Renal damage caused by warm ischaemia during laparoscopic and robot-assisted partial nephrectomy: an assessment using Tc 99m-DTPA glomerular filtration rate

Background

Few studies assessing the functional change of each kidney following warm ischaemia after partial nephrectomy are available.

Objectives

Our aim was to identify the effects of the warm ischaemic time (WIT) on renal function after partial nephrectomy under the pneumoperitoneum.

Design, setting, and participants

Forty-four consecutive patients who underwent laparoscopic partial nephrectomy (LPN) or robot-assisted partial nephrectomy (RAPN) from June 2008 to May 2009 for a single cT1 renal tumour were included in this prospective protocol.

Measurements

Technetium Tc 99m-diethylenetriaminepentaacetic acid (Tc 99m-DTPA) renal scintigraphy was used to determine the glomerular filtration rate (GFR) of both kidneys and each kidney individually. Tc 99m-DTPA GFR was performed preoperatively and 3 mo postoperatively. In addition, we analysed Tc 99m-DTPA scintigraphy GFR regionally in the healthy areas of the affected kidney.

Results and limitations

Patients with WIT >28 min had a significantly greater decrease in the GFR of the affected kidney (p = 0.031). The GFR of the affected kidney showed a significant decrease perioperatively (46.4 ± 14.3 to 37.9 ± 11.9 ml/min per 1.73 m²; p = 0.003). The functional change of the nonaffected kidney showed an increasing trend (47.5 ± 13.8 to 51.4 ± 14.3 ml/min per 1.73 m²), although it was not statistically significant (p = 0.103). Regional Tc 99m-DTPA GFR of both affected kidney and nonaffected kidney showed no significant differences perioperatively (6.3 ± 1.8 to 6.1 ± 1.9 ml/min per 1.73 m²; p = 0.641; 6.6 ± 1.9 to 7.1 ± 2.0 ml/min per 1.73 m²; p = 0.200). On multivariate analysis, preoperative GFR, resected volume of marginal healthy tissue, and WIT were independent predictors for functional reduction of the affected kidney (p < 0.05). The study was limited by small numbers and short follow-up periods.

Conclusions

Stationary overall renal function after LPN or RAPN is masked possibly by functional compensation of the contralateral healthy kidney. The damage of the affected kidney estimated by scintigraphy occurs when WIT exceeds 28 min during partial nephrectomy under the pneumoperitoneum.     

血清半胱氨酸蛋白酶抑制剂C在慢性肾脏病肾功能中的应用

目的以放射性核素99Tcm-DTPA清除率测定的肾小球滤过率为标准,比较血清胱抑素C和肌酐评价GFR的准确性和特异性。方法以99Tcm-DTPA清除率法测定38例慢性肾脏病患者GFR,并同时测定Scr浓度和Cys-C浓度。运用ROC分析曲线分析SCysC和Scr评价GFR的准确性、敏感性和特异性。结果 38例慢性肾脏病患者SCys-C浓度为（1.67±0.25）mg/L,Scr浓度为（198.77±98.01）μmol/L,GFR为（50.55±35.62）mL/（min.1.73m2）。SCys-C与Scr、GFR呈明显负相关,相关系数分别为-0.74和-0.6（1P〈0.05）;分别以GFR〈90mL（/min.1.73m2）、GFR〈60mL（/min.1.73m2）和GFR〈30mL/（min.1.73m2）为界点,Cys-C的Roc曲线下面积（AUC）分别为0.822、0.857、0.920;Scr的Roc曲线下面积分别为0.775、0.801和0.922。结论在慢性肾病患者中与Scr比较,Cys-C是评价GFR的一个良好内源性指标,且能更好地反映GFR的早期改变。     

Off-clamp robot-assisted partial nephrectomy does not benefit short-term renal function: a matched cohort analysis

