scholarly journals Associations between radiographic characteristics and change in renal function following partial nephrectomy using 24-hour creatinine clearance

2013 ◽  
Vol 5 (1) ◽  
pp. 45
Author(s):  
Rodney H. Breau ◽  
Aaron T.D. Clark ◽  
Chris Morash ◽  
Dean Fergusson ◽  
Ilias Cagiannos
Keyword(s):  
Renal Function ◽  
Creatinine Clearance ◽  
Partial Nephrectomy ◽  
Tumour Size ◽  
Multivariable Analysis ◽  
Function Change ◽  
Tumour Location ◽  
Function Preservation ◽  
The Mean ◽  
The Impact

Background: Radiographic characteristics may be associated withthe degree of renal function preservation following partial nephrectomy.The purpose of this study was to determine the impact ofpreoperative radiographic variables on change in renal functionusing 24-hour urine creatinine clearance (uCrCl).Methods: Patients with partial nephrectomy performed fromNovember 2003 to 2008 were enrolled in the study. Serum creatinineand 24-hour urine was collected preoperatively and at3, 6 and 12 months postoperatively. Computed tomography ormagnetic resonance imaging was used to determine tumour size,tumour location and renal volume.Results: Of the 36 patients, median age was 62 (range 30-78) and21 (58%) were male. The mean tumour diameter was 2.8±1.4 cm.Twenty-two (61%) tumours were located at the renal pole and11 (31%) were endophytic. Overall, mean preoperative uCrClwas 88.8±34.2 mL/min and mean postoperative uCrCl was82.8±33.6 mL/min (6.8%; p < 0.01). On multivariable analysis,no single characteristic was associated with a clinically prohibitivedecrease in renal function (-9.4% if endophitic, p = 0.06; -0.57%per cm diameter, p = 0.73; and -6.9% if located at the renal pole,p = 0.15). The total renal volume was also not significantly associatedwith renal function change (-1.1% per 100 cc, p = 0.86).Interpretation: Preoperative radiographic characteristics seem tobe associated with small changes in renal function following partialnephrectomy. These data support renal functional benefits of partialnephrectomy regardless of tumour size and location.

Is whenever feasible-strategy for partial nephrectomy invariably justified? The impact of clinical tumour size on postoperative renal function

2021 ◽  
Vol 79 ◽  
pp. S777-S778
Author(s):  
G. Colandrea ◽  
D. Cignoli ◽  
G. Basile ◽  
G. Rosiello ◽  
G. Fallara ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Tumour Size ◽  
Postoperative Renal Function ◽  
The Impact

scholarly journals Open Partial Nephrectomy with Zero Ischaemia Using a Supra 12th Rib Miniflank Incision: A Minimally Invasive Open Approach for Small Renal Masses

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Syed Ali Ehsanullah ◽  
Abida Sultana ◽  
Brian Kelly ◽  
Charlotte Dunford ◽  
Zaheer Shah
Keyword(s):  
Renal Function ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
Tumour Size ◽  
Open Approach ◽  
Open Partial Nephrectomy ◽  
Estimated Blood Loss ◽  
The Mean

Introduction. To assess a minimally invasive open technique for partial nephrectomy with zero ischaemia time. Methods. A review was performed in a prospectively maintained database of a single surgeon series of all patients undergoing partial nephrectomy using a supra 12th rib miniflank incision with zero ischaemia. Data of seventy one patients who underwent a partial nephrectomy over an 82-month period were analyzed. Data analyzed included operative time, estimated blood loss, pre and postoperative renal function, complications, final pathological characteristics, and tumour size. Results. Seventy one partial nephrectomies were performed from February 2009 to October 2015. None were converted to radical nephrectomy. Mean operative time was 72 minutes (range 30–250), and mean estimated blood loss was 608 mls (range 100–2500) with one patient receiving blood transfusion. The mean pre and postoperative haemoglobin levels were 144 and 112 g/l. The mean pre and postoperative creatinine levels were 82 and 103 Umol/L. There were 8 Clavian–Dindo Grade 2 complications and 1 major complication (Clavian IIIa). Histology confirmed 24 benign lesions and 47 malignant lesions, 46 cT1a lesions, 24 cT1b lesions, and 1 cT2 lesion. Median follow-up was 38 months with no local recurrence or progression of disease with 5 patients having a positive margin (7%). Conclusion. Our results demonstrate that a supra 12th miniflank incision open partial nephrectomy with zero ischaemic time for SRMs has satisfactory outcomes with preservation of renal function. A minimally invasive open partial nephrectomy remains an important option for units that cannot offer patients a laparoscopic or a robotic procedure.

scholarly journals 1532 Strict Trifecta Outcomes of Robotic-Assisted Partial Nephrectomy inT1a and T1b Renal Tumours

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Abdalla ◽  
I Alzouebi ◽  
M Kumar ◽  
T Nambi Rajan
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Tumour Size ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Robotic Assisted ◽  
Function Change ◽  
Renal Tumours ◽  
Tumour Characteristics ◽  
Robotic Assisted Partial Nephrectomy

