Bonaiuto, Elisabetta; Vaccarisi, Sebastiano; Naso, Agostino; Grande, Raffaele; Nardo, Bruno


    Il cancro del rene rappresenta la 13a forma di tumore a livello mondiale e risulta incrementata, dal punto di vista epidemiologico, di circa il 2% annuo nelle ultime due decadi. Studi recenti hanno mostrato un numero complessivo di 65,150 nuovi casi di cancro renale diagnosticato nei paesi occidentali e circa 13.680 morti. Il carcinoma a cellule renali rappresenta approssimativamente il 90% di tutte le forme di cancro renale e presenta un tasso di mortalità di circa 4 soggetti ogni 100000 abitanti per anno. Il carcinoma a cellule renali ha, spesso, un particolare corteo sintomatologico caratterizzato da dolore addominale, masse addominali ed ematuria. Caratteristico è il fatto che circa il 25-30% dei pazienti, all’atto della diagnosi, presentano già metastasti a distanza; un ulteriore 30-50%, inoltre, svilupperanno metastasi nel corso della malattia, anche dopo molti anni dall’operazione chirurgica di nefrectomia radicale. Il Cancro del Rene a Cellule Chiare metastatizza in genere per via linfatica, ematogena, transperitoneale o per invasione diretta, ed i siti di metastasi più comuni sono il polmone ed i linfonodi, seguiti dalle ossa e dal fegato. Tra tutte le possibili localizzazioni ai segmenti addominali, il duodeno rappresenta la sede meno colpita: quando coinvolta, viene, in genere, invasa la regione periampollare ed il bulbo del duodeno. Tali localizzazioni danno segno di sè, spesso tardivamente, con sanguinamenti (ematemesi) o ostruzioni del tratto gastrointestinale superiore (vomito). Il nostro caso clinico descrive un carcinoma a cellule renali che si presentava, dopo soli 5 mesi dalla nefrectomia radicale destra, con sanguinamento del tratto gastrointestinale superiore e metastasi a carico del duodeno, e che è stato trattato chirurgicamente con duodenocefalopancreasectomia. L’intervento chirurgico, noto per essere altamente demolitivo ed associato ad elevata morbilità, applicato a recidiva precoce di cancro, ha garantito un ottimo risultato

  16. 5-Lypoxygenase products are involved in renal tubulointerstitial injury induced by albumin overload in proximal tubules in mice.

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    Sharon Schilling Landgraf

    Full Text Available The role of albumin overload in proximal tubules (PT in the development of tubulointerstitial injury and, consequently, in the progression of renal disease has become more relevant in recent years. Despite the importance of leukotrienes (LTs in renal disease, little is known about their role in tubulointerstitial injury. The aim of the present work was to investigate the possible role of LTs on tubulointerstitial injury induced by albumin overload. An animal model of tubulointerstitial injury challenged by bovine serum albumin was developed in SV129 mice (wild-type and 5-lipoxygenase-deficient mice (5-LO(-/-. The changes in glomerular morphology and nestin expression observed in wild-type mice subjected to kidney insult were also observed in 5-LO(-/- mice. The levels of urinary protein observed in the 5-LO(-/- mice subjected or not to kidney insult were lower than those observed in respective wild-type mice. Furthermore, the increase in lactate dehydrogenase activity, a marker of tubule damage, observed in wild-type mice subjected to kidney insult did not occur in 5-LO(-/- mice. LTB4 and LTD4, 5-LO products, decreased the uptake of albumin in LLC-PK1 cells, a well-characterized porcine PT cell line. This effect correlated with activation of protein kinase C and inhibition of protein kinase B. The level of proinflammatory cytokines, tumor necrosis factor-α and interleukin (IL-6, increased in mice subjected to kidney insult but this effect was not modified in 5-LO(-/- mice. However, 5-LO(-/- mice subjected to kidney insult presented lower macrophage infiltration and higher levels of IL-10 than wild-type mice. Our results reveal that LTs have an important role in tubulointerstitial disease induced by albumin overload.

  17. 5-Lypoxygenase products are involved in renal tubulointerstitial injury induced by albumin overload in proximal tubules in mice. (United States)

    Landgraf, Sharon Schilling; Silva, Leandro Souza; Peruchetti, Diogo Barros; Sirtoli, Gabriela Modenesi; Moraes-Santos, Felipe; Portella, Viviane Gomes; Silva-Filho, João Luiz; Pinheiro, Carla Silva; Abreu, Thiago Pereira; Takiya, Christina Maeda; Benjamin, Claudia Farias; Pinheiro, Ana Acacia Sá; Canetti, Claudio; Caruso-Neves, Celso


    The role of albumin overload in proximal tubules (PT) in the development of tubulointerstitial injury and, consequently, in the progression of renal disease has become more relevant in recent years. Despite the importance of leukotrienes (LTs) in renal disease, little is known about their role in tubulointerstitial injury. The aim of the present work was to investigate the possible role of LTs on tubulointerstitial injury induced by albumin overload. An animal model of tubulointerstitial injury challenged by bovine serum albumin was developed in SV129 mice (wild-type) and 5-lipoxygenase-deficient mice (5-LO(-/-)). The changes in glomerular morphology and nestin expression observed in wild-type mice subjected to kidney insult were also observed in 5-LO(-/-) mice. The levels of urinary protein observed in the 5-LO(-/-) mice subjected or not to kidney insult were lower than those observed in respective wild-type mice. Furthermore, the increase in lactate dehydrogenase activity, a marker of tubule damage, observed in wild-type mice subjected to kidney insult did not occur in 5-LO(-/-) mice. LTB4 and LTD4, 5-LO products, decreased the uptake of albumin in LLC-PK1 cells, a well-characterized porcine PT cell line. This effect correlated with activation of protein kinase C and inhibition of protein kinase B. The level of proinflammatory cytokines, tumor necrosis factor-α and interleukin (IL)-6, increased in mice subjected to kidney insult but this effect was not modified in 5-LO(-/-) mice. However, 5-LO(-/-) mice subjected to kidney insult presented lower macrophage infiltration and higher levels of IL-10 than wild-type mice. Our results reveal that LTs have an important role in tubulointerstitial disease induced by albumin overload.

  18. Abdominal polytrauma and parenchymal organs; Abdominelles Polytrauma und Parenchymorgane

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    Krestan, C.R. [Medizinische Universitaet Wien AKH, Abteilung fuer Allgemeine Radiologie und Kinderradiologie, Klinik fuer Radiologie und Nuklearmedizin, Wien (Austria)


    The acute radiological diagnostics of polytrauma patients has become an essential part of the interdisciplinary treatment in the emergency room. The incidence of polytrauma patients with an injury severity score (ISS) > 16 is approximately 450 cases/million inhabitants/year in Europe. Injuries of the parenchymal organs are of utmost importance for the prognosis and treatment of these patients. The injury patterns are complex and a great deal of experience is necessary to be able to obtain the correct diagnosis within minutes. This review article deals with the radiological diagnostics and grading of the severity of injuries to the spleen, liver, pancreas and kidneys. The use of ultrasound for the evaluation of polytraumatized patients will be discussed. The most important trauma-associated findings for the above mentioned organs using multidetector computed tomography (MDCT) will be described and illustrated by dedicated case findings. Ultrasound contrast agents can supply valuable, additional diagnostic information in the evaluation of polytraumatized patients. Computed tomography has become established as the most relevant imaging modality in severe trauma. Innovative organ-adapted and contrast application protocols improve the diagnostic performance of MDCT. The use of focused assessment sonography for trauma (FAST) scanning as a screening tool is in agreement with the other clinical disciplines of the trauma team. The use of MDCT is trauma-dependent and the classification of the severity of the different parenchymal organ injuries is ultimately decisive for further treatment and prognosis of trauma victims. (orig.) [German] Die akute radiologische Diagnostik bei Polytraumapatienten ist in den letzten Jahren unerlaesslicher Bestandteil der interdisziplinaeren Versorgung im Schockraum geworden. Die Inzidenz von Polytraumata mit einem Injury Severity Score (ISS) > 16 betraegt in Europa ca. 450/Mio. Einwohner/Jahr. Verletzungen abdomineller Parenchymorgane sind von

  19. Clinicopathologic study of pineal parenchymal tumors of intermediate differentiation. (United States)

    Ito, Tamio; Kanno, Hiromi; Sato, Ken-ichi; Oikawa, Mitsuteru; Ozaki, Yoshimaru; Nakamura, Hirohiko; Terasaka, Shunsuke; Kobayashi, Hiroyuki; Houkin, Kiyohiro; Hatanaka, Kanako; Murata, Jyun-ichi; Tanaka, Shinya


    Pineal parenchymal tumors of intermediate differentiation (PPTID) are extremely rare tumor entities, and only limited data are available regarding their pathologic features and biologic behaviors. Because grading criteria of pineal parenchymal tumors (PPTs) have yet to be established, the treatment strategy and prognosis of PPTIDs remain controversial. We describe the clinicopathologic study of six patients with PPTID and compare responses for the treatment and prognosis with cases of pineocytoma (PC) and pineoblastoma (PB). From this analysis, we attempt to clarify the treatment strategy for PPTIDs. This study included 15 patients with PPTs, consisting of 6 PCs, 6 PPTIDs, and 3 PBs. We focused on the 6 patients with PPTIDs. All PPTID cases were treated surgically, and radiotherapy and chemotherapy were administered as adjuvant therapies in some cases. We have earlier reported the histopathologic study (Neuropathology 32:647-653, 2012). Briefly, we examined mitotic figures and necrosis by hematoxylin-eosin staining and immunohistochemical markers such as neuronal markers (synaptophysin, neurofilament (NF), and neuronal nuclear antigen), and an MIB-1 labeling index was determined. In the PPTID cases, the extent of resection was variable and the recurrence rates among patients varied according to stage and treatment. All PC patients underwent total resection with no recurrence. All PB patients underwent resection and adjuvant therapy with radiotherapy and chemotherapy. There were no recurrences in patients with PC or PB. The results of histopathologic findings have been already reported as mentioned above. Briefly, the results indicated no mitotic figure or necrosis in any of the six cases of PPTID, but those features were observed in PB cases. All cases even including PC and PB were immunopositive for neuronal markers. The MIB-1 labeling index of PPTID was 3.5%, whereas it was 0% in PC and 10.5% in PB. Good radiosensitivity of PPTIDs was observed in our series

  20. Involvement of the renal kallikrein-kinin system in K(+)-induced diuresis and natriuresis in anesthetized rats. (United States)

    Suzuki, T; Katori, M; Fujita, T; Kumagai, Y; Majima, M


    Intravenous infusion of a high-K(+) solution (67.5 mM KCl, 67.5 mM NaCl) to anesthetized rats increased urine volume by 47.6% after 60 min, compared with infusion of a Na(+) solution (135 mM NaCl). This treatment also increased urinary excretion of Na(+) by 32.2%, in parallel with an increase in excretion of K(+) or Cl(-). Urinary excretion of kallikrein increased within 60 min after the start of K(+) infusion. A bradykinin B(2) receptor antagonist, 8-[3-[N-[(E)-3-(6-acetamidopyridin-3-yl)acryloylglycyl]-N-me thylamino ]-2,6-dichlorobenzyloxy]-2-methylquinoline (FR173657; 1.0 mg/kg, i.v. ), inhibited the K(+)-induced diuresis and natriuresis by 41.0% and 26.7%, respectively. These results indicate that K(+) load induces diuresis and natriuresis through the renal kallikrein-kinin system in rats.

  1. Lymphopaenia, anti-Ro/anti-RNP autoantibodies, renal involvement and cyclophosphamide use correlate with increased risk of herpes zoster in patients with systemic lupus erythematosus. (United States)

    Hu, Stephen Chu-Sung; Lin, Chi-Ling; Lu, Yi-Wei; Chen, Gwo-Shing; Yu, Hsin-Su; Wu, Ching-Shuang; Lan, Cheng-Che E


    Herpes zoster occurs with increased frequency in patients with systemic lupus erythematosus (SLE). The aim of this study was to identify and evaluate clinical and laboratory risk factors associated with development of herpes zoster in patients with SLE. A retrospective case-control study was performed in a population of patients with SLE. Patients were identified as cases if their first episode of herpes zoster occurred after diagnosis of SLE. Patients with SLE who never developed herpes zoster were enrolled as controls. Medical charts and laboratory data for both cases and control patients were comprehensively reviewed. A total of 65 cases and 105 controls were included. Risk factors associated with the development of herpes zoster in patients with SLE were found to be lymphopaenia, anti-Ro antibodies, anti-RNP antibodies, neuropsychiatric manifestations, renal involvement and cyclophosphamide use. Therefore, the presence of certain disease manifestations in patients with SLE represents risk factors for the development of herpes zoster.

  2. Evaluation of reflux nephropathy, pyelonephritis and renal dysplasia

    Energy Technology Data Exchange (ETDEWEB)

    Grattan-Smith, J.D. [Emory University School of Medicine, Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States); Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States); Little, Stephen B. [Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States); Jones, Richard A. [Emory University School of Medicine, Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States)


    MR urography has the potential to significantly improve our understanding of the relationship between reflux nephropathy, pyelonephritis, vesicoureteric reflux and renal dysplasia. MR urography utilizes multiple parameters to assess both renal anatomy and function and provides a more complete characterization of acquired and congenital disease. Pyelonephritis and renal scarring can be distinguished by assessing the parenchymal contours and signal intensity. Characteristic imaging features of renal dysplasia include small size, subcortical cysts, disorganized architecture, decreased and patchy contrast enhancement as well as a dysmorphic pelvicalyceal system. Because of its ability to subdivide and categorize this heterogeneous group of disorders, it seems inevitable that MR urography will replace DMSA renal scintigraphy as the gold standard for assessment of pyelonephritis and renal scarring. MR urography will contribute to our understanding of renal dysplasia and its relationship to reflux nephropathy. (orig.)

  3. Xp11.2 translocation renal cell carcinoma occurring during pregnancy with a novel translocation involving chromosome 19: a case report with review of the literature

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    Surti Urvashi


    Full Text Available Abstract The recently recognized renal cell carcinomas (RCCs associated with Xp11.2 translocations (TFE3 transcription factor gene fusions are rare tumors predominantly reported in children. They comprise at least one-third of pediatric RCCs and only few adult cases have been reported. Here, we present a case of Xp11.2 translocation RCC in 26-year-old pregnant female. Her routine antenatal ultrasonography accidentally found a complex cystic right renal mass. Further radiologic studies revealed unilocular cyst with multiple mural nodules at inferior pole of right kidney, which was suspicious for RCC. She underwent right radical nephrectomy at 15 weeks gestation. Macroscopically, the cystic tumor was well encapsulated with multiple friable mural nodules on its inner surface. Microscopically, the tumor consisted of clear and eosinophilic/oncocytic voluminous cells arranged in papillary, trabecular, and nested/alveolar patterns. Occasional hyaline nodules and numerous psammoma bodies were present. Immunohistochemically, the tumor showed strong nuclear positivity for TFE3. Epithelial membrane antigen, CD10, and E-cadherin were strongly positive. Cytokeratin AE1/AE3, cytokeratin CAM-5.2, calveolin, and parvalbumin were moderately positive. Cytokeratin 7, renal cell carcinoma antigen, and colloidal iron were focally weakly positive. BerEP4 and carbonic anhydrase IX were negative. Cytogenetically, the tumor harbored a novel variant translocation involving chromosomes X and 19, t(X;19(p11.2;q13.1. Interphase FISH analysis performed on cultured and uncultured tumor cells using a dual-color break-apart DNA probe within the BCL3 gene on 19q13.3 was negative for the BCL3 gene rearrangement. She received no adjuvant therapy, delivered a normal term baby five months later, and is alive without evidence of disease 27 months after diagnosis and surgery. Unlike most recently reported Xp11.2 translocation RCCs in adult patients with aggressive clinical course

  4. Effect of the menstrual cycle on background parenchymal enhancement observed on breast MRIs in Korean women

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    Park, Vivan Young Jean; KIm, Eun Kyung; Moon, Hee Jung; Yoon, Jung Hyun; Kim, Min Jung [Dept. of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)


    To evaluate the effect of the menstrual cycle on background parenchymal enhancement observed on breast MRIs in Korean women, and to suggest an optimal period for scheduling breast MRIs. Between March and December 2012, 214 premenopausal breast cancer patients who underwent breast MRIs for preoperative evaluation were included. Levels of background parenchymal enhancement were retrospectively compared according to the menstrual cycle. There was no significant difference between levels of background parenchymal enhancement (minimal, mild, moderate, and marked) according to the weeks of the menstrual cycle. However, the 1st and 2nd week of the menstrual cycle showed a significantly higher proportion of patients with minimal background parenchymal enhancement than the 3rd and 4th week of the menstrual cycle (47.0% vs. 32.0%; p = 0.025). For screening purposes and for the follow-up of Korean breast cancer patients, breast MRIs should be performed during the 1st or 2nd week of the menstrual cycle.

  5. Bone marrow-derived versus parenchymal sources of inducible nitric oxide synthase in experimental autoimmune encephalomyelitis

    DEFF Research Database (Denmark)

    Zehntner, Simone P; Bourbonniere, Lyne; Hassan-Zahraee, Mina;


    . These discrepancies may reflect balance between immunoregulatory and neurocytopathologic roles for NO. We investigated selective effects of bone marrow-derived versus CNS parenchymal sources of iNOS in EAE in chimeric mice. Chimeras that selectively expressed or ablated iNOS in leukocytes both showed significant...... delay in disease onset, with no difference in disease severity. We conclude that bone marrow-derived and CNS parenchymal sources of iNOS-derived NO both play a regulatory role in EAE....

  6. Serum Amyloid A as a Marker of Persistent Inflammation and an Indicator of Cardiovascular and Renal Involvement in Patients with Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    Bożena Targońska-Stępniak


    Full Text Available Objectives. Rheumatoid arthritis (RA is a systemic, inflammatory disease. Serum amyloid A (SAA is an acute-phase protein, involved in pathogenesis of atherosclerosis. The aim of the study was to assess serum concentration of SAA in RA patients, with reference to other inflammatory parameters and markers of extra-articular involvement. Methods. The study population consisted of 140 RA patients, low/moderate disease activity (L/MDA in 98 (70% patients and high disease activity (HDA in 42 (30%. Comprehensive clinical and laboratory assessment was performed with evaluation of electrocardiogram and carotid intima-media thickness. Results. The mean SAA concentration [327.0 (263.4 mg/L] was increased highly above the normal value, even in patients with L/MDA. Simultaneously, SAA was significantly higher in patients with HDA versus L/MDA. The mean SAA concentration was significantly higher in patients treated with glucocorticoids, was inversely associated with QTc duration, and was markedly higher in patients with atherosclerotic plaques, emphasizing increased CV risk. SAA was significantly higher in patients with increased cystatin-C level. Conclusions. In RA patients, high serum SAA concentration was strongly associated with activity of the disease and risk of CV and renal involvement. Recurrent assessment of SAA may facilitate searching patients with persistent inflammation and risk of extra-articular complications.

  7. Parenchymal neurocysticercosis: follow-up and staging by MRI

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    Dumas, J.L. [Dept. of Radiology, Hopital Avicenne, Bobigny (France)]|[Inst. of Tropical Neurology, Faculty of Medicine, Limoges (France); Visy, J.M. [Dept. of Neurology, Hopital Lariboisiere, Paris (France); Belin, C. [Dept. of Neurology, Hopital Avicenne, Bobigny (France); Gaston, A. [Dept. of Neuroradiology, Hopital Henri-Mondor, Creteil (France); Goldlust, D. [Dept. of Radiology, Hopital Avicenne, Bobigny (France); Dumas, M. [Inst. of Tropical Neurology, Faculty of Medicine, Limoges (France)


    We describe the evolution of parenchymal cerebral cysticerci on MRI, to assess signs of early cyst degeneration. We studied 15 lesions in four treated and one untreated patient. MRI was performed before therapy and repeated in the 1st month after each course of anticysticercus drugs, every 4 months during the 1st year and then annually; the follow-up period was 8-48 months. Lesions were classified according to changes in four features: cyst content and capsule signal, gadolinium enhancement and oedema signal. We were able to recognise each of the pathological phases; five MRI stages were identified. Stage 1 showed oedema and/or nodular gadolinium enhancement in the tissue invasion phase; stage 2 was cerebrospinal fluid-like signal within a cyst in the vesicular phase; stage 3 showed a thick capsule with an impure liquid content signal and surrounding oedema, in the cystic phase; stage 4 showed the disappearance of the cyst fluid content signal in the degenerative phase; stage 5 showed a calcified lesion in the residual phase. Stage 1 lesions disappeared after therapy; the other progressed from one stage to another. Stage 4 indicated the end of viability of the parasite and determined the point after which treatment was useless. On T2-weighted images changes in the cyst content differed according to the history of the lesion; nodular low intensity followed the natural degeneration of the parasite and a mixed fluid signal with punctate low signal seemed to represent the specific result of therapy. MRI staging can help in the evaluation of indications for treatment and facilitate clinical therapeutic trials. (orig.). With 4 figs., 1 tab.

  8. MRI Background Parenchymal Enhancement Is Not Associated with Breast Cancer.

    Directory of Open Access Journals (Sweden)

    Barbara Bennani-Baiti

    Full Text Available Previously, a strong positive association between background parenchymal enhancement (BPE at magnetic resonance imaging (MRI and breast cancer was reported in high-risk populations. We sought to determine, whether this was also true for non-high-risk patients.540 consecutive patients underwent breast MRI for assessment of breast findings (BI-RADS 0-5, non-high-risk screening (no familial history of breast cancer, no known genetic mutation, no prior chest irradiation, or previous breast cancer diagnosis and subsequent histological work-up. For this IRB-approved study, BPE and fibroglandular tissue FGT were retrospectively assessed by two experienced radiologists according to the BI-RADS lexicon. Pearson correlation coefficients were calculated to explore associations between BPE, FGT, age and final diagnosis of breast cancer. Subsequently, multivariate logistic regression analysis, considering covariate colinearities, was performed, using final diagnosis as the target variable and BPE, FGT and age as covariates.Age showed a moderate negative correlation with FGT (r = -0.43, p<0.001 and a weak negative correlation with BPE (r = -0.28, p<0.001. FGT and BPE correlated moderately (r = 0.35, p<0.001. Final diagnosis of breast cancer displayed very weak negative correlations with FGT (r = -0.09, p = 0.046 and BPE (r = -0.156, p<0.001 and weak positive correlation with age (r = 0.353, p<0.001. On multivariate logistic regression analysis, the only independent covariate for prediction of breast cancer was age (OR 1.032, p<0.001.Based on our data, neither BPE nor FGT independently correlate with breast cancer risk in non-high-risk patients at MRI. Our model retained only age as an independent risk factor for breast cancer in this setting.

  9. Steady-state captopril renography: continuous monitoring of the captopril-induced increase in {sup 99m}Tc-MAG{sub 3} mean parenchymal transit time in renovascular hypertension

    Energy Technology Data Exchange (ETDEWEB)

    El Esper, I. [Department of Biophysics and Nuclear Medicine, Centre Hospitalier Universitaire, Amiens (France); Chajari, M`H. [Department of Biophysics and Nuclear Medicine, Centre Hospitalier Universitaire, Amiens (France); Fonroget, J. [Department of Biophysics and Nuclear Medicine, Centre Hospitalier Universitaire, Amiens (France); Neveu, J.P. [Department of Biophysics and Nuclear Medicine, Centre Hospitalier Universitaire, Amiens (France); Makdassi, R. [Department of Nephrology, Centre Hospitalier Universitaire, Amiens (France); Bailly, P. [Department of Biophysics and Nuclear Medicine, Centre Hospitalier Universitaire, Amiens (France); Fournier, A. [Department of Nephrology, Centre Hospitalier Universitaire, Amiens (France)


    Steady-state captopril renography (SSCR) is an original technique for assessing the captopril-induced increase in technetium-99m mercaptoacetyltriglycine ({sup 99m}Tc-MAG{sub 3}) mean parenchymal transit time (MPTT) in kidneys affected with functional renal artery stenosis (RAS). The steady-state parenchymal activity achieved by constant infusion of {sup 99m}Tc-MAG{sub 3}is directly linked to the MPTT of the radiopharmaceutical. This steady-state parenchymal activity was continuously monitored from 15 min before to 60 min after a single dose of captopril in order to detect possible disruption of the steady state. SSCR was performed in 11 hypertensive patients with unilateral RAS and in two with RAS of a solitary kidney before renal revascularization (RR). In four of these patients, an additional SSCR was performed after RR. Of the ten patients whose hypertension was cured or improved by RR, one presented an uninterpretable SSCR and six presented a positive SSCR on the affected side. Control SSCR performed in four of these six patients was bilaterally negative. SSCR was also bilaterally negative in the three patients who showed no blood pressure response to RR. These preliminary results tend to indicate that, in spite of the stability of pre- and post-captopril hydration and data acquisition conditions allowed by this steady-state technique, the sensitivity is lower than expected. However, the reason for the false-negative results does not seem to be inherent to SSCR. (orig.). With 2 figs., 2 tabs.

  10. The US color Doppler in acute renal failure. (United States)

    Nori, G; Granata, A; Leonardi, G; Sicurezza, E; Spata, C


    Imaging techniques, especially ultrasonography and Doppler, can give an effective assistance in the differential diagnosis of acute renal failure (ARF). An resistance Index (RI) value >0.75 is reported as optimal in attempting differential diagnosis between acute tubular necrosis (ANT) and prerenal ARF. In hepatorenal syndrome (HRS) RIs is very increased. In some renal vasculitis, as nodose panarteritis (PN), hemolytic-uremic syndrome (HUS), thrombotic thrombocytopenic purpura (TTP), parenchymal perfusion is reduced and RI increased. In lupus nephritis the RI values are correlated with creatinine level and normal RI are considered as a good prognostic tool. In acute primitive or secondary glomerulonephritis (GN), RI value is normal, with diffuse parenchymal hypervascularization. In acute crescentic and proliferative GN and tubulo-interstitial disease, color Doppler (CD) and power Doppler (PD) reveal a decreased renal parenchymal perfusion, which correlates with increased RI values. In acute thrombosis of renal artery, US color Doppler (DUS) reveals either an absence of Doppler signal or a tardus-parvus pulse distal to the vascular obstruction. In this situation it is possible to visualize hyperthropic perforating vessels that redirect their flow from the capsular plexus to the renal parenchyma. In acute thrombosis of the renal vein Doppler analysis of parenchymal vessels reveals remarkable RI values, sometimes with reversed diastolic flow. In postrenal ARF an adjunct to the differentiation between obstruction and non obstructive dilatation can be found through RIs. Diagnostic criteria of obstruction as reported by literature are: RI>0.70 in the obstructed kidney and, mostly, a difference in RI between the 2 kidneys >0.06-0.1.

  11. Renal (Kidney) Manifestations in TSC (United States)

    ... International TSC Research Conference Text Size Get Involved RENAL (KIDNEY) MANIFESTATIONS IN TSC Download a PDF of ... sclerosis complex (TSC) will develop some form of renal (kidney) disease during their lifetime. There are three ...

  12. Renal relevant radiology: renal functional magnetic resonance imaging. (United States)

    Ebrahimi, Behzad; Textor, Stephen C; Lerman, Lilach O


    Because of its noninvasive nature and provision of quantitative measures of a wide variety of physiologic parameters, functional magnetic resonance imaging (MRI) shows great potential for research and clinical applications. Over the past decade, application of functional MRI extended beyond detection of cerebral activity, and techniques for abdominal functional MRI evolved. Assessment of renal perfusion, glomerular filtration, interstitial diffusion, and parenchymal oxygenation turned this modality into an essential research and potentially diagnostic tool. Variations in many renal physiologic markers can be detected using functional MRI before morphologic changes become evident in anatomic magnetic resonance images. Moreover, the framework of functional MRI opened a window of opportunity to develop novel pathophysiologic markers. This article reviews applications of some well validated functional MRI techniques, including perfusion, diffusion-weighted imaging, and blood oxygen level-dependent MRI, as well as some emerging new techniques such as magnetic resonance elastography, which might evolve into clinically useful tools.

  13. Endovascular Management of Iatrogenic Native Renal Arterial Pseudoaneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Sildiroglu, Onur; Saad, Wael E.; Hagspiel, Klaus D.; Matsumoto, Alan H.; Turba, Ulku Cenk, E-mail: [University of Virginia Health System, Department of Radiology (United States)


    Purpose: Our purpose was to evaluate iatrogenic renal pseudoaneurysms, endovascular treatment, and outcomes. Methods: This retrospective study (2003-2011) reported the technical and clinical outcomes of endovascular therapy for renal pseudoaneurysms in eight patients (mean age, 46 (range 24-68) years). Renal parenchymal loss evaluation was based on digital subtraction angiography and computed tomography. Results: We identified eight iatrogenic renal pseudoaneurysm patients with symptoms of hematuria, pain, and hematoma after renal biopsy (n = 3), surgery (n = 3), percutaneous nephrolithotomy (n = 1), and endoscopic shock-wave lithotripsy (n = 1). In six patients, the pseudoaneurysms were small-sized (<20 mm) and peripherally located and were treated solely with coil embolization (n = 5). In one patient, coil embolization was preceded by embolization with 500-700 micron embospheres to control active bleeding. The remaining two patients had large-sized ({>=}50 mm), centrally located renal pseudoaneurysms treated with thrombin {+-} coils. Technical success with immediate bleeding cessation was achieved in all patients. There were no procedure-related deaths or complications (mean follow-up, 23.5 (range, 1-67) months). Conclusions: Treatment of renal pseudoaneurysms using endovascular approach is a relatively safe and viable option regardless of location (central or peripheral) and size of the lesions with minimal renal parenchymal sacrifice.

  14. Vascular smooth muscle G(q) signaling is involved in high blood pressure in both induced renal and genetic vascular smooth muscle-derived models of hypertension. (United States)

    Harris, David M; Cohn, Heather I; Pesant, Stéphanie; Zhou, Rui-Hai; Eckhart, Andrea D


    More than 30% of the US population has high blood pressure (BP), and less than a third of people treated for hypertension have it controlled. In addition, the etiology of most high BP is not known. Having a better understanding of the mechanisms underlying hypertension could potentially increase the effectiveness of treatment. Because G(q) signaling mediates vasoconstriction and vascular function can cause BP abnormalities, we were interested in determining the role of vascular smooth muscle (VSM) G(q) signaling in two divergent models of hypertension: a renovascular model of hypertension through renal artery stenosis and a genetic model of hypertension using mice with VSM-derived high BP. Inhibition of VSM G(q) signaling attenuated BP increases induced by renal artery stenosis to a similar extent as losartan, an ANG II receptor blocker and current antihypertensive therapy. Inhibition of G(q) signaling also attenuated high BP in our genetic VSM-derived hypertensive model. In contrast, BP remained elevated 25% following treatment with losartan, and prazosin, an alpha(1)-adrenergic receptor antagonist, only decreased BP by 35%. Inhibition of G(q) signaling attenuated VSM reactivity to ANG II and resulted in a 2.4-fold rightward shift in EC(50). We also determined that inhibition of G(q) signaling was able to reverse VSM hypertrophy in the genetic VSM-derived hypertensive model. These results suggest that G(q) signaling is an important signaling pathway in two divergent models of hypertension and, perhaps, optimization of antihypertensive therapy could occur with the identification of particular G(q)-coupled receptors involved.

  15. Polycystic Ovary Syndrome: The Correlation Between Renal Doppler Ultrasound and Laboratory Parameters

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    Elif Karadeli


    Full Text Available Aim: To investigate whether there is alteration both right and left kidney lenght, parenchymal thickness, renal arterial,venous blood flow measurements in normotensive reproductive age women with polycystic ovary syndrome (PCOS. Material and Method: Forty women with PCOS according to Rotterdam criteria and thirty-six healthy volunteers women were included in our study. Hormonal, biochemical analysis, renal Doppler ultrasonography were performed and were investigated in terms of both left and right renal lenght, parenchymal thickness, peak systolic velocity (PSV, resistive index (RI, venous impedance index (VI, metabolic characteristics having insulin resistance, impaired glucose tolerance, serum lipid concentration. The student t test and pearson corelation test were used for statistical analysis.Results: The measurements for kidneys were not different between women with PCOS and healthy women. The peak systolic velocity of mean renal artery was lower in PCOS group. The mean renal venous impedance also was higher in PCOS group than control group. The mean renal resistive index was slightly higher in PCOS but not statistical significant. In bivariate corelation analyse including all patients, it was seen that BMI, WHR, level of serum fasting glucose, insulin, LDL, trigliserides were positively related with mean renal length and mean parenchymal thickness measurements. Discussion: We found that there was alterations kidney blood flow in normotensive reproductive age women with PCOS. This findings may indicate results of long term renal and cardiovascular complications of PCOS.

  16. Ultrasound tomography imaging with waveform sound speed: parenchymal changes in women undergoing tamoxifen therapy (United States)

    Sak, Mark; Duric, Neb; Littrup, Peter; Sherman, Mark; Gierach, Gretchen


    Ultrasound tomography (UST) is an emerging modality that can offer quantitative measurements of breast density. Recent breakthroughs in UST image reconstruction involve the use of a waveform reconstruction as opposed to a raybased reconstruction. The sound speed (SS) images that are created using the waveform reconstruction have a much higher image quality. These waveform images offer improved resolution and contrasts between regions of dense and fatty tissues. As part of a study that was designed to assess breast density changes using UST sound speed imaging among women undergoing tamoxifen therapy, UST waveform sound speed images were then reconstructed for a subset of participants. These initial results show that changes to the parenchymal tissue can more clearly be visualized when using the waveform sound speed images. Additional quantitative testing of the waveform images was also started to test the hypothesis that waveform sound speed images are a more robust measure of breast density than ray-based reconstructions. Further analysis is still needed to better understand how tamoxifen affects breast tissue.

  17. Isolated renal metastasis from squamous cell lung cancer

    Directory of Open Access Journals (Sweden)

    Cai Jun


    Full Text Available Abstract Renal metastasis from non-small cell lung cancer is rather uncommon. The mechanism underlying the occurrence of metastasis in this site is still not well understood. We report a case of a 53-year-old Chinese woman who had moderately differentiated squamous cell carcinoma of the lung. After a ten months post-surgery interval of disease free survival, computed tomography (CT scan found that left renal parenchymal was occupied by a mass, confirmed by kidney biopsy to be a metastasis from squamous cell lung carcinoma. Based on this case, we are warned to be cautious in diagnosis and treatment when renal lesion are detected.

  18. Major role for a 3p21 region and lack of involvement of the t(3;8) breakpoint region in the development of renal cell carcinoma suggested by loss of heterozygosity analysis

    NARCIS (Netherlands)

    van den Berg, Anke; Hulsbeek, MMF; deJong, D; Kok, K; Veldhuis, PMJF; Roche, J; Buys, CHCM


    In a loss of heterozygosity analysis of 3p, we examined 44 sporadic cases of renal cell carcinoma (RCC) and matched normal tissue with 18 markers distributed over the whole p-arm. The majority of these markers clustered in three regions that have been suggested to be involved in the development of R

  19. The outcome of patients with renal involvement in pediatric-onset systemic lupus erythematosus--a 20-year experience in Asia. (United States)

    Lee, P-Y; Yeh, K-W; Yao, T-C; Lee, W-I; Lin, Y-J; Huang, J-L


    Systemic lupus erythematosus (SLE) predominantly affects women of childbearing age, but 15-20% of cases are diagnosed during childhood. It is important for physicians to understand the epidemiology and clinical presentation for early detection and diagnosis of this disease in difference races. The aim of this retrospective review was to provide a 20-year experience for initial clinical and laboratory manifestations and outcomes in pediatric-onset SLE (pSLE) in a medical center in Asia. We reviewed medical records between April 1990 and June 2012 of patients with a diagnosis of International Classification of Diseases, Ninth Revision (ICD-9) code 710.0 (SLE), who admitted or received follow-up in the Department of Pediatrics at Chang Chung Memorial Hospital. Patients with a diagnosis of SLE prior to their 18th birthday and followed up at our hospital were eligible for inclusion in this study. Medical records regarding age, gender, date of birth and diagnosis, clinical manifestations at diagnosis, laboratory results, image studies and the classification criteria were reviewed. Patients received regular outpatient department follow-up and laboratory survey every 1-6 months. The study cohort consisted of 189 patients; 164 females (86.87%) and 25 males (13.23%). The overall mean age at pSLE diagnosis was 12.62 ± 2.77 years. The most common clinical symptom was malar rash, followed by arthritis and oral ulcers. There was no significant difference in clinical and laboratory manifestations between females and males. More than half of the patients presented with renal involvement initially. The most common histological finding was Class IV lupus nephritis (LN), especially in males (p = 0.034) and young age. Even with severe LN, the rate of end-stage renal disease (ESRD) was low if adequate treatment was initiated. The 5, 10 and 15-year ESRD-free survival rates were 95.4%, 94.0% and 89.9% in patients with biopsy-proven LN. However, infection was the leading cause of

  20. Quantitative MRI of kidneys in renal disease. (United States)

    Kline, Timothy L; Edwards, Marie E; Garg, Ishan; Irazabal, Maria V; Korfiatis, Panagiotis; Harris, Peter C; King, Bernard F; Torres, Vicente E; Venkatesh, Sudhakar K; Erickson, Bradley J


    To evaluate the reproducibility and utility of quantitative magnetic resonance imaging (MRI) sequences for the assessment of kidneys in young adults with normal renal function (eGFR ranged from 90 to 130 mL/min/1.73 m(2)) and patients with early renal disease (autosomal dominant polycystic kidney disease). This prospective case-control study was performed on ten normal young adults (18-30 years old) and ten age- and sex-matched patients with early renal parenchymal disease (autosomal dominant polycystic kidney disease). All subjects underwent a comprehensive kidney MRI protocol, including qualitative imaging: T1w, T2w, FIESTA, and quantitative imaging: 2D cine phase contrast of the renal arteries, and parenchymal diffusion weighted imaging (DWI), magnetization transfer imaging (MTI), blood oxygen level dependent (BOLD) imaging, and magnetic resonance elastography (MRE). The normal controls were imaged on two separate occasions ≥24 h apart (range 24-210 h) to assess reproducibility of the measurements. Quantitative MR imaging sequences were found to be reproducible. The mean ± SD absolute percent difference between quantitative parameters measured ≥24 h apart were: MTI-derived ratio = 4.5 ± 3.6%, DWI-derived apparent diffusion coefficient (ADC) = 6.5 ± 3.4%, BOLD-derived R2* = 7.4 ± 5.9%, and MRE-derived tissue stiffness = 7.6 ± 3.3%. Compared with controls, the ADPKD patient's non-cystic renal parenchyma (NCRP) had statistically significant differences with regard to quantitative parenchymal measures: lower MTI percent ratios (16.3 ± 4.4 vs. 23.8 ± 1.2, p quantitative measurements was obtained in all cases. Significantly different quantitative MR parenchymal measurement parameters between ADPKD patients and normal controls were obtained by MT, DWI, BOLD, and MRE indicating the potential for detecting and following renal disease at an earlier stage than the conventional qualitative imaging techniques.

  1. Primary renal hydatidosis

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    Johnsy Merla Joel


    Full Text Available Echinococcosis or hydatidosis caused by the tapeworm, Echinococcus granulosus, has the highest prevalence in endemic regions and sheep farming areas. The most common organ involved is the liver (50–75% followed by the lungs (15–20% and other organs (10–20%. Primary involvement of the kidney without the involvement of the liver and lungs, i.e., isolated renal hydatid disease is extremely rare even in endemic areas. The incidence of renal echinococcosis is 2–4%. Renal hydatid cysts usually remain asymptomatic for many years and are multiloculated. A 63-year-old male presented with left loin pain. Computed tomography scan abdomen revealed a presumptive diagnosis of renal hydatid disease. The nephrectomy specimen received in histopathology confirmed the diagnosis. We describe a rare case of primary renal hydatidosis.

  2. Renal trauma in occult ureteropelvic junction obstruction: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Sebastia, M.C.; Rodriguez-Dobao, M.; Quiroga, S.; Pallisa, E.; Martinez-Rodriguez, M.; Alvarez-Castells, A. [Dept. of Radiology, Hospital General Universitari Vall d`Hebron, Barcelona (Spain)


    The aim of this study was to present CT findings of occult ureteropelvic junction obstruction in patients with renal trauma and to describe the clinical signs and singular CT features that are characteristically observed with trauma and are relevant to management of these patients. We retrospectively reviewed 82 helical CT studies in patients with renal trauma referred to our institution. We found 13 cases of occult preexisting renal pathology, six of which were occult ureteropelvic junction obstructions. The clinical presentation, radiologic findings of trauma according to the Federle classification, and CT findings of obstructed ureteropelvic junction are presented. We found three category-I lesions (one in a horseshoe kidney), two of them treated with nephrostomy because of increased ureteropelvic junction obstruction due to pelvic clots; two category-II lesions (parenchymal and renal pelvis lacerations) that had presented only with microhematuria; and one category-IV lesion (pelvic laceration alone). Pelvic extension was demonstrated in all the cases with perirenal collections. The CT studies in all the cases with suspected ureteropelvic junction obstruction showed decreased parenchymal thickness and enhancement, and dilatation of the renal pelvis and calyx, with a normal ureter. Computed tomography can provide information to confidently diagnose underlying ureteropelvic junction obstruction in renal trauma, categorize the traumatic injury (at times clinically silent) and facilitate proper management according to the singularities observed, such us rupture of the renal pelvis alone (Federle category IV) and increasing ureteropelvic obstruction due to clots which can be decompressed by nephrostomy. (orig.) With 6 figs., 3 tabs., 13 refs.

  3. Trauma renal Renal trauma

    Directory of Open Access Journals (Sweden)

    Gerson Alves Pereira Júnior


    Full Text Available Apresentamos uma revisão sobre trauma renal, com ênfase na avaliação radiológica, particularmente com o uso da tomografia computadorizada, que tem se tornado o exame de eleição, ao invés da urografia excretora e arteriografia. O sucesso no tratamento conservador dos pacientes com trauma renal depende de um acurado estadiamento da extensão da lesão, classificado de acordo com a Organ Injury Scaling do Colégio Americano de Cirurgiões. O tratamento conservador não-operatório é seguro e consiste de observação contínua, repouso no leito, hidratação endovenosa adequada e antibioti- coterapia profilática, evitando-se uma exploração cirúrgica desnecessária e possível perda renal. As indicações para exploração cirúrgica imediata são abdome agudo, rápida queda do hematócrito ou lesões associadas determinadas na avaliação radiológica. Quando indicada, a exploração renal após controle vascular prévio é segura, permitindo cuidadosa inspeção do rim e sua reconstrução com sucesso, reduzindo a probabilidade de nefrectomia.We present a revision of the renal trauma with emphasis in the radiographic evaluation, particularly CT scan that it has largely replaced the excretory urogram and arteriogram in the diagnostic worh-up and management of the patient with renal trauma. The successful management of renal injuries depends upon the accurate assessment of their extent in agreement with Organ Injury Scaling classification. The conservative therapy managed by careful continuous observation, bed rest, appropriate fluid ressuscitation and prophylactic antibiotic coverage after radiographic staging for severely injured kidneys can yield favorable results and save patients from unnecessary exploration and possible renal loss. The indications for immediate exploratory laparotomy were acute abdomen, rapidly dropping hematocrit or associated injuries as determinated from radiologic evaluation. When indicated, renal exploration

  4. Renal arteriography (United States)

    ... Read More Acute arterial occlusion - kidney Acute kidney failure Aneurysm Atheroembolic renal disease Blood clots Renal cell carcinoma Renal venogram X-ray Review Date 1/5/2016 Updated by: Jason Levy, ...

  5. Interferon regulatory factor 3 and type I interferons are protective in alcoholic liver injury in mice by way of crosstalk of parenchymal and myeloid cells. (United States)

    Petrasek, Jan; Dolganiuc, Angela; Csak, Timea; Nath, Bharath; Hritz, Istvan; Kodys, Karen; Catalano, Donna; Kurt-Jones, Evelyn; Mandrekar, Pranoti; Szabo, Gyongyi


    Alcoholic liver disease (ALD) features increased hepatic exposure to bacterial lipopolysaccharide (LPS). Toll-like receptor-4 (TLR4) recognizes LPS and activates signaling pathways depending on MyD88 or TRIF adaptors. We previously showed that MyD88 is dispensable in ALD. TLR4 induces Type I interferons (IFNs) in an MyD88-independent manner that involves interferon regulatory factor-3 (IRF3). We fed alcohol or control diets to wild-type (WT) and IRF3 knock-out (KO) mice, and to mice with selective IRF3 deficiency in liver parenchymal and bone marrow-derived cells. Whole-body IRF3-KO mice were protected from alcohol-induced liver injury, steatosis, and inflammation. In contrast to WT or bone marrow-specific IRF3-KO mice, deficiency of IRF3 only in parenchymal cells aggravated alcohol-induced liver injury, associated with increased proinflammatory cytokines, lower antiinflammatory cytokine interleukin 10 (IL-10), and lower Type I IFNs compared to WT mice. Coculture of WT primary murine hepatocytes with liver mononuclear cells (LMNC) resulted in higher LPS-induced IL-10 and IFN-β, and lower tumor necrosis factor alpha (TNF-α) levels compared to LMNC alone. Type I IFN was important because cocultures of hepatocytes with LMNC from Type I IFN receptor KO mice showed attenuated IL-10 levels compared to control cocultures from WT mice. We further identified that Type I IFNs potentiated LPS-induced IL-10 and inhibited inflammatory cytokine production in both murine macrophages and human leukocytes, indicating preserved cross-species effects. These findings suggest that liver parenchymal cells are the dominant source of Type I IFN in a TLR4/IRF3-dependent manner. Further, parenchymal cell-derived Type I IFNs increase antiinflammatory and suppress proinflammatory cytokines production by LMNC in paracrine manner. Our results indicate that IRF3 activation in parenchymal cells and resulting type I IFNs have protective effects in ALD by way of modulation of inflammatory

  6. The internist and the renal resistive index: truths and doubts. (United States)

    Boddi, Maria; Natucci, Fabrizia; Ciani, Elisa


    The renal resistive index (RRI) is measured by Doppler sonography in an intrarenal artery, and is the difference between the peak systolic and end-diastolic blood velocities divided by the peak systolic velocity. The RRI is used for the study of vascular and renal parenchymal renal abnormalities, but growing evidence indicates that it is also a dynamic marker of systemic vascular properties. Renal vascular resistance is only one of several renal (vascular compliance, interstitial and venous pressure), and extrarenal (heart rate, aortic stiffness, pulse pressure) determinants that combine to determine the RRI values, and not the most important one. RRI cannot always be considered a specific marker of renal disease. To summarize from the literature: (1) hydronephrosis, abdominal hypertension, renal vein thrombosis and acute kidney injury are all associated with an acute increase in interstitial and venous pressure that determine RRI values. In all these conditions, RRI is a reliable marker of the severity of renal damage. (2) The hemodynamic impact of renal artery stenosis can be assayed by the RRI decrease in the homolateral kidney by virtue of decreasing pulse pressure. However, renal diseases that often coexist, increase renal vascular stiffness and hide the hemodynamic effect of renal stenosis. (3) In transplant kidney and in chronic renal disease, high RRI values (>0.80) can independently predict renal and clinical outcomes, but systemic (pulse pressure) rather than renal hemodynamic determinants sustain the predictive role of RRI. (4) Higher RRI detects target renal organ damage in hypertension and diabetes when renal function is still preserved, as a marker of systemic atherosclerotic burden. Is this the fact? We attempt to answer.