In the interest of renal functional preservation, partial nephrectomy has supplanted radical nephrectomy as the preferred treatment for T1 renal masses. This procedure usually involves the induction of renal warm ischemia by clamping the hilar vessels prior to tumor excision. Performing robot-assisted partial nephrectomy (RAPN) “off-clamp” can theoretically prevent renal functional loss associated with warm ischemia. We describe our institutional experience and compare perioperative and renal functional outcomes using a propensity score matched cohort. We conducted a retrospective comparison from a prospectively maintained database of all patients who underwent RAPN from 2009 to 2015. Of those patients, 143 underwent off-clamp RAPN. Fifty off-clamp RAPN patients were propensity score matched with fifty clamped RAPN patients based on renal function, tumor size, and R.E.N.A.L. nephrometry score. The cohorts were compared across demographics, operative information, perioperative outcomes, and renal functional outcomes. For all off-clamp RAPN patients, mean nephrometry score was 7.1, mean estimated blood loss (EBL) was 236.9 mL, perioperative complication rate was 7.7%, and mean decrease in estimated glomerular filtration rate (eGFR) was 7.1% at a median follow-up of 9.2 months. In the propensity score matched cohorts, off-clamp RAPN resulted in a shorter mean operative time (172.0 versus 196.0 min, p = 0.025) and a lower mean EBL (179.7 versus 283.2 mL, p = 0.046). A lower complication rate of 6.0% in the off-clamp group compared with 20.0% in the clamped group approached significance (p = 0.071). Mean preoperative eGFR was similar in both cohorts. Importantly, there was no significant difference in decrease in eGFR between the clamped cohort (9.8%) and off-clamp cohort (11.9%) at a median follow-up of 9.0 months (p = 0.620). Off-clamp RAPN did not result in improved renal functional preservation in our experience. Surprisingly, the off-clamp cohort experienced lower intraoperative blood loss, shorter operative times, and fewer complications.     

99Tcm-DTPA肾动态显像评估单侧根治性肾切除术后早期患者肾功能

目的 观察⁹⁹Tc^m-二亚乙基三胺五乙酸（DTPA）肾动态显像评估单侧根治性肾切除术后早期患者肾功能的价值。方法 回顾性分析158例接受根治性肾切除术的单侧肾实质肿瘤患者资料及术前经肾动态显像所获肾小球滤过率（GFR）结果,计算估算GFR （eGFR）,并以eGFR 60、90 ml/（min·1.73 m²）为临界值将患者分为3组;评价各组临床资料、肾功能指标与术后3个月eGFR的关系,并以线性回归分析影响术后早期肾功能的独立因素。结果 术前eGFR<60 ml/（min·1.73 m²）患者术后早期肾功能与术前eGFR及对侧GFR均相关（P均<0.05）;对侧GFR为术后早期肾功能的独立影响因素（调整R²=0.910,P<0.001）。术前60 ml/（min·1.73 m²）≤ eGFR<90 ml/（min·1.73 m²）时,术后早期肾功能与患者年龄、高血压病史及术前对侧GFR均相关（P均<0.05）,其中术前对侧GFR为独立影响因素（调整R²=0.463,P<0.001）;术前eGFR ≥ 90 ml/（min·1.73 m²）时,术后早期肾功能与患者年龄、肿瘤性质、术前eGFR、对侧GFR及患侧GFR均相关（P均<0.05）,其中患者年龄、术前eGFR及对侧GFR为独立影响因素（调整R²=0.486,P<0.001）。结论 术前⁹⁹Tc^m-DTPA肾动态显像可用于评估单侧根治性肾切除术后早期患者肾功能。     

The plasma creatinine concentration is not an accurate reflection of the glomerular filtration rate in stable renal transplant patients receiving cyclosporine

We studied 31 stable renal cadaver kidney transplant patients receiving cyclosporine (CyA) and prednisone for immunosuppression to determine what reduction in true glomerular filtration rate (GFR) was reflected by their mild elevation in plasma creatinine concentration (1.8 +/- 0.11 mg/dL). We measured both the creatinine clearance (60 +/- 4.32 mL/min/1.73 m2) and the true GFR using Technetium 99m-DTPA (44 +/- 2.72 mL/min/1.73 m2). The creatinine clearance overestimated true GRF by a mean of 38%, indicating that this percentage of creatinine reached the urine by tubular secretion rather than glomerular filtration. A similar degree of overestimation was found in a separate group of 14 patients receiving imuran for immunosuppression. In 23 patients receiving CyA in whom the serum creatinine concentration was less than 2.0 mg/dL, the mean DTPA clearance was 49.5 +/- 2.83 mL/min/1.73 m2. In stable renal transplant patients receiving CyA, a serum creatinine concentration at, or close to, the upper limit of the normal range may reflect markedly impaired renal function.     

