The prevalence and associated risk factors of detectable renal morphological abnormalities in acromegaly.

PURPOSE: The aim of this study was to investigate the prevalence of simple renal cysts (SRCs) and kidney stone disease (KSD) together with laboratory data in patients with acromegaly through comparisons with healthy subjects, and to examine the possible risk factors associated with these abnormalities in acromegaly. METHODS: This retrospective, single-center study included 125 acromegaly patients (46.4 ± 11.6 years, 68 females/57 males) and 114 age-sex matched healthy individuals (45.3 ± 12.4 years, 59 females/55 males). Demographic data, clinical history, biochemical and abdominal/urinary system ultrasonographic data of the patients were reviewed. RESULTS: The SRC prevalence (28.8% vs. 8.8%, p < 0.001) and the longitudinal and transverse lengths of kidneys (p < 0.05) were significantly higher in patients with acromegaly compared to the control group. The presence of acromegaly was determined to increase the risk of SRC formation 12.8-fold. The prevalence of KSD was similar in both the patient and control groups (15.2% vs. 7.9%, p = 0.08). Patients with acromegaly with renal cysts (n = 36) compared to the group without cysts (n = 89) were older, had a higher male gender frequency, a longer pre-diagnosis symptom duration, and a higher incidence of hypertension and diabetes mellitus at the time of diagnosis. The multivariate logistic regression analysis showed that only advanced age and male gender were associated risk factors for SRCs in acromegaly patients. CONCLUSION: The results of this study showed that acromegaly disease significantly increased the prevalence of SRCs and kidney length compared to the age-sex matched healthy population, while the prevalence of KSD was similar. Advanced age and male gender were seen to be independent risk factors for SRC formation in patients with acromegaly.

Association of simple renal cysts to aneurysm sac shrinkage in true thoracic aortic aneurysms after thoracic endovascular aortic repair.

BACKGROUND: An increased prevalence of thoracic aortic aneurysms (TAA) has been demonstrated in patients with simple renal cysts (SRC); patients with SRC have a less elastic aortic wall than those without SRC. The purpose of this study was to evaluate aneurysm sac shrinkage after thoracic endovascular aortic repair (TEVAR) for true TAA in patients with and without SRC. METHODS: One hundred three patients with true aneurysms of the thoracic aorta who underwent TEVAR at our university hospital from November 2013 to December 2021 were included in this study. Aneurysm sac size was compared between that on baseline preoperative computed tomography and that on postoperative computed tomography scans at 1 year. A change in aneurysm sac size ≥5 mm was considered to be significant, whether due to expansion or shrinkage. RESULTS: The patients were divided into two groups: those with SRC (46 patients [45%]) and those without SRC (57 patients [55%]). At 1 year, there was a significant difference in the proportion of aneurysm sac shrinkage between patients with SRC and those without SRC (23.9% vs 59.6%; P < .001). Patients with SRC showed significantly less aneurysm sac shrinkage than those without SRC (-1.8 ± 5.6 mm vs -5.1 ± 6.6 mm; P = .009). Univariable and multivariable analyses showed that the initial sac diameter (odds ratio, 1.08; 95% confidence interval, 1.03-1.14; P = .002) and the presence of SRC (odds ratio, 0.15; 95% confidence interval, 0.06-0.40; P < .001) were positively and negatively associated with aneurysm sac shrinkage after TEVAR, respectively. CONCLUSIONS: The presence of a SRC was independently associated with failure of aneurysm sac shrinkage after TEVAR for true TAA. This suggests that the presence of a SRC may be a predictor for the failure of aneurysm sac shrinkage after TEVAR.

[Effect of a simple kidney cyst on renal function].

