Using MsfNet to Predict the ISUP Grade of Renal Clear Cell Carcinoma in Digital Pathology Images

Clear cell renal cell carcinoma(ccRCC)represents the most frequent form of renal cell carcinoma(RCC),and accurate International Society of Urological Pathology(ISUP)grading is crucial for prognosis and treatment selection.This study presents a new deep network called Multi-scale Fusion Network(MsfNet),which aims to enhance the automatic ISUP grade of ccRCC with digital histopathology pathology images.The MsfNet overcomes the limitations of traditional ResNet50 by multi-scale information fusion and dynamic allocation of channel quantity.The model was trained and tested using 90 Hematoxylin and Eosin(H&E)stained whole slide images(WSIs),which were all cropped into 320×320-pixel patches at 40×magnification.MsfNet achieved a micro-averaged area under the curve(AUC)of 0.9807,a macro-averaged AUC of 0.9778 on the test dataset.The Gradient-weighted Class Activation Mapping(Grad-CAM)visually demonstrated MsfNet’s ability to distinguish and highlight abnormal areas more effectively than ResNet50.The t-Distributed Stochastic Neighbor Embedding(t-SNE)plot indicates our model can efficiently extract critical features from images,reducing the impact of noise and redundant information.The results suggest that MsfNet offers an accurate ISUP grade of ccRCC in digital images,emphasizing the potential of AI-assisted histopathological systems in clinical practice.

Simultaneous Compression of the Celiac Trunk, Superior Mesenteric Artery, and Renal Arteries by the Median Arcuate Ligament: About One Case

Median arcuate ligament syndrome (MALS), is a rare abdominal vascular compression syndrome caused by the compression of the proximal celiac trunk by the median arcuate ligament. According to many authors, a low insertion of the diaphragmatic crura or an abnormally high origin of the celiac trunk from the aorta can cause compression of the celiac artery. Usually, patients with MALS are asymptomatic. Computed tomography (CT) angiography of the abdomen is the main imaging modality to confirm the diagnosis. The coexistence of celiac trunk and superior mesenteric artery compression by the median arcuate ligament is rarely described in the literature. To our knowledge, until now, a simultaneous combination of three abdominal vascular compressions by the median arcuate ligament has never been described. From this case, we report a simultaneous compression of the celiac trunk, superior mesenteric artery, and renal arteries by the median arcuate ligament.

Drug coated balloon angioplasty for renal artery stenosis due to Takayasu arteritis: Report of five cases

BACKGROUND Takayasu arteritis is a rare but intractable chronic disease in young female patients. Percutaneous transluminal angioplasty of the involved renal arteries has been reported;however, few studies have reported the use of drug coated balloon angioplasty in the treatment of Takayasu arteritis. We aimed to demonstrate five young female patients who presented with a history of hypertension due to Takayasu arteritis. CASE SUMMARY From April 2017 to October 2018, five female patients were diagnosed with hypertension due to Takayasu arteritis by computed tomography angiography (CTA) and laboratory tests. Four patients had a complaint of headache with or without dizziness, and one patient showed no symptom. There was no significant family or past history of hypertension or kidney disease, and the physical examinations were almost normal on admission. We performed a treatment by drug coated balloon angioplasty. Blood pressure decreased dramatically in all patients after balloon angioplasty, and the patency of treated renal artery was demonstrated with CTA over 5 months after the angioplasty procedure. CONCLUSION Drug coated balloon angioplasty is safe and effective for renal artery stenosis due to Takayasu arteritis. A prospective study with a larger sample size is necessary to further demonstrate the effectiveness of the treatment.

Effects of renal artery stenosis on realistic model of abdominalaorta and renal arteries incorporating fluid-structureinteraction and pulsatile non-Newtonian blood flow

The effects of the renal artery stenosis （RAS） on the blood flow and vessel walls are investigated. The pulsatile blood flow through an anatomically realistic model of the abdominal aorta and renal arteries reconstructed from CT-scan images is simulated, which incorporates the fluid-structure interaction （FSI）. In addition to the investigation of the RAS effects on the wall shear stress and the displacement of the vessel wall, it is determined that the RAS leads to decrease in the renal mass flow. This may cause the activation of the renin-angiotension system and results in severe hypertension.

