Renal Function Outcomes Research Articles

PD07-11 PARTIAL VERSUS RADICAL NEPHRECTOMY FOR COMPLEX RENAL MASS: MULTICENTER COMPARATIVE ANALYSIS OF FUNCTIONAL OUTCOMES (ROSULA COLLABORATIVE GROUP)

PD07-11 PARTIAL VERSUS RADICAL NEPHRECTOMY FOR COMPLEX RENAL MASS: MULTICENTER COMPARATIVE ANALYSIS OF FUNCTIONAL OUTCOMES (ROSULA COLLABORATIVE GROUP)

MP47-12 SINGLE LAYER CORTICAL RENORRHAPHY AS A SAFE ALTERNATIVE TO DUAL LAYER RENORRHAPHY DURING ROBOTIC PARTIAL NEPHRECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP47-12 SINGLE LAYER CORTICAL RENORRHAPHY AS A SAFE ALTERNATIVE TO DUAL LAYER RENORRHAPHY DURING ROBOTIC PARTIAL NEPHRECTOMY Tarek El-Ghazaly, Jonathan Rosenfeld, Shilajit Kundu, Robert Nadler, and Kent Perry Tarek El-GhazalyTarek El-Ghazaly More articles by this author , Jonathan RosenfeldJonathan Rosenfeld More articles by this author , Shilajit KunduShilajit Kundu More articles by this author , Robert NadlerRobert Nadler More articles by this author , and Kent PerryKent Perry More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic partial nephrectomy (RPN) is being increasingly adopted in the management of renal masses amenable to nephron-sparing surgery. Robotic renorraphy techniques, including dual layer repairs, have carried over from laparoscopic partial nephrectomy (LPN) which was initially associated with higher bleeding and urine leak rates compared to open partial nephrectomy (OPN). Dual layer repair has been shown in previous studies to prolong warm ischemia time, while potentially leading to a higher rate of pseudoaneurysm formation and worse long term renal function parameters. Our aim is to compare single cortical robotic renorrhaphy (SCRR) to dual-layer robotic renorrhaphy (DLRR) in terms of bleeding rates secondary to pseudoaneurysm formation, urine leak rates, and long-term renal functional outcomes. METHODS: A prospectively maintained list of all RPN procedures at Northwestern Memorial Hospital from January 2018 to July 2022 was retrospectively reviewed. 247 RPNs were identified, including 71 cases with SCRR carried out, and 176 cases with DLRR. Preoperative imaging was used to calculate nephrometry scores using R.E.N.A.L. (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, location relative to polar lines, hilar) measurements. Charts of patients with a length of stay longer than 72 hours, or with any readmissions under the urology service were closely examined for bleeding or leakage complications. Other examined parameters included drain fluid-to-serum creatinine ratios, as well as short term and long term changes in glomerular filtration rates (GFR). RESULTS: Comparing SCRR to DLRR, similar nephrometry scores were seen across both groups undergoing RPN (6.6 vs 7, p=0.29), including equivalent tumor sizes (34 mm vs 30 mm, p=0.11) and nearness to the collecting system (p=0.25). No significant differences in rates of bleeding secondary to pseudoaneurysms (0.03% vs 0.02%, p=0.8), urine leak rates (0% vs 0%), or changes in GFR (p=0.25) were seen between both groups of this study. CONCLUSIONS: No significant changes in urine leakage or bleeding rates secondary to pseudoaneurysm formation or changes in renal functions were found when comparing SLRR to DLRR during RPN for masses of equivalent sizes, depth and nephrometry scores. Single layer cortical repair seems to offer a safe method of shortening renorrhaphy and warm ischemia times compared to dual layer repairs. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e648 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tarek El-Ghazaly More articles by this author Jonathan Rosenfeld More articles by this author Shilajit Kundu More articles by this author Robert Nadler More articles by this author Kent Perry More articles by this author Expand All Advertisement PDF downloadLoading ...

