Search

Anomalias reprodutivas em fêmeas domésticas são de rara ocorrência e caracterizam-se na grande maioria dos casos pela ausência de sintomatologia clínica que possa ser percebida pelos proprietários, dessa maneira o diagnóstico ocorre muitas vezes de forma incidental durante OSH, necropsia ou celiotomia exploratória. Este artigo descreve o achado incidental de agenesia ovariana unilateral direita em gata SRD submetida a OSH em programa de castração solidária. Na ocasião, não foram realizados exames complementares pré-cirúrgicos, estando a avaliação do animal restrita apenas a exame físico geral e palpação abdominal. A abordagem foi realizada por meio de acesso mediano ventral. Após a exposição do corno uterino esquerdo foi constatada inexistência do ovário esquerdo, que foi confirmada mediante palpação cranial do complexo arteriovenoso ovariano (CAVO) até a superfície renal. Não houveram dificuldades na realização das manobras de hemostasia, no entanto, a ausência de exames de imagem pode aumentar o risco cirúrgico, sobretudo para profissionais ou estudantes inexperientes. Apesar de ser uma condição de simples resolução cirúrgica, deve-se evitar demasiada e brusca tração do CAVO devido ao risco de complicações decorrentes de sua ruptura.

Objective To explore the association between quantitative classification of renal surface nodularity (qRSN) based on computed tomography (CT) imaging and early renal injury (ERI) in patients with aerial hypertension.Methods A total of 143 patients with a history of hypertension were retrospectively enrolled; clinical information (age, sex, hypertension grade, hypertension course, poorly controlled hypertension), laboratory tests and qRSN were collected or assessed. The subjects were divided into an ERI (n=60) or a control (CP, n=83) group according to ERI diagnosis based on the following criteria: cystatin C > 1.02 mg/L, creatinine ≤ 127 μmol/L, and urea nitrogen ≤ 8.3 mmol/L. Univariate analysis and multiple logistic regression were used to examine the association between ERI and qRSN. A receiver operating characteristic curve (ROC) was produced to compare multiple logistic regression models with or without qRSN for differing the ERI group from the control group.Results In univariate analysis, hypertension grade, poorly controlled hypertension, hypertension course, triglycerides (TG) and qRSN were related to ERI in patients with arterial hypertension (all PZ=2.317, P=0.021).Conclusion CT imaging-based qRSN was associated with ERI in patients with arterial hypertension and may be an imaging biomarker of early renal injury.

The quantities that determine the relative image noise level by either increasing or reducing its value are photon quality (kVp) and photon quantity (mAs). This study is to determine the effect of LET, energy and particle fluence on the renal surface area during abdominal CT scan. The method involve extracting three exposure parameters from image data using MVL DICOM application software including: kVp, mA and scan time. The kVp or the photon peak energy which is applied in the A-P direction during abdominal CT scan was used to estimate linear energy transfer. While the particle fluence and the energy fluence were estimated from the effective mAs and the kVp on the total renal surface respectively. The effective mAs were estimated by dividing the mAs by the average pitch factor of approximately 0.813. In all the examinations, the average protocol setting in terms of exposure time and kilovolts peak were 500s and 120keV respectively. While the average protocol in all the centers recorded a mean effective milliamp second (mAs) of 59.27 mAs and tube current of 94.22A. The influence of these parameters on abdominal scan depends on the scan time, scan scope, the size of the renal surface area (RSA) which has varied values. The effects of effective mean mAs per unit mean renal surface area, described as mean effective particle fluence were 1.32mAs/cm2 and 1.50 mAs/cm2 for male and female respectively. The energy fluence, which is the photon energy per unit renal surface area estimated to have a mean value of 4.02 keVcm-2 and 4.51 keVcm-2 for male and female respectively. In addition, the maximum and minimum variations of all the measured parameters. The LET, which described the lost in photon energy as it traverses across the renal tissues in the A-P direction was estimated, with a mean value of 2.60 keV/µm and 2.67 keV/µm for male and female respectively. The maximum and minimum LET values were 4.49 keV/µm and 1.90 keV/µm for male and 5.26 keV/µm and 1.98 keV/µm for female respectively. The maximum measured values were below the critical LET values estimated to be between 15 to 20 keV/µm. These estimated risk parameters were used to predict the effect on abdominal and kidney tissues using the various modeled equations.

