The Diagnosis of Obstructive Hydronephrosis with Color Doppler Ultrasound

Renal screening sonography-A comparative study in a Portuguese basic emergency service

INTRODUCTION

This study intends to compare the accuracy and pertinence of sonographic findings obtained by a sonographer in a Basic Emergency Service (BES) with the imaging findings at the Referral Hospital (RH).

METHODS

Thirty-one patients suspected of having renal pathology underwent initial renal sonography screening with sonographer reporting at the BES and were subsequently referred to the RH for additional imaging examinations. The results of both examinations were compared to verify whether the findings from the BES were confirmed by the radiologist in the RH and to ensure that the patient referrals from BES to RH were appropriate.

RESULTS

In our sample, most patients (80%) exhibited varying degrees of pyelocaliceal distension, with nearly half (48%) presenting obstructions. A strong association between the sonographic findings in the BES and the RH was found in the variables "Dilatation of pyelocaliceal system" (V=0.895; p=0.000), "Simple cystic formation" (V=0.878; p=0.000), respectively. There was a statistically significant correlation between BES and RH findings, indicating a strong association between these two variables respectively (k=0.890; p=0.000) and (k=0.870; p=0.000). In this research, an achieved sensitivity of 96% and a specificity of 85% were demonstrated in the identification of pyelocaliceal dilatation.

CONCLUSION

Renal sonographer reporting screening successfully detected abnormalities in the urinary system of patients suspected of having renal colic. The sonographic data obtained at the BES demonstrated a strong correlation with the additional imaging findings from the RH in Portugal. These results suggest that Radiographers/Sonographers can have an important role in the preliminary assessment of urgent renal pathology in remote areas, contributing to a correct referral and early treatment.

Intelligent Ureteral Stent Placeable via Standard Procedure for Kidney Pressure Telemetry: An Ex-Vivo Study

This paper reports the first telemetric ureteral stent compatible with common placement procedure, enabling wireless sensing and detection of ureteral obstruction and resultant kidney swelling known as hydronephrosis at an early stage. This sensor-integrated "intelligent" ureteral stent is prototyped via the design and fabrication approaches that raise the practicality of the device and tested in a harvested swine kidney-ureter model ex vivo. Leveraging a polymeric double-J stent and micro-electro-mechanical systems technology, the intelligent stent is built by embedding micro pressure sensors and a radiofrequency antenna, forming a resonant circuit that enables wireless kidney pressure monitoring in an operating frequency of 40-50 MHz. The stent device is entirely packaged with Parylene-C for both biocompatibility and electrical insulation of the device in order to function in the real environment including urine, an electrically conductive liquid. A comparison between the results measured in in-vitro and ex-vivo settings show a good match in the sensitivity to applied pressure. In particular, the ex-vivo test in the kidney-ureter model pressurized with artificial urine in a cycled manner demonstrates wireless pressure tracking with a response of 1.3 kHz/mmHg, over pressures up to 37 mmHg that well covers a range of pressure increase known for chronic obstruction. This testing is enabled by the prototype placement into the ex-vivo model using the standard stenting technique and tools without noticeable functional degradation or failures, showing potential compatibility of the device with today's clinical need as a ureteral stent.

Neutrophil Extracellular Traps Drive Kidney Stone Formation

Introduction

This study aims to explore the contribution of neutrophil extracellular traps (NETs) to kidney stones.

Methods

The microarray data from GSE73680 and bioinformatic analysis were applied to identify differentially expressed genes in patients with kidney stones. A rat model of kidney stones was established through ethylene glycol and ammonium chloride administration. The plasma was collected for examining cf-DNA, DNase I, MPO-DNA, H3Cit and NE. Superoxide dismutase, malondialdehyde, creatinine, blood urea nitrogen, and calcium were examined through biochemical analysis. MPO, H3Cit, and NE in kidney tissues were detected via immunofluorescence staining. Cell apoptosis was evaluated through TUNEL assays. HE, Periodic Acid-Schiff and Von Kossa staining were applied to determine histological structure, calcium deposits and stone formation in the kidneys. Neutrophil elastase inhibitor Sivelestat (SIVE) was administrated for NET suppression in rats.