PD12-04 UPDATED EVALUATION OF THE IMPACT OF ANGIOEMBOLIZATION ON THE NEED FOR DIALYSIS FOLLOWING HIGH-GRADE RENAL TRAUMA

You have accessJournal of UrologyCME1 Apr 2023PD12-04 UPDATED EVALUATION OF THE IMPACT OF ANGIOEMBOLIZATION ON THE NEED FOR DIALYSIS FOLLOWING HIGH-GRADE RENAL TRAUMA George Koch, Leah Chisholm, Rohan Bhalla, Abimbola Ayangbesan, Craig Hill, Jennifer Huang, William Walton, and Niels Johnsen George KochGeorge Koch More articles by this author , Leah ChisholmLeah Chisholm More articles by this author , Rohan BhallaRohan Bhalla More articles by this author , Abimbola AyangbesanAbimbola Ayangbesan More articles by this author , Craig HillCraig Hill More articles by this author , Jennifer HuangJennifer Huang More articles by this author , William WaltonWilliam Walton More articles by this author , and Niels JohnsenNiels Johnsen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003259.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: AUA guidelines recommend immediate intervention for hemodynamically unstable renal trauma patients. Selective angioembolization is favored due to potential nephron sparing when compared to surgery, yet the impact on renal function is not well established. We previously reported that angioembolization was associated with renal failure requiring hemodialysis (HD). We now present updated data with additional patients and associated transfusion data. We hypothesized that angioembolization for high-grade renal injuries does not increase the need for HD when corrected for the degree of hemorrhage. METHODS: 742 patients with high-grade renal trauma, defined as American Association for the Surgery of Trauma Grade (AAST) III-V injuries, from 2005 through 2022 were identified from our institutional trauma registry. Univariate and multivariate analyses were performed to identify associations with hypotension on arrival, ASST, age, injury severity score (ISS), presence of bilateral renal injuries, urinary extravasation, perinephric fluid collection, transfusion status and renal embolization with the need for HD. RESULTS: 574 (77.4%) patients had AAST III injuries, 91 (12.3%) had AAST IV and 77 (10.4%) had AAST V. Twenty-one (2.8%) of 742 patients had renal failure requiring HD during their trauma admission. Of those 21 patients, 4 (19.0%) underwent an angioembolization. Variables associated with need for HD were hypotension on admission (p=0.003), concomitant adrenal injury (p<0.001), concomitant pancreatic injury (p=0.047), renal vascular injury (p<0.0001), AAST injury grade (p<0.0001), age (p=0.003), ISS (p<0.0001), units of blood transfused in the first 24 hours (p=0.008) and angioembolization (p<0.001). ISS (OR 1.06, 95% CI 1.03-1.10) and angioembolization (OR 7.77, 95% CI 2.00-25.3) were found to be independently associated with renal failure requiring HD in a multivariate model, while blood transfused during the first 24 hours post-injury was not (OR 1.03, 95% CI 0.98-1.10). CONCLUSIONS: Current practice in high-grade renal trauma favors selective embolization as first-line therapy for renal hemorrhage in unstable patients. Our data suggest that overall injury severity and selective embolization are independently associated with need for HD following high-grade renal trauma. While angioembolization is the current best strategy to preserve renal function, further research is required to understand its impact on renal functional outcomes long-term. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e401 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information George Koch More articles by this author Leah Chisholm More articles by this author Rohan Bhalla More articles by this author Abimbola Ayangbesan More articles by this author Craig Hill More articles by this author Jennifer Huang More articles by this author William Walton More articles by this author Niels Johnsen More articles by this author Expand All Advertisement PDF downloadLoading ...