Summary For microcirculation research there is a need for baseline data and feasibility protocols describing microcirculation of various organs. The aim of our study was to examine the reliability and reproducibility of sidestream dark-field (SDF) imaging within the renal cortical microcirculation in rats. Renal microcirculation was observed using SDF probe placed on the exposed renal surface via the upper midline laparotomy. Video sequences recorded intermittently in short apneic pauses were analyzed off-line by using AVA 3.0 software (MicroVision Medical, Amsterdam, the Netherlands). Results are expressed as mean (SD) or median (25–75% percentiles). We obtained 60 clear sequences from all recorded analyzable videos from all the animals. The total small vessel and all vessel density (in mm.mm–2) were (28.79 ± 0.40) and (28.95 ± 0.40), respectively. The perfused small and all vessel density were (28.79 ± 0.40) and (28.95 ± 0.40), respectively. The DeBacker Score was (19.14 ± 0.43), the proportion of perfused vessels was 100% (100–100%) and the microvascular flow index was 3.49 (3–3.75). We conclude SDF imaging provides a reliable method to examine the renal microvascular bed in vivo and thus can be used for the study of the renal cortical vascular network in various experimental diseases models and clinical settings. Lay Description This article aims to discuss the practicability of obtaining the baseline data and feasibility protocols needed to describe the microcirculation in various organs. In order to examine the reproducibility as well as the reliability of obtaining valid microcirculatory data of particular organs, the authors choose a renal cortical microcirculation in rats observed by using the sidestream dark field imaging (SDF). SDF method can be used non-invasively as well, especially in the sublingual area even in clinical research. However, in this study, the SDF probe is placed on the exposed renal surface. The subsequent analysis of all recorded videos is off-line using special software capable of image stabilization and semi-automatic evaluation of microcirculation. The program provides a number of output data, such as vascular density, vascular perfusion and blood velocity. The findings indicate that SDF imaging provides a reliable method of examining the renal microvascular bed in vivo and thus can be used to study the renal cortical vascular network in various experimental models of diseases and clinical settings.

This study gives a three-dimensional (3D) structural analysis of rat nephrons and their connections to collecting ducts. Approximately 4,500 2.5-μm-thick serial sections from the renal surface to the papillary tip were obtained from each of 3 kidneys of Wistar rats. Digital images were recorded and aligned into three image stacks and traced from image to image. Short-loop nephrons (SLNs), long-loop nephrons (LLNs), and collecting ducts (CDs) were reconstructed in 3D. We identified a well-defined boundary between the outer stripe and the inner stripe of the outer medulla corresponding to the transition of descending thick limbs to descending thin limbs and between the inner stripe and the inner medulla, i.e., the transition of ascending thin limbs into ascending thick limbs of LLNs. In all nephrons, a mosaic pattern of proximal tubule (PT) cells and descending thin limb (DTL) cells was observed at the transition between the PT and the DTL. The course of the LLNs revealed tortuous proximal “straight” tubules and winding of the DTLs within the outer half of the inner stripe. The localization of loop bends of SLNs in the inner stripe of the outer medulla and the bends of LLNs in the inner medulla reflected the localization of their glomeruli; i.e., the deeper the glomerulus, the deeper the bend. Each CD drained approximately three to six nephrons with a different pattern than previously established in mice. This information will provide a basis for evaluation of structural changes within nephrons as a result of physiological or pharmaceutical intervention.

Upper abdominal ultrasound imaging in a 63-year-old woman who had been hypertensive for ten years revealed a tumour at the lower pole of the left kidney. It protruded from the renal surface and gave dense echoes, suggestive more of an angiomyolipoma than a hypernephroma. The former diagnosis was reenforced by the angiographic appearance and confirmed by biopsy at the time of surgery. Nephrectomy was performed and the postoperative course was without complication.

AIM: On magnetic resonance (MR) images, strands correspond to curvilinear areas running in the perinephric fat, and haloes to those lying on the renal surface. Our aim was to examine the diagnostic significance and histopathological basis of these areas. PATIENTS AND METHODS: MR images obtained in 46 patients without renal disease and 96 patients with renal disease were assessed for the signal intensity and extent of strands and haloes, and their degree of right-left asymmetry. RESULTS: Strands usually revealed low signal intensity on Tl-weighted MR images and high signal intensity on fat-suppressed T2-weighted images and contrast-enhanced fat-suppressed T1-weighted images. Haloes revealed high signal intensity on fat-suppressed T2-weighted images, but most of haloes were not clearly depicted on Tl-weighted images or contrast-enhanced fat-suppressed T1-weighted images. Strands and haloes were common and usually symmetrical or only mildly asymmetrical in both patient groups. However, in 11 of the 96 patients with renal disease, prominent strands and/or haloes appeared with remarkable asymmetry and likely represented definite changes in the perinephric fat. At histopathology, vascular loose fibrous tissue was found at the sites of strands and haloes. CONCLUSION: Strands and haloes usually represent normal anatomical variations. However, the presence of prominent strands or haloes with remarkable right-left asymmetry implies abnormality and may provide additional information in the evaluation of renal disease.

