Prevalence of Renal Artery and Kidney Abnormalities by Computed Tomography among Healthy Adults

Lorenz, Elizabeth C.; Vrtiska, Terri J.; Lieske, John C.; Dillon, John; Stegall, Mark D.; Li, Xujian; Bergstralh, Eric J.; Rule, Andrew D.

doi:10.2215/cjn.07641009

Cited by 93 publications

(86 citation statements)

References 41 publications

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“…Are these patients at increased risk for CKD? Lorenz et al (55) recently found that 11% of potential kidney donors at the Mayo Clinic have at least one kidney stone. Although the finding of a radiographic stone did not lead to exclusion from donation in most (76%), kidney stone was the most common radiographic kidney abnormality and the radiographic kidney abnormality that contributed most to nondonation (39% of exclusions).…”

Section: Asymptomatic Stone Formersmentioning

confidence: 99%

Chronic Kidney Disease in Kidney Stone Formers

Rule¹,

Krambeck²,

Lieske³

2011

Clinical Journal of the American Society of Nephrology

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184

120

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SummaryRecent population studies have found symptomatic kidney stone formers to be at increased risk for chronic kidney disease (CKD). Although kidney stones are not commonly identified as the primary cause of ESRD, they still may be important contributing factors. Paradoxically, CKD can be protective against forming kidney stones because of the substantial reduction in urine calcium excretion. Among stone formers, those with rare hereditary diseases (cystinuria, primary hyperoxaluria, Dent disease, and 2,8 dihydroxyadenine stones), recurrent urinary tract infections, struvite stones, hypertension, and diabetes seem to be at highest risk for CKD. The primary mechanism for CKD from kidney stones is usually attributed to an obstructive uropathy or pyelonephritis, but crystal plugs at the ducts of Bellini and parenchymal injury from shockwave lithotripsy may also contribute. The historical shift to less invasive surgical management of kidney stones has likely had a beneficial impact on the risk for CKD. Among potential kidney donors, past symptomatic kidney stones but not radiographic stones found on computed tomography scans were associated with albuminuria. Kidney stones detected by ultrasound screening have also been associated with CKD in the general population. Further studies that better classify CKD, better characterize stone formers, more thoroughly address potential confounding by comorbidities, and have active instead of passive follow-up to avoid detection bias are needed.

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Section: Asymptomatic Stone Formersmentioning

confidence: 99%

Chronic Kidney Disease in Kidney Stone Formers

Rule¹,

Krambeck²,

Lieske³

2011

Clinical Journal of the American Society of Nephrology

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184

120

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“…CT angiography is a proven tool in this domain. It also has the ability to detect parenchymal abnormalities and calculi; however, its use of ionising radiation is a disadvantage that should be considered when evaluating a donor population [11,12].Balanced steady-state free precession (SSFP) MRA provides a high signal-to-noise ratio (SNR) of blood and a unique T 1 /T 2 weighting [13]. SSFP MRA is a noncontrast technique that has been used for the imaging of renal vasculature in several studies [14][15][16].…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Is there a role for free breathing non-contrast steady-state free precession renal MRA imaging for assessing live donors? A preliminary study