Results

A total of 403 differentially expressed genes including 270 upregulated and 133 downregulated genes were identified between renal papillary tissues with Randall's plaque and normal tissues. Gene ontology enrichment, KEGG pathway and protein-protein interaction network analysis of these dysregulated genes were performed. Moreover, increased NET markers including cf-DNA, DNase I, MPO-DNA, H3Cit and NE and calcium deposits were observed in patients with kidney stones. Subsequently, we established a rat model of kidney stones. We found that NET formation was significantly elevated in kidney stone rats, and renal tubular injury and apoptotic cells were enhanced as kidney stones developed. Strikingly, we found that suppression of NETs via SIVE could significantly reduce calcium deposits and apoptotic cells and alleviate tubular injury, thus improving kidney function.

Conclusion

NETs drive the formation of kidney stones, thus aggravating kidney injury. Our study identifies NETs as a potential diagnostic and therapeutic biomarker for nephrolithiasis.

An Objective Computer-Assisted Measurement of Sonographic Renal Cortical Echogenicity: The Splenorenal Index

ABSTRACT

Renal cortical echogenicity represents a marker of renal function. However, evaluation of the renal echotexture is subjective and thus disposed to error and interrater variability. Computer-aided image analysis may be used to objectively assess renal cortical echogenicity by comparing the echogenicity of the left kidney to that of the spleen; the resultant ratio is referred to as the splenorenal index (SRI). We performed a retrospective review of all adult patients who received a renal ultrasound over a 45-day period at our institution. Demographic data and kidney function laboratory values were documented for each patient. Regions of interest (ROIs) were selected in the left renal cortex and spleen using ImageJ software. The SRI was calculated as a ratio of the mean pixel brightness of the left kidney cortex ROI to the mean pixel brightness of the spleen ROI. The SRI was then correlated with serum creatinine, blood urea nitrogen, and estimated glomerular filtration rate. We found that among the 94 patients included in the study, the SRI had a significant positive correlation with serum creatinine ( r = 0.43, P < 0.001) and serum blood urea nitrogen ( r = 0.45, P < 0.001) and negative correlation with estimated glomerular filtration rate ( r = -0.47, P < 0.001). Our data indicate that SRI may serve as a valuable tool for sonographic evaluation of renal parenchymal disease.

Virtual Reality Therapy as an Adjunct to Physiotherapy for Postoperative Pain Management: A Case Report of Laparoscopic Open Pyeloplasty for Hydronephrosis

Hydronephrosis occurs when the tubes connecting the kidneys and bladder become blocked. These tubes carry urine from the kidneys, where it is created, to the bladder, where it is stored until elimination. When one or both ureters get blocked, serious complications and symptoms might arise. These symptoms include urinary tract obstruction, urine backflow, kidney distension, increased intra-renal pressure, impaired kidney function, infection risk, urinary incontinence, which is the involuntary loss of urine, and discomfort in the side, abdomen, or groin. This case report describes the effective postoperative management of abdominal surgery with virtual reality therapy (VRT) combined with standard medical care as additional therapy and physical therapy for hydronephrosis in a 22-year-old male patient. After undergoing laparoscopic open pyeloplasty, the patient developed right-sided hydronephrosis due to ureteral stenosis. He had a ureteral stent inserted and received physical therapy, including pelvic floor muscle training, core strengthening, and diaphragmatic breathing exercises. After four weeks of physical therapy, the patient reported improvement in his symptoms, including reduced discomfort and increased urination. These findings imply that physical therapy, in addition to advanced treatment with the help of VRT for hydronephrosis following abdominal surgery, might be beneficial.