INTRODUCTION: Renal cysts are a common disease that occurs at a rate of 7-10%. Currently there are no clinical recommendations for the treatment of patients with simple renal cysts. In the current literature there is some evidence that a simple renal cyst has negative effects on renal function. Decreased renal function occurs due to partial atrophy and loss of the renal parenchyma (in the "crater" area at the base of the cyst) caused by compression. Therefore, the efforts to analyze the effect of simple kidney cysts on kidney function and identify the characteristics of the cyst that affect renal function to determine the indications for surgical treatment remains a substantial task. The aim of the study was to analyze the effect of simple renal cysts on renal function, to investigate the relationship between cyst size, atrophied parenchyma volume, and renal function, and to determine indications for surgical treatment of simple renal cysts. MATERIALS AND METHODS: We conducted a prospective cohort study. The study included 109 patients with simple renal cysts. Patients with a solitary cyst of the right or left renal kidney, grade I-II according to Bosniak classification, were included in the study. The estimated glomerular filtration rate (eGFR) of the patients was calculated using various formulas. A contrast CT scan of the urinary tract was also performed to determine the maximum size of the cyst, calculate the volume of the renal parenchyma, and the volume of the lost (atrophied) parenchyma. Patients underwent renal scintigraphy with calculation of total GFR and split renal function. We analyzed the symmetry of the function of both kidneys by comparing the GFR of the affected and healthy kidneys, analyzed the relationship between the presence of a kidney cyst and a decrease in GFR, between the maximum size of a renal cyst and a decrease in its function compared with that of a healthy kidney. We also analyzed the correspondence of total GFR values obtained in renal scintigraphy and GFR values calculated according to the formulas. RESULTS: Data from 109 patients were available for analysis; the mean blood creatinine was 87.4 mol/L. The median maximum cyst size was 80 mm. The median baseline volume of the affected kidney parenchyma was 174 ml, the median volume of the lost parenchyma was 49 ml, and the median proportion of the lost parenchyma was 28%. The median total GFR was 77.07 ml/min. The median GFR of the healthy kidney was 45.49 mL/min, and the median GFR of the kidney affected by the cyst was 34.46 mL/min. The median difference in GFR of the healthy and affected kidney units was 11 mL/min and was statistically significant. Comparison of the eGFR values obtained by the formulas with the reference values of GFR obtained by scintigraphy showed that the Cockcroft-Gault formula with standardization on the body surface area calculated closest eGFR values to the reference ones. Correlation analysis revealed a statistically significant association between the proportion of lost parenchyma volume and the maximum cyst size: =0.37 with 95% CI [0.20; 0.52] (p-value = 0). A multivariate logistic regression model revealed that a statistically significant factor influencing the probability of a significant decrease in GFR was the percent of lost renal parenchyma volume (OR=1,13; =0). CONCLUSIONS: Our study showed that growth of renal cysts associated with renal parenchyma atrophy and decrease of GFR of the affected kidney. An increase in the volume of atrophied parenchyma leads to the decrease in GFR of the affected kidney. The obtained data suggest that performing dynamic renal scintigraphy to assess the decrease in affected renal function and determine the indications for surgical treatment of renal cysts is a reasonable recommendation. According to the results of the study, the loss of 20% of the renal parenchyma can be considered an indication for renal scintigraphy. The Cockcroft-Gault formula with standardization on the body surface area allows to calculate closest GFR values to those obtained by scintigraphy and, therefore, can be recommended as the optimal formula for calculating eGFR in daily clinical practice.

Association of Abdominal Aortic Aneurysm and Simple Renal Cysts: A Systematic Review and Meta-Analysis.

