Test-retest reliability analysis of MRI criteria in the 2019 Bosniak classification of cystic renal masses / 中华放射学杂志

Objective:To evaluate the test-retest reliability of MRI criteria in the 2019 Bosniak classification of cystic renal masses (CRMs) and to analyze the impact of lesions′ property, size and readers′ experience on the test-retest reliability.Methods:From January 2009 to June 2019, 207 patients with 207 CRMs were included in this retrospective study. All of them underwent renal MRI and surgical-pathologic examination. According to Bosniak classification, version 2019, all CRMs were independently classified twice by eight radiologists with different levels of experience. All radiologists were blinded to the pathology of the lesions. By using intraclass correlation coefficient (ICC), test-retest reliability was evaluated for all CRMs and for subgroups with different pathological properties (benign and malignant) and different sizes (≤40 mm and>40 mm). The test-retest reliability of 4 senior readers (≥10 years of experience) and 4 junior readers (<10 years of experience) were evaluated respectively. The comparison of ICC was performed using Z test. Results:The 207 CRMs included 111 benign lesions (83 benign cysts, 28 benign tumors) and 96 malignant tumors. There were 87 lesions with maximum diameter ≤40 mm and 120 with maximum diameter>40 mm. The test-retest reliability (ICC) of each reader for all lesions was 0.776-0.888, the overall ICC was 0.848 (95%CI 0.821-0.872). The ICCs of senior and junior readers were 0.853 (95%CI 0.824-0.880) and 0.843 (95%CI 0.811-0.871) respectively, without significant difference between the two groups ( Z=0.85, P=0.374). The ICC of all readers was 0.827 for benign lesions and 0.654 for malignant lesions, showing significant difference ( Z=2.80, P=0.005). The ICC was 0.770 for lesions ≤40 mm and 0.876 for lesions>40 mm, which was significantly different ( Z=-2.36, P=0.018). For CRM subgroups with different pathological properties and different sizes, there was no significant difference in test-retest reliability between senior and junior readers (all P>0.05). Conclusion:The test-retest reliability of MRI criteria in the 2019 Bosniak classification of CRMs is excellent and unaffected by readers′ experience. The reliabilities are not consistent among CRMs of different pathological properties and different sizes, but all reached the level of good and above.

A rare case of Human Dioctophyma renale infection in an adult Filipino male

Introduction@#Dioctophyma renale, also known as the “giant kidney” worm is the largest nematode that infects mammals. Most commonly, it infects dogs and only a few cases of human infestation have been reported.@*Case Presentation@#In this case, we present a 71-year-old male with a history of right flank pain, painless hematuria, obstructive urinary symptoms and occasional passage of a long red meat-like structure via urethra. Previous ultrasonography revealed a renal mass that was interpreted as renal malignancy. Patient was advised radical nephrectomy with biopsy; however, he was lost to follow up. After 8 years, he again presented with a 2-month history of right flank pain, gross hematuria, unintentional weight loss and obstructive urinary symptoms. He was admitted to our institution and laboratory findings revealed microcytic hypochromic anemia. Ultrasound showed a focal bulge in the superior wall of the urinary bladder and an enlarged right kidney with a large heterogeneous solid structure. Insertion of a foley catheter relieved the urinary obstruction and there was noted passage of a single roundworm measuring 55 cm by 0.32 cm. The specimen was sent for histopathology and microscopic examination revealed a necrotic body of a roundworm consistent with Dioctophyma renale.@*Case Discussion@#The clinical manifestations of D. renale infection are non-specific and the diagnosis can be a challenge as it commonly mimics renal malignancy and other intra-abdominal tumors. The diagnosis is often an incidental finding of the parasite on necropsy or by finding ova in the urine. The clinical findings of painless hematuria, unintentional weight loss and an ultrasound finding of renal mass usually point toward the diagnosis of renal cell carcinoma. As we present this case, it will be highlighted that such signs and symptoms, such as painless hematuria, unintentional weight loss and ultrasound finding of a renal mass, can also be found in patients with rare human parasitism from Dioctophyma renale.

