Invasion of renal cell carcinoma into the renal vein has a detrimental effect on the prognosis as this is an important tumour dissemination route. Determination of renal vein invasion is vital to accurate pathological staging. The purpose of this study is to determine if perfusing with formalin and probing the veins of radical nephrectomy specimens allows for easier visualization of the veins and an improved diagnosis of vascular invasion. In this study, 28 radical nephrectomy specimens were examined using renal vein probing and perfusion techniques. The tumours were segregated based on size, Fuhrman grade and tumour type. Comparison of the study tumours versus renal tumours examined in 2009 that were not perfused and probed were based on these groupings. There was a trend to identifying more renal vein invasion, especially for tumours 4.1 to 7.0 cm in diameter, but this did not result in statistical significance in this small study group.

Invasion of renal cell carcinoma into the renal vein has a detrimental effect on the prognosis as this is an important tumour dissemination route. Determination of renal vein invasion is vital to accurate pathological staging. The purpose of this study is to determine if perfusing with formalin and probing the veins of radical nephrectomy specimens allows for easier visualization of the veins and an improved diagnosis of vascular invasion. In this study, 28 radical nephrectomy specimens were examined using renal vein probing and perfusion techniques. The tumours were segregated based on size, Fuhrman grade and tumour type. Comparison of the study tumours versus renal tumours examined in 2009 that were not perfused and probed were based on these groupings. There was a trend to identifying more renal vein invasion, especially for tumours 4.1 to 7.0 cm in diameter, but this did not result in statistical significance in this small study group.

Compared to radical nephrectomy (RN), partial nephrectomy (PN) leads to improved renal function preservation. However, PN may be infrequently utilized, particularly in patients susceptible to chronic kidney disease. We conducted a population-based, retrospective, observational study using the Canadian Institute for Health Information Discharge Abstract Database. All patients treated for a renal mass with either RN or PN from April 1, 1998 to March 31, 2008 were included in the analysis. Using descriptive statistics and multivariable regression modelling, we demonstrated low uptake of PN (17.5% overall); year, age, geographic region, Charlson score, hospital volume, and physician volume were independently associated with PN use, whereas DM, HTN and income quintile were not. In this contemporary analysis PN continues to be underutilized, and the rate of PN in DM, HTN and the elderly was less than expected given their known relationship to chronic renal failure.

Compared to radical nephrectomy (RN), partial nephrectomy (PN) leads to improved renal function preservation. However, PN may be infrequently utilized, particularly in patients susceptible to chronic kidney disease. We conducted a population-based, retrospective, observational study using the Canadian Institute for Health Information Discharge Abstract Database. All patients treated for a renal mass with either RN or PN from April 1, 1998 to March 31, 2008 were included in the analysis. Using descriptive statistics and multivariable regression modelling, we demonstrated low uptake of PN (17.5% overall); year, age, geographic region, Charlson score, hospital volume, and physician volume were independently associated with PN use, whereas DM, HTN and income quintile were not. In this contemporary analysis PN continues to be underutilized, and the rate of PN in DM, HTN and the elderly was less than expected given their known relationship to chronic renal failure.

No description available.

Thesis (doctoral)--Uppsala University, 1983. / Includes bibliographical references (p. 29-33).