LUPUS NEPHRITIS COMPLICATED WITH MALIGNANT HYPERTENSION:FROM RENAL VASCULAR PATHOLOGY TO CLINICAL RELEVANCE

Objective To investigate the clinical and pathological characteristics of lupus nephritis patients complicated with malignant hypertension.Methods We retrospectively studied 19 patients with lupus nephritis complicated with malignant hypertension who underwent renal biopsy between January 2002 and December 2006.Results Of 19 patients,3 were men and 16 were women,with a mean age of 24.4±7.7 years old.All had positive antinuclear antibodies and low serum complement was found in 13 patients.All were anemic and 12 of them were thrombocytopenic.Impaired renal function was found in 17 patients with an average serum creatinine of 184.5±88.9 μmol/L.Severe intrarenal arteriolar lesion was found in all patients.Six patients had lupus vasculopathy,11 patients had renal thrombotic microangiopathy lesion,2 had severe arteriosclerosis.All patients received steroids and immunosuppressive drugs,15 received angiotensin-converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB)with resultant well-controlled blood pressure.Thrombocytopenia and hemolytic anemia resolved remarkably.The renal function improved or recovered in 14 of 17 patients,and 3 developed end-stage renal disease on maintenance dialysis.Conclusions Severe intrarenal vascular lesion complicated with renal nephritis parallels clinical manifestation of malignant hypertension.Renal pathology is the key of treatment strategy emphasizing on the significance of renal vascular involvement and type.On the basis of immunosuppressive drugs and steroids to control systemic lupus activity,timely initiation of ACEI/ARB could be of benefit to blood pressure control and long term renal survival.

The Prognostic Value of BMI, Serum Glucose, Endometrial Echo Pattern and Uterine Artery Doppler Velocimetry as a Predictor for Endometrial Pathology in Women with Postmenopausal Bleeding (Prospective Observational Study)

Background: Post-menopausal bleeding is a warning sign that accounts for about 5% of all outpatient gynaecologic visits and is a common indication for referral to rapid access clinics because of the fear of underlying malignancy. Endometrial malignancies differ from other malignancies in that early symptomization is common, allowing early cure. Patients and Methods: During the study period, 100 women with post-menopausal bleeding having inclusion criteria were evaluated in Al Hussein University Hospital. For each patient full history, general, abdominal and pelvic examination was performed. Routine pre-operative investigations were done. Patients were divided into four groups: Group 1 included 29 patients with endometrial polyp. Group 2 included 34 patients with endometrial hyperplasia. Group 3 included 21 patients with atrophic endometrium. Group 4 included 16 patients with endometrial carcinoma. Results: As regards the predictive value of BMI, in the study there was a high statistical significance in comparison between the endometrial carcinoma group and all other benign groups. When discussing the predictive value of blood glucose level, in the study there was a high statistical significance in comparison between the endometrial carcinoma group and all other benign groups. It is worth to mention that the predictive value of endometrial thickness, in the study, was with high statistical significance in comparison between the endometrial carcinoma group and all other benign groups providing the highest specificity and sensitivity. At the last the predictive value of uterine artery velocimetry, in the study, was with high statistical significance in comparison between the endometrial carcinoma group and all other benign groups. Conclusion: BMI, blood glucose level, endometrial thickness and uterine artery velocimetry indices, improve the prediction of endometrial carcinoma in women with post-menopausal bleeding.

