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de Oliveira Bezerra D, Aita GA, de Moura CRC, Silva LDS, de Carvalho CES, da Silva CRA, de Sousa MRSC, Ferraz JCB, de Brito FC, Carvalho MS, de Melo WGG, Campêlo CB, de Carvalho MAM. Kidney/Aorta Ratio for Renal Morphometric Determination in Swine Subjected to Acute Kidney Injury Using an Optimized Surgical Model. Comp Med 2024; 74:255-262. [PMID: 38849202 PMCID: PMC11373677 DOI: 10.30802/aalas-cm-23-000080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
This research aims to establish an experimental surgical model for access to the renal pedicle and kidney and to determine renal length measurement via the kidney/aorta ratio (K/AO) using ultrasound. Fifteen swine underwent ventral median celiotomy with a supraumbilical transverse incision to access the right and left renal pedicles and induce renal ischemia-reperfusion injury (IRR). The kidneys were evaluated using ultrasonography to standardize renal length, aortic diameter, and the K/AO. Assessment was performed at 2 time points: 1 h before and 24 h after the surgery to induce IRR. Blood and urine samples were collected to assess renal function. Histologic evaluation of kidney fragments was also conducted. The proposed abdominal cavity access method proved to be highly efficient for exposing the right and left renal pedicles and inducing IRR. Serum levels of urea, creatinine, calcium, and phosphorus, as well as levels of the urinary protein/urinary creatinine ratio and urinary GGT, did not show significant differences. Acute kidney injury was confirmed through histopathology. The mean lengths of the right and left kidneys were 82.63 and 87.64 mm, respectively. The values of the right and left K/AO were 9.81 and 10.38, respectively. There was no statistically significant difference in the K/AO ratio before and after IRR. The proposed surgical model allowed surgical intervention on the renal pedicles without intra- or postoperative complications. Furthermore, the K/AO could be measured through ultrasonography, establishing a reference for healthy animals.
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Affiliation(s)
- Dayseanny de Oliveira Bezerra
- Núcleo Integrado e Morfologia e Pesquisas com Células-tronco (NUPCelt), Centro de Ciências Agrárias, Universidade Federal do Piauí, Teresina, Brazil
| | | | - Charlys Rhands Coelho de Moura
- Núcleo Integrado e Morfologia e Pesquisas com Células-tronco (NUPCelt), Centro de Ciências Agrárias, Universidade Federal do Piauí, Teresina, Brazil
| | - Lucilene Dos Santos Silva
- Núcleo Integrado e Morfologia e Pesquisas com Células-tronco (NUPCelt), Centro de Ciências Agrárias, Universidade Federal do Piauí, Teresina, Brazil
| | - Camila Ernanda Sousa de Carvalho
- Núcleo Integrado e Morfologia e Pesquisas com Células-tronco (NUPCelt), Centro de Ciências Agrárias, Universidade Federal do Piauí, Teresina, Brazil
| | - Catarina Rafaela Alves da Silva
- Núcleo Integrado e Morfologia e Pesquisas com Células-tronco (NUPCelt), Centro de Ciências Agrárias, Universidade Federal do Piauí, Teresina, Brazil
| | | | | | | | - Marina Silva Carvalho
- Núcleo Integrado e Morfologia e Pesquisas com Células-tronco (NUPCelt), Centro de Ciências Agrárias, Universidade Federal do Piauí, Teresina, Brazil
| | - Wanderson Gabriel Gomes de Melo
- Núcleo Integrado e Morfologia e Pesquisas com Células-tronco (NUPCelt), Centro de Ciências Agrárias, Universidade Federal do Piauí, Teresina, Brazil
| | - Camile Benício Campêlo
- Núcleo Integrado e Morfologia e Pesquisas com Células-tronco (NUPCelt), Centro de Ciências Agrárias, Universidade Federal do Piauí, Teresina, Brazil
| | - Maria Acelina Martins de Carvalho
- Núcleo Integrado e Morfologia e Pesquisas com Células-tronco (NUPCelt), Centro de Ciências Agrárias, Universidade Federal do Piauí, Teresina, Brazil
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Kellner E, Sekula P, Reisert M, Köttgen A, Lipovsek J, Russe M, Horbach H, Schlett CL, Nauck M, Völzke H, Kröncke T, Bette S, Kauczor HU, Keil T, Pischon T, Heid IM, Peters A, Niendorf T, Lieb W, Bamberg F, Büchert M, Reichardt W. Imaging Markers Derived From MRI-Based Automated Kidney Segmentation. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:284-290. [PMID: 38530931 PMCID: PMC11381199 DOI: 10.3238/arztebl.m2024.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Population-wide research on potential new imaging biomarkers of the kidney depends on accurate automated segmentation of the kidney and its compartments (cortex, medulla, and sinus). METHODS We developed a robust deep-learning framework for kidney (sub-)segmentation based on a hierarchical, three-dimensional convolutional neural network (CNN) that was optimized for multiscale problems of combined localization and segmentation. We applied the CNN to abdominal magnetic resonance images from the population-based German National Cohort (NAKO) study. RESULTS There was good to excellent agreement between the model predictions and manual segmentations. The median values for the body-surface normalized total kidney, cortex, medulla, and sinus volumes of 9934 persons were 158, 115, 43, and 24 mL/m2. Distributions of these markers are provided both for the overall study population and for a subgroup of persons without kidney disease or any associated conditions. Multivariable adjusted regression analyses revealed that diabetes, male sex, and a higher estimated glomerular filtration rate (eGFR) are important predictors of higher total and cortical volumes. Each increase of eGFR by one unit (i.e., 1 mL/min per 1.73 m2 body surface area) was associated with a 0.98 mL/m2 increase in total kidney volume, and this association was significant. Volumes were lower in persons with eGFR-defined chronic kidney disease. CONCLUSION The extraction of image-based biomarkers through CNN-based renal sub-segmentation using data from a population-based study yields reliable results, forming a solid foundation for future investigations.
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Affiliation(s)
- Elias Kellner
- Division of Medical Physics, Department of Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peggy Sekula
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center – University of Freiburg, Freiburg, Germany
| | - Marco Reisert
- Division of Medical Physics, Department of Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anna Köttgen
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center – University of Freiburg, Freiburg, Germany
| | - Jan Lipovsek
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center – University of Freiburg, Freiburg, Germany
| | - Maximilian Russe
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, Albert-Ludwigs-University Freiburg, Germany
| | - Harald Horbach
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, Albert-Ludwigs-University Freiburg, Germany
| | - Christopher L. Schlett
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, Albert-Ludwigs-University Freiburg, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine Greifswald, Germany
| | - Henry Völzke
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Germany
| | - Thomas Kröncke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Germany
- Centre for Advanced Analytics and Predictive Sciences (CAAPS), University of Augsburg, Germany
| | - Stefanie Bette
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostical and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Institute of Clinical Epidemiology and Biometry, University of Würzburg, State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Tobias Pischon
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group; Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin; Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Iris M. Heid
- Chair of Genetic Epidemiology, University of Regensburg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg; Chair of Epidemiology, Institute for Medical Information Processing, Biometrics, and Epidemiology, Medical Faculty, Ludwig-Maximilians-University Munich; DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, Munich; DZD (German Centre for Diabetes Research), Neuherberg
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin
| | - Wolfgang Lieb
- Institute of Epidemiology, Kiel University, Kiel, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, Albert-Ludwigs-University Freiburg, Germany
| | - Martin Büchert
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, Core Facility MRDAC, University Medical Center Freiburg, Faculty of Medicine, Albert-Ludwigs-University Freiburg, Germany
| | - Wilfried Reichardt
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Dabers T, Sass P, Fechner F, Weyer J, Völzke H, Mahnken AH, Lorbeer R, Mensel B, Stracke S. Age- and Sex-Specific Reference Values for Renal Volume and Association with Risk Factors for Chronic Kidney Disease in a General Population-An MRI-Based Study. J Clin Med 2024; 13:769. [PMID: 38337463 PMCID: PMC10856696 DOI: 10.3390/jcm13030769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Renal volume (RV) is associated with renal function and with a variety of cardiovascular risk factors (CVRFs). We analysed RV using magnetic resonance imaging (MRI) in a large population-based study (Study of Health in Pomerania; SHIP-TREND) to find sex- and age-specific reference values for RV and to test the influence of several markers on RV. The main objective is to describe reference values for RV in people from the general population without kidney disease. METHODS 1815 participants without kidney disease (930 women) aged 21-81 years were included in our study. Right and left RV with and without body surface area (BSA) indexation were compared among three age groups (22-39 years, 40-59 years, 60-81 years) by median and interquartile range and tested separately in women and men. RESULTS The estimated glomerular filtration rate (eGFR), serum uric acid, and right and left RV were higher in men compared to women (all p < 0.001). Left kidneys were larger than right kidneys (both sexes). With age, RV showed a continuously decreasing trend in women and an upside-down U-shaped relation in men. In multivariable linear regression models, current smoking (β = 14.96, 95% CI 12.12; 17.79), BSA (β = 97.66, 95% CI 90.4; 104.93), diastolic blood pressure (β = 0.17, 95% CI 0.01; 0.32), and eGFR (β = 0.57, 95% CI 0.50; 0.65) were positively associated with both left and right RV, whereas uric acid (β = -0.03, 95% CI -0.05; -0.01) showed an inverse association with RV. Interestingly, the same eGFR correlated with higher RV in men compared to women. CONCLUSION Reference values for RV are different for age groups and sex. For any given age, female kidneys are smaller than male kidneys. RV associates positively with eGFR, but for any chosen eGFR, renal volume in females is lower compared to males. RV decreases with age, but in men showed a U-shaped correlation. This may reflect hyperfiltration and glomerular hypertrophy associated with the presence of CVRF in middle-aged males.
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Affiliation(s)
- Thomas Dabers
- Nephrology, Internal Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (T.D.)
- KfH Renal Center, 17475 Greifswald, Germany
| | - Peter Sass
- Nephrology, Internal Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (T.D.)
| | - Fritz Fechner
- Nephrology, Internal Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (T.D.)
| | - Julian Weyer
- Nephrology, Internal Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (T.D.)
| | - Henry Völzke
- Institute for Community Medicine—SHIP Clinical-Epidemiological Research, University Medicine Greifswald, 17475 Greifswald, Germany;
| | - Andreas Horst Mahnken
- Department of Diagnostic & Interventional Radiology, Philipps-University Marburg, 35037 Marburg, Germany;
| | - Roberto Lorbeer
- Department of Radiology, University Hospital, LMU Munich, 80539 Munich, Germany;
| | - Birger Mensel
- Department of Diagnostic & Interventional Radiology, Philipps-University Marburg, 35037 Marburg, Germany;
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Central Hospital Bad Berka, 99438 Bad Berka, Germany
| | - Sylvia Stracke
- Nephrology, Internal Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (T.D.)
- KfH Renal Center, 17475 Greifswald, Germany
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Narikiyo K, Tanabe M, Higashi M, Kawano Y, Inoue A, Kiyoyama H, Kamamura N, Kobayashi T, Ueda T, Ito K. Longitudinal changes in renal volumes evaluated by automated three-dimensional volumetric computed tomography of the whole kidney: The association with the renal function and disease progression. Eur J Radiol 2024; 170:111245. [PMID: 38042018 DOI: 10.1016/j.ejrad.2023.111245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Abstract
PURPOSE To clarify the changes in the total renal volume over time with changes of the renal function using automated 3D volumetric CT of the whole kidney and to evaluate the usefulness of the total renal volume CT measurement in predicting chronic kidney disease (CKD) grade progression. METHODS A total of 961 patients who underwent abdominal CT at least twice (an interval of more than 4 years) were included. The automated 3D volumetric CT measurement of the whole kidney was performed at the initial and latest CT examination. Patients with CKD grade G2 at the time of the initial CT were divided into two groups: a progression group (CKD grade progressed to G3-G5) and a non-progression group. Changes in the renal volume over time were compared between the two groups. RESULTS The volume of both kidneys measured on initial CT was positively correlated with eGFR (ρ = 0.490, p < 0.001). There was a significant difference in the initial volume of both kidneys among CKD grades (p < 0.001, G1:318.7 ± 60.5 ml, G2:275.5 ± 53.5 ml, G3:233.7 ± 46.9 ml, G4:183.2 ± 22.5 ml, G5:157.7 ± 77.4 ml). When comparing the progression and non-progression groups, the initial volume of both kidneys was significantly smaller in the progression group, compared with the non-progression group (252.0 ± 50.6 ml vs. 278.9 ± 53.7 ml). In addition, the annual reduction volume in both the right and left kidneys was significantly greater in the progression group than in the non-progression group (p < 0.001). CONCLUSION The automated 3D volumetric CT measurement of the whole kidney has the potential to monitor changes in renal volume over time with changes of the renal function.