In patients with autosomal dominant polycystic kidney disease (ADPKD), laparoscopic cyst decortication (LCD) has been proposed as a means to relieve chronic cyst-related pain. We present our 7-year experience with LCD for ADPKD with regard to pain relief, hypertension, and renal function.Between August 1994 and February 2001, 29 ADPKD patients with chronic pain (N=29), hypertension (N=21), and renal insufficiency (N=10) underwent 35 LCD procedures. Every detectable cyst within 2 mm of the renal surface was treated. Pain relief was assessed using a pain analog scale; relative pain relief (RPR) equaled (preoperative pain score) - (postoperative pain score)/(preoperative pain score). Hypertension was evaluated using the antihypertensive therapeutic index (ATI): [(dose of blood pressure medication 1/max dose 1) + (dose med 2/max dose 2) + etc.] x 10. Renal function was assessed using the Cockcroft and Gault formula for creatinine clearance.The mean operating room time was 4.9 hours (range 2.6-6.6 hours) with no conversions to open surgery. An average of 220 cysts (range 4-692) were treated per patient. The mean follow-up was 32.3 months (range 6-72 months). The RPR was 58%, 47%, and 63% at 12, 24, and 36 months, respectively. At 12, 24, and 36 months, 73%, 52%, and 81% of patients, respectively, noted50% improvement in their pain compared with the preoperative situation. Five patients became normotensive, and patients improved their ATI by an average of 49% (range 11%-93%). However, six patients had worsening hypertension, with an ATI increase averaging 53% (range 11%-122%), and one patient who was not hypertensive preoperatively has since developed hypertension. The creatinine clearance changed +4%, +7%, and -2% at 12, 24, and 36 months, respectively. Only one patient had a20% increase in creatinine clearance. The only patients with a20% decrease in creatinine clearance were those who had a creatinine clearance30 mg/dL preoperatively (average decrease 34% [range 20%-51%]).For ADPKD patients with debilitating pain, extensive LCD can provide durable relief. In the majority of patients with pain and hypertension, a marked improvement in blood pressure also occurs. Cyst decortication was not associated with worsening renal function; indeed, renal function remained largely unchanged over the 3-year follow-up period.

The glomerular distribution in the renal cortex of the Munich Wistar Frömter (MWF) rat, a substrain of the Munich Wistar rat selected for superficial glomeruli, was compared to that of a control strain (LEW/Ztm) between 10 and 150 days of age. While there were no significant differences in body growth, kidney weight, or growth of the renal cortex in these two strains, the average diameter of Bowman’s capsule and of the glomerular tuft was significantly larger (about 12%) in rats of the MWF strain which were older than 60 days. In histological sections of kidneys of MWF rats in all age groups, many glomeruli in direct contact with the renal capsule were found; thus, this developmental step must have taken place before 10 days of age. The appearance of superficial glomeruli was due to a shift of glomeruli to a position just under the renal surface, the subcapsular zone or ‘cortex corticis’, which is normally free of glomeruli. For the rest of the renal cortex there were only slight differences in glomerular density and in total number of glomeruli per section between these two strains. These results lead us to suppose that superficial glomeruli belong to a special nephron type; thus, these glomeruli are not enveloped by parts of the proximal tubule.

The perinephric space is not a simple fat-filled chamber through which fluid may be distributed unhindered. It is divided into multiple compartments by fibrous lamellae, the bridging septa. Some of these structures arise from the renal capsule and extend to the perinephric fascia; others are attached only to the renal capsule and are arranged more or less parallel to the renal surface. Still others connect the anterior to the posterior leaves of the perinephric fascia. The resulting compartments exert an important influence on pathologic processes, resulting, for example, in limitation of the spread of pus and tamponade of bleeding points. The configuration of many perinephric collections can only be understood by knowledge of the existence and arrangement of these lamellae. The current criteria for differentiation of subcapsular from perinephric hematomas are shown to be in error, and a new sign for such differentiation is described. There are also implications regarding therapeutic drainage of perinephric abscesses, particularly by the percutaneous route. A new classification of the perinephric fascia is proposed.

