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Artículo especial
Unexpected Discoveries: Uncovering Incidental Tumors in Simple Nephrectomy Specimens
Hallazgos inesperados: descubrimiento de tumores incidentales en muestras de nefrectomía simple
Ganime Coban
Corresponding author
drgcoban@hotmail.com

Autor para correspondencia.
, Büşra Coşanay Tekden, Nurhan Şahin, Özlem Toluk, Hüseyin Toprak, Pelin Yıldız, Abdullah İlktaç
Faculty of Medicine, Bezmialem Vakif University, İstanbul, Turkey
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The non-functioning kidney is diagnosed based on clinical and radiological findings&#46; Several criteria are utilized to define non-functional kidneys&#44; including paper-thin renal parenchyma &#40;renal parenchymal thickness<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">&#60;</span><span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mm&#41; on urinary ultrasound or computed tomography&#44; non-visualization of collecting duct system on intravenous pyelography &#40;IVP&#41;&#44; an exhibition of less than 10&#37; renal function in dimercaptosuccinic acid scan &#40;DMSA&#41; and a glomerular filtration rate of <span class="elsevierStyleSmallCaps">&#60;</span>10<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> in the affected kidney determined by nuclear renography<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; In the etiology of non-functioning kidneys&#44; there are many causes such as adult polycystic kidney disease&#44; acquired cystic kidney disease&#44; unsuccessful transplantation&#44; urolithiasis&#44; chronic pyelonephritis and end-stage kidney disease due to other causes &#40;diabetes&#44; hypertension&#44; etc&#46;&#41;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Surgical intervention is not always necessary for a non-functioning kidney&#46; A simple nephrectomy is usually performed in symptomatic patients with chronic infection&#44; pyelonephritis&#44; or obstruction&#46; Despite its name&#44; a simple nephrectomy can be challenging due to widespread inflammation and scar tissue&#44; potentially making it more difficult than radical nephrectomy&#46; The advancement of minimally invasive surgical techniques has introduced simple laparoscopic nephrectomy as a viable alternative to open nephrectomy<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; Histopathological examination of non-functioning kidneys reveals various findings depending on the underlying etiology&#46; These may include inflammation&#44; glomerular sclerosis&#44; tubular atrophy&#44; thyroidization&#44; nephrocalcinosis&#44; chronic pyelonephritis&#44; xanthogranulomatous pyelonephritis &#40;XP&#41;&#44; dysplastic tubules&#44; and cystic structures<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">There are several case reports in the literature about incidentally detected tumors of non-functioning kidneys<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; The preoperative diagnosis of renal lesions in non-functioning kidneys with conditions such as chronic pyelonephritis&#44; XP&#44; and obstructing renal stones can be challenging using imaging modalities&#46; In such cases&#44; the diagnosis is often made through pathological examination&#46; However&#44; only a limited number of studies that investigate incidentally detected renal tumors following a simple nephrectomy exist&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The objective of this study was to assess the characteristics of patients who had incidental kidney tumors identified during pathological examination following a simple nephrectomy for a non-functioning kidney&#46; Additionally&#44; we conducted a retrospective review of the histopathological features of these patients and documented the common findings&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patient data</span><p id="par0025" class="elsevierStylePara elsevierViewall">Patients who underwent simple nephrectomy with the diagnosis of a non-functioning kidney between January 2012 and March 2021 were included in the study&#46; The pathology reports of all the cases were reviewed&#44; and the histopathological features and the histological types of the cases with kidney tumors were documented&#46; Patients with a significant renal function &#40;split renal function<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">&#62;</span><span class="elsevierStyleHsp" style=""></span>15&#37;&#41; or a suspicious lesion diagnosed preoperatively with computed tomography &#40;CT&#41; or magnetic resonance imaging &#40;MRI&#41; and patients<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">&#60;</span><span class="elsevierStyleHsp" style=""></span>18 years old were excluded from the study&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The diagnosis of a non-functioning kidney in this study was established using DMSA&#46; Those with split renal function less than 10&#37; were considered non-functioning&#46; In patients with a split renal function between 10-15&#37;&#44; if there was a diffuse decrease in the renal parenchymal thickness &#40;<span class="elsevierStyleSmallCaps">&#60;</span>5<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; diffuse inflammation and scarring on CT or MRI&#44; the kidney was considered non-functioning and simple nephrectomy was performed&#46; This retrospective study was approved by the Medical Ethics Committee of our University &#40;Approval No&#58; 2021-7228&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Descriptive statistics