Renal cell carcinoma in patients with a solitary kidney after nephrectomy treated with radiofrequency ablation: Mid term results

This retrospective study aimed to evaluate the feasibility and effectiveness of radiofrequency ablation (RFA) in patients with solitary kidney for the treatment of renal cell carcinoma (RCC). Within 2 years 10 patients (seven males, three females; age 65 ± 8 years) were treated. All patients had a history of nephrectomy of the contralateral kidney. The indications for RFA were inoperability or high probability of complete renal failure after surgical enucleation of the tumor.13 tumors with a size between 1.9 and 4.2 cm (average 2.7 cm) were treated. In patients with a tumor diameter larger than 2.5 cm a transarterial embolization was performed prior to RFA to reduce heat sink effect and risk of bleeding. Therapeutical success was defined as a lack of contrast enhancement in follow up examinations and shrinking of the treated area. Furthermore all patients’ renal function was monitored.RFA of renal tumors under CT-fluoroscopy was feasible in all patients. Within the follow up (3 and 24 months) no tumor recurrence or major complication was detected. One patient developed another RCC and was successfully treated with a second RF-ablation. None of the patients developed renal failure with the need of hemodialysis. In one of the patients a hemorrhage into the surrounding tissue was noticed, which stopped spontaneously.RFA is a valuable and effective therapeutical option in patients with solitary kidney suffering from inoperable renal cell carcinoma. The complication rate is small and an excellent tumor control can be achieved without deterioration of the renal function.     

Breast calcifications in renal hyperparathyroidism

A prospective mammographic study was performed on 151 women to determine the prevalence of breast calcifications in patients with chronic renal failure. Frequency, size, structure, and location of calcific lesions were assessed in 15 patients with compensated renal insufficiency, 22 on hemodialysis, 14 who had renal transplants, and 100 who had normal kidney function. Serum levels of calcium, phosphorus, alkaline phosphatase, and parathyroid hormone were determined for all 151 women. The calcific lesions occurred preponderantly in dialysis patients (arteries, 55%; parenchyma, 68%; and ducts, 36%). Next in order were those with renal transplants (43%, 64%, and 29%, respectively) and those with renal insufficiency (33%, 53%, and 20%, respectively). Patients with renal disease had significantly more calcifications (p less than .001) than the patients with normal kidney function: arteries, 45% vs 8%; parenchyma, 61% vs 27%; and ducts, 29% vs 9%. Frequencies of calcifications correlated with serum levels of parathyroid hormone. None of the calcifications induced by renal disease simulated those seen in carcinoma of the breast.     

Pharmacokinetics and safety of iomeprol in healthy volunteers and in patients with renal impairment or end-stage renal disease requiring hemodialysis.

RATIONALE AND OBJECTIVES: To present the results of two studies conducted to evaluate the pharmacokinetics and safety of iomeprol in healthy volunteers and in patients with various degrees of renal impairment. METHODS: In these two open-label, single-dose, phase I studies, a 50-mL dose of iomeprol 400 was administered intravenously to a total of 30 subjects of either sex. In study 1, six healthy volunteers with normal renal function, six patients with mild renal failure, six patients with moderate renal failure, and four patients with severe renal failure were enrolled. In study 2, eight patients with end-stage renal disease requiring hemodialysis were enrolled. Safety was determined by predose and postdose (up to 10 days) measurement of vital signs, hematology, blood chemistry, urinalysis, electrocardiogram, physical examinations, and the incidence of adverse events. Pharmacokinetics was determined by measuring iomeprol levels in plasma, urine, feces, and dialysate samples, by using a validated high-performance liquid chromatography assay, up to 7 days after administration. RESULTS: The plasma concentration of iomeprol declined biexponentially in both healthy subjects and patients. As expected, mean body and renal clearances decreased progressively with increasing renal impairment, with a significant correlation with the glomerular filtration rate. The elimination half-life increased progressively with increasing renal impairment. The extraction efficiency of dialyser was estimated as approximately 40%, and dialysis clearance of iomeprol was approximately 1.26 mL. min-1. kg-1 (80.6 mL/min), slightly less than the body clearance previously observed in healthy subjects. It appears that dialysis is almost as efficient as renal function in healthy subjects in the removal of iomeprol. After a single dialysis session, approximately 58% of the dose was recovered in dialysate. Mild to moderate adverse events were reported by 17 of 30 subjects; none was clinically meaningful. One serious adverse event, unrelated to iomeprol, was reported. No clinically meaningful findings were noted for other safety parameters. CONCLUSIONS: Iomeprol was almost completely eliminated both in patients with renal impairment and in patients receiving dialysis. No dose adjustment appears to be necessary either in patients with renal impairment or with end-stage renal disease requiring hemodialysis. In this risk population, iomeprol 400 was safe and well tolerated.     

