[68 Ga]Ga-FAPI uptake correlates with the state of chronic kidney disease

Purpose Kidney fibrosis leads to a progressive reduction in kidney function ultimately resulting in kidney failure. Diagnostic tools to detect kidney fibrosis are all invasive in nature requiring kidney biopsies with subsequent histological validation. In this retrospective study, the diagnostic value of three different radiotracers for the noninvasive prediction of kidney fibrosis was analyzed, taking into account the glomerular filtration rate (GFR) and the intra-renal parenchymal radiotracer uptake. Methods In 81 patients receiving either one of the following molecular imaging probes, [68 Ga]Ga-FAPI, [68 Ga]Ga-PSMA, or [68 Ga]Ga-DOTATOC, kidney function parameters were correlated with SUVmax and SUVmean of the renal parenchyma and background activity measured in lung parenchyma, myocardium, gluteal muscle, and the abdominal aorta. Patients were clustered according to their grade of chronic kidney disease (CKD), and a regression analysis and one-way ANOVA were conducted in this retrospective analysis. Results We found a negative correlation between GFR and [68 Ga]Ga-FAPI uptake for both SUVmax and SUVmean values, whereas background activity showed no correlation with GFR. [68 Ga]Ga-DOTATOC and [68 Ga]Ga-PSMA did not correlate between CKD stage and intra-renal parenchymal radiotracer uptake. Only [68 Ga]Ga-PSMA background activity exhibited a positive correlation with GFR suggesting an unspecific binding/retention potentially due to longer circulation times. Conclusion There is a significant negative correlation between renal parenchymal [68 Ga]Ga-FAPI uptake and GFR, which was not the case for [68 Ga]Ga-DOTATOC and [68 Ga]Ga-PSMA. This correlation suggests a specific binding of FAPI rather than a potential unspecific retention in the renal parenchyma, underlining the potential value of [68 Ga]Ga-FAPI for the noninvasive quantitative evaluation of kidney fibrosis.

Nephrectomy in a Dog infected with Dioctophyma renale - Mato Grosso do Sul, Brazil

Background: Dioctophymosis is caused by Dioctophyma renale, a parasite known as the giant kidney worm, that can parasitize the kidneys of domestic and wild animals. There are also reports of its occurrence in humans, thus revealing its zoonotic potential. In most cases, parasitized animals are asymptomatic. This parasite can cause atrophy or destroy the renal parenchyma, although ectopic locations may occur. The diagnosis is made through ultrasonography, based on the presence of eggs in the urine, visualization of the parasite, or during necropsy. Therefore, the aim of this work was to report the case of a young dog infected with D. renale and subjected to nephrectomy in the state of Mato Grosso do Sul, Brazil.Case: A 6-month-old bitch with a clinical suspicion of hydronephrosis in the right kidney was referred to the Veterinary Hospital of Anhanguera-Uniderp University in the city of Campo Grande, MS. A physical examination of the patient revealed an alteration in the urinary system. An abdominal ultrasound, urinalysis, complete blood count (CBC) tests and biochemical profile were ordered. The erythrogram indicated erythrocytosis resulting from dehydration and loss of body fluids, while enzyme levels (creatinine, urea, alanine aminotransferase [ALT] and albumin) were within normal limits. The abdominal ultrasound showed the presence of a cylindrical and rounded structure characteristic of a nematode and in the right kidney, and loss of renal parenchyma typical of D. renale infection. A urinalysis then revealed the presence of helminth eggs, confirming the diagnosis. The owner was informed about the need for nephrectomy of the affected right kidney, which showed destruction of the renal parenchyma. One adult female and one adult male parasite were removed from inside the kidney, measuring approximately 50 cm and 35 cm in length. The patient was successfully treated, kept in hospital for observation, and returned two weeks later for reassessment of her renal function and removal of stitches. Discussion: Dioctophymosis is often diagnosed based on ultrasound and urine tests. These tests proved sufficient to diagnose parasitism by D. renale. However, the infection is usually discovered during necropsy. D. renale is popularly known as the giant kidney worm, as it can reach up to 100 cm in length. In the present case, the female parasite was 50 cm long and the male was 35 cm. The patient presented parasitism very young, at just 6 months of age. The parasitic infection of the animal was attributed to the ingestion of water or food contaminated with an intermediate host, the aquatic annelid Lumbriculus variegatus. It is suggested that the ingestion of food or water contaminated with the infective stage of the parasite may have occurred at 2 months of age or younger, since the prepatent period is approximately 6 months. The parasite was found only in the patient’s right kidney. Hydronephrosis was reported in the patient and was caused by obstruction of the internal urethral ostium by the adult nematode. In this case, the recommended surgical treatment was nephrectomy, to which the patient was subjected, leading to successful recovery. This case occurred in the state of Mato Grosso do Sul, where there are no records of parasitism by D. renale in domestic dogs, unlike other states in Brazil. We therefore emphasize the importance of new studies on D. renale, given the lack of clear records describing the parasite’s epidemiological data, biological cycle and diagnosis, which may hinder the prevention and control of this zoonotic disease.Keywords: canine dioctophymosis, helminth, nematoid, giant kidney worm, hydronephrosis.Descritores: dioctofimose canina, helminto, nematoide, verme gigante renal, hidronefrose.