were used to summarize the data&#44; and the frequencies with percentages were reported for categorical variables&#46; SPSS &#40;IBM Corp&#46; Released 2019&#46; IBM SPSS Statistics for Windows&#44; Version 26&#46;0&#46; Armonk&#44; NY&#58; IBM Corp&#41; software was used for data analysis&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">A total of 163 patients with non-functioning kidneys who underwent simple nephrectomy between January 2012 and March 2021 were included in the study&#46; Demographic data and clinical features are given in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The median age of the patients was 48 &#40;38-58&#41; years&#46; Sixty-nine &#40;42&#46;3&#37;&#41; patients were male and 94 &#40;57&#46;7&#37;&#41; patients were female&#46; The most common complaint was flank pain and it was reported by 99 &#40;60&#46;7&#37;&#41; patients&#46; Non-functioning kidneys were incidentally detected in 32 &#40;19&#46;6&#37;&#41; patients&#46; Recurrent urinary tract infections and hematuria were reported by 18 &#40;11&#46;1&#37;&#41; and 4 &#40;2&#46;5&#37;&#41; patients&#44; respectively&#46; The other 10 patients had various complaints like abdominal swelling&#44; urinary incontinence&#44; nausea&#44; and vomiting&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The main cause of non-functioning kidneys was urinary stones&#44; affecting 116 &#40;71&#46;2&#37;&#41; patients&#44; followed by ureteropelvic&#47;ureterovesical junction &#40;UPJ&#47;UVJ&#41; stenosis in 30 &#40;18&#46;4&#37;&#41; cases and vesicoureteral reflux &#40;VUR&#41; in 11 &#40;6&#46;8&#37;&#41; patients&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">All patients underwent urinary ultrasonography preoperatively&#46; Additionally&#44; 100 patients had non-contrast CT&#44; 45 patients had contrast-enhanced CT&#44; 8 patients had CT-urography&#44; 1 patient had a non-contrast MRI&#44; 4 patients had contrast-enhanced MRI&#44; 2 patients had MRI-urography and 3 patients had intravenous pyelography &#40;IVP&#41; before the operation&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">After pathological examination of nephrectomy specimens&#44; chronic pyelonephritis was detected in 121 &#40;74&#46;2&#37;&#41; patients&#44; tumors in 21 &#40;12&#46;9&#37;&#41; patients&#44; XP in 18 &#40;11&#46;1&#37;&#41; patients&#44; polycystic kidneys in 2 &#40;1&#46;2&#37;&#41; patients and necrotizing granulomatous pyelonephritis was detected in 1 &#40;0&#46;6&#37;&#41; patient &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a><a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#44; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Of the tumors detected histopathologically&#44; 13 &#40;61&#46;9&#37;&#41; were benign and 8 &#40;38&#46;1&#37;&#41; were malignant &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; In patients with tumors&#44; 20 patients had chronic pyelonephritis and one patient had xanthogranulomatous pyelonephritis&#46; The most commonly observed benign tumor was papillary adenoma&#46; Four patients were diagnosed with renal cell carcinoma &#40;RCC&#41;&#44; and another four patients with urothelial cell carcinoma &#40;UCC&#41;&#46; Among the UCC cases&#44; three had high-grade invasive UCC with squamous differentiation&#44; and one had low-grade papillary UCC &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; The median tumor size of the malignant tumors was 8&#46;25 &#40;4&#46;5-9&#46;5&#41; cm&#46; In patients with malignant tumors &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&#44; the most common preoperative complaint was flank pain and it was reported by 4 patients &#40;50&#37;&#41;&#46; One &#40;12&#46;5&#37;&#41; patient had hematuria and 3 &#40;37&#46;5&#37;&#41; patients had no complaints&#46; Further details regarding the characteristics of patients with malignant tumors are shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Thanks to the advances in radiological imaging methods&#44; the diagnosis of kidney tumors has become easier with imaging modalities like ultrasonography&#44; CT&#44; or MRI in individuals with normally functioning kidneys&#46; However&#44; renal tumors can be missed in patients with non-functioning kidneys especially in those with severe inflammation&#44; scarring&#44; and urolithiasis&#46; These situations may obscure the presence of a malignant tumor&#46; Simple nephrectomy is the surgical removal of the kidney through Gerota&#39;s fascia and is performed in patients with benign diseases of the kidney&#46; Radical nephrectomy is the removal of the kidney with Gerota&#39;s fascia and is performed in malignant diseases of the kidney<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Although it is rare&#44; a kidney tumor may be detected after pathological examination of the specimen in patients who underwent simple nephrectomy&#46; There is limited data available in the literature regarding this topic&#46; Zengin et al&#46; conducted a study involving 97 patients who underwent simple nephrectomy for non-functioning kidneys caused by urolithiasis and reported that in 9 &#40;9&#46;3&#37;&#41; patients&#44; a malignant tumor was detected in pathological examination<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; This rate is almost twice the rate of what we detected&#46; Among these 9 patients&#44; 3 had UCC&#44; 3 had RCC &#40;1 sarcomatoid&#44; 1 papillary&#44; and 1 clear cell&#41;&#44; 2 had squamous cell cancer &#40;SCC&#41; and 1 patient had both RCC and UCC&#46; In their series&#44; the