Role of diffusion: weighted magnetic resonance imaging in evaluation of renal masses

Background: Diffusion-weighted magnetic resonance imaging (DWI) is a valuable tool to narrow down the differential diagnosis of renal masses. Studies have shown that benign renal masses have higher Apparent diffusion coefficient (ADC) value than malignant renal masses. Aim of study was to evaluate the role of diffusion-weighted magnetic resonance imaging in the characterization of renal masses.Methods: The study was conducted in department of Radio diagnosis at ABVIMS and Dr. RML Hospital, New Delhi between June 2017 to March 2019. This was a cross-sectional observational study comprising of 28 patients. Patients found to have renal mass on ultrasound and computed tomography (CT) were evaluated further on 3T siemens Magnetic resonance imaging (MRI) scanner. In addition to routine sequences, DWI using b value of 0,500,1000 s/mm2 sequence was used to study to differentiate benign and malignant renal masses.Results: Of a total of 28 cases, the most common malignant mass was renal cell carcinoma (RCC). Angiomyolipoma (AML) was the most common benign masses. DWI showed low ADC values in most of the malignant masses and high ADC values in most of the benign masses. The cut-off level of ADC value for differentiation among benign and malignant renal masses was 1.08×10-3 mm2/s. DWI-MR findings were correlated with histopathological diagnosis.Conclusion: DWI with ADC measurements are a non-invasive, problem solving tool for characterization of renal masses helping to differentiate malignant from benign masses.

Primary renal lymphoma: a rare cause of renal mass in pediatric age group: case report and review of literature

The secondary renal involvement of non-Hodgkin lymphoma is frequently encountered but primary renal lymphoma is extremely rare in children. We hereby present a rare case of primary renal diffuse lymphoma in a 3-year-old girl child who presented with bilateral renal masses.  The tumour was initially diagnosed as bilateral Wilms’ tumour but on biopsy, it turned out to be non-Hodgkin's lymphoma. Primary renal lymphoma is an aggressive tumour with guarded prognosis. There are a variety of diseases which present as renal masses in children amongst which primary renal lymphoma is extremely rare. This article describes the clinical features and diagnostic features of primary renal lymphoma. Our report highlights the importance of keeping this neoplastic condition under consideration while evaluating children with renal mass .In order to distinguish primary renal lymphoma from other renal tumours, the authors have also described the clinical, imaging and pathological features of various other renal tumours prevalent in children.

Ultrasound evaluation of non-cystic renal masses and correlation with ultrasound guided fine needle aspiration cytology/biopsy

Background: The purpose of present study was to identify sonologically, the cystic and non-cystic renal mass lesions, to attempt differentiating benign lesions from the malignant ones and to correlate ultrasound findings with ultra sonographically guided cytological or pathological findings.Methods: In this hospital based prospective observational study, all the patients with confirmed renal mass were subjected to USG guided fine needle aspiration cytology (FNAC). All the patients presenting with lump in abdomen, haematuria or pain in abdomen, wherein the clinical diagnosis of renal mass was being considered by the clinician, were enrolled for the study. Total 54 participants were enrolled. Those with confirmed renal mass were subjected to USG guided FNAC and which was carried out in supine position by transabdominal route in all patients.Results: About 42 participants were retained for final analysis; since FNAC was not possible in 12 patients. Pain in abdomen (36, 85.7%), mass in abdomen (34, 81%) were the most predominant clinical findings. Mixed echogenicity was the commonest echo pattern (42, 77.7%) on ultrasonography. Histopathologic/cytologic examination of the 39 malignant cases confirmed renal cell carcinoma (18, 46.5%) to be the commonest malignancy, followed by Wilms’ tumour (10, 26%). Out of the 39 cases in which clinico-radiological diagnoses were correlated with histo-cytological diagnoses, it was found to be consistent in 30 (77%) cases and inconsistent in 9 (23.1%) cases.Conclusions: Fine needle aspiration cytology/biopsy performed under ultrasonography guidance demonstrates high diagnostic accuracy. It is hence recommended as part of fundamental approach to the diagnosis of non-cystic renal mass.

