Decline in Renal Function after Partial Nephrectomy: Etiology and Prevention

Mir, Maria Carmen; Ercole, Cesar E.; Takagi, Toshio; Zhang, Zhiling; Velet, Lily; Remer, Erick M.; Demirjian, Sevag; Campbell, Steven C.

doi:10.1016/j.juro.2015.01.093

Cited by 245 publications

(169 citation statements)

References 47 publications

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“…However, as these lost nephrons cannot be restored, the individual is more likely to develop renal insufficiency/failure at the long term. This may explain the decrease in renal function observed after some years in patients submitted to renal ischemia for partial nephrectomy 4,19,20 .…”

Section: Resultsmentioning

confidence: 98%

“…Warm ischemia during partial nephrectomy is identified as a factor that negatively influences the postoperative renal function and is the most frequent cause of chronic and acute renal failure 4,5 . Despite some techniques for avoiding the use of warm ischemia during partial nephrectomy 6 , the hemostatic control by clamping the renal vessels is still used by several groups 7 .…”

Section: Introductionmentioning

confidence: 99%

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Glomerular loss after arteriovenous and arterial clamping for renal warm ischemia in a swine model

et al. 2016

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PURPOSE:To evaluate the glomerular loss after arteriovenous or arterial warm ischemia in a swine model. METHODS:Twenty four pigs were divided into Group Sham (submitted to all surgical steps except the renal ischemia), Group AV (submitted to 30 minutes of warm ischemia by arteriovenous clamping of left kidney vessels), and Group A (submitted to 30 minutes of ischemia by arterial clamping). Right kidneys were used as controls. Weigh, volume, cortical volume, glomerular volumetric density (Vv[Glom]), volume-weighted glomerular volume (VWGV), and the total number of glomeruli were measured for each organ. RESULTS:Group AV showed a 24.5% reduction in its left kidney Vv[Glom] and a 25.4% reduction in the VWGV, when compared to the right kidney. Reductions were also observed when compared to kidneys of sham group. There was a reduction of 19.2% in the total number of glomeruli in AV kidneys. No difference was observed in any parameters analyzed on the left kidneys from group A. CONCLUSIONS:Renal warm ischemia of 30 minutes by arterial clamping did not caused significant glomerular damage, but arteriovenous clamping caused significant glomerular loss in a swine model. Clamping only the renal artery should be considered to minimize renal injury after partial nephrectomies.

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Section: Resultsmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Glomerular loss after arteriovenous and arterial clamping for renal warm ischemia in a swine model

et al. 2016

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“…Partial nephrectomy (PN) now represents the standard treatment for localized renal tumors over the complete removal of the organ [2]. In this surgical setting, volume of preserved parenchyma, ischemia time and quality of the operated kidney are the main factors that affect functional recovery [3].…”

Section: Introductionmentioning

confidence: 99%

Impact of the off-clamp endoscopic robot-assisted simple enucleation (ERASE) of clinical T1 renal tumors on the postoperative renal function: Results from a matched-pair comparison

Mari

Morselli

Sessa

et al. 2018

European Journal of Surgical Oncology

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a b s t r a c tPurpose: To evaluate the surgical and functional outcomes of a matched-paired series of on-clamp vs offclamp endoscopic robot-assisted simple enucleation (ERASE) and standardized renorraphy in a tertiary referral institution, to search for predictors of functional drop after surgery and to investigate the influence of off-clamp technique in patients presenting these characteristics. Materials and methods: A matched-pair comparison of 120 on-clamp vs 120 off-clamp over 491 patients treated with ERASE was performed. Perioperative and functional outcomes were compared between groups. Results: Patients treated with on-clamp and off-clamp technique had comparable complication and positive surgical margin rate. The off-clamp group had a significantly lower eGFR drop compared to the on-clamp group at 3rd postoperative day (POD) (1% vs 7%, p ¼ 0.0001) and at 30th POD (2.5% vs 9%, p ¼ 0.01) from baseline. This difference lost its statistical significance at 6th month and at last follow-up (median 40 months). At multivariable analysis the Charlson comorbidity index (OR 2.06, p < 0.0001), uncontrolled type 2 diabetes mellitus (OR 4.13, p < 0.001) were independent predictive factors of a >15% eGFR drop from baseline to last follow-up. In a subanalysis over 64 comorbid patients, those patients who underwent off-clamp ERASE had a significantly lower eGFR drop compared to the comorbid counterpart during the whole follow-up. Conclusions: The off-clamp ERASE is a safe surgical technique with a significantly lower renal function drop compared to on-clamp ERASE in the early perioperative time. Patients with comorbidity might represent a subgroup of patients having a functional benefit after off-clamp RAPN even in the long-term period.

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“…11,[23][24][25] Since it was adopted in 2013, we have performed ECR exclusively for both laparoscopic and robotic PN, which reduced WIT by nearly 14 minutes. Although there have been previous studies describing the ECR technique, this is the first study to assess its impact on WIT and renal damage compared with the standard technique.…”

Section: Discussionmentioning

confidence: 99%

Early clamp release during laparoscopic partial nephrectomy: Implications for preservation of renal function

Campbell

Chan²,

Luke

2017

CUAJ

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Introduction: Intraoperative warm ischemic time (WIT), associated with hilar clamping during partial nephrectomy (PN), is an established modifiable risk factor for renal dysfunction. We assessed early clamp release (ECR) as a strategy to reduce WIT and assess its impact on renal function and bleeding. Methods: We retrospectively assessed patients who underwent minimally invasive PN by a single surgeon at our centre since December 2011. Comparing the standard technique to an ECR modification, WIT, complications, change in estimated glomerular filtration rate (eGFR), and change in differential function as demonstrated by MAG-3 nuclear renography were assessed. Followup blood work and renograms were performed at 6-12 weeks postoperatively and compared to baseline in 70 patients (35 ECR: 35 control). Results: The ECR and control groups were similar in age, sex, and tumour size, with only patient weight being higher in the ECR group (91.6 vs. 81.6 kg; p<0.05). WIT was significantly lower in ECR group compared to control (18.8 vs. 31.5 minutes; p<0.05). Although there was no significant difference in change from baseline eGFR in the early postoperative period (Day 3) or in followup (6-12 weeks), the control group had a significantly greater loss of ipsilateral renal function from baseline compared to the ECR group (9 vs. 4% change; p<0.05). Blood loss and complication rate were similar between groups. Conclusions: The ECR technique offers a safe, reproducible alternative that reduces WIT during laparoscopic PN. ECR demonstrates a reduction in overall ipsilateral renal dysfunction, without increasing complication or intraoperative bleeding risk.

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Decline in Renal Function after Partial Nephrectomy: Etiology and Prevention

Cited by 245 publications

References 47 publications

Glomerular loss after arteriovenous and arterial clamping for renal warm ischemia in a swine model

Glomerular loss after arteriovenous and arterial clamping for renal warm ischemia in a swine model

Impact of the off-clamp endoscopic robot-assisted simple enucleation (ERASE) of clinical T1 renal tumors on the postoperative renal function: Results from a matched-pair comparison

Early clamp release during laparoscopic partial nephrectomy: Implications for preservation of renal function

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