Efficacy of Follow-up Care System of Living Kidney Donors in Monitoring of Residual Kidney Function

Background

The possibility of an increased risk of end-stage renal disease is a major concern associated with living kidney donation. Therefore, monitoring of residual kidney function becomes most essential.

Postoperative renal function after partial nephrectomy for renal cell carcinoma in patients with pre‐existing chronic kidney disease: A comparison with radical nephrectomy

We assessed whether adequately functioning parenchyma is preserved in patients with pre‐existing chronic kidney disease (CKD) after partial nephrectomy (PN) compared with those who underwent radical nephrectomy (RN). A total of 95 patients with pre‐existing CKD who underwent curative surgery for pathological T1a‐T2N0M0 renal cell carcinoma with a follow‐up period of 12 months or more were the subject of the present study. Of these, 51 patients underwent RN, and 44 PN. Renal function was assessed by using the estimated glomerular filtration rate (e‐GFR). We classified the subjects into two groups according to the preoperative e‐GFR: preoperative e‐GFR 45–59 mL/min/1.73 m² (68 patients); and 30–44 mL/min/1.73 m² (27 patients). In the former group, the probability of freedom from new onset of e‐GFR <45 mL/min/1.73 m² stemmed from the significant difference between the PN and RN groups (P = 0.006; PN: 2 years 64%; RN: 2 years 22%). In contrast, in the latter group, the probability of freedom from new onset of e‐GFR <30 mL/min/1.73 m² was not associated with a significant difference between PN and RN group (P = 0.80). Overall survival and the number of the patients who went on to develop end‐stage renal disease requiring renal replacement therapy between PN and RN were not significantly different in each group. Death from renal cell carcinoma was not noted in either group. PN could significantly prevent development to late‐stage CKD in patients with preoperative e‐GFR 45–59 mL/min/1.73 m² compared with RN. Patients with preoperative e‐GFR 30–44 mL/min/1.73 m² should be reviewed in a more strict study.     

肾部分切除术后术肾功能影响因素37例分析

目的探讨肾部分切除术后术肾功能的主要影响因素。方法回顾性分析2007年10月~2009年7月37例肾癌患者行开放肾部分切除术的临床资料。其中3例为双侧肾癌患者。采用99 mTc-DTPA肾核素扫描评估术前及术后3月术侧肾的肾小球滤过率（GFR）。术中所有患者行单独肾动脉阻断。统计学分析应用t检验和多变量回归分析。结果手术时间80~195min,平均（122.51±25.86）min。肾动脉阻断时间（24.51±8.05）min。肿瘤大小（3.62±0.76）cm。术前及术后3月术肾GFR分别是（47.19±6.85）、（30.40±8.87）mL/min。术侧肾术后GFR下降（16.79±6.35）mL/min,与术前相比下降约34%。经随访3~21月,无复发及转移病例。患者全部无瘤生存。多元回归分析显示,年龄（P=0.004）、术前术肾GFR（P=0.000）及肾动脉阻断时间（P=0.000）对术肾功能的影响有统计学意义。结论年龄、术前术肾肾小球滤过率及肾动脉阻断时间是影响术后肾功能的主要因素。     

Comparison of surgical outcomes and split renal function between laparoscopic and robot-assisted partial nephrectomy: a propensity score-matched analysis

Purpose

The objective of this study was to compare perioperative outcomes and total and split renal function between laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN). Predictive risk factors of preservation of operated renal function were also assessed.

Methods

We retrospectively analyzed 173 patients who underwent LPN (n?=?84) or RAPN (n?=?89) between 2010 and 2020. After propensity score matching (1:1), perioperative outcomes and total and split renal function were assessed. Logistic regression analysis was used to evaluate predictive risk factors of preservation of operated renal function. Trifecta criteria were defined as negative surgical margins, warm ischemia time (WIT)?<?25 min, and no complications more than Clavien–Dindo grade II within 4 weeks after surgery. Split renal function was evaluated by mercaptoacetyltriglycine renal scan.