Abstract Aim To evaluate and compare strict Trifecta outcomes of robotic assisted partial nephrectomy (RAPN) in patients with T1a and T1b renal tumours. Method A retrospective analysis of 146 consecutive patients undergoing a robotic assisted partial nephrectomy for T1a and T1b renal tumours from 2014-2019. Patient demographics, tumour characteristics, strict trifecta measures including warm ischaemia time, minimal renal function change (≤15% postoperative eGFR decrease), complications, and surgical margin positivity were collected, as well as intra-operative and oncological outcomes. Results In total 146 patients underwent RAPN. 113 patients had T1a tumours, 30 had T1b with a mean tumour size of 2.5cm (0.8-3.9cm) and 4.5cm (4.1-7cm) respectively, and 3 patients had T2a tumours. The nephrometry score was higher in stage T1b patients, however all other variables were similar between the two stage groups. Overall strict Trifecta was 75.5% with 77.9% in T1a group compared to 66.7% in T1b group (p = 0.21). Postoperative renal function was preserved in 102 patients in T1a vs 26 patients in T1b. Approximately 9 patients with T1a had positive surgical margin compared to 3 patients in T1b cohort. Post-operatively 3 patients in T1b (10%) group developed a Clavien Dindo score of 3 complications, compared to none in the T1a group (p 0.009). These were due to pseudoaneurysm and bleeding. No statistical difference in Fuhrman score and tumour types in the two groups. No cancer recurrences were observed during the 30 months follow up period in both T1a and T1b groups. Conclusions RAPN is a feasible treatment choice in selected T1b renal tumours.

scholarly journals Renal function after partial nephrectomy following intra-arterial embolization of renal tumors

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Germain Bréhier ◽  
Antoine Bouvier ◽  
Louis Besnier ◽  
Serge Willoteaux ◽  
Cosmina Nedelcu ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Negative Impact ◽  
Multivariable Analysis ◽  
Arterial Embolization ◽  
Renal Tumors ◽  
Renal Function Impairment ◽  
Function Impairment ◽  
Before And After ◽  
The Mean

AbstractLaparoscopic Partial Nephrectomy (LPN) after intra-arterial Embolization of renal tumors (LPNE) in a hybrid operating room allows renal tumor enucleation without dissection and clamping of the renal pedicle. The purpose was to assess the potential negative impact of embolization on the renal function. This prospective monocentric study included all patients treated with LPNE between May 2015 and June 2019. Clinical data was collected and incorporated into the UroCCR database (NCT03293563). Glomerular Filtration Rate (GFR) and Computed Tomography Renal Volume (CTRV) were compared before and after 6 months following LPNE. The mean post-operative GFR was 86.6 mL/min (SD 22.9). The mean GFR loss was 9.4% (SD 15.1) and the median renal parenchyma loss was 21 mL (SD 20.6). Using a threshold of 25% GFR loss, age was the only significant predictive factor of renal function impairment according to bivariate (59.5 vs 69.3 years, p = 0.017) and multivariable analysis (OR 1.075, CI 1–1.2], p = 0.05). Significant renal function impairment was not correlated with the renal parenchymal volume loss (OR 0.987, CI [0.95–1.02], p = 0.435). Renal function impairment after LPNE seems to be comparable to other techniques of partial nephrectomy.

scholarly journals Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

2013 ◽  
Vol 7 (9-10) ◽  
pp. 348 ◽  
Author(s):  
Guillaume Ploussard ◽  
Richard Haddad ◽  
Evan Kovac ◽  
Patrick Richard ◽  
Maurice Anidjar ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Tumour Size ◽  
Admission Rate ◽  
Complication Rates ◽  
Robot Assisted ◽  
Nephrometry Score ◽  
Surgeon Experience ◽  
The Mean

Background: Although robot-assisted partial nephrectomy (RALPN) has been increasingly adopted, open procedures continue to be the reference nephron-sparing technique. We describe our initial surgical outcomes of RALPN in our single institution robotic program.Methods: Between January 2011 and February 2013, 65 consecutive patients underwent a RALPN by 2 surgeons. Preoperative characteristics, including the R.E.N.A.L. nephrometry score, perioperative parameters, and postoperative course, including renal function, were assessed from a retrospective database. The mean follow-up was 12 months.Results: The mean age was 60.2 years and the mean tumour size was 3.9 cm. According to the R.E.N.A.L. nephrometry score, the tumours were classified moderately and highly complex tumours in 51% and 18.5% of cases, respectively. Median warm ischemia time (WIT) was 21 minutes. Factors associated with WIT were R.E.N.A.L. nephrometry score, tumour size, complication rates and surgeon experience. No conversion or grade 4 to 5 complications were reported. The mean hospital stay was 3 days. The overall complication rate was 24.6% (re-admission rate 7.7%), and decreased to 12% after 20 cases. After these initial 20 cases, a trifecta rate (no margins, preserved renal function, no complications) of 64.3% was achieved in moderately and highly complex tumours. The mean change in estimated glomerular filtration rate was 6.7 mL/min without severe postoperative renal failure.Interpretation: RALPN is a safe and feasible procedure with low specific morbidity, even in moderately or highly complex renal masses. The WIT depends on tumour characteristics, mainly determined by the R.E.N.A.L. nephrometry score and is improved by surgeon experience. Longer follow-up is needed to assess the oncologic mid-term safety of the procedure. 