Radiologische Diagnostik der Nieren bei Dialysepatienten

The kidneys of patients with chronic renal failure undergoing maintenance hemodialysis may show different variances or complications. Most common are secondarily acquired renal cysts, which may be found in as many as 92% of patients after 8 years of hemodialysis. Single (in 12.5% of patients) or multiple (8.3%) cysts with bleeding are common; additionally, hematuria or ruptured cysts may be found. Bleeding into cysts is more common in patients with autosomal dominant polycystic kidney disease. Due to the decreasing urinary production development of kidney stones is very uncommon, but calcifications in or around cysts can be found in 71% of patients. Kidney tumors occur 41 times more often in patients with chronic renal failure than in patients without kidney disease. We detected tumors in 4.2% of our patients on long-term dialysis. Diagnostic differentiation of the relatively slow growing and fairly late metastasizing malignant tumors from adenomas is not possible. Nevertheless, we screen our patients every 3-4 years. Computed tomography is superior to ultrasonography for this purpose, because ultrasonography lacks the necessary sensitivity in this group of patients.     

Renal failure and cystic kidney diseases

Cystic kidney diseases often are discovered at the time of initial work-up of renal failure through ultrasound or family history, or incidentally at the time of an imaging test. Hereditary diseases include autosomal dominant or recessive polycystic kidney disease (PKD), tuberous sclerosis (TS) and medullary cystic kidney disease (MCKD). Autosomal dominant PKD is characterized by large renal cysts developing in young adults. Renal failure is progressive and becomes severe around 50-60 years of age. Atypical cysts (hemorrhagic or hyperdense) are frequent on CT and MRI examinations. Imaging plays a valuable role in the management of acute complications such as cyst hemorrhage or infection. Autosomal recessive PKD is often detected in neonates, infants or young adults. It is characterized by renal enlargement due to the presence of small cysts and liver disease (fibrosis and biliary ductal dilatation). Late manifestation or slow progression of autosomal recessive PKD may be more difficult to distinguish from autosomal dominant PKD. These cystic kidney diseases should not be confused with non-hereditary incidental multiple renal cysts. In tuberous sclerosis, renal cysts are associated with angiomyolipomas and sometimes pulmonary lymphangioleiomyomatosis. Renal failure is inconstant. Other hereditary cystic kidney diseases, including MCKD and nephronophtisis, are usually associated with renal failure. Non-hereditary cystic kidney diseases include multicystic renal dysplasia (due to complete pelvi-ureteric atresia or hydronephrosis), acquired multicystic kidney disease (chronic renal failure, chronic hemodialysis) and varied cystic kidney diseases (multicystic renal disease, glomerulocystic kidney disease, microcystic kidney disease).     

Computed tomography of renal cell carcinoma in patients with terminal renal impairment

PURPOSE: Current kidney surgery uses less invasive laparoscopic and nephron-sparring procedures. Thus, perfect imaging of the renal vasculature is essential for surgery planning. The aim of our retrospective study was to evaluate the accuracy of 16-detector-row CT-angiography in assessing the vascular anatomy of the kidney with a tumor. SUBJECTS AND METHODS: Referred for computed tomography (CT) because of a suspected renal tumor, 50 consecutive patients (mean age 58.6 years; range 43-82) were enrolled into our retrospective study. All examinations were performed with 16x0.75 mm collimation after the intravenous application of 80 ml of a non-ionic contrast material. The imaging protocol contained two-phase scanning in the arterial and then in the venous phase. The vascular anatomy of the kidney with tumor was evaluated using volume rendered (VRT) and maximum intensity images (MIP). Findings were compared with the anatomy found during surgery. RESULTS: Forty-seven patients underwent nephrectomy, with an advanced clinical stage (IV) found in the three remaining ones. Correct topography of the renal hilus, including a number of arteries and veins, and the anatomy of their branching, was described in 46 patients. A very small upper polar artery was overlooked in one patient. The accuracy for the only-arterial was 97.9% and only-venous anatomy was 100%. The parasitic vasculature of the tumor was discovered in 10 cases and all of them were confirmed by surgery (100% accuracy). Macroscopic intravenous spread of the tumor was discovered in two cases, but microscopic intravenous invasion was confirmed during histology of the kidney specimens in another two cases, the overall tumor staging accuracy reaching 95.7%. CONCLUSION: Two-phase multidetector CT is a valuable tool for assessing vascular supply of the kidney before surgery due to the tumor and can fully replace catheter-based angiography.     

