title: [Ischemia is not an independent predictive factor of chronic renal failure after partial nephrectomy in a solitary kidney in patients without pre-operative renal insufficiency].
abstract: OBJECTIVE
  To assess the influence of vascular clamping and ischemia time on long-term post-operative renal function following partial nephrectomy (PN) for cancer in a solitary kidney.
  
  
  METHODS
  This is a retrospective study including 259 patients managed by PN between 1979 and 2010 in 13 centers. Clamping use, technique choice (pedicular or parenchymal clamping), ischemia time, and peri-operative data were collected. Pre-operative and last follow-up glomerular filtration rates were compared. A multivariate analysis using a Cox model was performed to assess the impact of ischemia on post-operative chronic renal failure risk.
  
  
  RESULTS
  Mean tumor size was 4.0±2.3cm and mean pre-operative glomerular filtration rate was 60.8±18.9mL/min. One hundred and six patients were managed with warm ischemia (40.9%) and 53 patients with cold ischemia (20.5%). Thirty patients (11.6%) have had a chronic kidney disease. In multivariate analysis, neither vascular clamping (P=0.44) nor warm ischemia time (P=0.1) were associated with a pejorative evolution of renal function. Pre-operative glomerular filtration rate (P<0.0001) and blood loss volume (P=0.02) were significant independent predictive factors of long-term renal failure.
  
  
  CONCLUSIONS
  Renal function following PN in a solitary kidney seems to depend on non-reversible factors such as pre-operative glomerular filtration rate. Our findings minimize the role of vascular clamping and ischemia time, which were not significantly associated with chronic renal failure risk in our study.
  
  
  METHODS
  5.
authors.affiliation: Service d'urologie, hôpital Bicêtre, CHU Bicêtre, université Paris-11, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France. Electronic address: rachid.bahi@bct.aphp.fr.
authors.forename: R
authors.initials: R
authors.lastname: Bahi
authors.affiliation: Service d'urologie, hôpital Bicêtre, CHU Bicêtre, université Paris-11, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Pignot
authors.affiliation: Service d'urologie, hôpital Bicêtre, CHU Bicêtre, université Paris-11, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Hammoudi
authors.affiliation: Service d'urologie, université et hôpital de Rennes, Rennes, France.
authors.forename: K
authors.initials: K
authors.lastname: Bensalah
authors.affiliation: Service d'urologie, université et hôpital de Rennes, Rennes, France.
authors.forename: E
authors.initials: E
authors.lastname: Oger
authors.affiliation: Department of Urology, AMC University Hospital, Amsterdam, Pays-Bas.
authors.forename: P
authors.initials: P
authors.lastname: Laguna
authors.affiliation: Department of Urology, AMC University Hospital, Amsterdam, Pays-Bas.
authors.forename: K
authors.initials: K
authors.lastname: Barwari
authors.affiliation: Service d'urologie, hôpital Bicêtre, CHU Bicêtre, université Paris-11, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France.
authors.forename: T
authors.initials: T
authors.lastname: Bessède
authors.affiliation: Service d'urologie, université et hôpital de Nantes, Nantes, France.
authors.forename: J
authors.initials: J
authors.lastname: Rigaud
authors.affiliation: Service d'urologie, hôpital de la Pitié-Salpêtrière, université Paris-6, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Roupret
authors.affiliation: Service d'urologie, université et hôpital de Bordeaux, Bordeaux, France.
authors.forename: J-C
authors.initials: JC
authors.lastname: Bernhard
authors.affiliation: Service d'urologie, université et hôpital de Grenoble, Grenoble, France.
authors.forename: J-A
authors.initials: JA
authors.lastname: Long
authors.affiliation: Department of Urology, Tel Aviv University, Tel Aviv, Israël.
authors.forename: A
authors.initials: A
authors.lastname: Zisman
authors.affiliation: Service d'urologie, université et hôpital de Limoges, Limoges, France.
authors.forename: J
authors.initials: J
authors.lastname: Berger
authors.affiliation: Service d'urologie, hôpital Lyon-Sud, université Claude-Bernard, Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Paparel
authors.affiliation: Service d'urologie, hôpital de la Conception, Marseille, France.
authors.forename: E
authors.initials: E
authors.lastname: Lechevallier
authors.affiliation: Department of Urology, Vita-Salute San Raffaele, Milan, Italie.
authors.forename: R
authors.initials: R
authors.lastname: Bertini
authors.affiliation: Service d'urologie, hôpital Henri-Mondor, université Paris-12, Créteil, France.
authors.forename: L
authors.initials: L
authors.lastname: Salomon
authors.affiliation: Department of Urology, AMC University Hospital, Amsterdam, Pays-Bas.
authors.forename: A
authors.initials: A
authors.lastname: Bex
authors.affiliation: Department of Urology, Bnai Zion Medical Center, Haifa, Israël.
authors.forename: R
authors.initials: R
authors.lastname: Farfara
authors.affiliation: Department of Urology and Andrology, University of Umeå, Umeå, Suède.
authors.forename: B
authors.initials: B
authors.lastname: Ljungberg
authors.affiliation: Department of Urology, University of South Florida, Tampa, FL, États-Unis.
authors.forename: A R
authors.initials: AR
authors.lastname: Rodriguez
authors.affiliation: Service d'urologie, hôpital Bicêtre, CHU Bicêtre, université Paris-11, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France.
authors.forename: J-J
authors.initials: JJ
authors.lastname: Patard
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D050377:Cold Ischemia; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology*; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D052096:Warm Ischemia
keywords: Chirurgie conservatrice; Fonction rénale; Nephron-sparing surgery; Néphrectomie partielle; Partial nephrectomy; Rein unique; Renal function; Solitary kidney