RESUMEN

BACKGROUND: Kidneys with double renal arteries are used on a routine basis nowadays, and separate anastomosis in situ is one of the suitable arterial anastomosis procedures. The commonly used methods are parallel end-to-side anastomoses of double arteries to the external iliac artery, and end-to-end anastomosis to the internal iliac artery combined with end-to-side anastomosis to the external iliac artery. No studies have compared the prognoses of the two procedures in deceased kidney transplantation. METHODS: We retrospectively analyzed 35 consecutive deceased kidney transplantations with double arterial anastomoses in the urology department of China-Japan Friendship Hospital from January 2018 to April 2021. Group I comprised recipients with double parallel end-to-side anastomoses to the external iliac artery; Group II comprised the others. Their prognoses were then compared. RESULTS: There were no significant differences between Group I and II in characteristics of recipients and donors. The mean eGFRs at 1, 3, 6 and 12 months post-transplant in Group I and II were 36.4 vs 54.1 (P = 0.009), 40.4 vs 54.4 (P = 0.02), 40.4 vs 56.9 (P = 0.02) and 39.8 vs 57.9 (P = 0.007) mL/min respectively. There was no difference in early postoperative complications and 1-year survival rates between the two groups (P = 1.00). CONCLUSION: Separate anastomosis is a reliable procedure for deceased kidney transplantation with double arteries. Double separate anastomoses to the external and internal iliac arteries have better graft function compared with double parallel anastomoses to the external iliac artery during the first year after transplantation.

RESUMEN

BACKGROUND: Renal artery variations are clinically significant due to their implications for surgical procedures and renal function. However, data on these variations in Sudanese populations are limited. This study aimed to determine the prevalence and characteristics of renal artery variations in a Sudanese population. METHODS: A cross-sectional retrospective study was conducted in Khartoum state from October 2017 to October 2020. A total of 400 Sudanese participants who underwent abdominal CT scans were included. Data on demographic characteristics, kidney measurements, and renal vasculature were collected and analyzed using descriptive statistics and inferential tests. RESULTS: The mean age of participants was 46.7 ± 18 years, with a nearly equal gender distribution. Overall, renal artery variations were present in 11% of participants, with accessory renal arteries observed in 6% of the study population. Among those with accessory vessels, 50% were on the right side, 29.2% on the left, and 20.8% bilateral, distributed across hilar 29.2%, lower polar 29.2%, and upper polar 41.7% regions. No significant associations were found between accessory renal arteries and age or gender (p-value > 0.05). However, participants with accessory renal arteries exhibited significantly narrower width 5.0 ± 1.4 than those with no with accessory renal arteries 5.8 ± 1.1 (p-value 0.002) Early dividing renal arteries were found in 5% of participants, with nearly half being bilateral. No significant associations were found between the presence of early dividing renal arteries and demographic or renal measurements (p-value > 0.05). CONCLUSION: This study provides valuable insights into the prevalence and characteristics of renal artery variations in a Sudanese population. The findings contribute to our understanding of renal anatomy in this demographic and can inform clinical practice and surgical planning, particularly in renal transplantation and other renal procedures.

Asunto(s)

RESUMEN

The mechanisms behind renal vasodilatation elicited by stimulation of ß-adrenergic receptors are not clarified. As several classes of K channels are potentially activated, we tested the hypothesis that KV7 and BKCa channels contribute to the decreased renal vascular tone in vivo and in vitro. Changes in renal blood flow (RBF) during ß-adrenergic stimulation were measured in anaesthetized rats using an ultrasonic flow probe. The isometric tension of segmental arteries from normo- and hypertensive rats and segmental arteries from wild-type mice and mice lacking functional KV7.1 channels was examined in a wire-myograph. The ß-adrenergic agonist isoprenaline increased RBF significantly in vivo. Neither activation nor inhibition of KV7 and BKCa channels affected the ß-adrenergic RBF response. In segmental arteries from normo- and hypertensive rats, inhibition of KV7 channels significantly decreased the ß-adrenergic vasorelaxation. However, inhibiting BKCa channels was equally effective in reducing the ß-adrenergic vasorelaxation. The ß-adrenergic vasorelaxation was not different between segmental arteries from wild-type mice and mice lacking KV7.1 channels. As opposed to rats, inhibition of KV7 channels did not affect the murine ß-adrenergic vasorelaxation. Although inhibition and activation of KV7 channels or BKCa channels significantly changed baseline RBF in vivo, none of the treatments affected ß-adrenergic vasodilatation. In isolated segmental arteries, however, inhibition of KV7 and BKCa channels significantly reduced the ß-adrenergic vasorelaxation, indicating that the regulation of RBF in vivo is driven by several actors in order to maintain an adequate RBF. Our data illustrates the challenge in extrapolating results from in vitro to in vivo conditions.

