Poorly Functioning Kidneys Recover from Ischemia after Partial Nephrectomy as Well as Strongly Functioning Kidneys

Abstract

Our results suggest that the quantity of parenchyma preserved is the main determinant of the postoperative glomerular filtration rate after partial nephrectomy as long as limited warm ischemia or hypothermia is used. Even poorly functioning kidneys recover well from the ischemic insult proportionate to the amount of parenchyma preserved.

Robot‐assisted laparoscopic versus open partial nephrectomy in patients with chronic kidney disease: A propensity score‐matched comparative analysis of surgical outcomes

“…Thus, the different surgical expertise might affect the outcome of ischemia time. However, rates of preservation of global renal function after 3–6 months postoperatively were 92% in the RAPN group and 91% in the OPN group; these rates are comparable with those reported in other previous studies on patients with different background characteristics …”

“…Compared with other studies, cold ischemia time during OPN was relatively long, despite acceptable warm ischemia time during RAPN . As described in the Methods section, RAPN was carried out by three specific surgeons.…”

Possible impact of continuous drainage after minimally invasive partial nephrectomy

“…In a recent report, the incidence of hematoma and urine leakage after partial nephrectomy was 2.6-13.3 %, depending on the definitions used [3,13,14]. In our study, there were three immediate postoperative complications (Clavien-Dindo classification grade ≥2), including two hematomas and one urinoma ( Table 2).…”

Editorial Comment

“…Whether preexisting CKD compromises compensation remains unclear, although the authors noted that poor renal function does not necessarily impair ipsilateral renal recovery. 1 External validation of clinical parameters such as specific comorbidities and volume loss together with baseline GFR and patient age, which were identified in other studies, could help construct predictive models of compensation after nephron loss (reference 9 in article). Ultimately understanding the physiological and biochemical basis of compensatory hypertrophy could allow for directed manipulation of this process for possible therapeutic benefit in patients undergoing PN or RN.…”