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Affiliation(s)
- Koji Narikiyo
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Masahiro Tanabe
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Mayumi Higashi
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Yosuke Kawano
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Atsuo Inoue
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Haruka Kiyoyama
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Naohiko Kamamura
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Taiga Kobayashi
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Takaaki Ueda
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Katsuyoshi Ito
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
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Tanaka M, Okada H, Hashimoto Y, Kumagai M, Yamaoka M, Nishimura H, Fukui M. Trunk muscle quality and quantity are associated with renal volume in nondiabetic people. Clin Kidney J 2023; 16:2597-2604. [PMID: 38046018 PMCID: PMC10689130 DOI: 10.1093/ckj/sfad202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Indexed: 12/05/2023] Open
Abstract
Background Renal disease is a major problem in terms of community health and the economy. Skeletal muscle is involved in crosstalk with the kidney. We therefore investigated the relationship between muscle quality and quantity, and renal parenchymal volume (RPV). Methods The association between the parameters of skeletal muscle and RPV/body surface area (BSA) was analyzed by computed tomography in 728 middle-aged participants without kidney disease or diabetes mellitus in a cross-sectional study. A retrospective cohort study of 68 participants was undertaken to analyze the association between changes in RPV/BSA and muscle parameters. Parameter change was calculated as follows: parameter at the follow-up examination/parameter at the baseline examination. The normal attenuation muscle (NAM) and low attenuation muscle (LAM) were identified by Hounsfield Unit thresholds of +30 to +150, and -29 to +29, respectively. Results Positive correlations were found between estimated glomerular filtration rate and RPV/BSA (r = 0.451, P < .0001). Multiple regression analyses revealed that the NAM index was positively related to RPV/BSA (β = 0.458, P < .0001), whereas the LAM index was negatively related to RPV/BSA (β = -0.237, P < .0001). In this cohort study, a change in the LAM index was independently associated with a change in RPV/BSA (β = -0.349, P = .0032). Conclusion Both trunk muscle quantity and quality were associated with renal volume related to renal function in nondiabetic people. An increase in low quality muscle volume might be related to a decrease in renal volume.
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Affiliation(s)
- Muhei Tanaka
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
- Department of Diabetes and Metabolism, Saiseikai Suita Hospital, Osaka, Japan
| | - Hiroshi Okada
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | | | - Muneaki Kumagai
- Medical Corporation Soukenkai, Nishimura Clinic, Kyoto, Japan
| | - Miyoko Yamaoka
- Medical Corporation Soukenkai, Nishimura Clinic, Kyoto, Japan
| | | | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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Zhang QH, Chen LH, An Q, Pi P, Dong YF, Zhao Y, Wang N, Fang X, Pu RW, Song QW, Lin LJ, Liu JH, Liu AL. Quantification of the renal sinus fat and exploration of its relationship with ectopic fat deposition in normal subjects using MRI fat fraction mapping. Front Endocrinol (Lausanne) 2023; 14:1187781. [PMID: 37621645 PMCID: PMC10446762 DOI: 10.3389/fendo.2023.1187781] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/29/2023] [Indexed: 08/26/2023] Open
Abstract
Purpose To determine the renal sinus fat (RSF) volume and fat fraction (FF) in normal Chinese subjects using MRI fat fraction mapping and to explore their associations with age, gender, body mass index (BMI) and ectopic fat deposition. Methods A total of 126 subjects were included in the analysis. RSF volume and FF, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) area, and hepatic and pancreatic FFs were measured for each subject. The comparisons in gender were determined using two-tailed t-tests or the nonparametric Mann-Whitney U-test for normally or non-normally distributed data for continuous variables and the chi-square test for categorical variables. Comparisons of RFS volume and FF between right and left kidneys were determined using paired sample t-tests. Multivariable logistic models were performed to confirm whether RSF differences between men and women are independent of VAT or SAT area. When parameters were normally distributed, the Pearson correlation coefficient was used; otherwise, the Spearman correlation coefficient was applied. Results The RSF volumes (cm3) of both kidneys in men (26.86 ± 8.81 for right and 31.62 ± 10.32 for left kidneys) were significantly bigger than those of women (21.47 ± 6.90 for right and 26.03 ± 8.55 for left kidneys) (P < 0.05). The RSF FFs (%) of both kidneys in men (28.33 ± 6.73 for right and 31.21 ± 6.29 for left kidneys) were significantly higher than those of the women (23.82 ± 7.74 for right and 27.92 ± 8.15 for left kidneys) (P < 0.05). The RSF differences between men and women are independent of SAT area and dependent of VAT area (except for right RSF volume). In addition, the RSF volumes and FFs in both kidneys in the overall subjects show significant correlations with age, BMI, VAT area, hepatic fat fraction and pancreatic fat fraction (P < 0.05). However, the patterns of these correlations varied by gender. The RSF volume and FF of left kidney were significantly larger than those of the right kidney (P < 0.05). Conclusion The association between renal sinus fat and ectopic fat deposition explored in this study may help establish a consensus on the normal values of RSF volume and FF for the Chinese population. This will facilitate the identification of clinicopathological changes and aid in the investigation of whether RSF volume and FF can serve as early biomarkers for metabolic diseases and renal dysfunction in future studies.
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Affiliation(s)
- Qin-He Zhang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Li-Hua Chen
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qi An
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Peng Pi
- Department of Medical Imaging, Dalian Medical University, Dalian, China
| | - Yi-Fan Dong
- Department of Medical Imaging, Dalian Medical University, Dalian, China
| | - Ying Zhao
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Nan Wang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xin Fang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ren-Wang Pu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qing-Wei Song
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Liang-Jie Lin
- Clinical & Technical Solutions, Philips Healthcare, Beijing, China
| | - Jing-Hong Liu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ai-Lian Liu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Choi YH, Jo S, Lee RW, Kim JE, Paek JH, Kim B, Shin SY, Hwang SD, Lee SW, Song JH, Kim K. Changes in CT-Based Morphological Features of the Kidney with Declining Glomerular Filtration Rate in Chronic Kidney Disease. Diagnostics (Basel) 2023; 13:diagnostics13030402. [PMID: 36766507 PMCID: PMC9914455 DOI: 10.3390/diagnostics13030402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
Chronic kidney disease (CKD) progression involves morphological changes in the kidney, such as decreased length and thickness, with associated histopathological alterations. However, the relationship between morphological changes in the kidneys and glomerular filtration rate (GFR) has not been quantitatively and comprehensively evaluated. We evaluated the three-dimensional size and shape of the kidney using computed tomography (CT)-derived features in relation to kidney function. We included 257 patients aged ≥18 years who underwent non-contrast abdominal CT at the Inha University Hospital. The features were quantified using predefined algorithms in the pyRadiomics package after kidney segmentation. All features, except for flatness, significantly correlated with estimated GFR (eGFR). The surface-area-to-volume ratio (SVR) showed the strongest negative correlation (r = -0.75, p < 0.0001). Kidney size features, such as volume and diameter, showed moderate to high positive correlations; other morphological features showed low to moderate correlations. The calculated area under the receiver operating characteristic (ROC) curve (AUC) for different features ranged from 0.51 (for elongation) to 0.86 (for SVR) for different eGFR thresholds. Diabetes patients had weaker correlations between the studied features and eGFR and showed less bumpy surfaces in three-dimensional visualization. We identified alterations in the CKD kidney based on various three-dimensional shape and size features, with their potential diagnostic value.
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Affiliation(s)
- Yoon Ho Choi
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Jacksonville, FL 32224, USA
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Seongho Jo
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Ro Woon Lee
- Department of Radiology, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Ji-Eun Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Jin Hyuk Paek
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Byoungje Kim
- Department of Radiology, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Soo-Yong Shin
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Joon Ho Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Kipyo Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
- Correspondence: ; Tel.: +82-32-890-3246
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Kostakis ID, Chandak P, Assia-Zamora S, Gogalniceanu P, Loukopoulos I, Calder F, Stojanovic J, Kessaris N. Pediatric renal transplantation-A UNOS database analysis of donor-recipient size mismatch. Pediatr Transplant 2023; 27:e14470. [PMID: 36651195 DOI: 10.1111/petr.14470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/26/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND We used the BSAi (Donor BSA/Recipient BSA) to assess whether transplanting a small or large kidney into a pediatric recipient relative to his/her size influences renal transplant outcomes. METHODS We included 14 322 single-kidney transplants in pediatric recipients (0-17 years old) (01/2000-02/2020) from the United Network for Organ Sharing database. We divided cases into four BSAi groups (BSAi ≤ 1, 1 < BSAi ≤ 2, 2 < BSAi ≤ 3, BSAi > 3). RESULTS There were no differences concerning delayed graft function (DGF) or primary non-function (PNF) rates, whether the grafts were from living or brain-dead donors. In both transplants coming from living donors and brain-dead donors, cases with BSAi > 3 and cases with 2 < BSAi ≤ 3 had similar graft survival (p = .13 for transplants from living donors, p = .413 for transplants from brain-dead donors), and both groups had longer graft survival than cases with 1 < BSAi ≤ 2 and cases with BSAi ≤ 1 (p < .001). The difference in 10-year graft survival rates between cases with BSAi > 3 and cases with BSAi ≤ 1 reached around 25% in both donor types. The better graft survival in transplants with BSAi > 2 was confirmed in multivariable analysis. CONCLUSIONS There is no significant impact of donor-recipient size mismatch on DGF and PNF rates in pediatric renal transplants. However, graft survival is significantly improved when the donor's size is more than twice the pediatric recipient's size.
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Affiliation(s)
- Ioannis D Kostakis
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK.,Department of Hepato-Pancreato-Biliary Surgery and Liver transplantation, Royal Free Hospital, London, UK
| | - Pankaj Chandak
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK.,Nephrology Department, Great Ormond Street Hospital, London, UK
| | - Sergio Assia-Zamora
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK.,Nephrology Department, Great Ormond Street Hospital, London, UK.,Institute of Liver Studies, King's College Hospital, UK
| | - Petrut Gogalniceanu
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK.,Nephrology Department, Great Ormond Street Hospital, London, UK.,Institute of Liver Studies, King's College Hospital, UK
| | - Ioannis Loukopoulos
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK.,Nephrology Department, Great Ormond Street Hospital, London, UK
| | - Francis Calder
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK.,Nephrology Department, Great Ormond Street Hospital, London, UK
| | | | - Nicos Kessaris
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK.,Nephrology Department, Great Ormond Street Hospital, London, UK
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9
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Ji Y, Cho H, Seon S, Lee K, Yoon H. A deep learning model for CT-based kidney volume determination in dogs and normal reference definition. Front Vet Sci 2022; 9:1011804. [PMID: 36387402 PMCID: PMC9649823 DOI: 10.3389/fvets.2022.1011804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/13/2022] [Indexed: 10/07/2023] Open
Abstract
Kidney volume is associated with renal function and the severity of renal diseases, thus accurate assessment of the kidney is important. Although the voxel count method is reported to be more accurate than several methods, its laborious and time-consuming process is considered as a main limitation. In need of a new technology that is fast and as accurate as the manual voxel count method, the aim of this study was to develop the first deep learning model for automatic kidney detection and volume estimation from computed tomography (CT) images of dogs. A total of 182,974 image slices from 386 CT scans of 211 dogs were used to develop this deep learning model. Owing to the variance of kidney size and location in dogs compared to humans, several processing methods and an architecture based on UNEt Transformers which is known to show promising results for various medical image segmentation tasks including this study. Combined loss function and data augmentation were applied to elevate the performance of the model. The Dice similarity coefficient (DSC) which shows the similarity between manual segmentation and automated segmentation by deep-learning model was 0.915 ± 0.054 (mean ± SD) with post-processing. Kidney volume agreement analysis assessing the similarity between the kidney volume estimated by manual voxel count method and the deep-learning model was r = 0.960 (p < 0.001), 0.95 from Lin's concordance correlation coefficient (CCC), and 0.975 from the intraclass correlation coefficient (ICC). Kidney volume was positively correlated with body weight (BW), and insignificantly correlated with body conditions score (BCS), age, and sex. The correlations between BW, BCS, and kidney volume were as follows: kidney volume = 3.701 × BW + 11.962 (R 2 = 0.74, p < 0.001) and kidney volume = 19.823 × BW/BCS index + 10.705 (R 2 = 0.72, p < 0.001). The deep learning model developed in this study is useful for the automatic estimation of kidney volume. Furthermore, a reference range established in this study for CT-based normal kidney volume considering BW and BCS can be helpful in assessment of kidney in dogs.
