Decrease of Renal Function due to Warm Ischemia after Laparoscopic Partial Nephrectomy: Evaluation Using ^99mTc-DMSA Renal Scintigraphy

Abstract

Introduction: The purpose of this study is, using technetium-99m-dimercaptosuccinic acid (^99mTc-DMSA), to evaluate the decrease of renal function caused by warm ischemia. Patients and Methods: The ^99mTc-DMSA scan was performed before and 1, 3 and 6 months after the operation for 19 consecutive patients. The patients were divided into three groups by warm ischemic time (group A: ≤40 min, B: >40 min ∩ ≤60 min, C: >60 min). Renal function of the unresected part was defined as the uptake to unresected part relative to the uptake to the contralateral kidney. The reduction of renal function was expressed as a ratio of the function after the surgery divided by function before the surgery and was compared between the three groups. Results: The reduction in group C after 1 and 3 months tended to be greater than that in group A or B, although not reaching statistical significance (one-way ANOVA test, 1 month: p = 0.15 and 3 months: p = 0.13). There was a significant difference in reduction of renal function between the three groups after 6 months (one-way ANOVA test, p = 0.02). The Scheffé test showed a statistical significance between groups A and C (p < 0.05). Conclusion: Renal function calculated by ^99mTc-DMSA shows that prolonged ischemic time causes significant damage to the kidney.

Assessing Renal Function After Partial Nephrectomy Using Renal Nuclear Scintigraphy and Estimated Glomerular Filtration Rate

“…Our data are in concordance with a recent study by Tachikake et al, which concluded that increased intraoperative ischemic time during partial nephrectomy leads to kidney damage detectable by 99m Tc-DMSA renal scintigraphy. 14 …”

“…10 The utility of nuclear scans for predicting postoperative renal insufficiency of the affected kidney after radical and partial nephrectomy has previously been demonstrated. 11-14 Nuclear scans can indicate damage to the affected kidney that is not reflected in serum creatinine measurements and eGFR calculations. 14 We believe long ischemia time and large tumor size predict for renal damage that will impact postoperative kidney function.…”

“…11-14 Nuclear scans can indicate damage to the affected kidney that is not reflected in serum creatinine measurements and eGFR calculations. 14 We believe long ischemia time and large tumor size predict for renal damage that will impact postoperative kidney function. A useful measure of kidney function should be sensitive to nephrogenic injury induced by these variables.…”

Clinical application of calculated split renal volume using computed tomography‐based renal volumetry after partial nephrectomy: Correlation with technetium‐99m dimercaptosuccinic acid renal scan data

“…In addition, contralateral compensatory hypertrophy after partial nephrectomy can minimize postoperative GFR decrease in the two‐kidney model . As serum creatinine measurements and eGFR calculation cannot reflect the decreased renal function of the operated kidney, traditionally nuclear renal scan has been used to evaluate postoperative renal function . Among various types of nuclear renal scans, the 99m Tc‐DMSA renal scan is accepted as the most reliable method for quantifying cortical function and measuring the SRF .…”

“…6 As serum creatinine measurements and eGFR calculation cannot reflect the decreased renal function of the operated kidney, traditionally nuclear renal scan has been used to evaluate postoperative renal function. [7][8][9][10] Among various types of nuclear renal scans, the 99m Tc-DMSA renal scan is accepted as the most reliable method for quantifying cortical function and measuring the SRF. 11,12 In addition, as 99m Tc-DMSA cannot bind to renal tumor tissue, it is also used to visualize or distinguish the renal tumor from normal renal parenchyma.…”