Summary— The use of the Doppler probe to localise the intrarenal vessels was assessed in 15 dogs. This prevented the need for renal artery clamping and radial nephrotomies were placed in silent areas on the renal surface. Functional studies were performed post-operatively at 48 h and 1 month, using creatinine clearance, microfil casts and cast angiography. There was no significant loss of function when three or six radial nephrotomies were made and the Doppler accurately localised sites for nephrotomy between the intrarenal arteries and veins which were undamaged.

In order to analyse the mechanism of inhibition of water diuresis in adrenal insufficiency renal surface tubulus of male albino rats (group I: controls, group II: 8 days or more after bilateral adrenalectomy) have been perfused using the free flow microperfusion technique.

The passage time of I131-Hippuran and I131-Inulin was measured with Anger camera-scintigraphy after rapid arterial injection of these substances and compared with the results obtained with the Lissamingreen method. Corresponding to the passage time of Lissamingreen through the loops of Henle, there was a decrease in the kidney size in the scintiphotogram. in further agreement with the intravital microscopy, the passage time of the radioactivity was prolonged during hypotension and high intra-pelvic pressure. Similar results were obtained with collimator measurements of I125-Inulin and I125-Hippuran on the renal surface and with simultaneous measurements of the passage time of Lissamingreen.

Volumes and surface areas of 45 kidneys were determined ultrasonographically in vivo before autopsy and in a water bath phantom after autopsy by means of both the ellipsoid and the stepped section methods. Comparison of results revealed that renal volume may be determined by the simplest method, the ellipsoid method, with sufficient accuracy for clinical use. Results also revealed that renal mass expressed in grams may be directly obtained from renal volume expressed in milliliters, but mass in grams was found to correlate better with renal surface area than with renal volume. A formula relating renal mass to both volume and surface area was developed from regression analysis of the data and was found to provide a more precise estimate of renal mass than does mass computed from either volume or surface area alone.

After the puncture needle has reached the desired calyx, a flexible guide wire (Seldinger) or a semi-stiff guide wire (Lunderquist) is led through the needle and advanced deep into the kidney (Fig. 38). The track is then dilated, which one can facilitate by dividing the muscles all the way to the renal surface with the double blade knife (see Fig. 26). For this purpose, the distance between the skin and the surface of the kidney is measured beforehand with the ultrasound probe and the distance disc is set accordingly. To cut the track even further than the designated 10 mm, which might be necessary when there is hard scar tissue, the double blade is twisted about 90° at a selected depth and is pulled out. Then the central leading rod of the telescope dilator set or, if teflon dilators are used, the thin dilator is advanced. Since dilatation is done in one plane only, a soft Seldinger guide wire can easily kink in the second plane or can even be pulled out of the kidney through the leading rod or through the first dilator. The wire can be pushed back and forth in the central track with short, quick motions. The wire’s refusal to be moved anymore indicates that it has kinked, in which case the affected portion of the wire has to be pulled out through the track. This complication alone makes it advisable, when using Seldinger wires, to advance as much wire as possible into the cavity system.

Microfibrillar collagen hemostat was used in 23 patients with renal injuries owing to multiple causes in an attempt to control small vessel bleeding from raw renal surface areas. Minimal complications have occurred with the use of this substance. Control of bleeding has been prompt and no late bleeding has occurred.

The microperfusion pump described in this paper allows to perfuse the same peritubular capillary area on the renal surface with different test solutions. Solutions can be changed by means of a microcannula inside the pump which for this purpose can be moved near to the tip of the pipette. Concentration effect relations of various agents may thus be obtained on the single nephron level in vivo. This is illustrated on the example of the inhibitory effect of acetazolamide on proximal tubular reabsorption. Inhibition of this tubular function has been assessed by means of repeated determinations of split droplet half times.

In the present study it is demonstrated that reabsorptive functions of the proximal tubule during partial renal artery clamping display significant differences when compared to spontaneous GFR variations. During moderate clamping fractional fluid reabsorption was 69.8% and fell during severe clamping to 55.2%. Proximal tubular passage time increased progressively with the degree of clamping. This indicates that radius does not change as a function of GFR, a finding supported by microphotography of the renal surface. During moderate arterial clamping proximal reabsorptive rate was correlated to the tubular cross-sectional area, but in the face of severe clamping this relationship was abolished. We conclude, therefore, that mechanisms other than tubular geometry participate in regulating proximal tubular reabsorption, when GFR is altered by arterial constriction.