  7. Background parenchymal enhancement on baseline screening breast MRI: impact on biopsy rate and short-interval follow-up.

    LENUS (Irish Health Repository)

    Hambly, Niamh M


    Background parenchymal enhancement on breast MRI refers to normal enhancement of the patient\\'s fibroglandular tissue. The aim of this study was to determine the effect of background parenchymal enhancement on short-interval follow-up, biopsy, and cancer detection rate on baseline screening MRI in a high-risk group.

  8. Successful management of neonatal renal venous thrombosis. (United States)

    Piscitelli, Antonio; Galiano, Rossella; Piccolo, Vincenzo; Concolino, Daniela; Strisciuglio, Pietro


    Renal vein thrombosis is the most common vascular condition involving the newborn kidney and it can result in severe renal damage. We report a newborn with renal vein thrombosis treated with continuous infusion of unfractionated heparin who had normal total renal function after 3 years of follow up, despite reduction of the functional contribution of the affected kidney.

  9. Perirenal effusion in dogs and cats with acute renal failure. (United States)

    Holloway, Andrew; O'Brien, Robert


    Perirenal fluid accumulation has been described as an ultrasonographic feature of urine leakage, hemorrhage, abscessation, or neoplasia. The purpose of this retrospective study was to report perirenal effusion as an additional ultrasonographic finding in canine and feline patients with acute renal failure. The causes of acute renal failure in 18 patients included nephrotoxicity (4), leptospirosis (3), ureteral obstruction (2), renal lymphoma (2), ureteronephrolithiasis (2), prostatic urethral obstruction (1) and interstitial nephritis and ureteritis (1). An underlying cause was not identified in three patients. The sonographic finding of perirenal fluid was bilateral in 15 patients. Unilateral perirenal fluid was identified ipsilateral to the site of ureteric obstruction in two patients. Large effusions extended into the caudal retroperitoneal space. Additional sonographic findings suggestive of renal parenchymal disease included mild (5), moderate (5) or severe (2) pyelectasia, increased renal echogenicity (11), increased (9) or decreased renal size (2) and ureteral and/or renal calculi (3). There did not appear to be an association between the volume of perirenal fluid and the severity of renal dysfunction. All patients with large effusions underwent euthanasia. Perirenal fluid developing in acute renal failure is thought to be an ultrafiltrate associated with tubular back-leak into the renal interstitium that overwhelms lymphatic drainage within the perirenal and retroperitoneal connective tissues although obstruction to urine flow may also play a role. Localized perirenal retroperitoneal free fluid may be a useful ultrasonographic feature to assist with the characterization of, and determination of prognosis in, patients with suspected renal disease.

  10. Non-invasive parenchymal, vascular and metabolic high-frequency ultrasound and photoacoustic rat deep brain imaging. (United States)

    Giustetto, Pierangela; Filippi, Miriam; Castano, Mauro; Terreno, Enzo


    Photoacoustics and high frequency ultrasound stands out as powerful tools for neurobiological applications enabling high-resolution imaging on the central nervous system of small animals. However, transdermal and transcranial neuroimaging is frequently affected by low sensitivity, image aberrations and loss of space resolution, requiring scalp or even skull removal before imaging. To overcome this challenge, a new protocol is presented to gain significant insights in brain hemodynamics by photoacoustic and high-frequency ultrasounds imaging with the animal skin and skull intact. The procedure relies on the passage of ultrasound (US) waves and laser directly through the fissures that are naturally present on the animal cranium. By juxtaposing the imaging transducer device exactly in correspondence to these selected areas where the skull has a reduced thickness or is totally absent, one can acquire high quality deep images and explore internal brain regions that are usually difficult to anatomically or functionally describe without an invasive approach. By applying this experimental procedure, significant data can be collected in both sonic and optoacoustic modalities, enabling to image the parenchymal and the vascular anatomy far below the head surface. Deep brain features such as parenchymal convolutions and fissures separating the lobes were clearly visible. Moreover, the configuration of large and small blood vessels was imaged at several millimeters of depth, and precise information were collected about blood fluxes, vascular stream velocities and the hemoglobin chemical state. This repertoire of data could be crucial in several research contests, ranging from brain vascular disease studies to experimental techniques involving the systemic administration of exogenous chemicals or other objects endowed with imaging contrast enhancement properties. In conclusion, thanks to the presented protocol, the US and PA techniques become an attractive noninvasive

  11. Distinguishing between parenchymal and anastomotic leakage at duct-to-mucosa pancreatic reconstruction in pancreaticoduodenectomy

    Institute of Scientific and Technical Information of China (English)

    Justin H Nguyen


    AIM:To distinguish anastomotic from parenchymal leakage at duct-to-mucosa reconstruction of the pancreatic remnant.METHODS:We reviewed the charts of 68 pancreaticoduodenectomies performed between 5/2000 and 12/2005 with end-to-side duct-to-mucosa pancreatojejunostomy (PJ).The results of pancreatography,as well as peripancreatic drain volumes,and amylase levels were analyzed.RESULTS:Of 68 pancreatojejunostomies,48 had no leak by pancreatography and had low-drain amylase(normal); eight had no pancreatographic leak but had elevated drain amylase (parenchymal leak); and 12 had pancreatographic leak and elevated drain amylase(anastomotic leak).Although drain volumes in the parenchymal leak group were significantly elevated at postoperative day (POD) 4,no difference was found at POD 7.Drain amylase level was not significantly different at POD 4.In contrast,at POD 7,the anastomotic-leak group had significantly elevated drain amylase level compared with normal and parenchymalleak groups (14158 + 24083 IU/L vs 89 + 139 IU/L and 1707±1515 IU/L,respectively,P=0.012).CONCLUSION:For pancreatic remnant reconstruction after pancreaticoduodenectomy,a combination of pancreatogram and peripancreatic drain amylase levels can be used to distinguish between parenchymal and anastomotic leakage at pancreatic remnant reconstruction.

  12. Very low cerebral blood volume predicts parenchymal hematoma in acute ischemic stroke

    DEFF Research Database (Denmark)

    Hermitte, Laure; Cho, Tae-Hee; Ozenne, Brice;


    BACKGROUND AND PURPOSE: Parenchymal hematoma (PH) may worsen the outcome of patients with stroke. The aim of our study was to confirm the relationship between the volume of very low cerebral blood volume (CBV) and PH using a European multicenter database (I-KNOW). A secondary objective was to exp...

  13. Extrapancreatic necrosis without pancreatic parenchymal necrosis : a separate entity in necrotising pancreatitis?

    NARCIS (Netherlands)

    Bakker, Olaf J.; van Santvoort, Hjalmar; Besselink, Marc G. H.; Boermeester, Marja A.; van Eijck, Casper; Dejong, Kees; van Goor, Harry; Hofker, Hendrik; Ali, Usama Ahmed; Gooszen, Hein G.; Bollen, Thomas L.


    Objective In the revised Atlanta classification of acute pancreatitis, the term necrotising pancreatitis also refers to patients with only extrapancreatic fat necrosis without pancreatic parenchymal necrosis (EXPN), as determined on contrast-enhanced CT (CECT). Patients with EXPN are thought to have

  14. A clinical study of new cases of parenchymal neurosyphilis: has tabes dorsalis disappeared or been missed? (United States)

    Zhang, Yong-Qing; Huang, Ming; Jia, Xiao-Yan; Zou, Ya-Fen; Chen, Dan


    Tabes dorsalis (TD) was documented as the most common parenchymal neurosyphilis, but its incidence dramatically declined in the antibiotic era. Syphilis has resurged on the China mainland since the 1980s. In recent years, physicians have been reporting parenchymal neurosyphilis, and the overwhelming majority was general paresis, but this was not the case in the authors' hospital. To make clear the real situation of parenchymal neurosyphilis in the authors' hospital, a retrospective review was carried out of the records of patients during 2009-2012. Overrepresented clinical new cases of tabetic and paretic parenchymal neurosyphilis were collected. Clinical characteristics, neuroimaging, laboratory data, and responses to penicillin were analyzed in two groups. The efficiency of two current criteria based on CSF antibodies tests was inspected. In the 43 cases with positive serum rapid plasma reagin (RPR) and TPPA tests, 18 patients met the criteria of this study: 11 presented with symptoms of general paresis, and seven had typical presentations of TD. There were statistical differences in serum RPR titers, CSF RPR, white blood cell count, and TP between the paretic and tabetic groups. The response to penicillin was relatively poor in TD. The efficiency of two current criteria was lower in the diagnosis of TD. TD was not uncommon in our area. Its clinical features remained typical, but underdiagnosis with CSF-based criteria and a decreased response to penicillin were prominent issues.

  15. Parenchymal texture measures weighted by breast anatomy: preliminary optimization in a case-control study (United States)

    Gastounioti, Aimilia; Keller, Brad M.; Hsieh, Meng-Kang; Conant, Emily F.; Kontos, Despina


    Growing evidence suggests that quantitative descriptors of the parenchymal texture patterns hold a valuable role in assessing an individual woman's risk for breast cancer. In this work, we assess the hypothesis that breast cancer risk factors are not uniformly expressed in the breast parenchymal tissue and, therefore, breast-anatomy-weighted parenchymal texture descriptors, where different breasts ROIs have non uniform contributions, may enhance breast cancer risk assessment. To this end, we introduce an automated breast-anatomy-driven methodology which generates a breast atlas, which is then used to produce a weight map that reinforces the contributions of the central and upper-outer breast areas. We incorporate this methodology to our previously validated lattice-based strategy for parenchymal texture analysis. In the framework of a pilot case-control study, including digital mammograms from 424 women, our proposed breast-anatomy-weighted texture descriptors are optimized and evaluated against non weighted texture features, using regression analysis with leave-one-out cross validation. The classification performance is assessed in terms of the area under the curve (AUC) of the receiver operating characteristic. The collective discriminatory capacity of the weighted texture features was maximized (AUC=0.87) when the central breast area was considered more important than the upperouter area, with significant performance improvement (DeLong's test, p-valuepersonalized recommendations regarding women's cancer risk evaluation.

  16. Breast Cancer Risk Estimation Using Parenchymal Texture Analysis in Digital Breast Tomosynthesis (United States)

    Ikejimba, Lynda C.; Kontos, Despina; Maidment, Andrew D. A.


    Mammographic parenchymal texture has been shown to correlate with genetic markers of developing breast cancer. Digital breast tomosynthesis (DBT) is a novel x-ray imaging technique in which tomographic images of the breast are reconstructed from multiple source projections acquired at different angles of the x-ray tube. Compared to digital mammography (DM), DBT eliminates breast tissue overlap, offering superior parenchymal tissue visualization. We hypothesize that texture analysis in DBT could potentially provide a better assessment of parenchymal texture and ultimately result in more accurate assessment of breast cancer risk. As a first step towards validating this hypothesis, we investigated the association between DBT parenchymal texture and breast percent density (PD), a known breast cancer risk factor, and compared it to DM. Bilateral DBT and DM images from 71 women participating in a breast cancer screening trial were analyzed. Filtered-backprojection was used to reconstruct DBT tomographic planes in 1 mm increments with 0.22 mm in-plane resolution. Corresponding DM images were acquired at 0.1 mm pixel resolution. Retroareolar regions of interest (ROIs) equivalent to 2.5 cm3 were segmented from the DBT images and corresponding 2.5 cm2 ROIs were segmented from the DM images. Breast PD was mammographically estimated using the Cumulus scale. Overall, DBT texture features demonstrated a stronger correlation than DM to PD. The Pearson correlation coefficients for DBT were r = 0.40 (pbreast cancer risk assessment in the future.

  17. Topographic congruence of calcified parenchymal neurocysticercosis and other structural brain lesions with epileptiform activity (United States)

    Saito, Erin K; Nagpal, Meera; Leon, Amanda; Mehta, Bijal; McMurtray, Aaron Matthew


    Introduction: Calcified parenchymal neurocysticercosis (NCC) lesions are commonly detected in many individuals with refractory epilepsy. However, the relationship between these lesions and epilepsy is not fully determined. We sought to determine if calcified parenchymal NCC demonstrated topographic congruence with epileptiform activity in refractory epilepsy patients. Additional patients with other structural brain lesions were included for comparison. Subjects and Methods: Retrospective cross-sectional analysis of all patients treated at a community-based neurology clinic for refractory epilepsy during a 3-month period and with structural brain lesions detected by neuroimaging studies. Results: A total of 105 patients were included in the study, including 63 with calcified parenchymal NCC lesions and 42 with other structural brain lesions. No significant relationship was detected between hemispheric localization of calcified parenchymal NCC lesions and epileptiform activity. For those with other structural brain lesions, the hemispheric localization was significantly related to the side of epileptiform activity (Chi-square = 11.13, P = 0.025). In addition, logistic regression models showed that those with right-sided non-NCC lesions were more likely to have right-sided epileptiform activity (odds ratio = 4.36, 95% confidence interval [CI] =1.16–16.31, P = 0.029), and those with left-sided non-NCC lesions were more likely to have left-sided epileptiform activity (odds ratio = 7.60, 95% CI = 1.89–30.49, P = 0.004). Conclusion: The lack of correlation between the side of calcified parenchymal NCC lesions and the side of the epileptiform activity suggests that these lesions may be incidental findings in many patients. PMID:26998434

  18. Background parenchymal enhancement in breast MRIs of breast cancer patients: Impact on tumor size estimation

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Ji Eun [Department of Radiology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea (Korea, Republic of); Kim, Sung Hun, E-mail: [Department of Radiology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea (Korea, Republic of); Lee, Ah Won [Department of Hospital Pathology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea (Korea, Republic of)


    Objective: To evaluate whether the degree of background parenchymal enhancement affects the accuracy of tumor size estimation based on breast MRI. Methods: Three hundred and twenty-two patients who had known breast cancer and underwent breast MRIs were recruited in our study. The total number of breast cancer cases was 339. All images were assessed retrospectively for the level of background parenchymal enhancement based on the BI-RADS criteria. Maximal lesion diameters were measured on the MRIs, and tumor types (mass vs. non-mass) were assessed. Tumor size differences between the MRI-based estimates and estimates based on pathological examinations were analyzed. The relationship between accuracy and tumor types and clinicopathologic features were also evaluated. Results: The cases included minimal (47.5%), mild (28.9%), moderate (12.4%) and marked background parenchymal enhancement (11.2%). The tumors of patients with minimal or mild background parenchymal enhancement were more accurately estimated than those of patients with moderate or marked enhancement (72.1% vs. 56.8%; p = 0.003). The tumors of women with mass type lesions were significantly more accurately estimated than those of the women with non-mass type lesions (81.6% vs. 28.6%; p < 0.001). The tumor of women negative for HER2 was more accurately estimated than those of women positive for HER2 (72.2% vs. 51.6%; p = 0.047). Conclusion: Moderate and marked background parenchymal enhancement is related to the inaccurate estimation of tumor size based on MRI. Non-mass type breast cancer and HER2-positive breast cancer are other factors that may cause inaccurate assessment of tumor size.

  19. MR imaging of ischemic parenchymal lesions in moyamoya disease of children

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Whal; Kim, In One; Kim, Woo Sun; Yeon, Kyung Mo; Han, Man Chung [Seoul National Univ. College of Medicine, the Institute of Radiation Medicine and Neuroscience Research Institute, SNUMRC, Seoul (Korea, Republic of); Cho, Byung Kyu; Wang, Kyu Chang; Hwang, Yong Seung [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)


    To determine by means of MR imaging the ischemic status of parenchymal lesions in moyamoya disease. Ninety-two MR images in 50 children wiht moyamoya disease were retrospectively reviewed. Ischemic parenchymal lesions were categorized according to the signal intensities of cortex and subcortical white matter. We also analyzed enhancement patterns, time sequential changes in the lesions, and the Prognosis for each patient, according to lesion type. Among one hundred and seventeen parenchymal abnormalities, 89 gyral lesions were seen in 43 children (86%), predominantly in the frontal area (33.1%). Cortical parenchymal lesions were categorized as either type I-intermediate to high signal intensity (SI) on both T2 weighted (T2WI) and proton density images (PDI), and associated with low SI of the subcortical white matter;type II-high SI on T2WI and PDI, without low SI of the subcortical white matter;or type III-high SI on T2WI and iso SI on PDI. Thirty-three lesions were type I, ten were type II, and 43 were type III. Time sequential changes from type I to type II, and then to type III, were observed. The prognoses of patients with a type-I lesion were better than those of patients whose lesions were type II or III. Type I lesions presented with abnormal low signal intensity in the subcortical white matter, as seen on T2WI Images. This was the characteristic and earliest finding of ischemic parenchymal lesions in moyamoya disease; sequential MR images showed that type-I lesions progressed to type II or III.

  20. Renal damage after extracorporeal shock-wave lithotripsy detected by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Torii, Shinichiro; Machida, Toyohei; Ooishi, Yukihiko; Tashiro, Kazuya; Mochizuki, Atsushi; Yoshigoe, Fukuo


    The acute effects of extracorporeal Shock-wave lithotripsy (ESWL) on morphology of the renal parenchyma were evaluated by Magnetic Resonance Imaging (MRI) in 15 kidneys, before and immediately after (within 24 hours) ESWL in 11 cases. The renal parenchymal damages were observed by MRI as the changes of signal itensity of renal cortex and medulla, perirenal fluid, loss of corticomedullar differentiation, and other renal traumas. Loss of corticomedullar differentiation was seen in 9/11 cases and peripheral fluid of the kidney was seen in 4/11 cases. Irregular and edematous changes of renal capsula were seen in 5/11 cases. Obvious abnormal findings indicated renal trauma were not observed in this study. Several MRI findings may transient and reversible changes and the morpholigic changes detected by MRI may attributed to renal parenchymal obstruction and edema and decreasing of renal capillary flow, such as in renal contusion. It is concluded that MRI is very sensitive and the best technique to detect the effects and clinical trouble of ESWL.

  1. Renal tuberculosis

    Directory of Open Access Journals (Sweden)

    Džamić Zoran


    Full Text Available Tuberculosis is still a significant health problem in the world, mostly in developing countries. The special significance lies in immunocompromised patients, particularly those suffering from the HIV. Urogenital tuberculosis is one of the most common forms of extrapulmonary tuberculosis, while the most commonly involved organ is the kidney. Renal tuberculosis occurs by hematogenous dissemination of mycobacterium tuberculosis from a primary tuberculosis foci in the body. Tuberculosis is characterized by the formation of pathognomonic lesions in the tissues - granulomata. These granulomata may heal spontaneously or remain stable for years. In certain circumstances in the body associated with immunosuppression, the disease may be activated. Central caseous necrosis occurs within tuberculoma, leading to formation of cavities that destroy renal parenchyma. The process may gain access to the collecting system, forming the caverns. In this way, infection can be spread distally to renal pelvis, ureter and bladder. Scaring of tissue by tuberculosis process may lead to development of strictures of the urinary tract. The clinical manifestations are presented by nonspecific symptoms and signs, so tuberculosis can often be overlooked. Sterile pyuria is characteristic for urinary tuberculosis. Dysuric complaints, flank pain or hematuria may be presented in patients. Constitutional symptoms of fever, weight loss and night sweats are presented in some severe cases. Diagnosis is made by isolation of mycobacterium tuberculosis in urine samples, by cultures carried out on standard solid media optimized for mycobacterial growth. Different imaging studies are used in diagnostics - IVU, CT and NMR are the most important. Medical therapy is the main modality of tuberculosis treatment. The first line anti-tuberculosis drugs include isoniazid, rifampicin, pyrazinamide and ethambutol. Surgical treatment is required in some cases, to remove severely damaged kidney, if

  2. Renal Osteodystrophy

    Directory of Open Access Journals (Sweden)

    Aynur Metin Terzibaşoğlu


    Full Text Available Chronic renal insufficiency is a functional definition which is characterized by irreversible and progressive decreasing in renal functions. This impairment is in collaboration with glomeruler filtration rate and serum creatinine levels. Besides this, different grades of bone metabolism disorders develop in chronic renal insufficiency. Pathologic changes in bone tissue due to loss of renal paranchyme is interrelated with calcium, phosphorus vitamine-D and parathyroid hormone. Clinically we can see high turnover bone disease, low turnover bone disease, osteomalacia, osteosclerosis and osteoporosis in renal osteodystropy. In this article we aimed to review pathology of bone metabolism disorders due to chronic renal insufficiency, clinic aspects and treatment approaches briefly.

  3. Ultrasonographic imaging for structural characterization of renal affections and diagnosis of associated chronic renal failure in 10 dogs. (United States)

    Kumar, Vijay; Kumar, Adarsh; Varshney, A C


    The present study comprises of 10 dogs of either sex with primary indication of azotaemia. All the dogs were subjected to detailed clinical, haematobiochemical, urinalysis, and microbiological examination along with radiographical and ultrasonographical examination. Based on the ultrasonographic structural abnormalities, the different renal affections associated with CRF in majority of dogs were diagnosed. The different affections included "end-stage" kidneys (n = 4), hydronephrosis (n = 1), renomegaly (n = 1), nephritis (n = 1), nephrolithiasis (n = 1), nephrocalcinosis (n = 1), and renal cyst (n = 1). The significant ultrasonographic features in these affections included small kidneys with loss of corticomedullary demarcation ("end-stage" kidneys); increased cortical echogenicity (nephritis); dilation of the renal pelvis, separation of the central renal sinus with anechoic space, atrophy of renal medulla, (hydronephrosis); enlarged kidneys with increased overall echogenicity of renal cortex (renomegaly and associated nephritis); hyperechoic-mineralized structure with shadowing (nephrolithiasis); diffuse, small, multiple hyperechoic structures in the renal parenchyma with distal acoustic shadowing (nephrocalcinosis); small spherical intercortical anechoic structures fluid (renal cysts). In the present study, ultrasound proved to be a quick, convenient, and sensitive modality in detecting alterations in renal size and parenchymal architecture. All the dogs so diagnosed with CRF were rendered conservative medical treatment to control clinical signs of uraemia; maintain adequate fluid, electrolyte, and acid/base balance; provide adequate nutrition; minimize progression of renal failure.

  4. Renal autotransplantation: current perspectives. (United States)

    Stewart, B H; Banowsky, L H; Hewitt, C B; Straffon, R A


    Autotransplantation, with or without an extracorporeal renal operation, has been done 39 times in 37 patients. Indications for the procedure included severe ureteral injury in 4 patients, failed supravesical diversion in 2, renal carcinoma in a solitary kidney in 1, renovascular hypertension in 1 and donor arterial reconstruction before renal transplantation in 29. Success was obtained in all but 2 procedures, both of which involved previously operated kidneys with severe inflammation and adhesions involving the renal pelvis and pedicle. Based on our experience and a review of currently available literature we believe that renal autotransplantation and extracorporeal reconstruction can provide the best solution for patients with severe renovascular and ureteral disease not correctable by conventional operative techniques. The technique can be of particular value in removing centrally located tumors in solitary kidneys and in preparing donor kidneys with abnormal arteries for renal transplantation. The role of autotransplantation in the management of advanced renal trauma and calculus disease is less clear. A long-term comparison of patients treated by extracorporeal nephrolithotomy versus conventional lithotomy techniques will be necessary before a conclusion is reached in these disease categories.

  5. Small intestinal involvement by lymphoproliferative disorders post-renal transplantation: A report from the post-transplant lymphoproliferative disorder international survey

    Directory of Open Access Journals (Sweden)

    Hossein Khedmat


    Full Text Available In this study, data on post-renal transplant lymphoproliferative disorders (PTLD collected from the existing literature were pooled and analyzed to compare the characteristics, predictors and prognosis of small intestinal PTLDs. We performed a comprehensive search for the available data by Pubmed and Google scholar search engines for reports on this subject. Data from 18 previously published studies, comprising 120 renal allograft recipients, were included in the analysis. Renal transplant recipients with intestinal PTLD were significantly less likely to have Hogkin′s and Hogkin′s-like lesions (P = 0.044 and to be younger at the time of transplan-tation (P = 0.07. Except for Hodgkin′s-like lesions, histopathological evaluations elsewhere were comparable between the group with PTLD in the small intestine and age- and sex-matched renal transplant recipients with PTLD in other sites. The overall mortality was relatively higher in the control group (P = 0.09. When death only due to PTLD was used as the outcome, a trend toward better outcome was seen for the intestinal PTLD group compared with the other localizations (P = 0.1. The 1- and 5-year survival rates for intestinal PTLD patients were 57% and 37%, respectively, compared with 54% and 21%, respectively, for the control group. According to our findings based on analysis of international data, renal transplant patients with small intestinal PTLD are more likely to be of younger age but less frequently represent Hodgkin′s and Hodgkin′s-like lesions. They also have better patient survival compared with transplant recipients with PTLD in other locations. Further multi-center prospective studies are needed to confirm our results.

  6. Diminished response to furosemide in I-123 Hippuran renal studies of renovascular hypertension caused by unilateral renal artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Flueckiger, F.M.; Fueger, G.F.; Einspieler, R.; Hausegger, K. (Department of Radiology, Graz (Austria))


    Dynamic I-123 Hippuran renal studies to measure furosemide response (FR) were performed in three groups of patients: (1) 57 patients with renovascular hypertension due to a poststenotic, ischemic kidney; (2) 23 patients with essential hypertension; and (3) 50 nonhypertensive patients with healthy kidneys (control group). FR was observed as renal parenchymal tracer washout within 10 minutes after the injection of 40 mg of furosemide. The retention index (RI) took into consideration the renal parenchymal tracer content before and 10 minutes after furosemide injection. In the control group, the FR was greater than 50% and the RI was less than 20. Patients with essential hypertension revealed no differences in the amounts of FR and RI compared with the control group. In renovascular hypertension, the FR was diminished and the RI was raised significantly. The values of FR and RI showed a good correlation to the degree of the renal artery stenosis before and after percutaneous transluminal angioplasty. It is concluded that the stimulation of diuresis with furosemide and its quantification represent an important additional step in the evaluation of dynamic I-123 Hippuran studies to detect renal ischemia.

  7. Drug-induced renal disease. (United States)

    Curtis, J R


    The clinical manifestations of drug-induced renal disease may include all the manifestations attributed to natural or spontaneous renal diseases such as acute renal failure, chronic renal failure, acute nephritic syndrome, renal colic, haematuria, selective tubular defects, obstructive nephropathy, etc. It is therefore vital in any patient with renal disease whatever the clinical manifestations might be, to obtain a meticulous drug and toxin inventory. Withdrawal of the offending drug may result in amelioration or cure of the renal disorder although in the case of severe renal failure it may be necessary to utilise haemodialysis or peritoneal dialysis to tide the patient over the period of acute renal failure. Analgesic nephropathy is an important cause of terminal chronic renal failure and it is therefore vital to make the diagnosis as early as possible. The pathogenesis of some drug-induced renal disorders appears to be immunologically mediated. There are many other pathogenetic mechanisms involved in drug-induced renal disorders and some drugs may under appropriate circumstances be responsible for a variety of different nephrotoxic effects. For example, the sulphonamides have been incriminated in examples of crystalluria, acute interstitial nephritis, acute tubular necrosis, generalised hypersensitivity reactions, polyarteritis nodosa and drug-induced lupus erythematosus.

  8. Correlation between computed tomographic and magnetic resonance imaging findings of parenchymal lung diseases

    Energy Technology Data Exchange (ETDEWEB)

    Barreto, Miriam Menna; Rafful, Patricia Piazza [Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro (Brazil); Rodrigues, Rosana Souza [Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro (Brazil); D’Or Institute for Research and Education, Rio de Janeiro, RJ (Brazil); Zanetti, Gláucia [Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro (Brazil); Hochhegger, Bruno [Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS (Brazil); Souza, Arthur Soares [Department of Radiology, Medical School of Rio Preto (FAMERP) and Ultra X, São José do Rio Preto, SP (Brazil); Guimarães, Marcos Duarte [Department of Imaging, Hospital AC Camargo, São Paulo, SP (Brazil); Marchiori, Edson, E-mail: [Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro (Brazil)


    Computed tomography (CT) is considered to be the gold standard method for the assessment of morphological changes in the pulmonary parenchyma. Although its spatial resolution is lower than that of CT, MRI offers the advantage of characterizing different aspects of tissue based on the degree of contrast on T1-weighted image (WI) and T2-WI. In this article, we describe and correlate the MRI and CT features of several common patterns of parenchymal lung disease (air trapping, atelectasis, bronchiectasis, cavitation, consolidation, emphysema, ground-glass opacities, halo sign, interlobular septal thickening, masses, mycetoma, nodules, progressive massive fibrosis, reverse halo sign and tree-in-bud pattern). MRI may be an alternative modality for the collection of morphological and functional information useful for the management of parenchymal lung disease, which would help reduce the number of chest CT scans and radiation exposure required in patients with a variety of conditions.

  9. Isolated unilateral pulmonary artery hypoplasia with accompanying pulmonary parenchymal findings on CT: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Surin; Cha, Yoon Ki; Kim, Jeung Sook; Kwon, Jae Hyun; Jeong, Yun Jeong [Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang (Korea, Republic of); Kim, Seon Jeong [Dept. of Radiology, Myongji Hospital, Goyang (Korea, Republic of)


    Unilateral pulmonary artery hypoplasia or agenesis without congenital cardiovascular anomalies is rare in adults. We report a case of a 36-year-old man with isolated left unilateral pulmonary artery hypoplasia with recurrent hemoptysis. On computed tomography (CT), the left pulmonary artery showed hypoplasia with multiple collateral vessels seen in the mediastinum and the left hemithorax. Also, parenchymal bands and peripheral linear opacities were seen in the affected lung, which were probably due to chronic infarction induced by unilateral pulmonary artery hypoplasia. There are only a few reports focusing on the radiologic findings in the pulmonary parenchyma induced by unilateral pulmonary artery hypoplasia, such as parenchymal bands and peripheral linear opacities. Therefore we report this case, which focused on the CT findings in the pulmonary parenchyma due to isolated unilateral pulmonary artery hypoplasia.

  10. Measurement of the apparent diffusion coefficient in paediatric mitochondrial encephalopathy cases and a comparison of parenchymal changes associated with the disease using follow-up diffusion coefficient measurements

    Energy Technology Data Exchange (ETDEWEB)

    Uysal, Fatma, E-mail: [Dokuz Eylül University, Department of Pediatric Radiology, Izmir (Turkey); Çakmakçı, Handan, E-mail: [Dokuz Eylül University, Department of Pediatric Radiology, Izmir (Turkey); Yiş, Uluç, E-mail: [Dokuz Eylül University, Department of Pediatric Neurology, Izmir (Turkey); Ellidokuz, Hülya, E-mail: [Dokuz Eylül University, Department of Medical Statistics, Izmir (Turkey); Hız, Ayşe Semra, E-mail: [Dokuz Eylül University, Department of Pediatric Neurology, Izmir (Turkey)


    Objectives: To reveal the contribution of MRI and diffusion-weighted imaging (DWI) to the diagnosis of mitochondrial encephalopathy (ME) and to evaluate the parenchymal changes associated with this disease in the involved parenchymal areas using the apparent diffusion coefficient (ADC) parameter. Methods: Ten patients who had undergone MRI and DWI analysis with a pre-diagnosis of neurometabolic disease, and who were subsequently diagnosed with ME in laboratory and/or genetic studies, were included in our study. ADC values were compared with a control group composed of 20 patients of similar age with normal brains. Evaluations involved measurements made in 20 different areas determined on the ADC map. The dominance or contribution of ADC coefficient measurements to the conventional sequences was compared with the controls. Results: In the first examination, an increase in both diffusion and ADC values was detected in six cases and diffusion restriction and a decrease in ADC values in three patients. While an increase in both diffusion and ADC values was demonstrated in four cases, there was diffusion restriction and a decrease in ADC values in three cases in the control examinations. Conclusions: DWI provides information that complements conventional MRI sequences in the diagnosis of ME.

  11. Size, node status and grade of breast tumours: association with mammographic parenchymal patterns

    Energy Technology Data Exchange (ETDEWEB)

    Sala, E.; Solomon, L.; McCann, J. [Department of Community Medicine, Strangeways Research Laboratory, Worts Causeway, Cambridge (United Kingdom); Warren, R. [Cambridge and Huntingdon Breast Screening Service, Rosie Maternity Hospital, Robinson Way, Cambridge (United Kingdom); Duffy, S. [MRC-Biostatistics Unit, Institute of Public Health, Cambridge (United Kingdom); Luben, R. [Department of Clinical Gerontology, Strangeways Research Laboratory, Cambridge (United Kingdom); Day, N. [Department of Community Medicine, Institute of Public Health, Robinson Way, Cambridge, CB2 2SR (United Kingdom)


    A case-control study was designed to assess the association of mammographic parenchymal patterns with the risk of in-situ and invasive breast cancer. In addition, the relationship between tumour characteristics and mammographic patterns were also investigated. A total of 875 patients with breast cancer were selected and matched with 2601 controls. Mammographic parenchymal patterns of breast tissue were assessed according to Wolfe's classification, and statistical analysis was by conditional logistic regression. Relative to the N1 pattern, the odds ratios of having an invasive breast cancer associated with the P2 and DY patterns were 1.8 and 1.4, respectively. In addition, the odd ratios of having an invasive grade 3 breast cancer associated with the P2 and DY patterns were 2.8 and 3.9, respectively. Relative to the combined N1/P1 pattern, the odd ratios of having a breast cancer smaller than 14 mm, 15-29 mm, or larger than 30 mm associated with the combined high-risk P2/DY pattern (P2 + DY) were 1.2, 1.6, and 2.0, respectively. Finally, women with the P2/DY pattern were twice as likely to have a breast cancer which had already spread to the axillary nodes, compared to women with women with the N1/P1 pattern (odds ratios of 2.1 and 1.4, respectively). Our results confirm previous findings suggesting that mammographic parenchymal patterns may serve as indicators of risk for breast cancer. Our results also suggest that mammographic parenchymal patterns are associated with the stage at which breast cancer is detected. (orig.)

  12. Medical imaging for congenital anomalies of the lung. Focused on tracheobronchial and parenchymal anomalies

    Energy Technology Data Exchange (ETDEWEB)

    Kohda, Ehiichi; Shiraga, Nobuyuki; Higuchi, Mutsumi; Ishibashi, Ryouchi [Tachikawa Hospital, Tokyo (Japan)


    This is a review of medical imaging studies for congenital anomalies of the lung focused on tracheobronchial and parenchymal anomalies. It is important to know the findings of these developmental anomalies, because they are frequently manifested as infectious diseases or mass. Documented details are pulmonary agenesis, aplasia, pulmonary hypoplasia, tracheal agenesis, bridging bronchus, tracheal bronchus, congenital tracheal stenosis, bronchial atresia, bronchobiliary fistula, bronchogenic cyst, bronchopulmonary sequestration, congenital cystic adenomatoid malformation, and pulmonary lymphangiectasia. (author)

  13. Superoxide anions are involved in mediating the effect of low K intake on c-Src expression and renal K secretion in the cortical collecting duct. (United States)

    Babilonia, Elisa; Wei, Yuan; Sterling, Hyacinth; Kaminski, Pawel; Wolin, Michael; Wang, Wen-Hui


    We previously demonstrated that low K intake stimulated the expression of c-Src and that stimulation of protein tyrosine kinase inhibited ROMK channel activity (Wei, Y., Bloom, P., Lin, D. H., Gu, R. M., and Wang, W. H. (2001) Am. J. Physiol. 281, F206-F212). Decreases in dietary K content significantly increased O(2)(-) levels and the phosphorylation of c-Jun, a transcription factor, in renal cortex and outer medulla. The role of O(2)(-) and related products such as H(2)O(2) in stimulating the expression of protein tyrosine kinase is suggested by the observation that addition of 50-200 microm H(2)O(2) increased the phosphorylation of c-Jun and the expression of c-Src in M1 cells, a mouse collecting duct principal cell line. The effect of H(2)O(2) on c-Src expression was completely abolished with cyclohexamide or actinomycin D. The treatment of animals on a K-deficient (KD) diet with tempol for 7 days significantly decreased the production of O(2)(-), c-Jun phosphorylation, and c-Src expression. Moreover, low K intake decreased the activity of ROMK-like small conductance channels from 1.37 (control K diet) to 0.5 in the cortical collecting duct and increased the tyrosine phosphorylation of ROMK in the renal cortex and outer medulla. In contrast, the tempol treatment not only increased channel activity to 1.1 in the cortical collecting duct but also decreased the tyrosine phosphorylation of ROMK from rats on a KD diet. Finally, suppressing O(2)(-) production with tempol significantly increased renal K excretion measured with metabolic cage and lowered the plasma K concentration in comparison with those on a KD diet alone without tempol. We conclude that O(2)(-) and related products play a role in mediating the effect of low K intake on c-Src expression and in suppressing ROMK channel activity and renal K secretion.

  14. Mechanisms Involving Ang II and MAPK/ERK1/2 Signaling Pathways Underlie Cardiac and Renal Alterations during Chronic Undernutrition


    Silva, Paulo A.; Gustavo Monnerat-Cahli; Amaury Pereira-Acácio; Ricardo Luzardo; Luzia S Sampaio; Marcia A Luna-Leite; Lara, Lucienne S; Marcelo Einicker-Lamas; Rogério Panizzutti; Caroline Madeira; Vieira-Filho, Leucio D.; Carmen de Castro-Chaves; Ribeiro, Valdilene S.; Paixão, Ana D. O.; Emiliano Medei


    Background Several studies have correlated protein restriction associated with other nutritional deficiencies with the development of cardiovascular and renal diseases. The driving hypothesis for this study was that Ang II signaling pathways in the heart and kidney are affected by chronic protein, mineral and vitamin restriction. Methodology/Principal Findings Wistar rats aged 90 days were fed from weaning with either a control or a deficient diet that mimics those used in impoverished region...

  15. Impact of leukoaraiosis on parenchymal hemorrhage in elderly patients treated with thrombolysis

    Energy Technology Data Exchange (ETDEWEB)

    Nighoghossian, Norbert; Cho, Tae-Hee; Cottaz, Vincent; Mechtouff, Laura; Derex, Laurent [Universite Lyon 1, Department of Stroke, Neurological Hospital, Lyon (France); Abbas, Fatima; Schott, Anne Marie [Hospices Civils de Lyon, Pole Information Medicale Evaluation Recherche, Lyon (France); Geraldo, Ana Filipa; Janecek, Elie; Hermier, Marc; Tisserand, Louis Guy; Amelie, Roxana; Chamard, Leila; Berthezene, Yves [Universite Lyon 1, Department of Neuroradiology, Neurological Hospital, Bron, Lyon (France); Bischoff, Magali; El Khoury, Carlos [RESUVAL Stroke Network, Lyon (France)


    Severity of vascular damage of white matter may predict hemorrhagic transformation (HT). We assess the relationship between leukoaraiosis (LA) severity and the type of hemorrhagic transformation in elderly patients treated with thrombolysis. We retrospectively analyzed the clinical data and pretreatment magnetic resonance imaging (MRI) of 180 consecutive ischemic stroke patients aged over 75 years. LA severity was graded according to the Fazekas scale, and acute diffusion-weighted-imaging (DWI) lesion volumes were semi-automatically outlined. Predictors of hemorrhagic infarction (HI) and parenchymal hemorrhage (PH) were identified using logistic regression analysis and exact multinomial logistic analysis. HT occurred in 31 patients (17 %). Baseline National Institute of Health Stroke Score (NIHSS; p = 0.008), severe LA (p = 0.02), and diffusion lesion volume (p = 0.02) were predictors of HT in univariable logistic regression. Adjusted to lesion volume and baseline NIHSS score, exact multinomial logistic analysis showed that severe LA was the only independent predictor of parenchymal hemorrhage (p = 0.03). In elderly patients, LA severity better predicts parenchymal hemorrhage than infarct size. (orig.)

  16. Fibrocystic change of breast : relation with parenchymal pattern on mammogram and fibroadenoma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ki Yeol; Cha, In Ho; Kang, Eun Young; Kim, Jung Hyuk [Korea Univ. College of Medicine, Seoul (Korea, Republic of)


    To determine the relationship between fibrocystic change and parenchymal pattern and fibroadenoma on mammogram. Mammograms of 135 patients with histologically- diagnosed fibrocystic disease after excisional biopsy were retrospectively analyzed and correlated with pathologic specimens. Classification of the parenchymal pattern was based on Wolfe's method. On mammogram, we observed abnormality in 88 out of the 135 cases;these latter consisted of 70 cases of DY, 30 of P2, 20 of P1, and 15 of Nl, following Wolfe's parenchymal patterns. Among the 88 abnormal cases we obseved 37 cases of mass with clear boundaries, five cases of mass with unclear boundaries, 22 with clustered microcalcifications, six with macrocalcifications and 18 with asymmetric dense breast. Histologic examination revealed a varying composition of stromal fibrosis, epithelial hyperplasia,cyst formation, apocrine metaplasia, etc. Histologically fibroadenomatoid change in 18 cases was appeared as a radiopaque mass on mammogram, especially in those cases where the change was well-defined, which were all except three. Fibrocystic disease was prevalent in Wolfe's P2 and DY patterns(about 80%). About 40% of fibrocystic change appearing as a well defined mass on mammogram showed fibroadenomatoid chage histologically and was difficult to differentiate from fibroadenoma. Fibrocystic disease should therefore be included in the differential diagnosis of a mass which on mammogram is well-defined.

  17. Normal parenchymal enhancement patterns in women undergoing MR screening of the breast

    Energy Technology Data Exchange (ETDEWEB)

    Jansen, Sanaz A.; Lin, Vicky C.; Giger, Maryellen L.; Li, Hui; Karczmar, Gregory S.; Newstead, Gillian M. [University of Chicago, Department of Radiology, Chicago, IL (United States)


    To characterize the kinetic and morphological presentation of normal breast tissue on DCE-MRI in a large cohort of asymptomatic women, and to relate these characteristics to breast tissue density. 335 consecutive breast MR examinations in 229 asymptomatic women undergoing high-risk screening evaluations based on recommendations from the American Cancer Society including strong family history and genetic predisposition were selected for IRB-approved review (average age 49.2 {+-} 10.5 years). Breast tissue density was assessed on precontrast T{sub 2}-weighted images. Parenchymal enhancement pattern (PEP) was qualitatively classified as minimal, homogeneous, heterogeneous or nodular. Quantitative analysis of parenchymal enhancement kinetics (PEK) was performed, including calculation of initial and peak enhancement percentages (E{sub 1}, E{sub peak}), the time to peak enhancement (T{sub peak}) and the signal enhancement ratio (SER). 41.8% of examinations were classified as minimal, 13.7% homogeneous, 23.9% heterogeneous and 21.2% nodular PEP. Women with heterogeneously or extremely dense breasts exhibited a higher proportion of nodular PEP (44.2% (27/61)) and significantly higher E{sub 1}, and E{sub peak} (p < 0.003) compared with those with less dense breasts. Qualitative and quantitative parenchymal enhancement characteristics vary by breast tissue density. In future work, the association between image-derived MR features of the normal breast and breast cancer risk should be explored. (orig.)

  18. Impact of Pregnancy on Underlying Renal Disease


    Baylis, Chris


    Normal pregnancy involves marked renal vasodilation and large increases in glomerular filtration rate (GFR). Studies in rats reveal that the gestational renal vasodilation is achieved by parallel reductions in tone in afferent and efferent arterioles so GFR rises without a change in glomerular blood pressure. There is some evidence from animal studies that increased renal generation of nitric oxide (NO) may be involved. Although chronic renal vasodilation has been implicated in causing progre...

  19. AQP2 exocytosis in the renal collecting duct – involvement of SNARE isoforms and the regulatory role of Munc18b (United States)

    Procino, Giuseppe; Barbieri, Claudia; Tamma, Grazia; De Benedictis, Leonarda; Pessin, Jeffrey E.; Svelto, Maria; Valenti, Giovanna


    Summary Vasopressin regulates the fusion of the water channel aquaporin 2 (AQP2) to the apical membrane of the renal collecting-duct principal cells and several lines of evidence indicate that SNARE proteins mediate this process. In this work MCD4 renal cells were used to investigate the functional role of a set of Q- and R-SNAREs, together with that of Munc18b as a negative regulator of the formation of the SNARE complex. Both VAMP2 and VAMP3 were associated with immunoisolated AQP2 vesicles, whereas syntaxin 3 (Stx3), SNAP23 and Munc18 were associated with the apical plasma membrane. Co-immunoprecipitation experiments indicated that Stx3 forms complexes with VAMP2, VAMP3, SNAP23 and Munc18b. Protein knockdown coupled to apical surface biotinylation demonstrated that reduced levels of the R-SNAREs VAMP2 and VAMP3, and the Q-SNAREs Stx3 and SNAP23 strongly inhibited AQP2 fusion at the apical membrane. In addition, knockdown of Munc18b promoted a sevenfold increase of AQP2 fused at the plasma membrane without forskolin stimulation. Taken together these findings propose VAMP2, VAMP3, Stx3 and SNAP23 as the complementary set of SNAREs responsible for AQP2-vesicle fusion into the apical membrane, and Munc18b as a negative regulator of SNARE-complex formation in renal collecting-duct principal cells. PMID:18505797

  20. Renal perfusion scintiscan (United States)

    Renal perfusion scintigraphy; Radionuclide renal perfusion scan; Perfusion scintiscan - renal; Scintiscan - renal perfusion ... supply the kidneys. This is a condition called renal artery stenosis. Significant renal artery stenosis may be ...

  1. CT findings in ten patients with failed renal allografts: comparison with findings in functional grafts

    Energy Technology Data Exchange (ETDEWEB)

    Gayer, Gabriela E-mail:; Apter, Sara; Katz, Rama; Ben-David, Aharon; Katzir, Ze' ev; Hertz, Marjorie


    Our aim is to report the computed tomography (CT) features of the long-term failed renal allograft. Ten patients with failed renal transplants in whom the graft was left in situ underwent CT for various unrelated indications. The majority of the failed grafts showed marked shrinkage and coarse punctate diffuse parenchymal calcifications. Small cysts were seen in four grafts. A long-term failed renal transplant appeared on CT as a small rounded soft tissue mass. The graft was almost always heavily calcified. Lack of awareness of the nature of such a mass may mislead the radiologist in interpreting it as a space-occupying lesion.

