Importance and limits of ischemia in renal partial surgery: experimental and clinical research.
BACKGROUND
The objective is to determine the clinical and experimental evidences of the renal responses to warm and cold ischemia, kidney tolerability, and available practical techniques of protecting the kidney during nephron-sparing surgery.


METHODS
Review of the English and non-English literature using MEDLINE, MD Consult, and urology textbooks.


CONCLUSIONS
There are three main mechanisms of ischemic renal injury, including persistent vasoconstriction with an abnormal endothelial cell compensatory response, tubular obstruction with backflow of urine, and reperfusion injury. Controversy persists on the maximal kidney tolerability to warm ischemia (WI), which can be influenced by surgical technique, patient age, presence of collateral vascularization, indemnity of the arterial bed, and so forth.


CONCLUSIONS
When WI time is expected to exceed from 20 to 30 minutes, especially in patients whose baseline medical characteristics put them at potentially higher, though unproven, risks of ischemic damage, local renal hypothermia should be used.
Secin
Fernando P
FP
Urology Section, CEMIC University Hospital, Buenos Aires C1431FWO, Argentina. secinf@mskcc.org