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Flash pulmonary oedema can occur as a result of multiple triggers that may act independently or in concert. One such precipitating factor is bilateral renal artery stenosis which can be treated either with revascularisation or with medical therapy. Unilateral renal artery stenosis, however, is a rare cause of flash pulmonary oedema, especially when the contralateral kidney is still functional. We describe a case of an elderly woman with a history of heart failure with preserved ejection fraction and multiple hospitalisations for hypertensive crisis and flash pulmonary oedema who was found to have right, ostial renal artery stenosis that was treated with stent placement.

Tubulocystic renal cell carcinoma (RCC) is a rare subtype of RCC that was recently included in the 2016 World Health Organization classification of tumors of the kidney. Most of these tumors exhibit indolent behavior with low metastatic potential. However, here we report a case of recurrent tubulocystic RCC with aggressive features in the retroperitoneum and contralateral kidney treated with targeted agents and radiofrequency ablation.

Backgroung/Aim: Salivary gland malignancies are rare, with only a fraction due to metastases. We report a rare case of the Clear Cell Renal Cell Carcinoma (CCRCC), a subtype of the Renal Cell Carcinoma (RCC), metastasizing to the parotid gland more than five years following nephrectomy. Case report: A 75-year-old female presented with a unilateral left parotid mass that was growing over the period of 18 months. After clinical and laboratory examinations, the patient underwent left partial superficial parotidectomy with preservation of the facial nerve. The significance of the patient's history of the CCRCC was pivotal to the histopathological diagnosis of a metastatic CCRCC to the parotid. Conclusions: The unpredictable nature of the RCC results in the need for a long period of follow-up, as well as having a high degree of suspicion of metastasis in a patient presenting with a medical history of the RCC and a parotid mass.

Background/aim The criteria for surgical management of ureteropelvic junction obstruction are not well-defined, and there is a risk for loss of renal function before the operation. In this context, certain changes in contralateral kidney had been investigated in order to increase the sensitivity of diagnosis. In this study, we aimed to investigate whether contralateral transient minimal hydronephrosis (CTMH) can be considered as an “early alarm” sign for worsening of the affected kidney in infants with hydronephrosis. Materials and methods A total of 182 infants (92 surgically treated and 90 conservatively followed-up) with unilateral hydronephrosis were retrospectively analyzed. Ultrasonography and renal scan findings were evaluated. Correlation between the appearance of CTMH, contralateral compensatory hypertrophy (CCH) on ultrasonography, and prognosis of the affected kidney were evaluated. Results Among the surgically treated patients, 18 (19.6%) patients developed CTMH on average 7 months (0–13 months) before surgery. Among these 18 patients with CTMH, 12 patients (66.6%) had loss of renal function preoperatively, while this ratio was 29.7% on their counterparts (p = 0049). CCH was observed in 31 (33.7%) individuals in surgically treated patient group including all 18 patients with CTMH, while none of the conservatively followed-up patients developed CCH and/or CTMH. In the multiple logistic regression analysis, among the variables investigated, CTMH was found as an independent predictor of the deterioration in the affected kidney and of the poor prognosis (p = 0.011 and p = 0.0004, respectively). Conclusion In our study, among the variables investigated, CTMH was found as an independent predictor of the deterioration in the affected kidney and poor prognosis in infants followed-up with isolated unilateral hydronephrosis. Additionally, CTMH can be considered as an “early alarm” sign for worsening of the affected kidney and the need for surgical intervention.

Introduction Renal leiomyosarcoma is a rare entity in the world and its understanding is based on reports and various cases; however, the prognosis is bleak for its malignant potential and an average survival of 18 months. Clinical case A 54-year-old woman with a clinical picture of 6 months of pain in the right flank and a tomographic image of a bilateral renal lesion underwent right radical nephrectomy and left conservative surgery. The definitive histopathological study reported right primary renal leiomyosarcoma with left metastasis. Conclusion Renal leiomyosarcoma is an entity of low incidence and high mortality; however, our case represents the minority of patients with contralateral kidney metastasis reported in the literature.

Bilateral ADPKD is a well-known entity, but there are only a few reports on unilateral ADPKD in adults, most of which had associated contralateral agenesis. Further rare is the development of RCC in unilateral ADPKD. We present an exceedingly rare case of true unilateral ADPKD with normal contralateral kidney and an associated renal cell carcinoma in the same kidney. Keywords: ADPKD, RCC, agenesis

Renal cell carcinoma has a propensity to metastasize to lung, bone, liver, brain, adrenal glands and the contralateral kidney. The proportion of metastatic RCC at diagnosis is estimated to be about 30–40%, and about 20–50% patients will develop metastasis after radical nephrectomy. Gallbladder metastasis from RCC is rare and is found in only about 0.6% of patients at autopsy.1 We present a case of metachronous metastasis of clear cell carcinoma to the gallbladder in a 55-year-old woman one year after radical nephrectomy.

A 21-year-old man, a member of the track team, has his first kidney stone at college. Computed tomography showed a 4-mm obstructing distal ureteral stone and a nonobstructing 4-mm contralateral kidney stone. The stone passed: its composition was 100% calcium oxalate. Serum chemistry was normal with

INTRODUCTION AND OBJECTIVES:Replacement of healthy renal parenchyma by renal cell carcinoma (RCC) can contribute to preexisting CKD and thus complicate management. However the magnitude and factors associated with this phenomenon have not been described.METHODS:A retrospective review was performed of all radical nephrectomies (RN) performed at our center from 2006-2016. 155 patients with available nuclear renal scan and imaging demonstrating a single RCC tumor with normal contralateral kidney were included for analysis. Healthy renal parenchyma of each kidney and tumor volumes were measured by free-hand scripting from axial images at 3 mm intervals. Parenchymal volume discordance (volume ipsilateral kidney – volume contralateral kidney) was calculated assuming that the volume of the contralateral kidney serves as a control to assess replacement of healthy parenchyma by RCC. Split renal function was used as an internal control for volumetric measures. Multiple regression was used to identify preoperative a...

