Search Results (885)

Introduction: Renal malacoplakia is a rare chronic granulomatous disease, often associated with immunosuppression and persistent Gram-negative infections, particularly Escherichia coli. Case Presentation: We present a case involving a 31-year-old woman with hypertension, gestational diabetes, and prior uterine curettage after labor induction for preeclampsia at 23 weeks. She developed urinary sepsis post-procedure. Imaging revealed bilateral nephromegaly, while laboratory tests showed acute kidney injury (KDIGO stage III), anemia, and thrombocytopenia. Blood and urine cultures grew Escherichia coli. Renal biopsy confirmed malacoplakia, demonstrating PAS-positive Michaelis–Gutmann bodies and Von Hansemann cells. The patient responded to prolonged antibiotic therapy and supportive care. Discussion and Conclusion: This case highlights the importance of considering renal malacoplakia in patients with atypical urinary tract infections and nephromegaly, particularly in obstetric settings. Histopathological confirmation is essential, and timely treatment with intracellularly active antibiotics can lead to favorable outcomes. Early diagnosis is critical to prevent irreversible renal damage. Full article

Background and Objectives: The causes and clinical outcomes of renal perfusion abnormalities occurring after para-aortic lymphadenectomy (PANDx) for gynecologic malignancies are unknown. We investigated the potential involvement of accessory renal artery (ARA) obstruction in their development by reassessing perioperative contrast-enhanced computed tomography (CECT). Materials and Methods: This retrospective study investigated a clinical database to identify urinary contrast defects using CECT in all patients who had undergone PANDx between January 2020 and December 2024. The perfusion defects in the kidney detected by CECT were extracted by a gynecologic oncologist and evaluated by a radiologist and urologist for suspected obstruction of ARAs. Results: Postoperative renal contrast defects were observed in 3.8% (6/157) of patients. Renal parenchymal fibrosis, cortical atrophy, and parenchymal thinning were observed as universal findings in all patients showing renal contrast defects. In five of the six cases, ARAs supplying the infarcted renal segments were identified on preoperative CECT, and arterial obstruction was confirmed on postoperative imaging. The remaining case was considered to be latent pyelonephritis. All five patients underwent laparotomy, and preoperative CECT failed to detect ARAs. The median resected para-aortic lymph node was 23 nodes (range: 15–33) in five patients, showing no statistically significant difference compared to patients without perfusion abnormalities (p = 0.19). Postoperative serum creatinine levels remained stable. Conclusions: ARA obstruction appears to be a risk factor for segmental renal infarction after para-aortic lymphadenectomy in gynecological malignancies; however, the clinical impact on urinary function may be limited. Awareness of this potential complication is essential for gynecologic oncologists performing PANDx. Full article

Objectives: This study introduces an automated classification system for noisy kidney ultrasound images using an ensemble of deep neural networks (DNNs) with transfer learning. Methods: The method was tested using a dataset with two categories: normal kidney images and kidney images with stones. The dataset contains 1821 normal kidney images and 2592 kidney images with stones. Noisy images involve various types of noises, including salt and pepper noise, speckle noise, Poisson noise, and Gaussian noise. The ensemble-based method is benchmarked with state-of-the-art techniques and evaluated on ultrasound images with varying quality and noise levels. Results: Our proposed method demonstrated a maximum classification accuracy of 99.43% on high-quality images (the original dataset images) and 99.21% on the dataset images with added noise. Conclusions: The experimental results confirm that the ensemble of DNNs accurately classifies most images, achieving a high classification performance compared to conventional and individual DNN-based methods. Additionally, our method outperforms the highest-achieving method by more than 1% in accuracy. Furthermore, our analysis using Gradient-weighted Class Activation Mapping indicated that our proposed deep learning model is capable of prediction using clinically relevant features. Full article