most common pathological diagnosis&#44; similar to our study&#44; was chronic pyelonephritis &#40;in 79 patients&#41;&#44; followed by XP in 9 patients&#46; They also reported that papillary adenoma was detected in 2 patients with chronic pyelonephritis&#46; The rate of papillary adenoma in our series was higher&#46; They made no comment about the type of preoperative imaging method they used<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; Lin et al&#46; evaluated the incidence of RCC in non-functioning kidneys in their study<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; They analyzed 311 nephrectomy specimens obtained from 279 patients with non-functioning kidneys&#46; They found that 73 &#40;23&#46;5&#37;&#41; nephrectomy specimens had RCC and most of these cases had acquired cystic kidney disease or end-stage renal disease&#46; Clear cell RCC was the most common subtype followed by papillary RCC&#46; However&#44; the type of nephrectomy &#40;simple or radical&#41; was not specified in their study&#44; and it included patients who had a preoperative diagnosis of RCC&#46; Additionally&#44; the study did not provide information on other types of renal tumors apart from RCC&#46; Angerri et al&#46; performed simple laparoscopic nephrectomy on 96 patients with urolithiasis and split renal function<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">&#60;</span><span class="elsevierStyleHsp" style=""></span>15&#37;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; They detected SCC in 1 &#40;1&#46;04&#37;&#41; patient&#46; In our study&#44; we detected renal tumors in 21 &#40;12&#46;9&#37;&#41; patients and 8 &#40;4&#46;9&#37;&#41; were malignant in the whole group&#46; The number of patients who developed a non-functioning kidney due to urolithiasis was 116&#59; in 3 &#40;2&#46;6&#37;&#41; of these patients&#44; malignant tumors were detected through histopathological evaluation&#46; This rate is lower than the value reported by Zengin et al&#46; In the study conducted by Yeh et al&#46;&#44; 47 patients with non-functioning kidneys due to urolithiasis who underwent nephrectomy were evaluated<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; They detected renal tumors in 24 patients&#46; In 7 of these patients&#44; tumors were detected preoperatively therefore the detection rate of incidental tumors was 36&#46;2&#37;&#46; This is still a very high rate&#46; They speculated that the inadequacy of USG&#44; IVP and retrograde pyelography in detecting malignant lesions may have led to this result and they recommended performing an MRI before the operation in these patients&#46; It is worth noting that the study by Yeh et al&#46; is from 2007&#44; and advancements in imaging techniques and protocols have since been made&#46; These advancements may have improved the detection of malignancies in non-functioning kidneys&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The median tumor size of the malignant tumors in our study was 8&#46;25<span class="elsevierStyleHsp" style=""></span>cm &#40;4&#46;5-9&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#41;&#44; which is a significant size&#46; Despite this size&#44; there are several reasons why these tumors cannot be detected in preoperative evaluations&#46; Especially in cases with underlying stone disease and recurrent urinary infections&#44; inflammatory and fibrotic changes in the kidney parenchyma may prevent the detection of the tumor&#46; In cases with UPJ&#47;UVJ stenosis&#44; severe hydronephrosis of the kidney may mask cystic lesions&#46; In our study&#44; 4 &#40;50&#37;&#41; of the patients with malignant lesions were evaluated with non-contrast CT before the operation&#46; Non-contrast CT is mainly used for the evaluation of urinary stone disease and it is insufficient for malignancy evaluation&#46; Two patients with malignant lesions were evaluated with contrast-enhanced CT&#44; 1 patient was evaluated with contrast-enhanced MRI&#44; and 1 patient was evaluated with MRI urography&#46; Different radiological imaging methods were used during the evaluation of these patients with nonfunctioning kidneys depending on the underlying condition&#46; Some of the patients were admitted to emergency service with acute complaints such as flank pain and fever so CT was the preferred imaging method&#46; For patients with normal kidney function contrast-enhanced CT was performed&#46; In patients with a GFR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">&#60;</span><span class="elsevierStyleHsp" style=""></span>60&#44; we do not use contrast-enhanced CT in our institute so these patients were evaluated with non-contrast CT&#46; Also in patients with coexisting kidney stones non-contrast CT was used&#46; In patients with UPJ or UVJ obstruction&#44; MRI or CT urography was used depending on the GFR value&#46; In cases with solid renal masses&#44; the most important factor for differentiating malignant lesions from benign ones is the presence of contrast enhancement<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46; We believe that contrast-enhanced imaging should be recommended to all patients with non-functioning kidneys before simple nephrectomy to minimize the risk of not diagnosing a malignancy&#46; However&#44; it should be kept in mind that even with contrast-enhanced CT and MRI&#44; a concomitant malignant tumor may not be detected in these patients&#44; since the blood flow to the kidney may be impaired in non-functioning kidneys&#46; If a contrast-enhanced examination cannot