Asunto(s)

RESUMEN

BACKGROUND: Fibromuscular dysplasia is an idiopathic, segmental, nonatherosclerotic, noninflammatory vascular disease that can lead to arterial stenosis, tortuosity, occlusion, aneurysms, and dissection. Fibromuscular dysplasia is a rare cause of hypertension that can easily be missed. To date, there has been no definitive treatment for fibromuscular dysplasia. CASE REPORT: In this report, we present an uncommon case of renovascular hypertension in a 21-year-old non-white female with a 3-year history of hypertension secondary to fibromuscular dysplasia involving bilateral renal arteries. Computed tomography angiography during the arterial phase revealed distal focal narrowing of the right main renal artery, distal focal narrowing of the left main renal artery, and proximal focal narrowing of the left accessory lower renal artery. Percutaneous balloon dilatation of the stenotic lesion was performed successfully up to 1 year After the procedure, the arterial blood pressure was within the normal range (110/70 to 125/75 mmHg) without medication. After 1 year of follow-up, CTA revealed re-stenosis in left main renal artery without clinical symptoms and normal blood pressure. Repeated procedure was done successfully. CONCLUSIONS: This case report highlights the difficulty in the diagnosis and treatment of focal fibromuscular dysplasia in young non-white female patients. Computerized tomographic angiography is a useful tool for identifying the cause and showing the benefit of percutaneous transluminal renal angioplasty treatment for this rare entity, as an early percutaneous angioplasty intervention may have a clinical cure for hypertension.

Asunto(s)

RESUMEN

A 60-year-old man underwent open surgery for chronic dissecting abdominal aorta accompanied with a horseshoe kidney. Through open laparotomy, the abdominal aortic aneurysm was exposed without revision of the horseshoe kidney. Cold ringer solution was infused to accessory renal arteries for renal protection. After supra-renal clamping, proximal anastomosis was then performed at the level just below the renal arteries. Abdominal cross clamp time at the level of the supra-renal arteries was 23 min. Median and right accessory arteries were reattached with an ischemic time of 73 and 103 min, respectively. Although serum creatine was elevated a preoperative level of 1.17 mg/dl to 3.63 mg/dl at postoperative day 2, that was gradually decreased to nearly preoperative level of 1.25 mg/dl at discharge. Postoperative enhanced CT demonstrated patency of the reattached accessory arteries. The patient was discharged without major complication on postoperative day 21. One year postoperatively, his follow-up course was uneventful without deterioration of renal function.

RESUMEN

The aim of the present paper is to contribute to the understanding of the history of the anatomical study of the intra-renal arteries. The vasculature and especially the intra-renal arteries of the kidneys are an intriguing field which was first studied through art and then perfected by medicine. Angiography and microsurgery have resulted in partial nephrectomy techniques for surviving kidneys with adequate functional results. Graves' categorization dating from 1954 opened the way for innovative approaches that have resulted in modern topographical anatomy. CONCLUSION: Our understanding of the anatomy of intra-renal arteries has played a significant role in surgical anatomy and internal medicine.

Asunto(s)

RESUMEN

This case report describes a 59-year-old male patient after heart and kidney transplantation, subsequently diagnosed with refractory hypertension since implemented antihypertensive pharmacotherapy consisting of six agents did not provide a substantial therapeutic response. Elevated blood pressure and its impact on a hypertrophied transplanted heart and impaired renal graft function have led to a significant deterioration in the patient's cardiovascular risk profile. To address this issue, a native renal arteries denervation was performed. It resulted in a noteworthy decrease in both systolic and diastolic pressure values, thus manifesting a positive hypotensive effect. Furthermore, a sustainable reduction of left ventricular mass and stabilization in kidney graft function were noticed. The presented case provides evidence that renal denervation can be an efficacious complementary treatment method in individuals who received kidney and heart grafts as it leads to a decrease in cardiovascular risk.