Introduction: Leptospirosis is an under-recognized zoonosis that affects both tropical and temperate regions. While it is often associated with exposure to contaminated water or infected animals, its presentation and epidemiology in Mediterranean countries remain incompletely understood. This retrospective cohort study investigates the clinical and epidemiological profile of leptospirosis in Crete, Greece, a region where data are scarce. Methods: All adult patients with laboratory-confirmed leptospirosis admitted to three major public hospitals in Crete, Greece, between January 2019 and December 2023 were included in the analysis. Diagnosis was made through serologic testing along with compatible clinical symptoms. Results: A total of 17 patients were included. Their median age was 48 years, with a predominance of males (70.6%). Notably, more than half of the patients had no documented exposure to classic risk factors such as rodents or standing water. Clinical presentations were varied but commonly included fever, fatigue, acute kidney injury, and jaundice. Of the patients who underwent imaging, most showed hepatomegaly. The median delay from symptom onset to diagnosis was 11 days, underscoring the diagnostic challenge in non-endemic areas. Ceftriaxone was the most frequently administered antibiotic (76.5%), often in combination with tetracyclines or quinolones. Despite treatment, three patients (17.6%) died, all presenting with severe manifestations such as ARDS, liver failure, or shock. A concerning increase in cases was noted in 2023. Conclusions: Leptospirosis can present with severe and potentially fatal outcomes even in previously healthy individuals and in regions not traditionally considered endemic. The relatively high mortality and disease frequency noted emphasize the importance of maintaining a high index of suspicion. Timely diagnosis and appropriate antimicrobial therapy are essential to improving patient outcomes. Additionally, the need for enhanced public health awareness, diagnostic capacity, and possibly environmental surveillance to control this neglected but impactful disease better, should be emphasized. Full article

Background/Objectives: To evaluate the diagnostic performance of non-enhanced MRA in detecting intratumoral aneurysms in renal AML, using digital subtraction angiography (DSA) as the reference standard. Methods: Fourteen female patients (mean age, 39 years; range, 21–57 years) who received prophylactic transcatheter arterial embolization (TAE) for non-hemorrhagic renal AML(s) between July 2010 and September 2018 were included in this study. All received a non-enhanced MRA scan prior to TAE. Non-enhanced MRA images were obtained using the flow-in technique with three-dimensional balanced steady-state free precession (SSFP). The MRA and DSA images were jointly evaluated by three radiologists. In this study, significant aneurysms were defined as aneurysms with a diameter of 3 mm or more within the renal AML. The MRA images assessed the number and location of significant aneurysms. The DSA images were used as the reference standard. Results: DSA identified 30 significant aneurysms in eight kidneys; MRA identified 26, giving a sensitivity of 87%. There were no false positives, resulting in a specificity of 100%. Conclusions: Flow-balanced SSFP MRA is effective in detecting significant aneurysms in renal AML and could be a viable alternative for patient follow-up. Full article

Background/Objectives: Paclitaxel (PTX) is widely used in the treatment of a variety of solid tumours due to its broad-spectrum anti-tumour activity, but its use in brain gliomas is limited by insufficient blood–brain tumour barrier (BBTB) penetration and systemic toxicity. The aim of this study was to develop a Solutol HS-15-based micellar nanoparticle (PSM) to enhance the brain glioma targeting of PTX and reduce toxicity. Methods: PSMs were prepared by solvent injection and characterised for particle size, encapsulation rate, haemolysis rate and in vitro release properties. A C6 in situ glioma mouse model was used to assess the brain targeting and anti-tumour effects of the PSM by in vivo imaging, tissue homogenate fluorescence analysis and bioluminescence monitoring. Meanwhile, its safety was evaluated by weight monitoring, serum biochemical indexes and histopathological analysis. Results: The particle size of PSMs was 13.45 ± 0.70 nm, with an encapsulation rate of 96.39%, and it demonstrated excellent cellular uptake. In tumour-bearing mice, PSMs significantly enhanced brain tumour targeting with a brain drug concentration 5.94 times higher than that of free PTX. Compared with Taxol, PSMs significantly inhibited tumour growth (terminal luminescence intensity <1 × 10⁶ p/s/cm²/Sr) and did not cause significant liver or kidney toxicity or body weight loss. Conclusions: PSMs achieve an efficient accumulation of brain gliomas through passive targeting and EPR effects while significantly reducing the systemic toxicity of PTX. Its simple preparation process and excellent therapeutic efficacy support its use as a potential clinically translational candidate for glioma treatment. Full article

