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Aim of the research. Тo evaluate the diagnostic efficacy of the contrast-enhanced ultrasound examination of kidneys in patients with type 2 diabetes mellitus with a dose of 0.5 ml of contrast agent administered.Materials and methods. We examined 12 patients with a verified diagnosis of type 2 diabetes. The age of the examined patients was 31–59 years, the mean age was 49 ± 1.3 years. All patients underwent complex diagnostics, including ultrasound examination of the kidneys in B-mode with further renal vessels color Doppler imaging to assess vessels hemodynamics. A contrast-enhanced ultrasound examination of the kidneys was carried out using Sonovue contrast agent at the doses of 2.5 ml (according to the European Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound) and 0.5 ml (an improved technique of contrast agent intravenous bolus administration).Results. The improved technique (0.5 ml of contrast agent intravenous bolus administration) in comparison with the European Recommendations technique (2.5 ml of contrast agent intravenous bolus administration) used in patients with type 2 diabetes showed no or minor differences in the qualitative and quantitative indicators of contrast-enhanced ultrasound examination which did not affect the interpretation of the results.Conclusion. The improved contrast-enhanced ultrasound examination technique using 0.5 ml of a contrast agent showed its possibilities in diagnosing diabetic nephropathy in patients with type 2 diabetes, and also revealed the potential of an economically beneficial distribution of a contrast agent without losing the quality and information content of the study.

The study was performed on a number of 48 plastic molds, obtained by injection of Technovit 7143. Technovite is a self-curing resin based on methyl methacrylate. Technovite no longer requires the use of dyes that can adversely affect the polymerization process and has a short polymerization time, making corrosion possible shortly after injection.

BACKGROUND Bleeding, injures to surrounding organs and pleura are serious complications of percutaneous nephrolithotripsy. The inefficiency of hemostatic therapy is an indication for superselective embolization of the renal vessels. This technique demonstrates the high efficiency in case of postoperative bleeding. AIM To develop a treatment algorithm and to evaluate an efficiency of superselective embolization of the renal vessels, based on the results of treatment of postoperative complications, which are associated with bleeding. MATERIALS AND METHODS A retrospective analysis of 1375 patients treated from January 2011 to December 2018 for large (over 1.5 cm) and staghorn renal stones was performed. A number of patients had various complications in the early postoperative period, which were graded according to the Clavien-Dindo classification, including bleeding due to intraoperative damage to renal vessels, which required additional interventions. The treatment strategy was based on the assessment of volume and severity of blood loss as well as the hemodynamic stability. RESULTS Based on the severity of bleeding and hemodynamic stability, the treatment algorithm was developed. The analysis of the results of superselective embolization of renal arteries demonstrates the high effectiveness of this technique in case of postoperative bleeding. CONCLUSION Superselective embolization is an effective method of hemostasis in case of postoperative bleeding. The proposed algorithm allows for early coordination of therapeutic measures depending on the severity of bleeding and the patients condition in order to evaluate the risk of continued bleeding and the determine the optimal treatment strategy.

Introduction: In kidney transplantation, total laparoscopic live donor nephrectomy (TLLDN) in the presence of multiple renal arteries (MRA) is technically challenging and has traditionally been associated with higher complication rates. We report our experience of using MRA grafts procured by TLLDN. Materials and Methods: Patients undergoing TLLDN at our center (2004–2014) was identified from a prospectively maintained database and divided into single renal arteries (SRA) or MRA groups. Recipient perioperative parameters, postoperative complications, and long-term graft survival were analyzed. Results: Of 465 patients, 106 had MRA and 359 had an SRA. There were six vascular complications in the SRA group and two in the MRA group (1.7% vs. 1.8%). There were eight ureteric complications requiring intervention in the SRA group compared to three in the MRA group (4% vs. 3%; P = 0.45). Acute rejection was observed in 12% of the SRA group compared to 9% in the MRA group (P = 0.23). One-, 5- and 10-year graft survivals were 98.2%, 91.3%, and 89.8% in the MRA group versus 98.0%, 90.4%, and 77.5% in the SRA group (log-rank P = 0.13). Conclusion: The use of MRA grafts procured by TLLDN has comparable complication rates to SRA grafts and should not preclude selection for renal transplantation.