Diagnostic performance of contrast-enhanced ultrasound in the evaluation of renal masses in patients with renal impairment

Objective: To evaluate the performance of contrastenhanced ultrasound (CEUS) in the risk stratification of indeterminate renal lesions picked up incidentally on abdominal imaging, in patients with renal impairment. Methods: A retrospective study was performed of nonconsecutive patients who underwent CEUS at our tertiary care centre for indeterminate renal lesions between March 2010 and September 2014. A total of 63 patients with 74 nodules were assessed with CEUS and stratified into either benign (Bosniak I, II, IIF) or suspicious for malignancy (Bosniak III, IV or hypervascular solid lesions). Diagnostic accuracy was determined by comparing these findings to subsequent histological diagnoses, temporal change after at least 20 months follow-up or after a diagnostic computer tomography / magnetic resonance imaging study. Results: CEUS correctly identified 49/52 (94.2%) of benign lesions and 21/22 (95.5%) of malignant lesions, resulting in a sensitivity of 95.5% (95% CI 77.2-99.9%), specificity of 94.2% (95% CI 84.1-98.8%), positive predictive value (PPV) 87.5% (95% CI 67.6-97.3) and negative predictive value (NPV) 98.0% (95% CI 89.4-100%). Conclusion: CEUS has high diagnostic performance in predicting the benignity of a renal lesion in patients with renal impairment, showing sensitivity and NPV approaching 100%.

Laparoscopic Management of a Renal Hydatid Cyst Masquerading as Simple Renal Cyst.

Hydatid cyst is a parasitic disease caused by the tapeworm Echinococcus granulosus. Hydatid cyst disease mostly involves the liver and the lung, while renal involvement is rare. Hydatid disease may present in unusual ways and lead to diagnostic diffi culty and management problems. A high index of suspicion for hydatid disease should be maintained while evaluating complex cystic renal masses. Herein we present an interesting case who was diagnosed to have a simple renal cyst on contrast-enhanced computed tomogram, which turned out to be a renal hydatid cyst. Despite modern imaging methods, isolated renal hydatid disease might still cause diagnostic dilemma and hydatid cysts can be found in unusual localization. Th is case was managed laparoscopically.

The clinical application of the sliding loop technique for renorrhaphy during robot-assisted laparoscopic partial nephrectomy: Surgical technique and outcomes

PURPOSE: To report the initial clinical outcomes of the newly devised sliding loop technique (SLT) used for renorrhaphy in patients who underwent robot-assisted laparoscopic partial nephrectomy (RALPN) for small renal mass. MATERIALS AND METHODS: We reviewed the surgical videos and medical charts of 31 patients who had undergone RALPN with the SLT renorrhaphy performed by two surgeons (CWJ and CK) between January 2014 and October 2014. SLT renorrhaphy was performed after tumor excision and renal parenchymal defect repair. Assessed outcomes included renorrhaphy time (RT), warm ischemic time, perioperative complications, and perioperative renal function change. RT was defined as interval from the end of bed suture to the renal artery declamping. RESULTS: In all patients, sliding loop renorrhaphy was successfully conducted without conversions to radical nephrectomy or open approaches. Mean renorrhaphy and warm ischemic time were 9.0 and 22.6 minutes, respectively. After completing renorrhaphy, there were no adverse events such as dehiscence of approximated renal parenchyma, renal parenchymal tearing, or significant bleeding. Furthermore, no postoperative complications or significant renal function decline were observed as of the last follow-up for all patients. The limitations of this study include the small volume case series, the retrospective nature of the study, and the heterogeneity of surgeons. CONCLUSIONS: From our initial clinical experience, SLT may be an efficient and safe renorrhaphy method in real clinical practice. Further large scale, prospective, long-term follow-up, and direct comparative studies with other techniques are required to confirm the clinical applicability of SLT.

Imaging Findings of Common Benign Renal Tumors in the Era of Small Renal Masses: Differential Diagnosis from Small Renal Cell Carcinoma: Current Status and Future Perspectives

The prevalence of small renal masses (SRM) has risen, paralleling the increased usage of cross-sectional imaging. A large proportion of these SRMs are not malignant, and do not require invasive treatment such as nephrectomy. Therefore, differentation between early renal cell carcinoma (RCC) and benign SRM is critical to achieve proper management. This article reviews the radiological features of benign SRMs, with focus on two of the most common benign entities, angiomyolipoma and oncocytoma, in terms of their common imaging findings and differential features from RCC. Furthermore, the role of percutaneous biopsy is discussed as imaging is yet imperfect, therefore necessitating biopsy in certain circumstances to confirm the benignity of SRMs.