Results

After propensity score matching, 42 patients were allocated to each group. RAPN was associated with significantly shorter WIT (RAPN vs LPN: 12 vs 22 min; p?<?0.0001) and higher trifecta achievement rate (93.3 vs 64.2%; p?<?0.0001). Other perioperative outcomes and total and split renal function were not significantly different between LPN and RAPN. The R.E.N.A.L. nephrometry score (RNS) was a predictive risk factor of preservation of operated renal function in the multivariable logistic regression analysis (odds ratio 1.68, 95% confidence interval 1.29–2.20, p?<?0.0001).

Conclusions

RAPN improved WIT and trifecta achievement rate, but it did not improve the preservation of operated renal function, for which RNS was found to be a strong predictive risk factor.

     

Impact of microwave tissue coagulation during laparoscopic partial nephrectomy on postoperative renal function

Laparoscopic partial nephrectomy for small renal tumors has been performed with increasing frequency over the past few years. We prospectively evaluated preoperative and postoperative differential renal function in patients with functioning contralateral kidneys who underwent laparoscopic partial nephrectomy using a microwave tissue coagulator without hilar clamping. Seven patients (five men and two women) in this prospective protocol underwent laparoscopic partial nephrectomy for exophytic tumors using a microwave tissue coagulator when the tumor was 2 cm or less in diameter. Renal scanning with ⁹⁹technetium-labeled diethylenetetraminepentaacetic-acid scan was performed preoperatively and postoperatively at 7 days and 6 months after surgery in all patients. The mean tumor size and surgical duration were 17.0 ± 2.3 mm and 161.1 ± 20.5 min, respectively. Intraoperative blood loss was 35.6 ± 40.7 ml. The preoperative glomerular filtration rate (GFR) and differential split renal function (SF) in the affected kidney were 45.7 ± 12.8 ml/min and 50.5 ± 3.3%, respectively. On postoperative day 7 and at 6 months, GFR and SF in the affected kidney were 36.2 ± 9.0 and 36.8 ± 10.9 ml/min and 44.3 ± 4.1 and 45.0 ± 5.1%, respectively. No postoperative complications occurred. Laparoscopic nonischemic partial nephrectomy using a microwave tissue coagulator has the advantage of technical ease and adequate hemostasis. However, its indication should be restricted to small exophytic renal tumors due to the expected collateral damage causing renal impairment.     

Impact of parenchymal loss on renal function after laparoscopic partial nephrectomy under warm ischemia

Purpose

To elucidate the impact of renal parenchymal loss and the ischemic reperfusion injury (RI) on the renal function after laparoscopic partial nephrectomy (LPN) under warm ischemia (WI).

Methods

Thirty-five patients with a single polar renal mass ≤4 cm and normal contralateral kidney underwent LPN. Transperitoneal LPN with WI using en bloc hilar occlusion was performed. The total differential renal function (T-DRF) using ^99mTc-dimercaptosuccinic acid was evaluated preoperatively and postoperatively over a period of 1 year. A special region of interest (ROI) was selected on the non-tumorous pole of the involved kidney, and was compared with the same ROI in the contralateral kidney. The latter comparison was defined as partial differential renal function (P-DRF). Any postoperative decline in the P-DRF of the operated kidney was attributed to the RI. Subtraction of the P-DRF decline from the T-DRF decline was attributed to the parenchymal loss caused by the resection of the tumor and suturing of the normal parenchyma.

Results

The mean WI time was 22 min, and the mean weight of resected specimen was 18 g. The mean postoperative eGFR declined to 87 ml/min/1.73 m² from its baseline mean value of 97 ml/min/1.73 m² (p value = 0.075). Mean postoperative T-DRF and P-DRF of the operated kidney declined by 7 and 3 %, respectively.

Conclusions

After LPN of small renal mass, decline in renal function is primarily attributed to parenchymal loss caused by tumor resection and suturing of the normal parenchyma rather than the RI.