Most renal masses are diagnosed incidentally by imaging. Traditionally, conventional studies, in example ultrasonography (US), contrast enhanced computed tomography (ceCT) and magnetic resonance imaging (MRI) are employed for detecting and characterizing renal masses. International guidelines recommend the use of ceCT in order to asses the tumour extension, including the widespread of disease in the local and distant lymph nodes, the assessment of the surrounding and distant organs and the function of the contralateral kidney.

To investigate the usefulness of the ellipsoid formula for assessing compensatory hypertrophy of the contralateral kidney on pre-operative and post-operative CT in renal cell carcinoma (RCC) patients.We retrospectively identified 389 patients who had radical nephrectomy for RCC between 2011 and 2015. Contrast-enhanced CT was performed within 3 months pre-operative and at 1 year post-operative. The kidney volumes were calculated from CT using the ellipsoid formula. We subdivided patients into three groups based on tumour size (I: ≤4 cm, II: 4-7 cm, III: 7 cm). Volumetric renal parameters were compared and multivariate analyses were performed to determine predictors associated with pre-operative and post-operative compensatory hypertrophy.Kidney volume calculation using the ellipsoid method took a median of 51 s. Group III had a significantly larger median pre-operative contralateral renal volume than Groups I and II (I: 140.4, II: 141.6, III: 166.7 ml, p0.05). However, the median ratio of post-operative contralateral renal volume change was significantly higher in Groups I and II than Group III (I: 0.36, II: 0.23, III: 0.12, p0.001). On multivariate analysis, tumour size revealed the strongest positive association with pre-operative contralateral kidney volume (partial regression coefficient: β = 30.8, 7 cm) and ratio of post-operative contralateral kidney volume change (β = 0.214, I vs III; β = 0.168, II vs III).Kidney volume calculation for assessing pre- and post-operative compensatory hypertrophy of the contralateral kidney in RCC patients can be easily and rapidly performed from CT images using the ellipsoid formula. Advances in knowledge: The ellipsoid formula allows reliable method for assessing pre-operative and post-operative compensatory hypertrophy of the contralateral kidney in RCC.

Стаття присвячена дослідженню моделей патологічних станів, що найчастіше стають причиною однобічної нефректомії через необоротні зміни місцевого ниркового кровотоку (ішемія, уростаз) на нирках щурів лінії Вістар з метою визначення стану контралатеральних «здорових» нирок та їх компенсаторних можливостей імуногістохімічним методом з використанням моноклональних антитіл до CD3 та aSMA. Всі контралатеральні нирки дослідних груп щурів демонстрували дистрофічні зміни епітелію канальців, осередки склерозу навколо крупних судин, перитубулярні та периваскулярні круглоклітині запальні інфільтрати із вмістом CD3+ Т-лімфоцитів (для підгрупи АІІ – 10,3±1,2, для ВІІ – 11,9±1,1, для СІІ – 10,9±0,8), а також гіпертрофію м’язової оболонки артерій та артеріол через ренальну гіпертензію, що не було знайдено в зразках групи контролю., Background. Morphology of compensatory-adaptive changes and their dynamics in a single remained kidney are still not clarified. Therefore, the study of renal parenchyma lesions in rat models of the most common pathological states has a great practical importance. Objective. To investigate the models of unilateral pathological processes of breach of local renal blood flow (ischemia, infringement of urodynamics) in order to determine changes in the status of the contralateral kidney. Methods. In the experiment on white Wistar rats permanent ischemia was modeled by a fixed bending left kidney artery (15 individuals – group A), acute infringement of urodynamics was modeled by a fixed crossing of the left ureter kidney ( 4 individuals – group B) and both pathological conditions were simulated (5 individuals – group C). Kidneys of 10 relatively healthy rats were used as a control. The primary monoclonal antibodies for CD3 and aSMA (TermoScientific, USA) were used. Results. The main pathological manifestations in the contralateral right "healthy" kidneys was in degenerative changes in epithelial tubule cells, foci of edema and sclerosis around large vessels, interstitial and perivascular inflammatory infiltrates containing CD3+ T-cells (for A II – 10,3±1,2, for B II – 11,9±1,1, for C II – 10,9±0,8). It differs significantly from the control group (p, Статья посвящена исследованию моделей патологических состояний, которые чаще всего становятся причиной односторонней нефрэктомии из-за необратимых изменений местного почечного кровотока (ишемия, уростаз) на почках крыс линии Вистар с целью определения состояния контралатеральных «здоровых» почек и их компенсаторных возможностей иммуногистохимическим методом с использованием моноклональных антител к CD3 и aSMA. Все контралатеральные почки исследуемых групп крыс продемонстрировали дистрофические изменения эпителия канальцев, очаги склероза вокруг крупных сосудов, перитубулярные и периваскулярные круглоклеточные воспалительные инфильтраты с CD3+ Т-лимфоцитами (для подгруппы А ІІ – 10,3±1,2, для В ІІ – 11,9±1,1, для С ІІ – 10,9±0,8), а также гипертрофию мышечной оболочки артерий и артериол, вследствие почечной гипертензии, что не было обнаружено в образцах группы контроля.

The incidence of kidney cancer is 2–3 % of all malignancies and tends to rise. If the problems of treatment in patients with a renal tumor and a normally functioning contralateral kidney have mainly been solved, how to treat patients with bilateral tumors and a tumor in a solitary functioning kidney continues to be discussed. In particular, the limited decrease in renal function of the remaining kidney in a patient after nephrectomy, whose achievement does not require renal replacement therapy, has not been conclusively defined; what part of a solitary kidney with tumors will be able to maintain a good quality of life in the patient, without doing hemodyalisis, has not been elucidated either.