Surgical treatment of hydronephrosis in children: a single-centre study

Introduction: Hydronephrosis is one of the most commonly diagnosed urinary tract defects in children. It is characterised by various degrees of dilation of the renal pelvis and calyces with concomitant thinning of the renal parenchyma. The dilation is caused by a ureteropelvic junction defect obstructing the outflow of urine from the kidney. Extreme hydronephrosis can lead to a complete lack of function of the affected kidney. The treatment of hydronephrosis involves restoring normal urine outflow from the kidney and depends on the cause of the condition. The decision to perform surgery depends on the rate of progression of abnormalities observed in the renal parenchyma, among other aspects. Aim of the study: The paper presents the experiences of a single centre in the surgical treatment of hydronephrosis in children aged up to 18 years. Materials and methods: In 2016–2020, 77 children underwent surgery for hydronephrosis at the present authors’ department. In 40% of cases, hydronephrosis was diagnosed on antenatal screening, in 31% it was observed on abdominal ultrasound performed due to abdominal pain, in 17% the condition was detected incidentally when the causes of other diseases were being investigated, in 9% urinary tract infection led to the discovery of hydronephrosis and in 3% of cases abdominal trauma was the reason the patient was examined in the first place. In 58% of the subjects, the cause of hydronephrosis was intramural stenosis of the ureteropelvic junction, in 22% it was the presence of accessory vessels and in 20% various other causes were found. In all patients, Anderson–Hynes ureteropyeloplasty was performed. Results: Surgical outcomes were assessed 12 months after the procedure, and in 97.4% of cases they were considered good. A repeat operation was performed in only 2 cases due to a lack of improvement after the original hydronephrosis surgery. Conclusions: Surgical treatment of hydronephrosis caused by ureteropelvic obstruction is an effective and safe method with a low risk of early and late complications.

Lymphocytes: Versatile Participants in Acute Kidney Injury and Progression to Chronic Kidney Disease

Background: Acute kidney injury (AKI) remains a major global public health concern due to its high morbidity and mortality. The progression from AKI to chronic kidney disease (CKD) makes it a scientific problem to be solved. However, it is with lack of effective treatments.Summary: Both innate and adaptive immune systems participate in the inflammatory process during AKI, and excessive or dysregulated immune responses play a pathogenic role in renal fibrosis, which is an important hallmark of CKD. Studies on the pathogenesis of AKI and CKD have clarified that renal injury induces the production of various chemokines by renal parenchyma cells or resident immune cells, which recruits multiple-subtype lymphocytes in circulation. Some infiltrated lymphocytes exacerbate injury by proinflammatory cytokine production, cytotoxicity, and interaction with renal resident cells, which constructs the inflammatory environment and induces further injury, even death of renal parenchyma cells. Others promote tissue repair by producing protective cytokines. In this review, we outline the diversity of these lymphocytes and their mechanisms to regulate the whole pathogenic stages of AKI and CKD; discuss the chronological responses and the plasticity of lymphocytes related to AKI and CKD progression; and introduce the potential therapies targeting lymphocytes of AKI and CKD, including the interventions of chemokines, cytokines, and lymphocyte frequency regulation in vivo, adaptive transfer of ex-expanded lymphocytes, and the treatments of gut microbiota or metabolite regulations based on gut-kidney axis.Key Message: In the process of AKI and CKD, T helper (Th) cells, innate, and innate-like lymphocytes exert mainly pathogenic roles, while double-negative T (DNT) cells and regulatory T cells (Tregs) are confirmed to be protective. Understanding the mechanisms by which lymphocytes mediate renal injury and renal fibrosis is necessary to promote the development of specific therapeutic strategies to protect from AKI and prevent the progression of CKD.

Common Sonographic Patterns of Kidney Diseases in Nnewi North, Anambra State, Nigeria

