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Clinical and Experimental Nephrology

, Volume 22, Issue 3, pp 735–742 | Cite as

Prognostic value of intraoperative measurements of renal tissue oxygenation and microcirculation on renal function in partial nephrectomy

  • Matthias Maruschke
  • Katja Hagel
  • Oliver Hakenberg
  • Thomas Scheeren
Original article

Abstract

Background

Partial nephrectomy (PNx) can be associated with macrocirculatory and microcirculatory alterations, ultimately leading to acute kidney injury (AKI). Measuring kidney tissue oxygenation (μHbO2) and microcirculation during open PNx might be feasible to early detect these alterations and prevent postoperative AKI.

Methods

μHbO2 and microcirculation were measured in 45 patients undergoing PNx by reflectance spectrophotometry and laser Doppler flowmetry (O2C™, Lea, Germany), related to ischemia time and tumour size. Pre- and postoperative creatinine levels were determined.

Results

μHbO2 was lower after reperfusion than before clamping (72 vs. 75%), while microcirculation and regional haemoglobin did not differ. Ischemia time was 15.7 min on average. μHbO2 was higher without ischemia (80 vs. 70%, p = 0.109) and in T1a- than T1b-tumours, independent of ischemia time and reperfusion. The renal collecting system (RCS) was opened in 19/45 patients with μHbO2 of 68% after reperfusion compared to 74% with intact RCS. Postoperative complications occurred in 6/45 patients (13%). μHbO2 was 68% before clamping vs. 75% without complications. Serum creatinine of patients with T1b was higher compared to T1a (103 vs. 87 µmol/L). Patients with larger tumours had higher postoperative creatinine levels (173 vs. 124 µmol/L; p = 0.052).

Conclusion

We showed for the first time that the method is feasible to monitor renal tissue oxygenation at the level of microcirculation non-invasively and reproducibly during PNx. Tumour size seems to have a decisive influence on oxygenation and postoperative renal function. Our results imply that postoperative complications may be predicted by low intraoperative renal oxygenation and microcirculatory flow measurements.

Keywords

Renal function Microcirculation Partial nephrectomy Renal cell carcinoma Renal tissue oxygenation 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest, including financial interests or relationships.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Medical Ethical Committee of the University of Rostock (A57/2007).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Japanese Society of Nephrology 2017

Authors and Affiliations

  1. 1.Department of UrologyHelios Hanseklinikum StralsundStralsundGermany
  2. 2.Department of Internal MedicineFilder KlinikFilderstadtGermany
  3. 3.Department of UrologyUniversity Hospital RostockRostockGermany
  4. 4.Department of AnesthesiologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands

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