title: Ischemic renal damage after nephron-sparing surgery in patients with normal contralateral kidney.
abstract: BACKGROUND
  Although nephron-sparing surgery (NSS) has been reported not to affect total renal function, the functional damage of the operated kidney is masked by the contralateral kidney in elective indications.
  
  
  OBJECTIVE
  To determine ischemic renal damage after NSS.
  
  
  METHODS
  From August 2005 to October 2007, 32 consecutive patients with elective indications underwent NSS. The mean tumor diameter was 2.6 cm.
  
  
  METHODS
  Of our patients, the open surgery was performed in 20 patients, and laparoscopic surgery was performed in 12 patients. NSS was performed by hilar clamping with a warm ischemic time of 24.3 min.
  
  
  METHODS
  We analyzed effective renal plasma flow (ERPF) calculated from (99m)Tc-mercaptoacetyltriglycine ((99m)Tc-MAG-3) renal scintigraphy and renal parenchymal volume (RPV) measured from computed tomography (CT) scan. In addition, we analyzed (99m)Tc-MAG-3 uptake regionally in the surgically non-affected parts. (99m)Tc-MAG-3 and CT scans were performed preoperatively and 1 wk and 6 mo postoperatively.
  
  
  CONCLUSIONS
  One week after NSS, ERPF of the operated kidney decreased by 28.7% (from 158.9 to 113.3 ml/min per 1.73 m(2), p<0.001), and RPV decreased by 12.6% (from 149.8 to 131.0 cm(3), p<0.001). These changes were stable for 6 mo. Regional (99m)Tc-MAG-3 uptake of the operated kidney with an ischemic time of > or = 25 min decreased to 61.8% after 1 wk and 70.9% after 6 mo. In contrast, with ischemic times within 25 min, regional (99m)Tc-MAG-3 uptake was 87.4% after 1 wk and 94.4% after 6 mo. This is a relatively small study, and the follow-up period is short. A larger sample size and longer follow-up may be required.
  
  
  CONCLUSIONS
  Although total renal function was almost unaffected before and after NSS, a warm ischemic time of > or = 25 min caused irreversible damage distributed diffusely throughout the operated kidney.
authors.affiliation: Department of Urology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8550, Japan. funa418@yahoo.co.jp
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Funahashi
authors.forename: Ryohei
authors.initials: R
authors.lastname: Hattori
authors.forename: Tokunori
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Osamu
authors.initials: O
authors.lastname: Kamihira
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Kato
authors.forename: Momokazu
authors.initials: M
authors.lastname: Gotoh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000502:physiology; D007674:Kidney Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017263:Technetium Tc 99m Mertiatide; D013997:Time Factors; D052096:Warm Ischemia / Q000009:adverse effects*
chemical_list: D019275:Radiopharmaceuticals; D017263:Technetium Tc 99m Mertiatide