Spontaneous subcapsular and perinephric hemorrhage in end-stage kidney disease: clinical and CT findings

Clinical, CT, and pathologic findings were analyzed in six patients with spontaneous subcapsular or perinephric hematomas complicating end-stage kidney disease. Renal failure had been managed by hemodialysis in four patients, by renal transplantation in one, and by conservative methods in one. All patients had nonspecific abdominal pain. CT clearly showed in all cases that the pain resulted from hemorrhage and also revealed the extent and location of hematomas. In addition, in four patients, CT showed underlying acquired cystic kidney disease that was the probable cause of hemorrhage. In one of these patients, CT also showed a renal cell carcinoma in the opposite kidney. Other causes for renal hemorrhage encountered in the series included renal infarction due to small vessel disease, heparinization during hemodialysis, and thrombocytopenia. Abdominal CT is a useful technique for evaluating patients with end-stage renal disease who have abdominal pain or who exhibit clinical evidence of blood loss.     

马兜铃酸肾病尿毒症期维持性血透和肾脏移植的对比分析

目的 了解马兜铃酸肾病尿毒症期维持性血透或行肾移植后泌尿系肿瘤的发生情况及临床特点.方法 回顾调查自2000年3月～2006年12月在温州医学院附属第一医院的38例尿毒症期马兜铃酸肾病患者,在分别接受维持性血透和肾移植后泌尿系肿瘤的发生情况及临床病理特点,以及分析肿瘤发生与透析时间的关联.结果 38例马兜铃酸患者(血透患者15例,肾移植患者23例):随访11～85个月,肾移植患者中泌尿系肿瘤发生率13.0%(3/23)低于血透患者中泌尿系肿瘤发生率46.7%(7/15)(P＜0.05),移植前透析时间与肿瘤的发生无统计学差异(P＞0.05).结论 肾移植是尿毒症期马兜铃酸肾病患者较好的治疗措施,移植前透析时间与肿瘤的发生无关.     

Simultaneous chemoradiation with cisplatin in a patient with recurrent cervical cancer undergoing hemodialysis

Purpose

To prove the feasibility and toxicity of platinum-based chemoradiation in a patient with recurrent cervical cancer undergoing concomitant hemodialysis.

Patient and Methods

We report a patient with a renal transplant because of chronic renal failure who then underwent radical hysterectomy and lymphadenectomy due to cervical cancer FIGO stage IB1. One year after primary therapy, a 53 × 54 × 68 mm vaginal stump recurrence was treated by total translevatoric exenteration with lymphadenectomy, explantation of the transplant, and the right residual kidney. Because of microscopically involved margins, chemoradiation was recommended. Radiation was performed to the tumor region and pelvic lymph nodes up to 50.4 Gy. A boost was given to the clip-marked region to 66.6 Gy. Neurological, gastrointestinal and genitourinary toxicity was evaluated once a week, while hematological toxicity twice per week. Samples to evaluate cisplatin concentrations were taken from blood and dialysate.

Results

The patient completed chemoradiation with 5 cisplatin applications with a decreased dose (20 mg/m²) without any high grade toxicity. Hemodialysis was performed three times a week. Within 30 min after cisplatin application, the cisplatin serum concentration reached the highest level with 1,179.6 ??g/l and showed nearly stable concentrations over 120 min. There was an accumulation of cisplatin from week 1 (100%) to week 5 of application (219%). The corresponding concentration in the dialysate also showed a rapid increase within the first hour of hemodialysis and decreased to 50% within 2 h.

