RENAL ISCHEMIA IN PARTIAL NEPHRECTOMY AND OPTIONS FOR ITS INFLUENCE
Authors:
Petr Stránský 1; Milan Hora 1; Jan Hrbáček 2; Viktor Eret 1; Tomáš Ürge 1; Renáta Peteříková 3
Authors‘ workplace:
Urologická klinika FN Plzeň
1; Urologická klinika FN Motol, Praha
2; Oddělení specializačního vzdělávání LF UK Plzeň
3
Published in:
Ces Urol 2015; 19(2): 118-130
Category:
Review article
Overview
Introduction:
The objective of this literature review was to summarize clinical and experimental evidence of the renal responses to warm and cold ischemia. The study compared different surgical procedures and options for dealing with renal ischemia during partial nephrectomy. The article is a summary of the current literature data.
Results:
There are three main mechanisms of ischemic renal injury – vascular, persistent vasoconstriction with an abnormal endothelial cell compensatory response, and tubular obstruction, with backflow of urine, and injury due to reperfusion. Controversy regarding the maximal kidney tolerability to warm ischemia continues. This communication summarizes literary data regarding available surgical techniques used to diminish the effects of warm ischemia.
Conclusion:
If ischemia is required, the tumour should be removed within 25 minutes of warm ischemia, regardless of the surgical approach. If this longer time of resection is expected, we have to start immediately with cold ischemia. Cold ischemia, depending on the cooling method, can be tolerated for up to 2 hours (autotransplantation). The cold ischemia technique includes in situ cold arterial perfusion, ice slush placed around the kidney, retrograde caliceal perfusion or ex situ cold arterial perfusion with autotransplantation. The technique depends on preoperative findings, surgical technique (open, laparoscopic or robotic) and institutional experience.
Key words:
Ischemia, renal cell carcinoma, partial nephrectomy, kidney failure.
Sources
1. Novick AC. Renal hypothermia: in vivo and ex vivo. Urol Clin North Am 1983; 10: 637–644.
2. Marberger M. Renal ischemia: not a problem in laparoscopic partial nephrectomy? BJU Int 2007; 99: 3–4.
3. Šváb J. Resekce ledvin, Státní zdravotnické nakladatelství, 1961.
4. Nishikido M, Noguchi M, Koga S, et al. Kidney transplantation from non-heart-beating donors: analysis of organ procurement and outcome. Transplant Proc 2004; 36: 1888–1890.
5. McDougal WS. Renal perfusion/reperfusion injuries. J Urol 1988; 140: 1325–1330.
6. Secin FP. Importance and limits of ischemia in renal partial surgery: experimental and clinical research. Adv Urol 2008: 102461.
7. Abuelo JG. Normotensive ischemic acute renal failure. The New England Journal of Medicine 2007; 357, 8: 797–805.
8. Donnahoo KK, Meldrum DR, Shenkar R, et al. Early renal ischemia, with or without reperfusion, activates NFκB and increases TNF- α bioactivity in the kidney, J Urol 2000; 163, 4: 1328–1332.
9. Donnahoo KK, Shames BD, Harken AH, Meldrum DR. Review article: the role of tumor necrosis factor in renal ischemia-reperfusion injury, J Urol 1999; 162, 1: 196–203.
10. Thadhani R, Pascual M, Bonventre JV. Acute renal failure, N Engl J Med 1996; 334, 22: 1448–1460.
11. Newaz MA, Oyekan AO. Vascular responses to endothelin-1, angiotensin-II, and U46619 in glycerolinduced acute renal failure, Journal of Cardiovascular Pharmacology 2001; 38, 4: 569–577.
12. Kourembanas S, McQuillan LP, Leung GK, Faller DV. Nitric oxide regulates the expression of vasoconstrictors and growth factors by vascular endothelium under both normoxia and hypoxia. Journal of Clinical Investigation 1993; 92, 1: 99–104.
13. Lin A, Sekhon C, Sekhon B, et al. Attenuation of ischemia-reperfusion injury in a canine model of autologous renal transplantation. Transplantation 2004; 78, 5: 654–659.
14. Hernandez A, Light JA, Barhyte DY, Mabudian M, Gage F. Ablating the ischemia-reperfusion injury in nonheart-beating donor kidneys, Transplantation 1999; 67, 2: 200–206.
15. Chiu C, Sievert KD, Dahms S, Bretan P. Intraoperative reperfusion blood flow predicts post warm ischemic kidney transplant survival and efficacy of perservation maneuvers. Transplantation Proceedings 1999; 31, 1–2: 1049–1050.
