Extrarenal calyces mimicking retroperitoneal cystic mass with concomitant ureteropelvic junction obstruction: renal pelvis reconstruction using calyx unification

Irfan Wahyudi,1 Arry Rodjani,1 Gerhard Reinaldi Situmorang,1 Prahara Yuri,2 Fakhri Rahman11Urology Department, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia; 2Urology Department, Faculty of Medicine, Universitas Gadjah Mada, Sardjito Hospital, Yogyakarta, IndonesiaAbstract: Extrarenal calyces (ERCs) are a very rare urological anomaly, especially when concomitantly presenting with ureteropelvic junction obstruction (UPJO). Surgical intervention is often necessary in ERCs associated with UPJO, with dismembered pyeloplasty being the most commonly utilized technique. We present a case of UPJO-associated ERCs in which renal pelvis reconstruction using calyx unification was selected as the treatment technique. An 11-year-old boy was referred to our center due to bilateral hydronephrosis and left multicystic kidney disease. Magnetic resonance imaging showed severe left hydronephrosis with concomitant left cystic mass and left UPJO. A 99mTc diethylenetriaminepentaacetic diuretic renal scan showed residual renal function of 25.9% split function and 26.8 mL/minute glomerular filtration rate. Intraoperatively, we found ERCs with severely dilated renal pelvis. The renal pelvis was excised. Major calyces protruding from the kidney were unified using side-to-side anastomosis to form a new structure resembling a renal pelvis, which was further anastomosed to the ureter. Temporary urinary drainage from the affected kidney was achieved using a double-J (DJ) stent and nephrostomy. Pathological examination revealed atrophic transitional epithelial cells. There was no intra- or postoperative complication reported. The nephrostomy tube and DJ stent were removed 2 weeks and 3 months after surgery, respectively. Ultrasonography examination performed at 1 and 9 months after DJ-stent removal showed no hydronephrosis. We conclude that renal pelvis reconstruction using calyx unification can be performed safely and is effective in treating patients with ERCs associated with PUJO. This technique should be considered especially in cases where excision of the renal pelvis cannot be avoided.Keywords: extrarenal calyces, hydronephrosis, reconstructive surgical procedure, ureteropelvic junction obstruction, UPJ

MicroRNA antagonist therapy during normothermic machine perfusion of donor kidneys<strong> </strong>

Normothermic machine perfusion (NMP) is a novel clinical approach to overcome the limitations of traditional hypothermic organ preservation. NMP can be used to assess and recondition organs prior to transplant and is the subject of clinical trials in solid organ transplantation. In addition, NMP provides an opportunity to deliver therapeutic agents directly to the organ thus avoiding many limitations associated with systemic treatment of the recipient. We report the delivery of oligonucleotide-based therapy to human kidneys during NMP, in this case to target microRNA function (antagomir). An antagomir targeting mir-24-3p localised to the endothelium and proximal tubular epithelium. Endosomal uptake during NMP conditions facilitated antagomir co-localisation with proteins involved in the RNA-induced silencing complex (RISC) and demonstrated engagement of the miRNA target. This pattern of uptake was not seen during cold perfusion. Targeting mir-24-3p action increased expression of genes controlled by this microRNA, including heme oxygenase-1 and sphingosine-1-phosphate receptor 1. The expression of genes not under the control of mir-24-3p was unchanged, indicating specificity of the antagomir effect. In summary, this is the first report of ex-vivo gymnotic delivery of oligonucleotide to the human kidney and demonstrates that NMP provides the platform to bind and block detrimental microRNAs in donor kidneys prior to transplantation