be performed for any reason &#40;kidney failure&#44; allergy&#44; etc&#46;&#41;&#44; a non-contrast MRI should be preferred instead of a non-contrast CT&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Zengin et al&#46; and Lin et al&#46; did not provide information about the preoperative complaints of the patients&#46; However&#44; Yeh et al&#46; reported that the most common preoperative complaints were flank pain and gross hematuria&#46; In the case series of Jain et al&#46;&#44; all patients presented with flank pain&#46; The presenting complaint may also be related to the etiology of the non-functioning kidney &#40;urolithiasis&#44; ureteropelvic junction stenosis&#41;&#46; There is no specific symptom that is associated with a specific tumor and malignant tumors can be detected in patients without any complaints&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">SCC of the kidney is a rare renal neoplasm and it constitutes about 0&#46;8&#37; of renal malignancies<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; Most of the information on renal SCC is obtained from case reports<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#8211;12</span></a>&#46; It is believed that renal SCC is closely related to kidney stones&#44; chronic infection&#44; and inflammation<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; Jain et al&#46; reported a case series of 4 patients with renal SCC who had staghorn calculi and non-functioning kidneys<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; In three of these cases&#44; the diagnosis was established by postoperative pathological examination&#59; there was no evidence of malignancy on preoperative radiological evaluation&#46; Since SCC metastases to the kidney may also occur&#44; it is essential to show the transition from squamous metaplasia areas to the tumor to support the primary diagnosis&#46; In our study&#44; we did not have a case with a diagnosis of squamous cell carcinoma after a simple nephrectomy&#46; However&#44; we had a urothelial carcinoma case with an extensive squamous differentiation in a patient with urolithiasis and 2 cases of UCC with squamous differentiation in patients with ureteropelvic&#47;ureterovesical junction stenosis&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">There is no specific follow-up protocol defined for patients with malignant tumors detected after simple nephrectomy&#46; We considered these patients at high risk for recurrence or metastasis and followed them closely&#44; similar to patients who underwent radical nephrectomy&#44; with frequent contrast-enhanced CT or MRI&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">A papillary adenoma is an unencapsulated small-sized tumor with papillary or tubular architecture and low nuclear grade<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; They are associated with papillary RCC and the most important distinguishing factor is their size &#40;<span class="elsevierStyleSup"><span class="elsevierStyleSmallCaps">&#8804;</span></span>15<span class="elsevierStyleHsp" style=""></span>mm&#41;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46; Due to their small size&#44; they are not usually detected by imaging methods and are most commonly found incidentally in nephrectomy specimens&#46; Cali&#242; et al&#46; reported the incidence of papillary adenoma as 19&#37; in their autopsy study<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46; This incidence increased to 25&#37; in cases<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">&#62;</span><span class="elsevierStyleHsp" style=""></span>40 years old&#46; Wang et al&#46; evaluated 542 consecutive nephrectomy specimens and detected papillary adenomas in 38 &#40;7&#37;&#41; patients<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Papillary adenoma was the most common incidental tumoral lesion in our series &#40;6&#46;7&#37;&#41;&#44; a rate similar to that reported by Wang et al&#46; The high incidence of papillary adenoma in the study by Cali&#242; et al&#46; may be attributed to the fact that it was an autopsy study<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The most common histopathological diagnoses in nephrectomies performed for non-functioning kidneys are chronic pyelonephritis&#44; XP&#44; polycystic kidney&#44; and granulomatous pyelonephritis<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;18&#44;19</span></a>&#46; In our study&#44; chronic pyelonephritis was found in 71&#46;1&#37; and XP in 9&#46;6&#37;&#44; which is consistent with the literature&#46; Tuberculosis is a granulomatous disease and it is more commonly observed in developing and low-income countries<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46; Tuberculosis may affect the entire urinary system and the kidneys are the most frequently affected urogenital organs<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a>&#46; We also had a diagnosis of granulomatous pyelonephritis in one of our cases&#44; and the case was being followed up for tuberculosis&#46;</p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Limitations</span><p id="par0110" class="elsevierStylePara elsevierViewall">This study has several limitations&#46; It is a retrospective study with a limited number of patients&#46; The radiological imaging methods were reviewed by different radiologists which might affect the preoperative diagnosis of suspicious lesions&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusion</span><p id="par0115" class="elsevierStylePara