  2. [Renal abnormalities in ankylosing spondylitis]. (United States)

    Samia, Barbouch; Hazgui, Faiçal; Abdelghani, Khaoula Ben; Hamida, Fethi Ben; Goucha, Rym; Hedri, Hafedh; Taarit, Chokri Ben; Maiz, Hedi Ben; Kheder, Adel


    We will study the epidemiologic, clinical, biological, therapeutic, prognostic characteristics and predictive factors of development of nephropathy in ankylosing spondylitis patients. We retrospectively reviewed the medical record of 32 cases with renal involvement among 212 cases of ankylosing spondylitis followed in our service during the period spread out between 1978 and 2006. The renal involvement occurred in all patients a mean of 12 years after the clinical onset of the rheumatic disease. Thirty-two patients presented one or more signs of renal involvement: microscopic hematuria in 22 patients, proteinuria in 23 patients, nephrotic syndrome in 11 patients and decreased renal function in 24 patients (75%). Secondary renal amyloidosis (13 patients), which corresponds to a prevalence of 6,1% and tubulointerstitial nephropathy (7 patients) were the most common cause of renal involvement in ankylosing spondylitis followed by IgA nephropathy (4 patients). Seventeen patients evolved to the end stage renal disease after an average time of 29.8 ± 46 months. The average follow-up of the patients was 4,4 years. By comparing the 32 patients presenting a SPA and renal disease to 88 with SPA and without nephropathy, we detected the predictive factors of occurred of nephropathy: tobacco, intense inflammatory syndrome, sacroileite stage 3 or 4 and presence of column bamboo. The finding of 75% of the patients presented a renal failure at the time of the diagnosis of renal involvement suggests that evidence of renal abnormality involvement should be actively sought in this disease. Copyright © 2011 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  3. Oxidative stress causes renal dopamine D1 receptor dysfunction and hypertension via mechanisms that involve nuclear factor-kappaB and protein kinase C. (United States)

    Banday, Anees Ahmad; Fazili, Fatima Rizwan; Lokhandwala, Mustafa F


    Renal dopamine, via activation of D1 receptors, plays a role in maintaining sodium homeostasis and BP. There exists a defect in renal D1 receptor function in hypertension, diabetes, and aging, conditions that are associated with oxidative stress. However, the exact underlying mechanism of the oxidative stress-mediated impaired D1 receptor signaling and hypertension is not known. The effect of oxidative stress on renal D1 receptor function was investigated in healthy animals. Male Sprague-Dawley rats received tap water (vehicle) and 30 mM L-buthionine sulfoximine (BSO), an oxidant, with and without 1 mM tempol for 2 wk. Compared with vehicle, BSO treatment caused oxidative stress and increase in BP, which was accompanied by defective D1 receptor G-protein coupling and loss of natriuretic response to SKF38393. BSO treatment also increased NF-kappaB nuclear translocation, protein kinase C (PKC) activity and expression, G-protein-coupled receptor kinase-2 (GRK-2) membranous translocation, and D1 receptor serine phosphorylation. In BSO-treated rats' supplementation of tempol decreased oxidative stress, normalized BP, and restored D1 receptor G-protein coupling and natriuretic response to SKF38393. Tempol also normalized NF-kappaB translocation, PKC activity and expression, GRK-2 sequestration, and D1 receptor serine phosphorylation. In conclusion, these results show that oxidative stress activates NF-kappaB, causing an increase in PKC activity, which leads to GRK-2 translocation and subsequent D1 receptor hyper-serine phosphorylation and uncoupling. The functional consequence of this phenomenon was the inability of SKF38393 to inhibit Na/K-ATPase activity and promote sodium excretion, which may have contributed to increase in BP. Tempol reduced oxidative stress and thereby restored D1 receptor function and normalized BP.


    Directory of Open Access Journals (Sweden)

    Deb Kumar Boruah


    Full Text Available BACKGROUND Renal replacement lipomatosis is an uncommon benign entity where abundance of fibrofatty tissue proliferation occurs in renal sinus with further extension of proliferated fatty tissues into renal hilum, perinephric and periureteric spaces. It is usually associated with renal atrophy and marked renal parenchymal destruction. Aim of our study was cross-sectional imaging evaluation of Renal Replacement Lipomatosis (RRL. METHODS A hospital based cross-sectional retrospective study was conducted. The study group comprised of 16 patients presenting to the Departments of Radio-diagnosis, Surgery and Urology in a tertiary care hospital from May 2014 to April 2016. All patients were initially evaluated clinically and ultrasonographically followed by cross-sectional imaging modality like Computed Tomography (CT, Magnetic Resonance Imaging (MRI or both. RESULTS Out of 16 patients of renal replacement lipomatosis, 15 patients (93.8% had associated renal pelvic or ureteric calculus while 1 patient (6.2% had left para-aortic mass without associated calculus. Out of fifteen patients of calculus related RRL, 8 patients (53.3% had calculus size more than 40 mm, followed by 4 patients (26.7% who had size from 20 to 40 mm and 3 patients (20% had size less than 20 mm. The mean CT HU value of calculus was 1334±84.5 in our study. Three patients (18.8% had only renal hilar fatty excessive deposition, 1 patient (6.2% had renal hilar and perinephric space fat depositions, 3 patients (18.8% had renal hilar, perinephric and periureteric spaces depositions and 9 patients (56.2% had renal hilar and periureteric excessive fatty depositions. Delayed renal functioning was noted in 9 patients (56%, followed by non-functioning in 5 patients (31.2% and 2 patients (12.5% had normally functioning kidneys. CONCLUSION Cross-sectional imaging like CT and MRI scan helps in diagnosing RRL and proper delineation of extensions of excessive fatty tissue proliferation.

  5. A Modified method for reducing renal injury in zoledronic acid treatment of hypercalcemia and adverse skeletal events

    Directory of Open Access Journals (Sweden)

    Jiang Liu


    Full Text Available Aims: In this paper, we have reported a previously undescribed risk factor of deterioration of renal function in zoledronic acid treatment of skeletal metastasis - high serum calcium level. Based on this consideration, a modified method of treatment of hypercalcemia (HCM with zoledronic acid is suggested in this paper. Material and Methods: Bone scan findings of 1090 cancer patients were analyzed, of which 26 had intense renal parenchymal uptake as a result of HCM or bone metastases. Subsequently, a total of 56 bone metastases patients with zoledronic acid treatment were divided into three groups: HCM group who were pre-treated to normal serum calcium level (13 patients, HCM group (19 patients, and normal serum calcium group (24 patients. Results: More patients with intense renal parenchymal uptake were hyperglycemic, statistically significantly (18/26 versus 19/1064, P = 2.1, E-78. No more patients with intense renal parenchymal uptake were associated with bone metastases (14/26 versus 438/1064, P = 0.20. Subsequently, more HCM patients receiving zoledronic acid treatment showed renal injury compared to patients with normal serum calcium level (5/15 versus 2/24, P < 0.05 and HCM patients with pre-treatment to normal serum calcium level (5/15 versus 1/17, P < 0.05. Conclusions: Intense renal parenchymal uptake of bisphosphonates is closely related to HCM rather than to bone metastases in cancer patients. The serum calcium should be measured and reduced to normal level before zoledronic acid is used in managements of adverse skeletal events in order to decrease the risk of renal injury.

  6. Superoxide Anions Are Involved in Mediating the Effect of Low K Intake on c-Src Expression and Renal K Secretion in the Cortical Collecting Duct* (United States)

    Babilonia, Elisa; Wei, Yuan; Sterling, Hyacinth; Kaminski, Pawel; Wolin, Michael; Wang, Wen-Hui


    We previously demonstrated that low K intake stimulated the expression of c-Src and that stimulation of protein tyrosine kinase inhibited ROMK channel activity (Wei, Y., Bloom, P., Lin, D. H., Gu, R. M., and Wang, W. H. (2001) Am. J. Physiol. 281, F206–F212). Decreases in dietary K content significantly increased O2·¯ levels and the phosphorylation of c-Jun, a transcription factor, in renal cortex and outer medulla. The role of O2·¯ and related products such as H2O2 in stimulating the expression of protein tyrosine kinase is suggested by the observation that addition of 50–200 µM H2O2 increased the phosphorylation of c-Jun and the expression of c-Src in M1 cells, a mouse collecting duct principal cell line. The effect of H2O2 on c-Src expression was completely abolished with cyclohexamide or actinomycin D. The treatment of animals on a K-deficient (KD) diet with tempol for 7 days significantly decreased the production of O2·¯, c-Jun phosphorylation, and c-Src expression. Moreover, low K intake decreased the activity of ROMK-like small conductance channels from 1.37 (control K diet) to 0.5 in the cortical collecting duct and increased the tyrosine phosphorylation of ROMK in the renal cortex and outer medulla. In contrast, the tempol treatment not only increased channel activity to 1.1 in the cortical collecting duct but also decreased the tyrosine phosphorylation of ROMK from rats on a KD diet. Finally, suppressing O2·¯ production with tempol significantly increased renal K excretion measured with metabolic cage and lowered the plasma K concentration in comparison with those on a KD diet alone without tempol. We conclude that O2·¯ and related products play a role in mediating the effect of low K intake on c-Src expression and in suppressing ROMK channel activity and renal K secretion. PMID:15644319

  7. Disseminated fungal infection in a renal transplant recipient involving Macrophomina phaseolina and Scytalidium dimidiatum: case report and review of taxonomic changes among medically important members of the Botryosphaeriaceae. (United States)

    Tan, Darrell H S; Sigler, Lynne; Gibas, Connie F C; Fong, Ignatius W


    We report the first case of human infection with the fungal plant pathogen Macrophomina phaseolina in a Sri Lankan-born Canadian man following a renal transplant in India. The patient subsequently succumbed to invasive infection with Scytalidium dimidiatum. Molecular sequence analysis confirmed the identification of both fungi and revealed that they are related species within the ascomycete family Botryosphaeriaceae. We review the rationale for the recent reclassification of S. dimidiatum as Neoscytalidium dimidiatum and of Nattrassia mangiferae (formerly considered a synanamorph of S. dimidiatum) as Neofusicoccum mangiferae. This and other recent cases illustrate the potential for plant pathogenic fungi to cause invasive human diseases which are refractory to antifungal therapy.

  8. Renal Sympathetic Denervation by CT-scan-Guided Periarterial Ethanol Injection in Sheep

    Energy Technology Data Exchange (ETDEWEB)

    Firouznia, Kavous, E-mail:; Hosseininasab, Sayed jaber, E-mail: [Tehran University of Medical Sciences (TMUS), Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital Complex (Iran, Islamic Republic of); Amanpour, Saeid, E-mail: [Tehran University of Medical Science, Cancer Models Research Center, Cancer Institute of Iran (Iran, Islamic Republic of); Haj-Mirzaian, Arya, E-mail: [Tehran University of Medical Science, Department of Radiology and Imaging, MIC, Imam Khomeini Hospital (Iran, Islamic Republic of); Miri, Roza, E-mail: [Tehran University of Medical Science, Department of Pathology, Imam Khomeini Hospital Complex (Iran, Islamic Republic of); Muhammadnejad, Ahad, E-mail: [Tehran University of Medical Science, Cancer Research Center, Cancer Institute of Iran (Iran, Islamic Republic of); Muhammadnejad, Samad, E-mail: [Tehran University of Medical Sciences, Research Center for Molecular and Cellular Imaging (Iran, Islamic Republic of); Jalali, Amir H., E-mail: [Tehran University of Medical Sciences (TMUS), Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital Complex (Iran, Islamic Republic of); Ahmadi, Farrokhlagha, E-mail: [Tehran University of Medical Sciences, Nephrology Research Center, Imam Khomeini Hospital Complex (Iran, Islamic Republic of); Rokni-Yazdi, Hadi, E-mail: [Tehran University of Medical Sciences (TMUS), Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital Complex (Iran, Islamic Republic of)


    BackgroundRenal nerves are a recent target in the treatment of hypertension. Renal sympathetic denervation (RSD) is currently performed using catheter-based radiofrequency ablation (RFA) and because this method has limitations, percutaneous magnetic resonance (MR)-guided periarterial ethanol injection is a suggested alternative. However, few studies have been conducted on the effectiveness of percutaneous ethanol injection for RSD.AimTo evaluate the feasibility, efficacy, and complications of computed tomography (CT)-guided periarterial ethanol injection.MethodsEthanol (10 ml, 99.6 %) was injected around the right renal artery in six sheep under CT guidance with the left kidney serving as a control. Before and after the intervention, the sheep underwent MR imaging studies and the serum creatinine level was measured. One month after the intervention, the sheep were euthanized and norepinephrine (NE) concentration in the renal parenchyma was measured to evaluate the efficacy of the procedure. The treated tissues were also examined histopathologically to evaluate vascular, parenchymal, and neural injury.ResultsThe right kidney parenchymal NE concentration decreased significantly compared with the left kidney after intervention (average reduction: 40 %, P = 0.0016). Histologic examination revealed apparent denervation with no other vascular or parenchymal injuries observed in the histological and imaging studies.ConclusionEffective and feasible RSD was achieved using CT-guided periarterial ethanol injection. This technique may be a potential alternative to catheter-based RFA in the treatment of hypertension.

  9. Giant isolated renal cyst hydatid: From diagnosis to treatment

    Directory of Open Access Journals (Sweden)

    Senol Adanur


    Full Text Available Hydatid cyst disease is a parasitic infestation caused by Echinococcus granulosus. Renal involvement is rarely seen as 2-4% of all cases. Rarely renal involvement is isolated whereas commonly it accompanies involvement of other organs. We aimed to present a 30-year-old male patient with renal involvement reaching a giant size and undiagnosed in another center.

  10. Sono-Guided Percutaneous Automated Gun Biopsy in Pediatric Renal Disease

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong Chul [Chungnam National University College of Medicine, Daejeon (Korea, Republic of)


    To evaluate whether sono-guided percutaneous automated gun biopsy is also useful in pediatricpatients with renal diseases. In the prone position of twenty pediatric patients with renal parenchymal diseases, percutaneous biopsy was done through lateral aspect of the lower pole of left kidney with automated biopsy gun under the guidance of ultrasonography. The biopsy needle was either of 18 or 20 gauge. The obtained core of renal tissue was examined with light, immunofluorescent or electron microscope by the renal pathologist. In 18 among 20 patients, adequate renal tissue core sufficient to be pathologically diagnosed was obtained. The histologic findings were as follows : IG A nephropathy (n = 2), lupus nephritis (n =2), minimal change glomerulonephritis (n = 5), membranoproliferative glomerulonephritis (n = 3), mesangialproliferative glomeru-lonephritis (n = 1), diffuse proliferative glomerulonephritis (n = 3), focalglomerulo-sclerosis (n = 1), membranous glomerulopathy (n = 1). No significant complications occurred during or after the biopsy. Sono-guided percutaneous renal biopsy using automated biopsy gun is also useful todiagnose renal parenchymal diseases without significant complications in pediatric patients

  11. Inhibition of canonical WNT/β-catenin signaling is involved in leflunomide (LEF)-mediated cytotoxic effects on renal carcinoma cells. (United States)

    Chen, Yicheng; Huang, Qiaoli; Zhou, Hua; Wang, Yueping; Hu, Xian; Li, Tao


    Leflunomide (LEF), an inhibitor of dihydroorotate dehydrogenase (DHODH) in pyrimidine biosynthetic pathway, is an immunomodulatory agent approved for the treatment of rheumatoid arthritis. In this study, we show that LEF significantly reduced cell proliferation of renal carcinoma cells in a concentration-dependent manner. LEF at 50 μM induced S-phase arrest and autophagy. Higher doses of LEF (>50 μM) effectively induced cell apoptosis. Modulating the concentration of LEF resulted in distinct effects on the expression of regulatory proteins associated with cell cycle, apoptosis, and autophagy. In particular, high concentrations of LEF inhibited canonical WNT signaling by promoting nucleo-cytoplasmic shuttling and proteasome-dependent degradation of β-catenin. Mechanistic studies showed that the repression of AKT activation partly accounted for LEF-mediated WNT inhibition. Gene expression microarray revealed that LEF treatment greatly inhibited the expression of FZD10 gene, a receptor mediating WNT/β-catenin activation. In vivo xenograft study in NOD/SCID mice further validated the inhibitory effects of LEF on tumor growth and Wnt/β-catenin signaling. However, LEF treatment also triggered cell autophagy and elevated the expression of WNT3a, which ameliorated its cytotoxic effects. The combination of LEF with a WNT inhibitor IWP-2 or autophagy inhibitor HCQ could yield an enhanced anti-tumor outcome. Taken together, these results identify the potential utility and pharmacological feature of LEF in the chemotherapy of renal cell carcinoma (RCC).

  12. Peroxiredoxins, thioredoxin, and Y-box-binding protein-1 are involved in the pathogenesis and progression of dialysis-associated renal cell carcinoma. (United States)

    Fushimi, Fumiyoshi; Taguchi, Kenichi; Izumi, Hiroto; Kohno, Kimitoshi; Kuwano, Michihiko; Ono, Mayumi; Nakashima, Yutaka; Takesue, Tetsuro; Naito, Seiji; Oda, Yoshinao


    Patients with end-stage renal disease are exposed to increased oxidative stress and impairment of antioxidant mechanisms. We focused on dialysis renal cell carcinoma (RCC), including epithelial hyperplasia in acquired cystic disease of the kidney (ACDK). We attempted to obtain insight into the carcinogenesis and tumor progression in terms of cellular defense mechanisms associated with oxidative stress by investigating the expression of antioxidant proteins by immunohistochemistry. We evaluated retrospectively 43 cases of dialysis RCC and, as a control group, 49 cases of sporadic RCC. Peroxiredoxin (Prx) 1, 3, 4, 5, and 6 expression in dialysis RCC was positively correlated with the duration of dialysis. In epithelial hyperplasia, in 17 cases of acquired cystic disease of the kidney, Prxs and thioredoxin were highly expressed. Moreover, in dialysis RCC, Prx 3, 4, and 5 immunoreactivity and nuclear expression of Y-box-binding protein-1 were higher than in sporadic RCC. In dialysis RCC, Prx 3, 4, and 5 immunoreactivity positively correlated with the Fuhrman nuclear grade. These data suggest that oxidative stress during dialysis enhances antioxidant activity, with an inhibiting effect on carcinogenesis. Once cancer has developed, antioxidant activity might have a stimulating effect on the progression of dialysis RCC.

  13. Severe cerebral hypovolemia on perfusion CT and lower body weight are associated with parenchymal haemorrhage after thrombolysis

    Energy Technology Data Exchange (ETDEWEB)

    Tsetsou, S.; Eskandari, A.; Michel, P. [Centre Hospitalier Universitaire Vaudois and University of Lausanne CHUV, Department of Neurology, Lausanne (Switzerland); Amiguet, M. [Centre Hospitalier Universitaire Vaudois and University of Lausanne, Institute of Social and Preventive Medicine, Lausanne (Switzerland); Meuli, R.; Maeder, P. [Centre Hospitalier Universitaire Vaudois and University of Lausanne, Department of Radiology, Lausanne (Switzerland); Jiang, B.; Wintermark, M. [Stanford University and Medical Center, Department of Radiology, Neuroradiology Division, Stanford, CA (United States)


    Haemorrhagic transformation of acute ischemic stroke (AIS) and particularly parenchymal haemorrhage (PH) remains a feared complication of intravenous thrombolysis (IVT). We aimed to identify clinical and perfusion CT (PCT) variables which are independently associated with PHs. In this observational cohort study, based on the Acute Stroke Registry Analysis of Lausanne (ASTRAL) from 2003 to December 2013, we selected patients with AIS involving the middle cerebral artery (MCA) territory who were thrombolysed within 4.5 h of symptoms' onset and who had a good quality baseline PCT at the beginning of IVT. In addition to demographic, clinical, laboratory and non-contrast CT data, volumes of salvageable tissue and ischemic core on PCT, as well as absolute CBF and CBV values within the ischemic regions were compared in patients with and without PH in multivariate analysis. Of the 190 included patients, 24 (12.6%) presented a PH (11 had PH1 and 13 had PH2). In multivariate analysis of the clinical and radiological variables, the lowest CBV in the core and lower body weight was both significantly associated with PH (p = 0.009 and p = 0.024, respectively). In thrombolysed MCA strokes, maximal hypoperfusion severity depicted by lowest CBV values in the core region and lower body weight are independently correlated with PH. This information, if confirmed in other case series, may add to the stratification of revascularisation decisions in patients with a perceived high PH risk. (orig.)

  14. Renal myxoma: a case report

    Directory of Open Access Journals (Sweden)

    Carlos Henrique C Souza


    Full Text Available Myxomas are rare tumors that can appear in many anatomical locations. There are only 14 cases of renal involvement documented in the literature. This article reports a case of renal myxoma in an elderly woman with recurrent cystitis. After five years of follow-up, the computed tomography (CT revealed a large solid tumor mass in the left kidney. Tumor resection was performed preserving the affected kidney with histopathological diagnosis of renal myxoma. The objective of this study is to report a rare case of renal myxoma, emphasizing the importance of the differential diagnosis from other benign and malignant mesenchymal tumors.

  15. Acute renal dysfunction in liver diseases

    Institute of Scientific and Technical Information of China (English)


    Renal dysfunction is common in liver diseases, either as part of multiorgan involvement in acute illness or secondary to advanced liver disease. The presence of renal impairment in both groups is a poor prognostic indicator. Renal failure is often multifactorial and can present as pre-renal or intrinsic renal dysfunction. Obstructive or post renal dysfunction only rarely complicates liver disease. Hepatorenal syndrome (MRS) is a unique form of renal failure associated with advanced liver disease or cirrhosis, and is characterized by functional renal impairment without significant changes in renal histology. Irrespective of the type of renal failure, renal hypoperfusion is the central pathogenetic mechanism, due either to reduced perfusion pressure or increased renal vascular resistance. Volume expansion, avoidance of precipitating factors and treatment of underlying liver disease constitute the mainstay of therapy to prevent and reverse renal impairment. Splanchnic vasoconstrictor agents, such as terlipressin, along with volume expansion, and early placement of transjugular intrahepatic portosystemic shunt (TIPS) may be effective in improving renal function in HRS. Continuous renal replacement therapy (CRRT) and molecular absorbent recirculating system (MARS) in selected patients may be life saving while awaiting liver transplantation.


    Directory of Open Access Journals (Sweden)

    A. V. Govorov


    Full Text Available Renal cryoablation is an alternative minimally-invasive method of treatment for localized renal cell carcinoma. The main advantages of this methodology include visualization of the tumor and the forming of "ice ball" in real time, fewer complications compared with other methods of treatment of renal cell carcinoma, as well as the possibility of conducting cryotherapy in patients with concomitant pathology. Compared with other ablative technologies cryoablation has a low rate of repeat sessions and good intermediate oncological results. The studies of long-term oncological and functional results of renal cryoablation are presently under way.

  17. Renal angiomyolipoma

    DEFF Research Database (Denmark)

    Holm-Nielsen, P; Sørensen, Flemming Brandt


    lesion. Three cases of renal angiomyolipoma, 2 of which underwent perfusion-fixation, were studied by electron microscopy to clarify the cellular composition of this lesion. In the smooth muscle cells abundant accumulation of glycogen was found, whereas the lipocytes disclosed normal ultrastructural......-specific vesicular structures. These findings suggest a secondary vascular damage, i.e. the thickened vessels may not be a primary, integral part of renal angiomyolipoma. Evidence of a common precursor cell of renal angiomyolipoma was not disclosed. It is concluded that renal angiomyolipoma is a hamartoma composed...

  18. Diffuse FDG renal uptake in lymphoma. (United States)

    Navalkissoor, Shaunak; Szyszko, Teresa; Gnanasegaran, Gopinath; Nunan, Thomas


    In patients presenting with acute renal failure and known/suspected lymphoma, the diagnosis of diffuse renal involvement is important, as there is potential for rapid resolution with chemotherapy. Although FDG is excreted through the kidneys and focal renal disease may be difficult to identify, diffuse renal FDG is more easily recognized and is always abnormal. We report a patient presenting with acute renal failure and suspected lymphoma. F-18 FDG PET/CT study demonstrated diffuse increased FDG uptake in bilaterally enlarged kidneys. Following 1 cycle of chemotherapy, the renal function normalized. An interim F-18 FDG PET/CT demonstrated normal size and FDG uptake within both kidneys.

  19. Influence of alcohol on brain volume in social drinkers: evaluation with MR-based intracranial-parenchymal ratio

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Joo; Lee, Kyung Kyu; Lee, Sang Hoon; Kwon, Ho Jang [Dankook University College of Medicine, Seoul (Korea, Republic of); Kim, Jae Kyun [Ulsan University College of Medicine, Seoul (Korea, Republic of)


    To determine, by measuring the intracranial-parenchymal ratio at MR imaging, whether alcohol induces brain damage in social drinkers. One hundred and five male adults aged 20 or over were selected for this study. They inclued 41 non-drinkers, 43 mild to moderate social drinkers, nine heavy social drinkers and 12 alcoholics. Using a workstation, the intracranial-parenchymal ratio was measured at four levels of T1-weighted MR images: the fourth, third and lateral ventricle, and the level of the centrum semiovale. The mean ratios of all four levels (I-IV) were also calculated parenchymal ratios were compared between the four groups, and correlation between the amount of alcohol ingestion and the parenchymal ratio also determined. The parenchymal ratio at levels I-IV was 80.31{+-}3.73% in non-drinkers, 79.38{+-}4.39% in mild to moderate social drinkers, 80.92{+-}3.64% in heavy social drinkers and 73.48{+-}4.42% in alcoholics, The difference between alcoholics and the other three groups was statistically significant, but between non-drinkers and social drinkers was insignificant (ANOVA). Multiple regression analysis with control of the age factor revealed a decreased parenchymal ratio in mild to moderate and heavy social drinkers compared with non-drinkers, but without statistical significance. There was significant negative correlation between parenchymal ratio and amount of alcohol ingestion (pearson correlation). There was significant brain atrophy in alcoholics, but no significant difference between non-drinkers and social drinkers. We thus conclude that social drinking dose non induce significant alcohol-related brain atrophy.

  20. Predicting local recurrence following breast-conserving treatment: parenchymal signal enhancement ratio (SER) around the tumor on preoperative MRI

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mi Young; Cho, Nariya; Koo, Hye Ryoung; Yun, Bo La; Bae, Min Sun; Moon, Woo Kyung [Dept. of Radiology, Seoul National Univ. Coll. of Medicine, Seoul National Univ. Hospital, Seoul (Korea, Republic of)], e-mail:; Chie, Eui Kyu [Dept. of Radiation Oncology, Seoul National Univ. Coll. of Medicine, Seoul National Univ. Hospital, Seoul (Korea, Republic of)


    Background: The level of background parenchymal enhancement around tumor is known to be associated with breast cancer risk. However, there is no study investigating predictive power of parenchymal signal enhancement ratio (SER) around tumor for ipsilateral breast tumor recurrence (IBTR). Purpose: To investigate whether the breast parenchymal SER around the tumor on preoperative dynamic contrast-enhanced magnetic resonance imaging (MRI) is associated with subsequent IBTR in breast cancer patients who had undergone breast-conserving treatment. Material and Methods: Nineteen consecutive women (mean age, 44 years; range, 34-63 years) with breast cancer who developed IBTR following breast-conserving treatment and 114 control women matched for age, as well as T and N stages were included. We compared the clinicopathologic features of the two groups including nuclear grade, histologic grade, hormonal receptor status, human epidermal growth factor receptor-2 (HER-2) status, lymphovascular invasion, negative margin width, use of adjuvant therapy, and parenchymal SER around the tumor on preoperative DCE-MRI. The SER was measured on a slice showing the largest dimension of the tumor. Multivariate conditional logistic regression analysis was used to identify independent factors associated with IBTR. Results: In univariate analysis, ER negativity (odds ratio [OR] = 4.7; P = 0.040), PR negativity (OR = 4.0; P = 0.013), HER-2 positivity (OR = 3.6; P = 0.026), and a parenchymal SER greater than 0.53 (OR = 23.3; P = 0.011) were associated with IBTR. In multivariate analysis, ER negativity (OR = 3.8; P = 0.015) and a parenchymal SER greater than 0.53 (OR = 13.2; P = 0.040) on preoperative MRI were independent factors associated with IBTR. Conclusion: In addition to ER negativity, a higher parenchymal SER on preoperative MRI was an independent factor associated with subsequent IBTR in patients with breast cancer who had undergone breast-conserving treatment.

  1. Seizure recurrence in patients with solitary cystic granuloma or single parenchymal cerebral calcification: a comparative evaluation. (United States)

    Sharma, Laxmi Narayan; Garg, Ravindra Kumar; Verma, Rajesh; Singh, Maneesh Kumar; Malhotra, Hardeep Singh


    Solitary cysticercus granuloma and single parenchymal calcified lesion are two common neuroimaging abnormalities in Indian patients with epilepsy. In this study, we evaluated the frequency and predictors of seizure recurrence in patients presenting with new onset epilepsy or single epileptic seizures and these two different imaging findings. We enrolled 115 patients with newly diagnosed epilepsy. All patients were clinically evaluated and were treated with oxcarbazepine. No anti-helminthic treatment was prescribed. The patients were followed up for 6 months. In the solitary cystic granuloma group, repeat computed tomography was done after 6 months. The study included 80 patients with solitary cysticercus granuloma and 35 patients with a single calcified lesion. Twenty (25%) patients with solitary cysticercus granuloma and 12 (34.3%) patients with parenchymal calcified lesion had a seizure recurrence during the study period (p = 0.307). After 6 months, 57 (71.3%) patients in the solitary cysticercus granuloma group demonstrated complete resolution of the granuloma and in 21 (26.2%) patients the granuloma transformed into a calcified lesion. In the solitary cysticercus granuloma group, a family history of seizure, serial seizures and calcification on follow-up neuroimaging (p seizures. In patients with a single parenchymal calcified lesions, electroencephalographic abnormalities and serial seizures (p = seizure recurrence rate was insignificantly higher in patients with calcified lesions than in patients with solitary cysticercosis granulomas. In conclusion, in patients with solitary cysticercus granuloma, a family history of seizures, serial seizures and calcification of the granuloma, and in patients with a calcified brain lesion, electroencephalographic abnormalities, family history of epilepsy and serial seizures were associated with an increased risk of seizure recurrence. Copyright © 2013 British Epilepsy Association. Published by Elsevier Ltd. All rights

  2. The role of hepatic ischemia-reperfusion injury and liver parenchymal quality on cancer recurrence. (United States)

    Orci, Lorenzo A; Lacotte, Stéphanie; Oldani, Graziano; Morel, Philippe; Mentha, Gilles; Toso, Christian


    Hepatic ischemia/reperfusion (I/R) injury is a common clinical challenge. Despite accumulating evidence regarding its mechanisms and potential therapeutic approaches, hepatic I/R is still a leading cause of organ dysfunction, morbidity, and resource utilization, especially in those patients with underlying parenchymal abnormalities. In the oncological setting, there are growing concerns regarding the deleterious impact of I/R injury on the risk of post-surgical tumor recurrence. This review aims at giving the last updates regarding the role of hepatic I/R and liver parenchymal quality injury in the setting of oncological liver surgery, using a "bench-to-bedside" approach. Relevant medical literature was identified by searching PubMed and hand scanning of the reference lists of articles considered for inclusion. Numerous preclinical models have depicted the impact of I/R injury and hepatic parenchymal quality (steatosis, age) on increased cancer growth in the injured liver. Putative pathophysiological mechanisms linking I/R injury and liver cancer recurrence include an increased implantation of circulating cancer cells in the ischemic liver and the upregulation of proliferation and angiogenic factors following the ischemic insult. Although limited, there is growing clinical evidence that I/R injury and liver quality are associated with the risk of post-surgical cancer recurrence. In conclusion, on top of its harmful early impact on organ function, I/R injury is linked to increased tumor growth. Therapeutic strategies tackling I/R injury could not only improve post-surgical organ function, but also allow a reduction in the risk of cancer recurrence.

  3. Vitamin A deficiency alters the pulmonary parenchymal elastic modulus and elastic fiber concentration in rats

    Directory of Open Access Journals (Sweden)

    Holmes Amey J


    Full Text Available Abstract Background Bronchial hyperreactivity is influenced by properties of the conducting airways and the surrounding pulmonary parenchyma, which is tethered to the conducting airways. Vitamin A deficiency (VAD is associated with an increase in airway hyperreactivity in rats and a decrease in the volume density of alveoli and alveolar ducts. To better define the effects of VAD on the mechanical properties of the pulmonary parenchyma, we have studied the elastic modulus, elastic fibers and elastin gene-expression in rats with VAD, which were supplemented with retinoic acid (RA or remained unsupplemented. Methods Parenchymal mechanics were assessed before and after the administration of carbamylcholine (CCh by determining the bulk and shear moduli of lungs that that had been removed from rats which were vitamin A deficient or received a control diet. Elastin mRNA and insoluble elastin were quantified and elastic fibers were enumerated using morphometric methods. Additional morphometric studies were performed to assess airway contraction and alveolar distortion. Results VAD produced an approximately 2-fold augmentation in the CCh-mediated increase of the bulk modulus and a significant dampening of the increase in shear modulus after CCh, compared to vitamin A sufficient (VAS rats. RA-supplementation for up to 21 days did not reverse the effects of VAD on the elastic modulus. VAD was also associated with a decrease in the concentration of parenchymal elastic fibers, which was restored and was accompanied by an increase in tropoelastin mRNA after 12 days of RA-treatment. Lung elastin, which was resistant to 0.1 N NaOH at 98°, decreased in VAD and was not restored after 21 days of RA-treatment. Conclusion Alterations in parenchymal mechanics and structure contribute to bronchial hyperreactivity in VAD but they are not reversed by RA-treatment, in contrast to the VAD-related alterations in the airways.

  4. Renal cancer

    NARCIS (Netherlands)

    Corgna, Enrichetta; Betti, Maura; Gatta, Gemma; Roila, Fausto; De Mulder, Pieter H. M.


    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all acknowle

  5. Renal fallure

    Institute of Scientific and Technical Information of China (English)


    920705 Endothelin and acute renal failure:study on their relationship and possiblemechanisms. LIN Shanyan(林善锬), et al.Renal Res Lab, Huashan Hosp, Shanghai MedUniv, Shanghai, 200040. Natl Med J China 1992;72(4): 201-205. In order to investigate the role of endothelin

  6. Renal cancer.

    NARCIS (Netherlands)

    Corgna, E.; Betti, M.; Gatta, G.; Roila, F.; Mulder, P.H.M. de


    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all

  7. Renal cancer

    NARCIS (Netherlands)

    Corgna, Enrichetta; Betti, Maura; Gatta, Gemma; Roila, Fausto; De Mulder, Pieter H. M.


    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all

  8. 松果体实质肿瘤的诊断与治疗%Diagnosis and treatment for pineal parenchymal tumors

    Institute of Scientific and Technical Information of China (English)

    于洮; 王光华; 任晓辉; 姜中利; 张懋植; 林松


    Objective Pineal parenchymal tumors are rare intracranial tumors.We studied the clinical features,neuro- radiology and pathology of pineal parenchymal tumors and discussed the treatment strategy.Methods There were 35 pineal parenchymal tumors patients (10 pineocytoma,13 pineal parenchymal tumor of intermediate differentiation,12 pineoblastoma) involved in this study.CT and MRI revealed pineocytoma to be round and have regular margins. Pineal paranchymal tumor of intermediate differentiation and pineoblastoma were lobular,irregular marginal and heterogenous enhancement.Poppen approach was performed in 16 cases,transcallosum approach in 16 cases,subtentorial -supracerebellar approach in 1 case and transtrigone lateral ventricle approach in 1 case.Results All of the tumors were surgically removed,including 13 totally removed,16 subtotally removed and 6 partially removed.23 patients received radiotherapy after operation.During the follow up there was 7 patients died because of tumor recurrence.Conclusions Pineocytoma patients have good survival prognosis after surgical treatment.Microsurgery combining with radiotherapy represents the most effective therapy for pineal parenchymal tumor of intermediate differentiation and pineoblastoma.Although these tumors have poor prognosis and more efforts should be made to improve the level of treatment.%目的 探讨松果体实质肿瘤的诊断和治疗方法.方法 回顾性分析35例松果体实质肿瘤患者(松果体细胞瘤10例,中分化松果体实质肿瘤13例,松果体母细胞瘤12例).CT及MRI示松果体区团块样肿物,松果体细胞瘤边界规则、清楚,增强均匀.恶性松果体实质肿瘤边界不清、分叶状,不均匀增强.手术选择Poppen入路16例,经胼胝体-穹窿间入路16例,幕下小脑上入路1例和三角区入路2例.结果 肿瘤全切除13例,近全切除16例,部分切除6例.术中多数肿瘤与周围组织有粘连.术后23例患者进行了放射治疗.随访7例患者因

  9. MR to assess renal function in children

    Energy Technology Data Exchange (ETDEWEB)

    Rohrschneider, Wiltrud K.; Troeger, Jochen [Department of Pediatric Radiology, Radiological Clinic, University of Heidelberg, Im Neuenheimer Feld 153, 69120, Heidelberg (Germany); Haufe, Sabine [Department of Nuclear Medicine, Radiological University Clinic Heidelberg, Im Neuenheimer Feld 153, 69120, Heidelberg (Germany); Clorius, John H. [Department of Nuclear Medicine, German Cancer Research Institute, 69120, Heidelberg (Germany)


    Renal function evaluation in the pediatric patient is generally based on scintigraphic examinations where a baseline gamma-camera renography is used to determine single kidney function, and diuresis renography is obtained to assess urinary drainage from the pelvicalyceal system. Magnetic resonance imaging also permits the evaluation of renal functional processes using fast dynamic sequences. Principally, an agent cleared by renal excretion is intravenously injected and its cortical uptake, parenchymal transport, and eventually its urinary excretion are followed with serial images. Different approaches have been presented most of which are based on T1-weighted gradient-recalled echo sequences with short TR and TE and a low flip angle obtained after intravenous injection of Gd-DTPA or Gd-DOTA. These techniques permit renal functional assessment using different qualitative and quantitative parameters; however, most of these methods are not suitable for the evaluation of urinary tract dilatation in infants and children. For the diagnostic work-up of children with congenital urinary tract obstruction and malformation a technique was developed which permits quantitative determination of single kidney function, in addition to evaluating urinary excretion disturbances analogous to that possible with scintigraphy. (orig.)

  10. Parenchymal-sparing liver surgery in patients with colorectal carcinoma liver metastases

    Institute of Scientific and Technical Information of China (English)

    Fernando A Alvarez; Rodrigo Sanchez Claria; Sebastian Oggero; Eduardo de Santiba?es


    Liver resection is the treatment of choice for patients with colorectal liver metastases(CLM).However,major resections are often required to achieve R0 resection,which are associated with substantial rates of morbidity and mortality.Maximizing the amount of residual liver gained increasing significance in modern liver surgery due to the high incidence of chemotherapyassociated parenchymal injury.This fact,along with the progressive expansion of resectability criteria,has led to the development of a surgical philosophy known as "parenchymal-sparing liver surgery"(PSLS).This philosophy includes a variety of resection strategies,either performed alone or in combination with ablative therapies.A profound knowledge of liver anatomy and expert intraoperative ultrasound skills are required to perform PSLS appropriately and safely.There is a clear trend toward PSLS in hepatobiliary centers worldwide as current evidence indicates that tumor biology is the most important predictor of intrahepatic recurrence and survival,rather than the extent of a negative resection margin.Tumor removal avoiding the unnecessary sacrifice of functional parenchyma has been associated with less surgical stress,fewer postoperative complications,uncompromised cancer-related outcomes and higher feasibility of future resections.The increasing evidence supporting PSLS prompts its consideration as the gold-standard surgical approach for CLM.

  11. An adaptive knowledge-driven medical image search engine for interactive diffuse parenchymal lung disease quantification (United States)

    Tao, Yimo; Zhou, Xiang Sean; Bi, Jinbo; Jerebkoa, Anna; Wolf, Matthias; Salganicoff, Marcos; Krishnana, Arun


    Characterization and quantification of the severity of diffuse parenchymal lung diseases (DPLDs) using Computed Tomography (CT) is an important issue in clinical research. Recently, several classification-based computer-aided diagnosis (CAD) systems [1-3] for DPLD have been proposed. For some of those systems, a degradation of performance [2] was reported on unseen data because of considerable inter-patient variances of parenchymal tissue patterns. We believe that a CAD system of real clinical value should be robust to inter-patient variances and be able to classify unseen cases online more effectively. In this work, we have developed a novel adaptive knowledge-driven CT image search engine that combines offline learning aspects of classification-based CAD systems with online learning aspects of content-based image retrieval (CBIR) systems. Our system can seamlessly and adaptively fuse offline accumulated knowledge with online feedback, leading to an improved online performance in detecting DPLD in both accuracy and speed aspects. Our contribution lies in: (1) newly developed 3D texture-based and morphology-based features; (2) a multi-class offline feature selection method; and, (3) a novel image search engine framework for detecting DPLD. Very promising results have been obtained on a small test set.

  12. Pitfalls and Limitations of Radionuclide Renal Imaging in Adults. (United States)

    Keramida, Georgia; James, Jacqueline M; Prescott, Mary C; Peters, Adrien Michael


    To understand pitfalls and limitations in adult renography, it is necessary to understand firstly the physiology of the kidney, especially the magnitude and control of renal blood flow, glomerular filtration rate and tubular fluid flow rate, and secondly the pharmacokinetics and renal handling of the three most often used tracers, Tc-99m-mercaptoacetyltriglycine (MAG3), Tc-99m-diethylene triamine pentaacetic acid (DTPA) and Tc-99m-dimercaptosuccinic acid (DMSA). The kidneys may be imaged dynamically with Tc-99m-MAG3 or Tc-99m-DTPA, with or without diuretic challenge, or by static imaging with Tc-99m-DMSA. Protocols are different according to whether the kidney is native or transplanted. Quantitative analysis of dynamic data includes measurement of renal vascularity (important for the transplanted kidney), absolute tracer clearance rates, differential renal function (DRF) and response to diuretic challenge. Static image reveals functional renal parenchymal damage, both focal and global, is useful in the clinical management of obstructive uropathy, renal stone disease and hypertension (under angiotensin converting enzyme inhibition), and is the preferred technique for determining DRF. Diagnosis based on morphological appearances is important in transplant management. Even though nuclear medicine is now in the era of hybrid imaging, renal imaging remains an important subspecialty in nuclear medicine and requires a sound basing in applied physiology, the classical supporting discipline of nuclear medicine.

  13. Chemotherapeutic drugs sensitize human renal cell carcinoma cells to ABT-737 by a mechanism involving the Noxa-dependent inactivation of Mcl-1 or A1

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    Zantl Niko


    Full Text Available Abstract Background Human renal cell carcinoma (RCC is very resistant to chemotherapy. ABT-737 is a novel inhibitor of anti-apoptotic proteins of the Bcl-2 family that has shown promise in various preclinical tumour models. Results We here report a strong over-additive pro-apoptotic effect of ABT-737 and etoposide, vinblastine or paclitaxel but not 5-fluorouracil in cell lines from human RCC. ABT-737 showed very little activity as a single agent but killed RCC cells potently when anti-apoptotic Mcl-1 or, unexpectedly, A1 was targeted by RNAi. This potent augmentation required endogenous Noxa protein since RNAi directed against Noxa but not against Bim or Puma reduced apoptosis induction by the combination of ABT-737 and etoposide or vinblastine. At the level of mitochondria, etoposide-treatment had a similar sensitizing activity and allowed for ABT-737-induced release of cytochrome c. Conclusions Chemotherapeutic drugs can overcome protection afforded by Mcl-1 and A1 through endogenous Noxa protein in RCC cells, and the combination of such drugs with ABT-737 may be a promising strategy in RCC. Strikingly, A1 emerged in RCC cell lines as a protein of similar importance as the well-established Mcl-1 in protection against apoptosis in these cells.

  14. Signalling pathways involved in antitumoral effects of VIP in human renal cell carcinoma A498 cells: VIP induction of p53 expression. (United States)

    Vacas, Eva; Muñoz-Moreno, Laura; Fernández-Martínez, Ana B; Bajo, Ana M; Sánchez-Chapado, Manuel; Prieto, Juan C; Carmena, María J


    Vasoactive intestinal peptide (VIP) decreases cell proliferation through PI3K signalling and prevents tumour progression in clear renal cell carcinoma (RCC). Here we analyzed the signalling pathways that mediate such VIP effects by using human RCC A498 cells. The effects of treatment with 1 μM VIP and/or specific protein kinase inhibitors such as H89, Wortmannin and PD98059 were studied by cell adhesion assay, ELISA of VEGF165 and ROS production assays. Semiquantitative RT-PCR and western blot were performed to study p53 expression. VIP increased cell adhesion and ROS production, and decreased VEGF165 secretion through PI3K signalling. Moreover, VIP increased nuclear expression of tumour suppressor p53. VIP effects could be blocked by cell incubation with a specific p53 inhibitor, cyclin pifithrin-α hydrobromide (CPFT-αH). In conclusion, this study provides a p53-dependent mechanism by which VIP regulates cell proliferation in RCC development. It supports a potential usefulness of VIP in new therapies of RCC.

  15. Retroperitoneoscopic renal biopsy in children

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    Carlos M. Jesus


    Full Text Available OBJECTIVE: We present our experience in a series of 17 consecutive pediatric patients submitted to retroperitoneal laparoscopic renal biopsy. MATERIALS AND METHODS: Retroperitoneal laparoscopic renal biopsy (LRB was performed in 5 boys and 12 girls. Mean age was 8.1 years and age range from 2 to 12. Two or three trocars were used to expose the inferior pole of the kidney, remove enough cortical parenchymal specimen and fulgurate the biopsy site. Assessment included surgical time, estimated blood loss, hospitalization period, analgesia requirements, complications and number of glomeruli present in the specimen. RESULTS: LRB was successfully performed in all 15 patients (88%. In two cases, LRB was not possible to be performed. One patient was converted to a transperitoneal laparoscopy due to tear in the peritoneum. The other patient had had previous abdominal surgery and, during retroperitoneal balloon dilation, the peritoneum was opened and the open biopsy was performed. A third patient had postoperatively a perirenal hematoma, which was solved spontaneously. Complication rate was 17.6% (3/17 cases. Mean operative time was 65 minutes, while mean estimated blood loss was 52 mL, mean hospital stay was 2.2 days and mean analgesic requirement was 100 mg of tramadol. The mean number of glomeruli present in the specimen was 60. CONCLUSION: Retroperitoneal laparoscopic renal biopsy in children is a simple, safe. Bleeding is still the most common complication. However, direct vision usually allows a safe control of this drawback. In our institution, laparoscopic approach is the chosen procedure in pediatric patients older than one - year - old.

