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Systemic lupus erythematosus (SLE) is a complex autoimmune disease known for its diverse clinical presentations, and one severe complication is lupus nephritis (LN), which significantly contributes to morbidity and mortality. While LN often presents within the first 5 years of SLE diagnosis, renal vein thrombosis (RVT) is a rare vascular complication with a high risk of mortality and morbidity. This case report discusses the rare occurrence of RVT as the initial presentation of SLE in a 32-year-old Sudanese male patient, currently working in Palestine, presenting with flank pain, hematuria, fever, and lower limb edema. The case details the patient's symptoms, examination findings, and extensive laboratory and imaging workup leading to the diagnosis. This report highlights the rare association between RVT and SLE, emphasizing the importance of maintaining a high index of suspicion for SLE in patients with multisystem involvement, especially in males, where the diagnosis may be overlooked due to its lower prevalence. Early recognition can improve patient outcomes and reduce the risk of complications. Further research is needed to better understand the connection between RVT and SLE and to develop more effective treatment strategies. [ABSTRACT FROM AUTHOR]

Background: The venous excess ultrasound score (VExUS) is used to objectify systemic venous congestion. The aim of the paper was to determine the association between VExUS grades and worsening renal function (WRF), reduced natriuretic response, diuretics resistance, and mortality in patients with acute heart failure (AHF). Methods: One hundred patients were included, and Doppler ultrasound of hepatic, portal, and renal veins was performed. Severity of congestion was graded using the VExUS score (grade 0, 1, 2, or 3). Sodium concentration in a spot urine sample was assessed in 2 h after the first loop diuretic administration and was adjusted for the prescribed dose of furosemide (31 mmol/40 mg). Diuretics resistance was defined as the need to double the starting dose of intravenous furosemide in 6 h. Results: Patients with VExUS grade 3 showed a higher incidence of WRF (OR: 11.17; 95% CI: 3.86–32.29; p < 0.001) and a decreased natriuretic response: a spot urine sodium content of <50 mmol/L (OR: 21.53; 95% CI: 5.32–87.06; p < 0.001) and an adjusted spot urine sodium content of <31 mmol/40 mg (OR: 9.05; 95% CI: 3.15–25.96; p < 0.001). The risk of diuretic resistance (OR: 15.31; 95% CI: 5.05–46.43; p < 0.001), as well as the need for inotropic and/or vasopressor support (OR: 11.82; 95% CI: 3.59–38.92; p < 0.001), was higher in patients with severe congestion. The hospital mortality rate increased in patients with VExUS grade 3 compared to in patients with other grades (OR: 26.4; 95% CI: 5.29–131.55; p < 0.001). Conclusions: Patients with AHF and VExUS grade 3 showed a higher risk of developing WRF, a decreased diuretic and natriuretic response, a need for inotropic and/or vasopressor support, and a poor prognosis during their hospital stay. [ABSTRACT FROM AUTHOR]

Objective: A growing body of research suggests a link between varicocele and male infertility (MI). However, current evidence is mainly based on retrospective studies, which are prone to interference from confounding factors and cannot establish causal relationships. Mendelian randomization (MR) studies on the causal relationship between varicocele and MI are very limited. Therefore, this study conducted a two-sample MR study to elucidate the causal effect between the two. Methods: Download the data set GSE216907 from the GEO database, and use R software to screen differential genes in normal and varicocele tissue samples. The drug targets of Bu Shen Huo Xue Prescription (BSHXP) were derived from the Herb database. All genetic datasets were obtained using publicly available summary statistics based on individuals of European ancestry from the IEU GWAS database. MR analysis was performed using MR Egger, weighted median (WM) and inverse variance weighted (IVW) methods to assess the causal relationship between exposure and outcome and to validate the findings by comprehensively evaluating the effects of pleiotropic effects and outliers. The renal vein constriction method was used to establish a pathological model of varicocele infertility. The drug was administered continuously for 60 days and the relevant indicators of the rats were observed. Results: Obtain two therapeutic targets for varicocele through intersection analysis: MEGF9 and MLLT11, and were verified by molecular docking. MR analysis showed that MEGF9 was positively associated with MI (MR Egger, OR: 1.639, 95% CI: 1.124-2.391, P = 0.024; WM, OR: 1.235, 95% CI: 1.003-1.521, P = 0.047). MEGF9 is also positively associated with MI (IVW, OR: 1.35, 95% CI: 1.069- 1.705, P = 0.012). Sensitivity analysis showed no heterogeneity and horizontal pleiotropy. The expression of MEGF9 and MLLT11 increased in the varicocele model group, while the expression decreased after treatment with low, medium, and high doses of BSHXP. In addition, the sperm number, motility, morphology, and fertility of rats in the model group were significantly lower than those in the control group (P<0.05). After BSHXP treatment, all indicators were significantly better than those of the model group (P<0.05). Conclusion: In conclusion, this study indirectly supports that varicocele causes MI. BSHXP inhibiting MEGF9 and MLLT11 may become a potential therapeutic target for alleviating varicocele and MI. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess management and determine outcomes of renal tumors with inferior vena cava (IVC) and intracardiac (IC) extension in a tertiary care center in Pakistan. Methods: A retrospective chart review was conducted at the Aga Khan University Hospital, Karachi, Pakistan. All patients from 1 to 18 years of age with renal tumors with intravascular extensions, surgically managed from January 1988 till June 2016, were included. Data was extracted by reviewing medical records, and the tumor details, treatment and outcomes were analyzed. Results: A total of 18 patients out of the total 61 patients with renal tumors, presented with IVC and/or IC extension, with the majority involving the right kidney. Mean age was 5.9 (SD:4.9) and a female preponderance (56%) was seen. Wilms tumor (77%) was the most common tumor type, with the level of tumor extension into IVC predominantly being below the diaphragm (55.5%). Fourteen patients received preoperative chemotherapy, with tumor regression, seen in 10. Most patients underwent thrombectomy through the renal vein (56%). Regarding outcomes, frequency of mortality and morbidity was 1 and 2, respectively, with 7 patients having no recurrent 5 years post-surgery. Conclusion: A greater incidence (29.5%) of IVC and or IC Tumor extension was found compared to existing literature, which could likely be due to a higher referral rate to the center. Moreover, this is a single-center study and so a multi-center study is crucial to form an assessment of surgical management in resource-limited settings. Our study is the first from Pakistan on this particular renal tumor presentation. Considering the varying case presentations and surgical techniques used, further studies are needed to standardize surgical management and optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Pamukkale Medical Journal is the property of Pamukkale Journal of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: A reninoma (juxtaglomerular cell tumor) is a rare cause of secondary hypertension that can present with headaches alongside the triad of severe hypertension, hypokalemia, and metabolic alkalosis. Case Presentation: We describe a case of a 15-year-old previously healthy girl who presented with headaches and hypertensive urgency who had severe hypokalemia, moderate hyponatremia, and elevated aldosterone and renin levels. Abdominal ultrasound and MRI with contrast revealed a unilateral mass localized to the right kidney. Despite treatment of her hypertension, she had persistent hyponatremia with clinical euvolemia which was consistent with the paraneoplastic syndrome of inappropriate antidiuretic hormone secretion (SIADH). She underwent radical nephrectomy which normalized her blood pressure and aldosterone and renin values. The pathology findings were consistent with a reninoma with a mitotic rate of 1–2 mitoses per 10 high power fields. Discussion: Hypertension in the pediatric age group requires workup to rule out secondary causes. The classic triad of hypertension, hypokalemia, and metabolic alkalosis warrants assessment for aldosterone-mediated hypertension which can be a result of a renin-producing tumor. Curative approach requires surgical resection of the tumor. Reninomas may rarely manifest with a paraneoplastic phenomenon including SIADH, as seen in our case. Although reninomas are benign tumors, there are also a few reports of malignant transformation and metastases. Features uncommon in reninomas such as mitotic activity warrant long-term surveillance. Established Facts: Hypertension in the pediatric population requires a broad workup to exclude secondary causes. The triad of hypertension, hypokalemia, and metabolic alkalosis should prompt evaluation of aldosterone-mediated hypertension. Reninoma evaluation should include renin and aldosterone levels, renal imaging, and may require localization with selective renal vein sampling. [ABSTRACT FROM AUTHOR]

