PD17-03 POORLY FUNCTIONING KIDNEYS RECOVER FROM ISCHEMIA DURING PARTIAL NEPHRECTOMY AS WELL AS STRONGLY FUNCTIONING KIDNEYS

Abstract

You have accessJournal of UrologyKidney Cancer: Localized II1 Apr 2014PD17-03 POORLY FUNCTIONING KIDNEYS RECOVER FROM ISCHEMIA DURING PARTIAL NEPHRECTOMY AS WELL AS STRONGLY FUNCTIONING KIDNEYS Maria Carmen Mir, Toshio Takagi, Rebecca Campbell, Nidhi Sharma, Erick Remer, Jianbo Li, Sevag Demirjian, Jihad Kaouk, and Steve C. Campbell Maria Carmen MirMaria Carmen Mir More articles by this author , Toshio TakagiToshio Takagi More articles by this author , Rebecca CampbellRebecca Campbell More articles by this author , Nidhi SharmaNidhi Sharma More articles by this author , Erick RemerErick Remer More articles by this author , Jianbo LiJianbo Li More articles by this author , Sevag DemirjianSevag Demirjian More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , and Steve C. CampbellSteve C. Campbell More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1510AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Some authors have proposed that poorly functioning kidneys may not recover from ischemia as well as strongly functioning kidneys, which would have impact on the surgical approaches to partial nephrectomy (PN). Methods A total of 122 consecutive patients undergoing PN at our institution with appropriate studies to facilitate analysis of function and parenchymal mass volume in the operated kidney (CT and SCr within 2 months prior and 4-12 months postoperative) were analyzed. Patients with a contralateral kidney also required renal scans in the same time frame to provide split renal function. Volumetric CT was utilized to measure the volume of functional parenchyma pre and post PN in the operated kidney and the contralateral kidney. GFR was determined by the MDRD2 equation. Recovery of nephron function (GP/VS = % GFR preserved/% volume saved) would be 100% if all nephrons recovered from the ischemic insult. Results Median age was 61 years with approximately 50% of patients having open procedures. Median RENAL score was 7. Cold ischemia was used in 50 patients (median 26 min), while 72 had limited warm ischemia (median 20 min). Median %GFR preserved in the operated kidney was 79.5%. Median parenchymal volume saved was 84%. Function in the contralateral kidney remained stable without significant increase. Overall recovery of nephron function (GP/VS) was 95.5%, and was 100.7% for the cold ischemia subgroup and 93% in the limited warm ischemia subgroup. Recovery of nephron function (GP/VS) was similar for all strata of preoperative eGFR in the operated kidney (<30, 21-45, 46-60, and > 60) as detailed in the table (p > 0.18 for all comparisons), even in the limited warm ischemia subgroup Conclusions Preoperative GFR at PN does not correlate with how well the kidney will recover from the ischemia insult. Our results suggest that the amount vascularized parenchyma preserved by the PN is the main determinant of the postoperative GFR. Even poorly functioning kidneys recover well from the ischemic insult as long as limited warm ischemia or hypothermia are utilized. Preop eGFR Overall Cold Ischemia (n=50) Warm Ischemia (n=72) <30 (20) 101.0 (90-116) 109.0 (105-117) 96.2 (80-113) 31-45 (39) 93.2 (83-109) 97.0 (88-105) 90.6 (77-109) 46-60 (43) 95.5 (87-101) 100.6 (94-107) 92.2 (86-99) >60 (20) 98.7 (91-102) 100.5 (94-104) 96.6 (91-98) p=0.206 p=0.181 p=0.679 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e540-e541 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Maria Carmen Mir More articles by this author Toshio Takagi More articles by this author Rebecca Campbell More articles by this author Nidhi Sharma More articles by this author Erick Remer More articles by this author Jianbo Li More articles by this author Sevag Demirjian More articles by this author Jihad Kaouk More articles by this author Steve C. Campbell More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...