  16. Renal teratogens. (United States)

    Morgan, Thomas M; Jones, Deborah P; Cooper, William O


    In utero exposure to certain drugs early in pregnancy may adversely affect nephrogenesis. Exposure to drugs later in pregnancy may affect the renin-angiotensin system, which could have an impact on fetal or neonatal renal function. Reduction in nephron number and renal function could have adverse consequences for the child several years later. Data are limited on the information needed to guide decisions for patients and providers regarding the use of certain drugs in pregnancy. The study of drug nephroteratogenicity has not been systematized, a large, standardized, global approach is needed to evaluate the renal risks of in utero drug exposures.

  17. Next generation renal denervation: chemical “perivascular” renal denervation with alcohol using a novel drug infusion catheter

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    Fischell, Tim A. [Borgess Heart Institute, 1521 Gull Road, Kalamazoo, MI, 49008 (United States); Ablative Solutions, 801 Hermosa Way, Menlo Park, CA, 94025 (United States); Fischell, David R.; Ghazarossian, Vartan E. [Ablative Solutions, 801 Hermosa Way, Menlo Park, CA, 94025 (United States); Vega, Félix [Preclinical Consultation, San Francisco, CA (United States); Ebner, Adrian [Clinics, Ascension (Paraguay)


    Background/Purpose: We update the pre-clinical and early clinical results using a novel endovascular approach, to perform chemical renal denervation, via peri-adventitial injection of micro-doses of dehydrated alcohol (ethanol–EtOH). Methods/Materials: A novel, three-needle delivery device (Peregrine™) was used to denervate the renal arteries of adult swine (n = 17) and in a first-in-man feasibility study (n = 18). In the pre-clinical testing EtOH was infused bilaterally with one infusion per renal artery into to the perivascular space, using EtOH doses of 0.3 ml/artery (n = 8), and 0.6 ml/artery (n = 9), and with saline sham control (0.4 ml/artery n = 3). Renal parenchymal norepinephrine (NE) concentration (performed blindly), and safety were the primary endpoints. Data from the first-in-man study (n = 18) to evaluate device performance, safety and peri-procedural pain are reported. Results: In the pre-clinical testing renal function was unchanged at 3-month follow-up. Angiography at 90 days (n = 34 arteries) demonstrated normal appearing renal arteries, unchanged from baseline, and without stenosis or other abnormalities. The reductions in mean renal parenchymal NE reductions at 3 months were 68% and 88% at doses of 0.3 and 0.6 ml, respectively (p < 0.001 vs. controls). In the first-in-man study, there was 100% device success, no complications, a mean treatment time of 4.3 ± 3 minutes/artery, and minimal or no patient discomfort during treatment. Angiography at 6-months showed no evidence of renal artery stenosis, and evidence of a reduction of blood pressure from baseline. Conclusion: Perivascular RDN using micro-doses of alcohol is a promising alternative to energy-based systems to achieve dose-dependent, predictable, safe and essentially painless renal denervation. Further clinical evaluation is warranted. Summary: (For annotated table of contents) This paper describes the preclinical results, in a porcine model, and the early first-in-man results, using

  18. Envolvimento renal na púrpura de Henoch-Schönlein: uma análise multivariada de fatores prognósticos iniciais Renal involvement in Henoch-Schönlein purpura: a multivariate analysis of initial prognostic factors

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    José Luiz J. de Almeida


    Full Text Available OBJETIVOS: Identificar fatores preditivos iniciais de envolvimento renal nas crianças e adolescentes com púrpura de Henoch-Schönlein. MÉTODOS: Por um período de 21 anos, os prontuários de 142 pacientes com diagnóstico de púrpura de Henoch-Schönlein admitidos em nosso Hospital Universitário foram revistos. Os fatores preditivos iniciais avaliados nos primeiros 3 meses incluíram: dados demográficos, manifestações clínicas (púrpura palpável persistente, artrite, dor abdominal, dor abdominal intensa, sangramento gastrointestinal, orquite, envolvimento do sistema nervoso central e hemorragia pulmonar, exames laboratoriais (níveis séricos de IgA e tratamento utilizado (corticosteróides, imunoglobulina endovenosa e medicação imunossupressora. Os pacientes foram divididos em dois grupos (com presença ou ausência de nefrite e avaliados de acordo com a análise univariada e multivariada. RESULTADOS: Nefrite foi evidenciada em 70 pacientes (49,3%. A análise univariada revelou que dor abdominal intensa (p = 0,0049; OR = 1,6; IC95% 1,18-2,21, sangramento gastrointestinal (p = 0,004; OR = 1,6; IC95% 1,10-2,26 e uso dos corticosteróides (p = 0,0012; OR = 1,7; IC95% 1,28-2,40 foram associados com uma maior incidência de envolvimento renal. Na análise multivariada, a regressão logística mostrou que a única variável independente na predição da ocorrência de nefrite foi dor abdominal intensa (p OBJECTIVES: To identify initial predictive factors of renal involvement in children and adolescents with Henoch-Schönlein purpura. METHODS: We reviewed the medical records of 142 patients admitted to our University Hospital over a 21-year period with a diagnosis of Henoch-Schönlein purpura. The initial predictive factors assessed, observed during the first 3 months, included: demographic data, clinical manifestations (persistent palpable purpura, arthritis, abdominal pain, severe abdominal pain, gastrointestinal bleeding, orchitis

  19. Mechanisms involving Ang II and MAPK/ERK1/2 signaling pathways underlie cardiac and renal alterations during chronic undernutrition.

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    Paulo A Silva

    Full Text Available Several studies have correlated protein restriction associated with other nutritional deficiencies with the development of cardiovascular and renal diseases. The driving hypothesis for this study was that Ang II signaling pathways in the heart and kidney are affected by chronic protein, mineral and vitamin restriction.Wistar rats aged 90 days were fed from weaning with either a control or a deficient diet that mimics those used in impoverished regions worldwide. Such restriction simultaneously increased ouabain-insensitive Na+-ATPase and decreased (Na++K+ATPase activity in the same proportion in cardiomyocytes and proximal tubule cells. Type 1 angiotensin II receptor (AT1R was downregulated by that restriction in both organs, whereas AT2R decreased only in the kidney. The PKC/PKA ratio increased in both tissues and returned to normal values in rats receiving Losartan daily from weaning. Inhibition of the MAPK pathway restored Na+-ATPase activity in both organs. The undernourished rats presented expanded plasma volume, increased heart rate, cardiac hypertrophy, and elevated systolic pressure, which also returned to control levels with Losartan. Such restriction led to electrical cardiac remodeling represented by prolonged ventricular repolarization parameters, induced triggered activity, early after-depolarization and delayed after-depolarization, which were also prevented by Losartan.The mechanisms responsible for these alterations are underpinned by an imbalance in the PKC- and PKA-mediated pathways, with participation of angiotensin receptors and by activation of the MAPK/ERK1/2 pathway. These cellular and molecular alterations culminate in cardiac electric remodeling and in the onset of hypertension in adulthood.

  20. Impact of pregnancy on underlying renal disease. (United States)

    Baylis, Chris


    Normal pregnancy involves marked renal vasodilation and large increases in glomerular filtration rate (GFR). Studies in rats reveal that the gestational renal vasodilation is achieved by parallel reductions in tone in afferent and efferent arterioles so GFR rises without a change in glomerular blood pressure. There is some evidence from animal studies that increased renal generation of nitric oxide (NO) may be involved. Although chronic renal vasodilation has been implicated in causing progression of renal disease in nonpregnant states by glomerular hypertension, there are no long-term deleterious effects of pregnancies on the kidney when maternal renal function is normal because glomerular blood pressure remains normal. When maternal renal function is compromised before conception, there are no long-term adverse effects on renal function in most types of renal disease, providing that the GFR is well maintained before conception. When serum creatinine exceeds approximately 1.4 mg/dL, pregnancy may accelerate the renal disease increases and when serum creatinine >2 mg/dL, the chances are greater than 1 in 3 that pregnancy will hasten the progression of the renal disease. The available animal studies suggest that glomerular hypertension does not occur despite diverse injuries. Thus, the mechanisms of the adverse interaction between pregnancy and underlying renal disease remain unknown.

  1. Sarcoidose renal

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    Full Text Available Em uma mulher de 62 anos, branca, em avaliação pré-operatória de facectomia, foram detectadas alterações urinárias, tendo sido firmados os diagnósticos de calculose renal esquerda e exclusão renal homolateral. No pré-operatório da nefrectomia foram evidenciados processo pulmonar intersticial bilateral e adenopatia torácica, cuja investigação foi adiada para após a cirurgia. No rim retirado foram detectados granulomas epitelióides não necrotizantes, o mesmo ocorrendo posteriormente em biópsia transbrônquica. A paciente foi tratada com metilprednisolona, com discreta melhora pulmonar, o que não ocorreu com a função renal. O diagnóstico final foi de sarcoidose com envolvimento pulmonar, ganglionar torácico e renal.

  2. Renal failure

    Institute of Scientific and Technical Information of China (English)


    930150 Epidermal growth factor and its recep-tor in the renal tissue of patients with acute re-nal failure and normal persons.LIU Zhihong(刘志红),et al.Jinling Hosp,Nanjing,210002.Natl Med J China 1992;72(10):593-595.Epidermal growth factor(EGF)and its receptor(EGF-R)were identified by immunohis-tochemical method(4 layer PAP)in the renaltissue specimens obtained from 11 normal kid-neys and 17 cases of acute renal failure(ARF).The quantitative EGF and EGF-R in the tissuewere expressed as positive tubules per mm~2.The amount of EGF and EGF-R in renal tissue

  3. Renal failure

    Institute of Scientific and Technical Information of China (English)


    2005234 Association between serum fetuin-A and clinical outcome in end-stage renal disease patients. WANG Kai(王开), Dept Renal Dis, Renji Hosp Shanghai, 2nd Med Univ, Shanghai 200001. Chin J Nephrol, 2005;21(2):72-75. Objective: To investigate the change of serum fetuin-A level before and after dialysis, and the association of serum fetuin-A level with clinical parameters

  4. Renal failure

    Institute of Scientific and Technical Information of China (English)


    950351 Serum erythropoietin levels in chronic renalinsufficiency.ZHAI Depei(翟德佩),et al.DeptNephrol.General Hosp,Tianjin Med Univ,Tianjin,300000.Tianjin Med J 1995;23(1):19-21.Patients with chronic renal insufficiency(CRI) areoften associated with anemia.The deficiency of EPOproduction in the kidney is thought to be a key factorin the pathogenesis of renal anemia.Serum erythropoi-

  5. Renal failure

    Institute of Scientific and Technical Information of China (English)


    2008463 Protective effect of recombination rat augmenter of liver regeneration on kidney in acute renal failure rats. TANG Xiaopeng(唐晓鹏), et al. Dept Nephrol, 2nd Affili Hosp Chongqing Med Univ, Chongqing 400010.Chin J Nephrol 2008;24(6):417-421. Objective To investigate the protective effects of recombination rat augmenter of liver regeneration (rrALR) on tubular cell injury and renal dysfunction

  6. Renal Hemangiopericytoma

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    İbrahim Halil Bozkurt


    Full Text Available Hemangiopericytoma is an uncommon perivascular tumor originating from pericytes in the pelvis, head and tneck, and the meninges; extremely rarely in the urinary system. We report a case of incidentally detected renal mass in which radiologic evaluation was suggestive of renal cell carcinoma. First, we performed partial nephrectomy, and then, radical nephrectomy because of positive surgical margins and the pathological examination of the surgical specimen that revealed a hemangiopericytoma. No additional treatment was administered.

  7. Characterization of systemic disease in primary Sjogren's syndrome : EULAR-SS Task Force recommendations for articular, cutaneous, pulmonary and renal involvements

    NARCIS (Netherlands)

    Ramos-Casals, Manuel; Brito-Zeron, Pilar; Seror, Raphaele; Bootsma, Hendrika; Bowman, Simon J.; Doerner, Thomas; Gottenberg, Jacques-Eric; Mariette, Xavier; Theander, Elke; Bombardieri, Stefano; De Vita, Salvatore; Mandl, Thomas; Ng, Wan-Fai; Kruize, Aike; Tzioufas, Athanasios; Vitali, Claudio


    Objective. To reach a European consensus on the definition and characterization of the main organspecific extraglandular manifestations in primary SS. Methods. The EULAR-SS Task Force Group steering committee agreed to approach SS-related systemic involvement according to the EULAR SS Disease Activi

  8. C-arm flat detector computed tomography parenchymal blood volume imaging: the nature of parenchymal blood volume parameter and the feasibility of parenchymal blood volume imaging in aneurysmal subarachnoid haemorrhage patients

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    Kamran, Mudassar; Byrne, James V. [University of Oxford, Nuffield Department of Surgical Sciences, Oxford (United Kingdom)


    C-arm flat detector computed tomography (FDCT) parenchymal blood volume (PBV) measurements allow assessment of cerebral haemodynamics in the neurointerventional suite. This paper explores the feasibility of C-arm computed tomography (CT) PBV imaging and the relationship between the C-arm CT PBV and the MR-PWI-derived cerebral blood volume (CBV) and cerebral blood flow (CBF) parameters in aneurysmal subarachnoid haemorrhage (SAH) patients developing delayed cerebral ischemia (DCI). Twenty-six patients with DCI following aneurysmal SAH underwent a research C-arm CT PBV scan using a biplane angiography system and contemporaneous MR-PWI scan as part of a prospective study. Quantitative whole-brain atlas-based volume-of-interest analysis in conjunction with Pearson correlation and Bland-Altman tests was performed to explore the agreement between C-arm CT PBV and MR-derived CBV and CBF measurements. All patients received medical management, while eight patients (31 %) underwent selective intra-arterial chemical angioplasty. Colour-coded C-arm CT PBV maps were 91 % sensitive and 100 % specific in detecting the perfusion abnormalities. C-arm CT rPBV demonstrated good agreement and strong correlation with both MR-rCBV and MR-rCBF measurements; the agreement and correlation were stronger for MR-rCBF relative to MR-rCBV and improved for C-arm CT PBV versus the geometric mean of MR-rCBV and MR-rCBF. Analysis of weighted means showed that the C-arm CT PBV has a preferential blood flow weighting (∼60 % blood flow and ∼40 % blood volume weighting). C-arm CT PBV imaging is feasible in DCI following aneurysmal SAH. PBV is a composite perfusion parameter incorporating both blood flow and blood volume weightings. That PBV has preferential (∼60 %) blood flow weighting is an important finding, which is of clinical significance when interpreting the C-arm CT PBV maps, particularly in the setting of acute brain ischemia. (orig.)

  9. Reawakening the sleeping beauty in the adult brain: neurogenesis from parenchymal glia. (United States)

    Péron, Sophie; Berninger, Benedikt


    Life-long neurogenesis is highly restricted to specialized niches in the adult mammalian brain and therefore the brain's capacity for spontaneous regeneration is extremely limited. However, recent work has demonstrated that under certain circumstances parenchymal astrocytes and NG2 glia can generate neuronal progeny. In the striatum, stroke or excitotoxic lesions can reawaken in astrocytes a latent neurogenic program resulting in the genesis of new neurons. By contrast, in brain areas that fail to mount a neurogenic response following injury, such as the cerebral cortex, forced expression of neurogenic reprogramming factors can lineage convert local glia into induced neurons. Yet, injury-induced and reprogramming-induced neurogenesis exhibit intriguing commonalities, suggesting that they may converge on similar mechanisms.

  10. Effect of renal revascularization on the development of renal dysfunction in atherosclerotic ischemic nephropathy


    Rodrigo Hagemann; Vanessa dos Santos Silva; Roberto Jorge da Silva Franco; Pasqual Barretti; Luis Cuadrado Martin


    Chronic kidney disease (CKD) is characterized by a progressive loss of renal function and its main causes are hypertension and diabetes mellitus. Among the causes of hypertension is atherosclerotic renal disease (ARD). The development of CKD in patients with ARD appears to be due not only to the involvement of the main renal arteries, but also of the renal microcirculation, which may explain the fact that the success of the procedure does not guarantee an improvement in the progression of CKD...

  11. A syndrome of severe idiopathic pulmonary parenchymal disease with pulmonary hypertension in Pekingese

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    Köster LS


    Full Text Available Liza S Köster,1 Robert M Kirberger2 1Section of Medicine, Department of Clinical Sciences, Integrative Mammalian Research (IMR Center, Ross University School of Veterinary Medicine (RUSVM, Basseterre, St Kitts, West Indies; 2Diagnostic Imaging Section, Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa Abstract: This paper describes 35 Pekingese dogs with a syndrome characterized by dyspnea, cyanosis, episodic syncope, soft pulmonary “Velcro” crackles, pulmonary hypertension (PH, and computed tomography and radiographic changes consistent with pulmonary parenchymal disease. The medical data base was searched with the criteria “Pekingese” and “syncope” or “dyspnea” or “tachypnea” or “pulmonary hypertension”, over a 36-month period. Inclusion criteria were echocardiographic changes consistent with noninvasive diagnosis of PH, either subjectively by B-mode or objectively by Doppler. Dogs were excluded (n=106 if there were insufficient or poor-quality radiographic or echocardiographic records or if diseases other than chronic pulmonary disease were found to be the etiology. The records of 35 dogs met these criteria and presented with a respiratory crises preceded by a history of chronic exercise intolerance and episodic syncope. The average age was 14.5 years (range: 7–19 years, with 21 males and 14 females. Most of the dogs had an interstitial lung pattern with radiographic evidence of right heart enlargement. There was a 77% (n=27 mortality and a median survival of 60 days (interquartile range: 9–210 days. This study highlights a cor pulmonale syndrome from PH due to chronic pulmonary parenchymal disease, with a grave prognosis, in middle-aged to geriatric population of Hong Kong Pekingese. Keywords: computed tomography, interstitial lung disease, dog, syncope


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    Full Text Available Diffuse parenchyma lung disease (DPLD encompasses a hetero - geneous group of disorders, characterized by a spectrum of inflammatory and fibrotic changes affecting alveolar walls and air spaces. They comprise over 200 entities and include a wide spectrum of diseases, many uncommon and many of unknown etiology. The incidence and prevalence rates of DPLD have not been precisely estimated due to difficulties in ascertaining a specific diagnosis on a specific disease. MATERIAL & METHODS : Prospective observational study done on 20 adult patients with radiologically diffuse parenchymal lung disease admitted between January 2010 and May 2015 in Govt. General & Chest Hospital, Hyderabad were subjected for Transbronchial Lung Biopsy via flexible fibreoptic bronchoscopy, without fluoroscopic guidance. RESULTS : Out of 20 patients studied adequate lung tissue was obtained in 15 patients, yield of the procedure was 75%. Out of 15 patient’s histopathological diagnosis of chronic interstitial pneumonia is seen in 5 members, interstitial fibrosis is seen in 4 members, non caseating granulomas seen in 4 members, pulmonary alveolar protenosis was seen in 1 member and normal lung histopathology was seen in 1 members. Diagnostic yield of the procedure was 93.3% and overall diagnostic yield was 70%. Two patients developed post procedure pneumothorax. Both of them underwent closed - tube thoracostomy, lung expanded well and ICD was removed in 4 days. No significant bleeding was observed in any patient. No mortality was observed after the procedure . CONCLUSIONS : Transbronchial lung biopsy through flexible bronchoscopy is a simple, safe and effective procedure for the diagnosis of diffuse parenchymal lung diseases. Complications were observed in only few patients out of twenty, which were successfully managed with ICD.

  13. Renal involvement in human rabies: clinical manifestations and autopsy findings of nine cases from northeast of Brazil Envolvimento renal na raiva em humanos: manifestações clínicas e achados de autópsia de nove casos do nordeste do Brasil

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    Elizabeth De Francesco Daher


    Full Text Available A retrospective study was conducted in nine patients with rabies admitted to a hospital of Fortaleza, Brazil. Autopsy was performed in all cases. The ages ranged from three to 81 years and six were males. They all were bitten by dogs. The time between the accident and the hospital admission ranged from 20 to 120 days (mean 45 ± 34 days. The time until death ranged from one to nine days (mean 3.3 ± 5.5 days. The signs and symptoms presented were fever, hydrophobia, aerophobia, agitation, disorientation, dyspnea, sialorrhea, vomiting, oliguria, sore throat, pain and hypoesthesia in the site of the bite, headache, syncope, cough, hematemesis, mydriasis, hematuria, constipation, cervical pain and priapism. In three out of six patients, there was evidence of acute renal failure, defined as serum creatinine > 1.4 mg/dL. The post-mortem findings in the kidneys were mild to moderate glomerular congestion and mild to intense peritubular capillary congestion. Acute tubular necrosis was seen in only two cases. This study shows some evidence of renal involvement in rabies. Histopathologic findings are nonspecific, so hemodynamic instability, caused by autonomic dysfunction, hydrophobia and dehydration must be responsible for acute renal failure in rabies.Foi realizado estudo retrospectivo de nove casos de raiva internados em um hospital de Fortaleza, Brasil. Autópsia foi realizada em todos os casos. As idades variaram de 3 a 81 anos. Todos foram agredidos por cães. O tempo entre o acidente e a admissão hospitalar variou de 20 a 120 dias (média de 45 ± 34 dias. O tempo de internamento variou de 1 a 9 dias (média de 5.5 ± 3.1 dias. Os sinais e sintomas observados foram febre, hidrofobia, aerofobia, agitação, desorientação, dispnéia, sialorréia, vômitos, oligúria, faringite, dor e hipoestesia no local da mordida, cefaléia, síncope, tosse, hematêmese, midríase, hematúria, constipação, dor cervical e priapismo. Em três de seis pacientes

  14. Use of C-Arm Cone Beam CT During Hepatic Radioembolization : Protocol Optimization for Extrahepatic Shunting and Parenchymal Enhancement

    NARCIS (Netherlands)

    van den Hoven, Andor F.; Prince, Jip F.; de Keizer, Bart; Vonken, Evert Jan P A; Bruijnen, Rutger C G; Verkooijen, Helena M.; Lam, Marnix G E H; van den Bosch, Maurice A A J


    Purpose: To optimize a C-arm computed tomography (CT) protocol for radioembolization (RE), specifically for extrahepatic shunting and parenchymal enhancement. Materials and Methods: A prospective development study was performed per IDEAL recommendations. A literature-based protocol was applied in pa

  15. α1B-Adrenoceptors mediate adrenergically-induced renal vasoconstrictions in rats with renal impairment

    Institute of Scientific and Technical Information of China (English)

    Md Abdul Hye KHAN; Munavvar Abdul SATTAR; Nor Azizan ABDULLAH; Edward James JOHNS


    Aim: This study examined whether α1B-adrenoceptors are involved in mediating adrenergically-induced renal vasoconstrictor responses in rats with pathophysi-ological and normal physiological states. Methods: Male Wistar Kyoto and spon-taneously hypertensive rats were induced with acute renal failure or experimental early diabetic nephropathy by cisplatin or streptozotocin, respectively. Cisplatin-induced renal failure was confirmed by impaired renal function and pronounced tubular damage. Experimental early diabetic nephropathy was confirmed by hyperglycemia, changes in physiological parameters, and renal function. The hemodynamic study was conducted on anesthetized rats after 7 d of cisplatin (renal failure) and 4 weeks of streptozotocin (experimental early diabetic nephropathy). Results: In the rats with renal failure and experimental early dia-betic nephropathy, there were marked reductions in their baseline renal blood flow (P0.05) in the renal failure and experimental early diabetic nephropathy rats, respectively, as compared to their non-renal failure and non-diabetic nephropathy controls. In the rats with renal impairment, chloroethylclonidine caused either accentuation or attenuation (all P0.05). Conclusion: This study demonstrated the presence of functional α1B-adrenoceptors that mediated the adrenergically-induced renal vaso-constrictions in rats with renal impairment, but not in rats with normal renal function.

  16. Comparison of conventional versus three-dimensional ultrasound in fetal renal pelvis measurement and their potential prediction of neonatal uropathies. (United States)

    Duin, L K; Nijhuis, J G; Scherjon, S A; Vossen, M; Willekes, C


    To establish a threshold value for fetal renal pelvis dilatation measured by automatic volume calculation (SonoAVC) in the third trimester of pregnancy to predict neonatal uropathies, and to compare these results with conventional antero-posterior (AP) measurement, fetal kidney 3D volume and renal parenchymal thickness. In a prospective cohort study, 125 fetuses with renal pelvis AP diameter of ≥5 mm both at 20 weeks of gestation and in the third trimester, underwent an additional 3D volume measurement of the fetal kidney in the third trimester. Receiver operating characteristic (ROC) curves for establishing threshold values for fetal renal pelvis volume, AP measurement, fetal kidney volume and renal parenchymal thickness to predict neonatal uropathies were analyzed. Also, sensitivity, specificity, area under the curve (AUC) and likelihood ratios were calculated. A cut-off point of 1.58 cm³ was identified in the third trimester of pregnancy (AUC 0.865 (95% CI 0.789-0.940), sensitivity 76.3%, specificity 87.4%, LR+ 6.06, LR- 0.27) for measurements with SonoAVC. A cut-off value of 11.5 mm was established in the third trimester of pregnancy (AUC 0.828 (95% CI 0.737-0.918), sensitivity 71.1%, specificity 85.1%, LR+ 4.77, LR- 0.34) for the conventional AP measurement. A cut-off point for fetal kidney volume was calculated at 13.29 cm³ (AUC 0.769 (95% CI 0.657-0.881), sensitivity 71%, specificity 66%, LR+ 2.09, LR- 0.44). For renal parenchymal thickness, a cut-off point of 8.4 mm was established (AUC 0.216 (95% CI 0.117-0.315), sensitivity 31.6%, specificity 32.6%, LR+ 0.47, LR- 2.10). This study demonstrates that 3D fetal renal pelvis volume measurements and AP measurements both have a good and comparable diagnostic performance, fetal renal volume a fair accuracy and renal parenchymal thickness a poor accuracy in predicting postnatal renal outcome.

  17. A Comparative Study of Peripheral Immune Responses to Taenia solium in Individuals with Parenchymal and Subarachnoid Neurocysticercosis.

    Directory of Open Access Journals (Sweden)

    Iskra Tuero


    Full Text Available The ability of Taenia solium to modulate the immune system likely contributes to their longevity in the human host. We tested the hypothesis that the nature of the immune response is related to the location of parasite and clinical manifestations of infection.Peripheral blood mononuclear cells (PBMC were obtained from untreated patients with neurocysticercosis (NCC, categorized as having parenchymal or subarachnoid infection by the presence of cysts exclusively within the parenchyma or in subarachnoid spaces of the brain, and from uninfected (control individuals matched by age and gender to each patient. Using multiplex detection technology, sera from NCC patients and controls and cytokine production by PBMC after T. solium antigen (TsAg stimulation were assayed for levels of inflammatory and regulatory cytokines. PBMC were phenotyped by flow cytometry ex vivo and following in vitro stimulation with TsAg.Sera from patients with parenchymal NCC demonstrated significantly higher Th1 (IFN-γ/IL-12 and Th2 (IL-4/IL-13 cytokine responses and trends towards higher levels of IL-1β/IL-8/IL-5 than those obtained from patients with subarachnoid NCC. Also higher in vitro antigen-driven TNF-β secretion was detected in PBMC supernatants from parenchymal than in subarachnoid NCC. In contrast, there was a significantly higher IL-10 response to TsAg stimulation in patients with subarachnoid NCC compared to parenchymal NCC. Although no differences in regulatory T cells (Tregs frequencies were found ex vivo, there was a trend towards greater expansion of Tregs upon TsAg stimulation in subarachnoid than in parenchymal NCC when data were normalized for the corresponding controls.T. solium infection of the subarachnoid space is associated with an enhanced regulatory immune response compared to infection in the parenchyma. The resulting anti-inflammatory milieu may represent a parasite strategy to maintain a permissive environment in the host or diminish

  18. An unusual cause of acute renal failure: renal lymphoma. (United States)

    Ozaltin, Fatih; Yalçin, Bilgehan; Orhan, Diclehan; Sari, Neriman; Caglar, Melda; Besbas, Nesrin; Bakkaloglu, Aysin


    Renal involvement is a common finding in non-Hodgkin's lymphoma (NHL). Acute renal failure at initial presentation due to lymphomatous infiltration of the kidneys has been described infrequently. We report a 17-year-old male who presented with acute renal failure due to massive lymphomatous infiltration of the kidneys, which necessitated hemodialysis. The diagnosis of B-cell NHL was established by tru-cut biopsy of the kidneys and the patient had an excellent response to high-dose chemotherapy with no major complication. The presence of extrarenal involvement in the testes and the retroperitoneal lymph nodes made the diagnosis of primary renal lymphoma debatable. However, considering the delay in diagnosis and the high proliferative rate of B-cell NHL, we might postulate that the disease had originated primarily in the kidneys. We recommend that in NHL cases with severe renal involvement, full-dose chemotherapy should be instituted with meticulous clinical and laboratory follow-up in order to improve clinical and renal failure status rapidly and to avoid further dissemination of NHL.

  19. On renal pathophysiology in preeclampsia



    Preeclampsia is a complication of pregnancy which can suddenly change from a relatively mild phenotype into a life-threatening situation. One of the organs that is always involved during preeclampsia is the kidney. The placenta plays an important role in the renal pathophysiology of preeclampsia. The placenta produces excessive amounts of anti-angiogenic factors which are associated with systemic endothelial dysfunction. Although the underlying mechanisms of renal injury during preeclampsia r...

  20. Involvement of cytokines in the modulation and progression of renal fibrosis induced by unilateral ureteral obstruction in C57BL/6 mice: effects of thalidomide and dexamethasone. (United States)

    Bersani-Amado, Luiz Eduardo; Dantas, Jaílson Araujo; Damião, Marcio José; Rocha, Bruno Ambrósio; Besson, Jean Carlos Fernando; Bastos, Rafael Lucena; Silva, Letícia Nicoletti; Bersani-Amado, Ciomar Aparecida; Cuman, Roberto Kenji Nakamura


    This study investigated the kinetics of cytokines that are involved in the development of interstitial fibrosis in mice that were subjected to UUO, the interstitial type I and III collagen deposition, and the effects of Thalido and Dexa treatment on these parameters. Inbred C57BL/6 mice were divided into the groups: Normal (not submitted surgery), Sham (sham surgery), Control (UUO treated with 0.5% carboxymethyl cellulose), Thalido (UUO treated with 5 mg/kg thalidomide), and Dexa (UUO treated with 1 mg/kg dexamethasone). The treatments began the day before surgery and were administered once daily by gavage for 1, 7, or 14 days. At the end of each treatment period, blood samples were collected for the determination of creatinine, urea, cytokines. The Control group exhibited a increase in creatinine concentration compared with the Normal and Sham groups within the first 24 h after UUO, which remained high until days 7 and 14. The urea concentration was higher on days 7 and 14 in the Control group compared with the Sham group. In the Thalido and Dexa groups, a reduction of serum creatinine concentration was seen on day 14. Treatment with Dexa reduced the serum concentration of urea on day 7. The serum concentrations of cytokines (TNF-α, IL-1β, IL-6, IL-10 and IL-17) and chemokines (KC, MIG, bFGF) increased in UUO mice at all of the sampling times. The Dexa and Thalido groups exhibited alterations in the concentrations of these cytokines, suggesting the involvement of anti-inflammatory and immunomodulatory mechanisms that may have modified the fibrosis framework.

  1. Involvement of Cytokines in the Pathogenesis of Salt and Water Imbalance in Congestive Heart Failure

    Directory of Open Access Journals (Sweden)

    Zaher S. Azzam


    Full Text Available Congestive heart failure (CHF has become a major medical problem in the western world with high morbidity and mortality rates. CHF adversely affects several systems, mainly the kidneys and the lungs. While the involvement of the renin–angiotensin–aldosterone system and the sympathetic nervous system in the progression of cardiovascular, pulmonary, and renal dysfunction in experimental and clinical CHF is well established, the importance of pro-inflammatory mediators in the pathogenesis of this clinical setting is still evolving. In this context, CHF is associated with overexpression of pro-inflammatory cytokines, such as tumor necrosis factor-α, interleukin (IL-1, and IL-6, which are activated in response to environmental injury. This family of cytokines has been implicated in the deterioration of CHF, where it plays an important role in initiating and integrating homeostatic responses both at the myocardium and circulatory levels. We and others showed that angiotensin II decreased the ability of the lungs to clear edema and enhanced the fibrosis process via phosphorylation of the mitogen-activated protein kinases p38 and p42/44, which are generally involved in cellular responses to pro-inflammatory cytokines. Literature data also indicate the involvement of these effectors in modulating ion channel activity. It has been reported that in heart failure due to mitral stenosis; there were varying degrees of vascular and other associated parenchymal changes such as edema and fibrosis. In this review, we will discuss the effects of cytokines and other inflammatory mediators on the kidneys and the lungs in heart failure; especially their role in renal and alveolar ion channels activity and fluid balance.

  2. Renal lymphoma: spectrum of computed tomography findings; Linfoma renal: espectro de imagens na tomografia computadorizada

    Energy Technology Data Exchange (ETDEWEB)

    Maranhao, Carol Pontes de Miranda; Bauab Junior, Tufik [Faculdade de Medicina do Sao Jose do Rio Preto (FAMERP), SP (Brazil). Hospital de Base. Dept. de Imagem]. E-mail:


    Isolated renal lymphoma is rare due to the absence of lymphoid tissue in kidneys. Secondary involvement occurs more frequently and is reported in up to 1/3 of the autopsies of patients who died from lymphoma. Some authors believe this is actually the only existing form of renal lymphoma. The involvement of the kidney by lymphoma would occur through hematogenic metastasis or direct tumor invasion of the peri renal space. These different types of involvement determine the several forms of renal lymphoma presentation: multiple nodules, solitary mass, renal invasion from contiguous retroperitoneal disease, peri renal disease and diffuse infiltration. In this study the imaging findings features of the different forms of involvement are presented and discussed. (author)

  3. Renal aneurysm and arteriovenous fistula; Management with transcatheter embolization

    Energy Technology Data Exchange (ETDEWEB)

    Savastano, S.; Feltrin, G.P.; Miotto, D.; Chiesura-Corona, M. (Padua Univ. (Italy). Ist. di Radiologia Padua Univ. (Italy). Ist. di Fisioterapia)


    Embolization was performed in six patients with renal artery aneurysms (n=2) and arteriovenous fistulas (AVF) (n=5). The aneurysms were observed in one patient with fibromuscular dysplasia and in another with Ehlers-Danlos syndrome. All the AVFs were intraparenchymal and secondary to iatrogenic trauma. Elective embolization was performed in five patients with good clinical results at follow-up between 1 and 9 years. Because of rupture of the aneurysm emergency embolization was attempted without success in the patient with Ehlers-Danlos syndrome, and nephrectomy was carried out. A postembolization syndrome complicated three procedures in which Gelfoam and polyvinyl alcohol were used; in two of these cases unexpected reflux of the particulate material occurred, resulting in limited undesired ablation of the ipsilateral renal parenchyma. Embolization is the most reliable and effective treatment for intrarenal vascular abnormalities since it minimizes the parenchymal damage. (orig.).

  4. Diagnostic value of tri-phase dynamic enhancement scan with CT for acute renal infarction%CT三期动态增强扫描对急性肾梗死的诊断价值

    Institute of Scientific and Technical Information of China (English)

    禹智波; 张云泉; 宋凌恒; 乔清; 李福锁; 黄敏; 胡文友; 李锦青


    Objective To investigate the imaging characteristics and diagnostic value of tri-phase dynamic enhancement scan with CT for acute renal infarction. Methods The image features of CT plain scan and tri-phase dynamic enhancement scan of 10 patients (19 sides) with acute renal infarction were retrospectively analyzed, and the CTA expression of 6 patients were observed. Results Fourteen acute renal infarction lesions of 10 cases were diagnosed. The CT scan showed there were 4 cases with enlargement of kidney, and the other 6 cases were of no abnormality. The tri-phase enhancement CT scan showed there were 6 cases of unilateral renal infarction and 4 cases of bilateral renal infarction, which totally involving 14 sides. The acute renal infarction lesions lacked of high density region in the corticomedullary in cortical phase, and there were wedge-shaped hypodense area, even low density of full kidney in parenchymal phase and pyelographic phase. The a-cute renal infarction lesions were revealed better in parenchymal phase and pyelographic phase than in cortical phase. Six cases of CTA re-vealed the responsible vessels of renal infarction lesions and the other vascular diseases. Conclusion CT tri-phase dynamic enhancement scan has important value in the diagnosis of acute renal infarction, and CTA can identify the responsible vessels of renal infarction lesions.%目的:探讨急性肾梗死CT三期动态增强扫描影像学特点及临床意义。方法回顾性分析10例临床影像确诊急性肾梗死患者19侧肾脏CT平扫、三期动态增强表现及6例CTA( CT血管造影术)表现。结果10例患者14侧肾脏发生急性肾梗死。 CT平扫:4例肾脏影增大,6例双侧肾脏CT平扫未见异常。 CT三期动态增强扫描:单侧肾梗死6例、双侧肾梗死4例,共累及14侧肾脏;肾梗死灶在皮质期呈为高密度皮质环中断,在实质期及肾盂期呈楔形无强化低密度影,或全肾无强化低密度影,以实质期和肾盂

  5. Renal Cysts (United States)

    ... as “simple” cysts, meaning they have a thin wall and contain water-like fluid. Renal cysts are fairly common in ... simple kidney cysts, meaning they have a thin wall and only water-like fluid inside. They are fairly common in ...

  6. Renal failure

    Institute of Scientific and Technical Information of China (English)


    970363 Effect on serum PTH and 1, 25(OH)2 D3levels of rapid correction of metabolic acidosis in CRFpatients with secondary hyperparathyroidism. YUANQunsheng(袁群生), et al. Renal Div, PUMC Hosp,Beijing, 100730. Chin J Nephrol 1996; 12(6): 328-331.

  7. Drug-induced renal injury

    African Journals Online (AJOL)

    Drugs can cause acute renal failure by causing pre-renal, intrinsic or post-renal toxicity. Pre-renal ... incidence of drug dose adjustment in renal impairment in the SAMJ. ... Fever, haemolytic anaemia, thrombocytopenia, renal impairment and.

  8. Renal blood flow and metabolism after cold ischaemia

    DEFF Research Database (Denmark)

    Henriksen, J H; Petersen, H K


    Peroperative measurements of renal blood flow (RBF), renal O2-uptake, and renal venous lactate/pyruvate (L/P) ratio were performed before and after a period of 30-71 min of hypothermic (10-15 degrees C) renal ischaemia in nine patients, undergoing surgery for renal calculi. Before ischaemia, RBF.......01) immediately after re-established perfusion and 36% (P less than 0.02) 30 min later. In one additional patient, who had a short warm ischaemia (8 min), the flow pattern was the same. As arterial pressure remained constant, the reduced RBF signifies an increased renal vascular resistance. Renal O2-uptake...... and renal venous L/P ratio were almost constant, indicating no significant anaerobic processes being involved in the flow response. None of the patients showed any signs of reactive hyperaemia. It is concluded that hypothermic renal ischaemia may be followed by an increased renal vascular resistance even...

  9. Renal failure (chronic)


    Clase, Catherine


    Chronic renal failure is characterised by a gradual and sustained decline in renal clearance or glomerular filtration rate (GFR). Continued progression of renal failure will lead to renal function too low to sustain healthy life. In developed countries, such people will be offered renal replacement therapy in the form of dialysis or renal transplantation. Requirement for dialysis or transplantation is termed end-stage renal disease (ESRD).Diabetes, glomerulonephritis, hypertension, pyelone...

  10. Brain parenchymal damage in neuromyelitis optica spectrum disorder - A multimodal MRI study

    Energy Technology Data Exchange (ETDEWEB)

    Pache, F.; Paul, F. [Max Delbrueck Center for Molecular Medicine and Charite Universitaetsmedizin Berlin, NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Berlin (Germany); Charite Universitaetsmedizin Berlin, Department of Neurology, Berlin (Germany); Zimmermann, H.; Lacheta, A.; Papazoglou, S.; Kuchling, J.; Wuerfel, J.; Brandt, A.U. [Max Delbrueck Center for Molecular Medicine and Charite Universitaetsmedizin Berlin, NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Berlin (Germany); Finke, C. [Charite Universitaetsmedizin Berlin, Department of Neurology, Berlin (Germany); Humboldt-Universitaet zu Berlin, Berlin School of Mind and Brain, Berlin (Germany); Hamm, B. [Charite Universitaetsmedizin Berlin, Department of Radiology, Berlin (Germany); Ruprecht, K. [Charite Universitaetsmedizin Berlin, Department of Neurology, Berlin (Germany); Scheel, M. [Max Delbrueck Center for Molecular Medicine and Charite Universitaetsmedizin Berlin, NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Berlin (Germany); Charite Universitaetsmedizin Berlin, Department of Radiology, Berlin (Germany)


    To investigate different brain regions for grey (GM) and white matter (WM) damage in a well-defined cohort of neuromyelitis optica spectrum disorder (NMOSD) patients and compare advanced MRI techniques (VBM, Subcortical and cortical analyses (Freesurfer), and DTI) for their ability to detect damage in NMOSD. We analyzed 21 NMOSD patients and 21 age and gender matched control subjects. VBM (GW/WM) and DTI whole brain (TBSS) analyses were performed at different statistical thresholds to reflect different statistical approaches in previous studies. In an automated atlas-based approach, Freesurfer and DTI results were compared between NMOSD and controls. DTI TBSS and DTI atlas based analysis demonstrated microstructural impairment only within the optic radiation or in regions associated with the optic radiation (posterior thalamic radiation p < 0.001, 6.9 % reduction of fractional anisotropy). VBM demonstrated widespread brain GM and WM reduction, but only at exploratory statistical thresholds, with no differences remaining after correction for multiple comparisons. Freesurfer analysis demonstrated no group differences. NMOSD specific parenchymal brain damage is predominantly located in the optic radiation, likely due to a secondary degeneration caused by ON. In comparison, DTI appears to be the most reliable and sensitive technique for brain damage detection in NMOSD. (orig.)

  11. Background parenchymal enhancement in breast MRI before and after neoadjuvant chemotherapy: correlation with tumour response

    Energy Technology Data Exchange (ETDEWEB)

    Preibsch, H.; Wanner, L.; Bahrs, S.D.; Wietek, B.M.; Nikolaou, K.; Wiesinger, B. [University Hospital Tuebingen, Diagnostic and Interventional Radiology, Tuebingen (Germany); Siegmann-Luz, K.C. [Diagnostic Center for Breast Cancer and Screening Mammography Brandenburg Ost, Koenigs Wusterhausen (Germany); Oberlecher, E.; Hahn, M. [University Hospital Tuebingen, Department of Gynecology and Obstetrics, Tuebingen (Germany); Staebler, A. [University Hospital Tuebingen, Institute of Pathology and Neuropathology, Tuebingen (Germany)


    To correlate the decrease in background parenchymal enhancement (BPE) and tumour response measured with MRI in breast cancer patients treated with neoadjuvant chemotherapy (NAC). One hundred and forty-six MRI examinations of 73 patients with 80 biopsy-proven breast cancers who underwent breast MRI before and after NAC were retrospectively analysed. All images were reviewed by two blinded readers, who classified BPE into categories (BEC; 1 = minimal, 2 = mild, 3 = moderate, 4 = marked) before and after NAC. Histopathological and morphological tumour responses were analysed and compared. The distribution of BEC 1/2/3/4 was 25/46/18/11 % before and 78/20/2/0 % after NAC. On average, BPE decreased by 0.87 BEC. Cohen's kappa showed substantial agreement (k = 0.73-0.77) before and moderate agreement (k = 0.43-0.60) after NAC and moderate agreement (k = 0.62-0.60) concerning the change in BEC. Correlating the change in BPE with tumour response, the average decrease in BEC was 1.3 in cases of complete remission, 0.83 in cases with partial response, 0.85 in cases with stable disease and 0.40 in cases with progressive disease. Correlation analysis showed a significant correlation between the decrease in BEC and tumour response (r = -0.24, p = 0.03). BPE decreased by, on average, 0.87 BEC following NAC for breast cancer. The degree of BPE reduction seemed to correlate with tumour response. (orig.)

  12. Tc-99m erythromycin lactobionate inhalation scintigraphy in parenchymal lung diseases

    Energy Technology Data Exchange (ETDEWEB)

    Durak, Hatice E-mail:; Aktogu, Serir; Degirmenci, Berna; Sayit, Elvan; Ertay, Tuerkan; Dereli, Sevket


    We have investigated Technetium 99m erythromycin lactobionate (Tc 99m EL) clearance from the lungs after inhalation, in the presence of an alveolitis. Eighteen patients (6 sarcoidosis, 7 idiopathic fibrosis, and 5 miliary tuberculosis) were imaged after the patients inhaled 1,110 MBq of Tc 99m EL. Clearance half time for the first 45 min, for 24 h, and retention at 24 h correlated with percentage of lymphocytes in bronchoalveolar lavage fluid (BAL) (r=.729, r=.883, and r=.826, respectively). There was a positive correlation between peripheral penetration (PP) and forced expiratory volume in 1 s (FEV{sub 1}) (r=.806) and forced vital capacity (FVC) (r=.781). Retention was more marked in sarcoidosis compared with tuberculosis (0.025parenchymal lung diseases. Retention of Tc 99m EL may be related to number of BAL cells or presence of a lymphocytic alveolitis. Long residency time of Tc 99m EL in the lungs implies that erythromycin can also be administered by inhalation for therapeutic purposes.