Clinical characteristics of surgically managed patients with asymptomatic renal stones: Comparison of patients with symptomatic renal stones

PURPOSE

This study aimed to compare the characteristics of asymptomatic and symptomatic nephrolithiasis in patients who underwent surgical treatment for kidney stones.

MATERIALS AND METHODS

Between 2015 and 2019, 245 patients who underwent percutaneous nephrolithotomy or retrograde intrarenal surgery for kidney stones were included. The patients were divided into asymptomatic (n=124) and symptomatic (n=121) groups. All patients underwent blood and urine tests, preoperative non-contrast computed tomography, and postoperative stone composition analysis. We retrospectively analyzed and compared the characteristics of the patients and stones, operation time, stone-free rate, and postoperative complications between the two groups.

RESULTS

In the asymptomatic group, mean body mass index (BMI) was significantly higher (25.7±3.8 kg/m² vs. 24.3±2.8 kg/m², p=0.002) and urine pH was significantly lower (5.6±0.9 vs. 5.9±0.9, p=0.013). The ratio of calcium oxalate dihydrate stones was significantly higher in the symptomatic group (5.3% vs. 15.5%, p=0.023). No significant differences were observed in stone characteristics, postoperative outcomes, or complications. In the multivariate logistic regression analysis for predicting variables for asymptomatic renal stones, BMI (odds ratio [OR], 1.144; 95% confidence interval [CI], 1.038-1.260; p=0.007), and urine pH (OR, 0.608; 95% CI, 0.407-0.910; p=0.016) were independent predictive variables for asymptomatic renal stones.

CONCLUSIONS

This study demonstrated that thorough medical check-ups are needed for the early detection of renal stones in individuals with a high BMI or low urine pH.

How Serious Are Health-Related Welfare Problems in Unowned Unsocialised Domestic Cats? A Study from Denmark Based on 598 Necropsies

Free ranging unsocialised domestic cats are widely believed to suffer from a high load of welfare problems. We assessed the validity of this belief by performing necropsies on the corpses of 598 unsocialised cats, originating from all parts of Denmark, that had been euthanised by two Danish cat welfare organisations. We selected a number of variables for health-related cat welfare that could be assessed through necropsy (e.g., gross lesions, ectoparasites and body condition) or by laboratory analysis (e.g., infection with feline immunodeficiency virus (FIV), and by feline leukaemia virus (FeLV)). Each finding was classified as having either a major or minor welfare impact on the cat. More than 83% of the cats had no major finding, and 54% had no finding indicating a welfare issue at all. More than 83% of the cats had a body condition within normal range. Only 0.3% were emaciated. The most common finding was infestation with ectoparasites, with 15.9% infected with lice, 12.3% with fleas, 4.7% with ticks, and 6.7% with ear mites. FIV and FeLV were detected in 9.2% and 1.2% of the cases, respectively. The most common lesion related to the cats’ teeth. Overall, unsocialised cats in Denmark have a moderate level of health-related welfare problems.

Severe Hydronephrosis Secondary to Ovarian Serous Carcinoma

This case study examines a patient with severe hydronephrosis caused by ureteral obstruction, secondary to ovarian serous carcinoma. Gynecologic malignancies, especially advanced ovarian carcinoma, are common extrinsic causes of obstructive hydronephrosis. Sonography is a valuable modality to visualize the kidneys, diagnose hydronephrosis, and determine the grade of hydronephrosis. The treatment of hydronephrosis aims to remove the build-up of urine, prevent permanent kidney damage, and treat the underlying cause. Prolonged or severe cases of hydronephrosis can lead to acute kidney injury.

Etiology of Hydronephrosis in adults and children: Ultrasonographic Assessment in 233 patients

OBJECTIVES

Hydronephrosis (HN) is dilatation of the collecting system of the kidney due to obstruction of urine outflow. This study intended firstly, to investigate the efficacy of ultrasound (US) imaging to determine the cause of HN, and secondly, to list the causes of HN.