PD40-07 CUMULATIVE IMPACT OF REOPERATIVE PARTIAL NEPHRECTOMY FOR THE TREATMENT OF RECURRENT RENAL MASSES

You have accessJournal of UrologyCME1 Apr 2023PD40-07 CUMULATIVE IMPACT OF REOPERATIVE PARTIAL NEPHRECTOMY FOR THE TREATMENT OF RECURRENT RENAL MASSES Maria Antony, Zach Kozel, Nikhil Gopal, Lauren Loebach, Julie Solomon, Adam Metwalli, Sandeep Gurram, W. Marston Linehan, and Mark W. Ball Maria AntonyMaria Antony More articles by this author , Zach KozelZach Kozel More articles by this author , Nikhil GopalNikhil Gopal More articles by this author , Lauren LoebachLauren Loebach More articles by this author , Julie SolomonJulie Solomon More articles by this author , Adam MetwalliAdam Metwalli More articles by this author , Sandeep GurramSandeep Gurram More articles by this author , W. Marston LinehanW. Marston Linehan More articles by this author , and Mark W. BallMark W. Ball More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003345.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Repeat partial nephrectomy (RePN) offers advantages for the treatment of recurrent, multifocal renal masses. RePN has been demonstrated to be technically feasibile and delays the onset of renal failure. However, there are inherent intraoperative complexity and post-operative challenges with RePN. We studied the largest known population of patients undergoing RePN in order to characterize intra- and post-operative complications as well as renal functional outcomes to fully appreciate risks of and benefit to this operative strategy. METHODS: Retrospective query of an institutional registry of nephrectomies was conducted. Demographic data, serum creatinine (SCr) and protein dipstick results were assessed within one week prior to surgery, and postoperative function assessments were studied within a year of surgery. SCr was used to calculate eGFR using CKD-EPI 2021. RePN was defined as serial surgical resection of the ipsilateral renal unit. Statistical analysis was conducted on R Studio v 4.1.1. RESULTS: A total of 1,131 PNs performed on 663 patients at a single center were retrospectively evaluated. In reoperative cases, median number of operations per renal unit was 2 (range: 2-6). There was a stepwise decline in eGFR with an average decline of 6.1 with each RePN (p<0.001). With each subsequent nephrectomy, surgical duration (p<0.001), and estimated blood loss (p<0.001) increased. Patients encountered an increased incidence of anemia when controlling for gender, race, solitary kidney, and preoperative GFR (p=0.007). On multivariate analysis of post-surgical GFR, the number of tumors removed, largest tumor removed, age, total previous partial nephrectomies, presurgical GFR, pre-operative proteinuria and solitary kidney were significant independent predictors. Number of tumors removed, number of previous PN, and open surgical approach were significant predictors of surgical complications. CONCLUSIONS: Repeated PN contributes to renal functional decline, anemia, and an increased risk of surgical complications. Intraoperative blood loss and surgical duration increase with subsequent nephrectomy. These impacts must be fully appreciated to optimize patient counseling regarding surgical management and sequencing of available therapies. Source of Funding: NIH MRSP © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1054 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maria Antony More articles by this author Zach Kozel More articles by this author Nikhil Gopal More articles by this author Lauren Loebach More articles by this author Julie Solomon More articles by this author Adam Metwalli More articles by this author Sandeep Gurram More articles by this author W. Marston Linehan More articles by this author Mark W. Ball More articles by this author Expand All Advertisement PDF downloadLoading ...

Outcome of Renal Function after Laparoscopic Pyeloplasty in Children with High-Grade Hydronephrosis

Introduction: This study aimed to analyze the changes in differential renal function (DRF) after laparoscopic pyeloplasty in children with high-grade hydronephrosis and factors influencing DRF improvement. Methods: We reviewed the clinical data of unilateral ureteropelvic junction obstruction (UPJO) patients with SFU grade IV who underwent laparoscopic pyeloplasty between February 2018 and October 2020. The patients were divided into two groups: DRF improvement ≥5% (group 1) and DRF improvement <5% (group 2). Preoperative, operative, and postoperative parameters were included in the statistical analysis in both groups. Results: A total of 29 patients with a median age of 6 months were included. The preoperative DRF in group 1 was significantly lower than that in group 2 (36.97 ± 8.47% vs. 45.19 ± 5.22%, p = 0.004). Logistic regression and receiver operating characteristic analysis showed the preoperative DRF was the predictor for renal function improvement after pyeloplasty (p = 0.021) and had a significant predictive value (p = 0.004). Conclusion: Nearly half of the patients with high-grade UPJO had improved renal function at 1 year follow-up after laparoscopic pyeloplasty. Preoperative DRF was a predictor of renal function improvement, and postoperative functional recovery was superior in children with lower preoperative DRF.

Impact of early initiation of renin-angiotensin blockade on renal function and clinical outcomes in patients with hypertensive emergency: a retrospective cohort study

BackgroundHypertensive emergency is a critical disease that causes multifaceted sequelae, including end-stage kidney disease and cardiovascular disease. Although the renin–angiotensin–aldosterone (RAA) system is enormously activated in this disease, there are few reports that attempt to characterize the effect of early use of RAA inhibitors (RASi) on the temporal course of kidney function.MethodsThis retrospective cohort study was conducted to clarify whether the early use of RASi during hospitalization offered more favorable benefits on short-term renal function and long-term renal outcomes in patients with hypertensive emergencies. We enrolled a total of 49 patients who visited our medical center with acute severe hypertension and multiple organ dysfunction between April 2012 and August 2020. Upon admission, the patients were treated with intravenous followed by oral antihypertensive drugs, including RASi and Ca channel blockers (CCB). Kidney function as well as other laboratory and clinical parameters were compared between RASi-treated and CCB- treated group over 2 years.ResultsAntihypertensive treatment effectively reduced blood pressure from 222 ± 28/142 ± 21 to 141 ± 18/87 ± 14 mmHg at 2 weeks and eGFR was gradually restored from 33.2 ± 23.3 to 40.4 ± 22.5 mL/min/1.73m2 at 1 year. The renal effect of antihypertensive drugs was particularly conspicuous when RASi was started in combination with other conventional antihypertensive drugs at the early period of hospitalization (2nd day [IQR: 1–5.5]) and even in patients with moderately to severely diminished eGFR (< 30 mL/min/1.73 m2) on admission. In contrast, CCB modestly restored eGFR during the observation period. Furthermore, renal survival probabilities were progressively deteriorated in patients who had manifested reduced eGFR (< 15 mL/min/1.73 m2) or massive proteinuria (urine protein/creatinine ≥ 3.5 g/gCr) on admission. Early use of RASi was associated with a favorable 2-year renal survival probability (0.90 [95%CI: 0.77–1.0] vs. 0.63 [95%CI: 0.34–0.92] for RASi ( +) and RASi (-), respectively, p = 0.036) whereas no apparent difference in renal survival was noted for CCB.ConclusionsEarly use of RASi contributes to the renal functional recovery from acute reduction in eGFR among patients with hypertensive emergencies. Furthermore, RASi offers more favorable effect on 2-year renal survival, compared with CCB.