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Affiliation(s)
- Yewon Ji
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, South Korea
| | | | | | - Kichang Lee
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, South Korea
| | - Hakyoung Yoon
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, South Korea
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10
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Garg A, Jhobta A, Kapila S, Rathour D. Correlation of Sonographic Parameters with Renal Function in Patients with Newly Diagnosed Chronic Kidney Disease. J Ultrason 2022; 22:e216-e221. [PMID: 36483784 PMCID: PMC9714278 DOI: 10.15557/jou.2022.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/15/2022] [Indexed: 01/25/2023] Open
Abstract
AIMS To correlate sonographic renal parameters (mean renal cortical thickness, length and volume) with renal functions in patients with newly diagnosed chronic kidney disease. To predict the best renal parameter correlating with renal functions in patients with newly diagnosed chronic kidney disease. MATERIAL AND METHODS A hospital-based prospective cross-sectional study was conducted in the Department of Radiodiagnosis, Indira Gandhi Medical College and Hospital, Shimla, in 78 adults with newly diagnosed chronic kidney disease visiting the hospital from December 2019 to November 2020. RESULTS A statistically significant positive correlation was found between eGFR and mean renal length, mean renal cortical thickness, and mean renal volume (p <0.001).The strongest correlation was shown between mean renal volume and eGFR (r = 0.90, r2 = 0.82; p-value <0.001). CONCLUSIONS Renal volume and cortical thickness should be considered along with traditional renal parameters.
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Affiliation(s)
- Aborishi Garg
- Department of Radiodiagnosis, Indira Gandhi Medical College, Shimla, India, Corresponding author: Aborishi Garg, Department of Radiodiagnosis, Indira Gandhi Medical College, Shimla, Himachal Pradesh, IGMC Shimla, 171001, Shimla, India;
| | - Anupam Jhobta
- Department of Radiodiagnosis, Indira Gandhi Medical College, Shimla, India
| | - Sumala Kapila
- Department of Radiodiagnosis, Indira Gandhi Medical College, Shimla, India
| | - Devesha Rathour
- Department of General Surgery, Indira Gandhi Medical College, Shimla, India
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11
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Liu F, Chen J, Li Z, Meng X. Recent Advances in Epigenetics of Age-Related Kidney Diseases. Genes (Basel) 2022; 13:genes13050796. [PMID: 35627181 PMCID: PMC9142069 DOI: 10.3390/genes13050796] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 02/03/2023] Open
Abstract
Renal aging has attracted increasing attention in today’s aging society, as elderly people with advanced age are more susceptible to various kidney disorders such as acute kidney injury (AKI) and chronic kidney disease (CKD). There is no clear-cut universal mechanism for identifying age-related kidney diseases, and therefore, they pose a considerable medical and public health challenge. Epigenetics refers to the study of heritable modifications in the regulation of gene expression that do not require changes in the underlying genomic DNA sequence. A variety of epigenetic modifiers such as histone deacetylases (HDAC) inhibitors and DNA methyltransferase (DNMT) inhibitors have been proposed as potential biomarkers and therapeutic targets in numerous fields including cardiovascular diseases, immune system disease, nervous system diseases, and neoplasms. Accumulating evidence in recent years indicates that epigenetic modifications have been implicated in renal aging. However, no previous systematic review has been performed to systematically generalize the relationship between epigenetics and age-related kidney diseases. In this review, we aim to summarize the recent advances in epigenetic mechanisms of age-related kidney diseases as well as discuss the application of epigenetic modifiers as potential biomarkers and therapeutic targets in the field of age-related kidney diseases. In summary, the main types of epigenetic processes including DNA methylation, histone modifications, non-coding RNA (ncRNA) modulation have all been implicated in the progression of age-related kidney diseases, and therapeutic targeting of these processes will yield novel therapeutic strategies for the prevention and/or treatment of age-related kidney diseases.
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Affiliation(s)
- Feng Liu
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China;
| | - Jiefang Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China;
| | - Zhenqiong Li
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China;
- Correspondence: (Z.L.); (X.M.)
| | - Xianfang Meng
- Department of Neurobiology, Institute of Brain Research, School of Basic Medical Sciences, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Correspondence: (Z.L.); (X.M.)
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12
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Haghdani S, Mohammadi Sichani M, Safi R, Khorrami M, Alizadeh F, Izadpanahi M. Does the simple renal cyst treatment improve renal function: A pilot study. Adv Biomed Res 2022; 11:38. [PMID: 35814296 PMCID: PMC9259450 DOI: 10.4103/abr.abr_131_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/29/2020] [Accepted: 04/05/2021] [Indexed: 11/26/2022] Open
Abstract
Background: The current study aims to assess the effects of the large simple renal cyst (SRC) surgery on renal function for the first time. Materials and Methods: This case-series study included 22 patients with larger than 50 mm single SRC who underwent laparoscopic cyst unroofing surgery. Twenty-four-hour urinary protein, creatinine, and volume along with plasma creatinine and estimated glomerular filtration rate (GFR) were measured in patients before and 1 month after surgery. Patients underwent abdominopelvic computed tomography-scan without contrast and parenchymal thickness diameter adjacent to the cyst was measured before and after surgery. Results: Mean age and weight of patients were 52.2 ± 8.9 years and 77 ± 10.9 akg, respectively. There was no significant difference between plasma creatinine and GFR before and after surgery (P = 0.25 and 0.37, respectively). Twenty-four-hour urinary volume, creatinine, and protein before and after surgery revealed no significant changes (P = 0.37, 0.08, and 0.31, respectively). The mean improvement of parenchymal thickness diameter after surgery was 10.4 ± 0.7 mm which was statistically significant (P = 0.001). However, it was not correlated with the mean estimated GFR change (r = 0.349, P = 0.13). Conclusions: Although laparoscopic unroofing of renal cyst recovered renal parenchymal thickness noticeably, it did not improve renal function significantly; therefore, the latter factor lonely should not be considered a reason for surgery decision. Observation can be chosen as a safe treatment strategy in large SRCs without concern about renal function.
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13
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Lillås BS, Qvale TH, Richter BK, Vikse BE. Birth Weight Is Associated With Kidney Size in Middle-Aged Women. Kidney Int Rep 2021; 6:2794-2802. [PMID: 34805631 PMCID: PMC8589725 DOI: 10.1016/j.ekir.2021.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 01/21/2023] Open
Abstract
Introduction Low birth weight (LBW) is associated with increased risk of kidney disease due to lower nephron endowment leading to hyperfiltration and subsequent nephron loss. Kidney size is commonly used as a proxy for nephron number. We compared kidney volume measured by magnetic resonance imaging (MRI) with measured glomerular filtration rate (mGFR) in adults with either normal birth weight (NBW) or low birth weight (LBW). Methods Healthy individuals aged 42 to 52 years with LBW (1100−2300 g) and NBW (3500 −4000 g) were invited to participate. The GFR was measured using plasma clearance of iohexol. Kidney volume was measured on magnetic resonance images using axial T2 images and coronal T1 images with fat saturation without contrast enhancement; calculations were performed according to the ellipsoid formula π/6 × length × width × depth. Results We included 102 individuals (54 LBW and 48 NBW). Total kidney volume was 302 ± 51 ml for female NBW vs 258 ± 48 ml for female LBW individuals (P = 0.002). For male individuals, total kidney volume was 347 ± 51 ml vs. 340 ± 65 ml (P = 0.7). The mGFR was significantly associated with kidney volume, with r = 0.52 (P < 0.001) for women and r = 0.39 (P = 0.007) for men. A mediation analysis showed that the association between birth weight and mGFR (significant in total sample and women) was mediated by kidney volume. Conclusion Healthy female individuals born with LBW have smaller kidneys than healthy females born with NBW. The previously shown associations between LBW and lower mGFR in adult women might be explained by smaller kidney volume.
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Affiliation(s)
- Bjørn Steinar Lillås
- Department of Medicine, Haugesund Hospital, Haugesund, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Correspondence: Bjørn Steinar Lillås, Department of Medicine, Haugesund Hospital, Helse Fonna, Postboks 2170, N-5504 Haugesund, Norway.
| | | | - Blazej Konrad Richter
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Radiology, Haugesund Hospital, Haugesund, Norway
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway
| | - Bjørn Egil Vikse
- Department of Medicine, Haugesund Hospital, Haugesund, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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14
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Rodríguez-Rodríguez AE, Donate-Correa J, Luis-Lima S, Díaz-Martín L, Rodríguez-González C, Pérez-Pérez JA, Acosta-González NG, Fumero C, Navarro-Díaz M, López-Álvarez D, Villacampa-Jiménez J, Navarro-González JA, Ortiz A, Porrini E. Obesity and metabolic syndrome induce hyperfiltration, glomerulomegaly, and albuminuria in obese ovariectomized female mice and obese male mice. Menopause 2021; 28:1296-1306. [PMID: 34581293 DOI: 10.1097/gme.0000000000001842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Obese patients with metabolic syndrome have a high risk of chronic kidney disease. The prevalence of obesity, metabolic syndrome, and insulin resistance increase in women after menopause, as does the risk of chronic kidney disease. This may indicate an interaction between obesity, metabolic syndrome, and menopause in the induction of renal damage. However, the pathogenesis of kidney disease in postmenopausal obese women is poorly understood. METHODS We investigated the interaction of an obesogenic diet and menopause on renal dysfunction in ovariectomized and non-ovariectomized lean (n = 8 and 17) and obese (n = 12 and 20) female mice. Obese (n = 12) and lean (n = 10) male mice were also studied. Glucose metabolism, insulin resistance, and kidney function were evaluated with gold standards procedures. Changes in kidney histology and lipid deposition were analyzed. Females had a lower number of glomeruli than males at baseline. RESULTS Only female ovariectomized obese animals developed insulin resistance, hyperglycemia, and kidney damage, evidenced as glomerulomegaly, glomerular hyperfiltration, and increased urinary albumin excretion, despite a similar increase in weight than obese non-ovariectomized female mice. Male obese mice developed hyperglycemia, insulin resistance, and hyperfiltration without major renal histological changes. Males on high fat diet showed higher renal lipid content and females on high fat diet (ovariectomized or non-ovariectomized) showed higher total cholesterol content than males. CONCLUSIONS In mice, there is a clear interplay between obesity, metabolic syndrome, and menopause in the induction of kidney damage.
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Affiliation(s)
- Ana Elena Rodríguez-Rodríguez
- Research Unit, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
- Fundacion General de la Universidad, University of La Laguna, Tenerife, Spain
| | - Javier Donate-Correa
- Research Unit, Hospital Universitario de Nuestra Señora de La Candelaria, La Laguna, Tenerife, Spain
- GEENDIAB (Grupo Español para el Estudio de la Nefropatía Diabética), Sociedad Española de Nefrología, Santander, Spain
| | - Sergio Luis-Lima
- Department of Nephology and Hypertension, IIS-Fundación Jimenez Díaz, UAM, Madrid, Spain
| | - Laura Díaz-Martín
- Research Unit, Hospital Universitario de Canarias, FIISC (Fundación Canaria Investigación Sanitaria de Canarias), La Laguna, Tenerife, Spain
| | | | | | | | - Cecilia Fumero
- Research Unit, Hospital Universitario de Canarias, FIISC (Fundación Canaria Investigación Sanitaria de Canarias), La Laguna, Tenerife, Spain
| | | | | | | | | | - Alberto Ortiz
- GEENDIAB (Grupo Español para el Estudio de la Nefropatía Diabética), Sociedad Española de Nefrología, Santander, Spain
- Department of Nephology and Hypertension, IIS-Fundación Jimenez Díaz, UAM, Madrid, Spain
| | - Esteban Porrini
- Research Unit, Hospital Universitario de Canarias, University of La Laguna, Faculty of Medicine, Tenerife, Spain
- ITB (Instituto Tecnologías Biomédicas), University of La Laguna, Tenerife, Spain
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15
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Lin L, Dekkers IA, Huang L, Tao Q, Paiman EHM, Bizino MB, Jazet IM, Lamb HJ. Renal sinus fat volume in type 2 diabetes mellitus is associated with glycated hemoglobin and metabolic risk factors. J Diabetes Complications 2021; 35:107973. [PMID: 34217586 DOI: 10.1016/j.jdiacomp.2021.107973] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 11/18/2022]
Abstract
AIMS We aimed to compare renal sinus fat volume assessed by MRI between patients with type 2 diabetes and healthy volunteers, and investigate the association between renal sinus fat and metabolic traits. METHODS In this cross-sectional study, renal sinus fat and parenchyma volumes measured on abdominal MRI were compared between patients and controls using analysis of covariance. Associations of renal parameters with clinical characteristics were analyzed using linear regression analysis. RESULTS A total of 146 participants were enrolled, consisting of 95 type 2 diabetes patients (57.2±8.8years, 49.5% male) and 51 controls (54.0±9.2years, 43.1% male). Patients with diabetes demonstrated larger sinus fat volumes (15.4±7.5cm3 vs. 10.3±7.1cm3, p<0.001) and sinus fat-parenchyma ratio than controls. In the total population, renal sinus fat was positively associated with HbA1c, abdominal VAT, cholesterol and triglycerides, after adjustment for age, sex, ethnicity and type 2 diabetes. In type 2 diabetes patients, increased sinus fat volume was significantly associated with urinary albumin-to-creatinine ratio. CONCLUSION Renal sinus fat volume is positively associated with several metabolic risk factors including HbA1c level and urinary albumin-to-creatinine ratio in type 2 diabetes patients, indicating a potential role of renal sinus fat in the development of diabetic nephropathy. Future studies are needed to investigate whether sinus fat volume can serve as an early biomarker for diabetic nephropathy.
