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Impact of parenchymal loss on renal function after laparoscopic partial nephrectomy under warm ischemia

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Abstract

Purpose

To elucidate the impact of renal parenchymal loss and the ischemic reperfusion injury (RI) on the renal function after laparoscopic partial nephrectomy (LPN) under warm ischemia (WI).

Methods

Thirty-five patients with a single polar renal mass ≤4 cm and normal contralateral kidney underwent LPN. Transperitoneal LPN with WI using en bloc hilar occlusion was performed. The total differential renal function (T-DRF) using 99mTc-dimercaptosuccinic acid was evaluated preoperatively and postoperatively over a period of 1 year. A special region of interest (ROI) was selected on the non-tumorous pole of the involved kidney, and was compared with the same ROI in the contralateral kidney. The latter comparison was defined as partial differential renal function (P-DRF). Any postoperative decline in the P-DRF of the operated kidney was attributed to the RI. Subtraction of the P-DRF decline from the T-DRF decline was attributed to the parenchymal loss caused by the resection of the tumor and suturing of the normal parenchyma.

Results

The mean WI time was 22 min, and the mean weight of resected specimen was 18 g. The mean postoperative eGFR declined to 87 ml/min/1.73 m2 from its baseline mean value of 97 ml/min/1.73 m2 (p value = 0.075). Mean postoperative T-DRF and P-DRF of the operated kidney declined by 7 and 3 %, respectively.

Conclusions

After LPN of small renal mass, decline in renal function is primarily attributed to parenchymal loss caused by tumor resection and suturing of the normal parenchyma rather than the RI.

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Author’s contribution

Bagheri contributed to protocol development, data collection, data analysis, and manuscript writing and editing. Pusztai, Farkas (László), Buzogány, Szabó, Lantos, Imre, and Farkas (Nelli) helped in collecting and analyzing the data. Kallidonis helped in writing and editing the manuscript. Szántó contributed to protocol development and manuscript editing.

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Authors and Affiliations

  1. Department of Urology, Dubai Hospital, Dubai Health Authority, Dubai, UAE

    Fariborz Bagheri

  2. Department of Urology, University of Pécs Medical School, Pécs, Hungary

    Fariborz Bagheri, Csaba Pusztai, László Farkas & Árpád Szántó

  3. Department of Urology, University of Hospital of Patras, 26504, Rion, Patras, Greece

    Panagiotis Kallidonis

  4. Department of Urology, PéterfySándor Street Hospital, Budapest, Hungary

    István Buzogány

  5. Department of Nuclear Medicine, University of Pécs Medical School, Pécs, Hungary

    Zsuzsanna Szabó

  6. Department of Research and Techniques, University of Pécs Medical School, Pécs, Hungary

    János Lantos

  7. Diagnostic Center of Pécs, Pécs, Hungary

    Marianna Imre

  8. Institute of Bioanalysis, University of Pécs Medical School, Pécs, Hungary

    Nelli Farkas

Authors
  1. Fariborz Bagheri
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  2. Csaba Pusztai
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  3. László Farkas
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  4. Panagiotis Kallidonis
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  5. István Buzogány
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  6. Zsuzsanna Szabó
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  7. János Lantos
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  8. Marianna Imre
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  9. Nelli Farkas
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  10. Árpád Szántó
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Corresponding author

Correspondence to Panagiotis Kallidonis.

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Conflict of interest

No conflicts of interest are declared by the authors.

Ethical standard

Institutional board approval was obtained for the conduction of the study. Informed consent was obtained from all patients.

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Cite this article

Bagheri, F., Pusztai, C., Farkas, L. et al. Impact of parenchymal loss on renal function after laparoscopic partial nephrectomy under warm ischemia. World J Urol 34, 1629–1634 (2016). https://doi.org/10.1007/s00345-016-1798-2

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  • DOI: https://doi.org/10.1007/s00345-016-1798-2

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