BACKGROUND-OBJECTIVE: Prior studies have suggested a higher prevalence of simple renal cysts (SRC) among patients with aortic disease, including abdominal aortic aneurysms (AAA). Thus, the aim of this study was to systematically review all currently available literature and investigate whether patients with AAA are more likely to have SRC. METHODS: This study was performed according to the PRISMA guidelines. A meta-analysis was conducted with the use of random effects modeling and the I-square was used to assess heterogeneity. Odds ratios (OR) and the corresponding 95% confidence intervals (CI) were synthesized to compare the prevalence of several patients' characteristics between AAA vs. no-AAA cases. RESULTS: Eleven retrospective studies, 9 comparative (AAA vs. no-AAA groups) and 3 single-arm (AAA group), were included in this meta-analysis, enrolling patients (AAA: N = 2,297 vs. no-AAA: N = 35,873) who underwent computed tomography angiography as part of screening or preoperative evaluation for reasons other than AAA. The cumulative incidence of SRC among patients with AAA and no-AAA was 55% (95% CI: 49%-61%) and 32% (95% CI: 22%-42%) respectively, with a statistically higher odds of SRC among patients with AAA (OR: 3.02; 95% CI: 2.01-4.56; P< 0.001). The difference in SRC prevalence remained statistically significant in a sensitivity analysis, after excluding the study with the largest sample size (OR: 2.71; 95% CI: 1.91-3.84; P< 0.001). CONCLUSIONS: Our meta-analysis demonstrated a 3-fold increased prevalence of SRC in patients with AAA compared to no-AAA cases, indicating that the pathogenic processes underlying SRC and AAA could share a common pathophysiologic mechanism. Thus, patients with SRC could be considered at high risk for AAA formation, potentially warranting an earlier AAA screening.

Infected simple renal cyst due to Streptococcus pneumoniae rapidly diagnosed by the melting temperature mapping method: a case report.

BACKGROUND: Spontaneous infection of preexisting solitary renal cysts has been documented in adults but is extremely rare in children. To date, no cases of simple renal cysts infected with Streptococcus pneumoniae have been described. Recently, reports have described the diagnosis of bacterial infection using the 16 S rRNA gene as well as the accompanying antimicrobial stewardship for microorganisms that are difficult to culture and for culture-negative cases after preceding antibacterial administration. CASE PRESENTATION: A four-year-old Japanese girl who had a pleuroperitoneal shunt inserted to drain a right pleural effusion due to occlusion of the hepatic portion of the inferior vena cava at three years old visited our hospital due to fever and respiratory discomfort. She was incidentally found to have a right simple renal cyst 10 months before admission. The patient was suspected to have pneumonitis or catheter-related blood stream infection on chest X-ray, which showed right-side pleural effusion. She was diagnosed with invasive pneumococcal infection, as Streptococcus pneumoniae was detected from blood culture on admission. Transient improvements in her symptoms and decreases in the white blood cell count and C-reactive protein level were observed after effective antibiotic administration, but her respiratory condition deteriorated. Enhanced CT showed right renal cyst enlargement and enhancement and thickening of the surrounding wall. Using the melting temperature (Tm) mapping method, S. pneumoniae was rapidly detected directly from pus 4.5 hours after drainage. The specimen culture was negative, but the extracted 16 S rDNA sequence revealed 100 % identity for S. pneumoniae from the same specimen the subsequent day. We successfully performed optimal treatment and reduced medical cost based on the positive Tm mapping method result. CONCLUSIONS: We report the first case of a S. pneumoniae-infected simple renal cyst. The drainage culture was negative, but the Tm mapping method rapidly detected S. pneumoniae directly from the drainage. The Tm mapping method may have great impacts on rapid diagnosis and effective antimicrobial stewardship.

Simple renal cyst and its association with sac shrinkage after endovascular aneurysm repair for abdominal aortic aneurysms.