Perioperative, functional, and oncologic outcomes of robot-assisted versus open partial nephrectomy for complex renal tumors (RENAL score ≥ 7): an evidence-based analysis.

This study aims to assess the efficacy and safety of robot-assisted partial nephrectomy (RAPN) compared with open partial nephrectomy (OPN) in the management of complex renal tumors (defined as RENAL score ≥ 7). We conducted a comprehensive literature search in PubMed, Embase, Web of Science, and Cochrane Library to identify relevant comparative studies up to January 2023. This study was conducted with the Review Manager 5.4 software, and included RAPN and OPN-controlled trials for complex renal tumors. The prime outcomes were to assess the perioperative results, complications, renal function, and oncologic outcomes. A total of 1493 patients were included in seven studies. Compared to OPN, RAPN was associated with a significantly shorter hospital stay (weighted mean difference [WMD] - 1.53days, 95% confidence interval [CI] - 2.44, - 0.62; p = 0.001), less blood loss (WMD - 95.88mL, 95% CI - 144.19, - 47.56; p = 0.0001), lower transfusion rates (OR 0.33, 95% CI 0.15, 0.71; p = 0.005), fewer major complications (OR 0.63, 95% CI 0.39, 1.01; p = 0.05), and fewer overall complications (OR 0.49, 95% CI 0.36, 0.65; p < 0.00001). Nevertheless, no statistically significant differences were found between the two groups in operative time, warm ischemia time, estimated glomerular decline, intraoperative complications, positive surgical margins, local recurrence, overall survival, and recurrence-free survival. The study demonstrated that RAPN had superior perioperative parameters and fewer complications when compared to OPN for complex renal tumors. However, no significant differences were found in terms of renal function and oncologic outcomes.

The Association Between Baseline Hepatic or Renal Function and Clinical Outcomes for Patients With Non-Small Cell Lung Cancer Treated With a PD-1/PD-L1 Blocking Antibody Using Real-World and Trial Data.

Clinical trials have demonstrated the benefit of PD-1/PD-L1 blocking antibodies for the treatment of patients with advanced non-small cell lung cancer (NSCLC) in defined patient populations that often exclude patients with moderate or severe hepatic or renal impairment. We assessed the association between overall survival (OS) and baseline organ function in patients with advanced NSCLC treated with PD-1/PD-L1 blocking antibodies in real-world data (RWD; patient-level data from electronic health records) and pooled clinical trial data submitted to the US Food and Drug Administration (FDA). The Kaplan-Meier estimator was used to estimate OS in different subgroups based on organ function. Unadjusted and adjusted Cox proportional hazards models were used to estimate the association between OS and organ function. In this hypothesis-generating study, baseline renal impairment did not appear to be associated with OS, while patients with baseline liver impairment had shorter OS. RWD provided information on a broader range of renal and hepatic function than was evaluated in clinical trials and hold promise to complement trial data in better understanding populations not represented in clinical trials.

Effect of ertugliflozin on renal function and cardiovascular outcomes in patients with type 2 diabetes mellitus: A systematic review and meta-analysis.

