Long‐term response to renal ischaemia in the human kidney after partial nephrectomy: results from a prospective clinical trial

BJU International - Tập 117 Số 5 - Trang 766-774 - 2016
George Kallingal1, Joel M. Weinberg2, Isildinha M. Reis3, Avinash Nehra1, Manjeri A. Venkatachalam4, Dipen J. Parekh1
1Department of Urology, University of Miami Miller School of Medicine Miami, Miami, FL, USA
2Division of Nephrology, Department of Internal Medicine, University of Michigan and Veterans Affairs Ann Arbor Healthcare System and University of Michigan, Ann Arbor, MI, USA
3Department of Public Health Sciences, University of Miami Miller School of Medicine Miami, Miami, FL, USA
4Department of Pathology, University of Texas, Health Science Center, San Antonio, San Antonio, TX, USA

Tóm tắt

ObjectiveTo assess the 1‐year renal functional changes in patients undergoing partial nephrectomy with intra‐operative renal biopsies.Patients and MethodsA total of 40 patients with a single renal mass deemed fit for a partial nephrectomy were recruited prospectively between January 2009 and October 2010. We performed renal biopsies of normal renal parenchyma and collected serum markers before, during and after surgically induced renal clamp ischaemia during the partial nephrectomy. We then followed patients clinically with interval serum creatinine and physical examination.ResultsPeri‐operative data from 40 patients showed a transient increase in creatinine levels which did not correlate with ischaemia time. Renal ultrastructural changes were generally mild and included mitochondrial swelling, which resolved at the post‐perfusion biopsy. A total of 37 patients had 1‐year follow‐up data. Creatinine at 1 year increased by 0.121 mg/dL, which represents a 12.99% decrease in renal function from baseline (preoperative creatinine 0.823 mg/dL, estimated glomerular filtration rate = 93.9 mL/min/1.73 m2). The only factors predicting creatinine change on multivariate analysis were patient age, race and ischaemia type, with cold ischaemia being associated with higher creatinine level. Importantly, the duration of ischaemia did not show any significant correlation with renal function change, either as a continuous variable (P = 0.452) or as a categorical variable (P = 0.792).ConclusionsOur data suggest that limited ischaemia is generally well tolerated in the setting of partial nephrectomy and does not directly correspond to long‐term renal functional decline. For surgeons performing partial nephrectomy, the kidney can be safely clamped to ensure optimum oncological outcomes.

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10.1016/j.juro.2011.10.146

10.1016/j.eururo.2011.08.040

10.1681/ASN.2012080786

10.1056/NEJMoa041031

10.1016/S1470-2045(06)70803-8

10.1016/j.juro.2006.09.036

10.1016/j.eururo.2010.05.047

10.1016/j.juro.2013.03.042

10.1097/01.ju.0000138158.16968.8d

10.1016/j.urology.2004.04.019

10.1016/j.juro.2008.08.036

10.1016/j.juro.2011.12.068

10.1016/j.juro.2008.09.030

10.1016/j.juro.2010.09.131

10.1007/s00345-014-1315-4

10.2169/internalmedicine.34.520

10.1016/j.juro.2012.11.121

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BJU International

Tập 117 Số 5

766-774

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