Objectives. To document the feasibility of nephron-sparing surgery (NSS) for the surgical treatment of renal masses measuring larger than 7 cm (cT2) on preoperative imaging. Methods. A total of 139 patients have undergone NSS between 2001 and 2012 by a single surgeon in our clinic. Of these, we identified 17 patients whose tumors were measuring greater than 7 cm on preoperative imaging studies and were limited to the kidney. Their charts were retrospectively reviewed. Results. Mean age of the study population was years. Thirteen patients were managed by open NSS, while 4 patients have undergone robot-assisted NSS. Mean diameter and mean R.E.N.A.L. score of the tumors that were enucleoresected were 8.2 cm and 8.5, respectively. A total of 5 Clavien grade 2 and higher complications were recorded within 30 days of surgery. Histopathologic examination revealed benign histology in almost 1/4 of the cases. After a median followup of 33 months, all of our patients were alive. Only one patient (5.8%) experienced local recurrence. Conclusions. NSS is a feasible and safe option for large (>7 cm) renal masses. It may be considered not only for imperative conditions but also for highly selected cases with a normal contralateral kidney.

Introduction: We present our eight-year experience with open nephron-sparing surgery (NSS) in renal tumors with contralateral normal kidney to assess its oncological efficacy and safety. Materials and Methods: Thirty-six patients undergoing open NSS for small localized renal tumors with normal contralateral kidney from January 1998 to August 2006 were studied regarding demographic, clinical and pathological characteristics along with long-term follow-up. Results: The mean age was 48.28 ± 9.5 years. The mean tumor size was 3.72 cm (range 1.5-6). The following surgeries were performed: Wedge resection-13, partial polar nephrectomy-15, segmental resection-eight. The following techniques were used for vascular control: clamping and cooling-eight, warm ischemia-12, a novel technique of serial encirclage-16. The mean warm ischemia time was 23.2 ± 3.2 min. The mean operating time was 190.07 ± 11.3 min. The mean estimated blood loss was 331 ± 17.4 ml. The majority of renal tumors were renal cell carcinoma (97.22%). There were no positive surgical margins. There were no major intraoperative and postoperative complications. The mean follow up was 52.1 months (range 4-80) with no case showing progression to renal insufficiency (defined as serum creatinine > 2 mg/dl). There was only one local recurrence. However, four distant metastases were reported. The five-year cancer-specific survival, recurrence-free survival and overall survival were 94.4%, 88.88% and 86.11% respectively. Conclusions : In patients with solitary, small localized, unilateral renal tumors with normal contralateral kidney, elective open NSS is feasible, safe and provides excellent long-term local control and oncological efficacy with functional benefits.

An affected kidney was removed in various terms of the experiment in order to determine its influence on functional activity of the intact kidney. Nephrectomy on the affected side was performed on the 10th, 14th and 21st days. Functional scores of the residual kidney were evaluated 4, 7 and 14 days after nephrectomy. Control group constituted animals without nephrectomy. Scores were compared to the respective ones of the intact kidney in control group, on the same day of experiment. Reliable changes of almost all functional kidney scores were detected after removal of the affected organ. Early nephrectomy (on the10th and 14th days) evoked compensatory reaction of the residual kidney and resulted in normalization of functional parameters on the 28th day., С целью определения степени влияния пораженной почки на функциональную активность контралатерального органа, первую удаляли в разные термины от начала эксперимента. Нефрэктомию с пораженной стороны проводили на 10-ые, 14-ые и 21-ые сутки эксперимента. Функциональные показатели оставшейся почки исследовали через 4, 7 и 14 суток после нефрэктомии. Показатели сравнивали с аналогичными в интактной почке на такие самые сутки эксперимента, у крыс, которым не проводилась нефрэктомия с пораженной стороны. Определено, что после удаления пораженной почки у всех подгрупп животных изменялись практически все показатели функции контралатерального органа по отношению к таким, где нефрэктомия не проводилась. Ранняя нефрэктомия – на 10-ые и 14-ые сутки – приводила к нормализации функциональных показателей и развития компенсаторной реакции со стороны резидуальной почки до 28 суток., З метою визначення ступеня впливу ураженої нирки на функціональну активність контрлатерального органа, першу видаляли в різні терміни від початку експерименту. Нефректомію з ураженого боку проводили на 10-ту, 14-ту та 21-шу добу експерименту. Функціональні показники резидуальної нирки досліджували через 4, 7 та 14 діб від нефректомії. Показники порівнювали з аналогічними в інтактної нирки на таку ж добу експерименту у щурів, що не піддалися нефректомії з ураженого боку. Визначено, що після видалення ураженої нирки у всіх підгруп тварин змінювалися практично всі показники функції контрлатерального органа по відношенню до таких, де нефректомія не проводилася. Рання нефректомія – на 10-ту та 14-ту добу – призводила до нормалізації функціональних показників та розвитку компенсаторної реакції з боку резидуальної нирки до 28-ї доби.