Background/Objective: The endovenous embolization of insufficient abdominal/pelvic veins is the preferred method of treatment. Also, it seems to be crucial in the treatment of lower limb vein insufficiency, particularly in recurrent disease. This study aimed to evaluate of pelvic vein embolization safety and its impact on the short-term outcome in the sequential treatment of venous disease. Methods: A retrospective analysis involved data from 506 female patients with venous disease involving abdominal and pelvic veins. All records were extracted from the medical database and included patient history, imaging reports as well as pre- and post-operative surveys. Results: Among the patients analyzed, 37.2% underwent some venous intervention in the past, with significant differences in symptom severity between groups. The embolization procedure revealed a high safety profile, with no serious complications. Pain during and after the procedure was generally low, with significantly lower pain scores in patients with recurrence. In patients who required left renal vein venoplasty a 1.7-fold increased risk of lumbar pain after embolization and venoplasty procedure was observed. Overall, 66.6% of patients reported improvement in pelvic symptoms and 72.1% experienced improvement in leg symptoms. The full sequential treatment protocol (abdominal, pelvic, and leg compartment) demonstrated superior outcomes in leg symptom improvement compared to embolization alone. Conclusions: Pelvic vein embolization is a safe and effective method of treatment, significantly improving both pelvic and leg symptoms, particularly in patients with a history of previous interventions in lower limb veins. Further studies are warranted to validate our findings and further refine treatment protocols. [ABSTRACT FROM AUTHOR]

Superior mesenteric artery (SMA) syndrome or Wilkie's syndrome is a vascular compression disorder that causes the abnormal compression of the third portion of the duodenum by the SMA. It has a low incidence rate, which is higher in young women, and is rarely associated with the Nutcracker phenomenon: a condition of the compression of the left renal vein between the SMA and the aorta, which manifests as pain in the left flank and pelvis. Here, we report on the case of a 54-year-old woman with a history of repeated episodes of abdominal pain caused by the Nutcracker syndrome and Wilkie's syndrome. [ABSTRACT FROM AUTHOR]

Introduction: This study introduces and compares a new intraperitoneal laparoscopic para‐aortic lymphadenectomy method to reach the level of the renal vein, the "tent‐pitching" antegrade approach with the retrograde approach in gynecological malignancy surgeries in terms of success rate, complication incidence, and the number of lymph nodes removed. It focuses on the feasibility, safety, and effectiveness. Meanwhile, this article reports on the vascular anatomical variations discovered in the para‐aortic region to enhance surgical safety. Material and Methods: This was a retrospective cohort study including patients undergone laparoscopic para‐aortic lymphadenectomy at a single center from January 2020 to December 2023 for high‐risk endometrial and early‐stage ovarian cancer. Patient charts were reviewed for mode of operation, perioperative complications, operative details, and histopathology. The patients were divided into anterograde group and retrograde group according to the operation mode. The two groups were further compared based on the success rate of lymph node clearance at the renal vein level, perioperative complications, and the number of removed lymph nodes. Quantitative data were analyzed using the t‐test, non‐normally distributed data using the rank‐sum test, and categorical data using Fisher's exact test and the chi‐square test, with statistical significance defined as P < 0.05. Results: Among 173 patients, the antegrade group showed higher surgery success (97.5% vs 68.82%), more lymph nodes removed (median 14 vs 7), and less median blood loss. The operation time was shorter in the antegrade group. Postoperative complications like lymphocele and venous thrombosis were lower in the antegrade group. Vascular abnormalities were found in 28.9% of patients, with accessory lumbar vein routing anomaly and accessory renal arteries being most common. Conclusions: The antegrade approach is feasible, safe, and effective, improving surgical exposure, reducing difficulty without additional instruments or puncture sites, and minimizing organ damage risk. It is effective in achieving better access to the renal vein and removing more para‐aortic lymph nodes than the retrograde method. Recognizing and carefully managing the diverse vascular abnormalities in the para‐aortic area, including variations in renal arteries, veins, and the inferior vena cava, is essential to reduce intraoperative bleeding and the likelihood of converting to open surgery. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Veterinary Journal / Revue Vétérinaire Canadienne is the property of Canadian Veterinary Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Left renal vein compression syndrome (LRVCS) remains a challenging diagnosis. This study aimed to correlate imaging and hemodynamic findings with clinical outcomes for patients with LRVCS. Materials and Methods: A retrospective review of 66 renal venography procedures with or without intravascular ultrasound (IVUS) was performed from 2017 to 2023 at a single institution. Patients with prior LRVCS treatment or other indications were excluded (n = 11). Primary outcome measure was correlation of catheter-based endovascular (CBE) findings with clinical outcomes (n = 55). Secondary outcome measures included correlation of CBE findings and LRV (i.e., beak) angle > 32°, beak sign, aortomesenteric angle (AMA < 41°), and hilar-to-aortomesenteric ratio (HTAMR ≥ 4.9) on cross sectional imaging. Descriptive statistics, chi-square testing, and ROC analyses were used. Results: Of the 55 patients, 52 (94.5%) were females (median age 31, range 14–72) and 56.4% (n = 31) had a diagnosis of LRVCS on CBE evaluation. A renocaval pressure gradient of ≥ 3 mmHg, presence of collaterals, and > 50% area stenosis on IVUS were significantly associated with CBE diagnosis of LRVCS (p < 0.001). Surgical treatment (renal autotransplantation or LRV transposition) was recommended to all patients with CBE diagnosis of LRVCS (n = 31). 81.2% (18/22) of patients who underwent surgery reported symptom resolution or improvement. When the cross sectional imaging measurements were compared with CBE evaluation, AMA was the most sensitive (100%), HTAMR and beak sign were highly specific (93.3%), and beak angle was the most predictive (77.4% sensitivity; 86.7% specificity). Conclusion: CBE diagnosis of LRVCS was highly predictive of surgical candidacy and post-surgical symptom resolution. The presence of collaterals, > 50% area stenosis on IVUS, or a renocaval pressure gradient ≥ 3 mmHg had a significant association with a CBE diagnosis of LRVCS. [ABSTRACT FROM AUTHOR]

Malposition is a relatively rare complication associated with peripherally inserted central catheters (PICCs), particularly in cases of superficial femoral vein (SFV) catheterization. To the best of our knowledge, we are the first to report this rare case of SFV PICC malposition in the contralateral renal vein.

Background: Schwannomas in the renal hilum are rare among retroperitoneal tumors. However, the possibility of malignant findings cannot be ruled out, and surgery is often indicated. This case was expected to be difficult to remove laparoscopically because the tumor was sandwiched between the arteriovenous veins of the renal portal. Sometimes, the tumor should be resected with a conservative approach to the kidney to preserve the renal function. Case presentation: Our patient was a 51-year-old Asian-Japanese man who was referred to our department for a retroperitoneal tumor in the renal hilum. Since malignancy could not be ruled out due to its size (45 × 48 × 55 mm) on imaging, the tumor was excised laparoscopically. Histopathology revealed schwannoma. Conclusions: We herein report a case in which a renal hilar tumor between renal arteriovenous vessels was successfully resected laparoscopically. [ABSTRACT FROM AUTHOR]