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Affiliation(s)
- Ling Lin
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands.
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands
| | - Lu Huang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Qiaokou District, Wuhan, Hubei, China
| | - Qian Tao
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands
| | - Elisabeth H M Paiman
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands
| | - Maurice B Bizino
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands
| | - Ingrid M Jazet
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands
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16
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Donor-Recipient BSA Matching Is Prognostically Significant in Solitary and En Bloc Kidney Transplantation From Pediatric Circulatory Death Donors. Transplant Direct 2021; 7:e733. [PMID: 34291155 PMCID: PMC8291353 DOI: 10.1097/txd.0000000000001186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background. As the rate of early postoperative complications decline after transplant with pediatric donation after circulatory death (DCD) kidneys, attention has shifted to the long-term consequences of donor–recipient (D-R) size disparity given the pernicious systemic effects of inadequate functional nephron mass. Methods. We conducted a retrospective cohort study using Organ Procurement and Transplantation Network data for all adult (aged ≥18 y) recipients of pediatric (aged 0–17 y) DCD kidneys in the United States from January 1, 2004 to March 10, 2020. Results. DCD pediatric allografts transplanted between D-R pairs with a body surface area (BSA) ratio of 0.10–0.70 carried an increased risk of all-cause graft failure (relative risk [RR], 1.36; 95% confidence interval [CI], 1.10–1.69) and patient death (RR, 1.32; 95% CI, 1.01–1.73) when compared with pairings with a ratio of >0.91. Conversely, similar graft and patient survivals were demonstrated among the >0.70–0.91 and >0.91 cohorts. Furthermore, we found no difference in death-censored graft survival between all groups. Survival analysis revealed improved 10-y patient survival in recipients of en bloc allografts (P = 0.02) compared with recipients of single kidneys with D-R BSA ratios of 0.10–0.70. A similar survival advantage was demonstrated in recipients of solitary allografts with D-R BSA ratios >0.70 compared with the 0.10–0.70 cohort (P = 0.02). Conclusions. Inferior patient survival is likely associated with systemic sequelae of insufficient renal functional capacity in size-disparate DCD kidney recipients, which can be overcome by appropriate BSA matching or en bloc transplantation. We therefore suggest that in DCD kidney transplantation, D-R BSA ratios of 0.10–0.70 serve as criteria for en bloc allocation or alternative recipient selection to optimize the D-R BSA ratio to >0.70.
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17
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Kostakis ID, Karydis N, Kassimatis T, Kessaris N, Loukopoulos I. The implications of donor-recipient size mismatch in renal transplantation. J Nephrol 2021; 34:2037-2051. [PMID: 34033003 DOI: 10.1007/s40620-021-01050-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Transplanting kidneys small for recipient's size results in inferior graft function. Body surface area (BSA) is related to kidney size. We used the BSA index (BSAi) (Donor BSA/Recipient BSA) to assess whether the renal graft size is sufficient for the recipient. METHODS We included 26,223 adult single kidney transplants (01/01/2007-31/12/2019) from the UK Transplant Registry. We divided renal transplants into groups: BSAi ≤ 0.75, 0.75 < BSA ≤ 1, 1 < BSAi ≤ 1.25, BSAi > 1.25. We compared delayed graft function rates, primary non-function rates and graft survival among them. (Reference category: BSAi ≤ 0.75). RESULTS Cases with BSAi ≤ 0.75 had the highest delayed graft function rates in living-donor renal transplants (11.1%) (0.75 < BSAi ≤ 1: OR = 0.59, 95% CI = 0.32-1.1, p = 0.095, 1 < BSAi ≤ 1.25: OR = 0.46, 95% CI = 0.23-0.89, p = 0.022, BSAi > 1.25: OR = 0.32, 95% CI = 0.13-0.77, p = 0.011) and in renal transplants from donors after brain death (26.2%) (0.75 < BSAi ≤ 1: OR = 0.72, 95% CI = 0.55-0.96, p = 0.024, 1 < BSAi ≤ 1.25: OR = 0.62, 95% CI = 0.47-0.83, p = 0.001, BSAi > 1.25: OR = 0.65, 95% CI = 0.47-0.9, p = 0.01). There were no significant differences in renal transplants from donors after circulatory death regarding delayed graft function rates (~ 40% in all groups). Graft survival was similar among BSAi groups in renal transplants from living donors and donors after brain death. Renal transplants from donors after circulatory death with BSAi ≤ 0.75 had the shortest graft survival (0.75 < BSAi ≤ 1: HR = 0.55, 95% CI = 0.41-0.74, p < 0.001, 1 < BSAi ≤ 1.25: HR = 0.48, 95% CI = 0.35-0.66, p < 0.001, BSAi > 1.25: HR = 0.45, 95% CI = 0.31-0.66, p < 0.001). Ten-year graft survival rate was 58.4% for renal transplants from donors after circulatory death with BSAi ≤ 0.75. CONCLUSIONS Delayed graft function risk is higher in renal transplants with BSAi ≤ 0.75 coming from living donors and donors after brain death. Graft survival is greatly reduced in renal transplants from donors after circulatory death with BSAi ≤ 0.75.
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Affiliation(s)
- Ioannis D Kostakis
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. .,Department of HPB Surgery and Liver Transplantation, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, NW3 2QG, UK.
| | - Nikolaos Karydis
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Theodoros Kassimatis
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicos Kessaris
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ioannis Loukopoulos
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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18
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Quantitative evaluation of chronically obstructed kidneys from noncontrast computed tomography based on deep learning. Eur J Radiol 2021; 136:109535. [PMID: 33460954 DOI: 10.1016/j.ejrad.2021.109535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/09/2020] [Accepted: 01/05/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To quantitatively report renal parenchymal volume (RPV), renal sinus volume (RSV), and renal parenchymal density (RPD) for chronically obstructed kidneys from noncontrast computed tomography (NCCT). METHODS This retrospective study was approved by the institutional review board of our hospital with a waiver of informed consent. We retrospectively collected 304 consecutive NCCT scans of urinary obstruction and constructed two datasets: one with 167 patient scans for parenchyma and sinus segmentation (segmentation dataset) and the other containing 137 scans from different patients diagnosed with chronic urinary obstruction (CUO dataset) and paired with split glomerular filtration rate (sGFR). A cascaded three-dimensional (3D) U-Net model was developed and validated for parenchyma and sinus segmentation. The RPV, RSV, and RPD of the CUO dataset were calculated by the model with manual editing. A multivariate analysis was performed to show the association between all parameters and the sGFR. RESULTS In the test dataset, the Dice values for parenchyma and sinus segmentation were 0.95 ± 0.04 and 0.90 ± 0.05, respectively. Compared with those of nonobstructed kidneys, the RSV and RPD of obstructed kidneys increased, but RPV and sGFR decreased (P < .001). For chronically obstructed kidneys, age (r = -0.292, P < .001), RPV (r = 0.849, P < .001), RSV (r = -0.331, P < .001), and RPD (r = -0.296, P < .001) were significantly correlated with sGFR. The fitted regression model was sGFR = 10.873-0.111 Age + 0.211 RPV - 0.022 RSV (r2 = 0.712). CONCLUSIONS NCCT combined with deep learning has the potential to be a single radiological procedure for morphological and functional evaluation of chronically obstructed kidneys.
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Piras D, Masala M, Delitala A, Urru SAM, Curreli N, Balaci L, Ferreli LP, Loi F, Atzeni A, Cabiddu G, Racugno W, Ventura L, Zoledziewska M, Steri M, Fiorillo E, Pilia MG, Schlessinger D, Cucca F, Rule AD, Pani A. Kidney size in relation to ageing, gender, renal function, birthweight and chronic kidney disease risk factors in a general population. Nephrol Dial Transplant 2020; 35:640-647. [PMID: 30169833 DOI: 10.1093/ndt/gfy270] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 07/18/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The relationship of kidney size to ageing, kidney function and kidney disease risk factors is not fully understood. METHODS Ultrasound length and parenchymal kidney volume were determined from a population-based sample of 3972 Sardinians (age range 18-100 years). We then identified the subset of 2256 'healthy' subjects to define age- and sex-specific reference ranges (2.5-97.5 percentile) of kidney volume. Logistic regression (accounting for family clustering) was used to identify the clinical characteristics associated with abnormally large kidneys or abnormally small kidneys. RESULTS In the healthy subset, kidney volume and length increased up to the fourth to fifth decade of life followed by a progressive decrease in men, whereas there was a gradual kidney volume decrease throughout the lifespan of women. In the whole sample, independent predictors of lower kidney volume (<2.5 percentile for age and sex) were male sex, low body mass index, short height, low waist:hip ratio and high serum creatinine (SCr); the independent predictors of larger kidney volume (>97.5 percentile for age and sex) were younger age, female sex, diabetes, obesity, high height, high waist:hip ratio and lower SCr. Estimated heritability for kidney volume was 15%, and for length 27%; kidney volume correlated strongly with birthweight. CONCLUSIONS Overall, in a general healthy population, kidney measures declined with age differently in men and women. The determinants of kidney parenchymal volume include genetic factors and modifiable clinical factors.