Arterial hypertension associated with somatic pathology in present-day practice of internal diseases

Dynamics of regional and gender features of occurrence of arterial hypertension associated with diseases of gallbladder, biliary ducts and pancreas for 2003-2011 was analyzed. There researched 23,310 patients (9111 males and 14,188 females) treated in clinic of scientific centre of clinical and experimental medicine SB RAMS. Occurrence of such combination, depending on gender, residence (the Novosibirsk region (NR) or Yakutia) as well as in age subgroups (16-39, 40-59 and over 60) was estimated. Occurrence of arterial hypertension associated with diseases of gallbladder, biliary ducts and pancreas was observed more in male of Subgroup I, living in NR and Yakutia. In 2003-2008 in female of Subgroup III, living in NR comorbidity pathology was observed more frequently than in male. In Subgroup III in female of NR occurrence of combined pathology was maximum (36.6%) 2006-2008, in female of Yakutia—38.5% in 2003-2005. Dependence of occurrence of combined pathology on residence was observed in male. In 2003-2011 in male of Yakutia combined pathology was observed frequently than in male of NR. Occurrence of comorbidity pathology, depending on gender and age was typical for inhabitants of NR. In Group I comorbidity pathology was frequently observed in male, in Group III—in female. It is necessary to develop regional strategies for observing patients with combined pathologies to improve prevention, rehabilitation and treatment of patients with arterial hypertension associated with diseases of gallbladder, biliary ducts and pancreas.

Response of blood pressure after percutaneous transluminal renal artery angioplasty and stenting

AIM: To evaluate the short and intermediate term out-come of percutaneous transluminal renal artery angioplasty (PTRA) and stenting particularly on blood pressure (BP) control and renal function and to evaluate predictors of poor BP response after successful PTRA and stenting. METHODS: We conducted a prospective analysis of all patients who underwent PTRA and stenting in our institute between August 2010 to September 2012. A total number of 86 patients were underwent PTRA and renal stenting. Selective angiography was done to confirm at least 70% angiographic stenosis. The predilatation done except few cases with critical stenosis, direct stenting was done in the rest of cases. All patients received aspirin 325 mg orally, and clopidogrel 300 mg orally within 24 h before the procedure. Heparin was used as the procedural anticoagulant agent. Optimal results with TIMI-Ⅲ flow obtained in all cases. Following stent placement, aspirin 150 mg orally once daily was continued for a minimum of 12 mo and clopidogrel 75 mg orally once daily for at least 4 wk. The clinical, radiological, electrocardiography, echocardiography and treatment data of all patients were recorded. The BP measurement, serum creatinine and glomerular filtration rate (GFR) were recorded before the procedure and 1 and 6 mo after PTRA. RESULTS: A total of 86 patients were included in the study. The mean age of study population was 55.87±11.85 years old and 67 (77.9%) of patients were male. There was a significant reduction in both systolic and diastolic BP at 1 mo after the procedure: 170.15±20.10 mmHg vs 146.60±17.32 mmHg and 98.38±10.55 mmHg vs 89.88±9.22 mmHg respectively (P=0.0000). The reduction in BP was constant throughout the follow-up period and was evident 6 mo after the procedure: 144.23±18.19 and 88.26±9.79 mmHg respectively (P=0.0000). However, no improvement in renal function was observed at any time during the follow-up period. After multivariate analysis, we found male sex, low GFR (<60 mL/min) and higher baseline mean BP as a poor predictors of successful outcome on BP response after PTRA and stenting. CONCLUSION: The PTRA and stenting can be considered as an effective therapeutic intervention for improving BP control with minimal effect on renal function. The male sex, higher baseline BP and low GFR are associated with poor BP response after successful PTRA and stenting.

Successful endovascular treatment of endoscopically unmanageable hemorrhage from a duodenal ulcer fed by a renal artery: A case report

A 52-year-old woman was admitted with hypovolemic shock. Emergency endoscopy revealed three hemorrhagic duodenal ulcers(all stage A1) with exposed vessels. Two ulcers were successfully treated by endoscopic clipping; however, the remaining ulcer on the posterior wall of the horizontal portion of the duodenum could not be clipped. Because her vital signs were rapidly worsening, we performed transcatheter arterial embolization(TAE) as it is less invasive than surgery. Computed tomography aortography showed that the duodenal hemorrhage was sourced from the lower branch of the right renal artery. In general, the duodenum is fed by branches from the gastroduodenal artery or superior mesenteric artery. However, this patient had three right renal arteries. The lower branch of the right renal artery at the L3 vertebral level was at the same level as the horizontal portion of the duodenum. Complete hemostasis was achieved by TAE using metallic coils and n-butyl-2-cyanoacrylate. After TAE, she recovered from the hypovolemic shock and was discharged from hospital. She has had no recurrence of the hemorrhagic duodenal ulcer for over 1 yr, and followup endoscopy showed no necrosis or stricture of the duodenum. Although she developed a small infarct of her right kidney, her renal function was satisfactory. In summary, the present case is the first reported case of hemorrhagic duodenal ulcer in which the culprit vessel was a renal artery that was successfully treated by TAE. Computed tomography aortography before TAE provides valuable information regarding the source of a duodenal hemorrhage.