Conclusion

Cisplatin application with a modified dose (20 mg/m²) is feasible and safe in a patient with cervical carcinoma undergoing chemoradiation and hemodialysis.     

CT of renal cell carcinoma in patients on chronic hemodialysis

The occurrence rate of renal cell carcinoma is significantly higher in the native kidneys of patients undergoing chronic hemodialysis than in kidneys of normal subjects. These carcinomas may be difficult to detect because these kidneys tend to be small and distorted owing to acquired cystic disease. Four cases of renal cell carcinoma detected by CT are presented (three in patients undergoing chronic hemodialysis, and one in a patient with a functioning transplant who had history of dialysis). All kidneys had extensive acquired cystic disease. In two cases, contrast-enhanced scans showed a solid lesion of lower density than the kidney. In another case, in which IV contrast material could not be given, the mass was of higher density than the kidney and retroperitoneal lymphadenopathy was present. In the fourth case, no distinct solid mass could be identified. The only sign of malignancy in this case was extensive lymphadenopathy. Whenever CT examination of the abdomen is performed in a patient undergoing chronic hemodialysis, the kidneys must be evaluated carefully because of the increased frequency of renal cell carcinoma. In a few cases, a distinct solid lesion may not be apparent or may be subtle owing to distortion of renal anatomy by acquired cystic disease.     

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

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.     

两种透析方式对常染色体显性多囊肾病预后影响

目的比较血液透析与腹膜透析对进入终末期肾病(ESRD)的常染色体显性多囊肾病(ADPKD)患者预后的影响。方法回顾性分析自1999年3月至2014年8月第二军医大学附属长海医院肾内科收治的43例ADPKD患者的临床资料。根据初始透析方法的不同,将43例患者分为血液腹膜透析组(n=20)及血液透析组(n=23)。随访期间,记录心血管事件发生情况,并对两组患者心血管事件发生率进行比较。以全因死亡为终点事件,绘制生存曲线,采用Kaplan Meier法和LogRank检验对两组患者存活率进行比较。结果本研究共43例患者,最长随访147个月。腹膜透析组心血管事件发生率5.0%(1/20),血液透析组26.1%(6/23),两组间比较,差异有统计学意义(P<0.01)。随访期内,腹膜透析组患者,存活率85.0%(17/20),血液透析组存活率73.9%(17/23),两组间比较,差异无统计学意义(P>0.05)。结论腹膜透析与血液透析均是ADPKD肾衰竭患者的有效肾替代治疗方法。与腹膜透析比较,血液透析患者心血管事件发生概率较低。     

Radiological aspects of primary hyperoxaluria

Primary hyperoxaluria is a rare metabolic disorder characterized by excessive synthesis and urinary excretion of oxalate. Nephrocalcinosis with or without calcium oxalate nephrolithiasis leads to renal failure in infancy through young adulthood. Oxalosis is the condition in which the highly insoluble calcium oxalate crystals are deposited in extrarenal tissues including bone, blood vessels, heart, and the male urogenital system. The radiographic abnormalities in 14 patients with primary hyperoxaluria are described. These abnormalities include nephrolithiasis, nephrocalcinosis, dense vascular calcifications, abnormal bone density, and characteristic metaphyseal abnormalities. Changes of renal osteodystrophy and pathologic fractures are common. Radiographic bone abnormalities are dependent on the age of the patient when renal failure occurred and the degree of success of renal transplantation. Characteristic skeletal changes are present in six of seven patients who developed renal failure when less than 7 years of age.     

Predictive value of 99Tcm-DTPA captopril scintigraphy in patients with a solitary kidney and reduced kidney function

The aim of this study was to determine if the qualitative 99Tcm-DTPA captopril radionuclide test (CRT) can help predict the acute detrimental effect of angiotensin-converting enzyme (ACE) inhibitors on renal function in hypertensive patients with solitary kidneys and chronic renal failure. Between 1991 and 1996, eight consecutive patients (6 males, 2 females) aged 27-73 years (mean 49.8 years) with known chronic renal failure and a solitary kidney referred for ACE treatment were included. 99Tcm-DTPA renography was performed at baseline and 1 h after the administration of 25 mg captopril within 1 week of each other. The CRT was performed in accordance with the criteria of the Working Party on the Diagnostic Criteria of Renovascular Hypertension with Captopril Renography. A beneficial or detrimental effect of subsequent ACE inhibitor treatment on renal function was determined by long-term follow-up (> or = 2 years). The CRT accurately predicted outcome in all eight patients subsequently treated with ACE inhibitors. In conclusion, our results suggest a role for qualitative 99Tcm-DTPA CRT in the prediction of renal function in patients with a solitary kidney and chronic renal failure subsequently treated with ACE inhibitors.     