RESUMEN

Hypertension remains the leading cause of death worldwide. Despite advances in drug-based treatment, many patients do not achieve target blood pressure. In recent years, there has been an increased interest in invasive hypertension treatment methods. Long-term effects and factors affecting renal denervation effectiveness are still under investigation. Some investigators found that the renal arteries' morphology is crucial in renal denervation effectiveness. Accessory renal arteries occur in 20-30% of the population and even more frequently in patients with resistant hypertension. Diversity in renal vascularization and innervation may complicate the renal denervation procedure and increase the number of people who will not benefit from treatment. Based on previous studies, it has been shown that the presence of accessory renal arteries, and in particular, the lack of their complete denervation, reduces the procedure's effectiveness. The following review presents the anatomical assessment of the renal arteries, emphasizing the importance of imaging tests. Examples of imaging and denervation methods to optimize the procedure are presented. The development of new-generation catheters and the advancement in knowledge of renal arteries anatomy may improve the effectiveness of treatment and reduce the number of patients who do not respond to treatment.

RESUMEN

INTRODUCTION: The aim of the study is to evaluate the vascular variations and incidental pathologies in potential living renal donors using 160-slice multidetector computed tomography (MDCT) angiography. METHODS: This is an observational study conducted at the Department of Radiology from January 2017 to May 2022. In this study, we performed retrospective data analysis of 61 CT renal angiograms, totaling 122 kidneys of potential renal donors, using a Toshiba 160 slice MDCT scanner with a four-phase CT image acquisition protocol, performed for pre-transplant workup. All patients had normal renal functions. RESULTS: Of our 61 patients, 34 (55.7%) were male and 27 (44.3%) were female, and their mean age was 31.2 ± 9.4 years. We have found 31 (50.8%) variations in the right renal arteries and 21 (34.4%) in the left renal arteries. Of these patients, 13 had bilateral renal arterial variations. The late confluence of the renal vein was found in 3.3% of males, multiple right renal veins in 7 (11.5%), and left renal veins in 2 (3.3%). By distributing the data according to gender, we noticed more diversity in the renal vessels of male patients. Left renal artery variations were more frequent in males (16, 76.2%) than in females (5, 23.8%), and they were statistically significant (p=0.02). Likewise, variations in the right renal arteries were also more frequently found in males (19, 61.3%) as compared to females (12, 38.7%). Right renal vein variations were more common in males (9, 81.8%) as compared to females (2, 18.2%) (p=0.05). CONCLUSION: Frequent renal vascular variations and incidental pathologies in potential living donors were found by MDCT examination, and these vascular variations should be analyzed before renal transplant.

Asunto(s)

RESUMEN

INTRODUCTION: Grafts with multiple renal arteries (MRAs) were historically considered a relative contraindication to transplantation due to the higher risk of vascular and urologic complications. This study aimed to evaluate graft and patient survival between single renal artery (SRA) and MRA living-donor kidney transplants. METHODS: An electronic literature search was conducted on PubMed, EMBASE, and Scopus for prospective or retrospective studies comparing SRA versus MRA in living donor renal transplantation, with the provision of Kaplan-Meier curves for recipient overall survival (OS) or graft survival (GS). A graphical reconstructive algorithm was used to obtain OS and GS of individual patients, which was then pooled under random-effects individual patient data (IPD) meta-analysis using Cox-models to determine hazard ratios (HRs) and 95% confidence intervals (CIs). Meta-regression of baseline covariates versus HRs of OS and GS was performed for variables reported in 10 or more studies. RESULTS: Fourteen studies were retrieved, of which 13 (8400 patients) reported OS and 9 (6912 patients) reported GS. There were no significant differences in OS (shared-frailty HR = .94, 95%CI = .85-1.03, p = .172) or GS (shared-frailty HR = .95, 95%CI = .83-1.08, p = .419) between SRA and MRA. This comparison remained non-significant even when restricted to open- or laparoscopic-only studies. Meta-regression yielded no significant associations of GS with donor age, recipient age, and percentage of double renal arteries within the MRA arm. CONCLUSIONS: The similar rates of GS and OS between MRA and SRA grafts suggest that there is no need for discrimination between the two when evaluating donors for nephrectomy.

