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

Abstract

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.

Full text

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World J Urol (2016) 34:1629–1634
DOI 10.1007/s00345-016-1798-2
ORIGINAL ARTICLE
Impact of parenchymal loss on renal function after laparoscopic
partial nephrectomy under warm ischemia
Fariborz Bagheri1,2 · Csaba Pusztai2 · László Farkas2 · Panagiotis Kallidonis3 ·
István Buzogány4 · Zsuzsanna Szabó5 · János Lantos6 · Marianna Imre7 ·
Nelli Farkas8 · Árpád Szántó2
Received: 6 January 2016 / Accepted: 16 February 2016 / Published online: 1 March 2016
© Springer-Verlag Berlin Heidelberg 2016
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 resec-
tion 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 postoper-
ative 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.
Keywords Laparoscopy · Parenchymal loss · Partial
nephrectomy · Renal function · Warm ischemia
Introduction
Partial nephrectomy (PN) has become a standard of care
for treatment of small renal masses. Hilar occlusion is com-
monly performed for a precise tumor resection and renal
reconstruction. The above surgical maneuver results in
warm ischemia (WI) of the remaining renal tissue and has
been associated with ischemic reperfusion injury (RI) to the
organ. Current evidence showed that the length of the warm
ischemia time (WIT) and the subsequent RI may result in
permanent renal damage [1, 2]. Moreover, the resection of
the renal tumor and the suturing of the parenchyma resulted
in additional reduction in the functional renal tissue [3,
4]. Thus, two mechanisms of renal function damage dur-
ing PN could be proposed. Nevertheless, the importance of
the mechanisms for the decline of the postoperative renal
Abstract
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 func-
tion (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
* Panagiotis Kallidonis
pkallidonis@yahoo.com
1 Department of Urology, Dubai Hospital, Dubai Health
Authority, Dubai, UAE
2 Department of Urology, University of Pécs Medical School,
Pécs, Hungary
3 Department of Urology, University of Hospital of Patras,
26504 Rion, Patras, Greece
4 Department of Urology, PéterfySándor Street Hospital,
Budapest, Hungary
5 Department of Nuclear Medicine, University of Pécs Medical
School, Pécs, Hungary
6 Department of Research and Techniques, University of Pécs
Medical School, Pécs, Hungary
7 Diagnostic Center of Pécs, Pécs, Hungary
8 Institute of Bioanalysis, University of Pécs Medical School,
Pécs, Hungary
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