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

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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.

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References

  1. Ljungberg B. Nephron-sparing surgery—strategies for partial nephrectomy in renal cell carcinoma. Scand J Surg. 2004;93(2):126–31.

    Article  PubMed  CAS  Google Scholar 

  2. Ljungberg B, Bensalah K, Canfield S, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 2015;67(5):913–24.

    Article  PubMed  Google Scholar 

  3. Van Poppel H, Da Pozzo L, Albrecht W, et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2011;59(4):543–52.

    Article  PubMed  Google Scholar 

  4. Hansen J, Sun M, Bianchi M, et al. Assessment of cancer control outcomes in patients with high-risk renal cell carcinoma treated with partial nephrectomy. Urology. 2012;80(2):347–53.

    Article  PubMed  Google Scholar 

  5. Christ F, Bauer A, Brügger D. Different optical methods for clinical monitoring of the microcirculation. Eur Surg Res. 2002;34(1–2):145–51.

    Article  PubMed  Google Scholar 

  6. Dantzker DR. Monitoring tissue oxygenation: the quest continues. Chest. 2001;120:701–2.

    Article  PubMed  CAS  Google Scholar 

  7. Scheeren TW, Martin K, Maruschke M, Hakenberg OW. Prognostic value of intraoperative renal tissue oxygenation measurement on early renal transplant function. Transpl Int. 2011;24(7):687–96.

    Article  PubMed  Google Scholar 

  8. Spronk PE, Zandstra DF, Ince C. Bench-to-bedside review: sepsis is a disease of the microcirculation. Crit Care. 2004;8(No 6):462–8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bauer A, Bruegger D, Christ F. Microcirculatory monitoring of sepsis. Anaesthesist. 2005;54:1163–75.

    Article  PubMed  CAS  Google Scholar 

  10. Beckert S, Witte MB, Königsrainer A, Coerper S. The impact of the micro-lightguide O2C for the quantification of tissue ischemia in diabetic foot ulcers. Diabetes Care. 2004;27(No 12):2863–7.

    Article  PubMed  Google Scholar 

  11. Laduner R, Feilitzsch M, Steurer W, et al. The impact of a micro-lightguide spectrophotometer on the intraoperative assessment of hepatic microcirculation: a pilot study. Microvasc Res. 2009;77:387–8.

    Article  Google Scholar 

  12. Sakr Y, Gath V, Oishi J, Klinzing S, Simon TP, Reinhart K, Marx G. Characterization of buccal microvascular response in patients with septic shock. Eur J Anaesthesiol. 2010;27(4):388–94.

    Article  PubMed  CAS  Google Scholar 

  13. Medizintechnik LEA. O2C (oxygen to see). http://www.lea.de/, http://www.lea.de/deu/fro2chd.htm-Informations-CD.

  14. Moll KJ, Moll M. Kurzlehrbuch Anatomie. 17th ed. München: Urban & Fischer Verlag; 2002. p. 530ff.

  15. Yin M, Currin RT, Peng XX, et al. Different patterns of renal cell killing after warm and cold ischemia. Ren Fail. 2002;24(2):147–63.

    Article  PubMed  Google Scholar 

  16. Voets T, Nilius B. TRPCs, GPCRs and the Bayliss effect. EMBO J. 2009;28(1):4–5.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Loutzenhiser R, Griffin K, Williamson G, Bidani A. Renal autoregulation: new perspectives regarding the protective and regulatory roles of the underlying mechanisms. Am J Physiol Regul Integr Comp Physiol. 2006;290(5):R1153–R1167.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Rosenbaum C, Wach S, Kunath F, Wullich B, Scholbach T, Engehausen DG. Dynamic tissue perfusion measurement: a new tool for characterizing renal perfusion in renal cell carcinoma patients. Urol Int. 2013;90(1):87–94.

    Article  PubMed  CAS  Google Scholar 

  19. Donin NM, Suh LK, Barlow L, et al. Tumour diameter and decreased preoperative estimated glomerular filtration rate are independently correlated in patients with renal cell carcinoma. BJU Int. 2001;109:379–83.

    Article  CAS  Google Scholar 

  20. Borofsky MS, Gill IS, Hemal AK, et al. Near-infrared fluorescence imaging to faciliate super-selective arterial clamping during zero-ischaemia robotic partial nephrectomy. BJU Int. 2013;111(4):604–10.

    Article  PubMed  Google Scholar 

  21. George AK, Herati AS, Srinivasan AK, et al. Perioperative outcomes of off-clamp vs. complete hilar control laparoscopic partial nephrectomy. BJU Int. 2013;111(4PtB):E235–E41.

    Article  PubMed  Google Scholar 

  22. Becker F, Van Poppel H, Hakenberg OW, et al: Assessing the impact of ischemia time during partial nephrectomy. Eur Urol. 2009;56:625–35. (© 2009 European Association of Urology. Published by Elsevier B.V.).

    Article  PubMed  Google Scholar 

  23. Ghavamian R, Zincke H. Partial nephrectomy treatment and management. Medscape reference© 2001 WebMD, LLC. http://emedicine.medscape.com/article/446317 (2001).

  24. Schmaderer C, Lutz J, Stangl M, Heemann U. Ischämie-/Reperfusionsschaden nach Nierentransplantation. In: TransplantLinc, Heft 10. © Pabst Science Publishers; 2005. p. 15–25.

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Authors and Affiliations

  1. Department of Urology, Helios Hanseklinikum Stralsund, Große Parower Str. 47-53, 18435, Stralsund, Germany

    Matthias Maruschke

  2. Department of Internal Medicine, Filder Klinik, Filderstadt, Germany

    Katja Hagel

  3. Department of Urology, University Hospital Rostock, Rostock, Germany

    Oliver Hakenberg

  4. Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Thomas Scheeren

Authors
  1. Matthias Maruschke
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  2. Katja Hagel
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  3. Oliver Hakenberg
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  4. Thomas Scheeren
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Correspondence to Matthias Maruschke.

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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).

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

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Maruschke, M., Hagel, K., Hakenberg, O. et al. Prognostic value of intraoperative measurements of renal tissue oxygenation and microcirculation on renal function in partial nephrectomy. Clin Exp Nephrol 22, 735–742 (2018). https://doi.org/10.1007/s10157-017-1506-6

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  • DOI: https://doi.org/10.1007/s10157-017-1506-6

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