Awareness of the vein dimensions facilitates the detection of both solid organ and vein pathologies. We aimed to provide reference values major intra-abdominal portal and systemic vein diameters in several pediatric age groups and reveal associations of vein diamaters with each other, age, and waist circumference using data from contrast-enhanced abdominal computed tomography. Abdominal computed tomography images of 800 pediatric patients (468 men, 332 women) aged 0–2, 3–5, 6–10, 11–14, and 15–17 years having normal abdominal radiological findings were examined. The means with standard deviations and the 10th, 25th, 50th, 75th, and 90th percentiles of the the major portal vein with right and left branches, superior mesenteric and splenic veins, right and left renal veins, and intrahepatic vena cava inferior diameters were calculated for all age groups. Differences in mean diameters were analyzed with the analysis of variance and Tukey's Honestly Significant Difference tests between age groups and with the t-test between gender groups. Pearson correlation analysis was performed to determine the associations of vein diameters with each other, age and waist circumference. There was no significant difference between gender groups in terms of age and vein diameters. Significant differences in mean diameters were identified in the consecutive age groups from group 1 to 4 (p = 0.001) for splanchnic venous system, renal veins, and vena cava inferior. Diameters were significantly greater in age group 5 compared to age group 4 (p = 0.049–0.001). Moderate positive correlations were found between diameters of the portal vein, superior mesenteric vein, and vena cava inferior with age and waist circumference (p = 0.001, r = 0.54–0.7). Moderate positive correlation was identified between age and estimated waist circumference (p = 0.001, r = 0.77). Age and waist circumference dependant regression equations and relative ratios for vein diamaters were depicted. We provide reference ranges as means and percentiles for the diameters of splanchnic venous system, renal veins, and vena cava inferior using computed tomography images of age stratified children. Vein diameters were correlated with each other, age, and waist circumference. [ABSTRACT FROM AUTHOR]

Background: Renal angiomyolipoma (AML) without local invasion is generally considered benign. However, it may extend to the renal sinus, even the renal vein, or the inferior vena cava (IVC). In patients with non-tuberous sclerosis complex, coexistence of renal cell carcinoma (RCC) and renal AML is uncommon. Case presentation: A 72-year-old woman was incidentally found to have a solitary right renal mass with an IVC thrombus extending into the right atrium during a routine health checkup. Robot-assisted laparoscopic radical nephrectomy and thrombectomy were successfully performed through adequate preoperative examination and preparation. Two tumor lesions were found and pathologically confirmed as renal AML and RCC, and the tumor thrombus was derived from the renal AML. During the one-year follow-up period, no signs of recurrence or metastatic disease were observed. Conclusions: Renal AML with a tumor thrombus in the IVC and right atrium accompanied by RCC may occur, although rarely. In clinical practice, if preoperative manifestations differ from those of common diseases, rare diseases must be considered to avoid missed diagnoses. In addition, adequate examination and multidisciplinary discussions before making a diagnosis are necessary. For a level 4 tumor thrombus with no infringement of the venous wall, adoption of robot-assisted minimally invasive surgery, without extracorporeal circulation technology, is feasible. [ABSTRACT FROM AUTHOR]

Background Continuous ultrafiltration consists a decongestion method for patients with refractory decompensated heart failure with diuretic resistance as it enables the energetic withdrawal of isotonic fluid under controlled rate according to the patient's vital signs, offering decongestion without exceeding plasma refill rate. Case summary A 62-year-old male with history of Holt–Oram syndrome with Eisenmenger physiology presented with worsening dyspnoea. Patient initial clinical and laboratory examination, renal vein ultrasound, and echocardiogram were consistent with significant congestion. A combined strategy of intravenous furosemide with early initiation of continuous ultrafiltration at an adjustable rate for 4 days was finally selected. Patient remained haemodynamically stable during the total treatment time and exhibited significant clinical and laboratory improvement. Consecutive renal vein ultrasounds and echocardiograms demonstrated a continuous and steady recession of congestion. During the 4 days of ultrafiltration, total fluid loss was estimated at 42 L. Patient remained asymptomatic without signs of worsened congestion at 1, 3, and 5 months follow-up. Discussion Our case depicts that continuous ultrafiltration without exceeding plasma refill rate allows an impaired right ventricle to maintain significant preload. This suggests that it might be considered for patients in whom a session of short classic ultrafiltration might have detrimental results regarding cardiac output. [ABSTRACT FROM AUTHOR]

Introduction: The left kidney is often preferred for living donor kidney transplantation because of its anatomical advantages. However, the right kidney may be procured due to donor conditions. Few studies have assessed the safety and graft outcome of right retroperitoneal laparoscopic donor nephrectomy (RDN). This study aimed to compare the outcomes between right and left RDN with respect to donor outcome and the graft function of recipients. Methods: This retrospective study included 230 consecutive living donor kidney transplants performed at our institution between May 2019 and March 2023. We reviewed the outcomes of kidney transplant in the right and left kidneys after RDN. Results: A total of 230 living donor kidney transplants were performed, with 32 donors receiving right RDN (right RDN group) and 198 donors receiving left RDN (left RDN group). The renal veins and ureters were significantly shorter in the right RDN group than in the left RDN group (both p <.001). Donor operation and warm ischemia time were significantly longer in the right RDN group than in the left RDN group (p =.012 and p <.001, respectively). None of the groups exhibited any cases of delayed graft function owing to donor‐related reasons. Perioperative changes in the estimated glomerular filtration rate of recipients and death‐censored graft survival were not significantly different between the two groups. Conclusions: In RDN, the outcomes of right donor nephrectomy were comparable to those of left donor nephrectomy in terms of donor safety and recipient renal function. [ABSTRACT FROM AUTHOR]

Testicular malignancies commonly affect adolescent and young adult males. Although they tend to respond well to cisplatin-based chemotherapy with excellent overall survival, complications such as inferior vena cava tumor thrombus are rare and can be associated with high morbidity and mortality. We present a case of tumor thrombus in a 21-year-old active duty male with a newly diagnosed stage IIIB non-seminomatous germ cell tumor presenting with extensive left lower extremity swelling. Ultrasound with Doppler was notable for significant thrombus of the left common femoral, femoral, and popliteal vein. Computed tomography imaging revealed extensive thrombus of the inferior vena cava, left iliac veins, and left gonadal vein with sparing of the left renal vein. Endovascular thrombectomy was performed with pathologic analysis confirming the presence of malignant cells consistent with tumor thrombus. The patient continued subsequent non-seminomatous germ cell tumor treatment without complications. [ABSTRACT FROM AUTHOR]

Renin‐secreting tumours are rare causes of secondary hypertension and hypokalaemia. They are usually surgically curable, hence proper diagnostic work‐up and tumour localisation is essential. In this paper, we present three Swedish patients recently diagnosed with renin secreting tumours, two with reninomas and one with an extrarenal renin‐producing tumour, to illustrate diagnostic challenges. We also discuss the biochemical work‐up, the pros and cons of different imaging techniques (computer tomography [CT], magnetic resonance imaging and [18F]fluorodeoxyglucose‐positron emission tomography‐CT), as well as how renal vein sampling (RVC) may contribute to localisation of the tumour. [ABSTRACT FROM AUTHOR]

Introduction Varicocele, which is defined as varicose veins in the scrotum, is associated with different complications, in particular infertility. However, the definite etiologies have not determined yet. Our objective was to investigate the association between left lumbar, renal, and gonadal veins diameters and varicocele occurrence and grading in kidney donors underwent left-sided nephrectomy. Also, the frequency of varicocele were evaluated three months after the surgery. Methods In this observational study, male kidney donors aged 18 to 65, who underwent open nephrectomy were included between 2022 and 2023. Baseline data on age, body mass index (BMI), and the presence or grade of varicocele were collected through medical records and physical examinations. During the procedure, the diameter of the left lumbar, renal, and gonadal veins was measured using a graded ruler on the back Table. Three months after the nephrectomy, the patients were re-evaluated for varicocele recurrence. Results We included 30 kidney donor with a mean age of 38.2 years and BMI of 23.5 kg/m2. The renal vein diameter decreased with higher grading (P-Value=0.05) and the gonadal vein diameter increased with higher grading (P-Value=0.04). However, there was no significant association between varicocele grading and left lumbar vein diameter. Following three months of nephrectomy, the frequency of varicocele increased from 33.4% to 50.0%. Conclusions The diameter of the left lumbar vein was almost unchanged in varicocele, while the size of the left renal vein decreased, and the size of the left gonadal vein increased. Furthermore, occurrence of varicocele increased after three months of left-sided nephrectomy. Therefore, people undergoing nephrectomy are at a higher risk of developing varicocele which should be considered in follow-up visits. [ABSTRACT FROM AUTHOR]

