Ultrasonographic Characteristics of Diabetes Impacts in Kidneys’ Morphology

A total sample size consisting of 150 Diabetic male patients has been investigated by ultrasound system General Electric using gray-scale B-mode imaging with curvilinear transducer 3 MHz to assess the impact of diabetes in kidney morphology and it is distributed in Sudan. The collected data were the patient age, height, weight, kidneys size, ultrasound findings of involved kidneys, and duration of diabetes and residence region. The analyzed data show that the diabetes has been as endemic disease in central Sudan (Khartoum & Jazeera) representing 55% and in the west of Sudan representing 38%. The BMI of diabetic patients has been significantly (R2 = 0.6) decreasing following aging. The kidney size increases significantly as R2 = 0.75 and 0.6 for left and right kidney respectively. Their correlation is fitted in the following equations: y = 3.95x + 27.26 and y = 2.41x + 35.12 for the left and right kidney respectively. The impact of duration was a reduction in size significantly as R2 = 0.61 and 0.55 with a correlation fitted in the following equations: y = –2.22x + 139.9 and y = –1.51x + 96.59 for the left and right kidney respectively. The mean kidney length was (14.5 cm) and the renal cortex in the range of 2 - 2.3 cm, the kidneys size were so enlarged as 92.4 ± 11.7 and 121 ± 17.1 for the right and left kidney respectively while in late case of Diabetes, the kidney is more echogenic, atrophied size with loss of corticomedullary differentiation.

Effect of Limiting Access to Drinking Water on Carcass Characteristics, Meat Quality and Kidneys of Rabbits

Feed restriction is a common practice to reduce post weaning digestive disorders in rabbits and to get carcasses with less fat. Hydric restriction is commonly used to induce feed restriction in growing rabbits. Two hydric restriction times （2 h and 4 h per day, continuously） were used in our trial carried in good sanitary conditions. Thirty six rabbits were divided at weaning （28 days） into three groups： R2 with restricted access to drinking water from 35 days to 80 days age of 2 h per day （from 8 a.m. to 10 a.m.）, R4： access to drinking water 4 h per day （from 8 a.m. to 12 a.m.） and T （control group） with unlimited access to drinking water. Six animals from each group were slaughtered at 80 days of age. Carcass measurements and meat quality were studied. Histological study for kidneys was carried out. Relative weight of gastrointestinal tract increases with the degree of restriction： 16.5, 18.4 and 18.9 for T, R4 and R2, respectively （P 〈 0.05）. Perirenal fat was lower in restricted groups but differences were not statically significant. Scapular fat decreases of 2/3 or 1/3 respectively with limiting access to drinking water of 2 h or 4 h per day. Compared to control group （T）, meat of restricted groups contains more water： 70.3%, 70% and 69.3% respectively for R4, R2 and T （P 〈 0.01）. The same tendency was observed for proteins： 19.2%, 19.3% and 17.7% for groups R2, R4 and T. Fat decreases in meat of restricted animals： 8.4%, 8.2% and 8.1% respectively for T, R4 and R2 （P 〈 0.05）. Water restriction induced decrease of carcass and meat adiposity. There were no differences between pH post mortem and pH ultimate （after 24 h） between the three groups. Hydric restriction does not effect on kidney histology.

Post COVID-19 infection:Long-term effects on liver and kidneys

Coronavirus disease 2019 is a pandemic,which has affected millions of people across the globe in the year 2020.This disease is caused by a virus,severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),that belongs to the family of coronaviruses and primarily affects the respiratory system.This infection has a wide spectrum of clinical manifestations ranging from asymptomatic form to mild,moderate and severe forms depending upon the age,comorbidity and immunity of an affected individual.Hyper-inflammatory response due to SARSCoV-2 adversely affect several internal organs.Besides lung injury,which is the main outcome of SARS-CoV-2 infection,it has been reported to adversely impact other organs including the liver and kidneys.SARS-CoV-2 virus can also have a direct adverse impact on liver as well as kidneys due to systemic inflammatory response or drug toxicity,leading to elevated levels of liver injury markers and acute kidney injury.Clinical outcomes of SARS-CoV-2 infection could be worse in patients suffering from pre-existing liver and kidney disease.So far,there have been several reports on the mechanism of liver and kidney injury during SARSCoV-2 viral attack.However,the long-term impact of this infection on these organs is yet to be understood.This review summarizes the possible causes and effects of SARS-CoV-2 on the liver and kidneys during the infection and post recovery based on available literature.

