title: Effect of warm ischemia on renal function during partial nephrectomy: assessment with new 99mTc-mercaptoacetyltriglycine scintigraphy parameter.
abstract: OBJECTIVE
  A decrease in renal function after partial nephrectomy caused by ischemic damage or nephron loss cannot be distinguished by conventional methods. We quantified renal function using a new 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) renal scintigraphy parameter.
  
  
  METHODS
  We included 32 patients with a normally functioning contralateral kidney who received open partial nephrectomy with average warm ischemic time of 26.0 (range 14-46) min in this study. Effective renal plasma flow (ERPF) was calculated from 99mTc-MAG3 renal scintigraphy before and at 1 week and 6 months after surgery. We also analyzed regional 99mTc-MAG3 uptake in the surgically nonaffected parts.
  
  
  RESULTS
  One week after surgery, average ERPF in the operated kidney decreased to 66.4% from baseline (from 177.8 to 116.9 mL/min/1.73 m2) and regional 99mTc-MAG3 uptake decreased to 83.4%. A stronger correlation was found between ischemic time and the decrease in regional 99mTc-MAG3 uptake (P<.001) compared with ERPF (P=.029). The decrease in regional 99mTc-MAG3 uptake remained at 6 months in the group with ischemic time≥25 minutes, whereas it recovered when ischemic time was <25 minutes.
  
  
  CONCLUSIONS
  This new parameter quantified ischemic renal damage better than the conventional split functional evaluation. When warm ischemic time was ≥25 minutes, irreversible diffuse damage was seen in surgically preserved nephrons.
authors: Department of Urology, Nagoya University, Graduate School of Medicine, Showa-ku, Nagoya, Japan. funa418@yahoo.co.jp
authors: Yasuhito
authors: Y
authors: Funahashi
authors: Ryohei
authors: R
authors: Hattori
authors: Tokunori
authors: T
authors: Yamamoto
authors: Naoto
authors: N
authors: Sassa
authors: Takashi
authors: T
authors: Fujita
authors: Momokazu
authors: M
authors: Gotoh
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D011866:Radioisotope Renography / Q000379:methods; D018570:Risk Assessment; D017263:Technetium Tc 99m Mertiatide; D016896:Treatment Outcome; D052096:Warm Ischemia / Q000379:methods*
chemical_list: D017263:Technetium Tc 99m Mertiatide