OBJECTIVE: Patients with abdominal aortic aneurysm (AAA) frequently have simple renal cyst (SRC), a common manifestation of connective tissue degeneration. This study aimed to determine whether SRC is a risk factor for failure of sac shrinkage after endovascular aneurysm repair (EVAR). METHODS: Between October 2013 and May 2017, there were 155 consecutive patients with an infrarenal AAA or a common iliac artery aneurysm who underwent EVAR with the GORE C3 Excluder (W. L. Gore & Associates, Flagstaff, Ariz) at Tokyo Medical University Hospital. All these patients were registered in a prospectively maintained database. Any kidney lesion >5 mm in diameter, with no evidence of contrast enhancement or septation and with low attenuation, was defined as SRC. A change in sac size of >5 mm from baseline was considered significant. The patients were divided into those with SRC and those without SRC, and sac shrinkage at 1 year and 2 years was compared. The presence of SRC was assessed with respect to being a risk factor for failure of sac shrinkage at 1 year using univariate and multivariable logistic regression analysis. RESULTS: The patients were divided into two groups: those with SRC (92 patients [59.0%]) and those without SRC (63 patients [41.0%]). At 1 year and 2 years, significant differences were observed in the proportion of sac shrinkage between patients with SRC and those without SRC (19.2% vs 42.4% [P = .003] and 19.6% vs 53.3% [P = .001], respectively). Patients with SRC showed significantly less sac shrinkage than those without SRC at 1 year and 2 years (-2.0 ± 5.5 mm vs -4.4 ± 6.2 mm [P = .002] and -1.8 ± 6.3 mm vs -6.4 ± 8.6 mm [P = .005], respectively). Multivariable analysis demonstrated that SRC (odds ratio, 0.28; 95% confidence interval, 0.12-0.63; P = .002) and initial sac size (odds ratio, 1.05; 95% confidence interval, 1.01-1.09; P = .027) were positive and negative risk factors for sac shrinkage, respectively. CONCLUSIONS: The presence of SRC is a risk factor for failure of sac shrinkage after EVAR. This suggests that AAA in patients with SRC has a more degenerated wall than in those without SRC. The property of the aneurysm wall may be associated with sac shrinkage after EVAR.

Association between simple renal cyst and kidney damage in a Chinese cohort study.

Background: The presence of simple renal cyst (SRC) has been associated to renal dysfunction, but the results were inconsistent. Accordingly, we conducted a longitudinal cohort study to explore the association between SRC and kidney damage. Methods: A total of 4274 adults (aged 45.4 ± 13.6 years) without chronic kidney disease at baseline were enrolled in 2008. SRC was assessed by ultrasonography. Logistic regression analysis were applied to explore the relationships between SRC and indicators of kidney damage (proteinuria and renal insufficiency), and also with relatively rapid decline in renal function (defined as the lowest quartile of △eGFR). Results: During 5 years of follow-up, participants in the SRC group had higher incidence of proteinuria (5.2% versus 2.4%, p = 0.004) and renal insufficiency (3.8% versus 0.97%, p < 0.001) compared with control group. SRC was correlated with proteinuria (OR 2.24; 95% CI 1.34-3.75) and renal insufficiency (OR 4.0; 95% CI 2.11-7.58) in univariable analysis, despite that the correlation was not significant after adjusted for traditional kidney disease risk factors. Furthermore, after adjusted for potential confounders, maximum diameter of the cyst (≥2.2 cm) was significantly associated with rapid decline in renal function (OR 2.19; 95% CI 1.24-3.87). Conclusions: Participants with SRC may be associated with higher incidence of proteinuria and renal insufficiency. This relationship may be obscured by age and other traditional risk factors. Higher diameter of the cysts contributed to more rapid decline in renal function of SRC participants.

The association of simple renal cysts with abdominal aortic aneurysms and their impact on renal function after endovascular aneurysm repair.

We validated the association of simple renal cysts with abdominal aortic aneurysm and other cardiovascular factors and assessed simple renal cysts' impact on renal function before and after endovascular abdominal aortic aneurysm repair. A retrospective analysis of prospectively collected data was conducted. Computed tomography angiograms of 100 consecutive male patients with abdominal aortic aneurysm who underwent endovascular abdominal aortic aneurysm repair (Group 1) were reviewed and compared with 100 computed tomography angiogram of aged-matched male patients without abdominal aortic aneurysm (Group 2). Patients' demographic data, risk factors, abdominal aortic aneurysm diameter, the presence of simple renal cyst and laboratory tests were recorded. No difference was observed between the two groups in respect to other cardiovascular risk factors except hyperlipidemia with higher prevalence in Group 1 (p < 0.05). Presence of simple renal cysts was independently associated with age (p < 0.05) and abdominal aortic aneurysm (p = 0.0157). There was no correlation between simple renal cysts and abdominal aortic aneurysm size or pre-operative creatinine and urea levels. No difference was observed in post-operative creatinine and urea levels either immediately after endovascular abdominal aortic aneurysm repair or in 12-month follow-up. In male patients, the presence of simple renal cysts is associated with abdominal aortic aneurysm and is increasing with age. However, their presence is neither associated with impaired renal function pre-endovascular abdominal aortic aneurysm repair and post-endovascular abdominal aortic aneurysm repair nor after 12-month follow-up.

