PURPOSE: This study was performed to observe the utilization of ultrasonography in locating the position of UAC and to compare the position with anatomical landmarks seen on radiography. METHODS: Optimal position is when the catheter tip is located between T6-T10 or L3-L5 by anteroposterior radiography (AP-R) and above the diaphragm by cross-table lateral radiography (CTL-R). Ultrasonographic studies used a Hewlett Packard Sonos 1000 with 5 MHz scanner, the distance from the catheter tip to the origin of the celiac artery in high position and the distance from the catheter tip to the origin of the renal arteries and to the aortic bifurcation in low position were measured. RESULTS: In 23 of 36 newborns, high type UAC was properly positioned by AP-R, but ultrasonographic examination showed that 3 UAC were malpositioned under 5mm above the origin of the celiac artery. Detection of properly positioned UAC by AP-R had a sensitivity of 80% and specificity of 72.7%. In 19 of 28 newborns, high type UAC was properly positioned by CTL-R, but ultrasonographic examination showed that 2 UAC were malpositioned under 5mm above the origin of the celiac artery. Detection of properly positioned UAC by CTL-R had a sensitivity of 81% and specificity of 71.4%. In 15 of 20 newborns, low type UAC was properly positioned by AP-R, and ultrasonographic examination showed that 1 UAC was malpositioned below the aortic bifurcation. Detection of properly localized UAC by AP-R had a sensitivity of 77.8% and specificity of 50%. CONCLUSION: Ultrasonographic catheter localization is a noninvasive technique that uses no ionizing radiation and has no known deterimental side effects, and allows direct visualization of the pertinent vascular anatomy, providing more information than traditional radiography.
Catheters* ; Celiac Artery ; Diaphragm ; Humans ; Infant, Newborn ; Radiation, Ionizing ; Radiography* ; Renal Artery ; Sensitivity and Specificity ; Ultrasonography*

Atherosclerotic renal artery stenosis (RAS) usually involves the ostium and the proximal one-third of the renal artery main branch. Percutaneous renal artery angioplasty with stent placement is a well recognized treatment for atherosclerotic RAS. Occasionally, atherosclerotic RAS involves renal artery bifurcations. However, stent implantation in atherosclerotic RAS involving bifurcation is not only troublesome, but also challenging because of side branch occlusion and in-stent restenosis (ISR). In the present report, we describe the use of drug-eluting stents (DES) with provisional T-stenting technique for the treatment of renal artery bifurcation lesion. Follow-up angiogram showed no significant ISR 18 months after the procedure. In the treatment of renal bifurcation lesions, a two-stent strategy using DES could be a viable option in selected patients.
Aged ; *Angioplasty ; *Drug-Eluting Stents ; Humans ; Male ; Renal Artery/pathology/radiography ; Renal Artery Obstruction/pathology/*therapy ; Treatment Outcome

PURPOSE: To assess the utility of multiphasic spiral CT for characterizing renal masses. MATERIALS AND METHODS: The study included 36 patients (53 lesions) referred for the evaluation of renal masses suspected on the basis of the results of sonography or radiography. Spiral CT of the kidneys was performed prior to and following power injection of intravenous contrast material (Optiray-320). Postcontrast imaging data were obtained and analyzed during early and late corticomedullary (20-30-second delay), nephrographic (60-70-second delay), and excretory (5-minute delay) phases. During each phase, the ability to detect renal masses was evaluated, and the ability to diagnose these masses on routine and multiphasic CT was assessed. Routine precontrast and excretory phase CT studies were performed and the usefulness of each phase for the diagnosis of renal cell carcinoma (RCC) and transitional cell carcinoma (TCC) was evaluated. RESULTS: The rates for the detection of renal masses were as follows: 94.3% on precontrast scan, 93.8% during the early corticomedulolary phase (ECMP), 98.1% during the late corticomedullary phase (LCMP), 100% during the nephrographic phase (NP), and 98.1% during the excretory phase (EP). During both routine and multiphasic CT, diagnostic accuracy was 96.2%, though for differential diagnosis, multiphasic CT was more helpful than routine CT in 4/16 cases of RCC and 2/8 cases of TCC. The highest for lesion characterization, during the LCMP in RCC, and the LCMP and NP in TCC ; for evaluation of tumor margin during the EP in both RCC and TCC ; for delineation of the renal artery, during the LCMP in both RCC and TCC ; for delineating the renal vein, during the NP in RCC, and the LCMP in TCC. CONCLUSION: For the detection and correct diagnosis oflesions, multiphasic CT was not superior to routine CT, but for the characterization of RCC and TCC, the former was helpful. The most useful phase can differ according to the kind of renal mass, and so for characterization of the mass, the most appropriate phase must be selected.
Carcinoma, Renal Cell ; Carcinoma, Transitional Cell ; Diagnosis ; Diagnosis, Differential ; Humans ; Kidney ; Radiography ; Renal Artery ; Renal Veins ; Tomography, Spiral Computed*