Using neural networks has become the standard technique for medical diagnostics, especially in cancer detection and classification. This work evaluates the performance of Vision Transformer architectures, including Swin Transformer and MaxViT, for several datasets of magnetic resonance imaging (MRI) and computed tomography (CT) scans. We used three training sets of images with brain, lung, and kidney tumors. Each dataset included different classification labels, from brain gliomas and meningiomas to benign and malignant lung conditions and kidney anomalies such as cysts and cancers. This work aims to analyze the behavior of the neural networks in each dataset and the benefits of combining different image modalities and tumor classes. We designed several experiments by fine-tuning the models on combined and individual datasets. The results revealed that the Swin Transformer achieved the highest accuracy, with an average of 99.0% on single datasets and reaching 99.43% on the combined dataset. This research highlights the adaptability of Transformer-based models to various human organs and image modalities. The main contribution lies in evaluating multiple ViT architectures across multi-organ tumor datasets, demonstrating their generalization to multi-organ classification. Integrating these models across diverse datasets could mark a significant advance in precision medicine, paving the way for more efficient healthcare solutions. Full article

Background and Clinical Significance: Spontaneous renal hematoma, also known as Wunderlich syndrome (WS), is a rare disease characterized by the acute onset of spontaneous renal hemorrhage into the subcapsular, perirenal, and/or pararenal spaces without a history of prior trauma. WS can be a life-threatening condition due to hemorrhagic shock; consequently, prompt diagnosis and a therapeutic approach are essential for favorable outcomes. Treatment ranges from conservative management to surgical intervention. The most common etiologies are neoplasms and vascular diseases, but WS can also be observed in patients undergoing hemodialysis. In patients with end-stage renal disease (ESRD), especially those on hemodialysis, acquired cystic kidney disease and renal cell carcinoma are among the primary causes of WS. Although less common, WS can develop in dialysis patients even in the absence of traditional (primary) risk factors. In general, patients with chronic kidney disease (CKD) have a paradoxical hemostatic profile, likely explaining their higher tendency to bleed, so WS can occur without existing predisposing factors. The multifactorial pathogenesis in these patients includes functional platelet abnormalities, intimal arterial fibrosis, chronic inflammation, and oxidative stress associated with ESRD. The use of hemodialysis-related antithrombotic medications could serve as another contributing factor increasing the risk of bleeding. Case Presentation: We present a case report of a 62-year-old male on chronic dialysis who developed sudden right-sided lumbar pain and hematuria during dialysis without evidence of prior trauma. Imaging revealed a large subcapsular hematoma of the right kidney. Further investigations did not reveal additional risk factors in this instance; however, his routinely used hemodialysis-related antithrombotic medications were potentially a contributing factor. Despite conservative treatment, his condition worsened, and the hematoma enlarged, requiring emergency nephrectomy. Postoperatively, his condition gradually improved. Conclusions: This case highlights the importance of considering WS in hemodialysis patients, even without the presence of traditional risk factors, as well as including WS in the differential diagnosis of acute abdominal pain. Full article