Clinical and pathological characteristics of small renal mass analysis / 实用肿瘤学杂志

Objective To explore the clinicopathological characteristics of small renal mass .Methods We reviewed the medical records of patients who had received partial nephrectomy ( PN) or radical nephrectomy ( RN) in 2011 in the tumor hospital of harbin medical university .We identified xxx patients who were treated with PN or RN for renal masses within a size of 4 cm.All small renal masses were localized ,sporadic,solid,and had reports of renal carcinoma measurement by CT or MRI .Results Of the 36 SRMs,there were 32(88.89%)clear cell renal cell carcinoma,3(8.33%)papillary renal cell carcinoma,1(2.78%)begin tumor.Of the 36 patients, 34 patients received radical nephrectomy ( RN) and only 2 male patients received partial nephrectomy ( PN) .The mean tumor size of 36 SRMs was 2.9 cm.Conclusion The majority of 36 SRMs are categorized to clear cell re-nal cell carcinoma by histological type .Most of the 36 patients receive radical nephrectomy ( RN) .

Nefrectomía parcial laparoscópica: experiencia de 135 casos / Laparoscopic partial nephrectomy: experience of 135 cases

Introducción: La nefrectomía parcial laparoscópica (NPL) es considerada hoy una alternativa terapéutica para el manejo de tumores renales menores de 4 cm. Sus principales ventajas son permitir un excelente control oncológico, además de preservar la unidad renal. Por otro lado ha permitido acortar los tiempos de hospitalización, disminuir el dolor postquirúrgico y lograr menores tiempos de recuperación en los pacientes. El objetivo del presente estudio es presentar nuestra experiencia en nefrectomías parciales laparoscópicas durante los últimos 12 años. Materiales y métodos: Estudio retrospectivo de sometidos a NPL entre los años 2000 y 2012. En todos los casos la cirugía fue realizada por un mismo cirujano. Se obtuvo información demográfica de los pacientes, tamaño y ubicación del tumor, vía de abordaje, tiempo quirúrgico, sangrado intraoperatorio, tiempo de hospitalización y complicaciones. El análisis de los datos se llevo a cabo con el programa SPSS v17. Se consideró significativo un p<0.05.Resultados: En el periodo descrito se realizaron NPL en 135 pacientes (70.4 por ciento hombres). El promedio de edad fue de 56.9+/-12.8 años. Ochenta y dos cirugías fueron izquierdas y 53 derechas. Con respecto a la ubicación de la masa dentro del riñón, se encontraron un 25.2 por ciento en el polo superior, 46.7 por ciento en la porción media y 28.1 por ciento en el polo inferior. En el 40 por ciento de los casos los tumores se ubicaron en una posición calificada como técnicamente compleja. Con respecto al abordaje quirúrgico, un 42.2 por ciento fueron realizadas por vía transperitoneal y un 57.8 por ciento por vía retroperitoneal. Se realizaron 8 conversiones a cirugía abierta. El tamaño promedio de los tumores fue de 3.26+/-1.6 cm...

Introduction: Laparoscopic partial nephrectomy (LPN) has become the first-line surgical technique for the management of renal tumors smaller than 4 cm. Its main advantages are an excellent oncologic control together with the preservation of nephron units. Moreover it implies a shorter-length of hospital stay, less postoperative pain and shorter recovering times for patients. The aim of this report is to show our experience and compare it with the resuls reported in the international literature. Materials and methods: All patients that underwent LPN within years 2000 and 2010 were retrospectively studied. In all cases surgery was performed by the same surgeon. Data was collected retrospectively, including clinical and histopathologic information, as well as surgical and functional results. Results: One hundred and thirty five were included (70.4 percentmale). Mean age was 56.9 +/- 12.8 years. Eighty-two surgeries were left and 53 right. Regarding to the location of the mass within the kidney, 25.2 percent were found at the upper pole, 46.7 percent in the middle portion, and 28.1percent at the lower pole. In 40 percent of cases the tumor was located in a position described as technically complex. Regarding to the surgical approach, 42.2 percent were performed by transperitoneal and retroperitoneal 57.8 percent for. There were eight conversions to open surgery. The average tumor size was 3.26 +/- 1.6 cm. Mean operative time was 106.2 +/- 38.2 minutes. The median blood loss was 100cc (range <50-3000). Two patients required transfusion. Median hospital stay was 48 hours (range 23-120). Eleven patients (8.14 percent had complications related to surgery. The most of the cases (n = 5) were due to intraoperative bleeding. Conclusions: The LPN is a challenging surgical technique. The results of this study confirm that laparoscopic surgery is a safe technique for the management of renal tumors with a low rate of complications and shorter hospital stays.