  13. Parotid sialosis: morphometrical analysis of the glandular parenchyme and stroma among diabetic and alcoholic patients. (United States)

    Merlo, Carolina; Bohl, Luciana; Carda, Carmen; Gómez de Ferraris, María Elsa; Carranza, Miriam


    Among the agents that cause parotid sialosis, diabetes mellitus type 2 and chronic alcoholism are included. In this study, the morphometrical modifications in the diabetic parotid sialosis were determined to compare them with the histopathological characteristics of alcoholic parotid sialosis. Five parotid biopsy samples obtained from patients with diabetic sialosis, 12 samples from patients with alcoholic sialosis and seven from individuals without these pathologies (control group) were analyzed. A morphometrical study of parotid parenchyme and stroma, using a digital image analyzer attached to an optical microscope, was carried out. Dimensions of serous acini and striated ducts, the area occupied by the fatty tissue, and the number of ducts were recorded. Mean values were compared using the Mann-Whitney U-test (P

  14. Hepatic non-parenchymal cells and extracellular matrix participate in oval cell-mediated liver regeneration

    Institute of Scientific and Technical Information of China (English)

    Wei Zhang; Xiao-Ping Chen; Wan-Guang Zhang; Feng Zhang; Shuai Xiang; Han-Hua Dong; Lei Zhang


    AIM: To elucidate the interaction between nonparenchymal cells, extracellular matrix and oval cells during the restituting process of liver injury induced by partial hepatectomy (PH). METHODS: We examined the localization of oval cells, non-parenchymal cells, and the extracellular matrix components using immunohistochemical and double immunofluorescent analysis during the proliferation and differentiation of oval cells in N-2-acetylaminofluorene (2-AAF)/PH rat model. RESULTS: By day 2 after PH, small oval cells began to proliferate around the portal area. Most of stellate cells and laminin were present along the hepatic sinusoids in the periportal area. Kupffer cells and fibronectin markedly increased in the whole hepatic lobule. From day 4 to 9, oval cells spread further into hepatic parenchyma, closely associated with stellate cells, fibronectin and laminin. Kupffer cells admixed with oval cells by day 6 and then decreased in the periportal zone. From day 12 to 15, most of hepatic stellate cells (HSCs), laminin and fibronectin located around the small hepatocyte nodus, and minority of them appeared in the nodus. Kupffer cells were mainly limited in the pericentral sinusoids. After day 18, the normal liver lobule structures began to recover.CONCLUSION: Local hepatic microenvironment may participate in the oval cell-mediated liver regeneration through the cell-cell and cell-matrix interactions.

  15. Parenchymal texture analysis in digital mammography: robust texture feature identification and equivalence across devices. (United States)

    Keller, Brad M; Oustimov, Andrew; Wang, Yan; Chen, Jinbo; Acciavatti, Raymond J; Zheng, Yuanjie; Ray, Shonket; Gee, James C; Maidment, Andrew D A; Kontos, Despina


    An analytical framework is presented for evaluating the equivalence of parenchymal texture features across different full-field digital mammography (FFDM) systems using a physical breast phantom. Phantom images (FOR PROCESSING) are acquired from three FFDM systems using their automated exposure control setting. A panel of texture features, including gray-level histogram, co-occurrence, run length, and structural descriptors, are extracted. To identify features that are robust across imaging systems, a series of equivalence tests are performed on the feature distributions, in which the extent of their intersystem variation is compared to their intrasystem variation via the Hodges-Lehmann test statistic. Overall, histogram and structural features tend to be most robust across all systems, and certain features, such as edge enhancement, tend to be more robust to intergenerational differences between detectors of a single vendor than to intervendor differences. Texture features extracted from larger regions of interest (i.e., [Formula: see text]) and with a larger offset length (i.e., [Formula: see text]), when applicable, also appear to be more robust across imaging systems. This framework and observations from our experiments may benefit applications utilizing mammographic texture analysis on images acquired in multivendor settings, such as in multicenter studies of computer-aided detection and breast cancer risk assessment.

  16. Perforin-2 is essential for intracellular defense of parenchymal cells and phagocytes against pathogenic bacteria. (United States)

    McCormack, Ryan M; de Armas, Lesley R; Shiratsuchi, Motoaki; Fiorentino, Desiree G; Olsson, Melissa L; Lichtenheld, Mathias G; Morales, Alejo; Lyapichev, Kirill; Gonzalez, Louis E; Strbo, Natasa; Sukumar, Neelima; Stojadinovic, Olivera; Plano, Gregory V; Munson, George P; Tomic-Canic, Marjana; Kirsner, Robert S; Russell, David G; Podack, Eckhard R


    Perforin-2 (MPEG1) is a pore-forming, antibacterial protein with broad-spectrum activity. Perforin-2 is expressed constitutively in phagocytes and inducibly in parenchymal, tissue-forming cells. In vitro, Perforin-2 prevents the intracellular replication and proliferation of bacterial pathogens in these cells. Perforin-2 knockout mice are unable to control the systemic dissemination of methicillin-resistant Staphylococcus aureus (MRSA) or Salmonella typhimurium and perish shortly after epicutaneous or orogastric infection respectively. In contrast, Perforin-2-sufficient littermates clear the infection. Perforin-2 is a transmembrane protein of cytosolic vesicles -derived from multiple organelles- that translocate to and fuse with bacterium containing vesicles. Subsequently, Perforin-2 polymerizes and forms large clusters of 100 Å pores in the bacterial surface with Perforin-2 cleavage products present in bacteria. Perforin-2 is also required for the bactericidal activity of reactive oxygen and nitrogen species and hydrolytic enzymes. Perforin-2 constitutes a novel and apparently essential bactericidal effector molecule of the innate immune system.

  17. The impact of bilateral salpingo-oophorectomy on breast MRI background parenchymal enhancement and fibroglandular tissue

    Energy Technology Data Exchange (ETDEWEB)

    Price, E.R. [University of California, San Francisco, Department of Radiology and Biomedical Imaging, Division of Women' s Imaging, San Francisco, California (United States); Brooks, J.D. [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Watson, E.J.; Brennan, S.B.; Morris, E.A. [Department of Radiology, Breast Imaging Section, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Comen, E.A. [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)


    The objective of this study was to evaluate the effect of bilateral salpingo-oophorectomy (BSO) on background parenchymal enhancement (BPE) and the amount of fibroglandular tissue (FGT) seen on breast MRI. Retrospective review identified 21 BRCA mutation carriers who underwent breast MRI before and after elective BSO. After exclusion of patients placed on postoperative hormone replacement therapy, there were 18 eligible patients. Blinded to surgical status, three independent readers used categorical scales to rate BPE (minimal, mild, moderate, marked) and the amount of FGT (fatty, scattered, heterogeneously dense, dense) on pre- and post-BSO MRI examinations. The sign test was used to assess for changes in the categorical ratings of BPE and FGT. Significant proportions of women demonstrated decreases in BPE and in the amount of FGT following oophorectomy (P = 0.004 and 0.02, respectively.) BPE decreases were larger and seen earlier than FGT changes. There was no significant relationship between age/body mass index and changes in BPE and FGT. BPE and the amount of FGT seen on breast MRI are significantly decreased by oophorectomy; BPE decreases to a greater extent and earlier than FGT. (orig.)

  18. Pathogenesis of Nonalcoholic Steatohepatitis: Interactions between Liver Parenchymal and Nonparenchymal Cells

    Directory of Open Access Journals (Sweden)

    Nancy Magee


    Full Text Available Nonalcoholic fatty liver disease (NAFLD is the most common type of chronic liver disease in the Western countries, affecting up to 25% of the general population and becoming a major health concern in both adults and children. NAFLD encompasses the entire spectrum of fatty liver disease in individuals without significant alcohol consumption, ranging from nonalcoholic fatty liver (NAFL to nonalcoholic steatohepatitis (NASH and cirrhosis. NASH is a manifestation of the metabolic syndrome and hepatic disorders with the presence of steatosis, hepatocyte injury (ballooning, inflammation, and, in some patients, progressive fibrosis leading to cirrhosis. The pathogenesis of NASH is a complex process and implicates cell interactions between liver parenchymal and nonparenchymal cells as well as crosstalk between various immune cell populations in liver. Lipotoxicity appears to be the central driver of hepatic cellular injury via oxidative stress and endoplasmic reticulum (ER stress. This review focuses on the contributions of hepatocytes and nonparenchymal cells to NASH, assessing their potential applications to the development of novel therapeutic agents. Currently, there are limited pharmacological treatments for NASH; therefore, an increased understanding of NASH pathogenesis is pertinent to improve disease interventions in the future.

  19. Impact of menopausal status on background parenchymal enhancement and fibroglandular tissue on breast MRI

    Energy Technology Data Exchange (ETDEWEB)

    King, Valencia [Memorial Sloan-Kettering Cancer Center, Department of Radiology, Breast Imaging Section, New York, NY (United States); Memorial Sloan-Kettering Cancer Center, Department of Radiology, New York, NY (United States); Gu, Yajia [Fudan University Shanghai Cancer Center, Department of Radiology, Shanghai (China); Fudan University, Department of Oncology, Shanghai Medical College, Shanghai (China); Kaplan, Jennifer B.; Morris, Elizabeth A. [Memorial Sloan-Kettering Cancer Center, Department of Radiology, Breast Imaging Section, New York, NY (United States); Brooks, Jennifer D.; Pike, Malcolm C. [Memorial Sloan-Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, NY (United States)


    To evaluate the effect of menopausal status on the background parenchymal enhancement (BPE) and amount of fibroglandular tissue (FGT) on breast MRI. Retrospective review identified 1,130 women who underwent screening breast MRI between July and November 2010. In 28 of these women, breast MRI was performed both at one time point while pre- and one time point while post-menopausal (median interval 49 months). Two independent readers blinded to menopausal status used categorical scales to rate BPE (minimal/mild/moderate/marked) and FGT (fatty/scattered/heterogeneously dense/dense). Consensus was reached when there was disagreement. The sign test was used to assess changes in rating categories, and the Spearman rank and Fisher's exact tests were used to measure correlations and associations between variables. Significant proportions of women demonstrated decreases in BPE and FGT on post-menopausal breast MRI (P = 0.0001 and P = 0.0009). BPE category was unchanged in 39 % (11/28) and decreased in 61 % (17/28) of women. FGT category was unchanged in 61 % (17/28) and decreased in 39 % (11/28) of women. Age, reason for menopause, or interval between MRIs had no significant impact on changes in BPE and FGT. On MRI, BPE, and FGT decrease after menopause in significant proportions of women; BPE decreases more than FGT. (orig.)

  20. Pregnancy in renal transplant recipients. (United States)

    Fuchs, Karin M; Wu, Danny; Ebcioglu, Zeynep


    Women with renal disease face increasing infertility and high-risk pregnancy as they approach end-stage renal disease due to uremia. Renal transplantation has provided these patients the ability to return to a better quality of life, and for a number of women who are of child bearing age with renal disease, it has restored their fertility and provided the opportunity to have children. But, although fertility is restored, pregnancy in these women still harbors risk to the mother, graft, and fetus. Selected patients who have stable graft function can have successful pregnancies under the supervision of a multidisciplinary team involving maternal fetal medicine specialists and transplant nephrologists. Careful observation and management are required to optimize outcome for mother and fetus.

  1. Mucormycosis (zygomycosis) of renal allograft. (United States)

    Gupta, Krishan L; Joshi, Kusum; Kohli, Harbir S; Jha, Vivekanand; Sakhuja, Vinay


    Fungal infection is relatively common among renal transplant recipients from developing countries. Mucormycosis, also known as zygomycosis, is one of the most serious fungal infections in these patients. The most common of presentation is rhino-cerebral. Isolated involvement of a renal allograft is very rare. A thorough search of literature and our medical records yielded a total of 24 cases with mucormycosis of the transplanted kidney. There was an association with cytomegalovirus (CMV) infection and anti-rejection treatment in these patients and most of these transplants were performed in the developing countries from unrelated donors. The outcome was very poor with an early mortality in 13 (54.5%) patients. Renal allograft mucormycosis is a relatively rare and potentially fatal complication following renal transplantation. Early diagnosis, graft nephrectomy and appropriate antifungal therapy may result in an improved prognosis for these patients.

  2. Renale Osteopathie


    Horn S


    Die renale Osteopathie umfaßt Erkrankungen des Knochens, die bei Patienten mit chronischen Nierenerkrankungen auftreten, wie den sekundären bzw. tertiären Hyperparathyreoidismus, die adynamische Knochenerkrankung und die Osteopathie nach Nierentransplantation. Durch die Identifikation des Kalzium-Sensing-Rezeptors bzw. des Vitamin D-Rezeptors hat sich unser Verständnis der Zusammenhänge in den letzten Jahren erheblich verbessert. Neue Medikamente versprechen effizientere Prophylaxe- und Thera...

  3. Renale Knochenerkrankungen

    Directory of Open Access Journals (Sweden)

    Mayer G


    Full Text Available Störungen des Mineral- und Knochenstoffwechsels sind bei fast allen Patienten mit chronischen Nierenerkrankungen anzutreffen. Pathogenetisch spielt eine Neigung zur Phosphatretention bei einer Reduktion der glomerulären Filtrationsrate die zentrale Rolle. Neben typischen, aber sehr variablen Veränderungen der Knochenstruktur (renale Osteopathie besteht auch eine sehr enge Assoziation zwischen diesen Störungen und dem massiv erhöhten kardiovaskulären Risiko der Patienten.

  4. Impact of ventilation frequency and parenchymal stiffness on flow and pressure distribution in a canine lung model. (United States)

    Amini, Reza; Kaczka, David W


    To determine the impact of ventilation frequency, lung volume, and parenchymal stiffness on ventilation distribution, we developed an anatomically-based computational model of the canine lung. Each lobe of the model consists of an asymmetric branching airway network subtended by terminal, viscoelastic acinar units. The model allows for empiric dependencies of airway segment dimensions and parenchymal stiffness on transpulmonary pressure. We simulated the effects of lung volume and parenchymal recoil on global lung impedance and ventilation distribution from 0.1 to 100 Hz, with mean transpulmonary pressures from 5 to 25 cm H2O. With increasing lung volume, the distribution of acinar flows narrowed and became more synchronous for frequencies below resonance. At higher frequencies, large variations in acinar flow were observed. Maximum acinar flow occurred at first antiresonance frequency, where lung impedance achieved a local maximum. The distribution of acinar pressures became very heterogeneous and amplified relative to tracheal pressure at the resonant frequency. These data demonstrate the important interaction between frequency and lung tissue stiffness on the distribution of acinar flows and pressures. These simulations provide useful information for the optimization of frequency, lung volume, and mean airway pressure during conventional ventilation or high frequency oscillation (HFOV). Moreover our model indicates that an optimal HFOV bandwidth exists between the resonant and antiresonant frequencies, for which interregional gas mixing is maximized.

  5. Assessment of the relationship between lung parenchymal destruction and impaired pulmonary perfusion on a lobar level in patients with emphysema

    Energy Technology Data Exchange (ETDEWEB)

    Ley-Zaporozhan, Julia [Department of Radiology, Johannes Gutenberg University, Mainz (Germany) and Department of Radiology (E 010), German Cancer Research Center, Heidelberg (Germany)]. E-mail:; Ley, Sebastian [Department of Radiology (E 010), German Cancer Research Center, Heidelberg (Germany); Department of Pediatric Radiology, Ruprecht-Karls-University, Heidelberg (Germany); Eberhardt, Ralf [Department of Pulmology, Thoraxklinik, Heidelberg (Germany); Weinheimer, Oliver [Department of Radiology, Johannes Gutenberg University, Mainz (Germany); Fink, Christian [Department of Radiology (E 010), German Cancer Research Center, Heidelberg (Germany); Department of Clinical Radiology, University Hospital of Munich (Germany); Puderbach, Michael [Department of Radiology (E 010), German Cancer Research Center, Heidelberg (Germany); Eichinger, Monika [Department of Radiology (E 010), German Cancer Research Center, Heidelberg (Germany); Herth, Felix [Department of Pulmology, Thoraxklinik, Heidelberg (Germany); Kauczor, Hans-Ulrich [Department of Radiology (E 010), German Cancer Research Center, Heidelberg (Germany)


    Purpose: To assess the relationship between lung parenchymal destruction and impaired pulmonary perfusion on a lobar level using CT and MRI in patients with emphysema. Material and methods: Forty-five patients with severe emphysema (GOLD III and IV) underwent inspiratory 3D-HRCT and contrast-enhanced MR-perfusion (1.5T; 3.5 mm x 1.9 mm x 4 mm). 3D-HRCT data was analyzed using a software for detection and visualization of emphysema. Emphysema was categorized in four clusters with different volumes and presented as overlay on the CT. CT and lung perfusion were visually analyzed for three lobes on each side using a four-point-score to grade the abnormalities on CT (1: predominantly small emphysema-clusters to 4: >75% large emphysema-clusters) and MRI (1: normal perfusion to 4: no perfusion). Results: A total of 270 lobes were evaluated. At CT, the score was 1 for 9 lobes, 2 for 43, 3 for 77, and 4 for 141 lobes. At MRI, the score was 1 for 13 lobes, 2 for 45, 3 for 92, and 4 for 120 lobes. Matching of lung parenchymal destruction and reduced perfusion was found in 213 lobes (weighted kappa = 0.8). The score was higher on CT in 44, and higher on MRI in 13 lobes. Conclusion: 3D-HRCT and 3D MR-perfusion show a high lobar agreement between parenchymal destruction and reduction of perfusion in patients with severe emphysema.

  6. Obesity and renal hemodynamics

    NARCIS (Netherlands)

    Bosma, R. J.; Krikken, J. A.; van der Heide, J. J. Homan; de Jong, P. E.; Navis, G. J.


    Obesity is a risk factor for renal damage in native kidney disease and in renal transplant recipients. Obesity is associated with several renal risk factors such as hypertension and diabetes that may convey renal risk, but obesity is also associated with an unfavorable renal hemodynamic profile

  7. Obesity and renal hemodynamics

    NARCIS (Netherlands)

    Bosma, R. J.; Krikken, J. A.; van der Heide, J. J. Homan; de Jong, P. E.; Navis, G. J.


    Obesity is a risk factor for renal damage in native kidney disease and in renal transplant recipients. Obesity is associated with several renal risk factors such as hypertension and diabetes that may convey renal risk, but obesity is also associated with an unfavorable renal hemodynamic profile inde

  8. Successful Transplantation of a Split Crossed Fused Ectopic Kidney into a Patient with End-Stage Renal Disease

    Directory of Open Access Journals (Sweden)

    Kristin L. Mekeel


    Full Text Available Potential donors with congenital renal anomalies but normal renal function are often overlooked because of a possible increase in technical difficulty and complications associated with the surgery. However, as the waiting list for a deceased donor kidney transplant continues to grow, it is important to consider these kidneys for potential transplant. This paper describes the procurement of a crossed fused ectopic kidney, and subsequent parenchymal transection prior to transplantation as part of a combined simultaneous kidney pancreas transplant. The transplant was uncomplicated, and the graft had immediate function. The patient is now two years from transplant with excellent function.

  9. Targeting naproxen to non-parenchymal liver cells protects against endotoxin induced liver damage

    NARCIS (Netherlands)

    Lebbe, C; Reichen, J; Wartna, E.S; Sägesser, H; Poelstra, Klaas; Meijer, D.K F


    Non-steroidal anti-inflammatory drugs (NSAID's) could be of value in the treatment of liver disease; however, their use in this situation is limited by renal side effects. Therefore, we explored whether naproxen covalently bound to human serum albumin (NAP-HSA) was able to reduce toxicity in an acut

  10. Dupplex doppler sonography in patients with medical renal diseases: correlation with clinical and histopathologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Song, Soon Young; Koh, Byung Hee; Lee, Seung Chul; Bae, Jae Ik; Kim, Yong Soo; Rhim, Hyun Chul; Cho, On Koo; Park, Chan Hyun; Park, Moon Hyang [Hanyang Univ. College of Medicine, Seoul (Korea, Republic of)


    To compare the RI (resistive index) of renal artery with serum creatinine level and histological change in 50 patients with renal parenchymal disease. To measure RI in each patient, Doppler studies were performed three times in each kidney at the level of the interlobar arteries, and the average value of RI was taken. The study was performed 1 -3 days after renal biopsy and the time interval between blood sampling for serum creatinine and duplex study was also 1 - 3 days. The RI of patients with renal disease was also correlated with patient's age, sex and serum creatinine level, and RI was also correlated with the degree of severity of glomerular, interstitial, and vascular change in the kidneys. Statistical analysis was performed using Student's t test and Pearson's correlation method. The RI of the normal control and renal disease group was 0.566{+-}0.037 and 0.584{+-}0.038, respectively with no statistical significance(p=0.444). In the group with renal disease, there was no significant correlation between RI and a patient's age, sex, and serum creatinine level(p>0.05). RI was not significantly different between predominantly glomerular disease (n=45) and nonglomerular or mixed disease(n=5)(p=0.558), and did not correlate with the severity of glomerular sclerosis, interstitial fibrosis, or atherosclerosis(p>0.05). The authors conclude that RI is not helpful for the diagnosis and differential diagnosis of renal parenchymal diseases and does not correlate with serum creatinine levels. In order to define the role of the RI, further clinical experience with more cases is required.

  11. Pregnancy in women with renal disease. Part II: specific underlying renal conditions. (United States)

    Vidaeff, Alex C; Yeomans, Edward R; Ramin, Susan M


    The obstetric outcome in women with kidney disease has improved in recent years due to continuous progress in obstetrics and neonatology, as well as better medical management of hypertension and renal disease. However, every pregnancy in these women remains a high-risk pregnancy. When considering the interaction between renal disease and pregnancy, maternal outcomes are related to the initial level of renal dysfunction more than to the specific underlying disease. With regards to fetal outcomes, though, a distinction may exist between renal dysfunction resulting from primary renal disease and that in which renal involvement is part of a systemic disease. In part II of this review, some specific causes of renal failure affecting pregnancy are considered.

  12. Leukemic meningitis involving the cauda equina: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Dong Hyun; Kim, Ho Kyun; Lee, Young Hwan [School of Medicine, Catholic University of Daegu, Daegu (Korea, Republic of)


    The CNS involvement by leukemia may either be meningeal or parenchymal, although meningeal infiltration of leukemic cells, known as leukemic meningitis is more common. We report a case of leukemic meningitis involving the cauda equina in a patient with an acute lymphoblastic crisis which transformed from the chronic phase of chronic myeloid leukemia. An MR image revealed diffuse enlargement and peripheral ring enhancement of the nerve roots of the cauda equina.

  13. Lack of association between parenchymal neurocysticercosis and HLA Class I and Class II antigens

    Directory of Open Access Journals (Sweden)

    Eni Picchioni Bompeixe


    Full Text Available Neurocysticercosis, caused by encysted larvae of the tapeworm Taenia solium, is the most common infection of the central nervous system and a major public health problem in many countries. Prevalence in the region of Curitiba, located in the southern Brazilian State of Paraná, is one of the highest in the world. The genetics of host susceptibility to neurocysticercosis (NCC is still obscure. To investigate if major histocompatibility complex (MHC genes influence individual susceptibility to NCC, we performed a case-control association analysis. Fifty-two Caucasoid patients and 149 matched controls were typed for antigens of the HLA-A, B, C, DR and DQ loci. All patients had computerized tomography and clinical features compatible with parenchymal NCC. Indirect immunofluorescence of cerebrospinal fluid showed that 19 (37% of the patients presented anti-cysticercus antibodies at titers ³ 1:10. Frequencies of HLA specificities in the whole group of patients and in the subgroup with antibodies in cerebrospinal fluid were compared to those of the control group. No significant difference was found. These results do not support the hypothesis of HLA gene participation in susceptibility to parenchymal neurocysticercosis.A neurocisticercose, causada pelo cisticerco, a larva do cestóide Taenia solium, é a infecção mais comum do sistema nervoso central e constitui importante problema de saúde pública em muitos países. A sua prevalência na região de Curitiba, localizada no Estado do Paraná, foi estimada em 9%, situando-se entre as mais elevadas do mundo. Os aspectos genéticos de suscetibilidade à neurocisticercose (NCC ainda são pouco conhecidos. Com o objetivo de investigar se genes do MHC influenciam a suscetibilidade individual à NCC, realizamos uma análise de associação caso-controle. Cinqüenta e dois pacientes caucasóides e 149 indivíduos-controle pareados foram tipados para antígenos dos locos HLA-A, B, C, DR e DQ. Todos os

  14. A Clinicopathologic Correlation of Mammographic Parenchymal Patterns and Associated Risk Factors for Human Mammary Carcinoma (United States)

    Bland, Kirby I.; Kuhns, James G.; Buchanan, Jerry B.; Dwyer, Patricia A.; Heuser, Louis F.; O'Connor, Carol A.; Gray, Laman A.; Polk, Hiram C.


    The five-year screening experience for 10,131 asymptomatic women evaluated at the Louisville Breast Cancer Detection Demonstration Project (LBCDDP) disclosed 144 breast carcinomas in 1,209 patients (12%) aged 35 to 74 years in whom 904 biopsies and 305 aspirations were performed. This study included 44,711 high-quality xeromammograms (XM) prospectively classified by the modified Wolfe mammographic parenchymal patterns into low-risk (N1, P1) versus high-risk (P2, DY) groups, with expansion of the P2 cohort into three additional categories. Using BMDP computer-program analysis, each XM pattern was collated with 21 nonneoplastic and 18 malignant pathologic variables and commonly associated risk factors. A separate analysis of epithelial proliferative and nonproliferative fibrocystic disease of the breast (FCDB) was performed. The histopathology for each biopsy, with distinction of FCDB and neoplasms, was analyzed with regard to the statistical probability of influencing the XM pattern. An average of 1.05 biopsies per patient were performed in women with findings suggestive of carcinoma at clinical and/or XM examinations. An equal distribution of the N1, P1, and P2 DYXM patterns was observed in the 10,131 screenees. Of 8.5% of the screened population having biopsies, 623 were observed to have nonproliferative FCDB and 137, proliferative FCDB. For women 50 years of age or younger, these pathologic variables were seen more frequently in the P2 DY patterns (p < 0.001), whereas no difference in XM pattern distribution was observed for the screenee 50 years of age or older for proliferative FCDB (p = 0.65). Sixteen percent of the biopsied/aspirated lesions were carcinomas, yielding a biopsy/cancer ratio of 6.25:1. These in situ and invasive neoplasms were more commonly (p < 0.04) observed in 55% of the P2 (P2f, P2n, P2c) categories, while 64% of all cancers appeared more frequently in the P2 DY subgroup (p <0.001), compared with this pattern in the screened population. An

  15. Knockout of Toll-Like Receptors 2 and 4 Prevents Renal Ischemia-Reperfusion-Induced Cardiac Hypertrophy in Mice. (United States)

    Trentin-Sonoda, Mayra; da Silva, Rogério Cirino; Kmit, Fernanda Vieira; Abrahão, Mariana Vieira; Monnerat Cahli, Gustavo; Brasil, Guilherme Visconde; Muzi-Filho, Humberto; Silva, Paulo André; Tovar-Moll, Fernanda Freire; Vieyra, Adalberto; Medei, Emiliano; Carneiro-Ramos, Marcela Sorelli


    We investigated whether the pathways linked to Toll-like receptors 2 and 4 (TLRs) are involved in renal ischemia-reperfusion (I/R)-induced cardiac hypertrophy. Wild type (WT) C57BL/6J, TLR2-/- and TLR4-/- mice were subjected to left kidney ischemia for 60 min followed by reperfusion for 5, 8, 12 and 15 days. Proton density magnetic resonance showed alterations in the injured kidney from WT mice, together with signs of parenchymal edema and higher levels of vimentin mRNA, accompanied by: (i) small, but significant, increase in serum urea after 24 h, (ii) 100% increase in serum creatinine at 24 h. A serum peak of inflammatory cytokines occurred after 5 days of reperfusion. Heart weight/body weight and heart weight/tibia length ratios increased after 12 and 15 days of reperfusion, respectively. Cardiac hypertrophy markers, B-type natriuretic peptide (BNP) and α-actin, left ventricle mass, cardiac wall thickness and myocyte width increased after 15 days of reperfusion, together with longer QTc and action potential duration. Cardiac TLRs, MyD88, HSP60 and HSP70 mRNA levels also increased. After 15 days of reperfusion, absence of TLRs prevented cardiac hypertrophy, as reflected by similar values of left ventricular cardiac mass and heart weight/body weight ratio compared to the transgenic Sham. Renal tissular injury also ameliorated in both knockout mice, as revealed by the comparison of their vimentin mRNA levels with those found in the WT on the same day after I/R. The I/R TLR2-/- group had TNF-α, IFN-γ and IL-1β levels similar to the non-I/R group, whereas the TLR4-/- group conserved the p-NF-κB/NF- κB ratio contrasting with that found in TLR2-/-. We conclude: (i) TLRs are involved in renal I/R-induced cardiac hypertrophy; (ii) absence of TLRs prevents I/R-induced cardiac hypertrophy, despite renal lesions seeming to evolve towards those of chronic disease; (iii) TLR2 and TLR4 selectively regulate the systemic inflammatory profile and NF- κB activation.

  16. Bilateral Renal Mass-Renal Disorder: Tuberculosis

    Directory of Open Access Journals (Sweden)

    Ozlem Tiryaki


    Full Text Available A 30-year-old woman has presented complaining of weakness and fatigue to her primary care physician. The renal sonography is a routine step in the evaluation of new onset renal failure. When the renal masses have been discovered by sonography in this setting, the functional imaging may be critical. We reported a case about bilateral renal masses in a young female patient with tuberculosis and renal insufficiency. Magnetic resonance (MR has revealed the bilateral renal masses in patient, and this patient has been referred to our hospital for further management. The patient’s past medical and surgical history was unremarkable.

  17. A roadmap for the genetic analysis of renal aging

    NARCIS (Netherlands)

    Noordmans, Gerda A.; van Goor, Harry; Hillebrands, Jan-Luuk; Korstanje, Ron


    Several studies show evidence for the genetic basis of renal disease, which renders some individuals more prone than others to accelerated renal aging. Studying the genetics of renal aging can help us to identify genes involved in this process and to unravel the underlying pathways. First, this opin

  18. osteodystrophy in patients with chronic renal failure in enugu.

    African Journals Online (AJOL)

    Objectives: To study the prevalence of renal osteodystrophy in Chronic renal failure patients in Enugu, using ... Results: There was no obvious relationship between bone pain (a symptom of renal osteodystrophy) and the ... 1.1 Patient selection The study was carried out ... (c) Visceral calcifications, which can involve the.

  19. Scleroderma Renal Crisis: A Pathology Perspective

    Directory of Open Access Journals (Sweden)

    Ibrahim Batal


    Full Text Available Scleroderma renal crisis (SRC is an infrequent but serious complication of systemic sclerosis (SSc. It is associated with increased vascular permeability, activation of coagulation cascade, and renin secretion, which may lead to the acute renal failure typically associated with accelerated hypertension. The histologic picture of SRC is that of a thrombotic microangiopathy process with prominent small vessel involvement manifesting as myxoid intimal changes, thrombi, onion skin lesions, and/or fibrointimal sclerosis. Renal biopsies play an important role in confirming the clinical diagnosis, excluding overlapping/superimposed diseases that might lead to acute renal failure in SSc patients, helping to predict the clinical outcome and optimizing patient management. Kidney transplantation may be the only treatment option available for a subset of SRC patients who develop end-stage renal failure despite aggressive angiotensin-converting enzyme inhibitor therapy. However, the posttransplant outcome for SSc patients is currently suboptimal compared to the general renal transplant population.

  20. Renal denervation:history, today and tomorrow

    Institute of Scientific and Technical Information of China (English)

    BAO Ruo-tai; CHEN Zhong; MA Gen-shan


    Renal denervation is a new technique approved effective for resistant-hypertension treatment .The common renal denervation system consists of a generator and a flexible catheter .During this minimally invasive procedure , the interventionalist uses a steerable catheter with a radio frequency ( RF) energy electrode tip .The RF energy is delivered to the renal artery via standard femoral artery access .A series of 2-minute ablation are delivered in each renal artery to distroy the nerves system .The procedure does not involve a permanent device implant .By deactivating the renal nerves , and therefore reducing sympathetic nerve transmission , a significant and reliable reduction in blood pressure could be achieved .In this review, potential complications and future sights of renal denervation are also discussed .

  1. Distal renal tubular acidosis (United States)

    Renal tubular acidosis - distal; Renal tubular acidosis type I; Type I RTA; RTA - distal; Classical RTA ... excreting it into the urine. Distal renal tubular acidosis (Type I RTA) is caused by a defect ...

  2. Proximal renal tubular acidosis (United States)

    Renal tubular acidosis - proximal; Type II RTA; RTA - proximal; Renal tubular acidosis type II ... by alkaline substances, mainly bicarbonate. Proximal renal tubular acidosis (Type II RTA) occurs when bicarbonate is not ...

  3. Effect of menstrual cycle phase on background parenchymal uptake on molecular breast imaging (United States)

    Hruska, Carrie B.; Conners, Amy Lynn; Vachon, Celine M.; O’Connor, Michael K.; Shuster, Lynne T.; Bartley, Adam C.; Rhodes, Deborah J.


    Rationale and Objectives The level of Tc-99m sestamibi uptake within normal fibroglandular tissue on molecular breast imaging (MBI), termed background parenchymal uptake (BPU), has been anecdotally observed to fluctuate with menstrual cycle. Our objective was to assess the impact of menstrual cycle phase on BPU appearance. Materials and Methods Premenopausal volunteers who reported regular menstrual cycles and no exogenous hormone use were recruited to undergo serial MBI exams during the follicular and luteal phase. A study radiologist, blinded to cycle phase, categorized BPU as either photopenic, minimal-mild, moderate, or marked. Change in BPU with cycle phase was determined as well as correlations of BPU with mammographic density and hormone levels. Results Among 42 analyzable participants, high BPU (moderate or marked) was observed more often in luteal phase compared to follicular (p = 0.016). BPU did not change with phase in 30 of 42 (71%) and increased in the luteal phase compared to follicular in 12 (29%). High BPU was more frequent in dense breasts compared to non-dense breasts at both the luteal phase (58% [15/26] vs. 13% [2/16], p= 0.004) and follicular phase (35% [9/26] vs. 6% [1/16], p=0.061). Spearman’s correlation coefficients did not show any correlation of BPU with hormone levels measured at either cycle phase, and suggested a weak correlation between change in BPU and changes in estrone and estradiol between phases. Conclusion We observed variable effects of menstrual cycle on BPU among our cohort of premenopausal women, however, when high BPU was observed, it was most frequently seen during the luteal phase compared to follicular phase, and in women with dense breasts compared to non-dense breasts. PMID:26112057

  4. Featured Article: Isolation, characterization, and cultivation of human hepatocytes and non-parenchymal liver cells (United States)

    Pfeiffer, Elisa; Kegel, Victoria; Zeilinger, Katrin; Hengstler, Jan G; Nüssler, Andreas K; Seehofer, Daniel


    Primary human hepatocytes (PHH) are considered to be the gold standard for in vitro testing of xenobiotic metabolism and hepatotoxicity. However, PHH cultivation in 2D mono-cultures leads to dedifferentiation and a loss of function. It is well known that hepatic non-parenchymal cells (NPC), such as Kupffer cells (KC), liver endothelial cells (LEC), and hepatic stellate cells (HSC), play a central role in the maintenance of PHH functions. The aims of the present study were to establish a protocol for the simultaneous isolation of human PHH and NPC from the same tissue specimen and to test their suitability for in vitro co-culture. Human PHH and NPC were isolated from tissue obtained by partial liver resection by a two-step EDTA/collagenase perfusion technique. The obtained cell fractions were purified by Percoll density gradient centrifugation. KC, LEC, and HSC contained in the NPC fraction were separated using specific adherence properties and magnetic activated cell sorting (MACS®). Identified NPC revealed a yield of 1.9 × 106 KC, 2.7 × 105 LEC and 4.7 × 105 HSC per gram liver tissue, showing viabilities >90%. Characterization of these NPC showed that all populations went through an activation process, which influenced the cell fate. The activation of KC strongly depended on the tissue quality and donor anamnesis. KC became activated in culture in association with a loss of viability within 4–5 days. LEC lost specific features during culture, while HSC went through a transformation process into myofibroblasts. The testing of different culture conditions for HSC demonstrated that they can attenuate, but not prevent dedifferentiation in vitro. In conclusion, the method described allows the isolation and separation of PHH and NPC in high quality and quantity from the same donor. PMID:25394621

  5. Multiparametric Magnetic Resonance Imaging for Prediction of Parenchymal Hemorrhage in Acute Ischemic Stroke After Reperfusion Therapy. (United States)

    Nael, Kambiz; Knitter, James R; Jahan, Reza; Gornbein, Jeffery; Ajani, Zahra; Feng, Lei; Meyer, Brett C; Schwamm, Lee H; Yoo, Albert J; Marshall, Randolph S; Meyers, Philip M; Yavagal, Dileep R; Wintermark, Max; Liebeskind, David S; Guzy, Judy; Starkman, Sidney; Saver, Jeffrey L; Kidwell, Chelsea S


    Patients with acute ischemic stroke are at increased risk of developing parenchymal hemorrhage (PH), particularly in the setting of reperfusion therapies. We have developed a predictive model to examine the risk of PH using combined magnetic resonance perfusion and diffusion parameters, including cerebral blood volume (CBV), apparent diffusion coefficient, and microvascular permeability (K2). Voxel-based values of CBV, K2, and apparent diffusion coefficient from the ischemic core were obtained using pretreatment magnetic resonance imaging data from patients enrolled in the MR RESCUE clinical trial (Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy). The associations between PH and extreme values of imaging parameters were assessed in univariate and multivariate analyses. Receiver-operating characteristic curve analysis was performed to determine the optimal parameter(s) and threshold for predicting PH. In 83 patients included in this analysis, 20 developed PH. Univariate analysis showed significantly lower 10th percentile CBV and 10th percentile apparent diffusion coefficient values and significantly higher 90th percentile K2 values within the infarction core of patients with PH. Using classification tree analysis, the 10th percentile CBV at threshold of 0.47 and 90th percentile K2 at threshold of 0.28 resulted in overall predictive accuracy of 88.7%, sensitivity of 90.0%, and specificity of 87.3%, which was superior to any individual or combination of other classifiers. Our results suggest that combined 10th percentile CBV and 90th percentile K2 is an independent predictor of PH in patients with acute ischemic stroke with diagnostic accuracy superior to individual classifiers alone. This approach may allow risk stratification for patients undergoing reperfusion therapies. URL: Unique identifier: NCT00389467. © 2017 The Authors.

  6. A fully automated system for quantification of background parenchymal enhancement in breast DCE-MRI (United States)

    Ufuk Dalmiş, Mehmet; Gubern-Mérida, Albert; Borelli, Cristina; Vreemann, Suzan; Mann, Ritse M.; Karssemeijer, Nico


    Background parenchymal enhancement (BPE) observed in breast dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) has been identified as an important biomarker associated with risk for developing breast cancer. In this study, we present a fully automated framework for quantification of BPE. We initially segmented fibroglandular tissue (FGT) of the breasts using an improved version of an existing method. Subsequently, we computed BPEabs (volume of the enhancing tissue), BPErf (BPEabs divided by FGT volume) and BPErb (BPEabs divided by breast volume), using different relative enhancement threshold values between 1% and 100%. To evaluate and compare the previous and improved FGT segmentation methods, we used 20 breast DCE-MRI scans and we computed Dice similarity coefficient (DSC) values with respect to manual segmentations. For evaluation of the BPE quantification, we used a dataset of 95 breast DCE-MRI scans. Two radiologists, in individual reading sessions, visually analyzed the dataset and categorized each breast into minimal, mild, moderate and marked BPE. To measure the correlation between automated BPE values to the radiologists' assessments, we converted these values into ordinal categories and we used Spearman's rho as a measure of correlation. According to our results, the new segmentation method obtained an average DSC of 0.81 0.09, which was significantly higher (p<0.001) compared to the previous method (0.76 0.10). The highest correlation values between automated BPE categories and radiologists' assessments were obtained with the BPErf measurement (r=0.55, r=0.49, p<0.001 for both), while the correlation between the scores given by the two radiologists was 0.82 (p<0.001). The presented framework can be used to systematically investigate the correlation between BPE and risk in large screening cohorts.

  7. Parameter optimization of parenchymal texture analysis for prediction of false-positive recalls from screening mammography (United States)

    Ray, Shonket; Keller, Brad M.; Chen, Jinbo; Conant, Emily F.; Kontos, Despina


    This work details a methodology to obtain optimal parameter values for a locally-adaptive texture analysis algorithm that extracts mammographic texture features representative of breast parenchymal complexity for predicting falsepositive (FP) recalls from breast cancer screening with digital mammography. The algorithm has two components: (1) adaptive selection of localized regions of interest (ROIs) and (2) Haralick texture feature extraction via Gray- Level Co-Occurrence Matrices (GLCM). The following parameters were systematically varied: mammographic views used, upper limit of the ROI window size used for adaptive ROI selection, GLCM distance offsets, and gray levels (binning) used for feature extraction. Each iteration per parameter set had logistic regression with stepwise feature selection performed on a clinical screening cohort of 474 non-recalled women and 68 FP recalled women; FP recall prediction was evaluated using area under the curve (AUC) of the receiver operating characteristic (ROC) and associations between the extracted features and FP recall were assessed via odds ratios (OR). A default instance of mediolateral (MLO) view, upper ROI size limit of 143.36 mm (2048 pixels2), GLCM distance offset combination range of 0.07 to 0.84 mm (1 to 12 pixels) and 16 GLCM gray levels was set. The highest ROC performance value of AUC=0.77 [95% confidence intervals: 0.71-0.83] was obtained at three specific instances: the default instance, upper ROI window equal to 17.92 mm (256 pixels2), and gray levels set to 128. The texture feature of sum average was chosen as a statistically significant (p<0.05) predictor and associated with higher odds of FP recall for 12 out of 14 total instances.

  8. Comparison of needles size in pediatric renal biopsy with sono-guided percutaneous-automated gun technique

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong Chul; Park, Jin Yong [Chungnam National Univ. College of Medicine, Seoul (Korea, Republic of)


    To compare the efficacy of a 20-gauge and an 18-gauge needle in sono-guided percutaneous automated gun biopsy for establishing the specific diagnosis of renal parenchymal disease in pediatric kidneys. In 60 pediatric patients with renal parenchymal diseases, percutaneous sono-guided gun biopsy was performed by an experienced radiologist. In two groups of 30 patients, regardless of their age, two needle passes were performed, using alternately an 18-gauge or a 20-gauge biopsy needle. The core of renal tissue thus obtained was examined with light, immunofluorescent or electron microscopy by the renal pathologist. The mean number of intact glomeruli of whole tissue core per biopsy, as seen on the light microscopy, and post-bioptic complications were compared between the two different needle size groups. The number (mean{+-}1 standard deviation) of glomeruli obtained per biopsy was 17{+-}8 in the 18-gauge needle group, and 14{+-}5 in the 20-gauge group. Between two groups, there was no major post-bioptic complication requiring specific treatment, nor a statistically significant difference in the frequency of minor complications. Even though more glomeruli were obtained with an 18-gauge needle, the number obtained with a 20-gauge needle also permitted adequate pathologic examination. Both an 18-gauge and a 20-gauge needle may thus be suitable for renal biopsy in pediatric patients.

  9. Individual differences in renal ACE activity in healthy rats predict susceptibility to adriamycin-induced renal damage

    NARCIS (Netherlands)

    Rook, M; Lely, AT; Kramer, AB; van Goor, H; Navis, G


    Background. In man, differences in angiotensin converting enzyme (ACE) levels, related to ACE (I/D) genotype, are associated with renal prognosis. This raises the hypothesis that individual differences in renal ACE activity are involved in renal susceptibility to inflicted damage. Therefore, we stud

  10. Individual differences in renal ACE activity in healthy rats predict susceptibility to adriamycin-induced renal damage

    NARCIS (Netherlands)

    Rook, Mieneke; Lely, A Titia; Kramer, Andrea B; van Goor, Harry; Navis, Gerjan; van Goor, Harm


    BACKGROUND: In man, differences in angiotensin-converting enzyme (ACE) levels, related to ACE (I/D) genotype, are associated with renal prognosis. This raises the hypothesis that individual differences in renal ACE activity are involved in renal susceptibility to inflicted damage. Therefore, we stud

  11. Isolated renal hydatid presenting as a complex renal lesion followed by spontaneous hydatiduria

    Institute of Scientific and Technical Information of China (English)

    Anil; Bhaya; Archana; P; Shinde


    Echinococcosis is a zoonotic disease. Liver is the most common site of involvement. Renal involvement is seen in 2% to 3% of patients. Computed tomography findings in renal hydatid typically include: a cyst with thick or calcified wall, unilocular cyst with detached membrane, a multiloculated cyst with mixed internal density and daughter cysts with lower density than maternal matrix. Rarely type Ⅳ hydatid cysts may mimic hypovascular renal cell carcinoma. We report a case of previously asymptomatic middle aged female who presented with mild intermittent pain and a complex renal lesion on imaging which was considered to be a hypovascular renal carcinoma or urothelial neoplasm. However, by serendipity, the patient had spontaneous hydatiduria and later was definitively diagnosed and stented. Hydatid disease should always be considered amongst the top differential diagnosis of an isolated "complex" renal lesion which remains indeterminate on imaging.

  12. Renale Osteopathie

    Directory of Open Access Journals (Sweden)

    Horn S


    Full Text Available Die renale Osteopathie umfaßt Erkrankungen des Knochens, die bei Patienten mit chronischen Nierenerkrankungen auftreten, wie den sekundären bzw. tertiären Hyperparathyreoidismus, die adynamische Knochenerkrankung und die Osteopathie nach Nierentransplantation. Durch die Identifikation des Kalzium-Sensing-Rezeptors bzw. des Vitamin D-Rezeptors hat sich unser Verständnis der Zusammenhänge in den letzten Jahren erheblich verbessert. Neue Medikamente versprechen effizientere Prophylaxe- und Therapiemöglichkeiten. Wir beeinflussen dadurch nicht nur die Morbidität und Lebensqualität, sondern auch die Mortalität unserer Patienten.

  13. Renal disease in pregnancy. (United States)

    Thorsen, Martha S; Poole, Judith H


    Anatomic and physiologic adaptations within the renal system during pregnancy are significant. Alterations are seen in renal blood flow and glomerular filtration, resulting in changes in normal renal laboratory values. When these normal renal adaptations are coupled with pregnancy-induced complications or preexisting renal dysfunction, the woman may demonstrate a reduction of renal function leading to an increased risk of perinatal morbidity and mortality. This article will review normal pregnancy adaptations of the renal system and discuss common pregnancy-related renal complications.

