Functional Recovery After Partial Nephrectomy: Effects of Volume Loss and Ischemic Injury

Simmons, Matthew N.; Hillyer, Shahab; Lee, Byron; Fergany, Amr; Kaouk, Jihad; Campbell, Steven C.

doi:10.1016/j.juro.2011.12.068

Cited by 196 publications

(129 citation statements)

References 16 publications

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“…Our study also supports the findings by the group in Cleveland Clinic of the impact of parenchymal volume preservation on renal function after partial nephrectomy for small renal masses. 21,22 This impact may be even more important than warm ischemic time. Interestingly, kidney volumes obtained in these studies were larger in the Western population (median of 184-219 mL) than those in the Asian population 14,20 and may be related to body size.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Renal Volume: A Surrogate Measure for Radical Nephrectomy-Induced Chronic Kidney Disease

Tay

Tai

et al. 2015

Journal of Endourology

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Objectives: Surgically induced chronic kidney disease (CKD) has been found to have less impact on survival as well as function when compared to medical causes for CKD. The aim of this study is to evaluate whether preoperative remaining kidney volume correlates with renal function after nephrectomy, which represents an individual's renal reserve before surgically induced CKD. Methods: A retrospective review of 75 consecutive patients (29.3% females) who underwent radical nephrectomy (RN) (2000-2010) was performed. Normal side kidney parenchyma, excluding renal vessels and central sinus fat, was manually outlined in each transverse slice of CT image and multiplied by slice thickness to calculate volume. Estimated glomerular filtration rate (eGFR) was determined using the Modification of Diet in Renal Disease equation. CKD is defined as eGFR <60 mL/min/1.73 m 2 .Results: Mean preoperative normal kidney parenchymal volume (mean age 55 [SD 13] years) is 150.7 (SD 36.4) mL. Over median follow-up of 36 months postsurgery, progression to CKD occurred in 42.6% (n = 32) of patients. On multivariable analysis, preoperative eGFR and preoperative renal volume <144 mL are independent predictors for postoperative CKD. On Kaplan-Meier analysis, median time to reach CKD postnephrectomy is 12.7 (range 0.03-43.66) months for renal volume <144 mL but not achieved if renal volume is >144 mL. Conclusions: Normal kidney parenchymal volume and preoperative eGFR are independent predictive factors for postoperative CKD after RN and may represent renal reserve for both surgically and medically induced CKD, respectively. Preoperative remaining kidney volume may be an adjunct representation of renal reserve postsurgery and predict later renal function decline due to perioperative loss of nephrons.

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Section: Discussionmentioning

confidence: 99%

Preoperative Renal Volume: A Surrogate Measure for Radical Nephrectomy-Induced Chronic Kidney Disease

Tay

Tai

et al. 2015

Journal of Endourology

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“…15 The median WIT for simple tumors was 15 (IQR 9) minutes, which is within the safe range of <25 minutes described by Thompson and associates. 20 Although a growing body of evidence suggests that the amount of renal parenchyma removed rather than WIT is the determinant of final degree renal function preservation, 21,22 long WIT, especially in the setting of preexisting renal impairment and solitary kidney, is an important modifiable factor. [23][24][25][26] The rates of intraoperative (3.3%) and postoperative complications (30%) are slightly higher than in some of the published RAPN series, 27 but they are comparable with results from other OPN series for solitary kidneys.…”

Section: Surgical Techniquementioning

confidence: 99%

Comparison of Perioperative Outcomes of Robot-Assisted Partial Nephrectomy and Open Partial Nephrectomy in Patients with a Solitary Kidney

Zargar

Bhayani

Allaf

et al. 2014

Journal of Endourology

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Results: 40 RAPN and 85 OPN cases were identified. For both tumor complexity groups, patients in each treatment modality were comparable. There were higher proportions of OPN cases in the complex group (61.2% vs 25%; P = 0.001). For both complexity tumor groups, there was no statistical difference between the treatment modalities in overall intraoperative/postoperative complications, transfusion rate, and positive surgical margin (PSM) rates. Patients in the RAPN group had a shorter length of hospital stay. For the entire cohort, there was no difference in estimated glomerular filtration rate preservation beyond 1 month (OPN 80.51%, RAPN 81.29%). Limitations include retrospective, nonrandomized nature of the series and small number of cases in the RAPN groups. Conclusions: In the solitary kidney, RAPN offers comparable perioperative and short-term functional outcomes for localized tumors with low R.E.N.A.L. score. For more complex tumors, our early experience suggests comparability, but these results were obtained in selected cases and future studies will need to validate these results.

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“…Simmons et al suggested that a decrease of GFR in PN surgery may be influenced by 3 factors: functional volume loss, ischemia related acute kidney injury and mechanical trauma effects [14]. Collateral damage due to renorrhaphy volume loss occurs mainly as a result of resected normal parenchyma adjacent to the tumor margin.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of long-term postoperative renal function after partial nephrectomy in a solitary kidney

Kuru

Wei²,

Hatiboglu

et al. 2017

Open Life Sciences

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In conclusion, the quality of preoperative kidney primarily determines long-term postoperative renal function, while the quantity of preserved functional parenchyma volume was the main determinant for long-term kidney recovery. ARF was an independent risk factor while WIT was indirectly associated with postoperative renal function by causing perioperative ARF. IntroductionOver the last 2 decades, an increasing number of observational studies have indicated that partial nephrectomy (PN) was associated with elevated overall survival (OS) as well as better preservation of renal function, without compromising oncologic outcome, when compared with radical nephrectomy (RN) in treatment of renal cell carcinoma (RCC) [1][2][3][4]. PN has thus been accepted and applied by more and more urologists as a gold standard treatment for localized renal tumors. Abstract: The effect of warm ischemia time (WIT) on longterm renal function after partial nephrectomy remains controversial. In this retrospectively cohort study, 75 solitary kidney patients were included and the effects of warm ischemia time, preoperative renal function and resected normal parenchyma volume on long-term renal function were evaluated. Multivariable analysis showed that the preoperative renal function baseline was significantly associated with renal function 12 months postoperation (P=0.01), adjusting for age and comorbidities factors. Meanwhile, perioperative acute renal failure (ARF) events significantly affected postoperative renal function at postoperative time points of 12 months (P=0.001) and 60 months (P=0.03), as well as renal function change at postoperative 12 months (P<0.01). Warm ischemia time and resected normal parenchyma volume were not risk factors for long-term postoperative renal function, while the latter was significantly associated with renal function change (P=0.03 at 12 months, P<0.01 at 36 and 60 months).

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Functional Recovery After Partial Nephrectomy: Effects of Volume Loss and Ischemic Injury

Cited by 196 publications

References 16 publications

Preoperative Renal Volume: A Surrogate Measure for Radical Nephrectomy-Induced Chronic Kidney Disease

Preoperative Renal Volume: A Surrogate Measure for Radical Nephrectomy-Induced Chronic Kidney Disease

Comparison of Perioperative Outcomes of Robot-Assisted Partial Nephrectomy and Open Partial Nephrectomy in Patients with a Solitary Kidney

Risk factors of long-term postoperative renal function after partial nephrectomy in a solitary kidney

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