Asunto(s)

RESUMEN

A unique combination of triple abnormality in a willed male body donor dissection, with putative clinicopathological correlations during the subject's lifetime, is described in this case report. The subject had a three-piece artificial urinary sphincter surgically implanted around the proximal corpus spongiosum, left scrotal pouch and in the lower left abdominal wall, ostensibly for urinary incontinence during his lifetime, though the etiology of the latter was not immediately obvious. He also had a total of three accessory renal arteries involving both sides, complicated by bilateral diffuse renal atrophy from presumable glomerulosclerosis or nephrosclerosis-induced nephrotic syndrome. While each entity may not be so unique per se, each is not too common either. The combination of all three findings has not been described to date in the contemporary literature in a single male cadaver dissection. Only seven reports of artificial urinary sphincter studies on human cadaver subjects could be detected in contemporary literature, this being the eighth. Finally, there were no apparent etiopathological or pathogenetic mechanisms to explain the occurrence of each or the coexistence of all of them in a single male cadaveric subject. The artificial urinary sphincter was reviewed with respect to its characteristics, placement, and efficacy. An attempt was made to establish the cause-effect relationship between the artificial sphincter and urinary incontinence that necessitated the implant. Thereafter, a clinicopathological correlation was proposed in this case report to reconcile the concomitance of urinary incontinence, bilateral accessory renal arteries, and bilateral renal atrophy. An embryogenetic mechanism of the aberrant renal arteries was also suggested. Physician awareness from the standpoint of preoperative investigation of such cases was also highlighted.

RESUMEN

Introduction: To date, there is no unified approach to the lobar, zonal, and segmental structure of the kidney vasculature. There is no recognizable approach to define basic characteristics in regard to the lobes and segments identifying of the kidney. The branching of the renal artery has often been the subject of scientific research. This study aimed to analyze the arterial anatomy on the basis of zonal and segmental topography. Materials and methods: This study is a prospective cadaver study on autopsy material using corrosion casting and CT imaging techniques. The arterial vasculature was visualized using corrosive casting. In this study, 116 vascular casts were included. We identified the number of arteries in the kidney hilum, their topography, branching variations of the renal artery, and local blood supply zones of renal masses considering second- and third-order renal artery branches. We used a micro-CT BRUKER SkyScan 1178, digital camera, Mimics-8.1, and R. Results: This study has shown that RA divides into two or three zonal arteries, forming a two- or three-zonal vascular supply system. In the case of the two-zonal system, 54.3% of cases accounted for RA branching into ventral and dorsal arteries, whereas 15.5% of cases referred to superior polar and inferior polar zonal arteries. The three-zonal system implies 4 types of RA branching: 1) superior polar, ventral, and dorsal zonal branches (12.9%); 2) ventral, dorsal, and inferior polar zonal branches (9.5%); 3) two ventral and one dorsal zonal branches (5.2%), and 4) superior polar, central, and inferior polar zonal branches (2.5%). Conclusions: The results of this research make us reconsider Grave's classification theory.

RESUMEN

Takayasu arteritis is an idiopathic vasculitis that typically involves the aorta and its major branches. It is more common in women and has the highest prevalence in Asia. Imaging studies are crucial for establishing the diagnosis and for determining the extent of the disease. We present the case of a 47-year-old man who presented with a complaint of anuria and generalized weakness for the last three days. He reported a history of generalized abdominal pain for the last two weeks. His vital signs were within normal limits, but the systolic blood pressure in the lower limb was lower by 60 mmHg compared with that of the upper limb. Notably, the pulses were very faint on palpation. Laboratory investigations revealed deranged renal function parameters. Ultrasound examination showed increased renal parenchymal echogenicity bilaterally with elevated peak systolic velocity of the main renal artery on spectral Doppler. Further investigation by computed tomography demonstrated near-complete thrombosis of the abdominal aorta distal to the origin of the celiac artery and extending to the common iliac arteries with the involvement of bilateral renal arteries. Immunological investigations, including antinuclear antibody (ANA), double-stranded deoxyribonucleic acid (dsDNA), cyclic antineutrophil cytoplasmic antibody (c-ANCA), and perinuclear antineutrophil cytoplasmic antibody (p-ANCA), revealed negative results. However, the positron emission tomography showed markedly diffuse and circumferential increased uptake in the walls of the aorta, subclavian arteries, and femoral arteries. The patient underwent successful endovascular treatment with catheter-directed thrombolysis. High clinical suspicion is required to identify renal artery thrombosis since the clinical symptoms are non-specific. Early diagnosis is crucial to allow for prompt therapeutic interventions.