The global prevalence of type 2 diabetes mellitus (T2DM) is growing yearly. The efficacy of ertugliflozin (ERT), a recently licensed anti-diabetic drug, has been widely reported. However, additional evidence-based data is required to ensure its safety. In particular, convincing evidence on the effects of ERT on renal function and cardiovascular outcomes is needed. We searched PubMed, Cochrane Library, Embase, and Web of Science for randomized placebo-controlled trials of ERT for T2DM published up to August 11, 2022. Cardiovascular events here mainly refer to acute myocardial infarction and angina pectoris (AP) (including stable AP and unstable AP). The estimated glomerular filtration rate (eGFR) was used to measure renal function. The pooled results are risk ratios (RRs) and 95% confidence intervals (CIs). Two participants worked independently to extract data. We searched 1516 documents and filtered the titles, abstracts, and full text, 45 papers were left. Seven trials met the inclusion criteria and were ultimately included in the meta-analysis. The meta-analysis found that ERT reduced eGFR by 0.60 mL·min-1·1.733 m-2 (95% CI: -1.02--0.17, P = .006) in patients with T2DM when used for no more than 52 weeks and these differences were statistically significant. Compared with placebo, ERT did not increase the risk of acute myocardial infarction (RR 1.00, 95% CI: 0.83-1.20, P = .333) and AP (RR 0.85, 95% CI: 0.69-1.05, P = .497). However, the fact that these differences were not statistically significant. This meta-analysis shows that ERT reduces eGFR over time in people with T2DM but is safe in the incidence of specific cardiovascular events.

Treatment Outcomes and Survival in Hypercalcemia of Malignancy: A Grave Metabolic Emergency.

Management of hypercalcemia is based on the manifestation of symptoms and serum calcium levels. It is considered an oncological emergency; therefore, management has to be done on an urgent basis. In the present study, we analyzed the clinicopathological profile, treatment, and outcome of patients with hypercalcemia in solid malignancies at our institute. We retrospectively analyzed the medical records of patients diagnosed with cancer and admitted to the department of radiation oncology with hypercalcemia. The parameters studied were age, gender, performance status, date of diagnosis, the primary site of cancer, stage, histopathology, time of presentation of hypercalcemia since initial cancer diagnosis, clinical symptoms, parathyroid hormone levels, liver and renal function tests, bone metastases, management, outcome, and present status. In the present study, 47 patients of hypercalcemia from various solid malignancies were admitted during the study period between 1st January 2018 and 30th April 2022. Head and neck cancer (14, 29.7%) was the most common site of the primary malignancy. Twelve patients had incidental hypercalcemia and were asymptomatic. Management of hypercalcemia included intravenous saline hydration, bisphosphonates, and supportive medication. At the time of analysis, 17 patients were lost to follow-up, 23 patients died, and seven were alive and on follow-up. Median survival was 68.0 days (95% CI: 1.7-134.3 days). Hypercalcemia of malignancy is considered a metabolic oncological emergency and requires urgent and aggressive management. It gets complicated by a deranged kidney function test. Despite available treatment, it portends an abysmal prognosis.

The Effect of Clinical Pharmacist Intervention on Renal Function Impairment in Patients with Antimicrobial-Induced Acute Kidney Injury in ICU.

The purpose of this study was to analyze the improvement effect of clinical pharmacist intervention on renal function impairment in patients with antimicrobial-induced acute kidney injury (AKI). A total of 145 patients with AKI caused by antibiotics admitted to the ICU department were selected as the research subjects. The patients were divided into the control group (n=57) and the intervention group (n=88) according to whether there were ICU specialist clinical pharmacists involved in clinical treatment. The renal function outcome and infection control were evaluated in the two groups. The proportion of renal function outcome in the intervention group was 88.6%, which was significantly higher than that in the control group. However, there was no statistically significant difference in infection control between the two groups. For the intervention group, the clinical pharmacists adopted three intervention methods: dose adjustment, drug replacement and CRRT treatment, respectively, according to the disease conditions of AKI patients. Among them, dose adjustment and drug replacement were the most frequently used intervention methods. In addition, the proportion of renal function outcome was higher in the group of patients who changed antibiotics and underwent CRRT, which were 93.1% and 100%, respectively. The adjusted-dose group had the highest infection control rate at 82.1%. However, there were no statistically significant differences in renal function outcomes and infection control among the three interventions. Clinical pharmacists participating in the clinical treatment of patients with antimicrobial-induced AKI in ICU can effectively improve the renal function of patients.

Renal Mass with Renal Stones: A Challenging Scenario Managed with Robotic Assistance