  14. Sonographic patterns of renal lymphoma in B-mode imaging and in contrast-enhanced ultrasound (CEUS)—A retrospective evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Trenker, C., E-mail: [Hospital of Internal Medicine, Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Baldingerstraße, Marburg (Germany); Neesse, A. [Hospital for Gastroenterology II, University Hospital Göttingen, Robert-Kochstr. 40, 37075 Göttingen (Germany); Görg, C. [Interdisciplinary Center of Ultrasound, University Hospital Giessen and Marburg, Baldingerstraße, Marburg (Germany)


    Introduction: Retrospective analysis of sonographic patterns of renal lymphoma in B-mode imaging and contrast-enhanced ultrasound (CEUS). Patients/methods: From January 2000 to June 2014, 27 patients with clinical or histologically confirmed renal lymphoma were examined with B-mode imaging, followed by CEUS in 8 cases. Results: In B-mode imaging renal lymphoma were hypoechoic in all 27 cases (100%). 9 patients (33.3%) had a bilateral, 18 (66.7%) patients had an unilateral lymphoma infiltration of the kidneys. 8 (29.6%) cases of small nodular, 5 (18.5%) cases of large nodular and 6 (22.2%) cases of perirenal lymphoma infiltration of the kidney were observed in B-mode imaging. Bulky-formation of renal lymphoma was detected in 6 (22.2%) patients and 2 (7.4%) patients had a diffuse lymphoma infiltration of the kidneys. In CEUS an arterial isoechoic enhancement was observed in 5 (62.5%)- and, an arterial hypoechoic enhancement was observed in 3 (37.5%) cases of renal lymphoma. A hypoechoic enhancement in the parenchymal phase was observed in 8 (100%) cases of renal lymphoma infiltration. Conclusion: In B-mode-imaging, nodular lymphoma infiltration of the kidneys is the most common of all renal lymphoma patterns in B-mode imaging. In CEUS, renal lymphoma presented an arterial iso- or hypoechoic enhancement, followed by a hypoechoic enhancement in the parenchymal phase. In regard to the differentiation of renal lymphoma to benign lesions of the kidney, CEUS may be helpful. However, the differentiation of renal lymphoma from other malignant lesions of the kidney like renal cell carcinoma is not feasible by CEUS.

  15. Primary renal osteosarcoma: A case report

    African Journals Online (AJOL)

    C. Ahomadégbé

    Pan African Urological Surgeons' Association. African Journal of ... features of a case of primary renal osteosarcoma in a 56-year-old man with stage IV disease. This is the ..... Osteosarcoma metastatic to the kidneys without lung involvement.

  16. Renal calculus

    CERN Document Server

    Pyrah, Leslie N


    Stone in the urinary tract has fascinated the medical profession from the earliest times and has played an important part in the development of surgery. The earliest major planned operations were for the removal of vesical calculus; renal and ureteric calculi provided the first stimulus for the radiological investigation of the viscera, and the biochemical investigation of the causes of calculus formation has been the training ground for surgeons interested in metabolic disorders. It is therefore no surprise that stone has been the subject of a number of monographs by eminent urologists, but the rapid development of knowledge has made it possible for each one of these authors to produce something new. There is still a technical challenge to the surgeon in the removal of renal calculi, and on this topic we are always glad to have the advice of a master craftsman; but inevitably much of the interest centres on the elucidation of the causes of stone formation and its prevention. Professor Pyrah has had a long an...

  17. On renal pathophysiology in preeclampsia

    NARCIS (Netherlands)

    Penning, Maria Elisabeth (Marlies)


    Preeclampsia is a complication of pregnancy which can suddenly change from a relatively mild phenotype into a life-threatening situation. One of the organs that is always involved during preeclampsia is the kidney. The placenta plays an important role in the renal pathophysiology of preeclampsia. Th

  18. Renal Pelviceal Keratinizing Squamous Metaplasia with Sparing of Pyramidal Zones

    Directory of Open Access Journals (Sweden)

    Richard H. Siderits


    Full Text Available Metaplastic changes in the urothelium of the upper urinary tract are relatively infrequent. Metaplasia may present as either squamous or less often glandular differentiation. The process may be associated with chronic inflammation or associated chronic infections. There may be malignant transformation to either squamous cell carcinoma or adenocarcinoma. The demarcation of the metaplastic process in the minor calyces has not been well documented to date. We report the case of a 74-year-old female patient who presented with a history of chronic renal disease and acute pyohydronephrosis. The patient underwent a nephroureterectomy which revealed keratinizing desquamative squamous metaplasia throughout the renal pelvis and upper urinary tract with abrupt termination of metaplasia at the junction of the renal pelvis and the minor calyx (pyramidal zone. Immunohistochemical evaluation documents metaplastic urothelium stained positive for CK5, before converting sharply to simple cuboidal epithelium in the minor calyx (pyramidal zones which stained positive CK7. At the junction of the metaplastic components and low cuboidal lined minor calyceal surfaces, the underlying stroma showed loss of ureteral muscularis mucosa with transition to renal parenchymal type stroma. We believe that this observation is unique and potentially relevant to the etiology and pathophysiology of pelviceal metaplasia.

  19. Orai1 and STIM1 are critical for cell migration and proliferation of clear cell renal cell carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji-Hee [Department of Physiology, Yonsei University Wonju College of Medicine, Wonju (Korea, Republic of); Lkhagvadorj, Sayamaa; Lee, Mi-Ra [Department of Pathology, Yonsei University Wonju College of Medicine, Wonju (Korea, Republic of); Hwang, Kyu-Hee [Department of Physiology, Yonsei University Wonju College of Medicine, Wonju (Korea, Republic of); Chung, Hyun Chul; Jung, Jae Hung [Department of Urology, Yonsei University Wonju College of Medicine, Wonju (Korea, Republic of); Cha, Seung-Kuy, E-mail: [Department of Physiology, Yonsei University Wonju College of Medicine, Wonju (Korea, Republic of); Institute of Lifestyle Medicine, and Nuclear Receptor Research Consortium, Yonsei University Wonju College of Medicine, Wonju (Korea, Republic of); Eom, Minseob, E-mail: [Department of Pathology, Yonsei University Wonju College of Medicine, Wonju (Korea, Republic of)


    Highlights: • Orai1 channel is highly expressed in clear cell renal cell carcinoma (ccRCC) tissues. • Orai1 and STIM1 constitute a native store-operated Ca{sup 2+} entry in ccRCC cells. • Orai1 and STIM1 promote cell migration and proliferation of ccRCC cells. - Abstract: The intracellular Ca{sup 2+} regulation has been implicated in tumorigenesis and tumor progression. Notably, store-operated Ca{sup 2+} entry (SOCE) is a major Ca{sup 2+} entry mechanism in non-excitable cells, being involved in cell proliferation and migration in several types of cancer. However, the expression and biological role of SOCE have not been investigated in clear cell renal cell carcinoma (ccRCC). Here, we demonstrate that Orai1 and STIM1, not Orai3, are crucial components of SOCE in the progression of ccRCC. The expression levels of Orai1 in tumor tissues were significantly higher than those in the adjacent normal parenchymal tissues. In addition, native SOCE was blunted by inhibiting SOCE or by silencing Orai1 and STIM1. Pharmacological blockade or knockdown of Orai1 or STIM1 also significantly inhibited RCC cell migration and proliferative capability. Taken together, Orai1 is highly expressed in ccRCC tissues illuminating that Orai1-mediated SOCE may play an important role in ccRCC development. Indeed, Orai1 and STIM1 constitute a native SOCE pathway in ccRCC by promoting cell proliferation and migration.

  20. Renal effects of nabumetone, a COX-2 antagonist: impairment of function in isolated perfused rat kidneys contrasts with preserved renal function in vivo. (United States)

    Reichman, J; Cohen, S; Goldfarb, M; Shina, A; Rosen, S; Brezis, M; Karmeli, F; Heyman, S N


    The constitutive cyclooxygenase (COX)-1 enzyme has been considered the physiologically important isoform for prostaglandin synthesis in the normal kidney. It has, therefore, been suggested that selective inhibitors of the 'inducible' isoform (COX-2) may be free from renal adverse effects. We studied the renal effects of the predominantly COX-2 antagonist nabumetone in isolated perfused kidneys. As compared with controls, kidneys removed after in vivo administration of oral nabumetone (15 mg/kg) disclosed altered renal function with reduced glomerular filtration rate, filtration fraction, and urine volume and enhanced hypoxic outer medullary tubular damage. By contrast, renal function and morphology were not affected in vivo by nabumetone or its active metabolite 6-methoxy-2-naphthylacetic acid. The latter agent (10-20 mg/kg i.v.) did not significantly alter renal microcirculation, as opposed to a selective substantial reduction in medullary blood flow noted with the nonselective COX inhibitor indomethacin (5 mg/kg i.v.). In a rat model of acute renal failure, induced by concomitant administration of radiocontrast, nitric oxide synthase, and COX inhibitors, the decline in kidney function and the extent of hypoxic medullary damage with oral nabumetone (80 mg/kg) were comparable to a control group, and significantly less than those induced by indomethacin. In rats subjected to daily oral nabumetone for 3 consecutive weeks, renal function and morphology were preserved as well. Both nabumetone and 6-methoxy-2-naphthylacetic acid reduced renal parenchymal prostaglandin E2 to the same extent as indomethacin. It is concluded that while nabumetone adversely affects renal function and may intensify hypoxic medullary damage ex vivo, rat kidneys are not affected by this agent in vivo, both in acute and chronic studies. COX selectivity may not explain the renal safety of nabumetone.

  1. Renal actinomycosis with concomitant renal vein thrombosis. (United States)

    Chang, Dong-Suk; Jang, Won Ik; Jung, Ji Yoon; Chung, Sarah; Choi, Dae Eun; Na, Ki-Ryang; Lee, Kang Wook; Shin, Yong-Tai


    Renal actinomycosis is a rare infection caused by fungi of the genus Actinomyces. A 74-year-old male was admitted to our hospital because of gross hematuria with urinary symptoms and intermittent chills. Computed tomography of the abdomen showed thrombosis in the left renal vein and diffuse, heterogeneous enlargement of the left kidney. After nephrectomy, sulfur granules with chronic suppurative inflammation were seen microscopically, and the histopathological diagnosis was renal actinomycosis. Our case is the first report of renal actinomycosis with renal vein thrombosis.

  2. Use of C-Arm Cone Beam CT During Hepatic Radioembolization: Protocol Optimization for Extrahepatic Shunting and Parenchymal Enhancement

    Energy Technology Data Exchange (ETDEWEB)

    Hoven, Andor F. van den, E-mail:; Prince, Jip F.; Keizer, Bart de; Vonken, Evert-Jan P. A.; Bruijnen, Rutger C. G.; Verkooijen, Helena M.; Lam, Marnix G. E. H.; Bosch, Maurice A. A. J. van den [University Medical Center Utrecht, Department of Radiology and Nuclear Medicine (Netherlands)


    PurposeTo optimize a C-arm computed tomography (CT) protocol for radioembolization (RE), specifically for extrahepatic shunting and parenchymal enhancement.Materials and MethodsA prospective development study was performed per IDEAL recommendations. A literature-based protocol was applied in patients with unresectable and chemorefractory liver malignancies undergoing an angiography before radioembolization. Contrast and scan settings were adjusted stepwise and repeatedly reviewed in a consensus meeting. Afterwards, two independent raters analyzed all scans. A third rater evaluated the SPECT/CT scans as a reference standard for extrahepatic shunting and lack of target segment perfusion.ResultsFifty scans were obtained in 29 procedures. The first protocol, using a 6 s delay and 10 s scan, showed insufficient parenchymal enhancement. In the second protocol, the delay was determined by timing parenchymal enhancement on DSA power injection (median 8 s, range 4–10 s): enhancement improved, but breathing artifacts increased (from 0 to 27 %). Since the third protocol with a 5 s scan decremented subjective image quality, the second protocol was deemed optimal. Median CNR (range) was 1.7 (0.6–3.2), 2.2 (−1.4–4.0), and 2.1 (−0.3–3.0) for protocol 1, 2, and 3 (p = 0.80). Delineation of perfused segments was possible in 57, 73, and 44 % of scans (p = 0.13). In all C-arm CTs combined, the negative predictive value was 95 % for extrahepatic shunting and 83 % for lack of target segment perfusion.ConclusionAn optimized C-arm CT protocol was developed that can be used to detect extrahepatic shunts and non-perfusion of target segments during RE.


    Directory of Open Access Journals (Sweden)

    Soraia Geraldo Rozza Lopes


    Full Text Available El objetivo del estudio fue comprender el significado de espera del trasplante renal para las mujeres en hemodiálisis. Se trata de un estudio cualitativo-interpretativo, realizado con 12 mujeres en hemodiálisis en Florianópolis. Los datos fueron recolectados a través de entrevistas en profundidad en el domicilio. Fue utilizado el software Etnografh 6.0 para la pre-codificación y posterior al análisis interpretativo emergieron dos categorías: “las sombras del momento actual”, que mostró que las dificultades iniciales de la enfermedad están presentes, pero las mujeres pueden hacer frente mejor a la enfermedad y el tratamiento. La segunda categoría, “la luz del trasplante renal”, muestra la esperanza impulsada por la entrada en la lista de espera para un trasplante.

  4. Renal failure

    Institute of Scientific and Technical Information of China (English)


    930564 Dwell times affect the local host de-fence mechanism of peritoneal dialysis patients.WANG Tao(汪涛),et al.Renal Instit,SunYatsen Med Univ,Guangzhou,510080.Chin JNephrol 1993;9(2):75—77.The effect of different intraperitoneal awelltimes on the local host defence in 6 peritonealdialysis patients was studied.A significant de-crease in the number of peritoneal cells,IgG con-centration and the phagoeytosis and bactericidalactivity of macrophages was determined when thedwell time decreased from 12 to 4 hs or form 4 to0.5hs,but the peroxidase activity in macrophagesincreased significantly.All variables,except theperoxidase activity in macrophages,showed nosignificant difference between patients of high or

  5. Traumatismo renal


    Rocha, Sofia Rosa Moura Gomes da


    Introdução: A realização deste trabalho visa a elaboração de uma revisão sistematizada subordinada à temática da traumatologia renal. Objectivos: Os principais objectivos deste trabalho são: apurar a etiologia, definir a classificação, analisar o diagnóstico e expôr o tratamento e as complicações. Desenvolvimento: Os traumatismos são a principal causa de morte antes dos 40 anos. O rim é o órgão do aparelho génito-urinário mais frequentemente atingido. Os traumatismos renais são mais fre...


    Directory of Open Access Journals (Sweden)

    Greloni G


    Full Text Available Acute renal failure is a frequent entity in the elderly. This is due on one hand to the structural and physiological changes of the aged kidney, and on the other hand to the exposure of this population to polypharmacy and their reduced capability to metabolize drugs. In the present report we present a case of a seventy year-old woman who developed acute renal failure secondary to severe dehydration with a clinical and laboratory pattern of intermediate syndrome: laboratory results compatible with parenchymal renal insufficiency (elevated urinary sodium, plasma urea and creatinine, but with a positive response to hydration. The main characteristics of the aged kidney that predispose to the development of an intermediate syndrome are: the vascular dysautonomy and reduced capability of sodium and water reabsorption. The intermediate syndrome is a typical pattern of pre-renal insufficiency in the elderly. RESUMEN: La insuficiencia renal aguda es frecuente en el anciano. Esto se debe por un lado a los cambios estructurales y funcionales propios del riñón senil, y por otro a la gran exposición que esta población tiene a la polifarmacia, y su reducida capacidad para metabolizar los medicamentos. En este reporte presentamos el caso de una mujer de 70 años que desarrolló una insuficiencia renal aguda secundaria a severa deshidratación, mostrando un patrón clínico y de laboratorio propio de un sindrome intermedio: laboratorios compatibles con una insuficiencia renal parenquimatosa (sodio urinario, uremia y creatininemia elevadas, pero con una respuesta favorable a la hidratación. Las principales características del riñón senil que predisponen al desarrollo del sindrome intermedio: son la disautonomía vascular y la reducida capacidad en la recuperación de sodio y agua El sindrome intermedio es un patrón típico de insuficiencia prerrenal en el anciano.

  7. Renal secondary hyperparathyroidism in dogs. (United States)

    Stillion, Jenefer R; Ritt, Michelle G


    The parathyroid glands secrete parathyroid hormone (PTH), which is important for maintaining calcium homeostasis. Parathyroid gland hyperplasia and subsequent hyperparathyroidism can occur secondary to chronic renal failure in dogs, resulting in significant alterations in calcium metabolism. Renal secondary hyperparathyroidism is a complex, multifactorial syndrome that involves changes in circulating levels of calcium, PTH, phosphorus, and 1,25-dihydroxycholecalciferol (calcitriol). An increased PTH level can have deleterious effects, including soft tissue mineralization, fibrous osteodystrophy, bone marrow suppression, urolithiasis, and neuropathy. Dietary phosphorus restriction, intestinal phosphate binders, and calcitriol supplementation may slow the progression of renal disease and decrease PTH concentrations in animals with secondary hyperparathyroidism; however, the prognosis for these animals is guarded to poor.

  8. [Acetaminophen (paracetamol) causing renal failure: report on 3 pediatric cases]. (United States)

    Le Vaillant, J; Pellerin, L; Brouard, J; Eckart, P


    Renal failure secondary to acetaminophen poisoning is rare and occurs in approximately 1-2 % of patients with acetaminophen overdose. The pathophysiology is still being debated, and renal acetaminophen toxicity consists of acute tubular necrosis, without complication if treated promptly. Renal involvement can sometimes occur without prior liver disease, and early renal manifestations usually occur between the 2nd and 7th day after the acute acetaminophen poisoning. While therapy is exclusively symptomatic, sometimes serious metabolic complications can be observed. The monitoring of renal function should therefore be considered as an integral part of the management of children with acute, severe acetaminophen intoxication. We report 3 cases of adolescents who presented with acute renal failure as a result of voluntary drug intoxication with acetaminophen. One of these 3 girls developed severe renal injury without elevated hepatic transaminases. None of the 3 girls' renal function required hemodialysis, but one of the 3 patients had metabolic complications after her acetaminophen poisoning.

  9. Lupus nephritis and renal disease in pregnancy. (United States)

    Germain, S; Nelson-Piercy, C


    Management of pregnant women with renal disease involves awareness of, and allowance for, physiological changes including decreased serum creatinine and increased proteinuria. For women with systemic lupus erythematosus (SLE), pregnancy increases likelihood of flare. These can occur at any stage, and are more difficult to diagnose, as symptoms overlap those of normal pregnancy. Renal involvement is no more common in pregnancy. Worsening proteinuria may be lupus flare but differential includes pre-eclampsia. In women with chronic renal disease, pregnancy may accelerate decline in renal function and worsen hypertension and proteinuria, with increased risk of maternal (eg, pre-eclampsia) and fetal (eg, IUGR, IUD) complications, strongly correlating with degree of renal impairment peri-conception. Pregnancy success rate varies from 20% to 95% depending on base-line creatinine. Best outcome is obtained if disease was quiescent for >6 months pre-conception. Women on dialysis or with renal transplants can achieve successful pregnancy but have higher maternal and fetal complication rates. Acute on chronic renal failure can develop secondary to complications such as HELLP and AFLP. Management needs to be by a multidisciplinary team involving physicians and obstetricians, ideally beginning with pre-pregnancy counselling. Treatment of flares includes corticosteroids, hydroxychloroquine, azothioprine, NSAIDs and MME Blood pressure is controlled with methyldopa, nifedipine or hydralazine.

  10. [Renal toxicity of antiviral drugs]. (United States)

    Frasca', Giovanni M; Balestra, Emilio; Tavio, Marcello; Morroni, Manrico; Manarini, Gloria; Brigante, Fabiana


    Highly effective and powerful antiviral drugs have been introduced into clinical practice in recent years which are associated with an increased incidence of nephrotoxicity. The need of combining several drugs, the fragility of the patients treated, and the high susceptibility of the kidney are all factors contributing to renal injury. Many pathogenetic mechanisms are involved in the nephrotoxicity of antiviral drugs, including drug interaction with transport proteins in the tubular cell; direct cytotoxicity due to a high intracellular drug concentration; mitochondrial injury; and intrarenal obstruction or stone formation due to the low solubility of drugs at a normal urinary pH. As a result, various clinical pictures may be observed in patients treated with antiviral drugs, ranging from tubular dysfunction (Fanconi syndrome, renal tubular acidosis, nephrogenic diabetes insipidus) to acute renal failure (induced by tubular necrosis or crystal nephropathy) and kidney stones. Careful attention should be paid to prevent renal toxicity by evaluating the glomerular filtration rate before therapy and adjusting the drug dosage accordingly, avoiding the combination with other nephrotoxic drugs, and monitoring renal parameters on a regular basis while treating patients.

  11. Renal histology and pregnancy performance in systemic lupus erythematosus. (United States)

    Devoe, L D; Loy, G L; Spargo, B H


    Previous reports indicate that maternal and fetal outcome in pregnancies complicated by systemic lupus erythematosus (SLE) may be strongly influenced by the presence of renal disease. As the relationship between renal histology and clinical function in SLE is not consistent, prospective data on the outcomes of such pregnancies would aid patient counselling. Fifteen women with SLE had 18 pregnancies subsequent to renal biopsies, performed from 3 months to 8 years prior to conception. Their renal function was evaluated before, during and after pregnancy. Fourteen of 15 patients had evidence of renal involvement, based on by light and electron microscopic sections: 7 had mesangial involvement (WHO Class II); 5 had active focal or diffuse glomerulonephritis (Classes III and IV); two had membranous involvement (Class V); 1, no evident disease. Perinatal outcome was similar whether lesions were milder (8 continuing pregnancies, 4 term deliveries) or more severe (6 continuing pregnancies, 3 term deliveries). Clinical renal function was normal in all but 3 cases at the beginning of pregnancy; 2 additional patients experienced moderate deteriorations in renal function during pregnancy but recovered normal function in the puerperium. Fetal outcome was abnormal (3 premature deliveries, 1 neonatal death, 1 spontaneous abortion) in all cases where renal function was decreased, while 10 of 13 pregnancies in patients with normal renal function ended in term deliveries. The data suggest that currently preconceptual renal histology provides a less accurate basis for perinatal counselling than does the assessment of clinical renal function.

  12. A re-appraisal of volume status and renal function impairment in chronic heart failure: combined effects of pre-renal failure and venous congestion on renal function. (United States)

    Sinkeler, Steef J; Damman, Kevin; van Veldhuisen, Dirk J; Hillege, Hans; Navis, Gerjan


    The association between cardiac failure and renal function impairment has gained wide recognition over the last decade. Both structural damage in the form of systemic atherosclerosis and (patho) physiological hemodynamic changes may explain this association. As regards hemodynamic factors, renal impairment in chronic heart failure is traditionally assumed to be mainly due to a decrease in cardiac output and a subsequent decrease in renal perfusion. This will lead to a decrease in glomerular filtration rate and a compensatory increase in tubular sodium retention. The latter is a physiological renal response aimed at retaining fluids in order to increase cardiac filling pressure and thus renal perfusion. In heart failure, however, larger increases in cardiac filling pressure are needed to restore renal perfusion and thus more volume retention. In this concept, in chronic heart failure, an equilibrium exists where a certain degree of congestion is the price to be paid to maintain adequate renal perfusion and function. Recently, this hypothesis was challenged by new studies, wherein it was found that the association between right-sided cardiac filling pressures and renal function is bimodal, with worse renal function at the highest filling pressures, reflecting a severely congested state. Renal hemodynamic studies suggest that congestion negatively affects renal function in particular in patients in whom renal perfusion is also compromised. Thus, an interplay between cardiac forward failure and backward failure is involved in the renal function impairment in the congestive state, presumably along with other factors. Only few data are available on the impact of intervention in volume status on the cardio-renal interaction. Sparse data in cardiac patients as well as evidence from cohorts with primary renal disease suggest that specific targeting of volume overload may be beneficial for long-term outcome, in spite of a certain further decrease in renal function, at least

  13. In situ characterization of intrahepatic non-parenchymal cells in PSC reveals phenotypic patterns associated with disease severity. (United States)

    Berglin, Lena; Bergquist, Annika; Johansson, Helene; Glaumann, Hans; Jorns, Carl; Lunemann, Sebastian; Wedemeyer, Heiner; Ellis, Ewa C; Björkström, Niklas K


    Liver-infiltrating T cells have been implicated in the pathogenesis of primary sclerosing cholangitis (PSC), however little information is available about changes in other cellular compartments in the liver during PSC. This study aimed to characterize non-parenchymal intrahepatic cells in PSC livers and to find associations between phenotypes and disease severity. Using immunohistochemistry, followed by automated image analysis and quantification and a principal component analysis, we have studied non-parenchymal intrahepatic cells in PSC-patient livers (n = 17) and controls (n = 17). We observed a significant increase of T cells in the PSC patients, localized to the fibrotic areas. MAIT cells, normally present at high numbers in the liver, were not increased to the same extent. PSC patients had lower expression of MHC class I than controls. However, the levels of NKp46+ NK cells were similar between patients and controls, nevertheless, NKp46 was identified as a phenotypic marker that distinguished PSC patients with mild from those with severe fibrosis. Beyond that, a group of PSC patients had lost expression of Caldesmon and this was associated with more extensive bile duct proliferation and higher numbers of T cells. Our data reveals phenotypic patterns in PSC patients associated with disease severity.

  14. In situ characterization of intrahepatic non-parenchymal cells in PSC reveals phenotypic patterns associated with disease severity.

    Directory of Open Access Journals (Sweden)

    Lena Berglin

    Full Text Available Liver-infiltrating T cells have been implicated in the pathogenesis of primary sclerosing cholangitis (PSC, however little information is available about changes in other cellular compartments in the liver during PSC. This study aimed to characterize non-parenchymal intrahepatic cells in PSC livers and to find associations between phenotypes and disease severity. Using immunohistochemistry, followed by automated image analysis and quantification and a principal component analysis, we have studied non-parenchymal intrahepatic cells in PSC-patient livers (n = 17 and controls (n = 17. We observed a significant increase of T cells in the PSC patients, localized to the fibrotic areas. MAIT cells, normally present at high numbers in the liver, were not increased to the same extent. PSC patients had lower expression of MHC class I than controls. However, the levels of NKp46+ NK cells were similar between patients and controls, nevertheless, NKp46 was identified as a phenotypic marker that distinguished PSC patients with mild from those with severe fibrosis. Beyond that, a group of PSC patients had lost expression of Caldesmon and this was associated with more extensive bile duct proliferation and higher numbers of T cells. Our data reveals phenotypic patterns in PSC patients associated with disease severity.

  15. Multiple organ parenchymal cell apoptosis and its induction early after ischemia-reperfusion in rats and mice

    Institute of Scientific and Technical Information of China (English)


    AIM: To determine the evolutionary pattern of parenchymal cell apoptosis in multiple organs early after intestinal ischemia-reperfusion(I/R) and its induction mechanisms and the role of apoptosis in triggering SIRS/MODS. METHODS: An I/R model was reproduced by clipping and releasing the superior mesenteric artery in rats and mice. Flow cytometry, electron microscope, DNA agarose gel electrophoresis, TUNEL method, fluorescent and Gomori's silver-HE staining were used to detect apoptosis. Distribution features of apoptotic parenchymal cells in multiple organs were observed. Immunohistochemical staining of HSP 70 and Bcl-2 were performd to study the induction mechanisms of apoptosis.RESULTS and CONCLUSION: 1. Damage of the liver, lung, gut and kidney was appeared in early phase of I/R. The percentages of apoptosis in parenchyma organs increased progressively. The percentages of cell necrosis increased with the prolonged I/R duration. 2. Percentages of apoptosis were much higher near the central veins of liver lobules, in the outer medulla of the kidney, and the antimescenteric border of intestinal mucosal epithelium because of ischemia. 3. The expression of HSP 70 increased and Bcl-2 reduced in the areas mentioned above because of hypoperfusion. 4. Apoptosis of I/R hepatocytes, splenocytes and thymocytes was obviously increased after Kupffer cell blockage with GdCl3, showing the functional state of Kupffer cells may play an important role in SIRS/MODS.

  16. Mechanical Recanalization following i.v. Thrombolysis: A Retrospective Analysis regarding Secondary Hemorrhagic Infarctions and Parenchymal Hematomas

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    J. Höltje


    Full Text Available Introduction. In acute stroke by occlusion of the proximal medial cerebral artery (MCA or the distal internal carotid artery, intravenous thrombolysis is an established treatment. Another option is mechanical recanalization. It remains unclear if the combination of both methods poses an additional bleeding risk. The aim of this retrospective analysis is to determine the proportion of hemorrhagic infarctions and parenchymal hematomas. Methods. Inclusion criteria were an occlusion of the carotid T or proximal MCA treated with full dose thrombolysis and mechanical recanalization. 31 patients were selected. Devices used were Trevo, Penumbra Aspiration system, Penumbra 3D Retriever, and Revive. The initial control by computed tomography was carried out with a mean delay to intervention of 10.9 hours (SD: 8.5 hours. Results. A slight hemorrhagic infarction (HI1 was observed in 2/31 patients, and a more severe HI2 occurred in two cases. A smaller parenchymal hematoma (PH1 was not seen and a space-occupying PH2 was seen in 2/31 cases. There was no significant difference in the probability of intracranial bleeding after successful (thrombolysis in cerebral infarctions 2b and 3 or unsuccessful recanalization. Conclusion. The proportion of intracranial bleeding using mechanical recanalization following intravenous thrombolysis appears comparable with reports using thrombolysis alone.

  17. Mechanical Recanalization following i.v. Thrombolysis: A Retrospective Analysis regarding Secondary Hemorrhagic Infarctions and Parenchymal Hematomas (United States)

    Höltje, J.; Bonk, F.; Anstadt, A.; Terborg, C.; Pohlmann, C.; Urban, P. P.; Brüning, R.


    Introduction. In acute stroke by occlusion of the proximal medial cerebral artery (MCA) or the distal internal carotid artery, intravenous thrombolysis is an established treatment. Another option is mechanical recanalization. It remains unclear if the combination of both methods poses an additional bleeding risk. The aim of this retrospective analysis is to determine the proportion of hemorrhagic infarctions and parenchymal hematomas. Methods. Inclusion criteria were an occlusion of the carotid T or proximal MCA treated with full dose thrombolysis and mechanical recanalization. 31 patients were selected. Devices used were Trevo, Penumbra Aspiration system, Penumbra 3D Retriever, and Revive. The initial control by computed tomography was carried out with a mean delay to intervention of 10.9 hours (SD: 8.5 hours). Results. A slight hemorrhagic infarction (HI1) was observed in 2/31 patients, and a more severe HI2 occurred in two cases. A smaller parenchymal hematoma (PH1) was not seen and a space-occupying PH2 was seen in 2/31 cases. There was no significant difference in the probability of intracranial bleeding after successful (thrombolysis in cerebral infarctions 2b and 3) or unsuccessful recanalization. Conclusion. The proportion of intracranial bleeding using mechanical recanalization following intravenous thrombolysis appears comparable with reports using thrombolysis alone. PMID:26640710

  18. Convolutional neural network approach for enhanced capture of breast parenchymal complexity patterns associated with breast cancer risk (United States)

    Oustimov, Andrew; Gastounioti, Aimilia; Hsieh, Meng-Kang; Pantalone, Lauren; Conant, Emily F.; Kontos, Despina


    We assess the feasibility of a parenchymal texture feature fusion approach, utilizing a convolutional neural network (ConvNet) architecture, to benefit breast cancer risk assessment. Hypothesizing that by capturing sparse, subtle interactions between localized motifs present in two-dimensional texture feature maps derived from mammographic images, a multitude of texture feature descriptors can be optimally reduced to five meta-features capable of serving as a basis on which a linear classifier, such as logistic regression, can efficiently assess breast cancer risk. We combine this methodology with our previously validated lattice-based strategy for parenchymal texture analysis and we evaluate the feasibility of this approach in a case-control study with 424 digital mammograms. In a randomized split-sample setting, we optimize our framework in training/validation sets (N=300) and evaluate its descriminatory performance in an independent test set (N=124). The discriminatory capacity is assessed in terms of the the area under the curve (AUC) of the receiver operator characteristic (ROC). The resulting meta-features exhibited strong classification capability in the test dataset (AUC = 0.90), outperforming conventional, non-fused, texture analysis which previously resulted in an AUC=0.85 on the same case-control dataset. Our results suggest that informative interactions between localized motifs exist and can be extracted and summarized via a fairly simple ConvNet architecture.

  19. Renal Biopsy in Type 2 Diabetic Patients

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    Eugenia Espinel


    Full Text Available The majority of diabetic patients with renal involvement are not biopsied. Studies evaluating histological findings in renal biopsies performed in diabetic patients have shown that approximately one third of the cases will show pure diabetic nephropathy, one third a non-diabetic condition and another third will show diabetic nephropathy with a superimposed disease. Early diagnosis of treatable non-diabetic diseases in diabetic patients is important to ameliorate renal prognosis. The publication of the International Consensus Document for the classification of type 1 and type 2 diabetes has provided common criteria for the classification of diabetic nephropathy and its utility to stratify risk for renal failure has already been demonstrated in different retrospective studies. The availability of new drugs with the potential to modify the natural history of diabetic nephropathy has raised the question whether renal biopsies may allow a better design of clinical trials aimed to delay the progression of chronic kidney disease in diabetic patients.

  20. Pulmonary involvement and allergic disorders in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Nikolaos; E; Tzanakis; Ioanna; G; Tsiligianni; Nikolaos; M; Siafakas


    Inflammatory bowel disease (IBD) has been associated with either clinical or subclinical airway and parenchymal lung involvement and interstitial lung complications. Several studies have reported that atopy has a high prevalence in IBD patients. Overlapping allergic disorders seem to be present in both the respiratory and gastrointestinal systems. The purpose of this review is to update clinicians on recent available literature and to discuss the need for a highly suspicious approach by clinicians.

  1. Inflammation and innate immunity in renal ischemia/reperfusion injury

    NARCIS (Netherlands)

    Vries, Dorottya Katalin de


    The studies in this thesis describe the systematical search for factors involved in the pathophysiology of human renal I/R injury. Many of the processes assumed to be involved in renal I/R injury based on animal studies could not be confirmed in our clinical study in humans. However, we found new ev

  2. Renal injury due to hepatic hydatid disease. (United States)

    Altay, Mustafa; Unverdi, Selman; Altay, Fatma Aybala; Ceri, Mevlüt; Akay, Hatice; Ozer, Hüseyin; Kiraç, Halil; Denizli, Nazim; Yilmaz, Bilal; Güvence, Necmettin; Duranay, Murat


    Many studies on renal hydatid disease have been reported in the literature, and the disease process appears to be well defined. However, renal injury without direct renal invasion remains poorly understood. The present study aims to define the frequency and the property of the renal involvement in hydatid disease. Eighty patients older than 18 years and diagnosed with liver echinococcosis were included in the study. The echinococcosis was diagnosed by the haemagglutination test and abdominal ultrasonography. Twenty-four-hour protein excretion was measured for patients who had elevated serum creatinine levels or whose urinalyses were positive for haematuria or proteinuria. Subsequently, renal biopsy was performed, and the specimens were examined by light microscopy and immunofluorescence staining. Haematuria was detected in 11 patients (13.75%), and proteinuria was detected in nine patients (11.25%). Percutaneous renal biopsy was applied to nine patients who gave signed consents to undergo the test. We detected four immunoglobulin A nephritis (together with tubulointerstitial nephritis in one patient), one membranoproliferative glomerulonephritis, one immunoglobulin M nephritis together with mesangiocapillary glomerulonephritis, one membranous glomerulonephritis, one amyloidosis and one tubulointerstitial nephritis. Renal hydatid cyst was detected only in four patients (5%). Hydatid disease, which affects the kidney, is not rare, and we suggest that urinalysis and, if indicated, renal biopsy should be performed for hepatic hydatid disease diagnosis.

  3. Multidetector computed tomography findings of spontaneous renal allograft ruptures

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    Basaran, C. [Department of Radiology, Baskent University Faculty of Medicine, Ankara (Turkey)], E-mail:; Donmez, F.Y.; Tarhan, N.C.; Coskun, M. [Department of Radiology, Baskent University Faculty of Medicine, Ankara (Turkey); Haberal, M. [Department of General Surgery, Baskent University Faculty of Medicine, Ankara (Turkey)


    Aim: To describe the characteristics of spontaneous renal allograft rupture using multidetector computed tomography (MDCT). Method: Five patients with spontaneous renal allograft rupture, as confirmed by pathologic examination, were referred to our institution between 1985 and 2008. The clinical records and preoperative MDCT findings of the patients were studied retrospectively. Results: Clinical and/or histological findings were consistent with acute rejection in all cases. Using MDCT, disruption of the capsular integrity and parenchymal rupture was seen in four patients. Four of the five patients showed decreased enhancement and swollen grafts. Perirenal (n = 4), subcapsular (n = 1), and intraparenchymal (n = 1) haematomas were also seen. In the patient with an intraparenchymal haematoma there was no disruption of capsular integrity, but capsular irregularities were seen near the haematoma. Conclusion: MDCT is a useful investigative tool for the evaluation of suspected spontaneous renal allograft rupture. As well as a swollen graft, disruption of the capsule, parenchyma, and/or haematoma should prompt the radiologist to consider this diagnosis.

  4. ANCA-Associated Glomerulonephritis: Risk Factors for Renal Relapse (United States)

    Göçeroğlu, Arda; Berden, Annelies E.; Fiocco, Marta; Floßmann, Oliver; Westman, Kerstin W.; Ferrario, Franco; Gaskin, Gill; Pusey, Charles D.; Hagen, E. Christiaan; Noël, Laure-Hélène; Rasmussen, Niels; Waldherr, Rüdiger; Walsh, Michael; Bruijn, Jan A.; Jayne, David R. W.; Bajema, Ingeborg M.


    Relapse in ANCA-associated vasculitis (AAV) has been studied previously, but there are few studies on renal relapse in particular. Identifying patients at high risk of renal relapse may aid in optimizing clinical management. We investigated which clinical and histological parameters are risk factors for renal relapse in ANCA-associated glomerulonephritis (AAGN). Patients (n = 174) were newly diagnosed and had mild–moderate or severe renal involvement. Data were derived from two trials of the European Vasculitis Society: MEPEX and CYCAZAREM. The Cox regression model was used to identify parameters increasing the instantaneous risk (= rate) of renal relapse (useful for instant clinical decisions). For identifying predictors of renal relapse during follow-up, we used Fine & Gray’s regression model. Competing events were end-stage renal failure and death. The cumulative incidence of renal relapse at 5 years was 9.5% (95% CI: 4.8–14.3%). In the Cox model, sclerotic class AAGN increased the instantaneous risk of renal relapse. In Fine & Gray’s model, the absence of interstitial infiltrates at diagnosis was predictive for renal relapse. In this study we used two different models to identify possible relationships between clinical and histopathological parameters at time of diagnosis of AAV with the risk of experiencing renal relapse. Sclerotic class AAGN increased the instantaneous risk of renal relapse. This association is most likely due to the high proportion of sclerosed glomeruli reducing the compensatory capacity. The absence of interstitial infiltrates increased the risk of renal relapse which is a warning sign that patients with a relatively benign onset of disease may also be prone to renal relapse. Renal relapses occurring in patients with sclerotic class AAGN and renal relapses occurring in patients without interstitial infiltrates were mutually exclusive, which may indicate that they are essentially different. PMID:27973575

  5. CXCL16 regulates renal injury and fibrosis in experimental renal artery stenosis. (United States)

    Ma, Zhiheng; Jin, Xiaogao; He, Liqun; Wang, Yanlin


    Recent studies have shown that inflammation plays a critical role in the initiation and progression of hypertensive kidney disease, including renal artery stenosis. However, the signaling mechanisms underlying the induction of inflammation are poorly understood. We found that CXCL16 was induced in the kidney in a murine model of renal artery stenosis. To determine whether CXCL16 is involved in renal injury and fibrosis, wild-type and CXCL16 knockout mice were subjected to renal artery stenosis induced by placing a cuff on the left renal artery. Wild-type and CXCL16 knockout mice had comparable blood pressure at baseline. Renal artery stenosis caused an increase in blood pressure that was similar between wild-type and CXCL16 knockout mice. CXCL16 knockout mice were protected from RAS-induced renal injury and fibrosis. CXCL16 deficiency suppressed bone marrow-derived fibroblast accumulation and myofibroblast formation in the stenotic kidneys, which was associated with less expression of extracellular matrix proteins. Furthermore, CXCL16 deficiency inhibited infiltration of F4/80(+) macrophages and CD3(+) T cells in the stenotic kidneys compared with those of wild-type mice. Taken together, our results indicate that CXCL16 plays a pivotal role in the pathogenesis of renal artery stenosis-induced renal injury and fibrosis through regulation of bone marrow-derived fibroblast accumulation and macrophage and T-cell infiltration.

  6. Cardiac metastasis from a renal cell carcinoma


    AlGhamdi, Abdulaziz; Tam, James


    A 59-year-old man developed an episode of syncope while he was driving. This resulted in a motor vehicle accident, and the patient sustained an open fracture of the left femur. Biopsy of the left femur fracture showed a metastastic renal cell carcinoma, and echocardiography revealed a right ventricular mass without contiguous vena caval or right atrial involvement. This is one of the few reported cases of renal cell carcinoma associated with syncope as an initial symptom.

  7. Kidney (Renal) Failure (United States)

    ... How is kidney failure treated? What is kidney (renal) failure? The kidneys are designed to maintain proper fluid ... marrow and strengthen the bones. The term kidney (renal) failure describes a situation in which the kidneys have ...

  8. Renal arteries (image) (United States)

    A renal angiogram is a test used to examine the blood vessels of the kidneys. The test is performed ... main vessel of the pelvis, up to the renal artery that leads into the kidney. Contrast medium ...

  9. Renal injury in female dogs with pyometra

    Directory of Open Access Journals (Sweden)

    Mariana da Silva Figueiredo

    Full Text Available ABSTRACT: Pyometra is a common disease in intact female dogs and can cause glomerulopathy and tubular injury. This study aimed to evaluate kidney injury in female dogs with pyometra, as well as progression of the injury during treatment and the markers of this condition. This study analyzed 20 intact female dogs with both clinical and sonographic diagnosis of pyometra. Dogs were treated with intravenous fluids and antibiotics, and an ovariohysterectomy was performed. The following parameters were assessed at eight separate time points: blood pressure; serum creatinine, phosphorus, and urea levels; urinalysis and urinary biochemical parameters [urinary gamma-glutamyl transferase (uGGT and urinary protein-to-creatinine ratio (UPCR]; glomerular filtration rate (GFR; and urine output. All dogs showed some degree of kidney injury at the time of pyometra diagnosis. This was transient in most animals, resolving with treatment of the pyometra. Measurement of uGGT and UPCR identified renal parenchymal injury, helping to determine the prognosis of the animals analyzed in the present study.


    Directory of Open Access Journals (Sweden)

    Giulio Geraci


    Full Text Available Systemic lupus erythematosus (SLE is associated with a high prevalence of atherosclero-sis and an enhanced cardiovascular mortality. In adult subjects, several studies have shown the coexistence of SLE and renal artery stenosis, most of them with unilateral in-volvement or with renal dysfunction. We observed a 62-year-old man with SLE and a 10-year history of moderate-to-severe hy-pertension who was admitted to our hospital because of uncontrolled blood pressure val-ues (152/95 mmHg, despite drug therapy. No signs of renal impairment were evident. After an initial physical examination, which presented a periumbilical bruit, a renal ultra-sound was performed with evidence of bilateral renal artery stenosis. An angio-MR study also confirmed the diagnosis and showed a double renal artery on the right side. Many different factors can contribute to the bilateral renal artery stenosis in this patient. Chronic inflammatory state associated to SLE, metabolic alterations with dyslipidemia and steroid therapy may all be involved in the development of the renal atherosclerotic le-sions.

  11. [Nucleotide receptors and renal function]. (United States)

    Jankowski, Maciej


    Kidney plays a key role in homeostasis of human body. It has heterogenic structure and is characterized by complicated vascular beds and numbers of sympathetic nerves endings. Nucleotides receptors are involved in the regulation of blood flow, a fundamental process for renal function. Plasma is filtrated in renal glomerulus and activity of nucleotides receptors located on cells of glomerular filter modifies the physi- cochemical properties of filter and affects the filtration process. Electrolytes, water and low molecular weight molecules are reabsorbed from tubular fluid or secreted into fluid in proximal and distal tubules. Glomerular filtration rate and activity of tubular processes are regulated via nucleotides receptors by glomerulotubularbalance and tubuloglomerular feedback. Nucleotides receptors are involved in systemic regulation of blood pressure and carbohydrate metabolism.

  12. Acute Lymphocytic Leukemia with Bilateral Renal Masses Masquerading as Nephroblastomatosis

    Directory of Open Access Journals (Sweden)

    Poonam Thakore


    Full Text Available Acute lymphoblastic leukemia (ALL is the most common malignancy in the pediatric patient population. However, renal involvement as the primary manifestation of ALL is rare. We report a case of a 4-year-old boy with bilateral renal lesions resembling nephroblastic rests as the first finding of early stage ALL preceding hematological changes and subsequent classic clinical findings by two weeks. These renal hypodensities completely resolved after one week of induction chemotherapy. This case demonstrates that renal involvement can be the only initial presenting finding of leukemia. Children with lesions resembling nephroblastic rests need appropriate surveillance due to the risk of malignant disease.


    Directory of Open Access Journals (Sweden)

    Rodriguez Macías EL


    Full Text Available Cisplatin is one of the major antineoplastic used for treatment of tumors such as testicular, ovarian, cervical, lung, bladder and head, among others. It has been described various types of toxicities induced by cisplatin, but the renal is the main one. This toxicity consist sof an acute reduction in renal plasma flow and a decline in glomerular filtration and installation of a tubular necrosis, with predominant involvement of the distal tubules and accumulation of cellular debris (lumen obstruction. Other mechanisms involved in renal injury are microangiopathy and pro-inflammatory mediators. We conclude that the nephrotoxicity caused by cisplatin can induce renal failure in which tubular structural damage predominates.

  14. Evaluation of a liquid embolization agent (Onyx) for transcatheter embolization for renal vascular lesions

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    Rennert, Janine; Herold, T.; Schreyer, A.G.; Jung, E.M.; Mueller-Wille, R.; Zorger, N. [Inst. fuer Roentgendiagnostik, Klinikum der Univ. Regensburg (Germany); Banas, B.; Feuerbach, S. [Medizinische Klinik, Nephrologie, Univ. Regensburg (Germany); Lenhart, M. [Klinik fuer Diagnostische und Interventionelle Radiologie, Sozialstiftung Bamberg (Germany)


    Purpose: to evaluate the therapeutic outcome after endovascular treatment of renal vascular lesions using the liquid embolization agent, Onyx. Materials and methods: between 2004 and 2008 nine patients with renal vascular lesions were treated with transcatheter arterial embolization using Onyx. The renal vascular lesions consisted of 4 AV-fistulas, a pseudoaneurysm, bleeding from a single subsegmental artery, diffuse parenchymal bleeding after trauma, septic embolizations and multiple aneurysms in endocarditis. All patients underwent selective angiography of the renal artery. A dimethyl sulfoxide (DMSO)-compatible microcatheter was used and Onyx was injected. The technical and clinical success rate, examination time and procedure-related complications were documented. Results: the overall technical and clinical success rate was 100%. One patient had to be treated twice due to recurrent bleeding after an accidental puncture with a drainage catheter. No loss of viable renal tissue occurred in 4 cases. In 4 patients mild to moderate parenchyma loss was noted. In one patient having diffuse renal bleeding, occlusion of the main renal artery was performed. No procedure-related complications were noted. The mean examination time was 16.17 min when treating with Onyx alone and 60 min when using a combination of Onyx and coils. Within an average follow-up period of 21 months, no recurrent renal bleeding or recurrent AV-fistulas occurred. Conclusion: Onyx is an effective embolization agent for the treatment of renal vascular lesions. It allows controlled and quick application with low complication rates and a short examination time as a standalone agent or in combination with coils. (orig.)

