Abstract
We evaluated postoperative renal function in patients with/without combined therapy of ketorolac and remote ischemic preconditioning during partial nephrectomy. Sixteen patients were randomly allocated to either the ketorolac combined with RIPC group (KI, n = 8) or control group (n = 8). The KI group received both remote ischemic preconditioning before surgery and intravenous ketorolac of 1 mg/kg before renal artery clamping. Renal parameters were measured before induction, after anesthesia induction, and 2, 12, 24, 48, and 72 h after renal artery declamping. Acute kidney injury was assessed by Acute Kidney Injury Network criteria. The estimated glomerular filtration rate decreased in both groups, but then increased significantly at 48 h and 72 h after declamping only in the KI group compared to 24 h (p = 0.001 and p = 0.016). Additionally, it was higher at 48 h and 72 h after declamping in the KI group compared to the control group (p = 0.025 and p = 0.044). The incidence of acute kidney injury was significantly reduced in the KI group (13%) compared to the control group (83%) (p = 0.026). FENa was markedly increased at 2 h after declamping, and recovered in both groups, but it was more significant at 12 h after declamping in the KI group (p = 0.022). Urinary N-acetyl-1-β-D-glucosoaminidase and serum neutrophil gelatinase-associated lipocalin were similar (p = 0.291 and p = 0.818). There is a possibility that combined therapy of ketorolac and remote ischemic preconditioning prior to ischemia may alleviate renal dysfunction and reduce the incidence of acute kidney injury in patients undergoing partial nephrectomy.
Highlights
Partial nephrectomy (PN) is a standard procedure for a small kidney tumor
The benefit of PN is the better preservation of renal function compared to the radical nephrectomy, a part of viable parenchyma is removed, surrounding tissue is damaged by cautery or compression, and the remaining parenchyma usually experiences the ischemia [1]
Fractional excretion of urinary sodium (FENa) was markedly increased at 2 h after declamping, and recovered to baseline value in both groups (Figure 3), but it was more significant at 12 h after declamping compared with postind in the KI group (p = 0.022)
Summary
Partial nephrectomy (PN) is a standard procedure for a small kidney tumor. The benefit of PN is the better preservation of renal function compared to the radical nephrectomy, a part of viable parenchyma is removed, surrounding tissue is damaged by cautery or compression, and the remaining parenchyma usually experiences the ischemia [1]. Renal vascular clamping, which is frequently performed to secure bloodless surgical fields during PN, renders the kidney susceptible to tissue ischemic injury. Ischemia-reperfusion initiates a cascade of events of tissue injury and death [1,3]. Because ischemia is the main risk factor for the impairment of preserved renal tissue, various interventions have been conducted for prevention of ischemia-related postoperative renal dysfunction [4,5]
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