elsevierViewall">In non-functioning kidneys&#44; tumors may be overlooked due to radiological and clinical diagnostic difficulties&#46; The possibility of detecting a tumor in histopathological examination after simple nephrectomy is low and most of these tumors are benign&#46; However&#44; rarely&#44; malignant lesions like RCC and UCC can be missed preoperatively by imaging methods in some patients with non-functioning kidneys and detected after the pathological examination&#46; Therefore&#44; the possible presence of a concomitant tumor should be considered when evaluating non-functioning kidneys&#44; and macroscopic and microscopic examinations should be done carefully&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Funding sources</span><p id="par0120" class="elsevierStylePara elsevierViewall">Authors have not received any funding for this research&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">All authors declare that they have no conflicts of interest&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ethical approval</span><p id="par0130" class="elsevierStylePara elsevierViewall">The study was approved by the Ethics Committee of Bezmialem Vakif University with the approval number &#40;2021-7228&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Author Contributions</span><p id="par0135" class="elsevierStylePara elsevierViewall">Study conception and design&#58; G&#199;&#44; BCT&#44; N&#350;&#46; Acquisition of data&#58; G&#199;&#44; BCT&#44; HT&#44; AI and PY&#46; Analysis and interpretation of data&#58; G&#199;&#44; OT&#46; Drafting of the manuscript&#58; G&#199;&#44; OT Critical revision&#58; G&#199;&#44; PY&#44; N&#350;&#44; HT&#46;</p></span></span>"
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            0 => "Renal Cell Carcinomas"
            1 => "Stones"
            2 => "Urinary Bladder"
            3 => "Chronic Pyelonephritis"
            4 => "Xanthogranulomatous Pyelonephritis"
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            0 => "Carcinomas de C&#233;lulas Renales"
            1 => "C&#225;lculos"
            2 => "Vejiga Urinaria"
            3 => "Pielonefritis Cr&#243;nica"
            4 => "Pielonefritis Xantogranulomatosa"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We aimed to evaluate the characteristics of patients with incidental kidney tumors detected in the pathological examination performed after simple nephrectomy due to a non-functioning kidney&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The pathology results of nephrectomy specimens from patients who underwent simple nephrectomy with the diagnosis of non-functioning kidney between January 2012 and March 2021 were retrospectively analyzed&#46; Data regarding demographic information&#44; imaging methods&#44; and clinical and histopathological features of the patients were collected&#46; The number of patients with incidental renal tumors was determined&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 163 patients with nonfunctioning kidneys who underwent simple nephrectomy between January 2012 and March 2021 were included in the study&#46; Sixty-nine &#40;42&#46;3&#37;&#41; patients were male and 94 &#40;57&#46;7&#37;&#41; patients were female&#46; The most common complaint was flank pain &#40;60&#46;7&#37;&#41;&#46; The cause of the nonfunctioning kidney was urinary stones in 116 &#40;71&#46;2&#37;&#41; patients and ureteropelvic&#47;ureterovesical junction stenosis in 21 &#40;10&#46;1&#37;&#41; patients&#46; Incidental renal tumors were detected in 21 &#40;12&#46;9&#37;&#41; patients&#46; Papillary adenoma was the most common renal tumor and was detected in 11 patients&#46; Four patients had renal cell carcinoma and 4 patients had urothelial cell carcinoma &#40;UCC&#41;&#46; Three of the patients with UCC had high grade invasive UCC with squamous differentiation and 1 patient had low grade papillary UCC&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In non-functioning kidneys&#44; kidney tumors may be overlooked due to radiological and clinical diagnostic difficulties&#46; Therefore&#44; careful macroscopic and microscopic histopathological evaluation is necessary to detect incidental renal tumors&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Objectives"
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            "titulo" => "Patients and methods"
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          2 => array:2 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Nuestro objetivo fue evaluar las caracter&#237;sticas de los pacientes con tumores renales incidentales detectados en el examen patol&#243;gico realizado tras nefrectom&#237;a simple por ri&#241;&#243;n no funcionante&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se analizaron retrospectivamente los resultados anatomopatol&#243;gicos de las muestras de nefrectom&#237;a de pacientes sometidos a nefrectom&#237;a simple con diagn&#243;stico de ri&#241;&#243;n no funcionante entre enero de 2012 y marzo de 2021&#46; Se recopilaron datos sobre informaci&#243;n demogr&#225;fica&#44; m&#233;todos de imagen y caracter&#237;sticas cl&#237;nicas e histopatol&#243;gicas de los pacientes&#46; Se determin&#243; el n&#250;mero de pacientes con tumores renales incidentales&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron en el estudio un total de 163 pacientes con ri&#241;ones no funcionantes sometidos a nefrectom&#237;a simple entre enero de 2012 y marzo de 2021&#46; Sesenta y nueve &#40;42&#44;3&#37;&#41; pacientes eran hombres y 94 &#40;57&#44;7&#37;&#41; pacientes eran mujeres&#46; La queja m&#225;s com&#250;n fue el dolor en el flanco &#40;60&#44;7&#37;&#41;&#46; La causa del ri&#241;&#243;n no funcional fueron c&#225;lculos urinarios en 116 &#40;71&#44;2&#37;&#41; pacientes y estenosis de la uni&#243;n ureterop&#233;lvica&#47;ureterovesical en 21 &#40;10&#44;1&#37;&#41; pacientes&#46; Se detectaron tumores renales incidentales en 21 &#40;12&#44;9&#37;&#41; pacientes&#46; El adenoma papilar fue el tumor renal m&#225;s com&#250;n y se detect&#243; en 11 pacientes&#46; Cuatro pacientes ten&#237;an carcinoma de c&#233;lulas renales y 4 pacientes ten&#237;an carcinoma de c&#233;lulas uroteliales &#40;CCU&#41;&#46; Tres de los pacientes con ccu ten&#237;an CCU invasivo de alto grado con diferenciaci&#243;n escamosa y 1 paciente ten&#237;a ccu papilar de bajo grado&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En ri&#241;ones no funcionantes&#44; los tumores renales pueden pasar desapercibidos debido a dificultades de diagn&#243;stico cl&#237;nico y radiol&#243;gico&#46; Por lo tanto&#44; es necesaria una evaluaci&#243;n histopatol&#243;gica macrosc&#243;pica y microsc&#243;pica cuidadosa para detectar tumores renales incidentales&#46;</p></span>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">IQR&#58; Interquartile range&#44; UPJ&#58; Ureteropelvic Junction&#44; UVJ&#58; Ureterovesical Junction&#44; VUR&#58; Vesicoureteral Reflux&#44; PKD&#58; Polycystic Kidney Disease&#44; TBC&#58; Tuberculosis&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number of Patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">163&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Median Age&#44; years &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;38-58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94 &#40;57&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69 &#40;42&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Laterality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Right&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78 &#40;47&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Left&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85 &#40;52&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Median Split Renal Function&#44; &#37; &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;0-8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Main Complaint&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Flank pain&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99 &#40;60&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Incidental&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;19&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urinary tract infection&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;11&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hematuria&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Others&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;6&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Etiology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urolithiasis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">116 &#40;71&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>UPJ&#47;UVJ&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;18&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VUR&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;6&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Renal artery stenosis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PKD&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urinary TBC&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3386385.png"
              ]
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Demographic data and clinical features&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chronic Pyelonephritis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121 &#40;74&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tumor&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;12&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Xanthogranulomatous Pyelonephritis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;11&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polycystic Kidney Disease&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Necrotizing Granulomatous Nephritis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3386387.png"
              ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Histopathological characteristics of the patients&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">RCC&#58; Renal Cell Cancer&#59; UCC&#58; Urothelial Cell Carcinoma&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Benign Tumors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Papillary Adenoma&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;52&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oncocytosis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Renomedullary Interstitial Cell Tumor&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Malignant Tumors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>RCC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clear Cell RCC&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;9&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Papillary RCC&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chromophobe RCC&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>UCC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Low grade&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>High Grade UCC with squamous differentiation&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;14&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3386386.