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage and renal failure. Among the various hemorrhagic complications of HFRS, spontaneous rupture of the kidney and perirenal hematoma are very rare findings. We report here on a case of HFRS complicated by massive perirenal hematoma, and this was treated with transcatheter arterial embolization.
*Embolization, Therapeutic ; Hematoma/radiography/*therapy/virology ; Hemorrhagic Fever with Renal Syndrome/*complications ; Humans ; Kidney Diseases/radiography/*therapy/virology ; Male ; Middle Aged ; *Renal Artery/radiography

The increased use of laparoscopic nephrectomy and nephron-sparing surgery has prompted the need for a more detailed radiological evaluation of the renal vascular anatomy. Multidetector CT angiography is a fast and accurate modality for assessing the precise anatomy of the renal vessels. In this pictorial review, we present the multidetector CT angiography appearances of the normal renal vascular anatomy and a spectrum of various anomalies that require accurate vascular depiction before undergoing surgical treatment.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Renal Artery/abnormalities/anatomy & histology/*radiography ; Renal Veins/abnormalities/anatomy & histology/*radiography ; Tomography, X-Ray Computed/*methods ; Young Adult

Although recently, there have been introduced many new diagnostic tools such as renal scanning and renogram, intravenous urogram remains to be one of the most useful method of urological diagnosis. Therefore it seems warranted to review 363 cases of intravenous urograms performed in the department of urology, St. Mary's hospital, Catholic Medical College during the period of January, 1962 to June, 1964. Among others, especial attention was paid to 60 cases of nonvisualizing kidneys. Of 60 nonvisualizing kidneys, renal tuberculosis occupied 27 cases(45%); ureteral and renal stones 13(21.6%); hydronephrosis 9(15%) (metastatic carcinoma 6(10%)and surgical manipulation 3(5%); Wilms' tumor 5 (8.3%) chronic atrophic pyelonephritis 3(5%) ; One case each of renal cell carcinoma, cystic kidney and thrombosis of the renal artery. Inasmuch as the present study revealed renal tuberculosis to be the most common cause of nonvisualizing kidneys, it is felt that one should always consider the possibility of tuberculosis in the diagnosis of nonvisualizing kidneys in Korea. This fact should be stressed because nontuberculous pathology such as chronic pyelonephritis has been implicated to be the most frequent cause of nonvisualizing kidneys by American authors.
Carcinoma, Renal Cell ; Diagnosis ; Hydronephrosis ; Kidney Diseases, Cystic ; Kidney* ; Korea ; Pathology ; Pyelonephritis ; Radiography* ; Renal Artery ; Thrombosis ; Tuberculosis ; Tuberculosis, Renal ; Ureter ; Urology ; Wilms Tumor

OBJECTIVE: To determine the accuracy of the use of multi-detector row CT (MDCT) to predict vascular anatomy in living kidney donors and to reveal the prevalence of vascular variations in a Korean population. MATERIALS AND METHODS: A total of 153 living kidney donors that had undergone preoperative CT and nephrectomy, either with open or laparoscopic surgery, were selected retrospectively. The initial CT results were compared with the surgical findings and repeated review sessions of CT scans were performed to determine the causes of mismatches in discordant cases. RESULTS: The accuracy of CT angiography was 95% to predict the number of renal vessels. Four arteries and two veins were missed during the initial CT interpretation due to perception errors (for two arteries and two veins) and technical limitations (two arteries). The prevalence of multiple renal arteries and veins, early branching of a renal artery and late confluence of a renal vein were 31%, 5%, 12%, 17%, respectively. The circumaortic renal vein and the bilateral inferior vena cava were found in two cases each (1.3%). One case (0.7%) each of a retroaortic renal vein and a supradiaphragmatic originated renal artery were found. CONCLUSION: MDCT provides a reliable method to evaluate the vascular anatomy and variations of living kidney donors.
Adult ; Angiography/*methods/standards ; Female ; Humans ; Kidney/*blood supply/radiography ; *Living Donors ; Male ; Middle Aged ; Renal Artery/radiography ; Renal Veins/radiography ; Retrospective Studies ; *Tomography, X-Ray Computed/standards ; Young Adult

OBJECTIVETo assess the effect of a liquid embolic agent 2-poly-hydroxyethyl -methacrylate (2-P-HEMA) for renal artery embolization in rabbits.

METHODSThe precipitation time of different concentrations (2%, 3.5%, 5%, 6.5%, 8% and 9.5%) of 2-P-HEMA dissolved in different solutions (ethanol, ethanol/iobitridol, and ethanol/Bi2O3) were determined in flowing water. The mixtures of 2-P-HEMA (2%, 5%, and 8%) with ethanol/ Bi2O3 were injected into the renal arteries of the rabbits, and the artery-embolizing effects were assessed using angiography at 2 and 12 weeks after the injection, with also macroscopic and microscopic examination of the embolized kidneys.