Introduction/Background: Renal sarcoma constitute about 0.8-2.7% of all primary malignant renal tumor [1]. Of all the different types, Renal Leiomyosarcoma is the most common type (50-60%) which originates from the smooth muscle fibers of the renal pelvis, renal capsule or renal vessel [2]. Case Report: 65-year-old smoker male was seen in the clinic with for progressive right upper quadrant and right flank abdominal from the last 4-5 months, worse with eating (Spicy food) and associated with 30 pounds unintentional weight loss in the last 6 months. Patient denied nausea, vomiting, changes in bowel habits, melena, hematochezia and hematuria. There was an ill-defined firmness in the right upper quadrant on examination and laboratory work up was negative. Patient had an abdominal ultrasound as initial work up to rule out gallbladder pathology that showed right lower quadrant mass attached to the right kidney 13.5x11.9x8.9 cm, later confirmed on Computed Tomography (CT) of abdomen that revealed 14.7 x 10.5 cm fungating multilobular mass attached to the inferior pole of right kidney with extracapsular extension and retroperitoneal lymphadenopathy. Further, metastatic work include CT scan of the chest showed multiple small bilateral pulmonary nodules suggestive of metastatic disease. There was an increase in size of renal mass with SUV 10.8 and no bone metastasis was seen during follow up on positron emission tomography scan. CT guided needle core biopsy of renal mass showed spindle cells arranged in fascicles, increased nuclear polymorphisms and mitotic rates which were positive for desmin, smooth muscles myosin/actin immunostains and negative for CD 34, CD117 and HMB-45. Patient had an elective right radical nephrectomy and resection of leiomyosarcoma. Discussion: Primary renal leiomyosarcoma is very rare, more common in females age 50-60 and involves right kidney [3]. The clinical presentation is similar to renal cell carcinoma include abdominal pain or mass, and hematuria. The most common metastatic sites include liver, lungs, bone, and soft tissue. CT scan can be helpful in diagnosis but cannot differentiate from renal cell carcinoma. Biopsy with histopathology and immunohistochemistry is required to confirm the diagnosis. Management includes surgical approach, radiation and chemotherapy. Radical Nephrectomy is the treatment of choice. Most favorable prognostic factors includes tumor less than 4 cm, low grade, absence of nodal metastasis, and radical surgical treatment. Conclusion: Leiomyosarcoma is a rare aggressive tumor of kidney with higher chances of recurrence and metastasis. Only few case reports have been published so far. Reference: 1: Vogelzang NJ, Fremgen AM, Guinan PD, et al. Primary renal sarcoma in adults: A natural history and management study by the American Cancer Society, Illinois division. Cancer 1993; 71:804-10. 10.1002/1097-0142(19930201)71:33.0.CO; 2-A 2: Kavantzas N, Pavlopoulos PM, Karaitianos I, et al. Renal leiomyosarcoma: Report of three cases and review of the literature. Arch Ital Urol Androl 1999; 71:307-11 3: J. S. Miller, M. Zhou, F. Brimo, C. C. Guo, and J. I. Epstein, “Primary leiomyosarcoma of the kidney: a clinicopathologic study of 27 cases,” The American Journal of Surgical Pathology , vol. 34, no. 2, pp. 238–242, 2010

Urotensin II (UII) is a potent peptide hormone with a complex species and vessel-dependent vascular profile. UII and the homologous UII-related peptide (URP) bind to the g-protein coupled urotensin II receptor (UT) with high affinity. The peptide ligands and receptor have been detected in numerous human and rat tissues including heart, brain and kidney. The kidney is a major source of UII, which appears to act as both an endocrine and paracrine mediator of renal function. UII has been shown to influence renal blood flow, glomerular filtration rate and sodium handling in the renal tubules. More speculative actions of UII as a pro-fibrotic mediator include the activation of fibroblasts and promotion of collagen synthesis. Abnormally elevated UII, URP and UT expression has been highlighted in a number of cardio-renal disease states; particularly end stage renal disease, diabetes and diabetic nephropathy (DN). This work aims to investigate the role of the UII system in the development and progression of CKD using an experimental model of CKD in rodents. The first aim of the current work involved establishing the surgical 5/6th subtotal nephrectomy (SNx) model of chronic kidney disease (CKD) in the laboratory and forming a profile of UII expression in late stage experimental CKD to complement UII clinical data which are exclusively from patients in the later stages of disease. UII/URP and UT were substantially over-expressed in the kidneys of SNx rats in late stage CKD. This novel insight complements the clinical profile of CKD/DN where over expression of the UII system is routinely reported. In a second study the 5/6th SNx rat model was used to explore the effects of chronic UT receptor antagonism on the progression of CKD. Although there were no discernible differences in kidney mass or histological profile between the treatment groups at the end of the study, there was a small delay in the development of albuminuria and in the onset of systolic blood pressure elevation in the UT antagonist treated cohort. The study did not produce clear-cut evidence defining the potential therapeutic value of UT-antagonism in the treatment of CKD. Despite this the results are encouraging and suggest that the role of UT-inhibition in CKD is worth considering further.

