Utilizing RENAL nephrometry in pediatric patients undergoing nephron-sparing surgery for renal tumors: A single-institutional cohort

INTRODUCTION

RENAL Nephrometry is a complexity score validated in adults with renal tumors and describes the likelihood of complication after partial nephrectomy (PN). Utilization in pediatrics has been limited. Thus, our goal is to quantify inter-rater agreement as well as determine how scores correlate with outcomes. We hypothesize that the RENAL Nephrometry Score is reproducible in children with renal tumors and is related to perioperative and post-operative complications.

METHODS

All pediatric patients who underwent PN for a renal mass from 2006 to 2019 were identified. Patient data, operative details, and outcomes were aggregated. Pre-operative CT/MR imaging was anonymized and scored by 2 pediatric radiologists and 2 pediatric urologists using RENAL Nephrometry metrics. Statistical analysis utilized Fleiss' kappa and the intraclass correlation coefficient (ICC). Comparative analyses were performed based on Nephrometry Score <9 and ≥ 9.

RESULTS

28 patients undergoing 33 PN were identified. Median age at surgery was 3.2 years (IQR 1.8-4.0). There is moderate-good agreement across scorers on the domains of RENAL Nephrometry Score, with the lowest agreement noted for anterior vs posterior tumors. Comparing patients with scores <9 and ≥ 9, there was increased operative time (357 vs 267 min, p = 0.003) and LOS for those with a higher score, but no difference in the incidence of 30-day complications.

CONCLUSION

RENAL Nephrometry Score is an easily reproducible complexity score for renal tumors in pediatric patients. Higher scores are associated with increased length of stay and estimated blood loss but not complications. Reporting of nephrometry scores in future publications on pediatric renal tumors should become standard in the literature.

Chemical composition of the essential oils of two Citrus species and their biological activities

Essential oils obtained by hydrodistillation of the fruit rinds of Citrus jambhiri Lush. (Rough lemon) and C. pyriformis Hassk (Ponderosa lemon) were analyzed by capillary gas chromatography (GLC/FID) and gas chromatography-mass spectrometry (GLC/MS). A total of 94 compounds were unambiguously identified from the oils and the (hexane/ether) extracts of the rind and juices representing 98.55% and 97.98% of the total oil composition. The main component of both oils was D-limonene (92.48% and 75.56% respectively). The antioxidant, anti-inflammatory, antitrypanosomal, antimicrobial and cytotoxic activities of the essential oils were evaluated. Whereas Citrus jambhiri and C. pyriformis have antioxidant activity with IC50 +/- SD 37.69 +/- 0.21 mg/ml and 28.91 +/- 0.09 mg/ml, respectively. Ascorbic acid a known potential inhibitor for DPPH free radical an commonly used antioxidant showed an antioxidant activity with an IC50 value of 16.32 +/- 0.161 g/mI. Both oils inhibited the activity of 5-lipoxygenase (5-LOX) with an IC50 of 40 +/- 1.63 and 38 +/- 0.82 microg/ml, respectively, and could be considered as interesting candidates for antiinflammatory agents. The essential oils of both species showed substantial antimicrobial activity against all tested Gram positive bacteria and yeasts. The essential oil of C. pyriformis showed higher cytotoxic activity against tested cell lines than that of C. jambhiri. The IC50 values were 374.36 +/- 43.95 microg/ml and 588.06 +/- 27.12 microg/ml in case of HepG2 cells and 213.87 +/- 18.50 microg/ml and 512.45 +/- 61.46 microg/ml in case of MIA-PaCa-2 cells, respectively.