     

Progressive renal failure despite long-term biweekly enzyme replacement therapy in a patient with Fabry disease secondary to a new α-galactosidase mutation of Leu311Arg (L311R)

A 37-year-old Japanese man affected by Fabry disease secondary to a novel mutation of Leu311Arg (L311R) in α-galactosidase demonstrated progressive renal failure despite biweekly enzyme replacement therapy (ERT) for approximately 10 years. Kidney biopsy revealed foamy glomerular epithelial cells, compatible with the typical pathologic features of Fabry disease. The patient entered a phase III study of Replagal^® (agalsidase alfa) in 2001, allowing him to continue ERT with biweekly dosing for almost 10 years. During 2 years of that period, he was continued on Fabrazyme^® (agalsidase beta) biweekly dosing. His estimated GFR was calculated to decrease by 9.9 mL/min/1.73 m² per year. Patients with Fabry disease have been reported to have a mean decrease in GFR of 12.2 ± 8.1 mL/min/1.73 m² per year. This result suggests that biweekly ERT is only mildly effective at preventing loss of kidney function.     

Renal artery revascularisation can restore kidney function with absent radiotracer uptake

Background

Children with renovascular hypertension often present with severe hypertension. Some children have severe obstruction of their renal arteries resulting in <10% relative function on [^99mTc]dimercaptosuccinic acid (DMSA) scan. Conventional treatment of these children has been nephrectomy of the poorly functioning kidney to normalise their blood pressure (BP).

Case-Diagnosis/treatment

We describe three children aged 20 months to 9 years with severe renal artery stenosis and severe hypertension who had radionucleotide uptake of 0% in one kidney. In one case, no renal perfusion was demonstrated by duplex ultrasound scan. Significant recovery of relative renal function of 18 to 52% was achieved after revascularisation by percutaneous angioplasty or open surgery of the obstructed renal artery.

Conclusion

These cases illustrate that scintigraphy alone cannot be used to predict salvageable function in children with renovascular disease.     

Is Cyctatin C Valuable Marker of Glomerular Filtration Rate in Living Kidney Donors After Uninephrectomy?

BackgroundThe determination of kidney function plays a pivotal role in living donors renal assessment because of the long-term hazards of life with one kidney. Guidelines recommend estimation of glomerular filtration rate (GFR) by the Modification of Renal Disease (MDRD) or Cockroft-Gault equations for people with normal or near-normal renal function. Cystatin C (CysC) has been introduced as an alternative endogenous marker of GFR.ObjectiveThe objective of the study was to evaluate residual renal function among living kidney donors by comparing serum CysC concentrations and estimated GFR according to the MDRD formula or the Cockroft-Gault equation.Patients and methodsForty living kidney donors showed a mean age of 46.14 years. Their GFR was estimated according to the abbreviated MDRD (aMDRD) and Cockroft-Gault formula adjusted for body surface area. Twenty-two donors underwent diethylenetriaminepentaacetic acid (DTPA) renal studies. Serum CysC concentrations were measured during the last follow-up visit. GFR values according to Cockroft-Gault formula and MDRD formula were correlated with CysC concentrations using Pearson's linear correlation.ResultsMean GFR according to the aMDRD formula and Cocroft-Gault formula decreased after nephrectomy. The Cockroft-Gault formula overestimated the DTPA GFR in our study. No significant differences were observed between DTPA GFR and GFR estimated using the aMDRD equation. The rate of GFR decrease was approximately 0.8 mL/min/1.73m² per year. No significant correlation was observed between serum CysC concentration and GFR. Microalbuminuria was observed in one patient after nephrectomy.ConclusionsaMDRD equation to estimate GFR is more precise than Cockroft-Gault formula and cystatin C in living kidney donors after nephrectomy and should be preferred model in these patients.     

Preoperative radiographic parameters predict long-term renal impairment following partial nephrectomy

Purpose

We analyzed radiographic parameters describing anatomic features of renal tumors to identify preoperative characteristics that could help predict long-term decline in renal function following partial nephrectomy.