16. O’Hara JF, Hsu THS, Sprung JJB, et al. The effect of dopamine on renal function in solitary partial nephrectomy surgery. Journal of Urology 2002; 167, 1: 24–28.
17. Gilbert TB, Hasnain JU, Flinn WR, et al. Fenoldopam infusion associated with preserving renal function after aortic cross-clamping for aneurysm repair. Journal of Cardiovascular Pharmacology and Therapeutics 2001; 6, 1: 31–36.
18. Cau J, Favreau F, Tillement JP, et al. Trimetazidine reduces early and long-term effects of experimental renal warm ischemia: a dose effect study. Journal of Vascular Surgery 2008; 47, 4: 852–860.
19. Belzer FO, Southard JH. Principles of solid-organ preservation by cold storage. Transplantation 1988; 45, 4: 673–676.
20. Brasile L, Green E, Haisch C. Warm ex vivo perfusion prevents reperfusion injury in warm ischemically damaged kidneys, Transplantation Proceedings 1997; 29, 8: 3422–3423.
21. Rosetti SR. Impact of acute ischemia on human kidney. In: Marberger M, Dreikorn K, editors. Renal preservation. Baltimore, MD: Williams & Wilkins; 1983: 21–35.
22. Ward JP. Determination of the optimum temperature for regional renal hypothermia during temporary renal ischaemia. Br J Urol 1975; 47: 17–24.
23. De Maeyer P, Oosterlinck W, De Sy W. Prevention on vasospasms during extensive renal surgery. An experimental study in rats. Eur Urol 1981; 7: 224–226.
24. Baldwin DD, Maynes LJ, Berger KA, et al. Laparoscopic warm renal ischemia in the solitary porcine kidney model. Urology 2004 Sep; 64(3): 592–597.
25. Askari A, Novick AC, Stewart BH, Straffon RA. Surgical treatment of renovascular disease in the solitary kidney: results in 43 cases. J Urol 1982; 127: 20–22.
26. Jablonski P, Howden B, Rae D, et al. The influence of the contralateral kidney upon recovery from unilateral warm renal ischemia. Pathology 1985; 17: 623–627.
27. Thompson RH, Lane BR, Lohse CM, et al. Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol 2010; 58: 340–345.
28. Thompson RH, Lane BR, Lohse CM, et al. Renal function after partial nephrectomy: effect of warm ischemia relative to quantity and quality of preserved kidney. Urology 2012; 79: 356–360.
29. Mir MC, Campbell RA, Sharma N, et al. Parenchymal volume preservation and ischemia during partial nephrectomy: functional and volumetric analysis. Urology 2013; 82: 263–268.
30. Pouliot F, Pantuck A, Imbeault A, et al. Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time. Can Urol Assoc J 2011; 5: 89–95.
31. Porpiglia F, Fiori C, Bertolo R, et al. The effects of warm ischaemia time on renal function after laparoscopic partial nephrectomy in patients with normal contralateral kidney. World J Urol 2012; 30: 257–263.
32. Funahashi Y, Hattori R, Yamamoto T, Kamihira O, Kato K, Gotoh M. Ischemic renal damage after nephron-sparing surgery in patients with normal contralateral kidney. Eur Urol 2009; 55: 209–215.
33. Volpe A, Blute ML, Ficarra V, et al. Renal Ischemia and Function After Partial Nephrectomy: a Collaborative Review of the Literature. Eur Urol 2015, in print.
34. Thompson RH, Frank I, Lohse CM, et al. The impact of ischemia time during open nephron sparing surgery on solitary kidneys: a multiinstitutional study. J Urol 2007; 177: 471–476.
35. Becker F, Van Poppel H, Hakenberg OW, et al. Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol. 2009 Oct; 56(4): 625–634.
36. Iida S, Kondo T, Amano H, et al. Minimal effect of cold ischemia time on progression to late-stage chronic kidney disease observed long term after partial nephrectomy. Urology 2008; 72: 1083–1088.
37. Gill IS, Abreu SC, Desai MM, et al. Laparoscopic ice slush renal hypothermia for partial nephrectomy: the initial experience. J Urol 2003; 170: 52–56.
38. Janetschek G. Laparoscopic nephron sparing surgery: ischemic renal damage. Curr Opin Urol 2006; 16: 45–46.
39. Janetschek G, Abdelmaksoud A, Bagheri F, Al-Zahrani H, Leeb K, Gschwendtner M. Laparoscopic partial nephrectomy in cold ischemia: renal artery perfusion. J Urol 2004; 171: 68–71.