Riesgo de malignidad en masas renales sólidas menores a cuatro centímetros / Risk of malignancy in solid renal masses less than four centimeters

El tratamiento de las masas renales sólidas menores de cuatro centímetros constituye un tema de debate. La “vigilancia activa” se ha propuesto como alternativa para su manejo, sin embargo, estudios publicados recientemente, señalan que un porcentaje no despreciable de estos tumores resultan ser malignos, e incluso en un 6 por ciento de los casos pueden producir metástasis. El objetivo del presente estudio consiste en determinar el riesgo de malignidad en masas renales sólidas menores de cuatro centímetros en un grupo de pacientes sometidos a Nefrectomía Parcial Laparoscópica (NPL). Estudio retrospectivo de pacientes sometidos a NPL. Se seleccionaron aquellos que presentaron lesiones renales sólidas menores a 4 cm informadas por TAC y/o RMN. Se crearon intervalos de tamaño (<2 cm, 2-2.9 cm, 3-4 cm). Se realizó un análisis univariado para determinar el riesgo de malignidad de acuerdo al tamaño del tumor, estableciendo el Odds Ratio correspondiente y el intervalo de confianza (95 por ciento). Los datos obtenidos fueron analizados mediante el programa SPSS v17. Se consideró como significativo un p< 0.05. Entre los años 2000 y 2012 se efectuaron 135 nefrectomías parciales laparoscópicas por la presencia de una masa renal sólida. Noventa y dos casos presentaron lesiones menores a cuatro centímetros, los que fueron incluidos en este estudio. Del total de tumores el 9.8% resultó ser benigno en el estudio histopatológico definitivo. No existieron diferencias significativas (p=0,67) con respecto a la media del tamaño (2,2 y 2,57 cm respectivamente) entre los tumores benignos y malignos. El porcentaje de tumores malignos aumentó significativamente (p = 0,025) en las masas mayores de 2 cm, al compararlo con aquellas de menor tamaño (69 por ciento v/s 86.7 por ciento). Mediante el análisis univariado se estableció que el riesgo de malignidad se incrementa 4.9 veces (p=0.027) en aquellas masas renales sólidas mayores de 2 cm...

The treatment of solid renal masses less than four centimeters (cm) is a subject of debate. Active surveillance has been proposed as a management option, however, recently published studies indicate that, in a substantial proportion, these tumors are malignant; and even at 6 percent of the cases can produce metastases. The aim of this study was to determine the malignancy risk in solid renal masses less than four cm in a group of patients undergoing laparoscopic partial nephrectomy (LPN).A retrospective study of patients undergoing LPN was performed. We selected those who had solid renal lesions smaller than 4 cm reported by CT and/or MRI. Size ranges were set (<2 cm, 2-2.9 cm, 3-4 cm). Univariate analysis was performed to determine the risk of malignancy according to tumor size, obtaining the corresponding odds ratio and confidence interval (95 percent). Data were analyzed using SPSS v17. P-value < 0.05 was considered stadistically significant. RESULTS: One hundred and thirty five laparoscopic partial nephrectomies were performed due to a solid renal mass between 2000 and 2012. Of them, ninety-two cases had a lesion less than four cm, which were included in this study. From the total of tumors, 9.8 por ciento were proved benign on final histopathology. No significant difference was found between benign and malignant tumors when mean sizes were compared (2.2 and 2.57 cm, respectively, p =0.67). The percentage of malignant tumors was significantly higher in masses larger than 2 cm, compared with those of smaller size (86.7 percent v/s 69 percent respectively, p=0.025). Univariate analysis established that the malignancy risk is increased 4.9 times in solid renal masses larger than 2 cm (p = 0.027). Our study shows that although the risk of cancer increases significantly in renal masses from the 2 cm there is a considerable percentage of malignancy in masses below this size.