Background/Objectives: Acetazolamide is widely used for acute mountain sickness (AMS) prophylaxis. Whilst generally safe, acute kidney injury (AKI) is a rare but serious adverse event. We present a case of anuric AKI following minimal exposure to acetazolamide, contributing to the limited literature on its nephrotoxicity at prophylactic doses. Methods: A 54-year-old previously healthy male ingested 250 mg/day of oral acetazolamide for two days. He developed acute anuria and lumbar pain. Diagnostic evaluation included laboratory tests, imaging, microbiological cultures, autoimmune panels, and diuretic response. No signs of infection, urinary tract obstruction, or systemic disease were found. Results: The patient met KDIGO 2012 criteria for stage 3 AKI, with peak serum creatinine of 10.6 mg/dL and metabolic acidosis. Imaging confirmed non-obstructive nephrolithiasis. Conservative treatment failed; intermittent hemodialysis was initiated. Renal function recovered rapidly, with the normalization of serum creatinine and urinary output by day 4. Conclusions: This case represents the lowest cumulative dose of acetazolamide reported to cause stage 3 AKI. The findings support a pathophysiological mechanism involving sulfonamide-induced crystalluria and intratubular obstruction. Physicians should consider acetazolamide in the differential diagnosis of AKI, even with short-term prophylactic use. Full article

Background: Oncocytoma and angiomyolipoma (AML) are benign renal tumors that may mimic malignant lesions on imaging. With the increasing use of partial nephrectomy (PN) for renal masses, accurate preoperative characterization of these lesions is essential. This study highlights the role of partial nephrectomy as a valuable diagnostic tool in situations where imaging is inconclusive or raises concern for malignancy without definitive confirmation. In the absence of a reliable preoperative diagnosis, partial nephrectomy provides direct histologic verification with minimal perioperative morbidity. Moreover, it offers curative potential when malignancy is present. By achieving both diagnostic certainty and renal preservation, this approach is well-suited for clinical scenarios in which imaging ambiguity might otherwise result in overtreatment through radical surgery or undertreatment Material and methods: in this retrospective study, we reviewed our 5-year experience (2019–2024), 188 partial nephrectomies—including bilateral procedures and operations on solitary kidneys—using robotic and open approaches. All of these 30 tumors were solid renal masses with indeterminate imaging features or suspicious characteristics suggestive of malignancy, further underscoring the limitations of current preoperative diagnostic modalities. Results: Histopathological evaluation confirmed benign renal tumors in 30 cases, with oncocytoma diagnosed in 18 cases (16 robotic, 2 open) and AML in 12 cases (9 robotic, 3 open). Conclusions: Even when imaging raises suspicion of malignancy or remains inconclusive, many small renal masses are ultimately confirmed as benign upon histopathological examination. This study underscores the diagnostic uncertainty associated with small renal tumors and highlights the value of partial nephrectomy as a decisive diagnostic intervention. In situations where non-invasive modalities fail to provide definitive answers, partial nephrectomy offers tissue confirmation with minimal morbidity. Furthermore, when malignancy is present, this approach ensures appropriate oncologic management while preserving renal function. Our findings support the integration of this strategy into routine clinical practice, particularly when diagnostic clarity is essential for guiding safe and effective treatment. Full article

Background and clinical significance: Ectopic ureters are a rare urinary tract malformation, typically diagnosed in childhood and infrequently in adulthood. The prenatal detection by ultrasound and magnetic resonance imaging (MRI) of this clinical entity has scarcely been reported. Careful foetal scanning during the late second and third trimester might provide clues and lead to prenatal detection. However, even the postnatal diagnosis is challenging, and often delayed towards adulthood, since the condition may present with nonspecific symptoms, leading to underdiagnosis or misdiagnosis. In female patients, approximately 25% of ectopic ureters open into the vagina. Due to the high risk of recurrent urinary tract infections and the potential development of uretero-hydronephrosis, timely diagnosis is essential, and prompt surgical correction is mandated. Case presentation: We report the case of a 33-year-old GII PI patient diagnosed with cystic dysplasia of the left foetal kidney at the 16 WG (weeks of gestation) scan. The malformation was consistent at 21 WG when karyotyping by amniocentesis identified a normal female molecular karyotype. MRI performed at 28 weeks confirmed the left renal dysplasia and raised the suspicion of an abnormal insertion of the left ureter into the vagina. After delivery, the vaginal ureteral ectopy was confirmed at 3 weeks postpartum via cystoscopy. Postpartum whole exome sequencing identified a variant of uncertain significance (VUS) mutation in the SOX 13 gene (SRY-box transcription factor 13). Renal scintigraphy performed 7 months postnatally identified a hypo/afunctional left kidney which led to the indication of nephrectomy by the paediatric urologist. The surgical intervention was performed at 8 months postpartum with a favourable outcome. Conclusions: Ectopic ureters are a pathology generating life-long morbidity and discomfort of the offspring and young adult. Awareness to this pathology must be raised among clinicians, especially regarding the potential detection by minute prenatal ultrasound examinations, followed by MRI to refine diagnosis. Postnatally, the persistence of suspicious yet unspecific symptoms, in both males and females, must trigger thorough imaging/cystoscopic examination to reach diagnosis and provide correct management. Full article