Methods

We retrospectively reviewed the records of 194 consecutive patients who underwent partial nephrectomy from January 2006 to March 2009 and analyzed a cohort of 53 patients for whom complete clinical, radiographic, and operative information was available. Computed tomography images were reviewed by a single radiologist. Radiographic criteria for describing renal tumor size and location included diameter, volume, endophytic properties, proximity to collecting system, anterior/posterior location, location relative to polar lines, and R.E.N.A.L. nephrometry score. Postoperative estimated glomerular filtration rate was calculated using the MDRD study group equation with serum creatinine at last follow-up.

Results

The median preoperative and postoperative GFR values were 75 (IQR 65–97) and 66 (IQR 55–84) mL/min/1.73 m², respectively. At a median follow-up of 38 months, the median percentage decrease in GFR was 12%. On univariate analyses, tumor diameter (P = 0.002), tumor volume (P < 0.0001), nearness of tumor to collecting system (P = 0.017), and location relative to polar lines (P = 0.017) were associated with percentage decrease in GFR. Furthermore, higher R.E.N.A.L. nephrometry score was also associated with poorer renal functional outcomes following partial nephrectomy (P = 0.019).

Conclusions

Anatomic features of renal tumors defined by preoperative radiographic characteristics correlate with the degree of renal functional decline after partial nephrectomy. Identification of these parameters may assist in patient counseling and clinical decision making following partial nephrectomy. Validation in larger prospective studies is necessary.

     

Rapid communication: chronic renal insufficiency after laparoscopic partial nephrectomy and radical nephrectomy for pathologic t1a lesions

PURPOSE: To report the prevalence of new-onset renal insufficiency in patients undergoing laparoscopic partial nephrectomy (LPN) as compared to laparoscopic radical nephrectomy (LRN) for pathologic T1a lesions. PATIENTS AND METHODS: Forty-eight patients and 37 patients with a normal contralateral kidney, preoperative creatinine (Cr) concentration <2 mg/dL, and tumors <4 cm in size underwent LPN and LRN, respectively. Glomerular filtration rate (GFR) was estimated using an abbreviated Modification of Diet in Renal Disease (MDRD) equation. Cr concentrations and GFR values were analyzed in patients undergoing LPN or LRN. Statistical analysis was performed with two-tailed t-test assuming unequal variances, to establish significance by P < 0.05. RESULTS: Preoperative Cr and GFR was equivalent in the LPN and LRN groups (0.9 mg/dL and 90 mL/min). At last follow-up (mean 205 and 233 days in the LPN and LRN groups, respectively) mean creatinine was 1.03 +/- 0.3 mg/dL v 1.4 mg/dL +/- 0.3 (P = 0.0002). Estimated GFR was 79 +/- 22 mL/min per 1.73 m2 v 55 +/- 14 mL/min per 1.73 m2 (range 31-91 mL/min per 1.73 m2; P < .0001) in the LPN and LRN groups, respectively. One patient in the LPN group and three patients in the LRN group had clinical renal insufficiency as defined by Cr > 2.0 mg/dL. Subclinical renal insufficiency (Cr < 2.0, but calculated GFR <60 mL/min per 1.73 m2) was present in 57% of the LRN patients v 15% of the LPN patients. CONCLUSIONS: LPN preserves renal function more effectively than LRN for pathologic T1a lesions. Subclinical renal insufficiency (GFR <60 mL/min per 1.73 m2) was present in the majority of patients undergoing radical nephrectomy in our series. Importantly, this series included the use of warm ischemia in all cases.     