RESUMEN

Primary aldosteronism (PA) is the most frequent form of secondary endocrine hypertension, which is characterized by excessive aldosterone secretion and suppressed renin. The currently recommended diagnostic algorithm is very clear, and the plasma aldosterone-to-renin ratio (ARR) is considered the first-line screening test. However, this indicator is influenced by many factors, some of which may cause false-negative results, consequently leading to underdiagnosed PA. Here, we report the rare case of a 38-year-old man who presented with bilateral accessory renal arteries and aldosterone-producing adenoma but had a negative ARR test result.

RESUMEN

Resistant hypertension consists in the failure to achieve effective control of blood pressure despite the use of at least three drugs, including a diuretic, at the maximum tolerated dosage. Despite the progress made in terms of improving awareness and effectiveness of the available therapeutic strategies, the percentage of patients with resistant hypertension represents up to 18% of the entire hypertensive population. The management of resistant hypertension includes the combination of different strategies from lifestyle changes to complex interventional procedures. Lifestyle interventions include reducing salt intake, weight loss, quitting smoking and alcohol consumption, and performing aerobic physical activity. With regard to drug therapy, international guidelines recommend the introduction of a mineralocorticoid receptor antagonist or, if not tolerated, of a loop diuretic, or of the beta-blocker bisoprolol, or of the alpha-blocker doxazosin. In the last few years, promising results have been obtained from studies that have evaluated the efficacy and safety of the denervation of the renal arteries by ablation. This procedure may constitute an increasingly widespread option for those patients suffering from resistant hypertension despite the use of different drug classes, or who are intolerant or poorly adherent to medical therapy.

RESUMEN

Background: Kidney allografts with multiple renal arteries (MRA) are not infrequent and have been historically associated with a higher risk of developing vascular and urologic complications. Reports of kidney transplantation using MRA allografts in the pediatric population remain scarce. The aim of this study was to evaluate if transplantation of allografts with MRA with a surgical intent of creating a single arterial inflow using vascular reconstruction techniques when required, and without the routine use of surgical drains or ureteral stents, is associated with an increased risk of complications when compared to single renal artery (SRA) grafts. Methods: We retrospectively analyzed all pediatric renal transplant recipients performed by a single surgeon at our center between January 2015 and June 2022. Donor and recipient demographics, intraoperative data, and recipient outcomes were included. Recipients were divided into two groups based on SRA vs. MRA. Baseline variables were described using frequency distributions for categorical variables and means and standard errors for continuous variables. Comparisons of those distributions between the two groups were performed using standard chi-squared and t-tests. Time-to-event distributions were compared using the log-rank test. Results: Forty-nine pediatric transplant recipients were analyzed. Of these, 9 had donors with MRA (Group 1) and 40 had donors with SRA (Group 2). Native kidney and liver mobilization was performed in 44.4% (4/9) of Group 1 vs. 60.0% (24/40) of Group 2 cases (p = 0.39). There were no cases of delayed graft function or graft primary nonfunction. No surgical drainage or ureteral stents were used in any of the cases. One patient in Group 2 developed a distal ureter stricture. The geometric mean serum creatinine at 6- and 12-months posttransplant was 0.7 */ 1.2 and 0.9 */ 1.2 mg/dl in Group 1 and 0.7 */ 1.1 and 0.7 */ 1.1 mg/dl in Group 2. Two death-censored graft failures were observed in Group 2, with no significant difference observed between the two groups (p = 0.48). Conclusions: Our study demonstrates that pediatric renal transplantation with MRA grafts, using a surgical approach to achieve a single renal artery ostium, can be safely performed while achieving similar outcomes as SRA grafts and with a low complication rate.

