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There are several nephrometry scoring systems for predicting surgical complexity and potential perioperative morbidity. The R.E.N.A.L. scoring system, one of the most well-known nephrometry scoring systems, emphasizes the features on which it is based (Radius, Exophytic/endophytic, Nearness to collecting system or sinus, Anterior/posterior, and Location relative to polar lines). The ability of these nephrometry scoring systems to predict loss of renal function after robotic partial nephrectomy (RPN) remains controversial. Therefore, we verified which combination of factors from nephrometry scoring systems, including tumor volume, was the most significant predictor of postoperative renal function. Patients who underwent RPN for cT1 renal tumors in our hospital were reviewed retrospectively (n = 163). The preoperative clinical data (estimated glomerular filtration rate [eGFR], comorbidities, and nephrometry scoring systems including R.E.N.A.L.) and perioperative outcomes were evaluated. We also calculated the tumor volume using the equation applied to an ellipsoid by three-dimensional computed tomography. The primary outcome was reduced eGFR, which was defined as an eGFR reduction of ≥ 20% from baseline to 6 months after RPN. Multivariable logistic regression analyses were used to evaluate the relationships between preoperative variables and reduced eGFR. Of 163 patients, 24 (14.7%) had reduced eGFR. Multivariable analyses indicated that tumor volume (cutoff value ≥ 14.11 cm 3 , indicating a sphere with a diameter ≥ approximately 3 cm) and tumor crossing of the axial renal midline were independent factors associated with a reduced eGFR (odds ratio [OR] 4.57; 95% confidence interval [CI] 1.69-12.30; P = 0.003 and OR 3.50; 95% CI 1.30-9.46; P = 0.034, respectively). Our classification system using these two factors showed a higher area under the receiver operating characteristic curve (AUC) than previous nephrometry scoring systems (AUC = 0.786 vs. 0.653-0.719), and it may provide preoperative information for counseling patients about renal function after RPN., (© 2021. The Author(s).)

Aim: Optimizing nephron supply to recipient demand is a non-immunologic determinant of renal allograft outcome. Nephron reduction is usually caused by physical donor-recipient mismatch, but its pathologic relevance remains to be determined., Methods: Thirty-one recipients of living donor renal transplants were divided into three subgroups: those who received transplants from the same gender (n = 6, Group 1) and those who underwent male-to-female (n = 8, Group 2) and female-to-male (n = 17, Group 3) transplants. Renal mass was evaluated by three-dimensional computed tomography (3D-CT) volumetry before and one year after transplantation. Glomerular volume was determined from protocol biopsies obtained one hour and one year after transplantation., Results: Histologically determined glomerular volume in biopsied tissues showed a significant linear correlation with allograft size on 3D-CT volumetry (P < 0.001, r = 0.625). Mismatches in body weight, glomerular volume and kidney volume ratios were significantly greater in female-to-male (Group 3) than in male-to-female (Group 2) transplants (P < 0.001 each). Despite the two groups having nearly equal graft filtration rates one year after transplantation, proteinuria rate was three-fold higher in Group 3 than in Group 2 (P < 0.001)., Conclusion: These findings suggest that too small graft size, frequent in female-to-male transplants, could cause hypertrophy in both kidneys and glomeruli, thereby affecting allograft function and survival., (© 2016 Asian Pacific Society of Nephrology.)

Background: Live donor pre-transplant and recipient post-transplant kidney volumes based on three-dimensional computed tomography (3DCT) have been related to post-transplant renal function. We examined this association and the effect of sex/size differences between donor and recipient on kidney growth rate., Methods: We retrospectively reviewed 30 live donors who underwent pre-transplant and post-transplant 3DCT. We determined donor (Dvol) and recipient renal volumes (Rvol) based on 3DCT and calculated changes in graft volume after transplantation (Vol-ratio). We also divided Dvol by recipient body weight (Dvol/RWgt) and compared the correlations between Vol-ratio and Dvol/RWgt and post-transplant renal function after one yr. We determined the rates of change in kidney volume and renal function according to the sexes of the donor and recipient., Results: The mean Dvol and Rvol were 141.7 and 178.4 mL, respectively. The mean Vol-ratio was 127.3%. Dvol/RWgt showed a significant linear correlation with remaining renal function after one yr (r = 0.6745, p < 0.0001). The combination of female donor and male recipient resulted in the fastest increase in kidney volume (p < 0.001) and highest level of proteinuria (p < 0.001)., Conclusions: Pre-transplant and post-transplant kidney volumes are correlated with post-transplant graft function, and graft growth is affected by the relative sexes of the recipient and donor., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: In living donor kidney transplantation, the decision regarding which donor kidney to transplant is based on characteristics such as vascular anatomy and split renal function (SRF). Computed tomography (CT) was used to assess vascular anatomy and renal scintigraphy was used to evaluate SRF. The ability of split renal volume (SRV) calculated from volumetric examination of CT scans and that of SRF of renal scintigrams derived from Tc-99m mercaptoacetyltriglycine-3 (MAG3) renography to predict donor residual single kidney function after donor nephrectomy were compared., Material and Methods: CT images and renal scintigrams from 35 live kidney donors who had at least 1 year post-donation renal function follow-up were analyzed., Results: Predonation GFR was 99.1 ± 17.2 mL/min/1.73 m(2). The average right and left kidney volumes were 138.8 ± 29.4 mL and 136.1 ± 29.2 mL, respectively. SRV was strongly and significantly correlated with SRF-MAG3 (r = 0.714). The residual renal functions predicted from calculating SRV and SRF-MAG3 were 46.2 ± 8.3 mL/min/1.73 m(2) and 46.0 ± 9.2 mL/min/1.73 m(2), respectively. Both SRV (r = 0.708) and SRF-MAG3 (r = 0.634) showed significant linear correlations with residual renal function after 1 year, with SRV showing a stronger correlation., Conclusion: Calculating SRV from predonation CT examination is a valid method to estimate postdonation renal function after 1 year. CT volumetry may become a standard method in the near future., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Renal allograft rupture (RAR) is a rare but serious complication of renal transplantation. The most common cause of RAR is acute rejection but other causes have increased in frequency with advances in immunosuppressive therapy. We report a patient with RAR attributed to coughing while asleep. A 53-year-old male received a living-donor renal transplantation for end-stage renal failure due to diabetic nephropathy. The clinical course was satisfactory, and he was discharged on the 12th postoperative day with a serum creatinine level of 1.24 mg/dl. On the 24th morning, he felt sudden swelling and pain over the incision area soon after a big cough. Ultrasound and computed tomography revealed a perinephric hematoma. Emergency surgical exploration showed complete laceration of the abdominal fascia and 4-cm rupture at the anterolateral aspect of the kidney. High intra-abdominal pressure when coughing had torn the fascia, and the graft appeared to have ruptured under the fascial tension. Bleeding was controlled with a polyglactin 910 2/0 mattress parenchymal suture enforced with application of a fibrin tissue-adhesive collagen fleece. Twelve months after the repair, the patient's renal function was stable with a serum creatinine level of 1.3 mg/dl.