A Female Infant with Segmental Multicystic Dysplastic Kidney

There have only been 35 pediatric cases and one adult case reported on segmental multicystic dysplastic kidney (MCDK) from our search in PubMed, including 19 cases detected antenatally. There is little documentation of segmental MCDK, particularly concerning its natural history. Segmental MCDK can be presented atypically, making diagnosis more difficult. We report an another case with segmental MCDK. Multicystic abdominal mass detected on antenatal sonogram in this infant was diagnosed as segmental MCDK by renal ultrasonography and computed tomography. If a definitive diagnosis of segmental MCDK can be made on imaging, surgery is not required for a diagnostic biopsy.

Renal masses in end-stage renal disease patients on dialysis / 대한내과학회지

BACKGROUND/AIMS: End-stage renal disease (ESRD) patients are at a higher risk for cancer, especially renal cell carcinoma (RCC). Acquired cystic kidney disease (ACKD) and long duration of dialysis predict RCC in these patients. We explored the cilnical and pathologic characteristics of renal masses and the factors predicting malignant tumors. METHODS: The study examined the medical records of 38 ESRD patients who underwent partial/total nephrectomy due to renal masses diagnosed by abdominal ultrasound and computed tomography at YUHS from January 1995 to December 2009. RESULTS: Renal masses were recorded in 38 patients (21 males) with a mean age of 48.3+/-13.2 years. Twenty patients (52.6%) were on hemodialysis and 18 patients (47.4%) were on peritoneal dialysis, for a mean period of 106.4+/-62.5 months. ACKD was reported in 23 patients (67.6%). Of the 38 renal masses, 23 (60.5%) were diagnosed as malignant tumors and 15 (39.5%) were benign tumors. Clear cell RCC (n=16) and hematoma (n=6) was the predominant respective types. The patients with malignant tumors had a significantly longer duration of dialysis (122.3+/-61.8 vs. 81.1+/-56.7 months, p<0.05) and a higher prevalence of ACKD (87.0 vs. 46.7%, p<0.01) compared to the patients with benign tumors. CONCLUSIONS: The most common renal mass in ESRD patients was RCC. Malignant tumors were significantly associated with a longer duration of dialysis and ACKD. Therefore, early evaluation and treatment of RCC are mandatory in long-term dialysis patients with ACKD.

Renal angiomyolipomas in the University of Malaya Medical Centre: its spectrum of presentation and management

Renal angiomyolipoma, once considered a rare benign renal tumour, is relatively common these days. They account for 0.3-3.0% of all renal masses. Histologically, it is composed of adipose tissue, smooth muscles and blood vessels. Here, we wish to highlight five cases of renal angiomyolipomas which were presented to the University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia, over a two-year period between June 2005 and June 2007. This study wish to illustrate its varied clinical presentation and the management undertaken for each underlying condition. These cases were presented in the form of spontaneous perirenal haemorrhage, a large asymptomatic renal mass, a small asymptomatic renal mass, a symptomatic renal angiomyolipoma and a case of renal angiomyolipoma mimicking a renal tumour. Each of these cases varied in its clinical presentation; thus, management has become very challenging to clinicians ranging from conservative management to active intervention, be it operatively or non-operatively.

Multidetector CT and high magnetic field MRI in evaluation of small cystic-solid renal mass / 上海第二医科大学学报

Objective To evaluate the role of multidetector CT(MDCT) and high magnetic field MRI in diagnosis of small cystic-solid renal mass. Methods Fifty-two cases with small renal cystic-solid mass(≤3 cm) were consecutively collected,including small cystic-solid renal cell carcinoma(n=25),carcinoid(n=1),complex cysts(n=16),small angiomyolipoma(n=7) and benign cystic nephroma(n=3).All were examined by both 1.5T MRI and multidetector CT at intervals between 3 days and 2 months. Results All cases were proved by pathology.Multi-planar reconstruction techniques were useful for MDCT in differentiating small cystic-solid renal mass,with the sensitivity of 98.1%,which was as high as MRI.However,the accuracy for MDCT was 71.2%,significantly lower than that of MRI(90.4%)(P=0.001).MRI helped to identify the components and structure of renal masses,and behaved better in the detection of pseudo-capsule of renal cell carcinoma(57.7%).Conclusion High magnetic field MRI may play an important role in the diagnosis of small renal cystic-solid masses,and it may be feasible as a noninvasive examination when CT can not make the ultimate determination.