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Affiliation(s)
- Doloretta Piras
- Struttura complessa di Nefrologia e Dialisi, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Marco Masala
- Istituto di Ricerca Biomedica e Genetica, Consiglio Nazionale delle Ricerche, Monserrato (Cagliari), Italy
| | - Alessandro Delitala
- Center ProgeNIA, Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Lanusei, Italy
| | - Silvana A M Urru
- Biomedicine Sector, Center for Advanced Studies Research and Development in Sardinia (CRS4), Technology Park Polaris, Cagliari, Italy
| | - Nicolò Curreli
- Center ProgeNIA, Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Lanusei, Italy
| | - Lenuta Balaci
- Center ProgeNIA, Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Lanusei, Italy
| | - Liana P Ferreli
- Center ProgeNIA, Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Lanusei, Italy
| | - Francesco Loi
- Center ProgeNIA, Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Lanusei, Italy
| | - Alice Atzeni
- Struttura complessa di Nefrologia e Dialisi, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Gianfranca Cabiddu
- Struttura complessa di Nefrologia e Dialisi, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Walter Racugno
- Dipartimento di Statistica, Università degli Studi di Cagliari, Cagliari, Italy
| | - Laura Ventura
- Dipartimento di Statistica, Università di Padova, Padua, Italy
| | - Magdalena Zoledziewska
- Istituto di Ricerca Biomedica e Genetica, Consiglio Nazionale delle Ricerche, Monserrato (Cagliari), Italy
| | - Maristella Steri
- Istituto di Ricerca Biomedica e Genetica, Consiglio Nazionale delle Ricerche, Monserrato (Cagliari), Italy
| | - Edoardo Fiorillo
- Center ProgeNIA, Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Lanusei, Italy
| | - Maria G Pilia
- Center ProgeNIA, Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Lanusei, Italy
| | | | - Francesco Cucca
- Istituto di Ricerca Biomedica e Genetica, Consiglio Nazionale delle Ricerche, Monserrato (Cagliari), Italy.,Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, Sassari, Italy
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.,Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Antonello Pani
- Struttura complessa di Nefrologia e Dialisi, Azienda Ospedaliera G. Brotzu, Cagliari, Italy.,Istituto di Ricerca Biomedica e Genetica, Consiglio Nazionale delle Ricerche, Monserrato (Cagliari), Italy
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de Boer A, Harteveld AA, Stemkens B, Blankestijn PJ, Bos C, Franklin SL, Froeling M, Joles JA, Verhaar MC, van den Berg N, Hoogduin H, Leiner T. Multiparametric Renal MRI: An Intrasubject Test-Retest Repeatability Study. J Magn Reson Imaging 2020; 53:859-873. [PMID: 32297700 PMCID: PMC7891585 DOI: 10.1002/jmri.27167] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 12/13/2022] Open
Abstract
Background Renal multiparametric magnetic resonance imaging (MRI) is a promising tool for diagnosis, prognosis, and treatment monitoring in kidney disease. Purpose To determine intrasubject test–retest repeatability of renal MRI measurements. Study Type Prospective. Population Nineteen healthy subjects aged over 40 years. Field Strength/Sequences T1 and T2 mapping, R2* mapping or blood oxygenation level‐dependent (BOLD) MRI, diffusion tensor imaging (DTI), and intravoxel incoherent motion (IVIM) diffusion‐weighted imaging (DWI), 2D phase contrast, arterial spin labelling (ASL), dynamic contrast enhanced (DCE) MRI, and quantitative Dixon for fat quantification at 3T. Assessment Subjects were scanned twice with ~1 week between visits. Total scan time was ~1 hour. Postprocessing included motion correction, semiautomated segmentation of cortex and medulla, and fitting of the appropriate signal model. Statistical Test To assess the repeatability, a Bland–Altman analysis was performed and coefficients of variation (CoVs), repeatability coefficients, and intraclass correlation coefficients were calculated. Results CoVs for relaxometry (T1, T2, R2*/BOLD) were below 6.1%, with the lowest CoVs for T2 maps and highest for R2*/BOLD. CoVs for all diffusion analyses were below 7.2%, except for perfusion fraction (FP), with CoVs ranging from 18–24%. The CoV for renal sinus fat volume and percentage were both around 9%. Perfusion measurements were most repeatable with ASL (cortical perfusion only) and 2D phase contrast with CoVs of 10% and 13%, respectively. DCE perfusion had a CoV of 16%, while single kidney glomerular filtration rate (GFR) had a CoV of 13%. Repeatability coefficients (RCs) ranged from 7.7–87% (lowest/highest values for medullary mean diffusivity and cortical FP, respectively) and intraclass correlation coefficients (ICCs) ranged from −0.01 to 0.98 (lowest/highest values for cortical FP and renal sinus fat volume, respectively). Data Conclusion CoVs of most MRI measures of renal function and structure (with the exception of FP and perfusion as measured by DCE) were below 13%, which is comparable to standard clinical tests in nephrology. Level of Evidence 2 Technical Efficacy Stage 1
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Affiliation(s)
- Anneloes de Boer
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anita A Harteveld
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bjorn Stemkens
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Clemens Bos
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Suzanne L Franklin
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Radiology, C.J. Gorter Center for High Field MRI, Leiden University Medical Center, Leiden, The Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jaap A Joles
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nico van den Berg
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hans Hoogduin
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Cobb RJ, Thorpe RJ, Norris KC. Everyday Discrimination and Kidney Function Among Older Adults: Evidence From the Health and Retirement Study. J Gerontol A Biol Sci Med Sci 2020; 75:517-521. [PMID: 31838487 PMCID: PMC7021634 DOI: 10.1093/gerona/glz294] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND With advancing age, there is an increase in the time of and number of experiences with psychosocial stressors that may lead to the initiation and/or progression of chronic kidney disease (CKD). Our study tests whether one type of experience, everyday discrimination, predicts kidney function among middle and older adults. METHODS The data were from 10 973 respondents (ages 52-100) in the 2006/2008 Health and Retirement Study, an ongoing biennial nationally representative survey of older adults in the United States. Estimated glomerular filtration rate (eGFR) derives from the Chronic Kidney Disease Epidemiology Collaboration equation. Our indicator of everyday discrimination is drawn from self-reports from respondents. Ordinary Least Squared regression (OLS) models with robust standard errors are applied to test hypotheses regarding the link between everyday discrimination and kidney function. RESULTS Everyday discrimination was associated with poorer kidney function among respondents in our study. Respondents with higher everyday discrimination scores had lower eGFR after adjusting for demographic characteristics (B = -1.35, p < .05), and while attenuated, remained significant (B = -0.79, p < .05) after further adjustments for clinical, health behavior, and socioeconomic covariates. CONCLUSIONS Our study suggests everyday discrimination is independently associated with lower eGFR. These findings highlight the importance of psychosocial factors in predicting insufficiency in kidney function among middle-aged and older adults.
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Affiliation(s)
- Ryon J Cobb
- School of Social Work,The University of Texas at Arlington, TX
| | - Roland J Thorpe
- Johns Hopkins Center for Health Disparities Solutions, Baltimore, MD
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Lal H, Singh P, Yadav P, Singh A, Singh UP, Sureka SK, Kapoor R. Role of preoperative MR volumetry in patients with renal cell carcinoma for prediction of postoperative renal function after radical nephrectomy and nephron sparing surgery. Int Braz J Urol 2020; 46:234-241. [PMID: 32022512 PMCID: PMC7025851 DOI: 10.1590/s1677-5538.ibju.2019.0217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 10/22/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Preoperative computed tomography or magnetic resonance (MR) imaging are commonly used for radiological evaluation of renal cell carcinoma (RCC) before radical nephrectomy or nephron sparing surgery(NSS). This study aimed to assess the role of MRI for predicting postoperative renal function by preoperative estimation of renal parenchymal volume and correlation with glomerular filtration rate (GFR). Materials and Methods A prospective observational study was conducted from February 2015 to October 2016 at a tertiary care hospital in northern India. MR imaging was done on 3 Tesla MR scanner (Signa Hdxt General Electrics, Milwaukee, USA). MR volumetry was used to estimate the renal parenchymal volume. GFR was measured in all patients using Tc99m Diethyl-triamine-penta-acetic acid using Russell’s algorithm. Such measurement was done preoperatively, and postoperatively 3 months after surgery. Results 30 patients with suspected RCC underwent NSS (n=10) and radical nephrectomy (n=20). Median tumour volume was 175.7cc (range: 4.8 to 631.8cc). The median volume of the residual parenchyma on the affected side was 84.25±41.97cc while that on the unaffected side was 112.25±26.35cc. There was good correlation among the unaffected kidney volume and postoperative GFR for the radical nephrectomy group (r=0.83) as well as unaffected kidney volume, total residual kidney volume and residual volume of affected kidney with postoperative GFR for the NSS group (r=0.71, r=0.73, r=0.79 respectively; P <0.05). Conclusion Preoperative residual parenchymal volume on MR renal volumetry correlates well with postoperative GFR in patients with RCC undergoing radical nephrectomy or NSS.
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Affiliation(s)
- Hira Lal
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Paritosh Singh
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Priyank Yadav
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anuradha Singh
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Uday P Singh
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sanjoy K Sureka
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Rakesh Kapoor
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Estimation of nephron number in living humans by combining unenhanced computed tomography with biopsy-based stereology. Sci Rep 2019; 9:14400. [PMID: 31591408 PMCID: PMC6779756 DOI: 10.1038/s41598-019-50529-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/10/2019] [Indexed: 12/22/2022] Open
Abstract
Methods for estimating nephron number in a clinical setting may be useful for predicting renal outcomes. This study aimed to establish such a method using unenhanced computed tomography (CT) and biopsy-based stereology. Patients or living kidney donors simultaneously subjected to enhanced and unenhanced CT examinations were randomly assigned to development and validation groups. The enhanced CT-measured arterial phase and the venous phase images of kidneys were regarded as the true values for cortical volume and parenchymal volume, respectively. Linear multiple regression analysis was used to create models for estimating cortical volume using explanatory variables including unenhanced CT-measured parenchymal volume. Nephron number was determined as the product of cortical volume and the glomerular density in biopsies of donors. Five equations for estimating cortical volume were created and verified. In donors, estimated nephron number by unenhanced CT was consistent with that by enhanced CT, with minimal errors in all models (636–655 ± 210–219 vs. 648 ± 224 × 103/kidney). Clinical characteristics combined with parenchymal volume did not improve the equation over parenchymal volume alone. These results support the feasibility of estimating nephron number by a combination of unenhanced CT and biopsy-based stereology, with a possible application for renal disease patients who are often not suitable for contrast media.
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24
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Matsuo M, Yamagishi F, Higuchi A. A Pilot Study of Prediction of Creatinine Clearance by Ellipsoid Volumetry of Kidney Using Noncontrast Computed Tomography. JMA J 2019; 2:60-66. [PMID: 33681514 PMCID: PMC7930707 DOI: 10.31662/jmaj.2018-0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/17/2018] [Indexed: 12/17/2022] Open
Abstract
Introduction Aging is associated with a decline in kidney volume and function. The purpose of this study is to investigate a direct relationship between kidney volume and function in the elderly population and to challenge whether kidney function could be predictable by using the kidney volume. Methods We conducted a chart review of 366 patients who underwent abdominal computed tomography (CT) and renal function measurement prior to gastrointestinal surgery. The kidney volume was calculated by the ellipsoid method using a coronal section of noncontrast CT images. Results The patients were 72.2 ± 13.2 years of age, and 39.0% were female. Their average measured creatinine clearance (mCCr) was 72.0 ± 21.5 mL/min. The average kidney volume was 100.3 ± 27.6 cm3 in the right kidney and 109.3 ± 30.9 cm3 in the left. There was a significant positive correlation between the total kidney volume and mCCr. Multivariate regression analysis showed that age, diabetes mellitus, and total kidney volume were dependent variables with which to predict mCCr. The use of total kidney volume predicted mCCr of ≥50 mL/min with moderate accuracy (area under the curve = 0.782; 95% confidence interval = 0.692-0.871). Conclusions These results indicate a direct relationship between kidney volume and function in the elderly and might provide a pilot method which estimates the renal function using kidney morphology obtained from pre-existing CT images.
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Affiliation(s)
- Mitsuhiro Matsuo
- Department of Internal Medicine, Itoigawa General Hospital, Itoigawa, Niigata, Japan
| | - Fuminori Yamagishi
- Department of Surgery, Itoigawa General Hospital, Itoigawa, Niigata, Japan
| | - Akiko Higuchi
- Department of Internal Medicine, Itoigawa General Hospital, Itoigawa, Niigata, Japan
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Maxwell AD, MacConaghy B, Harper JD, Aldoukhi AH, Hall TL, Roberts WW. Simulation of Laser Lithotripsy-Induced Heating in the Urinary Tract. J Endourol 2019; 33:113-119. [PMID: 30585741 DOI: 10.1089/end.2018.0485] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Holmium laser lithotripsy is a common modality used to fragment urinary stones during ureteroscopy. Laser energy deposited during activation produces heat and potentially causes thermal bioeffects. We aimed to characterize laser-induced heating through a computational simulation. MATERIALS AND METHODS A finite-element model was developed and used to estimate temperature in the urinary tract. Axisymmetric models of laser lithotripsy in a renal calyx, the renal pelvis, and proximal ureter were created. Heat generation by laser and heat transfer were simulated under different laser powers between 5 and 40 W. Irrigation fluid flow was introduced at rates between 0 and 40 mL/min. The model was validated by comparison with previous in vitro temperature data in a test tube, then used to calculate heating and thermal dose in the three tissue models. RESULTS Simulated temperature rises agreed well with most in vitro experimental measurements. In tissue models, temperature rises depended strongly on laser power and irrigation rate, and to a lesser extent on location. Injurious temperatures were reached for 5-40 W laser power without irrigation, >10 W with 5 mL/min irrigation, 40 W with 15 mL/min irrigation, and were not found at 40 mL/min irrigation. Tissue injury volumes up to 2.3 cm3 were calculated from thermal dose. CONCLUSIONS The results suggest a numerical model can accurately simulate the thermal profile of laser lithotripsy. Laser heating is strongly dependent on parameters and may cause a substantial temperature rise in the fluid in the urinary tract and surrounding tissue under clinically relevant conditions.