Objective—To compare diagnostic quality of percutaneous kidney biopsy specimens obtained with laparoscopy versus ultrasound guidance in dogs and compare diagnostic quality of specimens obtained with 14- versus 18-gauge biopsy needles. Design—Prospective study. Animals—10 healthy dogs. Procedure—In each dog, 2 biopsy specimens were obtained from each kidney, 1 with a 14-gauge biopsy needle and 1 with an 18-gauge biopsy needle. Biopsy specimens were obtained from 1 kidney by means of ultrasound guidance and from the contralateral kidney by means of direct viewing during laparoscopy. Number of glomeruli, quality of the biopsy specimen, proportion of specimens that contained muscle tissue, and proportion of specimens with fragmentation or crushing were determined. Results—Mean ± SD number of glomeruli (32.6 ± 11.0) in laparoscopic, 14-gauge biopsy specimens was significantly higher than mean number of glomeruli in ultrasound-guided, 14-gauge specimens; mean number of glomeruli in ultrasound-guided, 18-gauge specimens; and mean number of glomeruli in laparoscopic, 18-gauge specimens. All 10 laparoscopic, 14-gauge biopsy specimens were classified as excellent. The proportion of 18-gauge biopsy specimens with crushing or fragmentation was significantly higher than the proportion of 14-gauge specimens. One of the kidneys biopsied with ultrasound guidance had a large amount of hemorrhage. Hemorrhage was modest and transient following laparoscopic biopsy. Conclusions and Clinical Relevance—Results suggest that excellent-quality renal biopsy specimens with large numbers of glomeruli can be obtained with 14-gauge, double-spring-activated biopsy needles during laparoscopy. Renal biopsy specimens obtained with 18-gauge biopsy needles frequently had few glomeruli and often were crushed or fragmented, increasing the difficulty in making an accurate diagnosis. (J Am Vet Med Assoc 2003;223:317–321)

Fibromuscular dysplasia is the second-most commonly encountered anatomic abnormality in potential renal donors. Normotensive patients with medial fibroplasia and low-grade lesions have been used as renal donors. However, no studies have reported the optimal choice of a kidney for donation where the kidney with fibromuscular dysplasia had a larger volume and a higher glomerular filtration rate than the unaffected side. Herein, we report a case of renal transplant using a kidney with fibromuscular dysplasia that had higher glomerular filtration rate than the normal side. After transplant, hypertension and abnormal serum creatinine did not occur in either the donor or the recipient during 12 months' follow-up.

Background: Although long-term effects of percutaneous nephrolithotomy (PCNL) on renal function and structure have been evaluated, knowledge regarding the immediate effects of surgery on renal function is limited. We conducted this study to evaluate the impact of unilateral PCNL on bilateral renal function during immediate post-operative period. Materials and Methods: From April to September 2012, 40 eligible patients were enrolled in this study and underwent unilateral PCNL. During the post-operative period, creatinine clearances (CrCl) of treated and untreated sides were estimated separately and pattern of changes in bilateral renal function following this procedure was evaluated. Results: Following the operation, CrCl of both kidneys showed a similar pattern of changes, of course more dramatic on treated side. We observed progressive decline in CrCl of both sides followed by bilateral improvement in renal function toward pre-operative values. Conclusions: During the early post-operative period following unilateral PCNL, both kidneys experienced a temporary drop in function warranting more intensive post-operative care.

The research aimed to identify presence and severity of contralateral kidney tissue changes while opposite kidney inflammation progresses. Our own model was used for disease evoking in rats. The observation period lasted 10 days. Starting from the 3rd day, signs of hematogenous dissemination of infection/inflammation into contralateral kidney were registered. Starting from the 5th day urinogenous dissemination process was observed. By the 3rd day of study a cortical hyperemia in contralateral kidney was seen, which possibly was of compensatory origin. Based on research results, a primarily bilateral urinary tract inflammation/infection can be suspected., Целью работы было определение присутствия и степени выраженности тканевых изменений контралатеральной почки в динамике развития воспалительного процесса в противоположной почке. Моделирование заболевания у крыс основано на собственной методике. Наблюдение за животными проводилось в течение 10 суток. Установлено, что модель заболевания отвечает клиническому прототипу. Определено признаки гематогенного распространения инфекта/воспалительных изменений в контралатеральную почку, начиная с 3-х суток эксперимента; с 5-х суток наблюдалось распространение воспалительного процесса уриногенным путем. До 3-х суток эксперимента наблюдалась кортикальная гиперемия контралатеральной почки, вероятно компенсаторного генеза. Впоследствии проведенного исследования можно судить о первично двустороннем характере воспалительного процесса в мочевой системе., Метою роботи було визначення наявності та ступеня вираженості тканинних змін контрлатеральної нирки в динаміці розвитку запального процесу в протилежній нирці. Моделювання захворювання у щурів базувалося на власній методиці. Спостереження тварин проводилося протягом 10 діб. Встановлено, що модель захворювання відповідає клінічному прототипу. Визначено ознаки гематогенного розповсюдження інфекту/запальних змін у контрлатеральну нирку, починаючи з 3-ї доби експерименту; з 5-ї доби спостерігалося розповсюдження запального процесу уриногенним шляхом. До 3-ї доби експерименту спостерігалась кортикальна гіперемія контрлатеральної нирки, ймовірно компенсаторного ґенезу. Внаслідок проведеного дослідження можна судити про первинно двобічний характер запального процесу в сечовій системі.

In this study the effect of a native recipient kidney on acute rat renal allograft rejection is analysed. The authors performed a sequential daily analysis of allograft morphology and infiltration by macrophages and T cells in the presence and the absence of a recipient kidney. Several differences among both experimental groups were observed. Infiltrating macrophages and T cells in the allograft interstitium were more numerous in the presence than in the absence of a recipient kidney. The ratio of macrophages to T cells was 2:1 in the presence and 1:1 in the absence of a recipient kidney. Interstitial allograft infiltration started 1 day earlier in the presence of a contralateral kidney than in its absence. Graft necrosis occurred on day 6 and was complete in the presence of a native kidney. After total nephrectomy a patchy pattern of necrotic and viable tubules was observed from day 5 until the death of the animal. The diameter of monocytes in graft vessels increased only moderately in the presence of a recipient kidney but duplicated in its absence. The authors propose that in experimental renal transplantation contralateral nephrectomy should be performed according to a standardized schedule.