Development of a Screening Tool to Predict Chronic Kidney Disease Risk in Post-nephrectomy Living Kidney Donors

Few studies have examined the long-term risks of kidney removal to donors despite the increase of frequency in kidney transplantation. This is the 1st study to develop prediction models of chronic kidney disease (CKD) for the 1-year period after donor nephrectomy in living donors. A prospective cohort of patients who underwent donor nephrectomy from March 1, 2006, to December 31, 2016, at the Severance Hospital, Seoul, South Korea, was used. CKD was defined as a glomerular filtration rate (GFR) <60 mL/min/1.73 m². GFR was estimated with the use of the abbreviated Modification in Diet and Renal Disease Study equation. Patients with a previous CKD history or estimated GFR <60 mL/min/1.73 m² were excluded, and those with 1-year post-nephrectomy follow-up were included. Among 440 patients who underwent donor nephrectomy, 144 (32.7%) developed a first-time onset of a GFR <60 mL/min/1.73 m² by 1 year after surgery. Our logistic regression models derived from these 3 variables predicted CKD with an area under the receiver operating characteristic curve of 0.796, an accuracy of 70.9%, and a sensitivity of 66.2% and specificity of 80.6%. This model could assist with decision making about potential donors and for surveillance of those at risk of post-nephrectomy CKD.     

Impact of the Ratio of Visceral to Subcutaneous Adipose Tissue in Donor Nephrectomy Patients

Objective

It was reported that a metabolic syndrome affected the remaining renal function after living donor nephrectomy. However, the measurement of waist circumference is unclear because it cannot distinguish between visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). We investigate the clinical correlation between body adipose tissue and renal function recovery after living donor nephrectomy.

Ibuprofen in very preterm infants impairs renal function for the first month of life

We carried out a study aiming to determine the renal effect of ibuprofen treatment for patent ductus arteriosus (PDA) in very preterm infants during the first month of life. Infants aged 27?31 weeks gestation were enrolled from October 2004 to August 2006. They were assigned to two different groups according to ibuprofen exposure during care of their PDA status assessed by echocardiography. Infants of both groups were matched based on gestational age, Clinical Risk Index for Babies score, birth weight and inclusion center. Renal function was evaluated at baseline and weekly for 1 month. One hundred and forty-eight infants were enrolled. Glomerular filtration rate (GFR) was significantly decreased in the ibuprofen group after treatment withdrawal (GFR on day 7, ibuprofen versus no ibuprofen: 12.8?±?6.2 vs. 18.1?±?12.1 ml/min/1.73 m²; P?<?0.001). Adjusted analysis proved this decrease to be sustained during the first month of life. Tubular function was also impaired during the first month in ibuprofen-treated infants. Ibuprofen administered for PDA is associated with a decreased GFR during the first month of life. Renal function of infants receiving ibuprofen should be carefully monitored and drugs that are eliminated by glomerular filtration handled cautiously during this period.     

Impact of temporary hilar clamping during laparoscopic partial nephrectomy on postoperative renal function: a prospective study

PURPOSE: Laparoscopic partial nephrectomy for small renal tumors has been increasingly performed in the last few years. We prospectively evaluated preoperative and postoperative differential renal function by renal scan in patients with contralaterally functioning kidneys who underwent laparoscopic partial nephrectomy with hilar clamping. MATERIALS AND METHODS: From July 2002 to June 2003, 17 consecutive patients were included in this prospective protocol and underwent laparoscopic partial nephrectomy for exophytic tumors using en bloc hilar clamping. Preoperative renal scan with differential function was performed 1 month before and 3 months after surgery in all patients. technetium labeled diethylenetetraminepentaacetic acid scan was performed in all patients. RESULTS: Mean warm ischemia time was 22.50 +/- 9.78 minutes (range 10 to 44). Preoperative differential renal function and glomerular filtration rate (GFR) in the affected kidneys were 50.20% +/- 4.90% (range 43 to 58) and 75.56 +/- 16.45 ml per minutes (range 39.4 to 105). At postoperative month 3 differential renal function and GFR in the affected kidney were 48.07% +/- 7.16% (range 39% to 63%) and 72.03 +/- 18.17 ml per minutes (range 31 to 101). There was a nonsignificant negative association between hilar clamp time and change in renal function (postoperative - preoperative) of the affected kidney (r = -0.26, p = 0.31), and a positive correlation between clamp time and change in GFR (r = 0.39, p = 0.12) that did not reach statistical significance. CONCLUSIONS: In patients with contralaterally functioning kidney, temporary hilar clamping with a mean warm ischemia time of 22.5 minutes results in preservation of renal function in the affected kidney. Larger studies with longer followup are necessary to study the impact of warm ischemia further.