Multiple and large simple renal cysts are associated with glomerular filtration rate decline: a cross-sectional study of Chinese population.

BACKGROUND: Although simple renal cyst (SRC) is a kind of structural alterations of kidney with age, the relationship between SRC and renal function is still obscure. We investigated the relationship between SRC and renal function in Chinese population. METHODS: The medical records of 41,842 individuals who underwent physical examinations at the Health Check-up Center at our institution in 2018 were reviewed. According to whether with SRC, they were divided into no-SRC and SRC groups. SRCs were classified into subgroups based on number (< 2 vs. ≥ 2) and size (< 2 cm vs. ≥ 2 cm). Logistic regression was used to examine the relationship between SRC and estimated glomerular filtration rate (eGFR). RESULTS: Multinomial logistic regression analysis showed that the adjusted odds ratio (OR) for eGFR slight decline in subjects with SRC was 1.26(95% confidence interval (95% CI):1.17-1.35, p < 0.001), and the OR for eGFR severe decline was 1.35(95% CI: 1.16-1.56, p < 0.001) compared with no-SRC. The adjusted OR of SRC number ≥ 2 and ≥ 2 cm on the risk of eGFR severe decline was the highest (OR:1.68, 95% CI:1.25-2.23, p < 0.01) of four SRC subgroups. CONCLUSIONS: SRC is related to eGFR decline, especially when the person with one more SRCs and the size of SRC is more than 2 cm. SRC could be a warning sign for clinicians to judge the decline of renal function.

Ultrasound-guided paravertebral nerve block anesthesia for percutaneous endoscopic laser unroofing treatment of symptomatic simple renal cysts-An innovative ambulatory surgery mode.

Objective: This study was designed to evaluate the feasibility, efficacy, and safety of percutaneous ureteroscopy laser unroofing as an ambulatory surgery for symptomatic simple renal cysts under multilevel paravertebral nerve block anesthesia. Methods: From December 2015 to September 2017, 33 simple renal cyst patients who had surgical indications were enrolled. Under ultrasound guidance, the T10/T11, T11/T12, and T12/L1 paravertebral spaces were identified, and 7-10 mL 0.5% ropivacaine was injected at each segment. Then a puncture needle was placed inside the cyst cavity under ultrasonic monitoring. A guidewire was introduced followed by sequential dilation up to 28/30 Fr. The extra parenchymal portion of the cyst wall was dissociated and incised using a thulium laser, and a pathological examination was performed. Results: Sensory loss to pinprick from T8 to L1 and sensory loss to ice from T6 to L2 were observed in all patients. None of the patients complained of pain during surgery. No serious complications occurred perioperatively. After the surgery, all patients recovered their lower limb muscle strength quickly, got out of bed, resumed oral feeding, and left the hospital within 24 h of admission. The pathologic diagnosis of all cyst walls was a simple renal cyst. The mean follow-up was 35.8 months. At the end of follow-up, the cyst units were reduced in size by more than 50% compared to the preoperative size, and no patient experienced a recurrence. Conclusion: Multi-level paravertebral nerve block for percutaneous ureteroscopy laser unroofing as an ambulatory surgery mode is feasible, safe, and effective for the treatment of simple renal cysts in selected patients.

Clinical Efficacy of Endoscopic Marsupialization in the Management of a Symptomatic Simple Renal Cyst: A Case Report and Review of the Current Literature.

Simple renal cysts are commonly acquired benign lesions of the kidney. Requiring management only when it causes pain, obstruction, or gross hematuria, endoscopic marsupialization of simple renal cysts is a new method for the management of renal cysts. Herein, we present a rare case of a 44-year-old female with a simple renal cyst that was managed for the first time in Saudi Arabia by endoscopic marsupialization and discuss its efficacy and outcome compared to other methods of management.