Introducción: La displasia renal multiquística (DRM) unilateral es una malformación frecuentemente encontrada en el ultrasonido obstétrico. En Colombia no existen publicaciones sobre las características clínicas y el comportamiento de esta enfermedad que permitan sugerir el tipo de estudios que se deben practicar en la fase inicial y en el seguimiento de estos niños. Objetivos: Describir las características clínicas de 40 pacientes con DRM unilateral con énfasis en la evaluación del riñón contralateral (RC) con respecto a sus funciones, tamaño y frecuencia de malformación urológicas asociadas. Metodología: Estudio descriptivo de pacientes menores de 18 años con diagnósticos pre o postnatales de DRM unilateral, atendidos en la consulta externa de nefrología pediátrica del Hospital Infantil Club Noel entre julio de 1997 y diciembre de 2007. Resultados: Se encontraron 40 pacientes. En ellos 88% el diagnóstico se hizo antes de nacer; 55% eran de sexo masculino, con una edad promedio al ingreso de 2 meses (rangos, 1 y 42 meses). En el RC se descubrió hidronefrosis (HN) en 2 casos (5%) y reflujo vesicoureteral (RVU) grados I y II en 3 casos (9%). El cálculo de la filtración glomerular fluctuó entre 81 ml/min/ 1.73 y 193 ml/min/1.73 (media, 105). Sólo uno de los 38 renogramas fue anormal e informó la presencia de una cicatriz renal. En el control ecográfico de 31 pacientes los quistes desaparecieron en 13 y persistían en 18, con una media de 60 meses (rango, 24 y 132 meses). El tiempo de seguimiento promedio fue 60 meses con un rango entre 15 y 132 meses. Conclusiones: En este grupo de pacientes se encontró buen pronóstico del RC: ninguno presentó disminución de la filtración glomerular y la frecuencia de malformaciones urológicas como la HN y el RVU fue muy baja. El ultrasonido renal (UR) es indispensable en la evaluación inicial y seguimiento de los casos. Es recomendable practicar al comienzo un renograma, preferiblemente con 99mTc-DMSA, para comprobar la no funcionalidad del riñón displástico y evaluar la morfología del RC. Se sugiere reservar la cistouretrografía miccional (CUGM) para los casos en los que se descubra HN postnatal y/o alteraciones del renograma en el RC. Es importante el cálculo periódico de la filtración glomerular para detectar hiperfiltración que puede comprometer a largo plazo el único riñón funcional. Introduction: The multicystic dysplastic kidney (MDK) is a frequent malformation discovered in obstetrical ultrasound. In Colombia, there are no publications on clinical characteristics and follow up studies suggesting initial evaluation and follow up in these children. Objectives: To describe the clinical characteristics of 40 patients with unilateral MDK, with emphasis in the evaluation of the contra-lateral kidney (CK) regarding function, size, and associated urological malformations. Methodology: A review of cases of patients under 18 years of age with prenatal or postnatal diagnosis of unilateral MDK that attended the Pediatric Nephrology outpatient clinic at Hospital Infantil Club Noel in the city of Cali from July 1997 to December 2007. Results: A total of 40 patients were found. In 88% of these, diagnosis of unilateral MDK was done prenatally; of these, 55% were males with a mean age of 2 months of age (range 1 to 42 months). Evaluation of contra-lateral kidney showed: hydronephrosis (HN) in 2 cases (5%), vesicouretheral reflux (VUR) grades I and II in 3 cases (9%). Glomerular filtration fluctuated between 81 ml/min/1.73 and 193 ml/min/1.73 (mean 105). Radioisotope renography was performed in 38 patients and only one patient was reported with renal scar. Follow up with renal ultrasound revealed that renal cysts disappeared in 13 patients and persisted in 18 with a media of 60 months (range 15 to 132 months). Conclusions: In this group of patients, a good prognosis of the CK was found: none presented decline of the glomerular filtration rate and frequency of urological malformations as HN and VUR was very low. Renal ultrasound is mandatory in the initial evaluation and follow up of these cases. Renography with 99mTc-DMSA is recommended in the initial evaluation of these patients to demonstrate no function of the MDK and to assess morphology and function of CK. A voiding cystogram should be reserved to patients with hydronephrosis in CK and/or anomalies in the renography. The periodic calculation of the glomerular filtration is important to detect hyperfiltration that can compromise a single functional kidney.

A bilateral S-shaped kidney is a rare anomaly in which both the kidneys are in their normal position, in contrast to the commonly reported S-shaped fusion anomaly, in which the contralateral kidney crosses the midline to fuse with opposite kidney leaving the ipsilateral renal fossa empty. Here we present the diagnosis and management of a case of bilateral S-shaped renal anomaly with associated left pelviureteric junction obstruction and nonfunctioning kidney and right renal stones. Left kidney was managed by open nephrectomy and right kidney by PNL.

The effects of partial or total removal of the kidney with ectopic ureter on the contralateral kidney were evaluated using DMSA renal uptake rate on 8 patients. After partial nephrectomy on 6 cases, the affected residual kidneys showed significant decrease in DMSA renal uptake rate in 2 cases in which the extirpated kidneys had normal renal tissue in part but did not show significant change in DMSA uptake rate in 4 cases in which the extirpated kidneys were dominated mainly with dysplasia. Post-operative increase in DMSA uptake rate of the contralateral kidneys were significant in 3 of 4 patients who had the operation before they became 2 years old. In 2 of these 3 cases, pre-operative scintigram showed extremely low rate of DMSA renal uptake. Four cases aged 2 years old and over did not show post-operative increase in the uptake rate. As we have previously reported on the cases with hydronephrosis, these results suggest that 1) existence of obstruction caused by ectopic ureter inhibit the development of the contralateral kidney and 2) the growth of the kidney can resume the release of that obstruction, if the release is made while the kidneys are still in developing stage.

