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A busy haematuria clinic
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
Patients with localised disease may be offered surgical treatment with a view to curing the disease. Options are: laparoscopic radical nephrectomy‘open’ radical nephrectomy‘nephron-sparing’ partial nephrectomy.
Complications of open repair of renal artery aneurysms
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Complex renal artery aneurysms involving multiple branches may not be conducive to in vivo revascularization because of suboptimal exposure, which increases the risk for prolonged renal ischemic time. In those circumstances, ex vivo reconstruction is advantageous. A nephrectomy is performed, after which the kidney is perfused with renal preservation solution. Following reconstruction, the kidney may be autotransplanted to the iliac fossa or to its original site.51,52
Wilms' tumor
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Kevin Cao, Denis A. Cozzi, Peter Cuckow
Partial nephrectomy or “nephron-sparing” surgery (NSS) can be achieved in some children. The ideal candidates have single, favorable histology masses, not involving the renal hilum and sparing at least a third of the kidney and no metastatic disease. Surgery is initiated in a similar fashion to conventional nephrectomy. After opening Gerota's fascia and freeing the kidney from the perirenal fat, the tumor can be assessed (Figure 59.11). Intraoperative US can be beneficial for determining tumor depth and parenchymal extension and finding unrecognized intrarenal tumors. Biopsies are then taken of perirenal fat and regional lymph nodes for frozen section to establish staging. Finally, the affected kidney is walled off from the peritoneum with laparotomy sponges in case of inadvertent tumor spillage.
Pragmatic Aspects of Controlled Donation after Circulatory Death and Ethical Considerations for Alternative Approaches
Published in The American Journal of Bioethics, 2023
In 2012, I proposed a strategy for kidney recovery prior to death in patients with severe neurological injury and no chance for survival, whose family had agreed to comfort measures and end-of-life care (Morrissey 2012). The procedure, a variation on current DCD protocols, begins with a patient suitable for DCD. However, applying the DDR as outlined by Nielsen Busch and Mjaaland, surgical removal of the kidneys precedes a death declaration, but does not cause the donor’s death. In the United States in 2021, over four thousand individuals donated organs after DCD. Why then should we consider a change? With astonishing frequency, no transplantable organs are recovered after DCD. Thirty percent of the time DCD candidates do not die soon enough for their organs to be transplanted, so none are recovered. Twenty percent of the kidneys removed are not transplanted, often because the extent of damage incurred while dying (respiratory arrest, hypoxia, low blood pressure, inadequate organ perfusion) makes transplantation too risky. Nephrectomy in a controlled operative setting could provide transplantable kidneys nearly 100% of the time which is akin to living kidney donation by healthy donors.
Prognostic Significance of Prognostic Nutritional Index in Patients with Renal Cell Carcinoma: A Meta-Analysis
Published in Nutrition and Cancer, 2022
San-Chao Xiong, Xu Hu, Thongher Lia, Yao-Hui Wang, Xiang Li
All enrolled studies were published within the last five years, which are all retrospective. The included studies were from China, Korea, Japan, Mexico, Turkey, the USA, and Austria. Three studies involved patients with metastatic RCC (mRCC) and treated with systemic treatments. The other studies involved patients undergoing nephrectomy. The sample size of each study is relatively large. Besides, the patients’ age of each study is similar, with a median age ranging from 55 to 65.5. The PNI was all calculated based on the formula (10× serum albumin (g/dl) + 0.005 × total lymphocyte count). The cut off value of PNI is slightly different in each study, ranging from 31 to 51.62. Most studies have a quite long follow-up duration. Nearly all studies were considered as high quality except for meeting abstracts. The detailed information was illustrated in Table 1.
Metastatic adult Xp11.2 translocation renal cell carcinoma with TFE3 gene fusion in complete remission
Published in Baylor University Medical Center Proceedings, 2021
Dharmini Manogna, Divya Tenneti, Zachary Kramer
Relevant laboratory studies are summarized in Table 1. Urinalysis was normal. Abdominal computed tomography revealed a 7.1 cm cystic mass at the upper pole of the right kidney with high attenuation and enhancing internal septation, consistent with cystic RCC. A right nephrectomy was performed. Morphology consisted of epithelial cells with clear cytoplasm and a papillary and cystic growth pattern (Figure 1). The nuclear grade was high (grade 3). By immunohistochemistry, alpha-methylacyl CoA racemase (AMACR) was positive. There was moderate to strong nuclear expression of transcription factor E3 (TFE3) (Figure 2). Carbonic anhydrase IX appeared positive around necrotic areas. The immunoprofile and morphology were consistent with XtRCC. Abdominal magnetic resonance imaging indicated osseous metastases in the thoracolumbar vertebral bodies, iliac wings, and ribs, which were confirmed by positron emission tomography (PET). The patient was started on axitinib and pembrolizumab. Follow-up PET demonstrated complete metabolic remission of previously noted metastases. He has remained in remission 12 months on maintenance axitinib.