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Affiliation(s)
- Adam D Maxwell
- 1 Department of Urology, University of Washington School of Medicine, Seattle, Washington.,2 Applied Physics Laboratory, University of Washington, Seattle, Washington
| | - Brian MacConaghy
- 2 Applied Physics Laboratory, University of Washington, Seattle, Washington
| | - Jonathan D Harper
- 1 Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Ali H Aldoukhi
- 3 Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Timothy L Hall
- 4 Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| | - William W Roberts
- 3 Department of Urology, University of Michigan, Ann Arbor, Michigan.,4 Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
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Lauerman MH, Raithel M, Kufera J, Shanmuganathan K, Bruns BR, Scalea TM, Stein DM. Comparison of individual and composite radiographic markers of frailty in trauma. Injury 2019; 50:149-155. [PMID: 30446256 DOI: 10.1016/j.injury.2018.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/17/2018] [Accepted: 11/02/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Clinical frailty scores usually involve questionnaires or physical testing. Many trauma patients are not able to participate in these. Radiographic measurement of frailty may be a viable alternative. Individual radiographic markers of frailty have been investigated, such as sarcopenia or osteopenia. The ideal radiographic variable (or variables) to measure frailty in trauma is unknown. STUDY DESIGN A retrospective review was performed of restrained drivers ages 40 and greater at a single institution from 2010-2015. Multiple markers of radiographic frailty were measured including: sarcopenia, osteopenia, vascular calcifications, sarcopenic obesity, emphysema, renal volume, cervical spine degeneration, and cerebral atrophy. Frailty was defined as the worst quartile for each radiographic variable, and these values were summed to create a composite marker of frailty. The primary outcome was discharge disposition. We hypothesized that a composite frailty score would be associated with discharge disposition while individual markers would not be associated with discharge disposition. RESULTS Overall 489 patients were included in this study. Cerebral atrophy (p = 0.05), renal volume (p = 0.004), sarcopenia (p = 0.05), vascular calcifications (p = 0.02) and sarcopenic obesity (p = 0.01) were associated with discharge disposition. Pearson's correlation coefficients between radiographic frailty markers were all less than 0.4. Youden's Index was 0.26 (p < 0.001) at a composite score of 3. In multivariable analysis, the composite score of 3 or greater was associated with poor discharge disposition (OR 2.39, 95% CI 1.10-5.18, p = 0.03). CONCLUSIONS Individual radiographic frailty markers are inadequate markers of frailty, as they may miss patients who are frail. This study also suggests that a composite radiographic frailty score may better predict patient outcome than individual radiographic markers of frailty.
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Affiliation(s)
- Margaret H Lauerman
- Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, 22 South Greene St, Baltimore, MD, 21201, USA.
| | - Maxwell Raithel
- Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, 22 South Greene St, Baltimore, MD, 21201, USA.
| | - Joseph Kufera
- Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, 22 South Greene St, Baltimore, MD, 21201, USA.
| | - Kathirkamanathan Shanmuganathan
- Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, 22 South Greene St, Baltimore, MD, 21201, USA.
| | - Brandon R Bruns
- Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, 22 South Greene St, Baltimore, MD, 21201, USA.
| | - Thomas M Scalea
- Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, 22 South Greene St, Baltimore, MD, 21201, USA.
| | - Deborah M Stein
- Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, 22 South Greene St, Baltimore, MD, 21201, USA.
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Chen FM, Hu RJ, Jiang XN, Zhong SW, Tang S. The correlation between affected renal function and affected renal residual volume: A retrospective outcome of laparoscopic nephron-sparing partial nephrectomy with segmental renal artery blocking-up for localized renal tumors. Medicine (Baltimore) 2019; 98:e13927. [PMID: 30633167 PMCID: PMC6336637 DOI: 10.1097/md.0000000000013927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Laparoscopic nephron-sparing partial nephrectomy with segmental renal artery blocking (SRPN) has been widely used in the treatment of localized renal tumors. However, the impact of ischemia-reperfusion injury (IRI) during SRPN remains controversial. This study aims to evaluate the correlation between affected renal function and affected renal volume after SRPN for localized renal tumor treatment, explore the effect of IRI on renal function after SRPN.A total of 39 patients who underwent SRPN for localized renal tumor from June 2009 to April 2012 were reviewed. These patients were followed-up for 5 years. The preoperative affected renal glomerular filtration rate (aGFRpre), postoperative affected renal glomerular filtration rate (aGFRpost), preoperative affected renal volume (aVolpre), and postoperative affected renal volume (aVolpost) were collected during the follow-up period. The correlation between aGFRpost/aGFRpre and aVolpost/aVolpre was compared.A total of 33 patients were successfully followed up. After 3, 6, 12, 24, and 60 months, aGFRpost was 34.6 ± 4.6, 34.7 ± 4.8, 34.9 ± 4.4, 35.1 ± 4.4, and 35.2 ± 4.2 mL/min. The correlation coefficients between aGFRpost/aGFRpre and aVolpost/aVolpre were 0.659 (P = .000), 0.667 (P = .000), 0.663 (P = .000), 0.629 (P = .000), and 0.604 (P = .000), respectively. The limitation of this study was the small cohort size.For the localized renal tumor, aGFRpost was associated with aVolpost, but was not associated with intraoperative factors, such as the time of clamping of the affected segmental renal artery. As a part of nephrons, the resected tumor tissue caused the lack of inherent nephrons, resulting in the loss of renal function. More nephrons should be maintained before resecting the tumor completely during SRPN.Trial registration: ChiCTR-RRC-17011418.
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Affiliation(s)
- Fang-Min Chen
- Department of Urology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Artificial Cell; Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin
| | - Rui-Jie Hu
- The First People's Hospital of Jiujiang City, Jiujiang, Jiangxi
| | - Xi-Nan Jiang
- Department of Urology, Affliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Si-Wen Zhong
- Department of Urology, Affliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Shuai Tang
- Department of Urology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Artificial Cell; Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin
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Saad M, Ellis CL, O'Neill WC. Renal Hypertrophy in Liver Failure. Kidney Int Rep 2018; 3:1464-1467. [PMID: 30450472 PMCID: PMC6224664 DOI: 10.1016/j.ekir.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Marc Saad
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Carla L Ellis
- Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - W Charles O'Neill
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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29
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Li Q, Wang D, Zhu X, Shen K, Xu F, Chen Y. Combination of renal apparent diffusion coefficient and renal parenchymal volume for better assessment of split renal function in chronic kidney disease. Eur J Radiol 2018; 108:194-200. [DOI: 10.1016/j.ejrad.2018.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 12/18/2022]
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Roseman DA, Hwang SJ, Oyama-Manabe N, Chuang ML, O'Donnell CJ, Manning WJ, Fox CS. Clinical associations of total kidney volume: the Framingham Heart Study. Nephrol Dial Transplant 2018; 32:1344-1350. [PMID: 27325252 DOI: 10.1093/ndt/gfw237] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 05/18/2016] [Indexed: 01/01/2023] Open
Abstract
Background Total kidney volume (TKV) is an imaging biomarker that may have diagnostic and prognostic utility. The relationships between kidney volume, renal function and cardiovascular disease (CVD) have not been characterized in a large community-dwelling population. This information is needed to advance the clinical application of TKV. Methods We measured TKV in 1852 Framingham Heart Study participants (mean age 64.1 ± 9.2 years, 53% women) using magnetic resonance imaging. A healthy sample was used to define reference values. The associations between TKV, renal function and CVD risk factors were determined using multivariable logistic regression analysis. Results Overall, mean TKV was 278 ± 54 cm3 for women and 365 ± 66 cm3 for men. Risk factors for high TKV (>90% healthy referent size) were body surface area (BSA), diabetes, smoking and albuminuria, while age, female and estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 were protective. Participants with high TKV had higher odds of diabetes [odds ratio (OR) 2.15, P < 0.001] and lower odds of eGFR <60 mL/min/1.73 m2 (OR 0.32, P = 0.007). Risk factors for low TKV (<10% healthy referent size) were age, female and eGFR <60 mL/min/1.73 m2, while BSA and diabetes were protective. Participants with low TKV had higher odds of eGFR <60 mL/min/1.73 m2 (OR 6.12, P < 0.001) and albuminuria (OR 1.56, P = 0.03). Conclusions Low TKV is associated with markers of kidney damage including albuminuria and eGFR <60 mL/min/1.73 m2, while high TKV is associated with diabetes and decreased odds of eGFR <60 mL/min/1.73 m2. Prospective studies are needed to characterize the natural progression and clinical consequences of TKV.
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Affiliation(s)
- Daniel A Roseman
- National Heart, Lung and Blood Institute, Framingham Heart Study, Framingham, MA, USA
| | - Shih-Jen Hwang
- National Heart, Lung and Blood Institute, Framingham Heart Study, Framingham, MA, USA.,Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Michael L Chuang
- National Heart, Lung and Blood Institute, Framingham Heart Study, Framingham, MA, USA.,Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Christopher J O'Donnell
- National Heart, Lung and Blood Institute, Framingham Heart Study, Framingham, MA, USA.,Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.,Cardiology Section, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Warren J Manning
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Caroline S Fox
- National Heart, Lung and Blood Institute, Framingham Heart Study, Framingham, MA, USA.,Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.,Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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31
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Steiner RW. Increased Single-Nephron GFR in Normal Adults: Too Much of a Good Thing . . . or Maybe Not? Am J Kidney Dis 2018; 71:312-314. [DOI: 10.1053/j.ajkd.2017.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 11/19/2017] [Indexed: 11/11/2022]
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32
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Xu J, Hwang S, Lee H, Chin H. Relationship of renal morphology on 3-dimensional ultrasonography with renal pathologic findings and outcome in biopsy-proven nephropathy. Exp Ther Med 2017; 15:2088-2096. [DOI: 10.3892/etm.2017.5626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 10/19/2017] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jianwei Xu
- Department of Internal Medicine, 12303 Seoul National University Bundang Hospital, Seongnam, Gyeonggi 13620, Republic of Korea
| | - Sung Hwang
- Department of Radiology, 12303 Seoul National University Bundang Hospital, Seongnam, Gyeonggi 13620, Republic of Korea
| | - Hak Lee
- Department of Radiology, 12303 Seoul National University Bundang Hospital, Seongnam, Gyeonggi 13620, Republic of Korea
| | - Ho Chin
- Department of Internal Medicine, 12303 Seoul National University Bundang Hospital, Seongnam, Gyeonggi 13620, Republic of Korea
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33
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Qiu C, Shao J, Liu X, Liu B. Utilizing flat-panel detector parenchymal blood volume imaging (FD-PBV) for quantitative kidney perfusion analysis during the process of percutaneous transluminal renal angioplasty (PTRA): A case report. Medicine (Baltimore) 2017; 96:e8654. [PMID: 29381939 PMCID: PMC5708938 DOI: 10.1097/md.0000000000008654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Traditional digital subtraction angiography (DSA) provides lumen morphology of renal artery as indicators for vascular patency in patients with renal artery stenosis (RAS). It, however, lacks hemodynamic information toward target kidney. To solve this shortcoming, a novel technique, flat-panel detector parenchymal blood volume imaging (FD-PBV), is introduced, which is able to evaluate hemodynamic changes of target kidney intraoperatively. PATIENTS CONCERNS A 77-year-old female presented with hypertension, intermittent dizziness, nausea, and fatigue. DIAGNOSES Ninety-nine percent stenosis of left RAS was found. INTERVENTIONS Percutaneous transluminal renal angioplasty was performed, along with FD-PBV acquisition protocol. OUTCOMES Her symptoms relieved gradually after procedure. Intuitive FD-PBV maps showed her renal perfusion improved remarkably. Quantitative analysis of FD-PBV showed her kidney volume was 47.02 and 75.61 cm with average density of contrast medium (CM) 58.1 HU and 311.5 HU before and after stenting. Follow-up at 6 months showed patency of the stent and stable kidney blood perfusion. LESSONS FD-PBV technique possesses a remarkable value in quantitatively assessing the changes of kidney blood perfusion and can be a useful auxiliary technique for DSA.
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van der Sande NG, Visseren FL, van der Graaf Y, Nathoe HM, de Borst GJ, Leiner T, Blankestijn PJ. Relation between Kidney Length and Cardiovascular and Renal Risk in High-Risk Patients. Clin J Am Soc Nephrol 2017; 12:921-928. [PMID: 28487344 PMCID: PMC5460708 DOI: 10.2215/cjn.08990816] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 02/15/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Kidney length is often measured during routine abdominal ultrasonography and may be of use to identify patients at high vascular and renal risk. We aimed to explore patient characteristics related to kidney length, from which reference values were derived, and evaluate the relationship between kidney length and the risk of cardiovascular events and ESRD in high-risk patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The study population consisted of 10,251 patients with clinical manifest arterial disease or vascular risk factors included in the Second Manifestations of ARTerial disease (SMART) Study cohort between 1996 and 2014. Linear regression was used to explore patient characteristics of kidney length. The relationship between kidney length and cardiovascular events (myocardial infarction, stroke, and cardiovascular mortality), all-cause mortality, and ESRD was analyzed using Cox regression. Kidney length was analyzed in tertiles, using the second tertile as the reference category. RESULTS Kidney length was strongly correlated with body surface area (2.04 mm; 95% confidence interval [95% CI], 1.95 to 2.13 per 0.1 m2 increase) and eGFR (1.62 mm; 95% CI, 1.52 to 1.73 per 10 ml/min per 1.73 m2 increase). During the median follow-up of 6.3 years, 1317 patients experienced a cardiovascular event, including 711 myocardial infarctions, 369 strokes, and 735 vascular cause deaths. A total of 1462 patients died of any cause and 52 patients developed ESRD. Irrespective of eGFR, patients in the third tertile of kidney length (11.7-16.1 cm) were at higher risk of cardiovascular mortality (hazard ratio, 1.33; 95% CI, 1.05 to 1.67) and cardiovascular events (hazard ratio, 1.28; 95% CI, 1.09 to 1.50). Patients in the first tertile of kidney length (7.8-10.8 cm) were not at higher risk of cardiovascular adverse events. CONCLUSIONS Large kidney length is related to higher risk of cardiovascular events and mortality in high-risk patients, irrespective of eGFR. Kidney length may serve as a clinical marker to further identify patients at high cardiovascular risk.