Introduction: A renal mass with a concurrent stone is a complex challenge. The challenge is to tackle both pathologies using a single anesthetic without compromising the oncologic or renal functional outcomes. This video demonstrates two cases using robot-assisted nephron-sparing surgery (RA-NSS) and provides tips for effective management to maintain the oncologic and functional safety. Methods: Simultaneous RA-NSS with stone retrieval was performed with DaVinci SiHD system using three robotic arms in two cases after obtaining due consent as per our previously described technique.1 Case 1 was a 66-year-old man, whereas the second case was a 56-year-old woman. In Case 1, during resection of the tumor the renal stone was identified through the opening in the pelvicaliceal system (PCS), which was further extended and three stones were retrieved intact. For Case 2, after dissecting the hilum, the renal pelvic dissection was performed followed by a pyelotomy to retrieve the stones. This mimics a previous published technique by Garisto et al.2 The PCS was closed with 3-0 polygalactin sutures over a Double-J stent (DJS), in both cases. Results: The warm ischemia time (WIT) was 27 minutes in Case 1 and the renal hilum was not clamped in Case 2. The estimated blood loss was 800 and 200 mL and the length of hospital stay was 7 and 5 days for Cases 1 and 2, respectively. The histopathology report in both the cases was clear cell with negative margins. The DJS were removed at 4 weeks. No adjuvant treatment was offered in both the cases. Both the patients were recurrence free with normal renal function at a follow-up of >5 years. Conclusions: During RA-NSS the focus is to limit WIT and maintain the oncologic margins. In a situation where a renal stone is large and the tumor is close to PCS (index Case 1), the NSS is performed initially followed by an incision further into pelvis for stone extraction. However, when the stone is in the pelvis and the tumor is in the periphery (index Case 2), pyelolithotomy should be performed first followed by NSS to decrease or avert the WIT. Patient consent statement: Both the patients of this video submission gave full consent for recording the surgical procedure and its use for publication. The authors have received and archived patient consent for video recording/publication None of the authors have any competing financial interests. Runtime of video: 8 mins 10 secs

Renal functional and cardiovascular outcomes of partial nephrectomy versus radical nephrectomy for renal tumors: a systematic review and meta-analysis.

This systematic review and meta-analysis aimed to evaluate the postoperative renal and cardiovascular outcomes of partial nephrectomy (PN) versus radical nephrectomy (RN) for the treatment of renal carcinoma. A systematic literature search was performed on scientific databases including Scopus, Web of Science, MEDLINE, and EMBASE from their inception to September 2021. Studies comparing renal and cardiovascular outcomes between PN and RN in patients with renal cancer were included. The generic inverse variance method with random-effects models was used to determine the pooled hazard ratios and odds ratio for each outcome. Quality Assessment for observational studies was guided by the New-Castle Ottawa Scale. Overall, a total of 31 studies (n=51,866) reported renal outcomes, while 11 studies (n= 101,678) reported cardiovascular outcomes. When compared to PN, RN had a higher rate of new-onset postoperative EGFR <60 mL/min/1.73 m2 (HR 3.39; CI 2.45 - 4.70; I2=93%; P=<0.00001) and EGFR <45 mL/min/1.73 m2 (HR 4.70; CI 2.26 - 9.79; I2=98%; P=<0.0001). No difference was observed in new-onset advanced kidney disease and end-stage renal disease. A 19% reduction in cardiovascular events was observed in the PN group (HR 0.81; CI 0.70 - 0.93, P=0.002). No protective effect of PN was observed in new-onset or worsening hypertension (HR 0.85; CI 0.64 - 1.14, P=0.28) nor myocardial infarction (HR 0.86; CI 0.71 - 1.04, P=0.13). PN was associated with a decreased risk of postoperative early-stage CKD and cardiovascular events compared with RN. However, no benefit of PN over RN was observed in advanced CKD, new-onset or worsening hypertension, myocardial infarction, and cardiovascular mortality.

Rationale and study design of the GOREISAN for heart failure (GOREISAN-HF) trial: A randomized clinical trial

BackgroundThe decongestion strategy using loop diuretics is essential for improving signs and symptoms of heart failure (HF). However, chronic use of loop diuretics in HF has been linked to worsening renal function and adverse clinical outcomes in a dose-dependent manner. Goreisan, a traditional Japanese herbal medicine, has a long history of use in Japan for regulating body fluid homeostasis and has been recognized as causing less adverse outcomes such as dehydration in contrast to loop diuretics in clinical practice. Therefore, we designed the GOREISAN-HF trial to evaluate the long-term effects of a new decongestion strategy adding Goreisan to usual care in patients with HF and volume overload. MethodsThe GOREISAN-HF trial is an investigator-initiated, multicenter, pragmatic, randomized, comparative effectiveness trial in which we will enroll 2,192 patients hospitalized for HF at 68 hospitals in Japan. All study participants will be randomly assigned to either a decongestion strategy that adds Goreisan at a dose of 7.5 g daily on top of usual care or usual care alone. Investigators have the flexibility to change the existing diuretic regimen in both groups. The primary end point is the improvement rate of cardiac edema at 12-month follow-up, and the co-primary end point is a composite of all-cause death or hospitalization up to the end of the planned follow-up period. Secondary end points include longitudinal changes in patient-reported outcomes, loop diuretics dose, and renal function. ConclusionsThe GOREISAN-HF is the first large-scale randomized pragmatic trial to assess the efficacy and safety of a new congestion control strategy adding Goreisan to usual care in patients with HF and volume overload. Registration Number: NCT04691700