Effect of dose and dose-distribution in damage to the kidney following abdominal radiotherapy

Purpose : To define the effects of abdominal radiotherapy on the kidney with regard to dose-distribution parameters. Materials and methods : Ninety-one patients with abdominal radiotherapy were included in the study, and the minimum follow-up was 1 year. Conventional fractionation, 5 ×1.8-2.0 Gy week -1 to total doses of 30.6-62.5 Gy, was employed. Assessment of organ function was performed before, immediately after, and at 6 months and 1 year after radiotherapy. In cases with a significant radiation response at 1 year, subsequent follow-ups were done at 6-month intervals. Documented parameters included clinical examination, static and sequential scintigraphy of the kidneys, abdominal computed tomography, and sonography. Results : Twenty-one patients (23%) developed a reduction in kidney function detected by static scintigraphy. Only in 15 of these patients was impairment of renal function observed by sequential scintigraphy. The contribution of the irradiated kidney to overall renal function decreased progressively to 34-40% by the third year after treatment. Hypertension was seen in two patients. No changes were found in laboratory parameters. ED 50 for scintigraphic changes decreased from 27 Gy for 10% of the volume to 7.6Gy for 100%. ED 5 were in the range of 3-6 Gy, and this was independent of volume. Conclusions : Sophisticated imaging techniques allow the identification of radiation effects in partial volumes of the kidneys. A dose-response relationship in relation to the volume of kidney irradiated can thus be established for scintigraphic changes. As in a number of other organs, such changes do not relate directly to loss of renal function due to the reserve capacity of unirradiated kidney tissue.     

人胎盘间充质干细胞条件培养基对急性缺血再灌注肾损伤的修复作用

目的观察尾静脉注射人胎盘间充质干细胞条件培养基(human placenta-mesenchymal stem cell conditional medium,MSCs-CM)对急性缺血再灌注肾损伤(acute renal ischemia reperfusion injury,IR)的修复作用。方法健康雄性SD大鼠(n=30)分为3组:空白对照组(sham组),模型组(IR组)和治疗组(IR+MSCs组),每组10只。制备大鼠缺血再灌注肾损伤模型,建模24h后以尾静脉注射MSCs条件培养基,并连续跟踪4d监测血清及尿液的肌酐含量,随后取肾脏组织行过碘酸雪夫反应(PAS)染色检查观察肾脏损伤及修复状况;经2',7'-二氯荧光黄双乙酸盐(DCFH-DA)法检测肾组织内活性氧含量;Western Blot法检测肾脏组织内血红素氧化酶1(heme oxygenase-1,HO-1)及磷酸酰胺腺嘌呤二核苷酸醌氧化还原酶1(NAPDH quinineoxidoreductase-1,NQO-1)的相对表达水平。结果模型组大鼠的血、尿肌酐含量相对于空白正常组明显升高,出现肾损伤;而治疗组大鼠的血、尿肌酐含量与IR组相比有明显改善且与Sham组指标相似;PAS染色观察显示,模型组大鼠存在肾小管损伤,而治疗组大鼠肾小管损伤明显轻于模型组;Western blot分析显示治疗组细胞抗氧化标志物NQO-1和HO-1的蛋白表达水平显著高于模型组(P0.05)。结论 MSCs-CM经尾静脉移植后,对缺血再灌注所致的肾损伤具有明显的修复作用,其修复肾脏损伤机制可能与抗氧化应激有关。     

Impact of Renal Artery Stent-Graft Placement on Renal Function in Chronic Aortic Dissection

