A case report of renal calyceal diverticulum with hypertension in children and review of literature

Background Renal calyx diverticulum refers to a cystic lesion covered with the transitional epithelium in the renal parenchyma. Although there is no clear evidence that calyx diverticulum can cause hypertension, there exists a close association between the two, and there are few related reports. Herein, we reported the case of a child with renal calyx diverticulum complicated with hypertension and summarized the diagnosis and treatment. Case presentation Physical examination of the patient, an 11-year-old child, revealed a left renal cyst with hypertension (155/116 mmHg). There were no related symptoms. Routine urine and blood biochemical examinations showed no abnormalities. Imaging revealed left renal cyst compression causing the hypertension. She underwent renal cyst fluid aspiration and injection of a sclerosing agent into the capsule, but her blood pressure increased again 3 days postoperatively. Color Doppler ultrasonography showed that the size of the left renal cyst was the same as that preoperatively. To further confirm the diagnosis, cystoscopic retrograde ureteropyelography was performed to confirm the diagnosis of renal calyx diverticulum. Subsequently, renal calyceal diverticulum resection and calyx neck enlargement were performed. The operation went smoothly and the blood pressure returned to normal postoperatively. No abnormalities were noted at the 7-month postoperative follow-up. Conclusion There exists an association between renal calyx diverticulum and hypertension. Therefore, hypertension can be considered a surgical indication for renal calyx diverticulum. Moreover, renal calyceal diverticulum in children can be easily misdiagnosed as a renal cyst. Therefore, it is important to be vigilant to prevent a series of complications, such as postoperative urine leakage, in such cases.

Association of High-Sensitivity C-Reactive Protein With Aneurysm Sac Shrinkage in Patients Undergoing Endovascular Abdominal Aneurysm Repair

Purpose: The factors associated with aneurysm sac shrinkage after endovascular aneurysm repair (EVAR) are not well established. As inflammation is implicated in aneurysm pathophysiology, we hypothesized that high-sensitivity C-reactive protein (hsCRP) was associated with aneurysm sac shrinkage after EVAR and compared the preoperative level of hsCRP between patients with and without postoperative aneurysm sac shrinkage after EVAR. Methods: From November 2013 to April 2019, 143 patients undergoing EVAR using Gore C3 Excluder (W. L. Gore & Associates, Inc, Flagstaff, Arizona) at our university hospital were included in this study. Aneurysm sac size was compared between that on baseline preoperative computed tomography (CT) and that on postoperative CT scans. A change in aneurysm sac size ≥5 mm was considered to be significant, whether due to enlargement or shrinkage. Results: Aneurysm sac size showed a significant decrease from 50.6 ± 9.8 mm to 47.1 ± 10.3 mm at 1 year. At 1 year postoperatively, aneurysm sac shrinkage (≥5 mm) was observed in 48 patients (34%), a stable aneurysm sac was noted in 93 patients (65%), and aneurysm sac enlargement was noted in 2 patients (1.4%). The mean preoperative hsCRP was 0.33 ± 0.54 mg/dL. Univariable analysis showed that preoperative hsCRP (p=0.029) and the presence of a renal cyst (p=0.002) were associated with aneurysm sac shrinkage. Multivariable analysis showed that preoperative hsCRP [>0.19mg/dL] (odds ratio [OR] = 0.22; 95% confidence interval [CI] = 0.05–0.96; p=0.042), and the presence of a renal cyst (OR = 0.31; 95% CI = 0.15–0.67; p=0.002) were independent risk factors for aneurysm sac shrinkage after EVAR. Conclusions: The level of preoperative hsCRP was independently associated with aneurysm sac shrinkage after EVAR in patients with abdominal aortic aneurysms. These data suggest that the high level of hsCRP can be a negative predictor for aneurysm sac shrinkage after EVAR.