Objective: The study was to investigate the feasibility and accuracy of assessment for living renal donors before transplantation by using 3.0 T non-contrast-enhanced magnetic resonance angiography (NCE-MRA). Methods: 30 renal donors were investigated and underwent computed tomography angiography (CTA) and 3.0 T NCE-MRA before nephrectomy. Two radiologists independently assessed arterial and venous anatomy and potential kidney lesions. The image quality score, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), diameters and lengths of renal arteries and veins were compared between CTA and NCE-MRA. Imaging findings were compared with the surgical results served as reference standard. Agreement was assessed using κ test. The Wilcoxon test and paired sample t test were used for statistically significant differences. Results: The results of image quality score for renal arteries and veins were highly consistent between the two radiologists in NCE-MRA (p < 0.001). There was no significant difference in the scores of renal arterial and venous branches between NCE-MRA and CTA (p > 0.05). The SNR and CNR of renal vessels were higher than CTA (p < 0.001). There were no statistically significant differences in the length of renal vessels measured by the two methods (p > 0.05), and the diameter was smaller than that of CTA (p < 0.05). The detection of normal renal arteries and early branches by both examination techniques was consistent with intraoperative findings. Both methods showed good consistency between the anatomical variation of renal vein and the intraoperative diagnosis (p < 0.001). Conclusion: 3.0 T NCE-MRA can be used for evaluation of main renal arteries and veins with high accuracy for anatomy and variation classification, and can be used for pre-operative vascular evaluation of living donor kidney transplantation. Advances in knowledge: 3.0 T NCE-MRA can be used for evaluation of main renal arteries and veins with high accuracy for anatomy and variation classification, and can be used for pre-operative vascular evaluation of living donor kidney transplantation.

INTRODUCTION AND OBJECTIVE:Diseases of the vascular system, such as renal artery stenosis, affect a large number of patients and have resulted in a clear clinical need for the development of functi...

Ureteropelvic junction obstruction results in functionally significant impairment of urinary transport from the renal pelvis to ureter, that may because of intrinsic or extrinsic causes. Abberent renal vessels is the most common cause of pelviureteric junction obstruction in children. Aberrant renal vessels one of the most important cause of ureteropelvic junction obstruction present in about 20-40% of individuals.

We review main issues of early diagnostics of kidney damage in patients with essential hypertension. The remodeling of renal vessels and the underlying mechanisms are discussed. The evidence-based data are reviewed to substantiate the use of laboratory methods for the kidney damage diagnostics (calculation of glomerular fltration rate and microalbuminuria). We discuss the role of Doppler methods in the assessment of intrarenal hemodynamics (the resistance index and blood flow acceleration time) for timely detection of changes in renal vessels and the choice of management strategy.

Introduction: Vascular anomalies related to the renal arteries are not uncommon. The literature indicates that multiple renal arteries are found in 9-76% of cadavers. Two groups of renal artery variations are considered, the early division (ED) and extra renal arteries (ERA). Surgeons operating on the kidney must be acquainted with normal and abnormal anatomy of the renal vessels to avoid inadvertent injury. Aim of this study was to establish the prevalence of cadaveric renal artery variations with the Objective to bring awareness to the surgeons and radiologists performing vascular surgeries and invasive procedures respectively. Materials and Methods: This is a descriptive observational study wherein dissected cadavers were observed for the presence of renal arterial variations. The study was conducted in the department of anatomy, SRTRGMC, Ambajogai, Maharashtra over a period of 2012-2017 and total of 30 cadavers that is total 60 kidneys were observed for the presence of various renal arterial variations during routine abdominal dissection conducted for medical undergraduates. Result: In this present study the incidence of various renal artery variations taken together amongst all cadaveric kidneys observed was 36.66%. Incidence of ERA was 20% and Incidence of ED was 16.66%. Keywords: Renal artery variations, Extra renal artery, Early division, Ladder pattern, Fork pattern.