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Classification of tumors &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">SRF&#58; Split renal function&#44; Preop&#58; Preoperative&#44; RCC&#58; Renal Cell Cancer&#44; TCC&#58; Transitional Cell Cancer&#44; squam&#46;&#58; Squamous&#44; diff&#46;&#58; Differentiation&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Laterality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SRF &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Etiology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Preop&#46; Imaging&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tumor Diameter &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UPJ stenosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Contrast CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clear cell RCC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urolithiasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Noncontrast CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Papillary RCC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urolithiasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Noncontrast CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UCC with squam&#46; diff&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urolithiasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Noncontrast CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chromophobe RCC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UPJ stenosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Noncontrast CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UCC low grade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VUR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Contrast CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clear cell RCC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UVJ stricture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Contrast MR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UCC with squam&#46; diff&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UPJ stenosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MR urography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UCC with squam&#46; diff&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the patients with malignant tumors &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&#46;</p>"
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                    0 => array:2 [
                      "titulo" => "Incidence of renal carcinoma in non-functioning kidney due to renal pelvic stone disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Zengin"
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                            2 => "N&#46;C&#46; Sener"
                            3 => "S&#46; Albayrak"
                            4 => "M&#46; Ekici"
                            5 => "I&#46;H&#46; Bozkurt"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3892/mco.2015.550"
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                        "tituloSerie" => "Mol Clin Oncol&#46;"
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                        "volumen" => "3"
                        "numero" => "4"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26171211"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Pathologic characterization of renal epithelial neoplasms arising in nonfunctioning kidneys"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "X&#46; Lin"
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                            2 => "X&#46;J&#46; Yang"
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                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.humpath.2019.09.011"
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                        "tituloSerie" => "Hum Pathol&#46;"
                        "fecha" => "2020"
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                      "titulo" => "Simple Laparoscopic Nephrectomy in Stone Disease&#58; Not Always Simple"
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                          "etal" => false
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                    0 => array:2 [
                      "doi" => "10.1089/end.2016.0281"
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                      "titulo" => "Incidentally detected squamous cell carcinoma of renal pelvis in patients with staghorn calculi&#58; case series with review of the literature"
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                      "doi" => "10.29271/jcpsp.2018.06.S148"
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                        "tituloSerie" => "J Coll Physicians Surg Pak&#46;"
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                      "titulo" => "Open Surgery of Kidney"
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                      "titulo" => "A high association of upper urinary tract transitional cell carcinoma with nonfunctioning kidney caused by stone disease in Taiwan"
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                    0 => array:2 [
                      "doi" => "10.1159/000102907"
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                        "tituloSerie" => "Urol Int&#46;"
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