Association between serum uric acid levels and simple renal cyst risk in a nondiabetic population: A nested case-control study.

BACKGROUND: Previous studies have found a relationship between hypertension or cardiovascular disease and simple renal cysts (SRCs) in health check-up population, but SRCs incidence is still controversially associated with serum uric acid (SUA) concentration in the nondiabetic participants. In this single-centre nest case-control study, serum uric acid levels were examined in relation to the incidence of SRCs in nondiabetic individuals. METHOD: Participants who underwent at least two renal ultrasound examinations with an interval of more than 12 months were enrolled. The results of clinical examinations, laboratory tests and abdominal ultrasound tests were recorded for each participant and analysed in this retrospective observation study. RESULT: A total of 144 control and 144 SRC patients were ultimately confirmed and included in further analysis. Hyperuricaemia (OR 2.846, 95% CI 1.519-5.332, p = 0.001) was significantly correlated with SRC formation according to multivariable analysis. In both the male and female groups, SRC patients had significantly higher serum uric acid levels compared with control subjects. In 54 SRC patients with cyst puncture, the serum uric acid concentration was positively correlated with the uric acid concentration in cyst fluid (r = 0.6144, p < 0.0001). The serum uric acid concentration was positively correlated with the maximum cyst diameter in the SRC patients (r = 0.4531, p < 0.0001). CONCLUSION: In a nondiabetic population, hyperuricaemia was significantly independently associated with a higher SRCs incidence. In SRC participants with cyst puncture, the SUA level had a significantly positive correlation with the uric acid level in cyst fluid. In SRC patients, the SUA level had a significantly positive correlation with cyst maximum diameter.

Effects of Renal Cysts on Renal Function.

BACKGROUND: People with simple renal cysts (SRCs) are more likely to develop renal injury and dysfunction, but the mechanisms remain controversial, as the process of SRC formation and its characteristics are not yet well-known. This research focuses on the characteristics of SRCs and discusses how SRCs cause renal injury. METHODS: In 2014, a total of 401 participants without any prior kidney disease were selected for the research. Their average age was 49.7 years. SRC morphology and changes were monitored over a 5-year follow-up period. Renal volume and blood perfusion were measured by ultrasound imaging. Logistic regression analysis was used to assess the relationship between renal cyst and renal function. RESULTS: During the 5-year follow-up, elderly participants with multiple cysts (odds ratio [OR] 1.89; 95% CI 1.67 to 5.99) and a maximum cyst diameter of 1.5 cm or greater (OR 1.93; 95% CI 1.15 to 5.34) were found to be positively correlated with renal injury. A decrease in intrarenal perfusion was observed at the early stages of follow-up, but the reduction in renal volume was a slow and gradual process. CONCLUSION: Elderly people with multiple cysts, a maximum cyst diameter of the cysts≥1.5 cm, and multiple cysts are more likely to suffer renal injury. Ultrasound examination has an important status in monitoring the changes in renal volume and peak systolic velocity (PSV) of the renal interlobar artery.

Comparison of Polidocanol Sclerotherapy with Laparoscopic Deroofing in the Management of Pediatric Symptomatic Simple Renal Cysts: A Long-Term Study.

Objective: To compare the efficacy and safety of percutaneous polidocanol sclerotherapy and laparoscopic deroofing in the management of pediatric symptomatic simple renal cysts (SRCs). Methods: Forty-six patients with symptomatic SRCs (cyst size ≥4 cm) were treated either with polidocanol sclerotherapy (group A) or by laparoscopic deroofing (group B) between December 2009 and October 2019. The patients were reevaluated at 1, 6, and 12 months and annually thereafter. Results: Twenty-one patients were treated with polidocanol sclerotherapy (group A) and 25 patients with laparoscopic deroofing (group B). The mean follow-up period was 58.7 months (14-107) in group A and 57.2 months (12-118) in group B. Complete regression was seen in 19 (90.5%) and 24 (96%) patients in groups A and B, respectively (p < 0.05). Partial regression was documented in one patient each in group A (4.8%) and B (4%). In one group A patient, a laparoscopic deroofing was performed due to sclerotherapy failure after 27 months. The operation time, postoperative hospital stay, and cost were significantly less in group A than in group B (36.3 ± 8.4 vs 96.9 ± 19.1, 19.7 ± 2.4 vs 56.0 ± 8.6, and ¥8173 ± 1343 vs ¥14,119 ± 2021, respectively; p < 0.05). Conclusion: Polidocanol sclerotherapy and laparoscopic deroofing were found to be equally effective interventions associated with minimal complications for pediatric symptomatic SRCs. We recommend polidocanol sclerotherapy as the first option for children with symptomatic SRCs and laparoscopic deroofing in cases of failed polidocanol sclerotherapy.