METHODS

In this retrospective study, 233 patients with HN were scanned to determine the cause of the HN in the period from 1st January 2016 to 31st October 2017. Categorical results were written as frequencies and percentages.

RESULTS

Out of 233, 91.41% were adults and 8.58% were children (P<0.001), 66.10% were male and 33.90% were female (P<0.001). In 55.36%, HN was in the right kidney and 44.64% was in the left (P=0.116). Exactly 58% of patients were suffering from grade-2, 21.5% grade-3, 11.6% grade-1, and 8.2% grade-4 HN. US imaging can determine the cause of HN in 70.4% of patients. Kidney or ureteric calculi were the cause of HN in 54.1% of cases, reflux was in 7.3%, and pelviureteric junction (PUJ) stenosis was in 3.9%.In cases of calculi induced HN, 25.3% of the calculi were in the vesicoureteric (VUJ) junction, 21.5% were in the renal pelvis, 6.4% were in the PUJ or upper ureter, and only 0.9% were in the middle ureter.

CONCLUSION

Ultrasound imaging can determine the cause of HN in more than two thirds of patients. Calculi are the most common cause of HN even in children and are most common in the VUJ junction.

Gender and side distribution of urinary calculi using ultrasound imaging

Introduction:

Urinary calculi constitute a significant medical problem worldwide. Due to lack of previous studies on gender and side distribution of urinary calculi, the current study was conducted.

Patients and Methods:

This retrospective study involved 590 urinary calculi from the electronic reports of 266 patients. Gender and side distribution were compared using Chi-square test. Relationship between gender and side of urinary calculi was analyzed using cross tabulation test.

Results:

This study involved 590 urinary calculi reported in 266 patients. Among 590 calculi; 565 (95.8%) were in adults, and 25 (4.2%) were in children. Urinary calculi were in male in 397 (67.3%) and in female in 193 (32.7%). Calculi were 304 (51.5%) in right side, and 286 (48.5%) in left side. Exactly 507 (85.9%) of calculi were in the kidneys, and 83 (14.1%) in the ureters. No significant relationship between gender and side of the calculi (P = 0.238), (Odds ratio 0.869, 95% Confidence interval 0.615-1.226).

Conclusion:

Urinary calculi affect male more than female and adults more than children. No significant relationship between calculi and right or left side of the body.

Association between grades of Hydronephrosis and detection of urinary stones by ultrasound imaging

OBJECTIVE

To correlate between hydronephrosis grades and detection of urinary stones by B-mode ultrasound imaging.

METHODS

This study included 210 ultrasound reports of patients who underwent abdominal ultrasound imaging in the period from 1st January 2016 to 31st October 2017, and diagnosed as hydronephrosis. Data collected from the ultrasound reports. The detection rates of stones using B-mode ultrasound imaging compared in different grades of hydronephrosis. Chi-square test and Odds Ratio (OR) were performed to assess the relationship between variables.

RESULTS

Of 210 patients, hydronephrosis was unilateral in 91.8% of patients and bilateral in 8.1%. It was distributed in grade 2, grade 3, grade 1 and grade 4 in 58.57%, 20%, 12.38% and 9.1% of the patients respectively. B-mode ultrasound imaging determined the cause of hydronephrosis in 65.2% of cases. Urinary stones were the cause in 60% of the patients. The detection rate of urinary stones was 50%, 61% and 71.4% for grades 1, 2 and 3 hydronephroses respectively. On simple logistic regression analysis, urinary stones detected in Grade-3 were four times more compared to that in grade 4 (P=0.016) (OR 4.125, 95% CI 1.29-13.136%).

CONCLUSION

Detection of urinary stones as the cause of hydronephrosis increases with increasing the grade of hydronephrosis from Grade-I to Grade-III and decrease in Grade-IV. Urinary stones were the cause of hydronephrosis in 60% of the patients in this study.