Ischemic renal damage after nephron-sparing surgery in patients with normal contralateral kidney.
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.
Funahashi
Yasuhito
Y
Department of Urology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8550, Japan. funa418@yahoo.co.jp
Hattori
Ryohei
R
Yamamoto
Tokunori
T
Kamihira
Osamu
O
Kato
Katsuhiko
K
Gotoh
Momokazu
M
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*
D019275:Radiopharmaceuticals; D017263:Technetium Tc 99m Mertiatide