A case involving laparoscopic decortication of a large simple renal cyst using conventional monopolar device.

INTRODUCTION AND IMPORTANCE: Simple renal cysts are common in adults, but most of them are asymptomatic. Usually, percutaneous puncture is an initial treatment, but laparoscopic decortication may be effective for recurrent simple renal cyst. Herein, we report a case in which a large symptomatic simple renal cyst was treated with laparoscopic decortication using conventional monopolar device. CASE PRESENTATION: A 34-year-old female visited our hospital with chief complaints of back pain and abdominal fullness. Computed tomography showed a right simple renal cyst (diameter: 140 mm). We performed percutaneous drainage with sclerotherapy, but the cyst recurred a month later. Thus, we carried out laparoscopic decortication. We opened the cyst wall via a retroperitoneal approach and trimmed it using monopolar scissors. The operation time was 124 min. The patient's postoperative course was uneventful, and no complications were observed. Following surgery, the patient was asymptomatic. CLINICAL DISCUSSION: In our case, we performed operation using a conventional monopolar device without sealing devices. It has been reported that the use of sealing devices can make laparoscopic surgery safer and reduce the operation time, but we herein report that laparoscopic decortication with a conventional monopolar device is an effective and safe treatment option for symptomatic simple renal cysts and that more expensive energy sources are not required. CONCLUSION: We successfully performed laparoscopic decortication of a large symptomatic simple renal cyst. This operation is minimally invasive and safe.

Incidentalomas Among Healthy Nephrology Fellow Volunteers at POCUS Workshops: A Case Series.

A radiographic incidental finding (sometimes called an incidentaloma) is defined as a structure that is unintentionally found during an exam for an unrelated indication. The increased use of routine abdominal imaging is associated with a rising incidence in incidentalomas of the kidney 1. In one meta-analysis, 75% of renal incidentalomas were benign 2. However, the overall prevalence of incidental carcinomas is low at 0.2% 3. With the growing uptake of POCUS, healthy volunteers for clinical demonstrations may find themselves with new findings despite a lack of symptoms 4. Having an incidentaloma discovered during the course of a nephrology POCUS workshop is a unique experience. Herein we report our experiences of having incidentalomas discovered during the course of POCUS demonstrations.

The Presence of Simple Renal Cysts Is Associated With Increased Arterial Stiffness in Patients With Abdominal Aortic Aneurysm.

Simple renal cysts (SRC) are associated with the development of abdominal aortic aneurysms (AAA). We hypothesized that patients with AAA and SRC have increased arterial stiffness (AS) compared with patients without SRC. Patients (n=223) with an infrarenal AAA undergoing pulse wave analysis were recruited. Brachial-ankle pulse wave velocity (PWV) was measured (automated oscillometric method) as an index of AS. Participants were categorized into those with increased AS and those with normal/borderline AS (threshold: 1800 cm/s); 134 patients (60.1%) had increased AS and 89 (39.9%) patients had normal/borderline AS. Multivariable analyses showed that age ≥75 years (odds ratio [OR], 2.83; 95% confidence interval [CI], 1.51-5.72; P=.002), systolic blood pressure ≥140 mmHg (OR, 5.05; 95% CI, 2.35-10.83; P<.001), hypertension (OR, 2.28; 95% CI, 1.08-4.79; P=.030), and presence of SRC (OR, 1.89; 95% CI, 1.03-3.46; P=.040) were independent risk factors for increased AS. The presence of SRC is an independent risk factor for increased AS in patients with an AAA. This association suggests that patients with SRC may have severe aortic wall degeneration and thus the presence of SRC may be pathologically linked to the development of AAA.