Focal Bacterial Nephritis (Lobar Nephronia) in a Four-Month Old Boy

Acute lobar nephronia is a focal form of acute bacterial nephritis, affecting one or more of the renal lobules. Nephronia is being diagnosed more frequently in accordance with the advancing imaging techniques of urinary tract. We report a case of acute nephronia in a 4 month old boy who presented persisting urinary tract infection after intial antibiotic treatment. Ultrasonography and computerized tomography showed round wedge-shaped, non-enhancing mass in right kidney. Gallium scan also revealed the lesion in the right kidney. This lesion resolved completely on one month follow up examinations.

Ratio of Kidney Weight to Recipient Weight Correlates with the 3-Year Graft Function / 대한이식학회지

Reduced renal mass, increased recipient body size, and their mismatching are the potential risk factor to explain the non-immunologic graft dysfunction. Present study was designed to assess the effect of mismatch between donor kidney weight (KW) and recipient body weight (BW) on the 3-year graft function in live donor renal transplantation (TX) patients (pts) who were operated before Nov. 1995 under cyclosporine. To remove immunologic injuries and effect of glomerulonephritis (GN), the pts experiencing episode of acute rejection or showing post-TX biopsy-proven GNs were excluded. A total of 82 pts cohort was identified and followed up till Nov. 1998. The donor KW after cold flushing, BW of recipient at TX, and renal parameters at 3-year post-TX such as serum creatinine (Scr), creatinine clearance ratio (CCR) and 24-hour urinary excretion of protein (24UP) were recorded. First, any correlation between the index value of the KW/BW ratio and each parameters was studied by the regression analysis, and secondly, the pts were stratified into 3 groups by the KW/BW ratio (3.5 4.0) and compared with each parameters by ANOVA test. Scr, CCR, and 24 UP was well correlated with the ratio KW/BW (p4.0) have significantly lower Scr, higher CCR and lower 24 UP compared with pts showing medium or low ratio. In conclusion, the mismatch between the donor KW and recipient BW has a substantial effect on the medium term graft function. Since estimating the kidney volume by CT scan or ex vivo after bench surgery is simple and easily applicable in clinical practice, KW/BW ratio is to be considered for the selection or allocation of potential donor in both cadaveric and living donor TX programs.

Detection and Identification of Renal Masses by Abdominal Ultrasonography and Incidence Estimation / 대한비뇨기과학회지

Abdominal ultrasonography was performed in 25,622 adults during the period from July 1992 to June 1995 at the Helth Care Examination Center. The renal masses detected and identified by abdominal sonography were investigated to estimate the incidence of each identification. Renal masses were found in 562 cases(2.19%). Of five hundred and sixty two cases, 555(98.75%) were cystic masses and seven(1.25%) were solid masses. Of five hundred and fifty five cystic masses, 550 were simple cyst(97.86%), four polycystic kindney(0.71%) and one cystic renal cell carcinoma(0.18%). Of seven solid masses, two were angiomyolipoma(0.36%) and another four were renal cell carcinoma(0.71%). The rest one case revealed equivocal finding on an ultrasonography, but the patient refused further study. Although the study population was not a random sampling, the incidence of simple cyst was 2,146 per 100,000 in adult and that of renal cell carcinoma was 19 per 100,000 in adult. Furthermore, ultrasonography is a useful tool for screening the renal carcinoma at the low cost.

Two cases of acute focal bacterial nephritis / 대한비뇨기과학회지

Acute focal bacterial nephritis (AFBN), synonymous with acute lobar nephronia (ALN) or focal pyelonephritis, is an inflammatory mass without liquefaction caused by severe acute bacterial infection of kidney. Unless treated effectively, progression to a renal abscees may ensue. Clinically, AFBN presents as acute pyelonephritis, and radiologically, as focal swelling or mass. The distinction between AFBN and renal abceess or even tumor may be confusing and difficult. Ultrasonography and computerized tomography(CT) aid in establishing the correct diagnosis. However, the appearance of AFBN on sonography and CT is by no means pathognomonic. Benign or malignant renal tumors may have a similar appearance. With the clinical history, a high index of suspicion, and follow-up studies after institution of medical treatment may further aid in the differentiation. Herein we report 2 cases of AFBN, which were presented as renal masses.