Abnormalities of the renal vasculature can manifest clinically as renal ischemia, renal insufficiency, and secondary hypertension. It is crucial to inspect the renal vessels not only for intrinsic or direct causes of vascular disease, but also for the enhancement pattern of the renal parenchyma as a

Background: We compared outcomes of en bloc stapler ligation of the renal hilum with separate Hem-o-lok polymer clip ligation of the renal vessels during laparoscopic nephrectomy (LN). Materials and Methods: Clinical data of patients who underwent LN for renal surgery from January 2009 to December 2015 were collected. Operation time, estimated blood loss, device malfunction rate, open conversion rate, complications and arteriovenous fistula (AVF) formation were evaluated. Results: En bloc stapler ligation and separate clip ligation were performed in 64 and 66 patients, respectively. The mean operative time was 106.8 +/- 20.8 min (range: 70-165) in the en bloc stapler ligation group compared with 112.5 +/- 24.1 min (range: 70-180) in the separate clip ligation group (P = 0.147). The mean estimated blood loss was 141.4 +/- 124.1 ml (range: 25-600) in the en bloc stapler ligation group compared with 147.6 +/- 112.4 ml (range: 25-450) in the separate clip ligation group (P = 0.767). The open conversion was required in 7/64 (10.9%) and 2/66 (3.0%) patients in the en bloc stapler ligation and separate clip ligation groups, respectively (P = 0.093). Stapler device malfunction occurred in 6 patients (9.3%). There were no statistically significant differences in overall complications (P = 0.726), minor (Grade 1-2) complications (P = 0.698) and major (Grade 3-5) complications (P = 0.716). No patient was diagnosed with AVF formation during overall median 33-month (interquartile range: 30, range: 24-96) follow-up. Conclusions: En bloc stapler ligation of the renal hilum during nephrectomy is an effective and safe technique. Although there is no reported AVF formation with en bloc stapler ligation of the renal hilum, longer follow-up is necessary.

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness and intravitreal anti-vascular endothelial growth factor (VEGF) injection is becoming a first-line choice for treatment of ROP. However, there is a major concern that intravitreally injected anti-VEGF agents could escape from the eye into the systemic circulation and impair systemic development. Moreover, escaped anti-VEGF agents could have an effect on the retina of the fellow eye. In this study, we investigated the hematogenous effect of a single intravitreal anti-VEGF injection in a mouse model of ROP. Here, we showed that single intravitreal aflibercept injection to one eye can affect body weight gain, the fellow eye, and renal vessels, although no apparent effect was observed in brain vessels. Furthermore, this hematogenous effect was dose-dependent. Our results provide very important insights into the clinical use of anti-VEGF agents for ROP treatment.

Main Problem: Robotic-assisted techniques are common for living-donor nephrectomy. While robotic stapling offers increased surgeon control, there is limited comparative data versus laparoscopic linear stapler use for ligation of renal vessels. Methods: We retrospectively reviewed 32 consecutive robotic-assisted donor nephrectomies by a single surgeon for perioperative outcomes. Results: Patients in the robotic stapler (RS; N=20) and laparoscopic stapler (LS; N=12) groups were comparable in terms of age and BMI. Estimated blood loss (p = 0.62), warm ischemia time (p=0.50), and console time (p=0.56) were similar between the RS and LS groups. There were no stapler misfires or major intraoperative complications in either group and no cases required conversion to open. Conclusions: Robotic stapler use is safe and effective in robotic-assisted donor nephrectomy. Further research on prevalence of robotic stapler use is needed to quantity the associated complication rate.

