Abstract
To investigate the glomerular number after different warm ischemia times. Thirty two pigs were assigned into four groups. Three groups (G10, G20, and G30) were treated with 10, 20, and 30 minutes of left renal warm ischemia. The sham group underwent the same surgery without renal ischemia. The animals were euthanized after 3 weeks, and the kidneys were collected. Right kidneys were used as controls. The kidney weight, volume, cortical-medullar ratio, glomerular volumetric density, volume-weighted mean glomerular volume, and the total number of glomeruli per kidney were obtained. Serum creatinine levels were assessed pre and postoperatively. Serum creatinine levels did not differ among the groups. All parameters were similar for the sham, G10, and G20 groups upon comparison of the right and left organs. The G30 group pigs' left kidneys had lower weight, volume, and cortical-medullar ratio and 24.6% less glomeruli compared to the right kidney. A negative correlation was found between warm ischemia time and glomerular number. About one quarter of glomeruli was lost after 30 minutes of renal warm ischemia. No glomeruli loss was detected before 20 minutes of warm ischemia. However, progressive glomerular loss was associated with increasing warm ischemia time.
Highlights
Partial nephrectomy provides oncological outcomes comparable to those of radical surgery of small renal cell masses as well as better preservation of renal function[1]
Warm renal ischemia is commonly performed during partial nephrectomy to achieve a bloodless surgical field, renal ischemia has been associated with renal function impairment[4]
The use of warm ischemia for 30 minutes or more is discouraged, and this is in accordance with the authors who recommend the time for safe warm ischemia to be lower than 30 minutes[24,25]
Summary
Partial nephrectomy provides oncological outcomes comparable to those of radical surgery of small renal cell masses as well as better preservation of renal function[1]. Partial nephrectomy is considered the gold standard for treating localized renal tumors[2,3]. Warm renal ischemia is commonly performed during partial nephrectomy to achieve a bloodless surgical field, renal ischemia has been associated with renal function impairment[4]. Warm ischemia during laparoscopic partial nephrectomy is considered the most negative modifiable factor for this kind of surgery[5,6,7]. 30 minutes is considered the maximum safe time for renal warm ischemia. Some authors suggest that the time should be preferably kept below 20 or 25 minutes in order to avoid postoperative acute renal failure, because every minute counts when the renal hilum is clamped[8,9]
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