Renal and genitourinary ultrasound are fundamental resources employed by emergency and critical care healthcare providers to make prompt diagnoses and perform ultrasound-guided procedures. At the bedside, ultrasound can aid in the diagnosis of relevant pathologies, such as post-renal obstruction or kidney stones, and life-threatening conditions such as aortic dissection or hemoperitoneum. A narrative overview was performed, providing an updated review of renal and genitourinary ultrasound for emergency and critical care healthcare providers, emphasizing its advantages and the latest advances in the field. A thorough summary that can be utilized as a guide for emergency and critical care healthcare providers is presented. The daily hemodynamic management of critically ill patients involves the implementation of new protocols, such as VexUS or the evaluation of the renal resistance index. The role of ultrasound in managing acute nephropathy and genitourinary issues is increasingly crucial given its bedside availability, thus this imaging modality not only facilitates the initiation of therapeutic interventions but also provides swift prognostic insights that are vital to provide tailored patient care. As further advances in ultrasound will arise, it is important for healthcare providers to foster the use of these technologies capable of improving patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Mesopancreas resection is a crucial but difficult procedure when performing pancreaticoduodenectomy. This study evaluated the influence of mesopancreas thickness on surgical outcomes in patients undergoing pancreaticoduodenectomy. Methods: We measured the thickness of the fat tissue on the right side of the superior mesenteric artery from the dorsal margin of the confluence of the superior mesenteric vein and portal vein to the ventral margin of the left renal vein on preoperative contrast-enhanced computed tomography and defined it as the mesopancreas thickness. We evaluated the correlation between mesopancreas thickness and intraoperative and postoperative variables in 357 patients who underwent pancreaticoduodenectomy. Results: Multivariate analysis revealed that a thick mesopancreas was significantly associated with a long operative time (β = 10.361; 95% confidence interval, 0.370–20.353, p = 0.042), high estimated blood loss (β = 36.038; 95% confidence interval, -27.192–99.268, p = 0.013), and a low number of resected lymph nodes (β = -1.551; 95% confidence interval, -2.662–-0.439, p = 0.006). This analysis further revealed that thick mesopancreas was a significant risk factor for overall morbidity (odds ratio 2.170; 95% confidence interval 1.340–3.520, p = 0.002), major morbidity (odds ratio 2.430; 95% confidence interval 1.360–4.340, p = 0.003), and a longer hospital stay (β = 2.386; 95% confidence interval 0.299–4.474, p = 0.025). Conclusion: A thick mesopancreas could predict a longer operation time, higher estimated blood loss, fewer resected lymph nodes, more frequent overall and major morbidities, and a longer hospital stay in patients who underwent pancreaticoduodenectomy more precisely than the body mass index. [ABSTRACT FROM AUTHOR]

Renal vein thrombosis (RVT) is a relatively uncommon condition that is most frequently observed in individuals with nephrotic syndrome. While rare, pyelonephritis (PN) may serve as a predisposing factor for secondary RVT. In such cases, one should consider the possibility of RVT when patients fail to respond to appropriate antibiotic treatment. Typically, these patients require additional anticoagulation therapy for a duration of 3 to 6 months, with a generally favorable prognosis. In this report, we present the case of a 74-year-old female who developed RVT due to Klebsiella pneumoniae PN. Additionally, we reviewed 11 cases of PN complicated by RVT, which were documented in the PubMed database over a span of 40 years, emphasizing key elements in diagnostic and therapeutic approaches. Lastly, we elaborated upon the role of thrombo-inflammation, especially in the context of sepsis. [ABSTRACT FROM AUTHOR]

Albeit rare, renal vein abnormalities on autopsy and in cases of abdominal surgery complications have been reported and should be kept in mind when performing invasive procedures, such as renal biopsy. We detected a rare renal vein abnormality on colour Doppler ultrasound before renal biopsy, thereby, avoiding a haemorrhagic complication. A 10‐year‐old boy presented to our department for the first time because of incidental findings of haematuria and proteinuria. We suspected chronic glomerulonephritis and scheduled an ultrasound‐guided percutaneous renal biopsy. A simple screening ultrasound at the initial visit revealed no renal or vascular abnormalities. The day before the renal biopsy, we confirmed the biopsy site by performing a colour Doppler ultrasound, which showed abnormal blood flow from the lower pole of the left kidney, which was the planned puncture site; therefore, we changed the biopsy site to the right and completed the examination. Subsequent computed tomography angiography depicted two renal veins; one was the usual left renal vein draining from the kidney hilum, and the second was an accessory vein draining from the inferior pole of the left kidney and entering the inferior vena cava through the dorsal side of the aorta. Although rare, abnormalities in the renal vessels on the inferior pole of the kidney, which is the usual site of renal biopsy, are essential to rule out preoperatively by colour Doppler ultrasound, because these can cause significant bleeding during renal biopsy if not recognized. [ABSTRACT FROM AUTHOR]

Background: Malignant kidney tumors are not uncommon worldwide. They are heterogeneous but have unified pathological prognostic features. Objectives: we focused on studying renal tumor in our centre, a large tertiary centre in the western region of Saudi Arabia, addressing gross and microscopic features of prognostic significance. Methodology: Nephrectomies due to renal parenchymal neoplasm from July 2010 to June 2020 in King Abdulaziz University Hospital were studied. Patients' demographic and radiology data were extracted from the Hospital data system. Pathological features were reviewed by combining the radiology, gross and microscopic features and applying the recent diagnostic, grading, and staging guidelines. Results: 146 out of 154 renal neoplasms were malignant. The patient's average age was 53 years. 62% of the patients were male. Clear cell renal cell carcinoma is the most common subtype (66%), followed by papillary and chromophobe renal cell carcinoma. 59% of the tumors have low nuclear ISUP grade. 55% of tumors were pT1 stage. Two cases were up-staged according to the updated guidelines for renal vein invasion. A shift toward partial nephrectomy is observed in the second five years. Conclusion: The patients' demographics and pathological tumor features are similar to the results of regional studies in our country and the Middle East. The updated staging guidelines modified the stage of two tumors. Lacking information such as tumor laterality may impact the patients' follow-up. A shift toward partial nephrectomy reflects early-stage tumor detection and advanced radiology modalities and will improve the patient's outcome and save the residual kidney function. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Because of the complex embryonic origin of the abdominal venous structures, IVC and azygous systems can show numerous and even previously unreported anatomical variations and anomalies. Also, evaluating major vascular structures should not be dismissed in non‐contrast‐enhanced CT as it can provide valuable information about these structures. Double IVC is a rare occurrence of IVC anatomical variations and congenital anomalies. Herein, we discuss a case of a very rare type of double IVC that has not been reported in the literature before. A non‐contrast‐enhanced CT study was performed for a 34‐year‐old patient who visited our ER to evaluate for urolithiasis, during which two IVCs were noted. Each renal vein joined the ipsilateral IVC at a perpendicular angle. Unusually, the right IVC was formed from the confluence of both left and right common iliac veins (CIV), and the left IVC—Instead of crossing the midline at the renal veins level and reuniting the right IVC—cranially contributed to the azygos vein formation and caudally joined the left CIV. Also, there were some small communicating veins between the two IVCs and the left gonadal vein was slightly dilated before suggesting a reflux from the left renal vein (LRV). A complimentary doppler ultrasound exam confirmed the diagnosis and revealed a left‐side varicocele. Although rare cases of hemiazygos continuation and interiliac connections of left‐side IVC in the cases of double‐IVC have been reported previously, a complete confluence of CIVs is rare. The main differential diagnosis is retro‐aortic left renal vein (RLRV) type IV which seems to have an oblique course. Radiologists and surgeons should expect previously unreported variations in the vena cava system. Furthermore, reviewing the main abdominal vasculature should not be dismissed in non‐contrast CT exams. [ABSTRACT FROM AUTHOR]