RESULTSThe mixtures of 2-P-HEMA and ethanol formed flocculent precipitation a few seconds after injection into flowing water, and the precipitation time showed no significant variations with the concentration of 2-P-HEMA in the mixture. Low and moderate concentrations of 2-P-HEMA could pass through the microcatheter smoothly with little injection resistance, and resulted in complete occlusion of the renal arteries without adhesion to the microcatheter. Angiography at 2 and 12 weeks detected no recanalization of the occluded renal arteries. Macroscopically, the lumen of the renal arteries was found to be occluded by the embolic agents, and deep penetration of the embolic agents into the glomerular arteries was observed microscopically. The mixture containing high-concentration 2-P-HEMA was difficult to deliver through the microcatheter due to high injection resistance.

CONCLUSION2-P-HEMA can be rapidly precipitated after injection into flowing water, and allows complete embolization of the renal arteries of rabbits at proper concentrations, suggesting its great potential as an endovascular liquid embolic agent.

Animals ; Embolization, Therapeutic ; methods ; Female ; Male ; Polyhydroxyethyl Methacrylate ; Rabbits ; Radiography ; Random Allocation ; Renal Artery ; diagnostic imaging ; pathology

OBJECTIVE: To evaluate mid-term imaging, clinical follow-up, and restenosis rates from patients that had undergone percutaneous transluminal renal artery angioplasty (PTRA) for symptomatic renal artery fibromuscular dysplasia (FMD). MATERIALS AND METHODS: Between March 1999 and July 2006, 16 consecutive renal artery FMD patients underwent PTRA for poorly controlled hypertension. The patients were enrolled into this retrospective study after receiving 19 primary and four secondary PTRAs in 19 renal artery segments. Follow-up monitoring of blood pressure, use of antihypertensive medication, and the serum creatinine level after PTRA were assessed at 1, 3, 6, 9, 12 months, and each following year. The degree of restenosis was evaluated with computed tomographic angiography (CTA) after PTRA at 6, 12 months, and every year if possible. Technical and clinical success rates for the treatment of FMD, and restenosis rates for the renal artery were evaluated. RESULTS: The technical success rate for primary PTRA was 79% (15/19) and the complication rate was 16% (3/19). Hypertension improved in 80% (12/15) of the patients after four weeks follow-up, and was finally cured or improved in 93% (14/15) during the mean follow-up period of 23.6 months. There was a cumulative 22% (4/18) restenosis rate during the follow-up period. All of the patients were treated with a second PTRA without complications and all of the patients were cured of hypertension after the second PTRA. CONCLUSION: Percutaneous transluminal renal artery angioplasty for clinically symptomatic renal FMD is technically and clinically successful and safe to perform. For all patients with restenosis, there was a good response after undergoing a second PTRA.
Adolescent ; Adult ; Angiography ; *Angioplasty, Balloon ; Child ; Female ; Fibromuscular Dysplasia/complications/radiography/*therapy ; Humans ; Male ; Middle Aged ; Recurrence ; Renal Artery Obstruction/etiology/radiography/*therapy ; Retrospective Studies ; Stents ; Treatment Outcome

OBJECTIVETo assess the value of renal vein renin , plasma endothelin (ET), nitric oxide (NO), calcitonin gene-related peptide (CGRP) in predicting the therapeutic effect of percutaneous renal artery stenting.

METHODSSelective renal angiography was performed in 60 patients with coronary artery disease and hypertension. All the patients with obvious unilateral renal artery stenosis (lumen narrowing >or =50%) underwent percutaneous transluminal renal angioplasty and stenting. Bilateral renal vein and inferior vena cava plasma renin activity (PRA) and plasma ET, NO, and CGRP levels were measured and the two-year follow-up data of the patients analyzed.

RESULTSIn all the patients, PRA in the ischemic kidney was significantly higher than that in the contralateral kidney (3.89-/+3.14 vs 2.01-/+1.93 nmol/L/h, P>0.05). After renal artery revascularization with stenting, PRA in the ischemic kidney was reduced obviously (P<0.05), which was significantly lower in patients with renal vein renin ratio (RVRR)>1.5 than in those with RVRR <1.5 (1.92-/+2.15 vs 2.42-/+0.56 nmol/L/h, P<0.05]. Plasma ET level was significantly higher, whereas plasma NO level significantly lower in patients with PVRR>1.5 (P<0.05). Greater improvement of blood pressure was observed in patients with RVRR>1.5 after two years than in those with RVRR< 1.5 (P<0.05).

CONCLUSIONThe activity of penal vein renin, plasma ET, NO, and CGRP may provide valuable information for predicting the therapeutic effect of percutaneous renal artery stenting.

Aged ; Angioplasty, Balloon ; methods ; Calcitonin Gene-Related Peptide ; blood ; Endothelin-1 ; blood ; Female ; Humans ; Hypertension, Renovascular ; blood ; therapy ; Male ; Middle Aged ; Nitric Oxide ; blood ; Radiography ; Renal Artery ; diagnostic imaging ; surgery ; Renal Artery Obstruction ; blood ; therapy ; Renal Veins ; Renin ; blood ; Stents