Purpose Although transplanting two kidneys from a single donor to two recipients has some advantages, the right and left kidneys are not anatomically identical; thus, a surgical procedure considering the anatomical features of the donor kidneys is needed when transplanting them into the opposite renal fossae. Based on vast experience, the surgical details of pig orthotopic kidney transplantation from one donor to two recipients was reported. Methods When the right kidney was transplanted to the left renal fossa, the graft was inverted upside down, not backwards, thus ensuring that the anteroposterior relationship of the renal vessels was maintained and anatomically natural vascular anastomosis could be performed. Results Using this technique, we could have developed a pig experimental model that is safe and has a high success rate, even for researchers in the middle of their training. This technique of inverting the graft upside down was reported in human kidney transplantation to make vascular anastomosis easier. Conclusions In pig orthotopic kidney transplantation from one donor to two recipients, an anatomically natural vascular anastomosis could be performed via inverted grafting when the right kidney was transplanted into the left renal fossa.

INTRODUCTION AND OBJECTIVE:With the advent of minimally invasive surgery, ligation of major renal vessels during radical nephrectomy is accomplished using endovascular staples as opposed to sutures...

Introduction: The internal three-dimensional structure of organs and patterns of blood vessels is complex and it is often difficult for medical students to visualize and interpret them. The corrosion cast technique is used to study the vascular patterns in kidney as it is one of the powerful tools with anatomical accuracy and durability. Aim: Preparation of corrosion casts of kidney using CAB (cellulose acetyl butyrate) granules for greater understanding of the spatial relationship of renal vasculature Objectives To accelerate knowledge acquisition To determine student’s perception to the utility of corrosion casts of kidney in UG teaching Methodology: Corrosion cast technique involves injection of the cast material (CAB granules) dissolved in acetone into the renal vessels. Gradually, the volatile solvent evaporates and the solute solidifies inside the vessel forming solid permanent cast. The unwanted tissues are then washed away using corrosive agents like conc HCl resulting in three-dimensional representation of blood vessels. The UG students were divided in 2 groups randomly having 50 students each. Half of the total participants received teaching lessons through a lecture discussing renal blood supply using corrosion casts while the rest with 2D images. The other aspects of teaching session, including content, teaching slides were kept identical in both batches. Crossing over was done. Results & Conclusion: Post session questionnaires were applied to assess knowledge acquisition and learner satisfaction. Feedback was taken of student’s perception on the utility of corrosion casts as an effective teaching – learning method. Analysis of feedback was done. Corrosion casts enhance the student’s skills in spatial visualisation of complex vascular relationships. This can be used for other topics as well. Keywords: corrosion casts, kidney, feedback

A successful PNL is to make a precise puncture into the target calyx, avoid perirenal viscera and interlobar artery injury, and get into different calyxes to remove stones. Since all these procedures are not carried out openly, several potential injuries are hard to be avoided. Thus, the anatomy of kidney, perirenal viscera, renal collecting system, and renal vessels is significant in the guidance of PNL.

More than 90% of adrenal tumors are benign lesions and small in size. It has a complex anatomy due to the deep location and closely related to many important structures including liver, spleen, pancreas, inferior vena cava and renal vessels. Open adrenectomy requires 20–30 cm length skin incision to resect a 2–3 cm tumors. This is a complicated surgery with high risk of mortality when injury to major vessels and vital organs. Laparoscopic technology, has gained great popularity worldwide for its prominent minimally invasive advantages including less traumatic, quick recovery, minimal postoperative pain, shorter hospital stay and small scar. With the evidences from large number of clinical trials and multi-center comparative analysis, it has replaced the open surgery as the mainstream surgical approach in the era of minimally invasive surgery due to its safety and reliability.