To elucidate the feasibility of surgical enucleation, the incidence of extracapsular tumor invasion in 30 cases of renal cell carcinoma with a diameter less than 5 cm was examined, based on the classification of extracapsular tumor invasion into three patterns, namely microinvasion, nodular invasion, and daughter tumors. Of the 30 cases of renal cell carcinoma, 22 cases (73%) revealed extracapsular tumor invasion. And the incidence of microinvasion, nodular invasion and daughter tumors was 7 cases (23%), 9 cases (30%) and 6 cases (20%), respectively. But the incidence of these three patterns of extracapsular tumor invasion correlated neither with the size of renal cell carcinoma nor with pT classification. There was a tendency for extracapsular tumor invasion to occur near the renal hilar site of the renal cell carcinoma, where the tumor vessels were rich, penetrated and twined around the tumor capsule, resulting in the disruption of the tumor capsule. These three patterns of invasion was located within 1 cm in distance from the tumor capsules in all cases. In conclusion, because of limited radicality achieved by tumor enucleation even in the case of pT1, partial nephrectomy was recommended in the presence of a normal contralateral kidney.

Background Radiotherapy for retroperitoneal sarcomas remains controversial and a technical challenge considering the threshold of contiguous critical organs tolerance. We performed consecutive RapidArc dosimetric plans in preoperative or postoperative setting. Methods A dosimetric study was carried out from six preoperative (group A) and four postoperative (group B) CT-scans, performed in 7 patients. Prescribed dose was 45 and 50 Gy for groups A and B, respectively. The planning target volume (PTV) was defined as the clinical target volume (CTV) plus 5 mm. The CTV encompassed the gross tumor volume (GTV) plus 10 mm or the tumoral bed. The dosimetric plans were optimized on a RapidArc Eclipse console using the progressive resolution algorithm, PRO version 8.8. Normalization method allowed the coverage of 99% of the PTV by 95% of the dose. Results Mean PTV were 2318.5 ± 2223.9 cc [range 348-6198 cc] and 698.3 ± 216.6 cc [range 463 -933 cc] for groups A and B, respectively. Plans were optimized for single arcs in group B and for single or two arcs in group A. The contralateral kidney volume receiving 5 Gy (V5Gy) was 21.5 ± 23.3% [range 0-55%] and 3.1 ± 2.6% [range 0-7.3%] for groups A and B, respectively. The mean dose received by 1% of the kidney (D1%) was 5.6 ± 2.4 Gy [range 3.6 -7.6 Gy] for group A and 5.4 ± 0.7 Gy [range 4.3-6 Gy] for group B. The volume of small bowel excluding the PTV (small bowel-PTV) that received 40 Gy and 30 Gy (V40Gy and V30Gy) in group A were 7.5 ± 4.4% [range 5.4-14.1%] and 18.5 ± 7.1% [range 10-30.4%], respectively. In group B, small bowel-PTV V40Gy and V30Gy were 4.7 ± 3.3% [range 3.3-8%] and 21.6 ± 7.5% [range 9.4-30%] respectively. In a second step, we treated two patients in the postoperative group. Treatment time delivery with one arc was 74 seconds. No severe acute toxicity was observed. Conclusion RapidArc technology for retroperitoneal sarcomas showed acceptable dosimetric results in preoperative or postoperative clinical situation. From the first treated patients, acute tolerability was good to excellent.

We experienced two cases of renal cell carcinoma with renal artery aneurysm in the contralateral kidney. These cases have not been reported in the literatures which we have so far explored. In our cases, firstly tumor was resected, and then extracorporeal surgery and autotransplantation were performed on the renal artery aneurysm of the opposite side. Their postoperative courses were uneventful. Only a few instances of extracorporeal surgery and autotransplantation for renal artery aneurysm in a solitary kidney have been reported in the literature. However, no report of a case treated by extracorporeal surgery and autotransplantation for renal artery aneurysm in the contralateral kidney after surgical treatment of renal cell carcinoma has been made. Regarding the treatment of renal artery aneurysm, extracorporeal surgery and autotransplantation appeared satisfactory in our experience. It was a safe and assured surgical procedure. We recommend extracorporeal surgery and autotransplantation for renal artery aneurysm when management in situ is considered difficult.

Objective: To determine whether the current indications for the long-term urologicalfollow-up of children with multicystic dysplastic kidneys (MCDKs) are supported by the literature.Methods: The membership of the Pediatric Urologists of Canada was surveyedto determine if long-term urological follow-up was being performed, and if so, for what indications. A literature search using PubMed, EMBASE and aConference Papers Index was performed to determine whether the indicationslisted were supported by the literature.Results: A response rate of 72% was achieved for the survey, with most respondentsfollowing children with MCDK long-term. The main indications for long term follow-up were the increased risk of Wilms’ tumour (54%) and hypertension(32%), observation of the contralateral kidney (43%) and involutionof the MCDK (36%). The literature search did not support long-term urological follow-up for any of these indications, provided unilateral MCDK was anisolated genitourinary abnormality. Although it is rare, a primary care physician could monitor for hypertension.Conclusion: Long-term urological follow-up of children with “simple MCDK”is not supported by the literature, provided the diagnosis has been confirmedwith a follow-up renal ultrasound at 12–24 months. Blood pressure monitoringby a primary care physician is recommended.