40. Landman J, Rehman J, Sundaram CP, et al. Renal hypothermia achieved by retrograde intracavitary saline perfusion. J Endourol 2002; 16: 445–449.
41. Landman J, Venkatesh R, Lee D, et al. Renal hypothermia achieved by retrograde endoscopic cold saline perfusion: technique and initial clinical application. Urology 2003; 61: 1023–1025.
42. Kemmer H, Siemer S, Stockle M. Nephrectomy, work bench surgery and autotransplantation: a case of a solitary left kidney with an extensive centrally located renal cell carcinoma and a tumour thrombus entering the vena cava. Eur Urol 2007; 52: 1518–1520.
43. Orvieto MA, Zorn KC, Mendiola F, et al. Recovery of renal function after complete renal hilar versus artery alone clamping during open and laparoscopic surgery. J Urol 2007; 177: 2371–2374.
44. Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 1986; 74, 5: 1124–1136.
45. Pasupathy S, Homer-Vanniasinkam S. Ischaemic preconditioning protects against ischaemia/reperfusion injury:emerging concepts. European Journal of Vascular and Endovascular Surgery, 2005; 29, 2: 106–115.
46. Linares Quevedo AI, Burgos Revilla FJ, Villafruela Sanz JJ, et al. Comparative analysis about hemodynamic and renal blood flow effects during open versus laparoscopic nephrectomy. An experimental study. Actas Urologicas Espa˜nolas 2007; 31, 4: 382–393.
47.Toosy N, McMorris ELJ, Grace PA, Mathie RT. Ischaemic preconditioning protects the rat kidney from reperfusion injury. BJU International 1999; 84, 4: 489–494.
48. Yilmaz S, Koken T, Tokyol C, et al. Can preconditioning reduce laparoscopy-induced tissue injury? Surgical Endoscopy 2003; 17, 5: 819–824.
49. Ates E, Yilmaz S, Ihtiyar E, Yasar B, Karahuseyinoglu E. Preconditioning-like amelioration of erythropoietin against laparoscopy-induced oxidative injury. Surgical Endoscopy 2006; 20, 5: 815–819.
50. Cevrioglu AS, Yilmaz S, Koken T, et al. Comparison of the effects of low intraabdominal pressure and ischaemic preconditioning on the generation of oxidative stress markers and inflammatory cytokines during laparoscopy in rats. Human Reproduction 2004; 19, 9: 2144–2151.
51. Simmons MN, Schreiber MJ, Gill IS. Surgical renal ischemia: a contemporary overview. J Urol 2008; 180: 19–30.
52. McLoughlin GA, Heal MR, Tyrell IM. An evaluation of techniques used for the production of temporary renal ischaemia. Br J Urol 1978; 50: 371–375.
53. Orvieto MA, Zorn KC, Mendiola FP, et al. Ischemia preconditioning does not confer resilience to warm ischemia in a solitary porcine kidney model. Urology 2007; 69: 984–987.
54. Ng CK, Gill IS, Patil MB, et al. Anatomic renal artery branch microdissection to facilitate zero-ischemia partial nephrectomy. Eur Urol 2012 Jan; 61(1): 67–74.
55. Wein AJ, Kavoussi LR, Novick AC, et al. Cambell-Walsh Urology, 10th ed., Philadelphia, PA: Saunders Elsevier 2012, 1598–1625.
56. Nissenson AR, Weston RS, Kleeman CR. Mannitol. West J Med 1979 Oct, 131, 277–284.
57. Gill IS, Eisenberg MS, Aron M, et al. Zero ischemia partial nephrectomy: novel laparoscopic and robotic technique. Eur Urol 2011; 59: 128–134.
58. Papalia R, Simone G, Ferriero M, et al. Evaluation of renal function under controlled hypotension in zero ischemia robotic assisted partial nephrectomy. Kidney Blood Press Res. 2013; 38(2–3): 181–185.
59. Papalia R, Simone G, Ferriero M, et al. Laparoscopic and robotic partial nephrectomy with controlled hypotensive anesthesia to avoid hilar clamping: feasibility, safety and perioperative functional outcomes. J Urol 2012 Apr; 187(4): 1190–1194.
60. Becker F, Siemer S, Humke U, HackM, Ziegler M, Stockle M. Elective nephron sparing surgery should become standard treatment for small unilateral renal cell carcinoma: long-term survival data of 216 patients. Eur Urol 2006; 49: 308–313.