Background and Objectives: Non-invasive imaging biomarkers for the early detection of chronic kidney allograft injury are needed to improve long-term transplant outcomes. T1 mapping by magnetic resonance imaging (MRI) has emerged as a promising method to assess renal structure and function. This study aimed to determine the potential of MRI as a diagnostic tool for evaluating graft function and structural changes in kidney grafts 1 year after transplantation. Materials and Methods: Thirty-four kidney transplant recipients were prospectively recruited, with 27 completing the follow-up at one year. Renal MRI at 3T was performed to acquire T1, T2, and apparent diffusion coefficient (ADC) maps. Clinical parameters, including estimated glomerular filtration rate (eGFR), albumin-to-creatinine ratio (ACR), protein-to-creatinine ratio (PCR), and histological IF/TA scores, were collected. MRI parameters were compared across the groups stratified by clinical and histological markers. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) analysis. Results: At 1 year, T1 corticomedullary differentiation (CMD) values were significantly higher in patients with elevated ACR (≥3 mg/mmol), PCR (≥15 mg/mmol), and mild to moderate or severe IF/TA, reflecting a reduction in the corticomedullary gradient. T1 CMD demonstrated moderate-to-good diagnostic performance in detecting ACR (AUC 0.791), PCR (AUC 0.730), and IF/TA (AUC 0.839). No significant differences were observed in T2 or ADC values across these groups. T1 CMD also showed a significant positive correlation with ACR but not with eGFR, suggesting a closer association with structural rather than functional deterioration. Conclusions: T1 mapping, particularly T1 CMD, shows promise as a non-invasive imaging biomarker for detecting chronic allograft injury and monitoring renal function 1 year after kidney transplantation. Full article

Introduction: Renal artery stenosis can significantly impact long-term graft survival rates following kidney transplant. Early recognition and management can improve the longevity of the kidney allograft. We aimed to evaluate the clinical role of duplex ultrasound in the diagnosis of renal artery stenosis (RAS). We also wanted to evaluate the current incidence of renal artery stenosis at our institute. Methods: A retrospective, consecutive series of 367 patients who underwent renal transplantation between 1 January 2020 and 30 December 2024 was conducted. We collected data regarding the recipients’ age, body mass index, and comorbidities. All patients diagnosed with renal artery stenosis were identified. The incidence of kidney transplant artery stenosis and presentation were recorded. All general physical parameters and laboratory data were collected and analyzed. Results: A total of 28 patients had initial suspicion of renal artery stenosis, documented via initial dedicated duplex ultrasound of the transplanted kidney. The initial mean systolic BP at initial US was 151 (99–213) mmHg, and mean creatinine was 2.43 (1.28–6.38) mg/dL. However, on repeat duplex ultrasound, three patients showed no features of renal artery stenosis and had no physical parameters consistent with RAS. A total of 25 patients diagnosed with RAS on initial duplex ultrasound underwent angiography. Twenty-four patients were confirmed with RAS on angiography, while one patient had a normal angiogram. Among patients diagnosed with TRAS, the mean resistive index was 0.71 ± 0.17 at the upper pole, 0.73 ± 0.19 at the mid pole, and 0.71 ± 0.21 at the lower pole. The mean peak systolic velocity was 462.57 ± 166.28 cm/s. Conclusions: Duplex ultrasound is an important initial tool for diagnosing transplant renal artery stenosis. An increase in peak systolic velocity was observed in our cohort; however, resistive indices were largely within acceptable limits. Management should be guided by clinical parameters (e.g., elevated systolic BP and rising creatinine) alongside imaging findings. Full article