Background and objectives This study is aimed to investigate the possibility of preoperative oral oil administration in displaying the chylous tubes and preventing chylous leakage in laparoscopic para-aortic lymphadenectomy. Materials and methods In this retrospective nonrandomized study, of the 30 patients with gynecological malignancies who had indications for laparoscopic para-aortic lymphadenectomy up to renal vessels, 15 were administered preoperative oral oil (oil a administration) (control group) at our hospital between September 2017 and June 2018. The chylous tube displaying rates, incidences of chylous leakage, and other perioperative data of the two groups were compared. Results Successful display of chylous tubes was observed in 93.3% (14/15) patients in the oil administration group. The chylous leakage was zero in the oil administration group, and 33.3% (5/15) in the control group. The postoperative drainage duration (4.1 ± 1.0 days vs 7.6 ± 1.4 days, P = 0.000), somatostatin application time (0 day vs 5.9 ± 0.8 days), and postoperative hospital stay (6.0 ± 2.3 days vs 9.1 ± 2.1 days, P = 0.001) were significantly shorter in the oil administration group. The total cost is lower in the oil administration group (4972.52 ± 80.54 dollars vs 6260.80 ± 484.47 dollars, P = 0.000). Conclusions Preoperative oil administration is a feasible and effective method to display the chylous tubes and to prevent the chylous leakage in para-aortic lymphadenectomy.

Purpose Horseshoe kidney is a rare congenital anomaly with potential clinical implications. The aim of this study was to determine the number of renal arteries and veins and the level at which the arteries branched off their parental vessels in individuals with horseshoe kidney (HSK) and in persons with separated kidneys (SK). Materials and methods The analysis included computed tomography angiography studies of 331 patients (83 HSK and 248 SK). The number of renal vessels and diameters of renal arteries were determined, along with the level at which they branched in relation to other ramifications (four groups of origin were proposed) and their entrance of the vessels to the kidney. Results Number of renal arteries in HSK group was 4.57 ± 1.39 per patient and 2.4 ± 0.43 in SK group (p

Background: Awareness of discrepancies of renal vasculature is crucial for some medical procedures. The present study investigated origin and course of aberrant and accessory renal vessels and any associated variations. Materials and methods: Renal blood vessels of 63 cadavers were examined. Number of renal veins and arteries, arrangement, location where the vasculature attached to the kidneys, and presence of variations were recorded. Incidence of renal vasculature variations was determined, and associations were tested with age at death, sex, and cause of death and whether variations were more common on a specific side. Results: Variations were found in 7 (11%; 95% confidence interval [CI] 5–22%) cadavers. For renal veins, double, triple, and quadruple veins unilaterally (5; 8%) and veins that drained the superior pole (1; 2%) or inferior pole only (5; 8%) were found. For renal arteries, double and triple arteries unilaterally (3; 5%) and arteries attached to the superior pole only (1; 2%) or inferior pole only (2; 3%) were found. Other variations (polycystic kidney, variations in the common iliac or gonadal veins) were observed. Only renal failure as a cause of death was different between those with or without variations (4/7 [57%] vs. 1/56 [2%]; p < 0.001). Conclusions: The present study found many variations in renal vasculature. Awareness of such variations may be useful for physicians concerned with this region.

Background Recently, we showed that long-term angiotensin receptor blocker (ARB) administration induced unusual proliferative changes in smooth muscle cells (SMCs) of afferent arterioles of the kidneys of Zucker fatty rats (ZFRs). In this study, we investigated renal afferent arteriolar changes induced by the long-term administration of an angiotensin converting enzyme inhibitor (ACEI) in ZFRs. Materials and Methods Fourteen 6-week-old male ZFRs were divided into two groups (n=14): the ZFR+ACEI group (n=6) was fed a standard diet containing ACEI (Enalapril, 2 mg/kg/day), and the ZFR control group (n=8) for 12 weeks. Blood pressure and proteinuria were examined and morphological studies on kidneys were performed. Results Remarkable proliferative changes in the afferent arteriolar SMCs were frequently observed in the group given ACEI; (66.1 ± 12.9%) compared with the control group (1.77 ± 1.56%, P

Introduction: Ureteropelvic junction obstruction (UPJO) is usually intrinsic; however, 15%–52% may be associated with crossing renal/lower pole vessels. Investigators have demonstrated that the presence of crossing vessels decreased the success rate of antegrade endopyelotomy. We prospectively reviewed our series of laparoscopic pyeloplasty in children and analyzed as to whether crossing vessels affected the morbidity and outcome. Methods: Children