Value of renal parenchymal volume and thickness by non-contrast spiral CT in evaluating differential glomerular filtration rate for chronic obstructed kidneys

Objective To evaluate the value of renal parenchymal volume and thickness by non-contrast spiral CT in evaluating the differential glomerular filtration rate ( GFR) for chronic obstructed kidneys,and to compare the correlations between two morphologic indices of renal parenchyma and GFR for chronic obstructed kidneys.

Predictors of time-to-nadir serum creatinine after drainage of bilaterally obstructed kidneys due to bladder cancer

Background:There are persistent controversies about the outcomes and benefits of drainage of malignant ureteral obstruction by percutaneous nephrostomy(PCN).This study aimed to assess the predictors of the time-to-nadir(TTN)of serum creatinine(SCr)levels after drainage of bilaterally obstructed kidneys(BOKs)due to bladder cancer(BC)by PCN.Materials and methods:This prospective nonrandomized study included patients with BOKs due to BC treated by PCN between April 2019 and March 2022.The primary outcome measure was TTN.Results:Of the 55 patients with a median age(range)of 66 years(47-86 years),32(58.2%)had a normal nadir SCr and 23(41.8%)had a high nadir SCr within 21 days after drainage of BOKs due to BC.High nadir SCr was associated with a higher mean age(p=0.011)and lower body mass index(BMI,p=0.043).However,patients with normal nadir SCr had a significantly shorter TTN(p=0.023)and an increased mean SCr trajectory(p<0.001)during TTN.In multivariate analysis,low urine output at presentation(p=0.021)and high BMI(p=0.006)were associated with longer TTN.However,the mean parenchymal thickness(p=0.428)and laterality of drainage(p=0.466)were not associated with the mean TTN and SCr normalization rates.According to the modified Clavien-Dindo classification,8 cases of hematuria were managed conservatively(grade 2),and 2 cases of PCN slippage were repositioned using local anesthesia(grade 3).Conclusions:Despite the safety of PCN for drainage of BOKs due to BC,more than 41%of the patients failed to have a normal nadir SCr.Predrainage low urine output and high BMI were associated with longer TTN.Laterality of drainage had no significant effects on the TTN and SCr trajectory.

Descriptive and Comparative Histology of the Urinary System of the Hematophagous Bats Desmodus rotundus and Diphylla ecaudata

Desmodus rotundus and Diphylla ecaudata, both of which are mammals of the order Chiroptera, Desmodontidae family, their diet consisting exclusively of blood. D. rotundus is the main vector and transmitter of the rabies virus, which affects human beings as well as several livestock species so the study of this bat species is of high importance within the fields of animal agriculture and public health. The present study describes and compares the histologic characteristics of the urinary system of two hematophagous bat species. A total of 5 bats from each species were captured in the municipalities of Progreso de Obregón, Hidalgo (D. rotundus), and Huayacocotla, Veracruz (D. ecaudata). Organs belonging to the urinary system were extracted: kidneys, ureters, urinary bladder, and urethra;samples were fixed using 10% formalin and processed by the paraffin embedding technique, obtaining sections of 5 µm thickness, which in turn were stained using hematoxylin-eosin (H-E) and Gomori trichrome (GT) stains. From the obtained histologic preparations, a descriptive and comparative analysis of the structural organography of the urinary system of both species was made, and no noteworthy histological differences between samples were noted. The present research is intended to provide a framework for future studies of these species’ currently understudied microscopic anatomy.

Complexity and Management of Chronic Kidney Disease

Chronic Kidney Disease (CKD) is ongoing damage of the kidneys, which affects their ability to filter the blood the way they should. Worldwide CKD is considered as the 16th leading cause of death and affects 8% - 16% of the population. CKD often goes unnoticed and is revealed as an incidental finding. Healthcare providers diagnose the condition as CKD based on persistent abnormal kidney function tests revealing kidney damage markers > 3 months, urine albumin creatinine ratio (UACR) > or equal to 30 mg/g per 24 hours, and GFR < 60 mL/min/1.73m2. In this article, we have discussed chronic kidney disease in terms of kidney physiology, chronic kidney disease pathophysiology, etiology, diagnosis, signs and symptoms, and management.