RESUMEN

The kidneys and ureters are retroperitoneal structures in the upper part of the paravertebral gutters, tilted against the structures on the sides of the lowest two thoracic and upper three lumbar vertebrae, so that their anterior and posterior surfaces face antero-laterally and postero-medially, respectively. Congenital anomalies of the urinary tract are often the underlying cause of renal pathologies; 40% of these pathological conditions are due to variations in location, shape, and size of the kidney(s), calyces, ureter, or bladder. This case report describes the presence of a unilateral non-rotated left kidney with vascular and ureter variations found during routine cadaveric dissection for medical graduates. Alterations in rotation of the kidney and its relation to structures at the hilum have great clinical significance when conducting surgical procedures like partial nephrectomy, nephron sparing surgery, and renal transplantation.

Os rins e o ureter são estruturas retroperitoneais localizadas na parte superior do sulco paravertebral, inclinados contra as estruturas laterais das duas vértebras torácicas inferiores e das três vértebras lombares superiores. Assim, as superfícies anteriores e posteriores estão nas porções anterolateral e posteromedial, respectivamente. As anomalias congênitas do trato urinário frequentemente são causas subjacentes de patologias renais, e 40% delas ocorrem devido a variações no local, formato e tamanho dos rins, cálices, ureter ou bexiga. Este relato de caso descreve a presença de rim esquerdo unilateral sem rotação com variações vasculares e de ureter encontradas durante uma dissecção de cadáver rotineira com graduandos de Medicina. As alterações na rotação do rim e a sua relação com as estruturas no hilo têm grande importância clínica durante procedimentos cirúrgicos como a nefrectomia parcial, a cirurgia poupadora de néfrons e o transplante renal.

RESUMEN

Having multiple renal arteries (MRA) has been linked to hypertension development. Whether kidney donors who are left with MRA in the nondonated kidney incur a higher risk of hypertension has not been studied. We compared the development of hypertension, reduced estimated glomerular filtration rate (eGFR), cardiovascular disease, and mortality in 2624 normotensive kidney donors with MRA in the nondonated kidney and to 2624 propensity score matched normotensive donor controls with a single renal artery. In total, 35% of donors had MRA. Donors with MRA were less likely to have undergone a left nephrectomy (51% vs. 83%). Postdonation hypertension was associated with age, male gender, non-White ethnicity, obesity, and family history of hypertension. Having MRA was not associated with risk of hypertension; aHR 0.92 (95% CI 0.82-1.03), P = 0.16. After 17 ± 11 years from donation, a similar proportion of donors with and without MRA developed cardiovascular disease, proteinuria and eGFR <30, <45 and <60 mL/min/1.73 m2 and the multivariable risks of developing these outcomes were similar in the two groups. Our study did not show increased risk for hypertension, reduced eGFR, proteinuria or cardiovascular disease in donors with MRA in the remaining kidney and without hypertension at donation.

Asunto(s)

RESUMEN

PURPOSE: The purpose of this retrospective study was to determine the incidence of persistent patent artery after percutaneous cryoablation of renal cell carcinoma (RCC) and the relationship between patent arteries one month after cryoablation and early tumor progression. MATERIALS AND METHODS: One hundred and fifty-nine patients (112 men, 47 women; mean age, 63.6±14.6 [SD] years; age range: 21-91 years) who underwent percutaneous cryoablation for 186 RCCs (mean diameter, 1.9±0.6 [SD] cm; range: 0.7-4.0cm) were retrospectively included. After cryoablation, patients underwent contrast-enhanced computed tomography (CT) with ≤2-mm slice thickness within one week from cryoablation, and at one, three, and six months. The time course of patent artery in the ablated renal parenchyma after cryoablation was the primary endpoint. The relationships between patent arteries one month after cryoablation and treatment effectiveness, tumor vascularity, tumor enhancement one month after cryoablation, tumor subtype, and renal function changes were evaluated as secondary endpoints. RESULTS: CT showed patent arteries in the ablated renal parenchyma within one week in 166 RCCs (89.2%), at one month in 54 RCCs (29.0%), at three months in 8 RCCs (4.3%), and at six months in 2 RCCs (1.1%). The presence of patent artery one month after cryoablation was significantly associated with tumor enhancement at the same time point (P=0.015). There was no association between patent arteries one month after cryoablation and treatment effectiveness (P=0.693). CONCLUSION: Patent arteries in the ablated renal parenchyma are commonly observed on CT examination after percutaneous cryoablation of RCC. However, they gradually disappear and do not require specific treatment.

Asunto(s)