Objetivo: Avaliar o efeito benéfico da nefrectomia do rim atrófico em pacientes portadores de hipertensão renovascular no controle da pressão arterial e da função renal. Casuística e Método: estudo retrospectivo e observacional de 51 pacientes com hipertensão refratária, portadores de um rim atrófico por estenose significativa ou oclusão total da artéria renal, submetidos à nefrectomia no período janeiro 1989 a janeiro 2007. A idade média foi 47,1± 15 anos (13 a 77 anos), a mediana da creatinina sérica pré nefrectomia de 1,3 mg/dl (0,8 a 4,5), a mediana do clearence de creatinina de 54 ml/min (15 a 100ml/min.), a PA sistólica (PAS) média pré de 149,6 ± 22,5 mm Hg, a PA diastólica (PAD) média pré de 90,8 ± 17 mm Hg e a média do número de hipotensores foi de 2,8 ± 1 hipotensores (1 a 5) por paciente por dia. A pressão arterial e creatinina sérica foram analisadas periodicamente de 12 a 60 meses após a nefrectomia. Resultados: a mortalidade operatória foi de 2%, houve melhora significativa da PAS média nos períodos de 12 a 36 meses (p<= 0,028) e para PAD média de 12 a 48 meses após a nefrectomia (p <= 0,045), acompanhada pela diminuição significativa do uso de hipotensores de 12 a 48 meses (p< 0,05). Um ano após a nefrectomia, houve melhora da pressão arterial em 69% dos pacientes e da função renal em 63,8%. Oito por cento dos pacientes que tiveram piora da função renal após os 12 meses iniciais, mostraram recuperação da função durante o período de observação de 60 meses. Não houve diferença significativa entre os pacientes que se beneficiaram e aqueles que não responderam ao tratamento da hipertensão renovascular com a nefrectomia do rim atrófico quando analisados quanto à idade (p=0,89), sexo (p=0,24), cor (p=0,50), presença de co-morbidades e fatores de risco (p>=0,43), nível da PA inicial (p>=0,24), creatinina prévia (p>= 0,90) e existência de lesão bilateral (p>=0,74). Oito por cento dos pacientes evoluíram com insuficiência renal dialítica no período do estudo, todos com lesão aterosclerótica da artéria renal e com clearence creatinina inicial inferior a 25 ml por minuto. Os doentes com fibrodisplasia da artéria renal tiveram melhores resultados tanto no controle da pressão arterial como na função renal. Conclusão: a retirada do rim atrófico causado por obstrução da artéria renal é procedimento seguro que traz benefícios para os níveis pressóricos e função renal nos portadores de hipertensão renovascular, com melhores resultados encontrados nos pacientes com fibrodisplasia. / Objective: to evaluate the beneficial effects of the Nephrectomy of atrophic kidney in patients with renovascular hypertension, on blood pression control and renal function. Methods: retrospective and observational study using data-base of 51 patients with refractory hypertension, atrophic kidney with significant stenosis or complete occlusion of renal artery undergone nephrectomy, between 1989 to 2005.The mean age of 47 ± 15 years (range 13-77 years), the median of serum creatinine level pre-op was 1.3 mg/dl (0.8- 4.5 mg/dl), the median of clearence of creatinine was estimated with MDRD was 54ml/min, the mean systolic blood pressure (BP) pre-op was 149,6± 22,5 mmhg and the mean diastolic BP pre-op was 90,8± 16,7 mmhg with mean 2,8± 1 of antihypertensive medication per day. The blood pressure and serum creatinine were analyzed each year for five years after nephrectomy. Results: The operative mortality was 2%, we found significant decrease of the mean systolic BP from 12 month until 36 month (p<=0,028) and the mean diastolic BP from 12 month until 48 month after nephrectomy (p<=0,045), associated to significant decrease of antihypertensive medication from 12 month to 48 month per patient (p<=0, 05).One year after the procedure, there was decrease of blood pressure in 69% of patients and improve of renal function in 64% of patients. Eight per cent who had worse of renal function after 12 month, recovery the function during the observation period of 60 month. There were no significant differences between \"respondedores\" (good response) and \"não respondedores (bad response)\" after the nephrectomy of the atrophic kidney when we have analyzed age (p=0,89), sex (=0,24), color (p=0,50), co-mobility and risk factors (p>=0,43), level of initial BP, previous serum creatinine (p>=0,90) and the existence of bilateral stenosis (p>=0,74). Eight per cent of patients had end stage of renal disease (ESRD) and dialysis treatment during the study period, all of them with atherosclerotic lesion of renal artery and initial clearence of creatinine less them 25 ml/min. Those patients with fibromuscular dysplasia had better results on the control of BP and renal function them atherosclerotic patients. Conclusion: The take off atrophic kidney caused by obstruction of renal artery is a safe procedure and brings benefits to blood pressure and preserve the renal function, in patients with renovascular hypertension, with better results in those patients with fbromuscular dysplasia