Acute and chronic sodium–glucose cotransporter 2 (SGLT-2) inhibition increases endogenous glucose production (EGP). However, the organ—liver versus kidney—responsible for the increase in EGP has not been identified. In this study, 20 subjects with type 2 diabetes (T2D) and 12 subjects with normal glucose tolerance (NGT) received [3-3H]glucose infusion (to measure total EGP) combined with arterial and renal vein catheterization and para -aminohippuric acid infusion for determination of renal blood flow. Total EGP, net renal arteriovenous balance, and renal glucose production were measured before and 4 h after dapagliflozin (DAPA) and placebo administration. Following DAPA, EGP increased in both T2D and NGT from baseline to 240 min, while there was a significant time-related decrease after placebo in T2D. Renal glucose production at baseline was <5% of basal EGP in both groups and did not change significantly following DAPA in NGT or T2D. Renal glucose uptake (sum of tissue glucose uptake plus glucosuria) increased in both T2D and NGT following DAPA (P < 0.05 vs. placebo). The increase in renal glucose uptake was entirely explained by the increase in glucosuria. A single dose of DAPA significantly increased EGP, which primarily is explained by an increase in hepatic glucose production, establishing the existence of a novel renal-hepatic axis. Article Highlights: Sodium–glucose cotransporter 2 (SGLT2) inhibitors increase endogenous glucose production (EGP) but the organ—liver versus kidney—responsible for the increase in EGP is unknown. Total EGP ([3-3H]glucose), net renal arteriovenous balance (renal vein catheterization), and renal glucose production were measured in 20 subjects with type 2 diabetes (T2D) and 12 subjects with normal glucose tolerance (NGT) before and 4 h after dapagliflozin and placebo administration. Dapagliflozin increased EGP in both T2D and NGT subjects. All of the increase in EGP was derived from an increase in hepatic glucose output. These results establish the existence of a novel renal-hepatic axis. [ABSTRACT FROM AUTHOR]

This article presents a case study on non-islet cell tumor induced hypoglycemia (NICTH), a rare condition associated with mesenchymal tumors. The study focuses on a patient with metastatic solitary fibrous tumors (SFT) and severe hypoglycemic symptoms. The researchers measured levels of insulin-like growth factor (IGF)-II and IIE(68-88) peptide in various sampling sites, including the hepatic vein draining the largest SFT metastasis. They also measured these substances in peripheral venous blood samples taken at different timepoints after tumor resection to determine their half-life and correlate the levels with tumor size and clinical parameters. The findings provide insight into the contribution of liver metastases to hormone production and highlight the importance of site-specific sampling in understanding the metabolism of tumor cells. However, the study suggests that site-specific sampling may have limited value in identifying the dominant hormone-producing site in patients with SFT. [Extracted from the article]

Simultaneous liver–kidney transplantation is indicated for patients with concomitant end-stage liver disease and end-stage renal disease. The traditional technique involves separate implantations of the liver and the kidney. In the en bloc approach, the liver is recovered en bloc with the right kidney and the donor renal artery is anastomosed to the donor splenic artery. We aimed to compare the outcomes of the traditional and en bloc techniques for simultaneous liver–kidney transplantation in a single center. This single-center retrospective study involved all adult patients who underwent simultaneous liver–kidney transplantation from brain-dead donors from January 2017 to December 2022. A total of 15 patients were included: 10 transplanted with the traditional technique and 5 with the en bloc approach. Patients in the en bloc group presented higher body mass index, shorter kidney cold and total ischemia times, shorter overall surgical time and longer kidney warm ischemia time (29.07 kg/m2vs 23.20 kg/m2 [ P =.048]; 560 minutes vs 880 minutes [ P =.026]; 615 minutes vs 908 minutes [ P = 0.025]; 405 minutes vs 485 minutes [ P =.046]; 46 minutes vs 33.5 minutes [ P = 0.027], respectively). Ureteroneocystostomy was performed in 2 patients of the en bloc group and ureteroureterostomy in the remaining 3 patients. One patient in the en bloc group presented stenosis of renal artery anastomosis and underwent percutaneous angioplasty. This same patient eventually developed late urinary fistula. In the traditional technique group, there were 2 cases of renal vein thrombosis and 1 of ureteral stenosis. Compared with the traditional technique, the en bloc approach is feasible and safe, reducing kidney total ischemia time and overall surgical time. [ABSTRACT FROM AUTHOR]

Purpose: Accurately predicting new baseline glomerular filtration rate (NBGFR) after radical nephrectomy (RN) can improve counseling about RN vs partial nephrectomy. Split renal function (SRF)--based models are optimal, and differential parenchymal volume analysis (PVA) is more accurate than nuclear renal scans (NRS) for this purpose. However, there are minimal data regarding the limitations of PVA. Our objective was to identify patient-/tumor-related factors associated with PVA inaccuracy. Materials and Methods: Five hundred and ninety-eight RN patients (2006-2021) with preoperative CT/MRI were retrospectively analyzed, with 235 also having NRS. Our SRF-based model to predict NBGFR was: 1.25 x (GlobalGFRPre-RN x SRFContralateral), where GFR indicates glomerular filtration rate, with SRF determined by PVA or NRS, and with 1.25 representing the median renal functional compensation in adults. Accuracy of predicted NBGFR within 15% of observed was evaluated in various patient/tumor cohorts using multivariable logistic regression analysis. Results: PVA and NRS accuracy were 73%/52% overall, and 71%/52% in patients with both studies (n [ 235, P < .001), respectively. PVA inaccuracy independently associated with pyelonephritis, hydronephrosis, renal vein thrombosis, and infiltrative features (all P < .03). Ipsilateral hydronephrosis and renal vein thrombosis associated with PVA underprediction, while contralateral hydronephrosis and increased age associated with PVA overprediction (all P < .01). NRS inaccuracy was more common and did not associate with any of these conditions. Even among cohorts where PVA inaccuracy was observed (22% of our patients), there was no significant difference in the accuracies of NRS- and PVAbased predictions. Conclusions: PVA was more accurate for predicting NBGFR after RN than NRS. Inaccuracy of PVA correlated with factors that distort the parenchymal volume/function relationship or alter renal functional compensation. NRS inaccuracy was more common and unpredictable, likely reflecting the inherent inaccuracy of NRS. Awareness of cohorts where PVA is less accurate can help guide clinical decision-making. [ABSTRACT FROM AUTHOR]

This article discusses the case of a 26-year-old female with abdominal pain, hypertension, and acute catecholamine cardiomyopathy caused by a large phaeochromocytoma in the left adrenal gland. The patient also had undiagnosed multiple endocrine neoplasia (MEN) 2A syndrome. The patient underwent angioembolization to manage the haemorrhagic phaeochromocytoma and received alpha- and beta-blockade treatment. After the resolution of cardiomyopathy, the tumour was surgically removed. The article emphasizes the importance of patience and multidisciplinary management in the acute management of phaeochromocytoma. [Extracted from the article]

Purpose: To estimate the incidences of left renal vein (LRV) entrapment by right renal artery (RRA), a phenomenon primarily reported as case reports. Methods: The cross-sectional study consecutively screened renal vessel CT data of 38 (Renal) patients with nephropathy and 305 (Non-renal) patients with peripheral arterial diseases in a teaching hospital in northeast China between November 2018 and March 2023. The LRV compression by adjacent anatomical structures, including but not limited to RRA and multiple compression-related parameters, were investigated through multiplanar analysis of the CT data. Results: The overall LRV entrapment rates by adjacent structures were 41.93% (12/31) and 24.00% (6/25), the rates of RRA-sourced LRV compression 22.58% (7/31) and 20.00% (5/25), and the rates of compression by superior mesenteric artery (SMA) 16.13% (5/31) and 4.00% (1/25) in the Renal and Non-renal groups, respectively, with no significance. The venous segments distal to the RRA-compressed site had a significantly larger transectional lumen area than those of the non-compressed veins in both groups (3.09 ± 1.29 vs. 1.82 ± 0.23, p < 0.001 and 4.30 ± 2.65 vs. 2.12 ± 0.55, p = 0.006; maximum-to-minimum area ratios in Renal and Non-renal groups, respectively). Nearly 80% of RRAs were found arising anteriorly rightwards instead of passing straight to the right. Conclusion: RRA-sourced LRV compression was not rare, and its incidence was higher than that of the compression by SMA in both patient cohorts. RRA could be a more common compression source than SMA concerning LRV entrapment. Further investigations involving different populations, including healthy individuals, are needed. [ABSTRACT FROM AUTHOR]