Introduction: Despite the increasing prevalence of kidney diseases in Nigeria, and the value of ultrasonography in the diagnosis of these diseases, there is a paucity of data on the sonographic patterns of kidney diseases peculiar to people in Nnewi North Anambra state, Nigeria.Objective: The objective of this study was to document the common sonographic patterns of kidney diseases in Nnewi-North, Anambra state, Nigeria and to correlate certain Ultrasound detectable kidney diseases of patients with age and sex.Methods: This study adopted a cross-sectional retrospective design. Secondary records from files, folders were retrieved from patient’s records from the Radiography departments of Waves diagnostic center and Nnamdi Azikiwe University teaching hospital both in Anambra State, Nigeria. A total of 400 patients were reviewed from the health institutions between April 2020 and April 2021. The data were analyzed using descriptive and inferential statistics.Results: Common kidney diseases were: hydronephrosis [74(17.8%)], nephrolithiasis [69 (17.3%)], renal cyst [39(9.8)], urolithiasis [9(75%)], renal parenchyma disease grade I [27(6.8%)], renal parenchyma disease grade II [12(3.0%)], renal parenchyma disease grade III [12(3.0%)],renal parenchyma disease grade I-II [6(1.5%)], renal parenchyma disease grade II-III [1(0.3)], nephritis [6(1.5%)], ectopic kidney [3(0.8)], polycystic kidney disease[ 9(2.3%)], pyelonephritis [14(3.5%)], nephrocalcinosis [29(7.2%)]. It was found out that normal patients had the highest occurrence [81 (21.3%)], the most prevalent kidney disease was hydronephrosis [74(17.8%)] and the least prevalent was renal parenchyma disease grade II-III [1(0.3%)]. The prevalence of hydronephrosis was seen more in male patients [42 (59.2%)] than their female counterparts [29 (40.8%)]. The subjects between the ages of 37-52 years were more likely to develop hydronephrosis than other age groups and also there was no significant relationship between kidney diseases and age. It is therefore recommended that Ultrasound should be used as the first line of diagnosis in kidney pathologies and suspected flank pain, because of its availability, cheapness, improved safety profile, and level of diagnostic accuracy.Conclusion: Common sonographic patterns of kidney diseases were those of hydronephrosis, nephrolithiasis, and renal parenchyma diseases grade I-III predominantly among male subjects. Age and sex had no significant effect on sonographic patterns of kidney diseases.

Experience of managing neonates and breastfed in-fants with grade IV bilateral hydronephrosis

To analyze the clinical cases of four patients with grade IV bilateral hydronephrosis. Ultrasound examination of the urinary system was used as the main examination method. During the first stage of surgical treatment, all children underwent preliminary urinary diversion; a month later, the results were assessed. The result of the preliminary urinary diversion was the implementation of the Heines-Andersen-Kucher reconstructive operation. According to the control ultrasound performed a month after the nephrostomy, pelvis on the nephrostomy was reduced in all cases, parenchyma thickness increased by an average of 4.5 times, improvement in intragranular blood flow was noted. Evaluation of the effectiveness of pyeloplasty was carried out according to three criteria: restoration of urodynamics, restoration of kidney function and the presence of infectious complications. The parenchyma of the operated kidney grew by an average of 3 times, the pelvis decreased by an average of 3.5 times. Restoration of intrarenal blood flow to the cortical layer, inclusive, was noted in 5 of 8 renal units. Before pyeloplasty, there were marked changes in the renal parenchyma and a decrease in its function by an average of 34 14 %; a year after reconstructive surgery, the changes became moderate, there was an improvement in renal function, a decrease in function by 25 10 %. In our opinion, the starting method for providing urgent surgical care to neonates and breastfed infants with grade IV GN is preliminary urinary diversion, which allows us to determine the functional reserve of the renal parenchyma, delay reconstructive surgery, thereby giving time for the restoration of renal function and avoiding organ-carrying surgery.

Why women with advanced cervical cancer die

According to HoIzbach'y (Zentr. F. Gyn., 1923, No. 50-51), almost every case of this disease that falls on the sectional table indicates a severe lesion of the urinary apparatus, dilatation of the ureters, the disappearance of the renal parenchyma and kidney infection.

Outcome of simultaneous angioembolization and nephron sparing surgery in large renal angiomyolipomas

Aim: To study the outcome of simultaneous angioembolization and nephron sparing surgery in large renal angiomyolipomas. Materials and methods: A prospective study of carried out from 2016 to 2019. A total of 15 patients were included in the study with a lesion (angiomyolipoma) more than 10 cm in size, suitable for nephron sparing surgery. The workup of the patients included history, baseline blood investigations, ultrasonography, and CT urography including angiographic films. All the patients were taken up for selective of angioembolization of the feeding vessels of the AML carried out by the interventional radiologist followed by nephron sparing surgery in the same sitting. The short term outcomes studied were warm ischemia time, average blood loss, and length of post-operative hospital stay. The oncological outcome was evaluated by noting the surgical margins of histopathological specimen and functional outcome by assessing the function of the preserved renal parenchyma. Results: Twelve out of fifteen cases were female. The mean age was 42.25 years. All the patients had lesion more than 10 cm with seven tumors located at the lower pole, four at mid-pole, and four at upper pole. Eight patients had low complexity score on RENAL score (i.e. 4–6), five patients medium complexity score (i.e. 7–9), and two had high complexity score (i.e. ⩾10). Average blood loss was 200 ml, warm ischemia time was 18.46 min and postoperative stay was 3.55 days. All the 15 specimens sent for histopathology were confirmed as AML (angiomyolipomas) with margins free of tumor. Follow up CECT done at 4 months postoperatively revealed functioning residual renal parenchyma with prompt excretion of contrast. Conclusion: Large AML’s are also amenable to nephron sparing surgery. However patient should always be warned about the possibility of total nephrectomy. Selective angioembolization helps in reducing the blood supply and risk of torrential bleeding thus facilitates in the removal of the tumor and increasing the chances of nephron sparing surgery.