Ex vivo revascularization of renal artery aneurysms in a patient with solitary kidney: A case report

BACKGROUND Multiple renal artery aneurysms (RAAs) involving multiple branches in a solitary kidney are rare and present a major challenge to surgeons.Ex vivo or in situ repair combined with renal artery revascularization is the classical procedure for these complicated cases,which are not suitable for endovascular repair.The choice of bypass graft remains controversial because of the risk of aneurysmal degeneration for autologous graft.CASE SUMMARY A 39-year-old female patient presented with left lumbar pain for more than 3 mo.Computed tomography angiography showed congenital absence of the right kidney and three left RAAs involving multiple distal branches.This patient met the criteria for surgical repair due to symptoms of threatened rupture.According to the anatomy and location of multiple RAAs,ex vivo revascularization with saphenous vein graft (SVG) was performed.At the 3-year follow-up,computed tomography angiography demonstrated the aneurysmal degeneration of the Yshaped SVG.The patient remained asymptomatic and follow-up ultrasound showed no continuous growth of SVG aneurysm.CONCLUSION SVG aneurysm in RAA revascularization causes us to reflect on the choice of graft,especially for solitary kidney patients.

Superselective transcatheter arterial embolization to control renal hemorrhage after partial nephrectomy for renal tumors:A report of 9 cases and a literature review

Objective:This study aimed to evaluate the efficacy and safety of selective arterial embolization for hemorrhage after renal surgery and to summarize the clinical experience.Materials and methods:A total of 9 patients underwent arterial embolization after partial nephrectomy from 2010 to 2018.Results:Technical success was achieved in all patients;however,3 patients underwent a secondary arterial embolization because of short-term re-hemorrhage or the co-occurrence of accessory renal arterial hemorrhage.No serious complications occurred during the follow-up.Conclusions:Superselective arterial embolization is an effective and minimally invasive treatment for hemorrhage after partial nephrectomy.To improve the success rate of surgery,attention should be paid to the evaluation of accessory renal arteries and the management of suspected bleeding arteries.

Successful endovascular treatment of transplant intrarenal artery stenosis in renal transplant recipients: Two case reports

Transplant renal artery stenosis(TRAS) is a relatively rare complication after renal transplantation. The site of the surgical anastomosis is most commonly involved, but sites both proximal and distal to the anastomosis may occur, as well. Angioplasty is the gold standard for the treatment of the stenosis, especially for intrarenal lesions. We report two cases of intrarenal TRAS and successful management with angioplasty without stent placement. Both patients were male, 44 and 55 years old respectively, and they presented with elevated blood pressure or serum creatinine within three months after transplantation. Subsequently, they have undergone angioplasty balloon dilatation with normalization of blood pressure and serum creatinine returning to baseline level. Percutaneous transluminal balloon renal angioplasty is a safe and effective method for the treatment of the intrarenal TRAS.

Clinicopathological Features of Renal Amyloidosis: A Single-center Study on 47 Cases