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Affiliation(s)
| | | | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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35
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Ichii T, Morimoto R, Okumura T, Ishii H, Tatami Y, Yamamoto D, Aoki S, Hiraiwa H, Furusawa K, Kondo T, Watanabe N, Kano N, Fukaya K, Sawamura A, Suzuki S, Yasuda Y, Murohara T. Impact of Renal Functional/Morphological Dynamics on the Calcification of Coronary and Abdominal Arteries in Patients with Chronic Kidney Disease. J Atheroscler Thromb 2017; 24:1092-1104. [PMID: 28392544 PMCID: PMC5684475 DOI: 10.5551/jat.39271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aim: Fast-progressing vascular calcification (VC) is accompanied by renal atrophy and functional deterioration along with atherosclerosis in patients with chronic kidney disease (CKD). However, the relationship between VC progression and renal functional and/or morphological changes remains unclear. Methods: We included 70 asymptomatic patients with CKD without hemodialysis in our study. To identify temporal variations, the coronary artery calcification score (CACS), abdominal aortic calcification index (ACI), and renal parenchymal volume index (RPVI) were determined via spiral computed tomography scans taken during the study. We investigated significant factors related to annualized variations of CACS (ΔCACS/y) and ACI (ΔACI/y). Results: During the follow-up period (4.6 years), median values of CACS [in Agatston units (AU)] and ACI increased from 40.2 to 113.3 AU (p = 0.053) and from 13.2 to 21.7% (p = 0.036), respectively. Multivariate analysis revealed that CACS at baseline (p < 0.001) and diabetes mellitus (DM) status (p = 0.037) for ΔCACS/y and ACI at baseline (p = 0.017) and hypertension (HT) status (p = 0.046) for ΔACI/y were significant independent predictors. Furthermore, annualized RPVI variation was significantly related to both ΔCACS/y and ΔACI/y (R = −0.565, p < 0.001, and R = −0.289, p = 0.015, respectively). On the other hand, independent contributions of the estimated glomerular filtration rate (eGFR) and annualized eGFR variation to VC progression were not confirmed. Conclusion: The degree of VC at baseline, DM, HT, and changes in renal volume, but not eGFR, had a strong impact on VC progression in patients with CKD.
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Affiliation(s)
- Takeo Ichii
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Ryota Morimoto
- Department of Cardiology, Nagoya University Graduate School of Medicine.,Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Yosuke Tatami
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Dai Yamamoto
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Soichiro Aoki
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Hiroaki Hiraiwa
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Naoki Watanabe
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Naoaki Kano
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kenji Fukaya
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Akinori Sawamura
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Susumu Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Yoshinari Yasuda
- Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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Narasimhamurthy M, Smith LM, Machan JT, Reinert SE, Gohh RY, Dworkin LD, Merhi B, Patel N, Beland MD, Hu SL. Does size matter? Kidney transplant donor size determines kidney function among living donors. Clin Kidney J 2017; 10:116-123. [PMID: 28638611 PMCID: PMC5469570 DOI: 10.1093/ckj/sfw097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/16/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Kidney donor outcomes are gaining attention, particularly as donor eligibility criteria continue to expand. Kidney size, a useful predictor of recipient kidney function, also likely correlates with donor outcomes. Although donor evaluation includes donor kidney size measurements, the association between kidney size and outcomes are poorly defined. METHODS We examined the relationship between kidney size (body surface area-adjusted total volume, cortical volume and length) and renal outcomes (post-operative recovery and longer-term kidney function) among 85 kidney donors using general linear models and time-to-chronic kidney disease data. RESULTS Donors with the largest adjusted cortical volume were more likely to achieve an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 over a median 24-month follow-up than those with smaller cortical volumes (P <0.001), had a shorter duration of renal recovery (1.3-2.2 versus 32.5 days) and started with a higher eGFR at pre-donation (107-110 versus 91 mL/min/1.73 m2) and immediately post-nephrectomy (∼63 versus 50-51 mL/min/1.73 m2). Similar findings were seen with adjusted total volume and length. CONCLUSIONS Larger kidney donors were more likely to achieve an eGFR ≥60 mL/min/1.73 m2 with renal recovery over a shorter duration due to higher pre-donation and initial post-nephrectomy eGFRs.
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Affiliation(s)
- Meenakshi Narasimhamurthy
- Division of Kidney Disease and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Lachlan M. Smith
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Jason T. Machan
- Biostatistics Core, Lifespan Hospital System, Departments of Orthopedic and Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Steven E. Reinert
- Lifespan Information Services, Lifespan Hospital System, Providence, RI, USA
| | - Reginald Y. Gohh
- Division of Renal Transplantation, Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Lance D. Dworkin
- Division of Kidney Disease and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Basma Merhi
- Division of Kidney Disease and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Nikunjkumar Patel
- Division of Kidney Disease and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Michael D. Beland
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Susie L. Hu
- Division of Kidney Disease and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
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37
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Denic A, Glassock RJ, Rule AD. Structural and Functional Changes With the Aging Kidney. Adv Chronic Kidney Dis 2016. [PMID: 26709059 DOI: 10.1053/h.ackd.2015.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Senescence or normal physiologic aging portrays the expected age-related changes in the kidney as compared to a disease that occurs in some but not all individuals. The microanatomical structural changes of the kidney with older age include a decreased number of functional glomeruli from an increased prevalence of nephrosclerosis (arteriosclerosis, glomerulosclerosis, and tubular atrophy with interstitial fibrosis), and to some extent, compensatory hypertrophy of remaining nephrons. Among the macroanatomical structural changes, older age associates with smaller cortical volume, larger medullary volume until middle age, and larger and more numerous kidney cysts. Among carefully screened healthy kidney donors, glomerular filtration rate (GFR) declines at a rate of 6.3 mL/min/1.73 m(2) per decade. There is reason to be concerned that the elderly are being misdiagnosed with CKD. Besides this expected kidney function decline, the lowest risk of mortality is at a GFR of ≥75 mL/min/1.73 m(2) for age <55 years but at a lower GFR of 45 to 104 mL/min/1.73 m(2) for age ≥65 years. Changes with normal aging are still of clinical significance. The elderly have less kidney functional reserve when they do actually develop CKD, and they are at higher risk for acute kidney injury.
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Affiliation(s)
- Aleksandar Denic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Department of Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA; and Division of Nephrology and Hypertension, Division of Epidemiology, Mayo Clinic, Rochester, MN
| | - Richard J Glassock
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Department of Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA; and Division of Nephrology and Hypertension, Division of Epidemiology, Mayo Clinic, Rochester, MN
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Department of Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA; and Division of Nephrology and Hypertension, Division of Epidemiology, Mayo Clinic, Rochester, MN.
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Barbas AS, Li Y, Zair M, Van JA, Famure O, Dib MJ, Laurence JM, Kim SJ, Ghanekar A. CT volumetry is superior to nuclear renography for prediction of residual kidney function in living donors. Clin Transplant 2016; 30:1028-35. [DOI: 10.1111/ctr.12784] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2016] [Indexed: 01/29/2023]
Affiliation(s)
- Andrew S. Barbas
- Kidney Transplant Program; Toronto General Hospital; University Health Network; Toronto Canada
- Division of General Surgery; University Health Network; Toronto Canada
- Department of Surgery; University of Toronto; Toronto Canada
| | - Yanhong Li
- Kidney Transplant Program; Toronto General Hospital; University Health Network; Toronto Canada
| | - Murtuza Zair
- Kidney Transplant Program; Toronto General Hospital; University Health Network; Toronto Canada
| | - Julie A. Van
- Kidney Transplant Program; Toronto General Hospital; University Health Network; Toronto Canada
| | - Olusegun Famure
- Kidney Transplant Program; Toronto General Hospital; University Health Network; Toronto Canada
| | - Martin J. Dib
- Kidney Transplant Program; Toronto General Hospital; University Health Network; Toronto Canada
- Division of General Surgery; University Health Network; Toronto Canada
- Department of Surgery; University of Toronto; Toronto Canada
| | - Jerome M. Laurence
- Kidney Transplant Program; Toronto General Hospital; University Health Network; Toronto Canada
- Division of General Surgery; University Health Network; Toronto Canada
- Department of Surgery; University of Toronto; Toronto Canada
| | - S. Joseph Kim
- Kidney Transplant Program; Toronto General Hospital; University Health Network; Toronto Canada
- Division of Nephrology; University Health Network; Toronto Canada
- Department of Medicine; University of Toronto; Toronto Canada
| | - Anand Ghanekar
- Kidney Transplant Program; Toronto General Hospital; University Health Network; Toronto Canada
- Division of General Surgery; University Health Network; Toronto Canada
- Department of Surgery; University of Toronto; Toronto Canada
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39
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Gonzalez-Heredia R, Patel N, Masrur M, Murphey M, Patton K, Elli EF. Does Bariatric Surgery Improve Renal Function? Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2015.0032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Raquel Gonzalez-Heredia
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois, Chicago, Illinois
| | - Neil Patel
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois, Chicago, Illinois
| | - Mario Masrur
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois, Chicago, Illinois
| | - Melissa Murphey
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois, Chicago, Illinois
| | - Kristin Patton
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois, Chicago, Illinois
| | - Enrique F. Elli
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois, Chicago, Illinois
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40
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Denic A, Alexander MP, Kaushik V, Lerman LO, Lieske JC, Stegall MD, Larson JJ, Kremers WK, Vrtiska TJ, Chakkera HA, Poggio ED, Rule AD. Detection and Clinical Patterns of Nephron Hypertrophy and Nephrosclerosis Among Apparently Healthy Adults. Am J Kidney Dis 2016; 68:58-67. [PMID: 26857648 DOI: 10.1053/j.ajkd.2015.12.029] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/28/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Even among ostensibly healthy adults, there is often mild pathology in the kidney. The detection of kidney microstructural variation and pathology by imaging and the clinical pattern associated with these structural findings is unclear. STUDY DESIGN Cross-sectional (clinical-pathologic correlation). SETTING & PARTICIPANTS Living kidney donors at Mayo Clinic (Minnesota and Arizona sites) and Cleveland Clinic 2000 to 2011. PREDICTORS Predonation kidney function, risk factors, and contrast computed tomographic scan of the kidneys. These scans were segmented for cortical volume and medullary volume, reviewed for parenchymal cysts, and scored for kidney surface roughness. OUTCOMES Nephrosclerosis (glomerulosclerosis, interstitial fibrosis/tubular atrophy, and arteriosclerosis) and nephron size (glomerular volume, mean profile tubular area, and cortical volume per glomerulus) determined from an implantation biopsy of the kidney cortex at donation. RESULTS Among 1,520 living kidney donors, nephrosclerosis associated with increased kidney surface roughness, cysts, and smaller cortical to medullary volume ratio. Larger nephron size (nephron hypertrophy) associated with larger cortical volume. Nephron hypertrophy and larger cortical volume associated with higher systolic blood pressure, glomerular filtration rate, and urine albumin excretion; larger body mass index; higher serum uric acid level; and family history of end-stage renal disease. Both nephron hypertrophy and nephrosclerosis associated with older age and mild hypertension. The net effect of both nephron hypertrophy and nephrosclerosis associating with cortical volume was that nephron hypertrophy diminished volume loss with age-related nephrosclerosis and fully negated volume loss with mild hypertension-related nephrosclerosis. LIMITATIONS Kidney donors are selected on health, restricting the spectrum of pathologic findings. Kidney biopsies in living donors are a small tissue sample leading to imprecise estimates of structural findings. CONCLUSIONS Among apparently healthy adults, the microstructural findings of nephron hypertrophy and nephrosclerosis differ in their associations with kidney function, macrostructure, and risk factors.