Multi-modality imaging review of congenital abnormalities of kidney and upper urinary tract

Congenital abnormalities of the kidney and urinary tract(CAKUT) include a wide range of abnormalities ranging from asymptomatic ectopic kidneys to life threatening renal agenesis(bilateral). Many of them are detected in the antenatal or immediate postnatal with a significant proportion identified in the adult population with varying degree of severity. CAKUT can be classified on embryological basis in to abnormalities in the renal parenchymal development, aberrant embryonic migration and abnormalities of the collecting system. Renal parenchymal abnormalities include multi cystic dysplastic kidneys, renal hypoplasia, number(agenesis or supernumerary), shape and cystic renal diseases. Aberrant embryonic migration encompasses abnormal location and fusion anomalies. Collecting system abnormalities include duplex kidneys and Pelvi ureteric junction obstruction. Ultrasonography(US) is typically the first imaging performed as it is easily available, noninvasive and radiation free used both antenatally and postnatally. Computed tomography(CT) and magnetic resonance imaging(MRI) are useful to confirm the ultrasound detected abnormality, detection of complex malformations, demonstration of collecting system and vascular anatomy and more importantly for early detection of complications like renal calculi, infection and malignancies. As CAKUT are one of the leading causes of end stage renal disease, it is important for the radiologists to be familiar with the varying imaging appearances of CAKUT on US, CT and MRI, thereby helping in prompt diagnosis and optimal management.

Frequent office visits of patients with chronic kidney disease: Is a prelude to prevention of dialysis

This study is an excerpt of broad-based offce practice which is designed to treat patients with diabetes and hypertension, the two most common causes of chronic kidney disease （CKD）, as well as CKD of unknown etiology. This model of offce practice is dedicated to evaluating patients with CKD for their complete well-being; blood pressure control, fuid control and main-tenance of acid-base status and hemoglobin. Frequent offce visits, every four to six weeks, confer a healthy life style year after year associated with a feeling of good well-being and a positive outlook. Having gained that, such patients remain compliant to their medica-tion and diet, and scheduled laboratory and offce vis-its which are determinant of a dialysis-free life.

Kidney disease in non-kidney solid organ transplantation

Kidney disease after non-kidney solid organ transplantation(NKSOT)is a common post-transplant complication associated with deleterious outcomes.Kidney disease,both acute kidney injury and chronic kidney disease(CKD)alike,emanates from multifactorial,summative pre-,peri-and post-transplant events.Several factors leading to kidney disease are shared amongst solid organ transplantation in addition to distinct mechanisms unique to individual transplant types.The aim of this review is to summarize the current literature describing kidney disease in NKSOT.We conducted a narrative review of pertinent studies on the subject,limiting our search to full text studies in the English language.Kidney disease after NKSOT is prevalent,particularly in intestinal and lung transplantation.Management strategies in the peri-operative and post-transplant periods including proteinuria management,calcineurin-inhibitor minimization/sparing approaches,and nephrology referral can counteract CKD progression and/or aid in subsequent kidney after solid organ transplantation.Kidney disease after NKSOT is an important consideration in organ allocation practices,ethics of transplantation.Kidney disease after SOT is an incipient condition demanding further inquiry.While some truths have been revealed about this chronic disease,as we have aimed to describe in this review,continued multidisciplinary efforts are needed more than ever to combat this threat to patient and allograft survival.

Relationships between Diatom Abundances in Rat Organs and in Environmental Waters

Objective:A diagnosis of drowning remains one of the most challenging issues in forensic science,especially for decomposed bodies.Diatom analysis is considered as an encouraging method for diagnosing drowning.In this study,we developed a drowned rat model using different diatom densities in water.Methods:A total of 120 adult Sprague-Dawley rats were used and divided into six groups,wherein experimental groups 1-5 were drowned rats(group A)and postmortem submersion rats(group B)that were submerged in water with five different Cyclotella sp.diatom densities,while the remaining group was used as a blank control.The combination of microwave digestion and vacuum filtration method was used to accomplish efficient tissue digestion and ascertain higher accuracy of diatom determinations within organs.Results:The abundances of diatoms in the lungs,livers,and kidneys were significantly different.The diatom abundances in the lungs,livers,and kidneys were directly proportional to the water diatom densities,and specific quantitative relationships could be approximated by separate regression equations for each organ type.However,the trends associated with the diatom increases among organs slightly differed.In addition,the diatom abundances in the lungs,livers,and kidneys were all positively correlated.Diatoms were not observed in the postmortem submersion groups nor in the blank control groups.Conclusion:The results of this study provide valuable information for establishing a quantitative diatom framework for informing future forensic medicine efforts.