OBJECTIVE: We aimed to investigate the effect of pelvicaliceal anatomical differences on the etiology of lower caliceal stones. MATERIALS AND METHODS: Records of adult patients between January 1996 and December 2005 with solitary lower caliceal stone were reviewed. After exclusion of patients with hydronephrosis, major renal anatomic anomalies, non-calcium stones, history of recurrent stone disease and previous renal surgery, 78 patients were enrolled into the study. Lower pole infundibulopelvic angle (IPA), infundibulovertebral angle (IVA), infundibular length (IL), width (IW), number of minor calices and cortical thickness of the lower pole together with other caliceal variables obtained from the whole pelvicaliceal anatomy of both stone-bearing and contralateral normal kidneys were measured from intravenous pyelogram of the patients. Total pelvicaliceal volume was also calculated by a previously described formula for both kidneys. RESULTS: There were statistically significant difference between two kidneys in terms of IW (p < 0.001) and IL (p = 0.002) of the upper calyx, IW (p = 0.001) and IVA (p < 0.001) of the lower calyx), pelvicaliceal volume (p < 0.001), IPA of middle calyx (p = 0.006) and cortical thickness over the lower pole (p < 0.001). However there was no difference between stone-bearing and contralateral normal kidneys in terms of lower pole IPA (p = 0.864) and IL (p = 0.568). CONCLUSION: Pelvicaliceal volume but not lower caliceal properties seem to be a risk factor for stone formation in lower calyx.

El riñón multicístico (RMC) se asocia a malformación del riñón contralateral en porcentajes variables. Con el propósito de determinar la prevalencia y tipo de malformaciones asociadas, y la evolución de la función renal, se estudiaron de manera retrospectiva 34 niños con diagnóstico de RMC entre 1 día y 13 meses de edad con ecotomografía renal, cintigrama renal Tc99 DMSA y uretrocistografía miccional. Se encontró malformación del riñón contralateral en 11/34 pacientes (32%) siendo las más frecuentes la estenosis pieloureteral y el reflujo vesicoureteral. En 5 pacientes el seguimiento demostró signos de displasia renal y en 1 hipertensión arterial. No hubo malignización. Se concluye que la malformación del riñón contralateral es de alta frecuencia, por lo que siempre debe realizarse el estudio completo con ecotomografía renal, cintigrama renal Tc99 DMSA y uretrocistografía. Debe además efectuarse control seriado del crecimiento y función renal, para la detección y manejo precoz de la insuficiencia renal A multicystic dysplastic kidney (MCDK) is often associated with contralateral kidney abnormalities. Medical records of 34 children with a diagnosis of MCDK were retrospectively analized for contralateral kidney abnormalities and global renal function. They were examined using ultrasound, isotope scan with Tc-99m dimercaptosuccinic acid (Tc-99 DMSA) and voiding cystouretrogrphy (VUG). Abnormalities of the contralateral kidney were found in 11/34 (32%). The most common being ureteropelvic junction obstruction and vesicoureteral reflux. In five patients follow-up revealed renal dysplasia, of these one developed hypertension. No malignancy was found. Based on the results of this study we recommend a complete evaluation of the contralateral kidney using ultrasound, Tc-99 DMSA and VUG. Regular follow-up must be performed, evaluating serum creatinine levels and kidney growth for the early detection and treatment of chronic renal failure

Tumor enucleation is not recommended for children with nephroblastoma and a normal contralateral kidney. However, in adults with unilateral low stage renal cell carcinoma tumor enucleation may offer an alternative to radical nephrectomy, since functioning renal tissue is preserved without a greater risk of residual microscopic disease. Enucleative surgery may be more reasonable in children with nephroblastoma, because the risk of relapse can be reduced with chemotherapy. Therefore, we prospectively evaluated the feasibility of enucleative surgery in children with stage I unilateral nephroblastoma.Between 1992 and 1995, 13 children with nephroblastoma and a normal contralateral kidney were consecutively admitted to our surgical unit. Possible candidates for tumor enucleation were evaluated according to certain criteria, including stage I disease at diagnosis, well-defined margins on post-contrast computerized tomography and at least 50% of the functioning kidney could be preserved. Preoperative and postoperative chemotherapy was given in all cases.Of 4 children with preservation of more than 50% of the functioning kidney 3 were considered eligible for enucleation. The tumors, which were confined to the mid kidney in 2 children and upper renal pole in 1, were successfully enucleated without hypothermia or vascular occlusion. All 3 children are disease-free at 49, 48 and 26 months of followup, respectively. Renal function has been almost completely restored postoperatively.These preliminary data suggest that enucleative surgery may be a reasonable option in select children with stage I nephroblastoma and a normal contralateral kidney.

The effect of unilateral hydronephrosis on the growth of contralateral kidney were evaluated with weanling rats of which kidneys were in growing stage (body weighted between 80 g and 90 g). These rats underwent complete unilateral ureteral obstruction (CUUO) on day 0. They were divided into 3 groups and went through second operations on day 3 (CUUO-3) as follows; a) CUUO released, b) nephrectomy performed and c) CUUO continued. Sham-operation was performed on day 0 and on day 3 to the controls. Wet weights and bromodeoxy-uridine (BrdU) labeling index (L.I.) (index for cell proliferation in the uriniferous tubules) of the contralateral kidneys were measured for the evaluation. The wet weights were significantly higher in all the groups than that of the controls throughout the observation period on and after the day 3. The group that underwent nephrectomy demonstrated a sharp rise in L.I. after the day 7. In the group that was continued in CUUO, the L.I. started to rise later than its rise in nephrectomised group but the index caught up at the time when the blood flow completely disappeared in the kidneys of the ligated side. L.I. in the group of which CUUO was released became significantly higher than that of controls on the day 7 and remained its significance until the day 21 in spite of resolution of the hydronephrosis. To reveal the effect of length of obstructed term, the same trial was carried out that rats endured in CUUO for 5 days (CUUO-5) till the second operation. This turned out lower L.I. in the CUUO-5 than the CUUO-3. These results suggest that the presence of hydronephrosis made by CUUO suppress the growth (cell proliferation) of contralateral kidney and also duration of obstruction can be critical on the renal growth that shorter obstructed period turns out preferable for cell proliferation after relief of CUUO.