The correlations between the clinicopathological features and the long-term outcomes of renal amyloidosis（RA） were analyzed with a view to develop strategies for improving diagnosis and prognosis of RA. We retrospectively reviewed the clinicopathological characteristics of 47 patients diagnosed with RA between 2004 and 2014 at the Wuhan Union Hospital. The data on the renal histology, clinical manifestations, and prognosis of RA patients were retrieved from the hospital records and characteristic patterns were identified. The histological changes in the kidneys were correlated with the clinical manifestations of RA. Additionally, most RA patients in this study had decreased serum levels of κ light chain and increased urine levels of κ and λ light chains as well as presence of M-protein in the urine and serum. Patients with early RA showed no specific pathognomonic symptoms. Bleeding associated with diagnostic renal biopsy was rare. We recommend that the routine work-up of patients aged over 40 years and presenting with non-diabetic nephropathy includes the non-invasive tests for the measurement of serum and urine levels of κ and λ light chains as well as protein electrophoresis tests for the presence of urinary and serum M-protein. Additionally, such patients should undergo renal biopsy screening with Cong-red staining to ensure early diagnosis of RA and improve their survival, since the risk of hemorrhage related to renal biopsy screening is low at early stages of RA.

Effects of Sub-chronic Aluminum Exposure on Renal Pathologic Structure in Rats

A total of 40 Wistar rats, weighing 130-140 g, were allocated randomly into four groups. They were orally administrated with 0 （control group, GC）, 64.18 （low-dose group, GL）, 128.36 （middle-dose group, GM）, and 256.72 （high-dose group, GH） mg aluminum chloride （AlCl3） per kilogram body weight in drinking water for 120 days. Kidney coefficient and aluminum （Al） concentrations in blood and kidney were determined, and renal autopsy and histological changes were observed. The results showed that kidney coefficient in all Al-treated groups were obviously lower than that in GC （P〈0.01） and there was a dose-effect relationship. The kidneys were solid, lusterless and pale brown with white necrosis point on surface. Under electron microscope, renal cortex became thin, the renal tubule was narrowed and the epithelium dissolved; the renal glomerulus became atrophied and the glomerular became vasodilator. The Al concentrations in blood and kidney were higher in all Al-treated rats than those in GC （P〈0.01）, and there was a dose-effect relationship. The results indicated that sub-chronic Al exposure could lead to Al accumulation in kidney, restrain the development of kidney and cause the pathologic damage in rats.

Renal artery embolization in the treatment of urinary fistula after renal duplication:A case report and review of literature

BACKGROUND Duplicate renal malformation is a congenital disease of the urinary system,with an incidence rate of 0.8%.Surgical treatment is suitable for symptomatic patients.Urinary fistula is one of the complications of heminephrectomy.Long-term urinary fistula has a great impact on patients'lives.CASE SUMMARY This article mainly reports on a 47-year-old man with duplication of kidney deformity,long urinary fistula after partial nephrectomy,and no improvement after conservative treatment.We have achieved positive results in the arterial embolization treatment of the residual renal artery,indicating that selective arterial embolization is a good way to treat urinary fistula after partial nephrectomy.It is worth noting that this patient violated the Weigert-Meyer law,which also gave us more consideration.CONCLUSION Renal artery embolization may be a simple and safe method to treat urinary fistula inefficacy with conservative treatment.

Infective Artery Rupture of Renal Allografts:A Single-Center Retrospective Study in China

Objective:This study investigated the composition of pathogenic microorganisms,clinical features,and therapeutic strategies of infective artery rupture of renal allografts in recipients receiving deceased donor(DD)kidneys.Methods:We retrospectively studied the clinical data of the DD kidney transplant recipients with donor-associated infection at Tongji Hospital,Wuhan,China from January 1,2015 to December 31,2018,related recipients and corresponding donors.We collected the entire results of pathogenic microorganisms cultured from these related ruptured kidneys and then analyzed their distribution and differences.Results:A total of 1440 kidney transplants from DD were performed in our center.The total incidence of infective artery rupture in kidney transplants was about 0.76%(11/1440),and the annual incidence ranged from 0.25%to 1.03%.The microbial culture results revealed that 11 recipients suffered from infective artery rupture and 3 recipients who accepted the kidney from same donor had the donor-associated pathogens,including 9 fungal strains(28.1%)and 23 bacterial strains(71.9%).There were 4 recipients infected with multi-drug-resistant Staphylococcus and Klebsiella pneumoniae from the above 11 recipients,of which,10 recipients underwent graft loss,and one died of septic shock.The microbial cultures of the remaining 3 recipients who received appropriate anti-infective regimens turned negative eventually,and the patients were discharged successfully without significant complications.Conclusion:Renal recipients with infections derived from DDs were at high risk of artery rupture,graft loss,or even death.Appropriate anti-infective treatment is essential to reduce the incidence of artery rupture and mortality.