Feeding Different Omega-3 Polyunsaturated Fatty Acid Sources Influences Renal Fatty Acid Composition, Inflammation, and Occurrence of Nephrocalcinosis in Female Sprague-Dawley Rats

The general population is encouraged to increase omega-3 polyunsaturated fatty acid (n-3 PUFA) intake in order to optimize health for preventative health care. Consumers are typically unaware that different amounts, types, and structural forms of n-3 PUFA have different efficacy. Therefore, the objectives of this study were to characterize different sources of n-3 PUFAs and to determine whether consumption of these oils influences renal fatty acid composition and renal health. Lipid classes and fatty acid profile of corn (CO), flaxseed (FO), menhaden (MO), salmon (SO), tuna (TO) or krill (KO) oils were determined by thin-layer and gas chromatography. All dietary oils consisted of >65% triglyceride with the exception of KO. KO and FO also contained phospholipids. FO was rich in the n-3 PUFA, alpha-linolenic acid (18:3n-3) whereas, the marine oils were rich in the long-chain n-3 PUFAs (>18 carbons). Following characterization of the oil sources, female Sprague-Dawley rats (age 28 d) were randomly assigned (n = 10/group) to be fed a high fat 12% (wt) diet consisting of these different oil sources for 8 weeks. Rats fed MO, TO, and SO had significantly higher renal eicosapentaenoic acid (20:5n-3) and docosahexaenoic acid (22:6n-3) deposition and this in turn, modulated inflammatory responses. Feeding rats MO, SO and TO reduced urinary excretion of 13,14-dihydro-15-keto prostaglandin E2. Feeding rats TO and SO reduced (P ≤ 0.002) nuclear factor kappa B activity and circulating TNFα (P < 0.05). In contrast, rats consuming KO had heavier kidney weights (P < 0.001), total calcium content, and histological evidence of renal calcification and tubulo-interstitial injury. This was due to increased (P < 0.001) urinary phosphorus excretion associated with the phospholipids content of KO. The study results indicated that consumption of n-3 PUFAs influences renal health and the effects varied depending on the n-3 PUFA source consumed.

Safety of the Aqueous Extract of the Leaves of Senna alata (L.) Roxb. (Leguminosae-Caesalpinioideae), a Plant Used in Benin to Treat Infections

Description of the Subject: Senna alata (L.) was a plant in the Benin pharmacopoeia used to treat skin infections. Objectives: The aim of our work was to test its harmlessness in vivo. Method: Wistar rats received by gavage a single dose of 2000 mg/kg of Senna alata leaves aqueous extract for the Acute Oral Toxicity (AOT) test. For the sub-Chronic Oral Toxicity (SCT) test, rats force-fed the extract at a daily dose of 300 mg/Kg of body weight for 28 days. The weight of the rats was taken and the blood samples were collected on Day 0, then respectively day 14 for the AOT and Day 28 for the SCT. The renal balance was carried out by dosage of the creatinine, the liver balance by the transaminases AST and ALT and the blood balance by the hemogram. The liver, kidneys and spleen were removed for histological analysis. The results were analyzed using the Student test, with the significance level set at 5%. Results: The weight of the rats did not change significantly in the acute or subchronic oral toxicity tests suggesting an absence of physical disturbance in the rats. Serum creatinine did not vary significantly, suggesting preservation of renal function. That was the same for ASAT and ALAT transaminases, indicating an absence of hepatic cytolysis. In hematology, the hemoglobin level and the number of blood platelets did not vary significantly, suggesting that the extract did not create anemia and did not influence blood coagulation. Hepatic, renal and splenic parenchyma showed no atypia. Conclusion: The aqueous extract of Senna alata (L.) leaves did not reveal any acute or subchronic toxicity and offered prospects for its use in the treatment of infections.

