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Objective To analyze the anatomical structure and distribution of the fused renal pyramid (FRP) in cadaveric kidney,and discuss its appearances by CT and ultrasonic examinations.Methods From June 2018 to September 2018,108 cadaveric kidneys were proceeded for regional anatomy.The distribution and anatomical manifestations of FRP was recorded.The renal pyramid was sliced and HE stained to explore the vascular distribution in FRP.From October 2018 to January 2019,ultrasound imaging data of 112 patients with 224 kidneys were collected,including 60 males and 52 females,age (39.0 ± 15.1),ranging from 16 to 73 years old.The renal imaging data of 89 patients and 178 patients with enhanced renal CT were collected,including 48 males and 41 females.Age (45.4 ± 13.6),ranging from 23 to 69 years old.The imaging findings of FRP in ultrasound and enhanced CT was summarized.Results In cadaver kidneys,the proportion of FRP in upper and lower calyces was 68.6％ (74/108) and 64.8％ (70/108),respectively,higher than that in middle calyces 34.3％ (37/108).In the middle group,the incidence of mild fusion was 39.0％ (16/41) and severe fusion was 48.8％ (20/41).The incidence of fusion of two renal pyramidal structures was 90.2％ (37/41).HE staining showed that the boundary between the artery in FRP and the surrounding renal pyramidal was unclear,and the protection of connective tissue was lacking.In Ultrasound,the FRP presented as a large trapezoidal hypo-echoic area with red and blue color signals in doppler mode.In ultrasound,the incidence of FRP was 18.8％ (42/224).In enhanced CT,the FRP presented as enhanced cord-like high density shade in large low density area in cortex phase.In enhanced CT,the incidence of FRP 27.5％ (49/178).Conclusions The FRP is a common structure in human kidney.The arteries localize within the FRP and are absence of sufficient connective tissue protection which are different from normal arteries.Ultrasound and enhanced CT have recognition ability for FRP.
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Objective@#To analyze the anatomical structure and distribution of the fused renal pyramid (FRP) in cadaveric kidney, and discuss its appearances by CT and ultrasonic examinations.@*Methods@#From June 2018 to September 2018, 108 cadaveric kidneys were proceeded for regional anatomy. The distribution and anatomical manifestations of FRP was recorded. The renal pyramid was sliced and HE stained to explore the vascular distribution in FRP. From October 2018 to January 2019, ultrasound imaging data of 112 patients with 224 kidneys were collected, including 60 males and 52 females, age (39.0±15.1), ranging from 16 to 73 years old. The renal imaging data of 89 patients and 178 patients with enhanced renal CT were collected, including 48 males and 41 females. Age (45.4±13.6), ranging from 23 to 69 years old. The imaging findings of FRP in ultrasound and enhanced CT was summarized.@*Results@#In cadaver kidneys, the proportion of FRP in upper and lower calyces was 68.6% (74/108) and 64.8% (70/108), respectively, higher than that in middle calyces 34.3% (37/108). In the middle group, the incidence of mild fusion was 39.0% (16/41) and severe fusion was 48.8% (20/41). The incidence of fusion of two renal pyramidal structures was 90.2% (37/41). HE staining showed that the boundary between the artery in FRP and the surrounding renal pyramidal was unclear, and the protection of connective tissue was lacking. In Ultrasound, the FRP presented as a large trapezoidal hypo-echoic area with red and blue color signals in doppler mode. In ultrasound, the incidence of FRP was 18.8% (42/224). In enhanced CT, the FRP presented as enhanced cord-like high density shade in large low density area in cortex phase. In enhanced CT, the incidence of FRP 27.5%(49/178).@*Conclusions@#The FRP is a common structure in human kidney. The arteries localize within the FRP and are absence of sufficient connective tissue protection which are different from normal arteries. Ultrasound and enhanced CT have recognition ability for FRP.
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Objective To explore the clinical significance of fused renal pyramid (FRP) structure in the establishment of percutaneous renal access.Methods From May 2017 to April 2018,10 fresh porcine kidneys were selected to cast in blood vessels for grading the kidney artery.Then another 80 isolated porcine kidueys were used to simulate percutaneous renal pu ncture and dilatation to establish F24 operative access by the same surgeon.Under the endoscope and microscope,we compared the effects of four different puncture paths on the occurrence of renal vascular injury when respectively punctured through the normal renal pyramid (group A),the side of the FRP (group B),the centre of the FRP (group C) and the renal column (group D).Results The kidney arteries can be divided into six grades,there is grade Ⅳ branchinterlobar artery walking inside the FRP.The diameter of interlobar artery in the FRP was significantly smaller than that in the renal column (0.442 ±0.012) mm vs.(0.778 ±0.037) mm,(P ＜0.001).Endoscopic observation and pathological tissue section showed the following results.In group A,there was no injured blood vessel distributed along the access.There were six specimens with grade Ⅴ or Ⅵ arteries injury in the cortex.Owing to the small size of the renal pyramid and the inaccurate location of the puncture,there was also injury associated with a normal grade Ⅳ artery in the renal column.In group B,there was a certain distance between the tract and the grade Ⅳ artery that distributed in the FRP,injury was still noticed in four specimens.And six specimens have grade Ⅴ/Ⅵ arterial injury.As the distance between the tract and the renal column decreased,there was a case in which a simultaneously injury occurred to the extremity of a grade Ⅲ artery and a grade Ⅳ artery.In group C,there was a white thin strip of connective tissue exposed along the puncture tract.Ectopic grade Ⅳ artery injury occurred in fourteen specimens,and grade Ⅴ/Ⅵ artery injury occurred in seven specimens.In group D,there were grade Ⅲ to Ⅵ arteries distributed along the operational access,which was cowered with white fat and connective tissue.The number of arteryinjury in grades Ⅲ,Ⅳ,and Ⅴ/Ⅵ were4,19,and 5,respectively.The mean ranks of artery injury degree in groups A (17.0),B (30.1),C (33.5) and D (41.5) gradually increased,and the difference was significant (P =0.006).There was a significant difference between group A and C (P =0.018),while no significant difference between group A and B (P =0.122),groups C and D (P =0.072).The proportion of grade Ⅳ artery injury in group A,B,and C was 5％ (1/20),25％ (5/20),and 70％ (14/20),respectively.There was a significant difference between group A and C (P =0.029),while no significant difference between group A and B (P =0.316).There was no significant difference in the injury of grade Ⅴ and Ⅵ artery in four groups (P =0.827).Conclusions When establishing a percutaneous renal access,vascular injury caused bv puncturing through the FRP cannot be ignored.It is necessary to carefu lly identify and bypass the FRP when selecting the puncture path.If unavoidable,the puncture path shoull be on the centreline of one side pyramid of the FRP.