Six patients with synchronous bilateral renal cell carcinoma were treated surgically over a 7-year period in our department. They were all males and the mean age was 60.3 years. They comprised 7.1% of all patients with renal cell carcinoma encountered during the same period. In four out of the six cases, radical nephrectomy for the larger tumor plus partial nephrectomy for contralateral kidney was performed simultaneously. In the remaining two cases, bilateral partial nephrectomy was performed simultaneously or as separate procedures. Two patients required chronic hemodialysis and died of cardio-pulmonary insufficiency on the 70th and 75th day. One patient, who underwent bilateral partial nephrectomy with incomplete tumor removal, subsequently died of metastatic disease at 27 months. Although one of them required transient hemodialysis, the remaining three patients were alive and disease-free 84, 42, and 17 months after operation, without evidence of tumor. This series suggests that partial nephrectomy is an appropriate option in the management of selected cases of bilateral renal cell carcinoma.

Renal cell carcinoma is a tumor that commonly occurs with distant metastases and typically metastasizes to the following distant sites, listed in order of descending frequency: the lung and mediastinum, bone, liver, contralateral kidney or adrenal gland, and brain. However, metastases to the face, skin, and skeletal muscle are extremely rare. We report here a case of a metastatic renal cell carcinoma involving the face, skeletal muscles and skin simultaneously.

Prostaglandins (PGs) E2 and F2α in the rabbit kidney were determined in order to study the effects of unilateral ureteral occlusion for periods up to 6 weeks. A significant increase of PGE2 concentration in the inner medulla of the obstructed kidney was always observed after ureteral occlusion of more than 24 h. In the contralateral kidney, PGE2 in the inner medulla gradually decreased in proportion to the period of ureteral occlusion. The present results suggest that the enhanced PGE2 may be a protective mechanism initiated to overcome the renal vasoconstriction after unilateral ureteral occlusion.

Reduction of the functioning renal mass by unilateral nephrectomy or unilateral ureteral occlusion (UUO) leads to increased function of the remaining nephrons, an important factor being the glomerular filtration rate (GFR). GFR can be modified via the tubuloglomerular feedback control (TGF), which senses the distal delivery of fluid and alters the tonus of the glomerular arterioles. The aim of the present study was to investigate the TGF sensitivity in the intact left kidney of rats after 24 hours of right ureteral occlusion. Using a micropuncture technique, proximal tubular stop-flow pressure (Psf), as a relative index of glomerular capillary pressure, was measured upstream to the block, while late proximal segments were perfused with Ringer solution (rates 0-40 nl/min). The maximal drop in Psf and the tubular flow rate at which 50% of this response was achieved, the turning point (TP), were determined. Considerable decrease in the sensitivity of the TGF system in the contralateral kidney during UUO was indicated by a significantly higher TP as compared with control rats (sham operation), viz. 29 v. 19 nl/min. Maximal Psf drop after UUO was significantly less than in the controls (6 v. 12 mm Hg). Reduced TGF sensitivity in the contralateral kidney after protracted UUO is a prerequisite for that kidney's increased excretion of salt and water to compensate for the loss of functioning renal mass.

1. In mice and guinea-pigs, the number of glomeruli was counted in kidneys during normal growth and in hypertrophy induced by unilateral nephrectomy. 2. In mice, the number of glomeruli increased sharply during the first 2 weeks in life, and more slowly afterwards. Unilateral nephrectomy, when performed during this period of natural increase, induced the formation of supplementary nephrons in the contralateral kidney. 3. In guinea-pigs, the number of glomeruli was almost complete at birth. No evidence of a supplementary increase in the number of nephrons was found in hypertrophied kidneys following unilateral nephrectomy. 4. These results, together wit previous data obtained in the rat, suggest that the ability to induce new nephrons after unilateral nephrectomy in different species would depend more on the state of kidney maturity at birth than on differences in the renal mechanisms which lead to hypertrophy.

The case histories of six children with absence of functioning renal parenchyma on one side and dilatation of the contralateral pelvis are reviewed. The hydronephrosis was obstructive in two cases. In the others no cause could be found. The development of this combination of renal malformations is discussed against an embryologic background.

203 HgCl 2 in trace amounts was injected together with [ methoxy - 3 H]inulin into the proximal convoluted tubules of the dog kidney superficial nephrons. Of the injected inulin, 97.3 ± 5.7% was recovered in the urine from the injected kidney. From the injected 203 Hg only 8.2 ± 1.0% was recovered in the urine from the injected kidney and 0.4 ± 0.7% from the contralateral kidney. These results were not significantly influenced by intrarterial infusion of KCN, ouabain, or 2,4-dinitrophenol, indicating that there occurred no active tubular reabsorption of mercury. Of the injected 203 Hg, 88.2–93.5% was recovered in the kidney whose tubules were punctured. When 203 Hg was injected into peritubular capillary, only 1.2 ± 0.7% was recovered in the urine from the injected and 0.91 ± 0.2% from the contralateral kidney, this difference being not significant. Results are interpreted as lacking evidence for active transport mechanism of Hg 2+ in the dog kidney under conditions of microinjection experiment.

Severe hypertension of at least 7 years' duration, due to coarctation of the right renal artery, was treated by reconstruction of the abnormal artery and restoration of blood flow to the coarcted kidney. Renal biopsies revealed normal microscopic architecture in the right kidney and advanced hypertensive pathology in the opposite kidney. After 8 months' observation of persistent, moderate hypertension, the left kidney was removed with prompt return of blood pressure to normal levels during the subsequent 2½ years. These observations demonstrate the precise correlation of hypertension due to renal artery stenosis in the human with the experimental model in rats.

Highly anaplastic renal tumors (nephroblastoma type) have been induced regularly in rats fed dimethylnitrosamine. In the course of carcinogenesis, proliferative lesions — renal oval cell proliferation — have been commonly observed in the contralateral kidney.