Pre-transplant treatment of large polycystic kidney

AIM: To evaluate the indications, optimal timing andoutcomes of native nephrectomy and other techniques in pretransplant treatment of autosomal dominant polycystic kidney disease(PKD).METHODS: A literature review was conducted using the Pub Med and Epistemonikos databases. Keywords for pre-transplant surgical management of polycystic kidneys were: Transplant, treatment and PKD. Keywords for pre-treatment embolization of PKD were: Embolization, transplant and polycystic kidney disease. The inclusion criterions were all articles found using this search method. The exclusion criterions were articles found to include bias and not attending pre-transplant treatment options. Fifteen articles were included in our final analysis. Ten articles were found regarding embolization of PKD of which three reviews were selected for final analysis. The reviews were divided into pre transplant and intra transplant treatment for the surgical treatment of PKD. All articles meeting inclusion criteria were thoroughly analyzed by two independent reviewers. A third independent reviewer was consulted if the reviewers did not agree upon the inclusion or exclusion of a specific article. No statistical analysis was performed.RESULTS: Studies vary regarding the technique used(open or laparoscopic), laterality(single or bilateral) and temporality of nephrectomy with respect to renal transplant(pre-transplant or simultaneous to transplant). Several groups argue in favor of simultaneous nephrectomy and kidney transplant since it avoids the deleterious effects of being anefric. Long-term results and patient satisfaction are acceptable. However, it is associated with increased operative time, transfusion rate, morbidity and length of hospital stay. Based on small sample studies, bilateral nephrectomy prior to transplant has been associated with a higher risk of morbidity and mortality. Studies on laparoscopic approach report it as a feasible and safe alternative to the open surgery approach, highlighting its lower complication rate, transfusions and shorter hospital stay. Arterial embolization of the kidney appears as an effectiveand low morbid alternative for the management of large native kidneys. The reduction in renal size allow transplant in a significant number of patients, which makes it an appealing alternative to surgery.CONCLUSION: There is limited evidence regarding best pretrasnplant treatment of large PKD but to date embolization seems an appealing alternative to augment space for renal graft allocation.

Comparative evaluation of urolithiasis management options in patients with horseshoe kidney:A systematic review and meta-analysis

Background:Horseshoe kidney is a rare congenital anomaly commonly complicated by urolithiasis.Extracorporeal shockwave lithotripsy(ESWL),ureteroscopy(URS),and percutaneous nephrolithotomy(PCNL)are treatment options for horseshoe kidney stones.The aim of this systematic review is to compare the benefits and risks of these management options.Methods:MEDLINE,EMBASE,and Cochrane Library databases were searched from inception to February 2022.A total of 516 nonduplicate studies were screened against the inclusion and exclusion criteria.Studies comparing at least 2 interventions with>10 patients per intervention were included.Results:Nine retrospective observational studies published from 2007 to 2021 with a total of 565 patients were included.Reported mean±SD or mean(range)stone sizes ranged between 17.90±2.43 mm and 27.9±8.6 mm for PCNL,8.4(2-25)mm and 22.3±9.1 mm for URS,and 11.9±2.0 mm and 16.8±4.4 mm for ESWL.There was no difference in single-session and overall stone-free rate(SFR)between PCNL and URS,with a risk ratio of 1.04(95%confidence interval,0.95-1.13;I2=20.63%).Ureteroscopy had better stone clearance than ESWL,with an overall SFR risk ratio of1.38(95%confidence interval,1.04-1.82;I2=0%).There was no statistically significant difference in overall SFR between PCNL and ESWL.Most patients who underwent URS and ESWL experienced Clavien-Dindo(CD)gradeⅠ-Ⅱcomplications.Percutaneous nephrolithotomy was associated with the highest complication rates,including 5 CD gradeⅢand 3 CD gradeⅣcomplications and a mean postoperative hemoglobin drop of 0.47 to 1.83 g/dL.There were no CD grade V complications across all studies.Conclusions:There was no difference in SFR between PCNL and URS.Ureteroscopy was associated with a smaller stone burden and fewer and less severe complications.Ureteroscopy was found to be more effective than ESWL with a higher SFR and comparable safety profile.Further large-scale randomized controlled trials are needed to confirm these findings.