Obacunone Retards Renal Cyst Development in Autosomal Dominant Polycystic Kidney Disease by Activating NRF2

Autosomal dominant polycystic kidney disease (ADPKD) is a common inherited disease characterized by progressive enlargement of fluid-filled cysts derived from renal tubular epithelial cells, which has become the fourth leading cause of end-stage renal diseases. Currently, treatment options for ADPKD remain limited. The purpose of this study was to discover an effective therapeutic drug for ADPKD. With virtual screening, Madin-Darby canine kidney (MDCK) cyst model, embryonic kidney cyst model and kidney-specific Pkd1 knockout mouse (PKD) model, we identified obacunone as a candidate compound for ADPKD drug discovery from a natural antioxidant compound library. In vitro experiments showed that obacunone significantly inhibited cyst formation and expansion of MDCK cysts and embryonic kidney cysts in a dose-dependent manner. In vivo, obacunone treatment significantly reduced the renal cyst development in PKD mice. Western blot and morphological analysis revealed that obacunone served as a NRF2 activator in ADPKD, which suppressed lipid peroxidation by up-regulating GPX4 and finally restrained excessive cell proliferation by down-regulating mTOR and MAPK signaling pathways. Experimental data demonstrated obacunone as an effective renal cyst inhibitor for ADPKD, indicating that obacunone might be developed into a therapeutic drug for ADPKD treatment.

Observations on the Curative Effect of a Holmium Laser Under a Flexible Ureteroscope in the Treatment of Endogenous Renal Cysts Combined with Renal Calculi

Background: To explore and analyse the curative effects of a holmium laser under a flexible ureteroscope in the treatment of endogenous renal cysts complicated with renal calculi. Methods: Seven patients with endogenous renal cysts and renal calculi were admitted to our hospital from April 2019 to April 2021. The renal calculi was smashed by a holmium laser under a flexible ureteroscope, and the kidney cysts were opened by holmium laser endotomy. Window decompression was performed, indwelling the ureteral double-J tube for 1 month after the operation. After 1 month, when the patient was hospitalized and the double-J tube was removed, a flexible ureteroscope was inserted into the renal pelvis to confirm the effect of window opening and lithotripsy, and CT or B-ultrasound was reviewed. Results: Among the 7 patients with endogenous renal cysts and kidney stones, one patient was scheduled to undergo an internal incision after successful lithotripsy. The renal cyst wall tissue was surrounded by the renal artery, and the internal incision was terminated. One patient had an unsuccessful lithotripsy due to the poor angle of the kidney stone but was successfully treated for the renal cyst. The remaining 5 patients successfully underwent lithotripsy and internal incision surgery, of which 2 cases had difficulty finding kidney cysts and stones during the operation and needed assistance in locating kidney cysts and kidney stones under B-ultrasound monitoring. The average operation time was 42 minutes. When the catheter was extubated, the diameter of the renal cyst window was 0.5 cm to 2.5 cm under a flexible ureteroscope. The stone discharge was fair. There were residual gravels in the lower calyx of the kidney in two patients, and the stone basket was removed. After extubation, the maximum diameter of the renal cyst was reduced by more than half by CT or B-ultrasound, the effect of fenestration and decompression was achieved, and there were no obvious residual stones. Conclusions: A holmium laser under a flexible ureteroscope has a reliable curative effect in the simultaneous treatment of endogenous renal cysts with kidney stones, with little damage, quick recovery, and low cost. It can be used as the first choice for the treatment of endogenous renal cysts with kidney stones.

First experience of laparoscopic kidney cyst resection by a single access method

We describe the first clinical experience of laparoscopic surgery for renal cyst by a single access. Advantages, disadvantages and prospects of this method are analized.

Steady-state ferumoxytol-enhanced MRI: early observations in benign abdominal organ masses and clinical implications

Introduction The off-label use of ferumoxytol as a vascular MR imaging agent is growing rapidly. However, the properties of ferumoxytol suggest that it may play an important role in the detection and characterization of abdominal mass lesions. Methods Thirty-six patients with benign abdominal mass lesions who underwent MR angiography with ferumoxytol also had T2-weighted HASTE imaging and fat-suppressed 3D T1-weighted imaging. The T1 and T2 enhancement characteristics of the lesions were analyzed and correlated with other imaging modalities and/or surgical findings and/or clinical follow-up. Results In all patients with benign masses in the liver (n = 22 patients), spleen (n = 6 patients), kidneys (n = 33 patients), adrenal (n = 2 patients) and pancreas (n = 4 patients), based on the enhancement characteristics with ferumoxytol, readers were confident of the benign nature of the lesions and their conclusions were consistent with correlative imaging, tissue sampling and follow-up. One patient with a suspicious enhancing 2F Bosniak renal cyst had renal cell carcinoma confirmed on biopsy. Conclusion Ferumoxytol-enhanced MRI can increase diagnostic confidence for benign abdominal masses and can increase the conspicuity of mass lesions, relative to unenhanced MRI. Graphic Abstract