• Asymptomatic May-Thurner syndrome, in the case of coincidence of other risk factors, can result in graft failure. • Renal vein and iliac thromboses can be the first clinical signs of May-Thurner syndrome. • May-Thurner syndrome should be considered in all patients presenting with a left lower extremity deep vein thrombosis, especially when risk factors of venous thromboembolism are present. May-Thurner syndrome (MTS) is an extrinsic venous compression by the arterial system against bony structures in the iliocaval territory. The most common variant of MTS is due to compression of the left iliac vein between the overlying right common iliac artery and the fifth lumbar vertebrae. The prevalence of MTS is unknown; therefore, there are only a few publications about MTS in kidney transplant recipients. Risk factors that may progress from usually asymptomatic to symptomatic MTS are female sex, scoliosis, dehydration, coagulation disorders, and radiation. Clinical presentations include acute extremity pain and swelling, venous claudication, and chronic signs of venous insufficiency. We describe a 63-year-old man who underwent kidney transplantation (left iliac fossa). Four days after transplantation, a graftectomy was done due to graft rupture caused by renal vein thrombosis. After imaging studies, a diagnosis of MTS was established. The patient had no typical symptoms of MTS. However, an incidence of right lower limb thrombosis was observed, and due to vertebral discopathy, the patient underwent surgery with implantation of a vertebral implant. After a successful second transplantation on the right side, incidents of thrombosis were observed: superficial thrombosis of the upper limbs and massive deep vein thrombosis of the right lower limb. Thrombophilia was recognized, the graft function is stable, and anticoagulation therapy is being continued. Asymptomatic MTS in the case of coincidence of other risk factors, such as coagulation disorders, history of vertebral operation, and additional pressure of the graft, can result in graft failure. [ABSTRACT FROM AUTHOR]

Purpose: Renal metabolic rate of oxygen (rMRO2) is a potentially important biomarker of kidney function. The key parameters for rMRO2 quantification include blood flow rate (BFR) and venous oxygen saturation (SvO2) in a draining vessel. Previous approaches to quantify renal metabolism have focused on the single organ. Here, both kidneys are considered as one unit to quantify bilateral rMRO2. A pulse sequence to facilitate bilateral rMRO2 quantification is introduced. Methods: To quantify bilateral rMRO2, measurements of BFR and SvO2 are made along the inferior vena cava (IVC) at suprarenal and infrarenal locations. From the continuity equation, these four parameters can be related to derive an expression for bilateral rMRO2. The recently reported K‐MOTIVE pulse sequence was implemented at four locations: left kidney, right kidney, suprarenal IVC, and infrarenal IVC. A dual‐band variant of K‐MOTIVE (db‐K‐MOTIVE) was developed by incorporating simultaneous‐multi‐slice imaging principles. The sequence simultaneously measures BFR and SvO2 at suprarenal and infrarenal locations in a single pass of 21 s, yielding bilateral rMRO2. Results: SvO2 and BFR are higher in suprarenal versus infrarenal IVC, and the renal veins are highly oxygenated (SvO2 >90%). Bilateral rMRO2 quantified in 10 healthy subjects (8 M, 30 ± 8 y) was found to be 291 ± 247 and 349 ± 300 (μmolO2/min)/100 g, derived from K‐MOTIVE and db‐K‐MOTIVE, respectively. In comparison, total rMRO2 from combining left and right was 329 ± 273 (μmolO2/min)/100 g. Conclusion: The present work demonstrates that bilateral rMRO2 quantification is feasible with fair reproducibility and physiological plausibility. The indirect method is a promising approach to compute bilateral rMRO2 when individual rMRO2 quantification is difficult. [ABSTRACT FROM AUTHOR]

Renal lymphangiectasia (RL) is a rare condition in which lymphatic vessels are dilated giving rise to cyst formation in peripelvic, perirenal and intrarenal locations. Knowledge about RL is limited and based upon individual case reports. This can be genetic or acquired. There is no significant association with any gender or age. It can be manifested as focal or diffuse forms and can be unilateral or bilateral. Most of the cases present with abdominal or flank pain. The diagnosis is based on radiological imaging. Due to rarity of diseases, it has potential to be misdiagnosed as other cystic disease of kidneys. The treatment is mainly conservative but prolonged follow up for associated complications like hypertension and renal vein thrombosis is required. We have presented a case of bilateral renal lymphangiectasia with the review of available literature. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course Background: Duplicate inferior vena cava (IVC) accompanied by deep venous thrombosis is rare. The optimal treatment plan is determined according to the results of imaging, including venography. In this report, we present a case of successful treatment of a patient with duplicate IVC and deep venous thrombosis (DVT). Case Report: An 84-year-old man with history of hypertension was admitted to the hospital because of 4 days of moderate left lower-limb edema. A thorough examination led to the diagnosis of the DVT. The duplicate IVC was discovered during venography. As the blood from the left common iliac vein mainly flowed to the left IVC, and there were no other communicating branches before the convergence of the left and right IVCs, which was located above the 1st lumbar vertebrae body near the junction of the hepatic vein and the IVC, the strategy of placing only 1 filter in the left inferior vena cava were chosen, rather than placing 1 filter above the confluence of bilateral IVC, or placing a filter in each IVC below the level of renal veins on each side. Following that, the DVT was safely treated with thrombolysis and aspiration without the risk of pulmonary embolism. Conclusions: This case report presented the complete evaluation and management of a patient with lower-limb DVT accompanied by the malformation of duplicate IVC. The filter placement strategy with duplicate IVC in the literature was summarized. We concluded that even in emergency situations, with comprehensive consideration, it is possible to perform endovascular intervention successfully and achieve satisfactory treatment results. [ABSTRACT FROM AUTHOR]

Introduction: Nutcracker phenomenon is the compression of the left renal vein between the superior mesenteric artery (SMA) and the abdominal aorta. Nutcracker syndrome refers to the presence of nutcracker phenomenon with symptoms. Between 2016 and 2022, we performed 18 robot-assisted laparoscopic extravascular renal vein stent (RALERVS) placements. We sought to assess patient-reported outcomes of RALERVS placement by a single institution. Methods: We performed a single-center retrospective review of 18 patients with a minimum of 3 months follow-up. Symptoms were assessed utilizing a questionnaire conducted with a 5-point Likert scale at a minimum of 3 months postoperatively. Five on the Likert scale was severe while 1 was none. Primary study outcomes compared pre- and postoperative patient-reported symptom scores. Results: Twelve out of 18 patients responded to the survey. The average length of time from date of operation to completion of survey was 2.6 years. Average age of the cohort was 36 years with a mean BMI of 19.4 kg/m2. There was only one man. Mean operative time was 137 minutes and mean estimated blood loss was 12 mL. Mean preoperative SMA angle was 19° and mean postoperative SMA angle was 36°. Patients reported that flank pain, abdominal pain, nausea, headaches, back pain, pelvic pain, and early satiety improved (p < 0.05). Ten of 12 respondents would recommend RALERVS for nutcracker syndrome. Conclusion: RALERVS demonstrates an effective treatment for nutcracker syndrome. Patients reported improved symptoms at 3 months postoperatively across multiple domains. Further studies need to be conducted to assess long-term durability of the extravascular renal vein graft. [ABSTRACT FROM AUTHOR]

Purpose: Our aim was to study the anatomy of the left and right main adrenal veins (LAV and RAV) and to identify their anatomical variations in order to see the practical application of these findings to adrenal venous sampling (AVS). Methods: Our work is based on dissection of 80 adrenal glands from fresh corpses in the forensic medicine department. We studied the number, the drainage, the direction and the level of termination of the main adrenal veins. Results: The average length of the LAV was 21 mm. It ended in 100% of cases at the upper edge of the left renal vein with a mean connection angle of 70° and after an anastomosis with the lower phrenic vein in 36 cases(90%). The average length of the RAV was 9 mm. It ended in 100% of cases at the level of the retro hepatic inferior vena cava (IVC) mainly on its posterior face in 21 cases (53%) and on its right lateral border in 18 cases (45%). The mean angle of the RAV in relation to the vertical axis of the IVC was 40°, with extremes ranging from 15° to 90°. Conclusions: AVS seems to be easier on the left than on the right side because of the greater length of the adrenal vein (21 mm vs. 9 mm) and a greater angle of connection (70° with the left renal vein vs. 40° with the IVC), which explains the lower success rate of cannulation and the more frequent occurrence of blood sample contamination on the right side. [ABSTRACT FROM AUTHOR]