Laurence

Ariff²,

Quest³

et al. 2012

The British Journal of Radiology

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Objective: Accurate pre-operative evaluation of renal vascular anatomy is essential for successful renal harvest in live donor transplantation. Non-contrast renal MR angiographic (MRA) techniques are potentially well suited to the screening of donors; however, their restricted imaging field of view (FOV) has previously been an important limitation. We sought to assess whether the addition of a large FOV balanced fast field echo (BFFE) steady-state free precession (SSFP) sequence to non-contrast SSFP MRA could overcome this problem. Comparison with contrast-enhanced MRA (CE MRA) and findings at surgery were performed. Methods: 22 potential renal donors each underwent SSFP and CE MRA. 11 out of 22 potential donors subsequently underwent a donor nephrectomy. Results: All images were diagnostic. Both SSFP MRA and CE MRA identified an equal number of arteries. Surgery confirmed two accessory renal arteries, both demonstrated with both imaging techniques. A third accessory vessel was identified with both techniques on a kidney contralateral to the donated organ. 6 out of 11 procured kidneys demonstrated early branch arteries at surgery, 5 out of 6 of which had been depicted on both SSFP and CE MRA. The median grading of image quality for main renal arteries was slightly better for CE MRA (p50.048), but for accessory vessels it was better for SSFP MRA. Conclusion: This pilot study indicates that by combining free-breathing SSFP MRA with large-FOV bFFE images, an accurate depiction of renal vascular anatomy without the need for intravenous contrast administration can be obtained, as compared with surgical findings and CE MRA. Living donor transplantation is becoming an increasingly important treatment option for end-stage renal failure (ESRF). The high prevalence of anatomical variants in renal vascular anatomy underscores the importance of accurate pre-operative evaluation of the vascular anatomy [1, 2], particularly in patients undergoing a laparoscopic approach, as the surgical field of view (FOV) is limited. Multiple renal arteries in the donor kidney result in a substantial increase in the risk of complications. Moreover, the presence of accessory arteries and early branches of the renal arteries, as well as variants in venous anatomy, can all affect the surgical decision for suitability for donor harvest [3,4].Although there has been some debate about the optimal imaging strategy for potential renal donors [5][6][7], with concerns raised over the ability of contrast-enhanced MR angiography (CE MRA) to detect all renal arteries [8], there is evidence to support the sole use of CE MRA for this purpose [9]. Non-contrast MRA techniques have been used for several years, but have been generally overshadowed by the more popular contrast-enhanced techniques [10]. CT angiography is a proven tool in this domain. It also has the ability to detect parenchymal abnormalities and calculi; however, its use of ionising radiation is a disadvantage that should be considered when evaluating a donor population [11,12].Balanced steady-...

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“…Despite accessory renal arteries 13 and prehilar branching 18 being relatively common, they represented the cause of exclusion in only 2.9% of patients. Multi-disciplinary rounds deemed these patients as requiring more extensive surgical reconstruction, higher operative risks, or necessitating sacrifice of accessory vessels that could compromise graft function.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography identified factors that preclude living kidney donation

Mastrocostas

Chingkoe

Pace

et al. 2018

CUAJ

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Introduction: The purpose of this study was to determine the variety and prevalence of renal and non-renal abnormalities detected on multi-detector computed tomography (MDCT) that precluded patients from donating a kidney. Methods: Institutional review board approval was obtained and the requirement for informed consent was waived. A retrospective, single-centre review of 701 patients (444 female, 257 male; age range 18-86 years; mean age 43.2±11.9 years) that underwent renal donor protocol MDCT was conducted. A systematic review of the CT report, records from multidisciplinary renal transplantation rounds, and electronic medical records was performed to determine which patients were approved or declined as live renal donors. If declined as a donor, CT-identified reasons were categorized as abnormalities of renal vasculature, renal parenchyma, collecting system, or extra-renal. Results: A total of 81 patients were excluded as renal donors on the basis of CT findings. Abnormalities of the collecting system accounted for the most frequent cause of exclusion (n=41), with asymptomatic renal calculi being detected in 39 patients. Complex vascular anatomy and vascular abnormalities resulted in the exclusion of 29 patients. Supernumerary arteries and early arterial branching resulted in the exclusion of 20 patients, while renal vein anomalies leading to exclusion were uncommon (n=2). Abnormalities of renal parenchyma resulted in the exclusion of nine patients. Three patients were diagnosed with autosomal dominant polycystic kidney disease, two patients had renal cell carcinoma, and two patients had areas of cortical scarring. A complex cystic lesion requiring surveillance imaging was encountered in one patient and a large area of renal infarction related to prior adrenalectomy was demonstrated in one patient. Extra-renal abnormalities leading to exclusion were limited to two patients with pulmonary nodules.

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Prevalence of Renal Artery and Kidney Abnormalities by Computed Tomography among Healthy Adults

Cited by 93 publications

References 41 publications

Chronic Kidney Disease in Kidney Stone Formers

Chronic Kidney Disease in Kidney Stone Formers

Is there a role for free breathing non-contrast steady-state free precession renal MRA imaging for assessing live donors? A preliminary study

Computed tomography identified factors that preclude living kidney donation

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