The Impact of Ischemia Time During Open Nephron Sparing Surgery on Solitary Kidneys: A Multi-Institutional Study

Thompson, R. Houston; Frank, Igor; Lohse, Christine M.; Saad, Ismail R.; Fergany, Amr; Zincke, Horst; Leibovich, Bradley C.; Blute, Michael L.; Novick, Andrew C.

doi:10.1016/j.juro.2006.09.036

Cited by 276 publications

(175 citation statements)

References 20 publications

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“…Diagnostic equipment technologic development has been providing new findings of ever smaller renal tumors in young individuals, therefore making way to needs of nephron sparing during surgical procedures towards removing such tumors; and partial nephrectomy relates to renal ischemia in order to allow nodule or renal mass removals; and, in order to prevent acute tubular necrosis, damage reduction due to blockage of renal blood flow -one of its main causes -must be attempted 2,3 .…”

Section: Discussionmentioning

confidence: 99%

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Influence of chlorpromazine on renal histology of rats submitted to ischemia and reperfusion injury

et al. 2016

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PURPOSE:To analyze the influence of chlorpromazine on renal histology of rats submitted to ischemia and reperfusion injury. METHODS:Sixteen Wistar rats -split in two groups -have been used: control group, receiving 3 mg/kg isotonic saline solution through caudal vein, and, the chlorpromazine group, receiving 3 mg/kg-IV of such medication. The nephrectomy of the left kidney lower third was carried out; immediately, the test-drug was administrated. After 15 minutes of test-drug administration, the renal pedicle was clamped; in 60 minutes of ischemia it was released. After 24 hours of the renal reperfusion, the rats were, once more, anesthetized and submitted to total left nephrectomy, and, afterwards, to euthanasia. Histological findings regarding ischemia have been evaluated and compared between the groups. RESULTS:There was no statistical difference related to inferior renal pole histological analysis. Regarding 60-minute renal ischemia, chlorpromazine has statistically reduced the accrual of leucocytes within the vasa recta renis (p=0.036) and the congestion of peritubular capillaries (p=0.041). When conducting joint analysis of histological patterns, the control group showed a median score of 11 and chlorpromazine group of 5.5 (p=0.036). CONCLUSION:Chlorpromazine significantly reduced the occurrence of secondary damage to ischemia and reperfusion process in the overall histological analysis.

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Section: Discussionmentioning

confidence: 99%

“…The kidney has low tolerance to ischemia; human solitary kidneys afford no more than 20 minutes on cold ischemia and no more than 35 minutes on warm ischemia 3 . Ischemia reversibility hinges on three variables: histology after reperfusion, ATP regeneration capabilities, and the ability to keep intracellular calcium homeostasis 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Influence of chlorpromazine on renal histology of rats submitted to ischemia and reperfusion injury

et al. 2016

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“…3 Multivariate analysis in the present study supports the notion that ischemia time is an independent predictor of renal function after PN. 25 A recent study suggested that the amount of preserved parenchyma and its baseline functionality could be the primary determinants of ultimate renal function after PN, although type and duration of ischemia remain the most important factors. 11 Shortening ischemia time, cooling a kidney during the period of ischemia, and optimizing the amount of preserved parenchyma could be the most important factors in renal protection against ischemic damage.…”

Section: Discussionmentioning

confidence: 99%

Mannitol has no impact on renal function after open partial nephrectomy in solitary kidneys

et al. 2013

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Abbreviations & AcronymsAbstract: Mannitol has been administered during partial nephrectomy as a renal protective agent for ischemic damage. However, we do not have any high-level clinical evidence of its effectiveness. The aim of the present study was to evaluate the effect of mannitol during open partial nephrectomy by comparing the postoperative renal function of patients who received it and those who did not. We retrospectively reviewed the records of 55 patients who underwent open partial nephrectomy for renal cancer in a solitary kidney from January 1990 to December 2012, and who were followed up postoperatively for at least 6 months. Of the 55 patients, mannitol was given to 20 patients (group M+) and not to the other 35 patients (group M−). We compared not only the postoperative estimated glomerular filtration rate, but also its decrease rate and the incidence of acute kidney injury requiring dialysis in the two groups. There were no significant differences in perioperative patient characteristics between the two groups. Mannitol made no significant difference in both the postoperative estimated glomerular filtration rate and its decrease rate at any point within 6 months of the postoperative period. The incidence of acute kidney injury requiring dialysis was one (5.0%) in group M+ and two (5.7%) in group M−. These findings suggest that there might be no advantage from the administration of mannitol during open partial nephrectomy.

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“…In view of studies demonstrating negligible effects on renal function after renal pedicle clamping for 90 minutes in porcine models [14][15][16] as well as retrospective clinical observations suggesting that WIT of 40 to 55 minutes may be tolerated, 16,17 some have asserted that the kidney can tolerate longer periods of WIT. Conversely, others have contended that the cutoff defining safe WIT be drawn at 20 minutes, [18][19][20] a view supported by a recent international collaborative review. 21 While efforts to define an appropriate cutoff for WIT abound, a compelling joint Cleveland Clinic/Mayo Clinic study examined the impact of WIT as a continuous variable on renal functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

Off-Clamp Robot-Assisted Partial Nephrectomy: Initial Washington University Experience

Tanagho

Bhayani²,

Kim³

et al. 2012

Journal of Endourology

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Tanagho, Youssef S.; Bhayani, Sam B.; Kim, Eric H.; Sandhu, Gurdarshan S.; Vaughn, Nicolas P.; and Figenshau, R. Sherburne, ,"Offclamp robot-assisted partial nephrectomy: Initial Washington University experience." Journal of Endourology.26,10. 1284Endourology.26,10. -1289Endourology.26,10. . (2012 . In all cases, warm ischemia time was 0 minutes. Mean operative time was 143 minutes (SD = 59), and median estimated blood loss was 138 mL (range 50-1500 mL). No intraoperative complications were encountered, and all surgical margins were negative. Our postoperative complication rate was 14.3%. At the most recent follow-up, the mean estimated glomerular filtration rate (eGFR) was 76.2 mL/min/ 1.73 m 2 (SD = 27.6), compared with 78.5 mL/min/1.73 m 2 (SD = 28.9) preoperatively (P = 0.11). Therefore, the mean eGFR decline of 2.3 mL/min/1.73 m 2 (SD = 9.1) was not significant. Conclusions: Off-clamp RAPN is associated with minimal morbidity and minimal decline in renal function on short-term follow-up. Further studies and continued monitoring of renal function are needed to determine if offclamp RAPN provides any advantage in renal function preservation relative to the traditional RAPN with vascular clamping.

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The Impact of Ischemia Time During Open Nephron Sparing Surgery on Solitary Kidneys: A Multi-Institutional Study

Abstract: Vascular clamping during open nephron sparing surgery is associated with a higher incidence of renal complications. Attempts to limit warm ischemia to 20 minutes and cold ischemia to 35 minutes should be used when vascular clamping is necessary.

Cited by 276 publications

References 20 publications

Influence of chlorpromazine on renal histology of rats submitted to ischemia and reperfusion injury

Influence of chlorpromazine on renal histology of rats submitted to ischemia and reperfusion injury

Mannitol has no impact on renal function after open partial nephrectomy in solitary kidneys

Off-Clamp Robot-Assisted Partial Nephrectomy: Initial Washington University Experience

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