Purpose: In the modern era of robotic renal procedures and diagnostics, an even more detailed anatomical understanding than hitherto is necessary. Valves of the renal veins (RVV) have been underemphasized and have been disputed by some authors, and few textbooks describe them. The current anatomical study was performed to address such shortcomings in the literature. Methods: One hundred renal veins were studied in fifty adult formalin-fixed cadavers. Renal veins were removed from the abdomen after sectioning them flush with their entrance to the renal hilum. The inferior vena cava was then incised longitudinally and opened, and RVV were examined grossly and histologically. A classification scheme was developed and applied to our findings. Results: Nineteen RVVs were observed in the fifty cadavers (38%). Four (8%) valves were found on right sides and fifteen (30%) on left sides. The valves were seen as cord/band-like, folds, and single and double leaflets. Histologically, they were all extensions of the tunica intima. Conclusion: On the basis of our study, RVV are not uncommon. They were more common on left sides, and on both sides, they were found within approximately one centimeter of the junction of the inferior vena cava and renal vein. Although the function of such valves cannot be inferred from this anatomical study, the structures of the Single leaflet valve (TS2) and Double leaflet valve (TS3) valves suggest they could prevent venous reflux from the IVC into the kidney. [ABSTRACT FROM AUTHOR]

Aim: In two recent studies, we observed that a 30‐min renal vein clamping caused formation of interstitial haemorrhagic congestion in ischaemic and ischaemic/reperfused kidney along with the development of severer acute kidney injury (AKI) than renal artery or pedicle clamping. It was suggested that the transmission of high arterial pressure into renal microvessels during vein occlusion probably causes the occurrence of interstitial haemorrhagic congestion that augments AKI. The present investigation aimed to evaluate this suggestion by reducing renal perfusion pressure (RPP) during renal venous occlusion. Methods: Anaesthetized male Sprague–Dawley rats were divided into three groups (n = 8), which underwent a 2‐h reperfusion period following 30‐min bilateral renal venous clamping along with reduced RPP (VIR‐rRPP group) or without reduced RPP (VIR group) and an equivalent period after sham‐operation (Sham group). Results: The VIR‐rRPP group compared with VIR group had lower levels of kidney malondialdehyde and tissue damages as epithelial injuries of proximal tubule and thick ascending limb, vascular congestion, intratubular cast and oedema, along with the less reductions in renal blood flow, creatinine clearance, Na+‐reabsorption, K+ and urea excretion, urine osmolality and free‐water reabsorption. Importantly, the formation of intensive interstitial haemorrhagic congestion in the VIR group was not observed in the VIR‐rRPP group. Conclusion: These results indicate that the transmission of high arterial pressure into renal microvessels during venous occlusion leads to rupturing of their walls and the formation of interstitial haemorrhagic congestion, which has an augmenting impact on ischaemia/reperfusion‐induced renal structural damages and haemodynamic, excretory and urine‐concentrating dysfunctions. Summary at a glance: This experimental study investigated the effects of renal perfusion pressure reduction during venous clamping in ischaemia/reperfusion‐induced acute kidney injury. The results indicated that the transmission of high arterial pressure into microvessels during renal venous occlusion leads to formation of interstitial haemorrhagic congestion that augments ischaemia/reperfusion‐induced renal structural and functional disorders. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to evaluate the outcomes of live‑donor renal allografts with multiple and single renal arteries taking into consideration ischemia times, graft function, and other complications including vascular and urological. Materials and Methods: We conducted a retrospective study by analyzing a prospectively maintained database from January 2021 to December 2021 of all patients undergoing live‑related renal allograft transplants at a tertiary care center in North India. A total of 239 live donor kidney transplants were performed during this period. Patients were divided into two groups – Group 1: Single artery single anastomosis and Group 2: Multiple arteries with two or more anastomoses. Duplex imaging of the graft was done at 6 months. Recipients were followed up for possible graft dysfunction, arterial insufficiency, and major urological complications. Results: Mean ischemia times in the two groups were 20.62 ± 1.05 and 30.45 ± 1.77 min, respectively. Failure to normalize creatinine (<1.2 mg/dl) within 72 h was seen in 6/183 and 3/56 (P > 0.05). Slow graft function was encountered in 6 cases in Group 1 and 3 cases in Group 2. Delayed graft function occurred in two patients in both groups. One‑year graft survival among the groups was 5/183 and 2/56, respectively (P > 0.05). One patient from Group 1 developed transplant renal artery stenosis. Six patients from Group 1 developed ureteric complications. Conclusion: Donor grafts with multiple renal arteries may be accepted safely with careful surgical reconstruction and close surveillance posttransplant. [ABSTRACT FROM AUTHOR]

Background: In liver transplant patients with hypoplastic portal vein (PV), when the narrowed segment is extended too deep into the dorsal side of the pancreas, it is difficult and dangerous to reconstruct the interposition graft from the upper part of the pancreas. Herein, we present a case of PV reconstruction with the autologous mesosystemic shunt vessel from the caudal side of the pancreas in a situation where the narrowed PV was deep, and we discuss the technical details. Case presentation: A 25-year-old woman presented with cholestatic liver cirrhosis due to biliary atresia after Kasai procedure. Since her jaundice progressed, she was referred to our hospital for liver transplantation. Laboratory tests showed that her total bilirubin was elevated to 7.6 mg/dL. The Model for End-Stage Liver Disease score was 18, and the Child–Pugh score was 9 (Grade B). She underwent living donor liver transplantation (LDLT) using a right hemi-liver graft procured from her 54-year-old mother. The conventional approach from the cephalad side to the superior mesenteric vein (SMV) and splenic vein (SpV) confluence behind the pancreas was extremely difficult in this case because the confluence of SMV and SpV was close to the lower edge of the pancreas. Therefore, we decided to perform PV reconstruction from the caudal side. The main trunk of PV was documented as narrow (5 mm in diameter), for which retro-pancreatic pull-through PV reconstruction was successfully performed using her own mesosystemic shunt vessel. A contrast computed tomography (CT) scan was performed on postoperative day 5 because of an elevation of D-dimer and found a partial thrombus in the left pulmonary artery, as well as in the PV and left renal vein. Thereafter, thrombolytic therapy with low-molecular-weight heparin was started immediately and switched to a direct oral anticoagulant. The follow-up CT taken 3 months after liver transplantation revealed a patent PV without thrombus; therefore, anticoagulant therapy was discontinued. Currently, the patient has been well and active with a patent PV without anticoagulant therapy for 3 years after LDLT. Conclusions: Retro-pancreatic pull-through reconstruction of the hypoplastic PV is a feasible and effective method when conventional reconstruction is not indicated. [ABSTRACT FROM AUTHOR]

Renal cell carcinoma (RCC) represents 2% of all diagnosed malignancies worldwide, with disease recurrence affecting 20% to 40% of patients. Existing prognostic recurrence models based on clinicopathological features continue to be a subject of controversy. In this meta‐analysis, we summarized research findings that explored the correlation between clinicopathological characteristics and post‐surgery survival outcomes in non‐metastatic RCC patients. Our analysis incorporates 99 publications spanning 140 568 patients. The study's main findings indicate that the following clinicopathological characteristics were associated with unfavorable survival outcomes: T stage, tumor grade, tumor size, lymph node involvement, tumor necrosis, sarcomatoid features, positive surgical margins (PSM), lymphovascular invasion (LVI), early recurrence, constitutional symptoms, poor performance status (PS), low hemoglobin level, high body‐mass index (BMI), diabetes mellitus (DM) and hypertension. All of which emerged as predictors for poor recurrence‐free survival (RFS) and cancer‐specific survival. Clear cell (CC) subtype, urinary collecting system invasion (UCSI), capsular penetration, perinephric fat invasion, renal vein invasion (RVI) and increased C‐reactive protein (CRP) were all associated with poor RFS. In contrast, age, sex, tumor laterality, nephrectomy type and approach had no impact on survival outcomes. As part of an additional analysis, we attempted to assess the association between these characteristics and late recurrences (relapses occurring more than 5 years after surgery). Nevertheless, we did not find any prediction capabilities for late disease recurrences among any of the features examined. Our findings highlight the prognostic significance of various clinicopathological characteristics potentially aiding in the identification of high‐risk RCC patients and enhancing the development of more precise prediction models. [ABSTRACT FROM AUTHOR]

