1080 PRE- AND POST-OPERATIVE MEASUREMENT OF SINGLE KIDNEY FUNCTION IN PARTIAL NEPHRECTOMY FOR RENAL MASSES USING MAGNETIC RESONANCE RENOGRAPHY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20111080 PRE- AND POST-OPERATIVE MEASUREMENT OF SINGLE KIDNEY FUNCTION IN PARTIAL NEPHRECTOMY FOR RENAL MASSES USING MAGNETIC RESONANCE RENOGRAPHY Stella Kang, Aron Bruhn, Hersh Chandarana, Jeff Zhang, Vivian Lee, Michael Stifelman, and William Huang Stella KangStella Kang New York, NY More articles by this author , Aron BruhnAron Bruhn New York, NY More articles by this author , Hersh ChandaranaHersh Chandarana New York, NY More articles by this author , Jeff ZhangJeff Zhang New York, NY More articles by this author , Vivian LeeVivian Lee New York, NY More articles by this author , Michael StifelmanMichael Stifelman New York, NY More articles by this author , and William HuangWilliam Huang New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1118AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial nephrectomy (PN) and preservation of renal function is an integral part of managing patients with localized renal tumors. Current estimates of kidney function, including estimated GFR (eGFR) based on serum creatinine, have limited sensitivity and accuracy, and cannot assess single kidney GFR (SK-GFR). Magnetic resonance renography (MRR) has been shown to accurately and reliably estimate SK-GFR. The goal of this pilot study was to determine the feasibility of using MRR in pre- and post-operative evaluation of SK GFR in patients undergoing PN. METHODS In this IRB-approved, prospective study 13 patients with renal neoplasms underwent PN with preoperative and early (48 hrs) post-operative MRR, and 5/13 returned for 6-month post-operative MRR. eGFR was calculated using the Modification of Diet in Renal Disease equation. MRR was performed at 1.5 T using coronal TWIST after administration of 4 mL gadolinium contrast. Signal curves of the aorta, cortex, and medulla were converted to MR-GFR using a tracer kinetic model as previously described. RESULTS Preoperative MR-GFR ranged from 43 to 112 mL/min/1.73 m2 overall.11 patients showed decreased postoperative SK-GFR (mean -45%), detected by eGFR in only 7 patients. The greatest decrease in SK-GFR was seen in patients with warm ischemia time > 40 min (Table 1). Contralateral kidney SK-GFR increased in 4 patients and decreased in 4 patients (Fig 1). Only 1/5 with pre-op CKD had a compensatory response to surgery in the contralateral kidney at 48 hours. At 6 months, 3 of 5 patients recovered function to near-baseline MR-GFR. Table 1. Ischemia Type Baseline MR-GFR (mL/min/1.73 m2) Baseline Operated Kidney SK-GFR (mL/min/1.73 m2) Early Decrease in Operated Kidney SK-GFR (%) Cold Ischemia 76 33 26 +/- 28 Warm Ischemia (all cases) 73 36 41 +/- 27 Warm Ischemia (< 40 min) 69 32 34 +/- 25 Warm Ischemia (> 40 min) 82 44 57 +/- 30 CONCLUSIONS MRR is useful for evaluating patients with renal masses as an adjunct to anatomic imaging, providing single kidney function with only 5 minutes of additional scan time and minimal contrast. MRR may be useful tool in assessing proper patient selection, surgical technique (warm vs. cold ischemia), as well as current and future renal protective strategies for patients undergoing PN. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e434-e435 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stella Kang New York, NY More articles by this author Aron Bruhn New York, NY More articles by this author Hersh Chandarana New York, NY More articles by this author Jeff Zhang New York, NY More articles by this author Vivian Lee New York, NY More articles by this author Michael Stifelman New York, NY More articles by this author William Huang New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...