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@ARTICLE{Egen:303040,
      author       = {L. Egen$^*$ and M. Hommel$^*$ and C. M. Haney$^*$ and B.
                      Özdemir$^*$ and S. Knoedler and J. Sellner$^*$ and S.
                      Seidlitz$^*$ and M. Dietrich and G. A. Salg and F. Nickel
                      and L. Maier-Hein$^*$ and M. S. Michel$^*$ and A.
                      Studier-Fischer$^*$ and K.-F. Kowalewski$^*$},
      title        = {{H}yperspectral {I}maging {A}ccurately {D}etects {R}enal
                      {M}alperfusion {D}ue to {H}igh {I}ntrarenal {P}ressure.},
      journal      = {European urology open science},
      volume       = {78},
      issn         = {2666-1691},
      address      = {[Amsterdam]},
      publisher    = {Elsevier ScienceDirect},
      reportid     = {DKFZ-2025-01487},
      pages        = {16 - 27},
      year         = {2025},
      note         = {#EA:E140#LA:E140#},
      abstract     = {High intrarenal pressure (IRP) is a significant concern in
                      both endoscopic procedures and acute hydronephrosis, and may
                      cause renal parenchymal damage, forniceal rupture, and
                      long-term impaired renal function. Its pathomechanism and
                      effect on renal perfusion patterns remain undetermined. This
                      study investigates the impact of elevated IRP on renal
                      perfusion and oxygen saturation (StO2) using hyperspectral
                      imaging (HSI).In vivo experiments were conducted on porcine
                      models establishing hydronephrosis on specific IRP levels
                      (30, 50, 70, and 90 mmHg) by pressure-controlled infusion of
                      crystalloid solution into the ureter after distal ureteral
                      clamping. HSI data were recorded at baseline, during IRP
                      application, and after release to measure
                      hydronephrosis-induced changes in reflectance and perfusion
                      in a total of 501 recordings. The results were compared with
                      spectral patterns of renal malperfusion states from previous
                      internal studies. In total, data of 73 pigs and 1744 HSI
                      recordings were included.Elevated IRP significantly affected
                      renal perfusion and oxygenation. StO2 decreased from
                      $70.3\%$ ± $10.9\%$ (physiological) to $39.9\%$ ± $9.5\%$
                      in hydronephrotic kidneys. Perfusion values in
                      hydronephrosis decreased significantly at the renal poles
                      $(6.5\%$ ± $4.0\%)$ compared with physiological values
                      $(34.8\%$ ± $7.5\%).$ A principal component analysis and
                      machine learning classification confirmed distinct
                      malperfusion states, with hydronephrosis resembling ischemic
                      conditions.HSI revealed that high IRP reduces renal
                      oxygenation and perfusion, with the poles being
                      disproportionately affected. The results from this study
                      provide quantitative evidence of perfusion restriction and
                      ischemic conditions as the pathomechanism behind
                      hydronephrosis-induced kidney damage. These findings
                      underscore the importance of monitoring IRP during
                      endourological procedures to mitigate renal damage and
                      associated complications.High pressure in the kidneys during
                      surgery or kidney disease can severely reduce blood flow and
                      oxygen, causing damage. This study used a special camera to
                      show this damage, especially at the end of the kidney. These
                      findings highlight the importance of monitoring kidney
                      pressure carefully during procedures to prevent damage to
                      the kidney.},
      keywords     = {Animal study (Other) / Hydronephrosis (Other) /
                      Hyperspectral imaging (Other) / Intrarenal pressure (Other)
                      / Porcine model (Other) / Urology (Other)},
      cin          = {E140 ; E140 / E130},
      ddc          = {610},
      cid          = {I:(DE-He78)E140-20160331 / I:(DE-He78)E130-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40688377},
      pmc          = {pmc:PMC12274906},
      doi          = {10.1016/j.euros.2025.06.007},
      url          = {https://inrepo02.dkfz.de/record/303040},
}