PurposeTo evaluate the effect of renal stent-graft placement on kidney function and size alternation in chronic aortic dissection.Materials and MethodsTwenty-five consecutive patients with chronic aortic dissection after thoracic endovascular aortic repair who underwent renal stent-graft placement between January 2015 and December 2016 were retrospectively reviewed. Forty-three patients with chronic aortic dissection who received thoracic endovascular aortic repair in the same period were reviewed as a control group for kidney volume comparison.ResultsTwenty-five stent-grafts were deployed over 25 renal arteries. Overall renal function was assessed by the slope of the regression line constructed from the plots of creatinine clearance versus time within 2 years after the procedure (–0.2810 vs –0.3146 mL/min^–1/mo^–1, P = .868), kidney volume at 12 months (129.4 ± 40.9 vs 137.0 ± 44.2 cm², P = .193) and effective renal plasma flow at 6 months (106.3 ± 46.9 vs 124.4 ± 55.5 mL/min, P = .050) and was not significantly deteriorated. Seven treated patients (87.5%) with a renal artery supplied by a false lumen had a decrease in kidney volume, as did 14 patients (56%) in the control group (P = .206). Three patients with a dissected renal artery (75%) in the stent-graft group had an increase in kidney volume compared with 1 patient (11.1%) in the control group (P = .052).ConclusionsOcclusion of the re-entry tear by a stent-graft in the renal artery remains a safe strategy to promote false lumen thrombosis. The stent-graft poses a potential risk of reducing the kidney volume in kidneys supplied by the false lumen but may provide a positive effect in kidney volume with a concomitant dissected renal artery in chronic aortic dissection.     

连续性肾替代疗法治疗老年慢性肾功能不全合并多器官功能障碍效果分析

目的探讨连续性肾替代疗法(CRRT)治疗老年慢性肾功能不全合并多器官功能障碍的效果。方法选取2012年6月至2015年6月接受CRRT治疗的年龄>65岁的老年慢性肾功能不全合并多脏器功能障碍患者60例。观察CRRT治疗前后心率、中心静脉压、平均动脉压、肌酐、尿素、乳酸、血清钾、碳酸氢盐、超敏C反应蛋白、氧合指数、p H值、急性生理与慢性健康Ⅱ(APACHEⅡ)评分等指标变化。结果 CRRT治疗后,患者的心率、中心静脉压、平均动脉压、肌酐、尿素、乳酸、血清钾、碳酸氢盐、超敏C反应蛋白、氧合指数、p H值、APACHEⅡ评分均较治疗前明显改善(P<0.05)。结论 CRRT是一种治疗老年慢性肾功能不全合并多脏器功能障碍的有效手段,可明显改善患者预后。     

Renal morphology and function immediately after extracorporeal shock-wave lithotripsy

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 treated kidneys and total parenchymal obstruction in 9 (22%). MRI disclosed one or more of the following abnormalities in 24 (63%) of 38 treated kidneys: (1) loss of corticomedullary differentiation, (2) perirenal fluid, (3) subcapsular hematoma, (4) hemorrhage into a renal cyst, and (5) unexplained abnormalities. 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.     

Treatment of Severe Renal Artery Stenosis with Acute Kidney Injury Requiring Hemodialysis by Percutaneous Transluminal Renal Angioplasty and Stent Implantation

PurposeTo evaluate the outcomes of percutaneous transluminal renal angioplasty with stent implantation (PTRAS) among patients with renal artery stenosis (RAS) who become dialysis-dependent due to acute deterioration of renal function.Materials and MethodsThis was a single-center retrospective cohort study of all PTRAS procedures performed from 2003 to 2019 in a referral hospital. A total of 109 procedures were performed in 92 patients. Eleven patients (12%) presented with anuric acute kidney injury (AKI) secondary to high-grade RAS (defined as intraluminal stenosis above 70% per angiography) and underwent PTRAS after starting hemodialysis. Data collected included demographic parameters, medical background, creatinine, blood pressure, indication for intervention, procedure characteristics, adverse events, and long-term data including dialysis treatment and mortality. Among the dialysis-dependent AKI group, outcome measures were defined based on the postprocedural improvement in kidney function and discontinuation of dialysis.ResultsFollowing PTRAS, 8 of 11 patients (73%) demonstrated improved kidney function and were able to discontinue dialysis. The median time on dialysis was 18 days (range, 2–35 days) before PTRAS and 4.5 days (range, 1–24 days) to recovery of kidney function after the time of intervention.ConclusionsPatients with atherosclerotic RAS who develop RAS-related AKI may benefit from PTRAS even after several weeks of anuria and dialysis dependence.