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Affiliation(s)
- Aleksandar Denic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Mariam P Alexander
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Vidhu Kaushik
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Mark D Stegall
- Division of Transplant Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph J Larson
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Walter K Kremers
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
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41
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Hoey SE, Heder BL, Hetzel SJ, Waller KR. Use of computed tomography for measurement of kidneys in dogs without renal disease. J Am Vet Med Assoc 2016; 248:282-7. [DOI: 10.2460/javma.248.3.282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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42
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Biles MJ, DeCastro GJ, Woldu SL. Renal Function Following Nephron Sparing Procedures: Simply a Matter of Volume? Curr Urol Rep 2016; 17:8. [DOI: 10.1007/s11934-015-0561-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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43
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Denic A, Glassock RJ, Rule AD. Structural and Functional Changes With the Aging Kidney. Adv Chronic Kidney Dis 2016; 23:19-28. [PMID: 26709059 DOI: 10.1053/j.ackd.2015.08.004] [Citation(s) in RCA: 438] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 07/07/2015] [Accepted: 08/19/2015] [Indexed: 01/08/2023]
Abstract
Senescence or normal physiologic aging portrays the expected age-related changes in the kidney as compared to a disease that occurs in some but not all individuals. The microanatomical structural changes of the kidney with older age include a decreased number of functional glomeruli from an increased prevalence of nephrosclerosis (arteriosclerosis, glomerulosclerosis, and tubular atrophy with interstitial fibrosis), and to some extent, compensatory hypertrophy of remaining nephrons. Among the macroanatomical structural changes, older age associates with smaller cortical volume, larger medullary volume until middle age, and larger and more numerous kidney cysts. Among carefully screened healthy kidney donors, glomerular filtration rate (GFR) declines at a rate of 6.3 mL/min/1.73 m(2) per decade. There is reason to be concerned that the elderly are being misdiagnosed with CKD. Besides this expected kidney function decline, the lowest risk of mortality is at a GFR of ≥75 mL/min/1.73 m(2) for age <55 years but at a lower GFR of 45 to 104 mL/min/1.73 m(2) for age ≥65 years. Changes with normal aging are still of clinical significance. The elderly have less kidney functional reserve when they do actually develop CKD, and they are at higher risk for acute kidney injury.
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Repopulation of porcine kidney scaffold using porcine primary renal cells. Acta Biomater 2016; 29:52-61. [PMID: 26596567 DOI: 10.1016/j.actbio.2015.11.026] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 11/11/2015] [Accepted: 11/16/2015] [Indexed: 12/23/2022]
Abstract
The only definitive treatment for end stage renal disease is renal transplantation, however the current shortage of organ donors has resulted in a long list of patients awaiting transplant. Whole organ engineering based on decellularization/recellularization techniques has provided the possibility of creating engineered kidney constructs as an alternative to donor organ transplantation. Previous studies have demonstrated that small units of engineered kidney are able to maintain function in vivo. However, an engineered kidney with sufficient functional capacity to replace normal renal function has not yet been developed. One obstacle in the generation of such an organ is the development of effective cell seeding methods for robust colonization of engineered kidney scaffolds. We have developed cell culture methods that allow primary porcine renal cells to be efficiently expanded while maintaining normal renal phenotype. We have also established an effective cell seeding method for the repopulation of acellular porcine renal scaffolds. Histological and immunohistochemical analyses demonstrate that a majority of the expanded cells are proximal tubular cells, and the seeded cells formed tubule-like structures that express normal renal tubule phenotypic markers. Functional analysis revealed that cells within the kidney construct demonstrated normal renal functions such as re-adsorption of sodium and protein, hydrolase activity, and production of erythropoietin. These structural and functional outcomes suggest that engineered kidney scaffolds may offer an alternative to donor organ transplant. STATEMENT OF SIGNIFICANCE Kidney transplantation is the only definitive treatment for end stage renal disease, however the current shortage of organ donors has limited the treatment. Whole organ engineering based on decellularization/recellularization techniques has provided the possibility of creating engineered kidney constructs as an alternative to donor organ transplantation. While previous studies have shown that small units of engineered kidneys are able to maintain function in animal studies, engineering of kidneys with sufficient functional capacity to replace normal renal function is still challenging due to inefficient cell seeding methods. This study aims to establish an effective cell seeding method using pig kidney cells for the repopulation of acellular porcine kidney scaffolds, suggesting that engineered kidneys may offer an alternative to donor organ transplant.
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What Should the Serum Creatinine Be After Transplantation? An Approach to Integrate Donor and Recipient Information to Assess Posttransplant Kidney Function. Transplantation 2015; 99:1960-7. [DOI: 10.1097/tp.0000000000000622] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW Renal transplantation is currently the only definitive treatment for end-stage renal disease; however, this treatment is severely limited by the shortage of implantable kidneys. To address this shortcoming, development of an engineered, transplantable kidney has been proposed. Although current advances in engineering kidneys based on decellularization and recellularization techniques have offered great promises for the generation of functional kidney constructs, most studies have been conducted using rodent kidney constructs and short-term in-vivo evaluation. Toward clinical translations of this technique, several limitations need to be addressed. RECENT FINDINGS Human-sized renal scaffolds are desirable for clinical application, and the fabrication is currently feasible using native porcine and discarded human kidneys. Current progress in stem cell biology and cell culture methods have demonstrated feasibility of the use of embryonic stem cells, induced pluripotent stem cells, and primary renal cells as clinically relevant cell sources for the recellularization of renal scaffolds. Finally, approaches to long-term implantation of engineered kidneys are under investigation using antithrombogenic strategies such as functional reendothelialization of acellular kidney matrices. SUMMARY In the field of bioengineering, whole kidneys have taken a number of important initial steps toward clinical translations, but many challenges must be addressed to achieve a successful treatment for the patient with end-stage renal disease.
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Woldu SL, Thoreson GR, Okhunov Z, Ghandour R, Rothberg MB, RoyChoudhury A, Kim HH, Bozoghlanian M, Newhouse JH, Helmy MA, Badani KK, Landman J, Cadeddu JA, McKiernan JM. Comparison of Renal Parenchymal Volume Preservation Between Partial Nephrectomy, Cryoablation, and Radiofrequency Ablation Using 3D Volume Measurements. J Endourol 2015; 29:948-55. [DOI: 10.1089/end.2014.0866] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Solomon L. Woldu
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Gregory R. Thoreson
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Zhamshid Okhunov
- Department of Urology, University of California Irvine Medical Center, Irvine, California
| | - Rashed Ghandour
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Michael B. Rothberg
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Arindam RoyChoudhury
- Department of Biostatistics, Columbia University Medical Center, New York, New York
| | - Helen H.R. Kim
- Department of Radiology, University of California Irvine Medical Center, Irvine, California
| | - Mari Bozoghlanian
- Department of Radiology, University of California Irvine Medical Center, Irvine, California
| | - Jeffrey H. Newhouse
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - Mohammad A. Helmy
- Department of Radiology, University of California Irvine Medical Center, Irvine, California
| | - Ketan K. Badani
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Jamie Landman
- Department of Urology, University of California Irvine Medical Center, Irvine, California
| | - Jeffrey A. Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James M. McKiernan
- Department of Radiology, University of California Irvine Medical Center, Irvine, California
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Tatar E, Sen S, Harman M, Kircelli F, Gungor O, Sarsik B, Asci G, Hoscoskun C, Basci A, Toz H. The relationship between renal volume and histology in obese and nonobese kidney donors. Eur J Clin Invest 2015; 45:565-71. [PMID: 25845420 DOI: 10.1111/eci.12444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/28/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Obesity and related kidney diseases have become a global epidemic problem. However, the underlying pathogenesis of obesity-related renal diseases has not been clearly understood. In this study, we explored the link between renal volume (RV) determined by computed tomography (CT) and renal histology together with functional parameters in an obese population. MATERIALS AND METHODS Eighty-two kidney donors who underwent CT for the measurement of kidney volume and zero-hour renal biopsy for renal histology were included in this cross-sectional study. Protein creatinine clearance and eGFR were evaluated in 24-h urine specimens as indicators of renal function. RESULTS Mean body mass index (BMI) was 28 ± 4.2 kg/m(2); 32.9% (n = 27) were obese. Mean RV was 196 ± 36 cm(3). RV was positively correlated with BMI, body surface area and creatinine clearance and negatively with HDL-cholesterol in the whole population. Renal function parameters of obese subjects were better, and their renal volumes were higher compared with the nonobese subjects. In obese subjects, corrected RV was positively correlated with glomerular filtration rate (r = 0.46, P = 0.01) and negatively with sclerotic glomeruli (r = -0.38, P = 0.04) and chronicity index (r = -0.43, P = 0.02). In adjusted ordinal logistic regression analysis, corrected RV was significantly associated with chronicity index (OR: 0.96; P = 0.01). CONCLUSIONS In obese cases, decreased RV determined by CT is associated with worse renal histology. In this population, kidney imaging techniques may provide important clues about renal survival.
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Affiliation(s)
- Erhan Tatar
- Department of Nephrology, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Sait Sen
- Department of Patology, Ege University School of Medicine, Izmir, Turkey
| | - Mustafa Harman
- Department of Radiology, Ege University School of Medicine, Izmir, Turkey
| | - Fatih Kircelli
- Department of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Ozkan Gungor
- Department of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Banu Sarsik
- Department of Patology, Ege University School of Medicine, Izmir, Turkey
| | - Gulay Asci
- Department of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Cuneyt Hoscoskun
- Department of General Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Ali Basci
- Department of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Huseyin Toz
- Department of Nephrology, Ege University School of Medicine, Izmir, Turkey
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Abstract
Although kidney size can be important in the evaluation of renal disease, it has not been carefully studied and true volume is rarely measured, and good normative data are lacking. Wang et al. measured both cortical and medullary volumes in potential transplant donors and correlate these with physiologic, morphometric, and metabolic parameters. The results reveal interesting and potentially important correlations and differential responses between the two compartments, providing a framework for future investigation.
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Affiliation(s)
- W Charles O'Neill
- Renal Division, Emory University School of Medicine, Atlanta, Georgia, USA
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Martinez-Suarez HJ, Durso T, Kadlec AO, Gupta GN, Farooq AV, Turk T. Three-Dimensional Renal Parenchymal Volume as a Surrogate for Renal Function Estimation in Obstructed Kidneys Undergoing Surgical Repair. J Endourol 2014; 29:630-3. [PMID: 25456828 DOI: 10.1089/end.2014.0232] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To investigate the relationship between renal parenchymal volume (RPV) and renal function in obstructed kidneys using a novel three-dimensional (3D) volume-rendering technique. MATERIALS AND METHODS Forty-seven consecutive patients who underwent pyeloplasty, ureteroureterostomy, or ureteroneocystostomy at a single institution between 2007 and 2013 were reviewed. Patients with preoperative CT scan and split differential functional (SDF) assessment by diuretic renography were included. Those with solitary kidneys and bilateral obstruction were excluded. Baseline serum creatinine (Cr) and estimated glomerular filtration rate (eGFR) as calculated by the modification of diet in renal disease equation were determined. Percent of total RPV for the obstructed kidney was determined using 3D reconstruction software by drawing regions of interest around the borders of the kidney on CT. The renal pelvis, hilar vessels, and hilar fat were excluded. Percent of total RPV was then correlated with SDF. RESULTS Nineteen patients with both preoperative CT and diuretic renal scans were included. Two underwent ureteroneocystostomy, 1 underwent ureteroureterostomy, and 16 underwent pyeloplasty. Mean serum Cr was 1.07±0.26 mg/dL with a mean eGFR of 69.43±18.90 mL/minute. Mean SDF was 37.32%±11.66% in the obstructed kidneys. There was a statistically significant correlation between percent of total RPV and SDF (R(2)=0.28, p=0.02). CONCLUSIONS There is a significant correlation between percent total RPV determined by 3D reconstruction of CT scan images and SDF as determined by diuretic renography in obstructed kidneys. CT-based percent RPV has potential as a functional assessment tool in obstructed kidneys. With further validation, it may be used to counsel patients considering surgical repair of ureteral or ureteropelvic junction obstruction.
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Affiliation(s)
| | - Timothy Durso
- Department of Urology, Loyola University Medical Center , Maywood, Illinois
| | - Adam O Kadlec
- Department of Urology, Loyola University Medical Center , Maywood, Illinois
| | - Gopal N Gupta
- Department of Urology, Loyola University Medical Center , Maywood, Illinois
| | - Ahmer V Farooq
- Department of Urology, Loyola University Medical Center , Maywood, Illinois
| | - Thomas Turk
- Department of Urology, Loyola University Medical Center , Maywood, Illinois
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