Purpose: To compare the oncologic outcomes of prophylactic extended-field radiation therapy (EFRT) and whole pelvic radiation therapy (WPRT) in cervical patients at high risk of para-aortic lymph node (PALN) recurrence. Patients and Methods: From July 1999 to May 2022, a total of 115 patients with cervical cancer and high-risk features of PALN recurrence based on tumor markers, positive LNs and extensive parametrial invasion were retrospectively analyzed. All patients had received EFRT or WPRT at a dose of 39.6– 45 Gy and concurrent chemotherapy. In EFRT, coverage was extended to include the para-aortic region below the level of the left renal vein or T12. Results: Twenty-eight and 87 patients underwent EFRT and WPRT, respectively. For patients who survived, the median follow-up time was 60.8 months (range 9.2– 131.6 months) in the EFRT group and 115.9 months (range 16.9– 212.1 months) in the WPRT group. The 5-year overall survival (OS) and pelvic, extrapelvic and PALN recurrence rates were 87.7% vs 60.8% (p=0.019), 10.9% vs 25.3% (p=0.119), 18.1% vs 45.8% (p=0.011), and 0% vs 30.4% (p=0.005), respectively, between the EFRT and WPRT groups. Multivariate analysis revealed that EFRT and 2018 FIGO stage IV disease status were significant predictors of OS and extrapelvic recurrence. Conclusion: Compared to WPRT, EFRT significantly improved OS and reduced extrapelvic and PALN recurrence in patients with cervical cancer with high-risk recurrence features. [ABSTRACT FROM AUTHOR]

Objective: Nutcracker syndrome (NS) is defined by the compression of the left renal vein by the superior mesenteric artery. The incidence of NS and the exact treatment protocols are not well known. The objective of this study is to analyze children with NS and evaluate the prognosis in follow-up. Methods: All patients were referred to the pediatric nephrology clinic by pediatricians because of proteinuria. The study includes 74 patients (52 girls, 22 boys) with a mean age of 13.15±2.32 and records the presenting symptoms, degree of proteinuria, and radiologic findings. The diameter ratios of the left renal vein before and after stenosis and peak systolic velocity (PSV) ratios were calculated with a Doppler ultrasound, with a peak systolic ratio of 3.0:1 or greater was accepted as the diagnostic criterion for NS. Results: The mean age was 13.15±2.32 (5.33-17.42) years, while the mean follow-up duration was 14.6±9.1 months. Proteinuria was not correlated with the degree of compression. Most patients had a good prognosis, and none of them required medical or surgical treatment. A significant reduction or complete normalization of proteinuria was seen in more than half of the patients under conservative management. Conclusions: Based on our findings, NS seems to have a good prognosis in children who present with isolated proteinuria. [ABSTRACT FROM AUTHOR]

Caudal vena cava (CVC) may develop abnormally due to its complex embryogenesis. Understanding congenital variants such as duplication of CVC is essential for clinical interventions, especially performed by surgeons and radiologists. In this context, we summarize the imaging and clinical characteristics of CVC duplication and accompanying portosystemic shunt diagnosed in a six-month-old cat using computed tomography angiography. In our patient, the CVC branched into two vessels on either side of the abdominal aorta and merged into a single vessel at the level where the renal veins emerge. The duplication of the CVC, along with portosystemic shunts and ureter anomalies, can increase the risk of thromboembolism, especially in cats with heart disease. Due to the evolving nature of computed tomography technology in animals, the number of diagnoses made using this method is still relatively low. It is anticipated that the rate of CVC duplication in cats and dogs will increase as diagnoses become more frequent. [ABSTRACT FROM AUTHOR]

Background: Nutcracker syndrome (NCS) describes a set of symptoms and signs resulting from compression of the left renal vein (LRV). There is a lack of knowledge about its natural course, diagnosis, and management, especially in children. Herein, we present our single-center experience with a large number of patients who have long-term follow-up results. Methods: All patients with NCS diagnosed between January 2011 and March 2021 were included and their data were obtained retrospectively. Results: A total of 123 NCS patients (85 females) were included. The median age at the time of diagnosis was 12 (IQR 10–14) years, and BMI percentiles were below 5% in 38% of the cases. At the time of diagnosis, two-thirds of the patients were asymptomatic. The most common laboratory finding was nephritic proteinuria (98%), followed by microscopic hematuria (16%). Signs of LRV compression were significantly more evident in upright position Doppler ultrasonography (DUS) examination. All patients have been followed conservatively; hematuria and/or proteinuria resolved in 43 of the 108 patients (40%) within 35.8 ± 25.8 months of follow-up. Control DUS was performed in 52 patients after a mean period of 39.1 ± 21.3 months. The median peak velocity and diameter ratios of the LRV in the upright position were found to be decreased significantly when compared to the initial assessment (p < 0.05). Normal DUS findings were noted in 13 patients at the final evaluation. Conclusions: In unexplained proteinuria and/or hematuria, NCS should be considered, especially in asthenic adolescents. Our results support conservative management in children as the first-line treatment approach. [ABSTRACT FROM AUTHOR]

Embryological development of the vascular system consists of growth and regression of developing vessels, often resulting in numerous variations. This cadaveric case report describes an individual with a duplicated inferior vena cava accompanied by multiple left accessory renal veins and a superior mesenteric artery-derived left colic artery. These structures may present clinical concerns when physicians are unaware of their presence during even routine surgeries. The 74-year-old female donor was dissected as part of a medical gross anatomy elective course. Anatomy was photographed and measurements were taken. Dissection revealed a duplicated inferior vena cava with a confluence between the right and left inferior venae cavae, known as the preaortic trunk. The left gonadal vein drained directly into the left inferior vena cava, inferior to the vena cava's junction with the left renal vein. The multiple accessory left renal veins drained into the left inferior vena cava at the level of the primary left renal vein. All three anomalies examined in this donor have the potential to create complications during surgery. Promoting familiarity amongst physicians, particularly radiologists and surgeons, with vascular anomalies can aid in their ability to assess patients and provide better care. [ABSTRACT FROM AUTHOR]

The American Institute of Ultrasound in Medicine (AIUM) has revised their Practice Parameter for the Performance of Duplex Sonography of Native Renal Vessels. This document provides recommendations for the performance and recording of high-quality ultrasound examinations of the kidneys. It includes indications for renal duplex sonography, qualifications and responsibilities of personnel, request and specification for the examination, documentation requirements, equipment specifications, and guidelines for quality and safety. The parameter was developed in collaboration with other organizations and is intended to provide guidance to the medical ultrasound community. [Extracted from the article]

Embryological development of the vascular system consists of growth and regression of developing vessels, often resulting in numerous variations. This cadaveric case report describes an individual with a duplicated inferior vena cava accompanied by multiple left accessory renal veins and a superior mesenteric artery-derived left colic artery. These structures may present clinical concerns when physicians are unaware of their presence during even routine surgeries. The 74-year-old female donor was dissected as part of a medical gross anatomy elective course. Anatomy was photographed and measurements were taken. Dissection revealed a duplicated inferior vena cava with a confluence between the right and left inferior venae cavae, known as the preaortic trunk. The left gonadal vein drained directly into the left inferior vena cava, inferior to the vena cava’s junction with the left renal vein. The multiple accessory left renal veins drained into the left inferior vena cava at the level of the primary left renal vein. All three anomalies examined in this donor have the potential to create complications during surgery. Promoting familiarity amongst physicians, particularly radiologists and surgeons, with vascular anomalies can aid in their ability to assess patients and provide better care.