Parapelvic Cysts: An Imaging Marker of Kidney Disease Potentially Leading to the Diagnosis of Treatable Rare Genetic Disorders? A Narrative Review of the Literature.

Simple renal cysts are a common finding during abdominal imaging assessment. The incidence increases with age and it is higher in male gender. Parapelvic cysts are a subset of simple cysts that arise within the renal parenchyma, adjacent to the renal sinus, characterized by being generally single, larger, and incompletely surrounded by renal parenchyma. Noteworthy, parapelvic cysts are a rare and understudied condition which, although considered clinically insignificant due to the absence of influence on renal function, still have a controversial aetiopathogenesis. On the other hand, urological management and differential diagnosis have been thoroughly investigated. The aim of our review is to provide an overall vision on this rare condition, usually misdiagnosed and underestimated, on the basis of more recent data. An accurate differential diagnosis of parapelvic cysts can lead to the identification of treatable conditions such as Fabry disease, autosomal dominant polycystic kidney disease, polycystic liver disease and tuberous sclerosis complex disease.

Simple renal cyst as an independent risk factor for hypertension.

A simple renal cyst (SRC) may increase the risk for hypertension. The authors examined the relationship between a SRC and hypertension in participants receiving physical examinations at Hebei Medical University. This study enrolled 66 883 participants who received physical examinations at our center from January 2012 to December 2017. Demographic data, medical history related to hypertension, hematological indexes, hypertension, and SRC subtype based on ultrasound examinations were examined. The relationship between SRC and hypertension was analyzed using univariate and multivariate logistic regression analysis in different models. Subgroup analysis and propensity score (PS) matching were also performed. Based on SRC subtype (unitary vs. multiple, small vs. large, unilateral vs. bilateral), a comprehensive scoring system was established to determine the effect of SRC load on hypertension. The results of univariate and multivariate analysis indicated that SRC was a risk factor for hypertension (P < .01). Subgroup and interaction analysis showed the homogeneity that SRC was an independent risk factor for hypertension in multiple subgroups (P > .05). A SRC remained an independent risk factor for hypertension after PS matching (P < .01). Based on a scoring system that considered different SRC subtypes, the risk for hypertension increased with renal cyst load (P < .01). In conclusions, a SRC was an independent risk factor for hypertension, and there was a positive correlation between SRC load and hypertension. The risk of hypertension increased gradually with the size, number, and location of a SRC. Careful follow-up or excision should be considered for patients with SRCs.

Development and external validation of a nomogram for predicting renal function based on preoperative data from in-hospital patients with simple renal cysts.

OBJECTIVE: To develop and validate a nomogram for predicting renal dysfunction in patients with simple renal cysts (SRCs). METHODS: We performed a multivariable logistic regression analysis of an in-hospital retrospective cohort of patients with SRCs in the Urology Department of the First Affiliated Hospital of Anhui Medical University. For prognostic model development, 386 patients with SRCs were enrolled from January 2016 to December 2018. External validation was performed in 46 patients with SRCs from January 2019 to April 2019. The primary outcome was renal dysfunction. RESULTS: Patients were divided into normal or abnormal estimated glomerular filtration rate groups (293 vs. 93) based on the cut-off value of 90 mL/minute/1.73 m2. Logistical regression analysis determined that age, haemoglobin, globulin, and creatinine might be associated with renal dysfunction, and a novel nomogram was established. Calibration curves showed that the true prediction rate was 77.42%, and decision curve analysis revealed that the nomogram was more effective with threshold probabilities ranging from 0.1 to 0.8. The area under the curves were 0.829, 0.752, and 0.888 in the overall training, internal, and external validation cohorts, respectively. CONCLUSIONS: We established a nomogram to predict the probability of developing renal dysfunction in patients with SRCs.