Background: Renal tumors, encompassing benign, malignant, and normal variants, represent a significant diagnostic challenge in radiology due to their overlapping visual characteristics on computed tomography (CT) scans. Manual interpretation is time consuming and susceptible to inter-observer variability, emphasizing the need for automated, reliable classification systems to support early and accurate diagnosis. Method and Materials: We propose KidneyNeXt, a custom convolutional neural network (CNN) architecture designed for the multi-class classification of renal tumors using CT imaging. The model integrates multi-branch convolutional pathways, grouped convolutions, and hierarchical feature extraction blocks to enhance representational capacity. Transfer learning with ImageNet 1K pretraining and fine tuning was employed to improve generalization across diverse datasets. Performance was evaluated on three CT datasets: a clinically curated retrospective dataset (3199 images), the Kaggle CT KIDNEY dataset (12,446 images), and the KAUH: Jordan dataset (7770 images). All images were preprocessed to 224 × 224 resolution without data augmentation and split into training, validation, and test subsets. Results: Across all datasets, KidneyNeXt demonstrated outstanding classification performance. On the clinical dataset, the model achieved 99.76% accuracy and a macro-averaged F1 score of 99.71%. On the Kaggle CT KIDNEY dataset, it reached 99.96% accuracy and a 99.94% F1 score. Finally, evaluation on the KAUH dataset yielded 99.74% accuracy and a 99.72% F1 score. The model showed strong robustness against class imbalance and inter-class similarity, with minimal misclassification rates and stable learning dynamics throughout training. Conclusions: The KidneyNeXt architecture offers a lightweight yet highly effective solution for the classification of renal tumors from CT images. Its consistently high performance across multiple datasets highlights its potential for real-world clinical deployment as a reliable decision support tool. Future work may explore the integration of clinical metadata and multimodal imaging to further enhance diagnostic precision and interpretability. Additionally, interpretability was addressed using Grad-CAM visualizations, which provided class-specific attention maps to highlight the regions contributing to the model’s predictions. Full article

This work aimed to evaluate two albumin affinity structure-containing peptide-radionuclide conjugate drugs, INER-PP-F11N-1 and INER-PP-F11N-2, for the diagnosis/treatment of cholecystokinin receptor subtype 2 (CCK2R)-overexpressing cancers. We developed In-111- and Lu-177-labeled INER-PP-F11N radiopharmaceuticals and compared them with the current PP-F11N to investigate metabolic stability, biodistribution, SPECT/CT imaging, and therapeutic responses in CCK2R-expressing tumor xenograft mice. The metabolic stability of [¹¹¹In]In/[¹⁷⁷Lu]Lu-INER-PP-F11N remained above 90% for up to 144 h after labeling, indicating that the compound is highly stable under in vitro conditions. INER-PP-F11N showed 27% and 11% higher cellular uptake and internalization than PP-F11N, respectively. In vivo SPECT/CT imaging confirmed that INER-PP-F11N could accumulate at the tumor site of mice 24 h after receiving the two radiopharmaceutical agents. Biodistribution analysis revealed a significantly greater tumor uptake and reduced accumulation of INER-PP-F11N in the kidneys compared with PP-F11N. Furthermore, INER-PP-F11N significantly inhibited the growth of the CCK2R-overexpressing tumors in mice. The INER-PP-F11N radiopharmaceutical was superior as a theragnostic agent compared with the current PP-F11N. Our study suggests that INER-PP-F11N may be an innovative radiopharmaceutical agent for CCK2R-overexpressing tumors. Full article