61. Humke U, Uder M. Renovascular hypertension: the diagnosis and management of renal ischemia. BJU Int 1999; 84: 555–569.
62. Chiu C, Sievert KD, Dahms S, Bretan Jr P. Intraoperative reperfusion blood flow predicts post warm ischemic kidney transplant survival and efficacy of preservation maneuvers. Transplant Proc 1999; 31: 1049–1050.
63. O’Hara Jr JF, Hsu TH, Sprung J, Cywinski JB, Rolin HA, Novick AC. The effect of dopamine on renal function in solitary partial nephrectomy surgery. J Urol 2002; 167: 24–28.
64. Fitzpatrick JM, Wallace DM, Whitfield HN, Watkinson LE, Fernando AR, Wickham JE. Inosine in ischaemic renal surgery: long-term follow-up. Br J Urol 1981; 53: 524–527.
65. Kyriazis I, Kagadis GC, Kallidonis P, et al. PDE5 inhibition against acute renal ischemia reperfusion injury in rats: does vardenafil offer protection? World J Urol 2013 Jun; 31(3): 597–602.
66. Fergany AF, Saad IR, Woo L, Novick AC. Open partial nephrectomy for tumour in a solitary kidney: experience with 400 cases. J Urol 2006; 175: 1630–1633.
67. Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, et al. EAU Guidelines on Renal Cell Carcinoma: 2014 Update. Eur Urol 2015 May, 67(5): 913–924.
68. Gill IS, Kavoussi LR, Lane BR, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 2007 Jul; 178(1): 41–46.
69. Lane BR, Gill IS. 7-year oncological outcomes after laparoscopic and open partial nephrectomy. J Urol 2010 Feb; 183(2): 473–479.
70. Gong EM, Orvieto MA, Zorn KC, et al. Comparison of laparoscopic and open partial nephrectomy in clinical T1a renal tumors. J Endourol 2008 May; 22(5): 953–957.
71. Marszalek M, Meixl H, Polajnar M, et al. Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 Patients. Eur Urol 2009 May; 55(5): 1171–1178.
72. Porpiglia F, Volpe A, Billia M, Scarpa RM. Laparoscopic versus open partial nephrectomy: analysis of the current literature. Eur Urol 2008; 53: 732–743.
73. Riggs SB, Larochelle JC, Belldegrun AS. Partial nephrectomy: a contemporary review regarding outcomes and different techniques. Cancer J 2008; 14: 302–307.
74. Hora M, Klečka J, Ürge T, Ferda J, Hes O, Eret V. Laparoskopická resekce tumorů ledvin, Ces Urol, 2006, 10(1): 32–39.
75. Aron M, Koenig P, Kaouk JH, NguyenMM, Desai MM, Gill IS. Robotic and laparoscopic partial nephrectomy: a matched-pair comparison from a high-volume centre. BJU Int 2008; 102: 86–92.
76. Kaul S, Laungani R, Sarle R, et al. Da Vinci-assisted robotic partial nephrectomy: technique and results at a mean of 15 months of follow-up. Eur Urol 2007; 51: 186–192, discussion 191–192.
77. Nguyen MM, Gill IS. Halving the ischemia time during laparoscopic partial nephrectomy. J Urol 2008; 179: 627–632.
78. Baumert H, Ballaro A, Shah N, et al. Reducing warm ischaemia time during laparoscopic partial nephrectomy: a prospective comparison of two renal closure techniques. Eur Urol 2007; 52: 1164–1169.
79. Zima T, Teplan V, Tesař V, et al. Recommendation of the Czech Nephrological Society and Czech Society of Clinical Biochemistry for examination of glomelular filtration. Klin. Biochem. Metab. 2009; 17(38), 2: 111–119.
80. Simmons MN, Hillyer SP, Lee BH, Fergany AF, Kaouk J, Campbell SC. Functional recovery after partial nephrectomy: effects of volume loss and ischemic injury. J Urol 2012 May; 187(5): 1667–1673.
81. Trof RJ, Di Maggio F, Leemreis J, Groeneveld ABJ. Biomarkers of acute renal injury and renal failure. Shock 2006; 26: 245–253.
82. Arellano-Buendía AS, García-Arroyo FE, Cristóbal-García M, et al. Urinary excretion of neutrophil gelatinase-associated lipocalin in diabetic rats. Oxid Med Cell Longev 2014; 961326: 11.
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Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2015 Issue 2
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