Percutaneous transcatheter super-selective renal arterial embolization with N-butyl cyanoacrylate for iatrogenic renal hemorrhage

Background:To evaluate the safety and efficacy of percutaneous transcatheter super-selective renal arterial embolization(SRAE)with N-butyl cyanoacrylate(NBCA)for iatrogenic renal hemorrhage.Methods:Between January 2014 and December 2019,45 patients(including 18 patients with coagulopathy),who underwent percutaneous transcatheter SRAE with NBCA for iatrogenic renal hemorrhage at our institution,were retrospectively reviewed.The technical success rate,clinical success rate,and embolization-related complications were analyzed.The values of estimated glomerular filtration rate(eGFR),serum creatinine(sCr),and serum urea(sUr)were analyzed at the time of pre-SRAE,post-SRAE,and last follow-up to evaluate the effects of NBCA-based SRAE on renal function.Results:Diagnostic renal arteriography revealed contrast extravasation in 18 patients and pseudoaneurysms in 27 patients.NBCA mixed with iodized oil in a 1:2–1:4 ratio was the sole embolic agent.No procedure-related mortality or major complications occurred.The technical and clinical success rates were both 100%.The values of eGFR,sCr and sUr were not found to be significantly different between pre-SRAE,post-SRAE and last follow-up(eGFR:91.52±21.17 vs.90.98±22.11 vs.92.14±23.51 mL/min/1.73 m^(2),p=0.729;sCr:74.73±11.08 vs.75.27±12.43 vs.73.95±10.14μmol/L,p=0.543;sUr:5.69±0.84 vs.5.71±0.96 vs.5.70±0.79,p=0.515,respectively).Conclusions:Percutaneous transcatheter SRAE with NBCA is a safe and effective treatment modality for iatrogenic renal hemorrhage with no deterioration of renal function.

Laparoscopic Partial Nephrectomy With Segmental Renal Artery Clamping:Technique and Clinical Outcomes

Background:Warm ischemic injury is one of the most important factors affecting renal function in partial nephrectomy(PN).The technique of segmental renal artery clamping emerges as an alternative to conventional renal artery clamping for renal hilar control.Objective:To evaluate the feasibility and efficiency of laparoscopic PN(LPN) with segmental renal artery clamping in comparison with the conventional technique.Design,setting,and participants:A total of 75 patients underwent LPN from June 2007 to November 2009.All patients had T1a or T1b tumor in one kidney and a normal contralateral kidney.Thirty-seven patients underwent surgeries with main renal artery clamping,and 38 underwent surgeries with segmental artery clamping.Intervention:All procedures were performed by the same laparoscopic surgeon.Measurements:Blood loss,operation time,warm ischemia(WI) time,and complications affected renal function before and after operation were recorded.Results and limitations:All LPNs were completed without conversion to open surgery or nephrectomy.The novel technique slightly increased WI time(p < 0.001) and intraoperative blood loss(p = 0.006),while it provided better postoperative affected renal function(p < 0.001) compared with the conventional technique.The total complication rate was 12%.Among the 38 cases where segmental renal artery clamping was performed,7 had to convert to the conventional method.Tumor size and location influenced the number of clamped segmental arteries.Long-term postoperative renal function is still awaited.Conclusions:LPN with segmental artery clamping is safe and feasible in clinical practice.It minimizes the intraoperative WI injury and improves early postoperative affected renal function compared with main renal artery clamping.(C) 2010 European Association of Urology.Published by Elsevier B.V.All rights reserved.

Retrieval of dislodged coronary stent from left renal artery by gooseneck snare

A rapamycin-eluting stent was dislodged during attempt of implantation at the proximal right coronary artery,which was found by fluoroscopy to have migrated into the anterior trunk of the left renal artery.We chose a 5 mm diameter Amplatz gooseneck snare and successfully retrieved the lost stent from the lodging vessel.