Unveil the interplay between baseline renal function, warm ischemia time and tumor complexity when assessing renal functional outcomes of on- vs. off-clamp robot-assisted partial nephrectomy

Unveil the interplay between baseline renal function, warm ischemia time and tumor complexity when assessing renal functional outcomes of on- vs. off-clamp robot-assisted partial nephrectomy

Does Simplified PADUA Renal (SPARE) Nephrometry scoring system can help predicting renal function outcomes after Robot-Assisted Partial Nephrectomy (RAPN) (UroCCR study 93)?

Does Simplified PADUA Renal (SPARE) Nephrometry scoring system can help predicting renal function outcomes after Robot-Assisted Partial Nephrectomy (RAPN) (UroCCR study 93)?

Non-race-based Glomerular Filtration Rates to Estimate Renal Functional Outcomes Following Radical and Partial Nephrectomy.

No AccessUrology PracticeResearch Letter24 Jan 2023Non-race Based Glomerular Filtration Rates to Estimate Renal Functional Outcomes Following Radical and Partial Nephrectomy Cameron J. Britton, Vidit Sharma, Christine M. Lohse, R. Houston Thompson, John C. Lieske, Andrew D. Rule, and Aaron M. Potretzke Cameron J. BrittonCameron J. Britton Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , Vidit SharmaVidit Sharma Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , Christine M. LohseChristine M. Lohse Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota More articles by this author , R. Houston ThompsonR. Houston Thompson Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , John C. LieskeJohn C. Lieske Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota More articles by this author , Andrew D. RuleAndrew D. Rule Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota More articles by this author , and Aaron M. PotretzkeAaron M. Potretzke *Correspondence: 200 First St SW Rochester, MN 55905 (telephone: 507-284-2511; Fax: 507-284-4951; email address: E-mail Address: [email protected]). Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000389AboutPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Supplementary Materials Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.Keywordsnephrectomyradicalrenal cellpartialrenal insufficiencychroniccarcinomanephrectomyMetricsAuthor Information Cameron J. Britton Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Vidit Sharma Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Christine M. Lohse Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota More articles by this author R. Houston Thompson Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author John C. Lieske Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota More articles by this author Andrew D. Rule Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota More articles by this author Aaron M. Potretzke Department of Urology, Mayo Clinic, Rochester, Minnesota *Correspondence: 200 First St SW Rochester, MN 55905 (telephone: 507-284-2511; Fax: 507-284-4951; email address: E-mail Address: [email protected]). More articles by this author Expand All Advertisement PDF downloadLoading ...

Acute Kidney Injury Classifications in the Prediction of In-hospital Mortality and Renal Function Non-recovery.

In the last two decades diagnostic criteria for acute kidney injury (AKI) were developed: Risk, Injury, Failure, Loss of Kidney Function, End-Stage Kidney Disease (RIFLE), Acute Kidney Injury Network (AKIN), and Kidney Disease: Improving Global Outcomes (KDIGO) classifications. The study aimed to determine the incidence of AKI based on the RIFLE, AKIN, and KDIGO criteria, as well as analyze their predictive value for mortality and renal function outcome. This was a single-center prospective study of patients diagnosed with AKI. Acute kidney injury was defined and classified according to the RIFLE, AKIN, and KDIGO criteria. The outcomes were renal function outcome and in-hospital mortality. The incidence rates of AKI based on the RIFLE, AKIN, and KDIGO criteria were 13.4%, 14-36%, and 14.64%, respectively. Multiple regression analysis showed that higher stages of AKI according to the KDIGO criteria were independently associated with non-recovery of renal function (p=0.011). However, the predictive ability of RIFLE, AKIN and KDIGO classifications for renal function recovery was poor (Area Under the Receiver Operating Characteristics-AUROC=0.599, AUROC=0.637, AUROC=0.659, respectively). According to the RIFLE and AKIN criteria, in-hospital mortality was statistically significantly higher in stage Failure/3 (p=0.0403 and p=0.0329, respectively) compared to stages Risk/1 and Injury/2. Receiver Operating Characteristics (ROC) analysis showed that all three classifications had poor predictive ability for in-hospital mortality (AUROC=0.675, AUROC=0.66, AUROC=0.681). KDIGO classification is an independent predictor of renal function non-recovery. However, by ROC analysis, all three classifications have poor predictive ability for renal function outcome and mortality.