  15. [Renal leiomyoma. Case report]. (United States)

    Joual, A; Guessous, H; Rabii, R; Benjelloun, M; Benlemlih, A; Skali, K; el Mrini, M; Benjelloun, S


    The authors report a case of renal leiomyoma observed in a 56-year-old man. This cyst presented in the from of loin pain. Computed tomography revealed a homogeneous renal tumor. Treatment consisted of radical nephrectomy. Histological examination of the specimen showed benign renal leiomyoma.

  16. Renal inflammatory myofibroblastic tumor

    DEFF Research Database (Denmark)

    Heerwagen, S T; Jensen, C; Bagi, P


    Renal inflammatory myofibroblastic tumor (IMT) is a rare soft-tissue tumor of controversial etiology with a potential for local recurrence after incomplete surgical resection. The radiological findings in renal IMT are not well described. We report two cases in adults with a renal mass treated...

  17. Mammographic parenchymal patterns and breast cancer risk in New South Wales North Coast Aboriginal and Torres Strait Islander women. (United States)

    Pape, Ruth; Spuur, Kelly Maree; Currie, Geoffrey; Greene, Lacey


    The objective of the study was to document the distribution of mammographic parenchymal patterns (MPP) of Indigenous Australian women attending BreastScreen New South Wales (NSW) North Coast, to profile breast cancer risk as it relates to breast density and to explore the correlation between MPP, breast size as described by the posterior nipple line (PNL) and age. Ethics was granted from CQUniversity Human Research Ethics Committee, NSW Population Health Services Research Ethics Committee and the Aboriginal Health and Medical Research Council Ethics Committee. A quantitative retrospective analysis reviewed 502 screening mammograms against the Tabár I-V MPP classification system. The PNL was measured in millimetres (mm) and the age of the patient documented. A statistically significant variation in the distribution of MPP (P distribution of MPP was noted in this snapshot of Indigenous women. A larger study of Indigenous Australian women is required for validation.

  18. Multicentre evaluation of multidisciplinary team meeting agreement on diagnosis in diffuse parenchymal lung disease: a case-cohort study

    DEFF Research Database (Denmark)

    Walsh, Simon L F; Wells, Athol U; Desai, Sujal R;


    . This difference is of particular importance, because accurate and consistent diagnoses of IPF are needed if clinical outcomes are to be optimised. Inter-multidisciplinary team agreement for a diagnosis of hypersensitivity pneumonitis is low, highlighting an urgent need for standardised diagnostic guidelines......-multidisciplinary team agreement for the diagnosis of diffuse parenchymal lung disease. METHODS: We did a multicentre evaluation of clinical data of patients who presented to the interstitial lung disease unit of the Royal Brompton and Harefield NHS Foundation Trust (London, UK; host institution) and required...... multidisciplinary team meeting (MDTM) characterisation between March 1, 2010, and Aug 31, 2010. Only patients whose baseline clinical, radiological, and, if biopsy was taken, pathological data were undertaken at the host institution were included. Seven MDTMs, consisting of at least one clinician, radiologist...

  19. A review of scientific topics and literature in abdominal radiology in Germany. Pt. 2. Abdominal parenchymal organs

    Energy Technology Data Exchange (ETDEWEB)

    Grenacher, L. [Diagnostik Muenchen-Diagnostic Imaging Centre (Germany); Juchems, M.S. [Konstanz Hospital (Germany). Diagnostic and Interventional Radiology; Holzapfel, K. [Technische Univ. Muenchen (Germany). Dept. of Radiology; Kinner, S.; Lauenstein, T.C. [University Hospital Essen (Germany). Dept. of Radiology; Wessling, J. [Clemens Hospital Muenchen (Germany). Dept. of Radiology; Schreyer, A.G. [University Hospital Regenburg (Germany). Dept. of Radiology


    The working group for abdominal and gastrointestinal diagnosis is a group of the German Radiological Society (DRG) focusing clinically and scientifically on the diagnosis and treatment of the gastrointestinal tract as well as the parenchymal abdominal organs. In this article we give an up-to-date literature review of scientific radiological topics especially covered by German radiologists. The working group experts cover the most recent relevant studies concerning liver-specific contrast media with an emphasis on a new classification system for liver adenomas. Additionally studies regarding selective internal radiotherapy (SIRT) are reviewed. For the pancreas the most important tumors are described followed by an introduction to the most recently introduced functional imaging techniques. The manuscript concludes with some remarks on recent studies and concerning chronic pancreatitis as well as autoimmune pancreatitis.

  20. Testicular Involvement of Tuberculous Epididymitis : Sonographic Findings

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    Chung, Jae Joon; Kim, Myeong Jin; Yoo, Hyung Sik; Lee, Jong Tae; Lee, Yong Hee [Yonsei University College of Medicine, Seoul (Korea, Republic of); Park, Joong Hwa [Yonsei University Wonju College of Medicine, Wonju (Korea, Republic of); Lee, Yeon Hee [Dankook University Hospital, Cheonan (Korea, Republic of)


    To report the sonographic findings of testicular involvement of tuberculous epididymitis. The sonographic findings of testicular involvement in twelve patients with histologically proven tuberculous epididymitis were retrospectively reviewed. The sonographic findings of testicular lesions are 1) an ill defined hypoechoic lesion (3 cases, 25.0%), 2) a well-demarcated hypoechoic lesion (3 cases, 25.0%),3) multiple and small hypoechoic nodules in the enlarged testis (2 cases, 16.7%), 4) indistinct margin between the testis and epididymis (2 cases, 16.7%) and 5) a diffusely enlarged testis with hypoechogenicity (2 cases, 16.7%).Nine patients had ipsilateral epididymitis, and 3 patients had bilateral epididymitis. Pus discharge through the draining sinus tract was noted in 4 cases (33.3%), and hydrocele in 8 cases (66.7%). No parenchymal calcification was seen in the involved testis. Sonographic findings of testicular involvement in tuberculous epididymitis were various

  1. Objective Assessment of the Severity of Patients Suffering from Fall from Height with Combined Injuries of the Abdominal Parenchymal Organs

    Directory of Open Access Journals (Sweden)

    Abdukhakim Khadjibaev


    Full Text Available In recent years, fall from a height (FFH has been a relatively frequent cause of injury and death in the urban environment. The purpose of this study was to optimize the risk stratification of FFH victims with combined injuries of the abdominal organs by using Injury Severity Score (ISS scale. The study included 111 patients (aged between 15 and 80 years injured by FFH. All the falls were accidental and occurred mainly among males (82%. The height of the fall ranged from 2 to 5 meters. Combined injuries were found in 98 patients and isolated injuries in 13 patients. The combination of the 6 injured body regions was identified in 5 patients, 5 regions in 17, 4 in 35, 3 in 23, and 2 in 18. The abdomen trauma was most commonly associated with the following injured body regions: head and neck-chest-extremities and pelvis (13.3%, head and neck-chest-extremities (12.2%, and head and neck-chest-pelvis (9.2%. Among the combined injuries of the abdomen, ruptures of parenchymal organs (liver, spleen and kidneys were predominant. To assess the severity of the injury, the ISS scale was applied. The injuries of abdominal parenchymal organs were evaluated according to the AAST (American Association for the Surgery of Trauma classification. Comparative analysis of the assessment of the severity of a patient's condition according to the traditional scale and the ISS scale showed that the ISS scale promotes the active and timely detection of the extremely severe and terminal condition in patients with injuries due to FFH with combined trauma of the abdominal organs. Objective assessment of the severity of trauma and the dominant injury region allows determining the optimal treatment algorithm and predicting the outcome of the injury.

  2. Fine-needle percutaneous transhepatic parenchymal portal venography by using carbon dioxide: a pilot study in pigs

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Fei; Hernandez, Javier; Crisostomo, Veronica; Pineda, Luis-Fernando; Lima, Juan Rafael; Uson, Jesus [Minimally Invasive Surgery Centre, Campus Universitario, Avenida de la Universidad, s/n, 10071 Caceres (Spain); Maynar, Manuel [Department of Radiology, Faculty of Medicine, Las Palmas University, 35016 Las Palmas de Gran Canaria (Spain)


    Our purpose was to evaluate the feasibility and safety of carbon dioxide (CO{sub 2}) in fine-needle percutaneous transhepatic parenchymal portal venography and its potential clinical applications. Three Belgian landrace pigs received fine-needle percutaneous transhepatic parenchymal portal venography by using CO{sub 2} as a contrast agent. Under fluoroscopic and B-mode ultrasonic guidance, right or left lobe of liver was punctured with a 22-G Chiba needle, through which CO{sub 2} was injected with a dedicated CO{sub 2} injector at injection rate of 20 ml/s for 20 ml, 40 ml/s for 40 ml, 40 ml/s for 60 ml, and 40 ml/s for 80 ml, respectively. The portal venograms were obtained by use of digital subtraction angiography (DSA) system with animal in supine position. In one pig transarterial portal venography was performed, in addition, using iodinated contrast agent. The portal vein was visualized in each run of venography. Optimal images of portal tree structure up to four-order branches were obtained in all those with CO{sub 2} injection rate of 40 ml/s, which appeared much better in quality than those obtained by cranial mesenteric arteriography with iodinated contrast agent. No extravasation of CO{sub 2}, liver laceration, or any other complication occurred during the procedures. The technique we proposed demonstrated optimal portography, which appeared to be safe, minimally invasive, less time-consuming, cost-effective, and easy to perform, with great potential in clinical applications. (orig.)

  3. Quantitative imaging values of CT, MR, and FDG-PET to differentiate pineal parenchymal tumors and germinomas: are they useful?

    Energy Technology Data Exchange (ETDEWEB)

    Kakigi, Takahide; Okada, Tomohisa; Kanagaki, Mitsunori; Yamamoto, Akira; Fushimi, Yasutaka; Sakamoto, Ryo; Togashi, Kaori [Kyoto University Graduate School of Medicine, Department of Diagnostic Imaging and Nuclear Medicine, Sakyo-ku, Kyoto (Japan); Arakawa, Yoshiki; Takahashi, Jun C. [Kyoto University Graduate School of Medicine, Department of Neurosurgery, Kyoto (Japan); Mikami, Yoshiki [Kyoto University Graduate School of Medicine, Department of Pathology, Kyoto (Japan); Shimono, Taro [Osaka City University Graduate School of Medicine, Department of Radiology, Osaka (Japan)


    Quantitative values of CT attenuation, apparent diffusion coefficient (ADC), and standardized uptake value (SUV) were investigated for differentiation between pineal parenchymal tumors (PPTs) and germinomas. Differences in age, sex, and calcification pattern were also evaluated. Twenty-three patients with PPTs and germinomas in 20 years were retrospectively enrolled under the approval of the institutional review board. CT attenuation, ADC, and SUV (20, 13, and 10 patients, respectively) were statistically compared between the two tumors. Differences in sex and patterns of calcification (''exploded'' or ''engulfed'') were also examined. Mean patient ages were compared among three groups of pineoblastoma, pineal parenchymal tumor of intermediate differentiation, (PPTID) and pineocytoma and germinoma. None of the quantitative values of CT attenuation, ADC, and SUV showed significant differences between PPTs and germinomas (p >.05). However, there was a significant difference in age (p <.05) among the three groups of pineoblastoma (mean age ± standard deviation 7.0 ± 8.7 years), PPTID, and pineocytoma (53.7 ± 11.4 years) and germinoma (19.1 ± 8.1 years). Sex also showed significant differences between PPTs and germinomas (p =.039). Exploded pattern of calcification was found in 9 of 11 PPT patients and engulfed pattern in 7 of 9 patients with germinomas. No reverse pattern was observed, and the patterns of calcification were considered highly specific of tumor types. None of the quantitative imaging values could differentiate PPTs from germinomas. Age, sex, and calcification patterns were confirmed useful in differentiating these tumors to some degree. (orig.)

  4. APOE epsilon 4 influences the pathological phenotype of Alzheimer's disease by favouring cerebrovascular over parenchymal accumulation of A beta protein. (United States)

    Chalmers, K; Wilcock, G K; Love, S


    The relative amounts of amyloid beta-protein (A beta) in cerebral blood vessels and parenchyma vary considerably amongst patients with Alzheimer's disease (AD). Although several mechanisms have been proposed to explain this variability, the underlying genetic and environmental determinants are still unclear, as are the functional consequences. Polymorphisms in APOE, the gene for apolipoprotein E (ApoE), influence the risk of developing AD and of deposition of A beta within the brain. We examined the relationship between the APOE genotype and the relative extent of accumulation of A beta as plaques within the cerebral parenchyma and in cortical blood vessels in the form of cerebral amyloid angiopathy (CAA), in autopsy brain tissue from 125 AD cases and from 53 elderly, neurologically normal controls of which 19 had CAA without other neuropathological features of AD. In the AD cases, we also assessed whether the severity of CAA was related to the age of onset and duration of dementia, risk factors for atherosclerotic vascular disease, and histologically demonstrable cerebral infarcts or foci of haemorrhage. The APOE genotype was determined by a standard polymerase chain reaction-based method. Paraffin sections of frontal, temporal and parietal lobes were immunolabelled for A beta and the parenchymal A beta load (total A beta minus vessel-associated A beta) was quantified by computer-assisted image analysis. CAA severity was scored for cortical and leptomeningeal vessels. The relevant clinical data were obtained from the database of the South West Brain Bank. In AD, we found the severity of CAA to be strongly associated with the number of epsilon 4 alleles (P possession of the APOE epsilon 4 allele favours vascular over parenchymal accumulation of A beta in AD. This may influence the pathogenesis of neurodegeneration in epsilon 4-associated AD.

  5. Protocol for Isolation of Primary Human Hepatocytes and Corresponding Major Populations of Non-parenchymal Liver Cells. (United States)

    Kegel, Victoria; Deharde, Daniela; Pfeiffer, Elisa; Zeilinger, Katrin; Seehofer, Daniel; Damm, Georg


    Beside parenchymal hepatocytes, the liver consists of non-parenchymal cells (NPC) namely Kupffer cells (KC), liver endothelial cells (LEC) and hepatic Stellate cells (HSC). Two-dimensional (2D) culture of primary human hepatocyte (PHH) is still considered as the "gold standard" for in vitro testing of drug metabolism and hepatotoxicity. It is well-known that the 2D monoculture of PHH suffers from dedifferentiation and loss of function. Recently it was shown that hepatic NPC play a central role in liver (patho-) physiology and the maintenance of PHH functions. Current research focuses on the reconstruction of in vivo tissue architecture by 3D- and co-culture models to overcome the limitations of 2D monocultures. Previously we published a method to isolate human liver cells and investigated the suitability of these cells for their use in cell cultures in Experimental Biology and Medicine(1). Based on the broad interest in this technique the aim of this article was to provide a more detailed protocol for the liver cell isolation process including a video, which will allow an easy reproduction of this technique. Human liver cells were isolated from human liver tissue samples of surgical interventions by a two-step EGTA/collagenase P perfusion technique. PHH were separated from the NPC by an initial centrifugation at 50 x g. Density gradient centrifugation steps were used for removal of dead cells. Individual liver cell populations were isolated from the enriched NPC fraction using specific cell properties and cell sorting procedures. Beside the PHH isolation we were able to separate KC, LEC and HSC for further cultivation. Taken together, the presented protocol allows the isolation of PHH and NPC in high quality and quantity from one donor tissue sample. The access to purified liver cell populations could allow the creation of in vivo like human liver models.

  6. Renal morphology and function immediately after extracorporeal shock-wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Kaude, J.V.; Williams, C.M.; Millner, M.R.; Scott, K.N.; Finlayson, B.


    The acute effects of extracorporeal shock-wave lithotripsy (ESWL) on morphology and function of the kidney were evaluated by excretory urography, quantitative radionuclide renography (QRR), and magnetic resonance imaging (MRI) in 33 consecutive patients. Excretory urograms demonstrated an enlarged kidney in seven (18%) of 41 treatments and partial or complete obstruction of the ureter by stone fragments after 15 (37%) of 41 treatments. Total effective renal plasma flow (ERPF) was not changed after ESWL, but the percentage ERPF of the treated kidney was decreased by more than 5% in 10 (30%) of 33 cases. QRR images showed partial parenchymal obstruction in 10 (25%) of 41 teated kidneys and total parenchymal obstruction in 9 (22%). MRI disclosed one or more abnormalities in 24 (63%) of 38 treated kidneys. Treated kidneys were normal by all three imaging methods in 26% and abnormal by one or more tests in 74% of cases. The morphologic and functional changes are attributed to renal contusion resulting in edema and extravasation of urine and blood into the interstitial, subcapsular, and perirenal spaces.

  7. [sup 99m]TC-MAG[sub 3] renal function scintigraphy and captopril in the diagnosis of renovascular hypertension. [sup 99m]Tc-MAG[sub 3]-Nierenfunktionsszintigraphie ohne und mit Captopril zur Diagnostik der renovaskulaeren Hypertonie

    Energy Technology Data Exchange (ETDEWEB)

    Piepenburg, R. (Mainz Univ. (Germany). Klinik mit Poliklinik fuer Nuklearmedizin); Bockisch, A. (Mainz Univ. (Germany). Klinik mit Poliklinik fuer Nuklearmedizin); Andreas, J. (Mainz Univ. (Germany). Klinik mit Poliklinik fuer Nuklearmedizin); Dueber, C. (Mainz Univ. (Germany). Klinik fuer Roentgendiagnostik); Kann, P. (Mainz Univ. (Germany). 3. Medizinische Klinik und Poliklinik, Innere Medizin und Endokrinologie); Maier, G. (Mainz Univ. (Germany). Klinik mit Poliklinik fuer Nuklearmedizin); Hahn, K. (Mainz Univ. (Germany). Klinik mit Poliklinik fuer Nuklearmedizin)


    In this study, the diagnostic value of renal function scintigraphy performed both without and with ACE inhibition has been evaluated using the new radiopharmaceutical [sup 99m]Tc-MAG[sub 3]. In cases of decompensated renal artery stenoses, the typical scan finding with this tubular excreted agent was shown to be a distinct parenchymal nuclide retention in combination with a delayed appearance of the radiotracer in the pelvic system. Using this criterion in 43 patients with suspected renovascular hypertension, sensitivity and specificity were 89 and 88%, respectively. Bilateral positive findings were non-specific; excluding them from the study, specificity increased to 100%. In renal insufficiency, captopril scans seem to be of reduced diagnostic value. Summarising our experiences, renal function scintigraphy using [sup 99m]Tc-MAG[sub 3] without and with captopril was proved to be a reliable non-invasive method to detect or exclude haemodynamically relevant renal artery stenosis. (orig.)

  8. A diet enriched in docosahexanoic Acid exacerbates brain parenchymal extravasation of apo B lipoproteins induced by chronic ingestion of saturated fats. (United States)

    Pallebage-Gamarallage, Menuka M; Lam, Virginie; Takechi, Ryusuke; Galloway, Susan; Mamo, John C L


    Chronic ingestion of saturated fatty acids (SFAs) was previously shown to compromise blood-brain barrier integrity, leading to brain parenchymal extravasation of apolipoprotein B (apo B) lipoproteins enriched in amyloid beta. In contrast, diets enriched in mono- or polyunsaturated (PUFA) oils had no detrimental effect. Rather, n3 and n6 oils generally confer protection via suppression of inflammation. This study investigated in wild-type mice if a PUFA diet enriched in docosahexanoic acid (DHA) restored blood-brain barrier integrity and attenuated parenchymal apo B abundance induced by chronic ingestion of SFA. Cerebrovascular leakage of apo B was quantitated utilising immunofluorescent staining. The plasma concentration of brain-derived S100β was measured as a marker of cerebrovascular inflammation. In mice fed SFA for 3 months, provision thereafter of a DHA-enriched diet exacerbated parenchymal apo B retention, concomitant with a significant increase in plasma cholesterol. In contrast, provision of a low-fat diet following chronic SFA feeding had no effect on SFA-induced parenchymal apo B. The findings suggest that in a heightened state of cerebrovascular inflammation, the provision of unsaturated fatty acids may be detrimental, possibly as a consequence of a greater susceptibility for oxidation.

  9. DMPD: Functions of anaphylatoxin C5a in rat liver: direct and indirect actions onnonparenchymal and parenchymal cells. [Dynamic Macrophage Pathway CSML Database

    Lifescience Database Archive (English)

    Full Text Available 11367531 Functions of anaphylatoxin C5a in rat liver: direct and indirect actions onnon...rect and indirect actions onnonparenchymal and parenchymal cells. PubmedID 113675...31 Title Functions of anaphylatoxin C5a in rat liver: direct and indirect actions onnonparenchymal and paren

  10. Metastatic Renal Cell Carcinoma to the Pancreas: A Review. (United States)

    Cheng, Shaun Kian Hong; Chuah, Khoon Leong


    The pancreas is an unusual site for tumor metastasis, accounting for only 2% to 5% of all malignancies affecting the pancreas. The more common metastases affecting the pancreas include renal cell carcinomas, melanomas, colorectal carcinomas, breast carcinomas, and sarcomas. Although pancreatic involvement by nonrenal malignancies indicates widespread systemic disease, metastatic renal cell carcinoma to the pancreas often represents an isolated event and is thus amenable to surgical resection, which is associated with long-term survival. As such, it is important to accurately diagnose pancreatic involvement by metastatic renal cell carcinoma on histology, especially given that renal cell carcinoma metastasis may manifest more than a decade after its initial presentation and diagnosis. In this review, we discuss the clinicopathologic findings of isolated renal cell carcinoma metastases of the pancreas, with special emphasis on separating metastatic renal cell carcinoma and its various differential diagnoses in the pancreas.

  11. Postpartum renal vein thrombosis. (United States)

    Rubens, D; Sterns, R H; Segal, A J


    Renal vein thrombosis in adults is usually a complication of the nephrotic syndrome. Rarely, it has been reported in nonnephrotic women postpartum. The thrombosis may be a complication of the hypercoagulable state associated with both the nephrotic syndrome and pregnancy. Two postpartum patients with renal vein thrombosis and no prior history of renal disease are reported here. Neither patient had heavy proteinuria. In both cases, pyelonephritis was suspected clinically and the diagnosis of renal vein thrombosis was first suggested and confirmed by radiologic examination. Renal vein thrombosis should be considered in women presenting postpartum with flank pain.

  12. Renal infarction resulting from traumatic renal artery dissection. (United States)

    Kang, Kyung Pyo; Lee, Sik; Kim, Won; Jin, Gong Yong; Na, Ki Ryang; Yun, Il Yong; Park, Sung Kwang


    Renal artery dissection may be caused by iatrogenic injury, trauma, underlying arterial diseases such as fibromuscular disease, atherosclerotic disease, or connective tissue disease. Radiological imaging may be helpful in detecting renal artery pathology, such as renal artery dissection. For patients with acute, isolated renal artery dissection, surgical treatment, endovascular management, or medical treatment have been considered effective measures to preserve renal function. We report a case of renal infarction that came about as a consequence of renal artery dissection.

  13. 肾脏缺血预处理对麻醉家兔心脏保护的神经机制%Involvement of neural mechanism in cardioprotection provided by renal ischemic preconditioniong in anesthetized rabbits

    Institute of Scientific and Technical Information of China (English)

    丁延峰; 史明珠; 牛新清; 李东亮; 何瑞荣


    目的探讨肾神经在肾脏缺血预处理(RIP)心肌保护中的作用.方法在麻醉家兔心肌缺血/再灌注(MIR)模型上,观察MIR和RIP对家兔血流动力学、心肌耗氧量、心外膜电图和心肌梗死范围的影响.结果在MIR过程中,血流动力学指标和心肌耗氧量均明显持续性降低;心外膜电图ST段在缺血期明显升高,再灌注过程中恢复到基础对照值.单纯MIR时的心肌梗塞范围占缺血心肌的(55.80±1.25)%,RIP后心肌梗塞范围为(36.51±2.8)%,较单纯MIR显著减少(P<0.01).肾神经切断后对MIR所致的心肌梗死范围无明显影响,但可取消RIP对心肌的保护效应.结论 RIP具有心肌保护作用,肾短暂缺血-再灌注所诱发的肾神经传入活动可能参与此心肌保护效应.%Objective To investigate the role of renal nerve in cardioprotection provided by renal ischemic preconditioning(RIP).Methods The effects of ischemia-reperfusion and RIP on the hemodynamics, myocardial oxygen consumption, epicardial electrography and infarct size were examined in anesthetized rabbit.Results During the 45 min of myocardial ischemia and 180 min of reperfusion, all hemodynamic parameters and myocardial oxygen consumption decreased progressively significantly. Epicardial electrographic ST-segment was elevated significantly during myocardial ischemia and return to baseline progressively in the course of reperfusion. The myocardial infarct size occupied 55.80±1.25% of area at risk,and RIP significantly reduced the myocardial infarct size to 36.51±2.80%(P<0.01). The renal nerve section (RNS) per se didn't affect myocardial infarct size produced by ischemia-reperfusion, while cardioprotection afforded by RIP was completely abolished by RNS.Conlusion RIP have the protective effect on heart, and activation of renal afferents by transient ischemia-reperfusion play an important role in such a cardioprotection.

  14. Management of obstructive renal failure caused by bilateral renal aspergilloma in an immunocompetent newborn. (United States)

    Martinez-Pajares, J D; Martinez-Ferriz, M C; Moreno-Perez, D; Garcia-Ramirez, M; Martin-Carballido, S; Blanch-Iribarne, P


    Fungal infection of the kidneys is a rare condition that has been reported in premature babies and in diabetic or immunocompromised adult patients. Candida spp. is the most frequent micro-organism involved. This paper reports a case of an immunocompetent newborn with a bladder exstrophy who suffered from an acute renal failure caused by bilateral renal aspergilloma (Aspergillus flavus). The newborn was treated with amphotericin B urinary tract irrigation through bilateral nephrostomy catheters, combined with liposomal amphotericin B and voriconazole therapy, which improved his renal function. However, due to persistent fungal colonization, a long antifungal treatment and permanent ureterostomies were necessary to deal with new episodes of ureterorenal obstruction. As of November 2009, despite the renal injuries, renal function had been conserved. The management of the mechanical obstruction and the choice of antifungal drugs are discussed in this unusual case.

  15. Acute pancreatitis and acute renal failure complicating doxylamine succinate intoxication. (United States)

    Lee, Yang Deok; Lee, Soo Teik


    Doxylamine succinate is an antihistaminic drugwith additional hypnotic, anticholinergic and local anesthetic effects first described in 1948. In Korea and many other countries, it is a common-over-the counter medication frequently involved in overdoses. Clinical symtomatology of doxylamine succinate overdose includes somnolence, coma, seizures, mydriasis, tachycardia, psychosis, and rhabdomyolysis. A serious complication may be rhabdomyolysis with subsequent impairment of renal function and acute renal failure. We report a case of acute renal failure and acute pancreatitis complicating a doxylamine succinate intoxication.

  16. Gastrin stimulates renal dopamine production by increasing the renal tubular uptake of l-DOPA. (United States)

    Jiang, Xiaoliang; Zhang, Yanrong; Yang, Yu; Yang, Jian; Asico, Laureano D; Chen, Wei; Felder, Robin A; Armando, Ines; Jose, Pedro A; Yang, Zhiwei


    Gastrin is a peptide hormone that is involved in the regulation of sodium balance and blood pressure. Dopamine, which is also involved in the regulation of sodium balance and blood pressure, directly or indirectly interacts with other blood pressure-regulating hormones, including gastrin. This study aimed to determine the mechanisms of the interaction between gastrin and dopamine and tested the hypothesis that gastrin produced in the kidney increases renal dopamine production to keep blood pressure within the normal range. We show that in human and mouse renal proximal tubule cells (hRPTCs and mRPTCs, respectively), gastrin stimulates renal dopamine production by increasing the cellular uptake of l-DOPA via the l-type amino acid transporter (LAT) at the plasma membrane. The uptake of l-DOPA in RPTCs from C57Bl/6J mice is lower than in RPTCs from normotensive humans. l-DOPA uptake in renal cortical slices is also lower in salt-sensitive C57Bl/6J than in salt-resistant BALB/c mice. The deficient renal cortical uptake of l-DOPA in C57Bl/6J mice may be due to decreased LAT-1 activity that is related to its decreased expression at the plasma membrane, relative to BALB/c mice. We also show that renal-selective silencing of Gast by the renal subcapsular injection of Gast siRNA in BALB/c mice decreases renal dopamine production and increases blood pressure. These results highlight the importance of renal gastrin in stimulating renal dopamine production, which may give a new perspective in the prevention and treatment of hypertension. Copyright © 2017 the American Physiological Society.

  17. 临床药师参与肾移植术后肺炎患者抗感染治疗分析%Clinical Pharmacists Involved in Anti-infection Treatment of Pneumonia After Renal Transplantation

    Institute of Scientific and Technical Information of China (English)

    李凌霞; 连玉菲; 王路


    Infection is common in patients after renal transplantation complications, if not treated early, even cause death.So, proper anti-infective treatment is particularly important.Based on 1 case of pneumonia after renal transplantation in patients with pharmaceutical care, explore the clinical practice of personalized medicine.Clinical pharmacist intervention by the patient's medication to make the pa-tient medication more safe, effective and reasonable.%感染是肾移植术后患者的常见并发症,若治疗不及时或不彻底,感染甚至会造成患者死亡。因此给予恰当的抗感染治疗尤为重要。本文通过对1例肺炎合并肾移植术后患者的药学监护,探讨临床个体化用药实践。临床药师通过对患者的用药干预,提升用药安全、有效和合理,体现了临床药师在参与药物治疗中的积极作用。

  18. Clinical Scenarios in Chronic Kidney Disease: Kidneys' Structural Changes in End-Stage Renal Disease. (United States)

    Meola, Mario; Samoni, Sara; Petrucci, Ilaria


    Acquired cystic kidney disease (ACKD) and renal cell carcinoma (RCC) are the most important manifestations of end-stage kidneys' structural changes. ACKD is caused by kidney damage or scarring and it is characterized by the presence of small, multiple cortical and medullary cysts filled with a fluid similar to preurine. ACKD prevalence varies according to predialysis and dialysis age and its pathogenesis is unknown, although it is stated that progressive destruction of renal tissue induces hypertrophy/compensatory hyperplasia of residual nephrons and may trigger the degenerative process. ACKD is almost asymptomatic, but it can lead to several complications (bleeding, rupture, infections, RCC). Ultrasound (US) is the first level imaging technique in ACKD, because of its sensitivity and reliability. The most serious complication of ACKD is RCC, which is stimulated by the same growth factors and proto-oncogenes that lead to the genesis of cysts. Two different histological types of RCC have been identified: (1) RCC associated with ACKD and (2) papillary renal clear cell carcinoma. Tumors in end-stage kidneys are mainly small, multifocal and bilateral, with a papillary structure and a low degree of malignancy. At US, RCC appears as a small inhomogeneous nodule (<3 cm), clearly outlined from the renal profile and hypoechoic if compared with sclerotic parenchyma. In some cases, tumor appears as a homogeneous and hyperechoic multifocal mass. The most specific US sign of a small tumor in end-stage kidney is the important arterial vascularization, in contrast with renal parenchymal vascular sclerosis.

  19. Telopéptido carboxilo terminal del colágeno tipo I (b-CTX sérico y compromiso óseo en la insuficiencia renal crónica Serum b-Type I collagen carboxyterminal telopeptide (b-CTXs and bone involvement in chronic renal failure

    Directory of Open Access Journals (Sweden)

    Beatriz Oliveri


    Full Text Available La osteodistrofia renal (ODR se caracteriza por alteraciones óseas. Se evaluaron métodos bioquímicos alternativos a la biopsia ósea en pacientes renales para determinar cambios rápidos del remodelamiento óseo en 43 pacientes predialíticos (PD y 49 hemodializados (HD. Los PD presentaron fosfatemia, fosfatasa alcalina ósea (FAO, hormona paratiroidea intacta (PTHi y b-telopéptido carboxilo terminal del colágeno tipo I (bCTXs mayores y clearence de creatinina (Ccr menores (p40 ml/min. En PD, bCTXs (pAn increase in parathyroid hormone (PTH levels in chronic renal failure (CRF induces bone abnormalities known as renal osteodystrophy (ROD. The aim of the present study was to evaluate alternative biochemical methods to bone biopsy, to evaluate changes in bone remodeling in renal patients. Intact PTH (iPTH and bone markers were measured in 43 predialysis (PD, 49 hemodialysis patients (HD and 185 controls. bCTXs, bone alkaline phosphatase (bAL, iPTH were higher and creatinine clearance (Ccr was lower in PD and HD compared with controls (p40 ml/min. bCTXs (p<0.05 in PD and bCTXs and bAL in HD patients were higher than controls, even when iPTH was within normal range (<65 pg/ml. Patients with severe secondary hyperparathyroidism showed higher bone markers than patients with normal or moderately increased iPTH (p<0.001. These results suggest that even when there is no increase in iPTH, bone remodeling increases (possibly due to other factors exhibiting higher bone resorption, and bCTXs would seem to be an adequate non-invasive tool to assess early bone changes in CRF and prevent future fractures. Bone marker measurements in ROD would be useful to identify patients who may require bone biopsy. However, further studies comparing both methods must be performed before replacing bone biopsy with serum b-CTX.

  20. Transient renal dysfunction with reversible splenial lesion. (United States)

    Watanabe, Toru; Matsuda, Tomoka; Kitagata, Ryoichi; Tajima, Iwao; Ono, Hiroyuki; Hirano, Keiko; Shirai, Masami; Endoh, Akira; Hongo, Teruaki


    We report the case of a 6-month-old boy with transient renal dysfunction who had an intensified signal in the splenium of the corpus callosum on magnetic resonance imaging. He presented to hospital with fever and sudden disturbance of consciousness. Cerebrospinal fluid analysis did not show pleocytosis. The mild consciousness disturbance disappeared after 30 min, but the splenial signal persisted even after 8 days. Further, renal glucosuria, increased excretion of select amino acids, and abnormal fractional excretion of electrolytes were observed, indicating renal tubular dysfunction. The abnormal urinary findings spontaneously resolved by day 9 of hospitalization. The splenial lesion took 21 days to normalize. There were no signs of neurological complications 2 months later. This case suggests the possibility of renal involvement in splenial lesions.

  1. [Treatment of renal anemia with erythropoietin]. (United States)

    Spustova, V; Kovac, A


    During the last decade, a considerable amount of new information has accumulated regarding therapy optimalization of renal anaemia with recombinant human erythropoietin (EPO). Key question involved is EPO hyporesponsiveness caused by absolute or functional iron deficiency. Most controversial issue in the treatment of renal anaemia in patients with chronic renal insufficiency is the definition of optimal target haemoglobin. Many questions about optimizing EPO therapy were considered at the 2nd European Epoetin Symposium which was held in April 1998 on Crete. Discussion was devoted also to revision of a draft version of the European Best Practice Guidelines for the Management of Anaemia in Patients with Chronic Renal Failure. The presented review is on summary of new insights presented at the symposium. (Ref. 85.)

  2. Renal nerves and nNOS

    DEFF Research Database (Denmark)

    Kompanowska-Jezierska, Elzbieta; Wolff, Helle; Kuczeriszka, Marta


    It was hypothesized that renal sympathetic nerve activity (RSNA) and neuronal nitric oxide synthase (nNOS) are involved in the acute inhibition of renin secretion and the natriuresis following slow NaCl loading (NaLoad) and that RSNA participates in the regulation of arterial blood pressure (MABP......). This was tested by NaLoad after chronic renal denervation with and without inhibition of nNOS by S-methyl-thiocitrulline (SMTC). In addition, the acute effects of renal denervation on MABP and sodium balance were assessed. Rats were investigated in the conscious, catheterized state, in metabolic cages...... of acutely and chronically denervated rats were less than control (15% and 9%, respectively, P renal denervation (14.5 +/- 0.2 vs. 19.3 +/- 1.3 mIU/l, P

  3. Renal malakoplakia presenting as a renal mass in a 55-year-old man: a case report

    Directory of Open Access Journals (Sweden)

    Abolhasani Maryam


    Full Text Available Abstract Introduction Malakoplakia is an uncommon chronic inflammatory condition that has a gross and microscopic appearance resembling that of xanthogranulomatous pyelonephritis. It is characterized by distinctive Michaelis-Gutmann bodies. Malakoplakia can affect any organ system but genitourinary tract involvement is the most common, particularly in immunocompromised individuals. Very rare cases have been reported to present as a unifocal lesion mimicking a renal tumor. Case presentation We report a case of renal malakoplakia in a 55-year-old Iranian man with a past history of recurrent urinary tract infections who presented with left flank pain. An ultrasound study showed a large solid left renal mass, and he underwent a left radical nephrectomy with a clinical diagnosis of a renal tumor. Pathology slides revealed the diffuse infiltration of sheets of Periodic Acid Schiff-positive histiocytes in his renal parenchyma; these cells showed strong immunoreactivity for CD 68. The final diagnosis was renal malakoplakia. Conclusion Renal malakoplakia must be kept in mind for patients presenting with a renal mass and a history of long-term recurrent renal infections or renal failure. The large, rapidly growing nodules of malakoplakia may mimic renal cell carcinoma in imaging studies. In these cases, a true cut needle biopsy may help the correct diagnosis and prevent unnecessary surgery.

  4. Refractory anemia leading to renal hemosiderosis and renal failure


    Sujatha Siddappa; K M Mythri; Kowsalya, R.; Ashish Parekh


    Renal hemosiderosis is a rare cause of renal failure and, as a result, may not be diagnosed unless a detailed history, careful interpretation of blood parameters and renal biopsy with special staining is done. Here, we present a rare case of renal hemosiderosis presenting with renal failure.

  5. Refractory anemia leading to renal hemosiderosis and renal failure

    Directory of Open Access Journals (Sweden)

    Sujatha Siddappa


    Full Text Available Renal hemosiderosis is a rare cause of renal failure and, as a result, may not be diagnosed unless a detailed history, careful interpretation of blood parameters and renal biopsy with special staining is done. Here, we present a rare case of renal hemosiderosis presenting with renal failure.

  6. The role of magnetic resonance imaging (MRI) in refining the diagnosis of suspected fetal renal anomalies

    Institute of Scientific and Technical Information of China (English)

    Ibrahim A Abdelazim; Maha M Belal


    Objective:To detect the role of magnetic resonance imaging in refining the diagnosis of suspected fetal renal anomalies detected during screening sonography.Methods: 54 pregnant women, with suspected fetal renal anomalies detected during routine ultrasound screening, were rescanned by MRI to refine the diagnosis of the suspected renal anomalies. The pregnancy outcome was examined externally and by postnatal ultrasonography.Results:54 cases of suspected renal anomalies detected during screening sonography of 8 400 pregnant women (0.6%), were rescanned by MRI in this study. The MRI diagnosed, 29 (53.7%) cases of parenchymal renal disease, 20 (37.0%) cases of hydronephrosis, 3 (5.6%) cases of single renal cyst and 2 (3.7%) cases of megacystis + hydroureter. The amniotic fluid volume was normal in 33 (61.0%) cases, while it was decreased in 21 (39.0%) cases. Two cases of chromosomal aberration (3.7%) were detected in the studied cases. During antenatal follow up of the prenatal diagnosed cases with renal anomalies 2 cases of bilateral RA (Potter's syndrome died in utero = IUFD) and out of 52 live births 1 case of NND occurred due to bilateral MCKD with trisomy 18. In this study, when the prenatal findings were compared with the postnatal findings, the MRI was 89.5% accurate, while the prenatal ultrasound was 85% accurate in diagnosing fetal renal anomalies.Conclusion:The MRI can be used as a complementary adjunctive modality with excellent tissue contrast especially in equivocal cases or inconclusive sonographic findings.

  7. Pulmonary complications in renal transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jung Bin; Choi, Yo Won; Jeon, Seok Chol; Park, Choong Ki; Lee, Seung Rho; Hahm, Chang Kok; Joo, Kyung Bin [Hanyang University College of Medicine, Seoul (Korea, Republic of)


    To evaluate the radiographic and CT findings of pulmonary complications other than pulmonary edema arising from renal transplantation. Among 393 patients who had undergone renal transplantation at our hospital during a previous ten-year period, 23 with pulmonary complications other than pulmonary edema were included in this study. The complications involved were infection caused by CMV (n=6), bacteria (n=4), fungus (n=4), tuberculosis (n=2), varicella (n=1) or chlamydia (n=1), and malignancy involving lung cancer (n=4) or Kaposi's sarcoma (n=1). Two chest radiologists reviewed all images. The complications manifesting mainly as pulmonary nodules were lung cancer (4/4), tuberculosis (1/2), and Kaposi's sarcoma (1/1). Pulmonary consolidation was a main feature in bacterial infection (4/4), fungal infection (3/4), tuberculosis (1/2), chlamydial infection (1/1), and varicellar pneumonia (1/1). Ground-glass attenuation was a main CT feature in CMV pneumonia (4/6), and increased interstitial making was a predominant radiographic feature in CMV pneumonia (2/6). The main radiologic features described above can be helpful for differential diagnosis of the pulmonary complications of renal transplantation.

  8. Effect of ipsilateral ureteric obstruction on contralateral kidney and role of renin angiotensin system blockade on renal recovery in experimentally induced unilateral ureteric obstruction

    Directory of Open Access Journals (Sweden)

    Shasanka S Panda


    Full Text Available Aims: To study, the effects of ipsilateral ureteric obstruction on contralateral kidney and the role of renin angiotensin system (RAS blockade on renal recovery in experimentally induced unilateral ureteric obstruction. Materials and Methods: Unilateral upper ureteric obstruction was created in 96 adult Wistar rats that were reversed after pre-determined intervals. Losartan and Enalapril were given to different subgroups of rats following relief of obstruction. Results: The severity of dilatation on the contralateral kidney varied with duration of ipsilateral obstruction longer the duration more severe the dilatation. There is direct correlation between renal parenchymal damage, pelvi-ureteric junction (PUJ fibrosis, inflammation and severity of pelvi-calyceal system dilatation of contralateral kidney with duration of ipsilateral PUJ obstruction. Conclusions: Considerable injury is also inflicted to the contralateral normal kidney while ipsilateral kidney remains obstructed. Use of RAS blocking drugs has been found to significantly improve renal recovery on the contralateral kidney. It can, thus, be postulated that contralateral renal parenchymal injury was mediated through activation of RAS.

  9. Renal replacement therapy for acute renal failure. (United States)

    Macedo, E; Bouchard, J; Mehta, R L


    Renal replacement therapy became a common clinical tool to treat patients with severe acute kidney injury (AKI) since the 1960s. During this time dialytic options have expanded considerably; biocompatible membranes, bicarbonate dialysate and dialysis machines with volumetric ultrafiltration control have improved the treatment for acute kidney injury. Along with advances in methods of intermittent hemodialysis, continuous renal replacement therapies have gained widespread acceptance in the treatment of dialysis-requiring AKI. However, many of the fundamental aspects of the renal replacement treatment such as indication, timing of dialytic intervention, and choice of dialysis modality are still controversial and may influence AKI patient's outcomes. This review outlines current concepts in the use of dialysis techniques for AKI and suggests an approach for selecting the optimal method of renal replacement therapy.

  10. Renal function after renal artery stenting

    Institute of Scientific and Technical Information of China (English)

    George S. Hanzel; Mark Downes; Peter A. McCullough


    @@ Atherosclerotic renal artery stenosis (ARAS), a common clinical finding, is increasing in prevalence as the population ages. ARAS is seen in ~ 7% of persons over 65 years of age1 and in ~ 20% of patients at the time of coronary angiography.2 It is an important cause of chronic kidney disease and may result in 11-14% of cases of end stage renal disease.3

  11. Renal denervation for resistant hypertension. (United States)

    Almeida, Manuel de Sousa; Gonçalves, Pedro de Araújo; Oliveira, Eduardo Infante de; Carvalho, Henrique Cyrne de


    There is a marked contrast between the high prevalence of hypertension and the low rates of adequate control. A subset of patients with suboptimal blood pressure control have drug-resistant hypertension, in the pathophysiology of which chronic sympathetic hyperactivation is significantly involved. Sympathetic renal denervation has recently emerged as a device-based treatment for resistant hypertension. In this review, the pathophysiological mechanisms linking the sympathetic nervous system and cardiovascular disease are reviewed, focusing on resistant hypertension and the role of sympathetic renal denervation. An update on experimental and clinical results is provided, along with potential future indications for this device-based technique in other cardiovascular diseases. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  12. Induction of apoptosis in renal cell carcinoma by reactive oxygen species: involvement of extracellular signal-regulated kinase 1/2, p38delta/gamma, cyclooxygenase-2 down-regulation, and translocation of apoptosis-inducing factor.

    LENUS (Irish Health Repository)

    Ambrose, Monica


    Renal cell carcinoma (RCC) is the most common malignancy of the kidney. Unfortunately, RCCs are highly refractory to conventional chemotherapy, radiation therapy, and even immunotherapy. Thus, novel therapeutic targets need to be sought for the successful treatment of RCCs. We now report that 6-anilino-5,8-quinolinequinone (LY83583), an inhibitor of cyclic GMP production, induced growth arrest and apoptosis of the RCC cell line 786-0. It did not prove deleterious to normal renal epithelial cells, an important aspect of chemotherapy. To address the cellular mechanism(s), we used both genetic and pharmacological approaches. LY83583 induced a time- and dose-dependent increase in RCC apoptosis through dephosphorylation of mitogen-activated protein kinase kinase 1\\/2 and its downstream extracellular signal-regulated kinases (ERK) 1 and -2. In addition, we observed a decrease in Elk-1 phosphorylation and cyclooxygenase-2 (COX-2) down-regulation. We were surprised that we failed to observe an increase in either c-Jun NH(2)-terminal kinase or p38alpha and -beta mitogen-activated protein kinase activation. In contradiction, reintroduction of p38delta by stable transfection or overexpression of p38gamma dominant negative abrogated the apoptotic effect. Cell death was associated with a decrease and increase in Bcl-x(L) and Bax expression, respectively, as well as release of cytochrome c and translocation of apoptosis-inducing factor. These events were associated with an increase in reactive oxygen species formation. The antioxidant N-acetyl l-cysteine, however, opposed LY83583-mediated mitochondrial dysfunction, ERK1\\/2 inactivation, COX-2 down-regulation, and apoptosis. In conclusion, our results suggest that LY83583 may represent a novel therapeutic agent for the treatment of RCC, which remains highly refractory to antineoplastic agents. Our data provide a molecular basis for the anticancer activity of LY83583.