Introduction/Background This study is aimed to investigate the possibility of pre-operative oral oil administration in displaying the chylous tubes and preventing chylous leakage in laparoscopic para-aortic lymphadenectomy in gynecologic surgeries. Methodology In this retrospective study, 30 patients with gynecological malignancies who had indications for laparoscopic para-aortic lymphadenectomy up to the renal vessels were give pre-operative oral oil (oil administration group) (n=15) or not (control group) (n=15) at our hospital between September 2017 and June 2018. The chylous tubes displaying rate, incidence of chylous leakage and other perioperative datum of the two groups were compared. Results uccessful display of chylous tubes was observed in 93.3% (14/15) patients in the oil administration group. The chylous leakage was 0 in the oil administration group, and 33.3% (5/15) in the control group. The postoperative drainage duration (4.1±1.0d vs 7.6±1.4d, P=0.000), somatostatin application time (0d vs 5.9±0.8d), and post-operative hospital stay (6.0±2.3 d vs 9.1±2.1d, P=0.001) were significantly shorter in the oil administration group. The total cost is lower in the oil administration group (4972.52±80.54dollars vs 6260.80±484.47 dollars, P=0.000). Conclusion Pre-operative oil administration is a feasible and effective method to display the chylous tubes and to prevent the chylous leakage in para-aortic lymphadenectomy. Disclosure Nothing to disclose.

Background: Didelphis aurita is a marsupial with wide distribution in the South American continent and highly adapted to urban centres. The objective of this study was to describe the measurements and skeletopy of the kidneys and renal vascularisation of this species. Materials and methods: With this aim, 29 cadavers (14 males and 15 females) of D. aurita collected on highways were analysed. The rostrum-sacral length of specimens, kidney measurements (length, width and thickness) and the length of the renal vessels were measured and the renal skeletopy registered. Results: In the right kidney, average length, width, thickness and ellipsoid volume were 28.6 ± 5.0 mm, 15.6 ± 2.9 mm, 12.8 ± 3.0 mm and 3.3 ± 2.4 cm3, respectively; in the left kidney, 31.0 ± 3.8 mm, 14.5 ± 3.6 mm, 12.6 ± 2.6 mm and 3.2 ± 2.2 cm3, respectively. There was no significant difference in the comparison of averages of renal dimensions between sexes and between antimeres. The right renal artery (13.2 ± 2.6 mm) was significantly longer (p < 0.01) than the left renal artery (10.7 ± 2.3 mm). In contrast, the left renal vein (13.9 ± 3.5 mm) was longer (p < 0.01) than the right renal vein (7.0 ± 2.3 mm). The skeletopy of the right kidney predominated between T13–L1 in 58.6% of the cases and the skeletopy of the left kidney between L1–L3 in 41.4%. The average length of the kidneys corresponded to 6% to 8% of the rostrum-sacral length of the specimens. Conclusions: The data of the present study characterised the measurements and topography of kidneys and renal vessels in D. aurita and can support the interpretation of clinical, experimental and pathological findings in this species.

Background The objective of this study is to quantitatively evaluate the protective effects of resveratrol for using during renal warm ischemia. Methods Rats were allocated into 4 groups: Sham, Sham Resveratrol, Ischemia, Ischemia Resveratrol. Sham Resveratrol and Ischemia Resveratrol received resveratrol before surgery. Ischemia and Ischemia Resveratrol had renal vessels clamped. Animals were euthanized four weeks after. Serum urea and creatinine were measured. Renal weight and volume, cortex-non-cortex areas ratio, cortical volume, glomerular volumetric density, volume-weighted mean glomerular volume and number of glomeruli per kidney were evaluated. Results Serum urea in Ischemia increased by 10.4% compared to Sham and no differences were observed among Ischemia Resveratrol and sham groups. The glomerular volumetric density and number of glomeruli of Ischemia were lower than Sham but Ischemia Resveratrol had no difference compared to sham groups. Conclusions Preoperative administration of resveratrol has renoprotective effects, preventing the glomerular number reduction observed in warm ischemia.