PS-C27-7: ELECTROCARDIOGRAPHIC LEFT VENTRICULAR HYPERTROPHY CAN PREDICT FUTURE DECLINE OF RENAL FUNCTION IN GENERAL POPULATION

Objective: Electrocardiographic left ventricular hypertrophy (LVH) has been shown to be associated with future renal function decline in patients with chronic kidney disease. However, this association remains unclear in general population. We aimed to elucidate the association between baseline LVH on electrocardiogram and future renal function decline using health checkup data. Design and method: We used a dataset derived from the annual health-screening program from 2010 to 2019. Patients with baseline estimated glomerular filtration rate (eGFR) &lt; 60 ml/min/1.73m2 were excluded. LVH was determined by the electrocardiographic voltage criteria at baseline. Association between LVH and renal function outcomes, specifically ≧ 30% decline in eGFR from baseline, eGFR decline less than 60 ml/min/1.73m2 and 45 ml/min/1.73m2, were analyzed using multivariate Cox proportional hazard models. Results: Among total of 19,825 participants, 1,263 had LVH and 18,562 no LVH. LVH group was older and more male and current smokers, and to complicated with more hypertension, and higher systolic (136.7 ± 20.9 vs 123.7 ± 19.1 mmHg, P &lt; 0.001) and diastolic blood pressure (81.8 ± 12.6 vs 74.6 ± 12.0 mmHg, P &lt; 0.001). Baseline eGFR and HbA1c were comparable between the groups. Incidence of ≧ 30% eGFR decline was significantly higher in LVH group (P &lt; 0.001, log-rank test). LVH was associated with ≧ 30% eGFR decline (HR 1.92, 95% CI 1.26–2.91, P = 0.002) and eGFR &lt; 45 ml/min/1.73m2 (HR 3.12, 95% CI 1.54–6.35, P = 0.002) after adjustment. LVH was not associated with eGFR &lt; 60 ml/min/1.73m2 in the overall population. However, when analyzed this association in subpopulation stratified by baseline SBP (&lt; 140 and ≧ 140 mmHg), LVH was associated with eGFR &lt; 60 ml/min/1.73m2 in persons with SBP ≧ 140 mmHg (HR 1.40, 95% CI 1.10–1.79, P = 0.007) but not in those with SBP &lt; 140 mmHg (HR 0.88, 95% CI 0.68–1.14, P = 0.32) (P for interaction between LVH and baseline SBP = 0.005). Similarly, LVH was significantly associated with ≧ 30% eGFR decline and eGFR &lt; 45 ml/min/1.73m2 in persons with SBP ≧ 140 mmHg but not in those with SBP &lt; 140 mmHg, although the interaction between LVH and baseline SBP was not significant in these renal outcomes. Conclusion: Electrocardiographic LVH was independently associated with the rate of renal function decline among general population. The association between LVH and future renal function decline might be stronger in people with SBP ≧140 mmHg.

Oncologic and Renal Function Outcomes of Segmental Ureterectomy Versus Radical Nephroureterectomy for Urothelial Carcinoma of the Ureter

Purpose: The gold standard for treatment of urothelial carcinoma (UC) of the ureter is radical nephroureterectomy (RNU) with bladder cuff excision. However, segmental ureterectomy (SU) can be considered in specific cases, such as serious renal insufficiency or solitary kidney. This study evaluated oncologic and renal function outcomes of SU compared with RNU for treatment of UC of the ureter. Materials and Methods: This single-center retrospective study assessed 99 patients who underwent SU or RNU for UC of the ureter from October 2005 to May 2021. Exclusion criteria were end-stage renal disease managed with regular hemodialysis (10 patients) and previous or concurrent radical cystectomy due to muscle-invasive bladder cancer (20 patients). The study enrolled 69 patients, with 39 in the RNU group and 30 in the SU group, to compare perioperative outcomes and renal function outcomes between the groups. Kaplan–Meier analysis and the log-rank test were performed to compare overall survival (OS), cancer-specific survival (CSS), intravesical recurrence-free survival (IVRFS), and disease-free survival (DFS) between the groups. Results: The mean age was 67.5 years in the RNU group and 68.3 years in the SU group. The median tumor length was 3.2 cm in the RNU group and 2.4 cm in the SU group. Patients who underwent RNU had a significantly decreased estimated glomerular filtration rate at 3 months postoperatively (−6.4 vs. 3.5 mL/min/1.73 m2; P = 0.001). No significant differences were found for OS, CSS, and IVRFS between the groups. However, the SU group had shorter DFS (P = 0.029). Conclusion: Results showed that SU may preserve better renal function. The OS and CSS were comparable between the groups; however, the SU group had shorter DFS. When preservation of renal function is warranted, SU may be considered for patients with UC of the ureter.