  13. Bilateral acrometastasis in a case renal cell carcinoma (United States)

    Vaishya, Raju; Vijay, Vipul; Vaish, Abhishek


    We present a unique case of bilateral skeletal metastasis below the knee in a patient with renal cell carcinoma. In this rarest of rare cases, bony metastases were the first presentation of a primary tumour. Incidentally, the primary tumour (renal cell carcinoma) involved the solitary kidney of the patient and the same patient also had coexisting carcinoma of the prostate. PMID:25368128

  14. The role of complement in autoimmune renal disease

    NARCIS (Netherlands)

    Seelen, M. A.; Daha, M. R.


    The predominance of renal involvement in autoimmune diseases can most likely be assigned to the specialised function of the kidneys filtrating over 120 ml plasma per minute. Complement activation by autoantibodies directed against planted antigens or antigens already present in renal tissue in the s

  15. Intrarenal purinergic signaling in the control of renal tubular transport

    DEFF Research Database (Denmark)

    Prætorius, Helle; Leipziger, Jens Georg


    Renal tubular epithelial cells receive hormonal input that regulates volume and electrolyte homeostasis. In addition, numerous intrarenal, local signaling agonists have appeared on the stage of renal physiology. One such system is that of intrarenal purinergic signaling. This system involves all ...

  16. Predictive properties and therapeutical use of gasotransmitters : A renal perspective

    NARCIS (Netherlands)

    Frenay, Anne-Roos Sophie


    In this thesis, we explored the predictive properties of gasotransmitters on graft survival and all-cause mortality in renal transplant recipients. To provide further evidence for the involvement of gasotransmitters in renal and cardiovascular damage we tested their therapeutical potential in experi

  17. Imaging of renal osteodystrophy

    Energy Technology Data Exchange (ETDEWEB)

    Jevtic, V. E-mail:


    Chronic renal insufficiency, hemodialysis, peritoneal dialysis, renal transplantation and administration of different medications provoke complex biochemical disturbances of the calcium-phosphate metabolism with wide spectrum of bone and soft tissue abnormalities termed renal osteodystrophy. Clinically most important manifestation of renal bone disease includes secondary hyperparathyroidism, osteomalacia/rickets, osteoporosis, adynamic bone disease and soft tissue calcification. As a complication of long-term hemodialysis and renal transplantation amyloid deposition, destructive spondyloarthropathy, osteonecrosis, and musculoskeletal infections may occur. Due to more sophisticated diagnostic methods and more efficient treatment classical radiographic features of secondary hyperparathyroidism and osteomalacia/rickets are now less frequently seen. Radiological investigations play an important role in early diagnosis and follow-up of the renal bone disease. Although numerous new imaging modalities have been introduced in clinical practice (scintigraphy, CT, MRI, quantitative imaging), plain film radiography, especially fine quality hand radiograph, still represents most widely used examination.

  18. Renal dysfunction in patients with cirrhosis: Where do we stand?

    Institute of Scientific and Technical Information of China (English)

    Chrysoula; Pipili; Evangelos; Cholongitas


    Patients with cirrhosis and renal failure are high-risk patients who can hardly be grouped to form precise instructions for diagnosis and treatment. When it comes to evaluate renal function in patients with cirrhosis,determination of acute kidney injury(AKI),chronic kidney disease(CKD) or AKI on CKD should be made. First it should be excluded the prerenal causes of AKI. All cirrhotic patients should undergo renal ultrasound for measurement of renal resistive index in every stage of liver dysfunction and urine microscopy for differentiation of all causes of AKI. If there is history of dehydration on the ground of normal renal ultrasound and urine microscopy the diuretics should be withdrawn and plasma volume expansion should be tried with albumin. If the patient does not respond,the correct diagnosis is HRS. In case there is recent use of nephrotoxic agents or contrast media and examination shows shock,granular cast in urinary sediment and proteinuria above 0.5 g daily,acute tubular necrosis is the prominent diagnosis. Renal biopsy should be performed when glomerular filtration rate is between 30-60 mL/min and there are signs of parenchymal renal disease. The acute renalfunction is preferable to be assessed with modified AKIN. Patients with AKIN stage 1 and serum creatinine ≥ 1.5 mg/dL should be at close surveillance. Management options include hemodynamic monitoring and management of fluid balance and infections,potentially driving to HRS. Terlipressin is the treatment of choice in case of established HRS,administered until there are signs of improvement,but not more than two weeks. Midodrine is the alternative for therapy continuation or when terlipressin is unavailable. Norepinephrine has shown similar effect with terlipressin in patients being in Intensive Care Unit,but with much lower cost than that of terlipressin. If the patient meets the requirements for transplantation,dialysis and transjugular intrahepatic portosystemic shunt are the bridging therapies

  19. Role of digital tomosynthesis and dual energy subtraction digital radiography in detection of parenchymal lesions in active pulmonary tuberculosis

    Energy Technology Data Exchange (ETDEWEB)

    Sharma, Madhurima, E-mail: [Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh 160012 (India); Sandhu, Manavjit Singh, E-mail: [Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh 160012 (India); Gorsi, Ujjwal, E-mail: [Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh 160012 (India); Gupta, Dheeraj, E-mail: [Department of Pulmonary Medicine, PGIMER, Chandigarh 160012 (India); Khandelwal, Niranjan, E-mail: [Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh 160012 (India)


    Highlights: • Digital tomosynthesis and dual energy subtraction digital radiography are modifications of digital radiography. • These modalities perform better than digital radiography in detection of parenchymal lesions in active pulmonary tuberculosis. • Digital tomosynthesis has a sensitivity of 100% in detection of cavities. • Centrilobular nodules seen on CT in active pulmonary tuberculosis, were also demonstrated on digital tomosynthesis in our study. • Digital tomosynthesis can be used for diagnosis and follow up of patients in pulmonary tuberculosis, thereby reducing the number of CT examinations. - Abstract: Objective: To assess the role of digital tomosynthesis (DTS) and dual energy subtraction digital radiography (DES-DR) in detection of parenchymal lesions in active pulmonary tuberculosis (TB) and to compare them with digital radiography (DR). Materials and methods: This prospective study was approved by our institutional review committee. DTS and DES-DR were performed in 62 patients with active pulmonary TB within one week of multidetector computed tomography (MDCT) study. Findings of active pulmonary TB, that is consolidation, cavitation and nodules were noted on digital radiography (DR), DTS and DES-DR in all patients. Sensitivity, specificity, positive and negative predictive values of all 3 modalities was calculated with MDCT as reference standard. In addition presence of centrilobular nodules was also noted on DTS. Results: Our study comprised of 62 patients (33 males, 29 females with age range 18–82 years). Sensitivity and specificity of DTS for detection of nodules and cavitation was better than DR and DES-DR. Sensitivity and specificity of DTS for detection of consolidation was comparable to DR and DES-DR. DES-DR performed better than DR in detection of nodules and cavitation. DTS was also able to detect centrilobular nodules with sensitivity and specificity of 57.4% and 86.5% respectively. Conclusion: DTS and DES-DR perform better

  20. Lung parenchymal change after the resolution of adenovirus pneumonia : chest radiographs and high-resolution CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Jung Hee; Kim, Joung Sook; Kim, Chang Kuen; Kang, Seung Pyung; Lee, Soo Hyun; Hur Gham [Inje Univ. Sanggye Paik Hospital, Seoul (Korea, Republic of)


    To evaluate lung parenchymal change as seen on chest radiographs and high-resolution CT (HRCT) after the resolution of adenovirus pneumonia (a common cause of lower respiratory infection in infants and children),and the usefulness of HRCT during follow-up. Material and Methods : Four to 13(mean, 8) months after recovery, ten patients infected with adenovirus pneumonia underwent HRCT and chest radiographs. Eight were boys and two were girls, and their mean age was 26(range, 14-45) months. Adenovirus pneumonia had been confirmed by viral isolation in culture or serologic test. CT scanning was performed during quiet breathing ; collimation was 2 mm and the interval from apex to diaphragm was 5-10 mm. Lung settings were 1600 HU (window width) and -700 HU(level). CT findings were assessed and compared with chest radiographs by two chest radiologists, who reached a consensus. The patients were clinically followed up for one year. Result : On chest radiographs, hyperlucent lung was seen in 8 of 10 patients (80%) ; in one other there was partial collapse, and in one, findings were normal. The most common HRCT finding was a mosaic pattern of lung attenuation with decreased pulmonary vascularity in the area of lower attenuation ; this was seen in 8 of 10 patients (80%). Other findings were partial collapse, bronchiectasis, and bronchial wall thickening, each seen in two patients, and reticulonodular density, seen in one. In two patients HRCT findings were normal ; in one of these, chest findings were normal but a mosaic pattern of lung attenuation was found in all lobes. During follow-up, three patients wheezed continuously. Conclusion : In cases of adenovirus pneumonia, HRCT demonstrated more specific parenchymal change than did chest radiographs ; a mosaic pattern of lung attenuation was seen, with decreased pulmonary vascularity in areas of lower attenuation ; bronchiectasis,bronchial wall thickening, and reticulo-odular density were also noted. These findings were

  1. Shear-Induced Amyloid Formation in the Brain: I. Potential Vascular and Parenchymal Processes. (United States)

    Trumbore, Conrad N


    Shear distortion of amyloid-beta (Aβ) solutions accelerates amyloid cascade reactions that may yield different toxic oligomers than those formed in quiescent solutions. Recent experiments indicate that cerebrospinal fluid (CSF) and interstitial fluid (ISF) containing Aβ flow through narrow brain perivascular pathways and brain parenchyma. This paper suggests that such flow causes shear distortion of Aβ molecules involving conformation changes that may be one of the initiating events in the etiology of Alzheimer's disease. Aβ shearing can occur in or around brain arteries and arterioles and is suggested as the origin of cerebral amyloid angiopathy deposits in cerebrovascular walls. Comparatively low flow rates of ISF within the narrow extracellular spaces (ECS) of the brain parenchyma are suggested as a possible initiating factor in both the formation of neurotoxic Aβ42 oligomers and amyloid fibrils. Aβ42 in slow-flowing ISF can gain significant shear energy at or near the walls of tortuous brain ECS flow paths, promoting the formation of a shear-distorted, excited state hydrophobic Aβ42* conformation. This Aβ42* molecule could possibly be involved in one of two paths, one involving rapid adsorption to a brain membrane surface, ultimately forming neurotoxic oligomers on membranes, and the other ultimately forming plaque within the ECS flow pathways. Rising Aβ concentrations combined with shear at or near critical brain membranes are proposed as contributing factors to Alzheimer's disease neurotoxicity. These hypotheses may be applicable in other neurodegenerative diseases, including tauopathies and alpha-synucleinopathies, in which shear-distorted proteins also may form in the brain ECS.

  2. FGF23 regulates renal sodium handling and blood pressure


    Andrukhova, Olena; Slavic, Svetlana; Smorodchenko, Alina; Zeitz, Ute; Shalhoub, Victoria; Lanske, Beate; Pohl, Elena E.; Erben, Reinhold G.


    Fibroblast growth factor-23 (FGF23) is a bone-derived hormone regulating renal phosphate reabsorption and vitamin D synthesis in renal proximal tubules. Here, we show that FGF23 directly regulates the membrane abundance of the Na+:Cl− co-transporter NCC in distal renal tubules by a signaling mechanism involving the FGF receptor/αKlotho complex, extracellular signal-regulated kinase 1/2 (ERK1/2), serum/glucocorticoid-regulated kinase 1 (SGK1), and with-no lysine kinase-4 (WNK4). Renal sodium (...

  3. Renogram and deconvolution parameters in diagnosis of renal artery stenosis. Variants of background subtraction and analysis techniques

    Energy Technology Data Exchange (ETDEWEB)

    Kempi, V. [Dept. of Clinical Physiology, Sjukhuset, Oestersund (Sweden)


    Aim: Multivariate statistical methods can be used for objective analysis. The emphasis is on analysing renal function parameters together, not one at a time. The aim is to identify curve parameters useful in making predictions in kidneys with and without renal artery stenosis (RAS). Patients, methods: 68 patients with resistant hypertension were subjected to captopril renography with {sup 99m}Tc-DTPA. Variants of background areas and background subtraction methods were employed. A correction was applied for loss of renal parenchyma. Parameters from time-activity curves and retention curves from deconvolution were calculated. Renal angiography established the presence or absence of RAS. Logistic regression analysis, using age- and kidney size-adjusted models, was performed to assess the capability of renography and deconvolution to differentiate between kidneys with and without RAS. Results: Discrimination between normal kidneys and RAS was achieved by deconvolution and by renography. Deconvolution was the method of first rank with a sensitivity of 87% and a specificity of 98%. For separation of RAS and kidneys with parenchymal insufficiency deconvolution was the method of first rank with a sensitivity of 80% and specificity of 89%, whereas renography produced poor results. Conclusion: The best performance with {sup 99m}Tc-DTPA was based on normalised background subtraction using a rectangular area between the kidneys. Deconvolution produced the most favourable results in the separation of kidneys with and without RAS. For separation of RAS and kidneys with parenchymal insufficiency conventional renography produced poor results. Conceptually, the results of a logistic regression analysis of renal function parameters may raise possibilities in the field of computer-aided diagnosis. (orig.)

  4. Incidental renal neoplasms

    DEFF Research Database (Denmark)

    Rabjerg, Maj; Mikkelsen, Minne Nedergaard; Walter, Steen;


    On the basis of associations between tumor size, pathological stage, histological subtype and tumor grade in incidentally detected renal cell carcinoma vs symptomatic renal cell carcinoma, we discussed the need for a screening program of renal cell carcinoma in Denmark. We analyzed a consecutive...... series of 204 patients with renal tumors in 2011 and 2012. The tumors were classified according to detection mode: symptomatic and incidental and compared to pathological parameters. Eighty-nine patients (44%) were symptomatic, 113 (55%) were incidental. Information was not available in two patients...

  5. Insuficiencia renal aguda.


    Carlos Hernán Mejía


    Acute renal failure (ARF) is a clinic syndrome characterized by decline in renal function occurring over a short time period. Is a relatively common complication in hospitalized critically ill patients and is associated with high morbidity and mortality. ARF has often a multi-factorial etiology syndrome usually approached diagnostically as pre-renal, post-renal, or intrinsic ARF. Most intrinsic ARF is caused by ischemia or nephrotoxins and is classically associated with acute tubular necrosis...

  6. Blunt renal trauma: comparison of contrast-enhanced CT and angiographic findings and the usefulness of transcatheter arterial embolization

    Energy Technology Data Exchange (ETDEWEB)

    Kitase, M.; Mizutani, M.; Tomita, H.; Kono, T.; Sugie, C.; Shibamoto, Y. [Nagoya City University, Nagoya, (Japan). Graduate School of Medical Sciences. Dept. of Radiology


    Full text: Background: The purpose of this study was to evaluate the role of contrast-enhanced CT and the usefulness of super selective embolization therapy in the management of arterial damage in patients with severe blunt renal trauma. Patients and Methods: Nine cases of severe renal trauma were evaluated. In all cases, we compared contrast enhanced CT findings with angiographic findings, and performed transcatheter arterial embolization (TAE) in six of them with microcoils and gelatin sponge particles. Morphological changes in the kidney and site of infarction after TAE were evaluated on follow-up CT Chronological changes in blood biochemistry findings after injury, degree of anemia and renal function were investigated. Adverse effects or complications such as duration of hematuria, fever, abdominal pain, renovascular hypertension and abscess formation were also evaluated. Results: The CT finding of extravasation was a reliable sign of active bleeding and useful for determining the indication of TAE. In all cases, bleeding was effectively controlled with super selective embolization. There was minimal procedure-related loss of renal tissue. None of the patients developed abscess, hypertension or other complications. Conclusions: In blunt renal injury, contrast-enhanced CT was useful for diagnosing arterial hemorrhage. Arterial bleeding may produce massive hematoma and TAE was a useful treatment for such cases. By using selective TAE for a bleeding artery, it was possible to minimize renal parenchymal damage, with complications of TAE rarely seen. (author)

  7. Spontaneous Renal Artery Dissection as a Cause of Acute Renal Infarction: Clinical and MDCT Findings. (United States)

    Yoon, Kibo; Song, Soon Young; Lee, Chang Hwa; Ko, Byung Hee; Lee, Seunghun; Kang, Bo Kyeong; Kim, Mi Mi


    The purpose of this study was to assess the incidence of spontaneous renal artery dissection (SRAD) as a cause of acute renal infarction, and to evaluate the clinical and multidetector computed tomography (MDCT) findings of SRAD. From November 2011 to January 2014, 35 patients who were diagnosed with acute renal infarction by MDCT were included. We analyzed the 35 MDCT data sets and medical records retrospectively, and compared clinical and imaging features of SRAD with an embolism, using Fisher's exact test and the Mann-Whitney test. The most common cause of acute renal infarction was an embolism, and SRAD was the second most common cause. SRAD patients had new-onset hypertension more frequently than embolic patients. Embolic patients were found to have increased C-reactive protein (CRP) more often than SRAD patients. Laboratory results, including tests for lactate dehydrogenase (LDH) and blood urea nitrogen (BUN), and the BUN/creatinine ratio (BCR) were significantly higher in embolic patients than SRAD patients. Bilateral renal involvement was detected in embolic patients more often than in SRAD patients. MDCT images of SRAD patients showed the stenosis of the true lumen, due to compression by a thrombosed false lumen. None of SRAD patients progressed to an estimated glomerular filtration rate renal disease during the follow-up period. SRAD is not a rare cause of acute renal infarction, and it has a benign clinical course. It should be considered in a differential diagnosis of acute renal infarction, particularly in patients with new-onset hypertension, unilateral renal involvement, and normal ranges of CRP, LDH, BUN, and BCR.

  8. Distal renal tubular acidosis in recurrent renal stone formers

    DEFF Research Database (Denmark)

    Osther, P J; Hansen, A B; Røhl, H F


    (1.1%) had complete distal renal tubular acidosis and 14 (15.5%) incomplete distal renal tubular acidosis. Our results confirm that distal renal tubular acidification defects are associated with a more severe form of stone disease and make distal renal tubular acidosis one of the most frequent...... metabolic disturbances in renal stone formers. Distal renal tubular acidosis (dRTA) was relatively more common in female stone formers and most often found in patients with bilateral stone disease (36%). Since prophylactic treatment in renal stone formers with renal acidification defects is available...

  9. Peroxisome proliferator-activated receptors and renal diseases. (United States)

    Wu, Jing; Chen, Lihong; Zhang, Dongjuan; Huo, Ming; Zhang, Xiaoyan; Pu, Dan; Guan, Youfei


    Peroxisome proliferator-activated receptors (PPARs) are members of the nuclear hormone receptor superfamily of ligand-dependent transcription factors. Three isoforms of PPAR, i.e., PPAR-a, -d, and -?, have been identified and are differentially expressed in various tissues, including the kidney. The target genes of PPARs are involved in diverse biological processes, including adipogenesis, lipid metabolism, insulin sensitivity, inflammatory response, reproduction, and cell growth and differentiation. PPARs have been reported to protect against renal injury through indirect systemic effects and/or direct renal effects in diabetic nephropathy, glomerulonephritis, renal cell carcinoma, acute renal failure and chronic renal disease. In this review, we summarize the role of the three identified PPAR isoforms, PPARa, -d, and -?, in renal physiology and discuss the renoprotective effects of PPAR ligands in various kidney diseases.

  10. Renal pelvis or ureter cancer (United States)

    Transitional cell cancer of the renal pelvis or ureter; Kidney cancer - renal pelvis; Ureter cancer ... Cancer can grow in the urine collection system, but it is uncommon. Renal pelvis and ureter cancers ...

  11. Two-year analysis for predicting renal function and contralateral hypertrophy after robot-assisted partial nephrectomy: A three-dimensional segmentation technology study. (United States)

    Kim, Dae Keun; Jang, Yujin; Lee, Jaeseon; Hong, Helen; Kim, Ki Hong; Shin, Tae Young; Jung, Dae Chul; Choi, Young Deuk; Rha, Koon Ho


    To analyze long-term changes in both kidneys, and to predict renal function and contralateral hypertrophy after robot-assisted partial nephrectomy. A total of 62 patients underwent robot-assisted partial nephrectomy, and renal parenchymal volume was calculated using three-dimensional semi-automatic segmentation technology. Patients were evaluated within 1 month preoperatively, and postoperatively at 6 months, 1 year and continued up to 2-year follow up. Linear regression models were used to identify the factors predicting variables that correlated with estimated glomerular filtration rate changes and contralateral hypertrophy 2 years after robot-assisted partial nephrectomy. The median global estimated glomerular filtration rate changes were -10.4%, -11.9%, and -2.4% at 6 months, 1 and 2 years post-robot-assisted partial nephrectomy, respectively. The ipsilateral kidney median parenchymal volume changes were -24%, -24.4%, and -21% at 6 months, 1 and 2 years post-robot-assisted partial nephrectomy, respectively. The contralateral renal volume changes were 2.3%, 9.6% and 12.9%, respectively. On multivariable linear analysis, preoperative estimated glomerular filtration rate was the best predictive factor for global estimated glomerular filtration rate change on 2 years post-robot-assisted partial nephrectomy (B -0.452; 95% confidence interval -0.84 to -0.14; P = 0.021), whereas the parenchymal volume loss rate (B -0.43; 95% confidence interval -0.89 to -0.15; P = 0.017) and tumor size (B 5.154; 95% confidence interval -0.11 to 9.98; P = 0.041) were the significant predictive factors for the degree of contralateral renal hypertrophy on 2 years post-robot-assisted partial nephrectomy. Preoperative estimated glomerular filtration rate significantly affects post-robot-assisted partial nephrectomy renal function. Renal mass size and renal parenchyma volume loss correlates with compensatory hypertrophy of the contralateral kidney. Contralateral hypertrophy

  12. Ability of the ankaferd blood stopper® to prevent parenchymal bleeding in an experimental hepatic trauma model (United States)

    Aysan, Erhan; Bektas, Hasan; Ersoz, Feyzullah; Sari, Serkan; Kaygusuz, Arslan; Huq, Gulben Erdem


    Hepatic parenchymal bleeding (HPB) is a major problem following both trauma and elective hepatic procedures. The present study investigated the effect of the Ankaferd Blood Stopper® (ABS) on HPB. Method(s): A total of 20 rats were used. After creating a laceration model in the left lateral hepatic lobe, the area was compressed for 3 minutes with the ABS in the rats in group 1 (n=10) and with 0.9% NaCl-soaked gauze in the rats in group 2 (n=10). Results: The mean change in haematocrit levels between baseline and the 24 hour values in group 1 was lower than group 2 (p=0.045). The mean perioperative bleeding in group 1 was lower than group 2 (p=0.003). The histopa-thologic evaluation revealed that there were no differences between the groups with respect to areas of necrosis (p=0.107) or inflammation (p=0.135). Conclusion: Although the ABS does not stop HPB completely, it ensures a statistically significant reduction in HPB. PMID:20827316

  13. Parenchymal and Stromal Cells Contribute to Pro-Inflammatory Myocardial Environment at Early Stages of Diabetes: Protective Role of Resveratrol (United States)

    Savi, Monia; Bocchi, Leonardo; Sala, Roberto; Frati, Caterina; Lagrasta, Costanza; Madeddu, Denise; Falco, Angela; Pollino, Serena; Bresciani, Letizia; Miragoli, Michele; Zaniboni, Massimiliano; Quaini, Federico; Del Rio, Daniele; Stilli, Donatella


    Background: Little information is currently available concerning the relative contribution of cardiac parenchymal and stromal cells in the activation of the pro-inflammatory signal cascade, at the initial stages of diabetes. Similarly, the effects of early resveratrol (RSV) treatment on the negative impact of diabetes on the different myocardial cell compartments remain to be defined. Methods: In vitro challenge of neonatal cardiomyocytes and fibroblasts to high glucose and in vivo/ex vivo experiments on a rat model of Streptozotocin-induced diabetes were used to specifically address these issues. Results: In vitro data indicated that, besides cardiomyocytes, neonatal fibroblasts contribute to generating initial changes in the myocardial environment, in terms of pro-inflammatory cytokine expression. These findings were mostly confirmed at the myocardial tissue level in diabetic rats, after three weeks of hyperglycemia. Specifically, monocyte chemoattractant protein-1 and Fractalkine were up-regulated and initial abnormalities in cardiomyocyte contractility occurred. At later stages of diabetes, a selective enhancement of pro-inflammatory macrophage M1 phenotype and a parallel reduction of anti-inflammatory macrophage M2 phenotype were associated with a marked disorganization of cardiomyocyte ultrastructural properties. RSV treatment inhibited pro-inflammatory cytokine production, leading to a recovery of cardiomyocyte contractile efficiency and a reduced inflammatory cell recruitment. Conclusion: Early RSV administration could inhibit the pro-inflammatory diabetic milieu sustained by different cardiac cell types. PMID:27854328

  14. Increased pressure-induced tone in rat parenchymal arterioles vs. middle cerebral arteries: role of ion channels and calcium sensitivity. (United States)

    Cipolla, Marilyn J; Sweet, Julie; Chan, Siu-Lung; Tavares, Matthew J; Gokina, Natalia; Brayden, Joseph E


    Brain parenchymal arterioles (PAs) are high-resistance vessels that branch off pial arteries and perfuse the brain parenchyma. PAs are the target of cerebral small vessel disease and have been shown to have greater pressure-induced tone at lower pressures than pial arteries. We investigated mechanisms by which brain PAs have increased myogenic tone compared with middle cerebral arteries (MCAs), focusing on differences in vascular smooth muscle (VSM) calcium and ion channel function. The amount of myogenic tone and VSM calcium was measured using Fura 2 in isolated and pressurized PAs and MCAs. Increases in intraluminal pressure caused larger increases in tone and cytosolic calcium in PAs compared with MCAs. At 50 mmHg, myogenic tone was 37 ± 5% for PAs vs. 6.5 ± 4% for MCAs (P channel (VDCC) inhibitor nifedipine than MCAs (EC50 for PAs was 3.5 ± 0.4 vs. 82.1 ± 2.1 nmol/l for MCAs;P channel inhibitor iberiotoxin, whereas MCAs constricted ∼15%. Thus increased myogenic tone in PAs appears related to differences in ion channel activity that promotes VSM membrane depolarization but not to a direct sensitization of the contractile apparatus to calcium.

  15. Iron content and acid phosphatase activity in hepatic parenchymal lysosomes of patients with hemochromatosis before and after phlebotomy treatment

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    Cleton, M.I.; de Bruijn, W.C.; van Blokland, W.T.; Marx, J.J.; Roelofs, J.M.; Rademakers, L.H.


    Lysosomal structures in liver parenchymal cells of 3 patients with iron overload and of 3 subjects without iron-storage disorders were investigated. A combination of enzyme cytochemistry--with cerium as a captive ion to demonstrate lysosomal acid phosphatase activity--and electron probe X-ray microanalysis (EPMA) was used. We were able (1) to define and quantify lysosomal structures as lysosomes, siderosomes, or residual bodies, (2) to quantify the amount of iron and cerium simultaneously in these structures, and (3) to evaluate a possible relation between iron storage and enzyme activity. With histopathologically increased iron storage, the number of siderosomes had increased at the cost of lysosomes, with a corresponding increase in acid phosphatase activity in both organelles. In histopahtologically severe iron overload, however, acid phosphatase activity was low or not detectable and most of the iron was stored in residual bodies. After phlebotomy treatment, the number of siderosomes had decreased in favor of the lysosomes, approaching values obtained in control subjects, and acid phosphatase activity was present in all iron-containing structures. In this way a relationship between iron storage and enzyme activity was established. The iron content of the individual lysosomal structures per unit area had increased with histopathologically increased iron storage and had decreased after phlebotomy treatment. From this observation, it is concluded that the iron status of the patient is not only reflected by the amount of iron-containing hepatocytes but, as well, by the iron content lysosomal unit area.

  16. The effects of hemorrhagic parenchymal infarction on the establishment of sensori-motor structural and functional connectivity in early infancy

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    Arichi, T.; Edwards, A.D. [Kings College London, St Thomas' Hospital, Department of Perinatal Imaging and Health, Division of Imaging Sciences and Biomedical Engineering, London (United Kingdom); Imperial College London, Department of Bioengineering, London (United Kingdom); Counsell, S.J.; Mondi, V.; Tusor, N.; Merchant, N. [Kings College London, St Thomas' Hospital, Department of Perinatal Imaging and Health, Division of Imaging Sciences and Biomedical Engineering, London (United Kingdom); Allievi, A.G.; Burdet, E. [Imperial College London, Department of Bioengineering, London (United Kingdom); Chew, A.T. [Kings College London, St Thomas' Hospital, Department of Perinatal Imaging and Health, Division of Imaging Sciences and Biomedical Engineering, London (United Kingdom); Imperial College Healthcare NHS Trust, Department of Paediatrics, London (United Kingdom); Martinez-Biarge, M.; Cowan, F.M. [Imperial College Healthcare NHS Trust, Department of Paediatrics, London (United Kingdom)


    The objective of the study was to characterize alterations of structural and functional connectivity within the developing sensori-motor system in infants with focal perinatal brain injury and at high risk of cerebral palsy. Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) data were used to study the developing functional and structural connectivity framework in six infants born prematurely at term equivalent age. This was first characterised in three infants without focal pathology, which was then compared to that derived from three infants with unilateral haemorrhagic parenchymal infarction and a subsequent focal periventricular white matter lesion who developed later haemiparesis. Functional responses to passive hand movement were in the contralateral perirolandic cortex, regardless of focal pathology. In infants with unilateral periventricular injury, afferent thalamo-cortical tracts appeared to have developed compensatory trajectories which circumvented areas of damage. In contrast, efferent corticospinal tracts showed marked asymmetry at term equivalent age following focal brain injury. Sensori-motor network analysis suggested that inter-hemispheric functional connectivity is largely preserved despite pathology and that impairment may be associated with adverse neurodevelopmental outcome. Following focal perinatal brain injury, altered structural and functional connectivity is already present and can be characterized with MRI at term equivalent age. The results of this small case series suggest that these techniques may provide valuable new information about prognosis and the pathophysiology underlying cerebral palsy. (orig.)

  17. Novel algorithm to identify and differentiate specific digital signature of breath sound in patients with diffuse parenchymal lung disease. (United States)

    Bhattacharyya, Parthasarathi; Mondal, Ashok; Dey, Rana; Saha, Dipanjan; Saha, Goutam


    Auscultation is an important part of the clinical examination of different lung diseases. Objective analysis of lung sounds based on underlying characteristics and its subsequent automatic interpretations may help a clinical practice. We collected the breath sounds from 8 normal subjects and 20 diffuse parenchymal lung disease (DPLD) patients using a newly developed instrument and then filtered off the heart sounds using a novel technology. The collected sounds were thereafter analysed digitally on several characteristics as dynamical complexity, texture information and regularity index to find and define their unique digital signatures for differentiating normality and abnormality. For convenience of testing, these characteristic signatures of normal and DPLD lung sounds were transformed into coloured visual representations. The predictive power of these images has been validated by six independent observers that include three physicians. The proposed method gives a classification accuracy of 100% for composite features for both the normal as well as lung sound signals from DPLD patients. When tested by independent observers on the visually transformed images, the positive predictive value to diagnose the normality and DPLD remained 100%. The lung sounds from the normal and DPLD subjects could be differentiated and expressed according to their digital signatures. On visual transformation to coloured images, they retain 100% predictive power. This technique may assist physicians to diagnose DPLD from visual images bearing the digital signature of the condition. © 2015 Asian Pacific Society of Respirology.

  18. Involvement of α-Klotho in development of renal secondary hyperparathyroidism%α-Klotho在肾性甲状旁腺功能亢进患者甲状旁腺组织中表达的研究

    Institute of Scientific and Technical Information of China (English)

    闫军放; 郝丽; 张凌; 姚力; 李铎


    Objective To investigate α-Klotho protein in the role of renal hyperparathyroidism development. Methods Hyperplas-tic parathyroid glands(n =50)were obtained from 14 patients with renal secondary hyperparathyroidism and surgically resected at China-Ja-pan Friendship Hospital. Normal parathyroid was obtained from glands inadvertently removed in conjunction with thyroidectomy from patients (n=5)with thyroid carcinoma. Immunohistochemical staining was used to detect the level ofα-Klotho protein in parathyroid. Results Com-pared with the normal parathyroid,the level ofα-Klotho protein was significantly reduced in hyperplastic parathyroid(30. 3% VS 9. 9%),and with the progress of parathyroid pathological degree of further reducing(diffuse type 12. 2%,nodular type 10. 1%,adenomatoid type 8. 2%). Conclusion The expression of α-Klotho protein decreases in hyperplastic parathyroid,which may play an important role in the pathogenesis of secondary hyperparathyroidism.%目的 探讨甲状旁腺α-Klotho蛋白在肾性甲状旁腺功能亢进发生、发展中的作用.方法 入选14例因尿毒症伴甲状旁腺功能亢进而在中日友好医院行甲状旁腺切除术的患者,并收集增生的甲状旁腺50枚;5例甲状腺癌患者因甲状腺手术而连带切除的甲状旁腺5枚作为对照组.用免疫组织化学染色法检测甲状旁腺α-Klotho蛋白的表达水平.结果 与正常甲状旁腺相比,增生的甲状旁腺α-Klotho蛋白表达显著减少(30.3%VS 9.9%),且随着甲状旁腺病理程度的进展而进一步下降(弥漫性增生12.2%,结节性增生10.1%,腺瘤样增生8.2%).结论 尿毒症患者增生的甲状旁腺α-Klotho蛋白表达明显减少,可能在肾性继发性甲状旁腺功能亢进的发生、发展过程中起重要作用.

  19. Gene profile of chemokines on hepatic stellate cells of schistosome-infected mice and antifibrotic roles of CXCL9/10 on liver non-parenchymal cells. (United States)

    Liang, Yue-jin; Luo, Jie; Lu, Qiao; Zhou, Ying; Wu, Hai-wei; Zheng, Dan; Ren, Yong-ya; Sun, Ke-yi; Wang, Yong; Zhang, Zhao-song


    Hepatic stellate cells (HSCs) play a key role in the development of liver fibrosis caused by schistosomiasis. Chemokines were widely expressed and involved in cellular activation, proliferation and migration in inflammatory and infectious diseases. However, little is known about the expressions of chemokines on HSCs in the schistosoma infection. In addition, the roles of chemokines in pathogenesis of liver fibrosis are not totally clear. In our study, we used microarray to analyze the temporal gene expressions of primary HSCs isolated from mice with both acute and chronic schistosomiasis. Our microarray data showed that most of the chemokines expressed on HSCs were upregulated at 3 weeks post-infection (p.i) when the egg granulomatous response was not obviously evoked in the liver. However, some of them like CXCL9, CXCL10 and CXCL11 were subsequently decreased at 6 weeks p.i when the granulomatous response reached the peak. In the chronic stage, most of the differentially expressed chemokines maintained persistent high-abundances. Furthermore, several chemokines including CCR2, CCR5, CCR7, CXCR3, CXCR4, CCL2, CCL5, CCL21, CXCL9 and CXCL10 were expressed by HCSs and the abundances of them were changed following the praziquantel treatment in the chronic stage, indicating that chemokines were possibly necessary for the persistence of the chronic stage. In vitro experiments, hepatic non-parenchymal cells, primary HSCs and human HSCs line LX-2 were stimulated by chemokines. The results showed that CXCL9 and CXCL10, but not CXCL11 or CXCL4, significantly inhibited the gene expressions of Col1α1, Col3α1 and α-SMA, indicating the potential anti-fibrosis effect of CXCL9 and CXCL10 in schistosomiasis. More interestingly, soluble egg antigen (SEA) of Schistosoma japonicum was able to inhibit transcriptional expressions of some chemokines by LX-2 cells, suggesting that SEA was capable of regulating the expression pattern of chemokine family and modulating the hepatic immune

  20. Assessment of Differential Renal Function in Children with Hydronephrosis: Comparison of DMSA and MAG-3

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    Cem Akbal


    Full Text Available Objective Nuclear imaging techniques such as 99mTc-dimercaptosuccinic acid (DMSA and 99mTc-mercaptoacetyltriglycine (MAG-3 are widely used for the diagnosis and follow-up of urinary tract obstructions. Both imaging techniques provide the differential renal function (DRF in slightly different ways. The aim of this study was to assess the MAG-3 scan as an adjunct or alternative to DMSA for evaluating DRF in children with hydronephrosis. Materials and Methods Eighty-one patients with hydronephrosis were enrolled in this study. Patient age, sex, anteroposterior renal pelvis diameter (RPD at the time of diagnosis, parenchymal thickness and the DRF percentage found by both DMSA and MAG-3 were recorded. DMSA scintigraphy was used for detecting renal scars and estimating DRF. MAG-3 scintigraphy was used for evaluation of renal clearance, the collecting system’s outflow pattern and estimating DRF. Results A total of 102 renal units (38 left, 22 right and 21 bilateral were evaluated. High correlation rates were found when we compared both tests’ DRF values according to antero-posterior renal pelvic diameter and patient age (p>0.05. In all groups compared in the present study, both tests demonstrated very similar results and DRF values. Statistical analysis of cut-offs (45%, 40%, 10% were also similar in both methods (p>0.05, kappa >0.7, r=0.926 Pearson. Conclusion DMSA and MAG-3 are tests that are of assistance in the evaluation of hydronephrosis. Compared to DMSA, MAG-3 also provides valuable information to evaluate DRF values in hydronephrotic renal unit (RU. Avoiding unnecessary DMSA imaging will save time and cost and prevent over-radiation of the pediatric population.

  1. Mid-Term Vascular Safety of Renal Denervation Assessed by Follow-up MR Imaging

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    Schmid, Axel, E-mail:; Schmieder, Raphael; Lell, Michael; Janka, Rolf [Friedrich-Alexander University Erlangen-Nuremberg, Department of Radiology (Germany); Veelken, Roland; Schmieder, Roland E. [Friedrich-Alexander University Erlangen-Nuremberg, Department of Nephrology and Hypertension (Germany); Uder, Michael [Friedrich-Alexander University Erlangen-Nuremberg, Department of Radiology (Germany); Ott, Christian [Friedrich-Alexander University Erlangen-Nuremberg, Department of Nephrology and Hypertension (Germany)


    Background/AimsRenal denervation (RDN) emerged as a treatment option for reducing blood pressure (BP) in patients with treatment-resistant hypertension (TRH). However, concerns have been raised regarding the incidence of late renal artery stenosis or thromboembolism after RDN. The goal of the current study was, therefore, to conduct a prospective clinical trial on the mid-term vascular integrity of the renal arteries and the perfusion of the renal parenchyma assessed by magnetic resonance imaging (MRI) in the follow-up after catheter-based RDN.MethodsIn our single-centre investigator initiated study, 51 patients with true TRH underwent catheter-based RDN using the Symplicity Flex{sup TM} catheter (Medtronic Inc., Palo Alto, CA). Follow-up MRI was performed at a median of 11 months (interquartile range 6–18 months) after RDN on a 1.5T MR unit. High-resolution MR angiography (MRA) and MRI results were compared to the baseline digital angiography of renal arteries obtained at time of RDN. In case of uncertainties (N = 2) catheter angiography was repeated.ResultsBoth office and 24-h ambulatory BP were significantly reduced 6 and 12 months after RDN. Renal function remained unchanged 6 and 12 months after RDN. In all patients, MRA excluded new or progression of pre-existing low grade renal artery stenosis as well as focal aneurysms at the sites of radiofrequency ablation. In none of the patients new segmental perfusion deficits in either kidney were detected on MRI.ConclusionsNo vascular or parenchymal complications after radiofrequency-based RDN were detected in 51 patients followed up by MRI.

  2. Statins and progressive renal disease. (United States)

    Buemi, Michele; Senatore, Massimino; Corica, Francesco; Aloisi, Carmela; Romeo, Adolfo; Cavallaro, Emanuela; Floccari, Fulvio; Tramontana, Domenico; Frisina, Nicola


    Thanks to the administration of hypocholesterolemic drugs, important advances have been made in the treatment of patients with progressive renal disease. In vitro and in vivo findings demonstrate that statins, the inhibitors of HMG-CoA reductase, can provide protection against kidney diseases characterized by inflammation and/or enhanced proliferation of epithelial cells occurring in rapidly progressive glomerulonephritis, or by increased proliferation of mesangial cells occurring in IgA nephropathy. Many of the beneficial effects obtained occur independent of reduced cholesterol levels because statins can directly inhibit the proliferation of different cell types (e.g., mesangial, renal tubular, and vascular smooth muscle cells), and can also modulate the inflammatory response, thus inhibiting macrophage recruitment and activation, as well as fibrosis. The mechanisms underlying the action of statins are not yet well understood, although recent data in the literature indicate that they can directly affect the proliferation/apoptosis balance, the down-regulation of inflammatory chemokines, and the cytogenic messages mediated by the GTPases Ras superfamily. Therefore, as well as reducing serum lipids, statins and other lipid-lowering agents may directly influence intracellular signaling pathways involved in the prenylation of low molecular weight proteins that play a crucial role in cell signal transduction and cell activation. Statins appear to have important potential in the treatment of progressive renal disease, although further studies are required to confirm this in humans.

  3. Enhanced thermal stability of lysosomal beta-D-galactosidase in parenchymal cells of tumour bearing mice. (United States)

    Lenti, L; Lipari, M; Lombardi, D; Zicari, A; Dotta, A; Pontieri, G M


    The thermal stability of the enzyme beta-D-galactosidase varies among different organs in normal C57Bl/6 mice, and increases in the same organs in mice with Lewis Lung carcinoma. Thermal stability of this enzyme is also increased by treatment of the mice with cell-free extracts of tumour cells or with inflammatory compounds such as carrageenan or orosomucoid. After desialylation, orosomucoid more effectively increases the heat stability of the enzyme. By contrast talc, which has no galactosyl groups, is without effect on the stability of the enzyme in vivo. Macrophages of tumour bearing mice release into the culture medium a more heat resistant enzyme than macrophages from control mice. In both cases the heat resistance of the secreted enzyme is higher when fetal calf serum is present in the culture medium. Bovine serum does not modify the thermal stability of beta-D-galactosidase in this system. Incubation of lysosomal fractions of various organs with the synthetic beta-D-galactosidase substrate, p-nitrophenyl-galactopyranoside, also strongly increases the heat resistance of the enzyme. The results suggest that one factor influencing the heat resistance of this enzyme may be complex formation between the enzyme and its substrates, an example of substrate protection of the enzyme. This may not be the only factor involved in enzyme stabilization in vivo.

  4. The Renal Protective Effects of Corn Silk and Feijoa by using in situ Rat Renal System

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    Mohammad Karami


    Full Text Available Background: Corn silk (CS is widely used in Iranian traditional medicine. Feijoa sellowiana (FS, on the other hand, is a non-native plant widespread in the southern part of Iran. The aim of the present study was to examine the renal protective activity of CS and FS against dosage-induced ecstasy (MDMA by in situ rat renal perfusion (IRRP system. Methods: Hydro-alcoholic extracts of CS and FS (10, 20, 40 and 100 mg/ kg were studied for their renal protective activities by IRRP system. In this study, the kidneys were perfused with Kerbs-Henseleit buffer, containing different concentrations of hydro-alcoholic (HA extracts of CS and FS (10, 20, 40, 50, and 100mg/kg added to the buffer and perfused for two hours. During the perfusion, many factors, including urea, creatinine and GSH levels assessed as indicator of renal viability. Consequently, sections of renal tissue were examined for any histopathological changes. Results: The results showed that histopathological changes in renal tissue related to HA extract of CS AND FS concentrations dose-dependently. Doses of 50, 100 mg/kg caused significant histopathological changes (P<0.05. Glutathione (GSH levels of samples perfused by HA extract of CS and FS increased compared with the positive control group. Conclusion: Renal protective effects of CS and FS decrease lipid peroxidation, although other mechanisms may also be involved.

  5. Utility of renal biopsy in the clinical management of renal disease. (United States)

    Dhaun, Neeraj; Bellamy, Christopher O; Cattran, Daniel C; Kluth, David C


    Characterizing chronic kidney disease (CKD) at all stages is an essential part of rational management and the renal biopsy plays a key role in defining the processes involved. There remain no global guidelines available to the renal community on indications for this important diagnostic, prognostic, and relatively safe test. Although most nephrologists recognize several clear indications for a renal biopsy, it is still underutilized. It not only helps the clinician to manage the patient with CKD, but it can also help clarify the epidemiology of CKD, and aid research into the pathobiology of disease with the aim of discovering new therapies. It may be useful for instance in elderly patients with CKD, those with diabetes and presumed 'hypertensive nephropathy', and in some patients with advanced CKD as part of the pretransplant work-up. In some populations (for example, immunoglobulin A nephropathy and ANCA vasculitis), renal biopsy allows disease classification that may predict CKD progression and response to therapy. For the individual, interval renal biopsy may be of use in providing ongoing therapeutic and prognostic information. Molecular advances will change the landscape of renal pathology and add a new dimension to the diagnostic precision of kidney biopsy. Organizing the multiplicity of information available in a renal biopsy to maximize benefits to the patient, as well as to the epidemiologist and researcher, is one of the challenges that face the nephrology community.

  6. Identifying Triple-Negative Breast Cancer Using Background Parenchymal Enhancement Heterogeneity on Dynamic Contrast-Enhanced MRI: A Pilot Radiomics Study.

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    Jeff Wang

    Full Text Available To determine the added discriminative value of detailed quantitative characterization of background parenchymal enhancement in addition to the tumor itself on dynamic contrast-enhanced (DCE MRI at 3.0 Tesla in identifying "triple-negative" breast cancers.In this Institutional Review Board-approved retrospective study, DCE-MRI of 84 women presenting 88 invasive carcinomas were evaluated by a radiologist and analyzed using quantitative computer-aided techniques. Each tumor and its surrounding parenchyma were segmented semi-automatically in 3-D. A total of 85 imaging features were extracted from the two regions, including morphologic, densitometric, and statistical texture measures of enhancement. A small subset of optimal features was selected using an efficient sequential