Introdução: A nefrometria tem sido utilizada para avaliação de complexidade anatômica de tumores renais desde 2009. Foram descritos 03 escores para classificar a complexidade anatômica das massas renais: R.E.N.A.L.; PADUA; c-Index. Esses escores foram propostos em casuísticas de nefrectomia parcial (aberta, laparoscópica ou robótica) com caráter retrospectivo, assim fatores de confusão podem explicar os resultados observados na literatura. Objetivo: Testar a acurácia do escore R.E.N.A.L. em predizer desfechos perioperatórios no tratamento cirúrgico de tumors renais < 7,0cm em um modelo prospectivo. Métodos: Entre janeiro de 2010 a junho de 2012, 320 pacientes foram submetidos ao tratamento cirúrgico de tumores renais no Instituto do Câncer do Estado de São Paulo. Desses, 173(54,1%) tinham tumores < 7 cm e 71(41%) foram estudados de acordo com os critérios de inclusão e exclusão. Foram avaliados a acurárica do escore R.E.N.A.L. em prever desfechos perioperatórios (tempo de isquemia; tempo operatório; perda sanguínea; taxa de conversão para cirurgia aberta ou totalização da nefrectomia; complicações; tempo de internação e margem cirúrgica), em nefrectomias parciais com uso de curvas ROC, análises uni e multivariadas. Resultados: Nenhum paciente no grupo de baixa complexidade (BC) apresentou tempo de isquemia >20 minutos, contra 12(41,4%) e 9 (64,3%), respectivamente nos grupos de media complexidade (MC) e alta complexidade (AC) (p=0,03); porém com acurácia não significativa: AUC=0,643 (p=0,07). O escore R.E.N.A.L. se associou a taxa de conversão (BC:28,6%; MC:47,6%; AC:77,3%, p=0,02). Pacientes com escore < 8 foram mais frequentemente submetidos a nefrectomia parcial (93% vs. 72%, p=0,03) e nefrectomia parcial videolaparoscópica (56,8% vs. 28%, p=0,02), com boa acurácia: AUC=0,715;(p=0,002). O escore R.E.N.A.L. também foi associado a tempo operatório. Pacientes com escore > 8 tiveram 6,06 vezes mais chances de terem tempo cirúrgico > 180 min. (p=0,017), AUC de 0,63 (p=0,059). O escore R.E.N.A.L. não se correlacionou com sangramento, complicações (Clavien > 3), tempo de internação ou margem Resumo cirúgica comprometida. Conclusões: O escore R.E.N.A.L., nesta casuística, mostrou-se ser bom método para prever acesso cirúrgico e tipo de nefrectomia; e também se correlacionou com tempo cirúrgico e de isquemia, porém com acurácias baixas. Entretanto, o escore R.E.N.A.L. não se associou a Clavien > 3, sangramento, dias de internação ou margens cirúrgicas comprometidas / Background and Purpose: The R.E.N.A.L. nephrometry score (RNS) has been validated in multiple open, laparoscopic and robotic partial nephrectomy series. However, those studies are most retrospective and confounding factors could explain the results. The aim of this study was to test the accuracy of RNS in predicting perioperative outcomes in surgical treatment of kidney tumors < 7,0cm (T1b) in a prospective model. Methods: Between January 2010 and June 2012, 320 patients underwent radical or partial nephrectomy at our institution for the treatment of renal cancer. Of these, 173(54,1%) patients had a tumor < 7 cm, 71 patients (41%) were selected according to the inclusion and exclusion criteria and included in the prospective study. We evaluate the accuracy of the score in predicting perioperative outcomes (WIT, OT, EBL, conversion rate and complications) in partial nephrectomy using ROC curve, univariate and multivariate analyses. Results: No patients in low complexity (LC) group had WIT > 20 min, versus 12(41,4%) and 9(64,3%) in medium complexity (MC) and high complexity (HC) groups respectively (p=0,03) however with no significant accuracy: AUC=0,643 (p=0,07). RNS was associated with convertion rate (LC:28,6% ; MC:47,6%; HC:77,3%, p= 0,02). Patients with RNS < 8 were most often subjected to partial nephrectomy (93% x 72%, p=0,03) and laparoscopic partial nephrectomy (56,8% x 28%, p 0,02), with good accuracy: AUC=0,715 (p=0,002). The RNS was also associated with operative time. Patients with a score >8 had 6.06 times greater chance of having a surgery duration > 180 min. (p=0,017), AUC=0,63 (p=0,059). R.E.N.A.L. score did not correlate with EBL, complications (Clavien > 3), LOS or positive surgical margin. Conclusion: R.E.N.A.L. score, in this data, was a good method in predicting surgical access route and type of nephrectomy. Also was associated with OT and WIT, but with weak accuracy. Although, RNS was not associated with Clavien > 3, EBL, LOS or positive surgical margin