scholarly journals Assessment of decrease in renal function associated with hypothyroidism

2021 ◽  
Vol 12 (1) ◽  
pp. 275-286
Author(s):  
Ayesha Ammar ◽  
Kahkashan Bashir Mir ◽  
Sadaf Batool ◽  
Noreen Marwat ◽  
Maryam Saeed ◽  
...  
Keyword(s):  
Renal Function ◽  
Confidence Interval ◽  
Creatinine Clearance ◽  
Confidence Intervals ◽  
Standard Error ◽  
Radioactive Iodine ◽  
T Test ◽  
Euthyroid State ◽  
Significant Difference ◽  
The Mean

Objective: Study was aimed to see the effects of hypothyroidism on GFR as a renal function. Material and methods: Total of Fifty-eight patients were included in the study. Out of those forty-eight patients were female and the rest were male. Out of fifty eight patients, fifty three patients were of thyroid cancer in which hypothyroidism was due to discontinuation of thyroxine before the administration of radioactive iodine for Differentiated thyroid cancer.Moreover, remaining five patients were post radioactive iodine treatment (for hyperthyroidism) hypothyroid. All of the patients were above eighteen years of age with TSH value > 30µIU/ml. Pregnant and lactating females were excluded.Renal function tests (urea/creatinine, creatinine clearance) and serum electrolytes followed by Tc-99m-DTPA renal scan for GFR assessment (GATES’ method) were carried out in all subjects twice during the study, One study during hypothyroid state (TSH > 30 µIU/ml) and other during euthyroid state (TSH between 0.4 to 4µ IU/ml). The results of Student’s t-test showed significant difference in renal functions (Urea, creatinine, creatinine clearance, GFR values) in euthyroid state and hypothyroid state (p-value <0.05). RESULTS: In case of creatinine the paired t test reveal the mean 1.014±0.428, with standard error of 0.669 within 95% confidence interval, for creatinine clearance 80.11±14.12 with standard error of 1.94 within 95% confidence intervals, for urea the mean 28±12.13 with standard error of 1.607 within 95% confidence intervals and for GFR for individual kidney is 38.056±8.56 with standard error of 1.3717 within 95% confidence interval. There was no difference in the outcome of the 2 groups. Conclusion: Hypothyroidism impairs renal function to a significant level and hence needs to be prevented and corrected as early as possible.

The Impact of Ischemia on Long-Term Renal Function After Partial Nephrectomy in the Two Kidney Model

2015 ◽  
Vol 29 (4) ◽  
pp. 474-478 ◽  
Author(s):  
Daniel A. Salevitz ◽  
Michael W. Patton ◽  
Mark D. Tyson ◽  
Rafael Nunez-Nateras ◽  
Erin N. Ferrigni ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
The Impact

Risk Factors for Early Mortality in U.S. Peritoneal Dialysis Patients: Impact of Residual Renal Function

2002 ◽  
Vol 22 (3) ◽  
pp. 371-379 ◽  
Author(s):  
◽  
Michael V. Rocco ◽  
Diane L. Frankenfield ◽  
Barbara Prowant ◽  
Pamela Frederick ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Creatinine Clearance ◽  
Residual Renal Function ◽  
Chronic Peritoneal Dialysis ◽  
Dialysis Patients ◽  
The Mean

Background Potential risk factors for 1-year mortality, including the peritoneal component of dialysis dose, residual renal function, demographic data, hematocrit, serum albumin, dialysate-to-plasma creatinine ratio, and blood pressure, were examined in a national cohort of peritoneal dialysis patients randomly selected for the Centers for Medicare and Medicaid Services End-Stage Renal Disease (ESRD) Core Indicators Project. Methods The study involved retrospective analysis of a cohort of 1219 patients receiving chronic peritoneal dialysis who were alive on December 31, 1996. Results During the 1-year follow-up period, 275 patients were censored and 200 non censored patients died. Among the 763 patients who had at least one calculable adequacy measure, the mean [± standard deviation (SD)] weekly Kt/V urea was 2.16 ± 0.61 and the mean weekly creatinine clearance was 66.1 ± 24.4 L/1.73 m2. Excluding the 365 patients who were anuric, the mean (±SD) urinary weekly Kt/V urea was 0.64 ± 0.52 (median: 0.51) and the mean (±SD) urinary weekly creatinine clearance was 31.0 ± 23.3 L/1.73 m2 (median: 26.3 L/1.73 m2). By Cox proportional hazard modeling, lower quartiles of renal Kt/V urea were predictive of 1-year mortality; lower quartiles of renal creatinine clearance were of borderline significance for predicting 1-year mortality. The dialysate component of neither the weekly creatinine clearance nor the weekly Kt/V urea were predictive of 1-year mortality. Other predictors of 1-year mortality ( p < 0.01) included lower serum albumin level, older age, and the presence of diabetes mellitus as the cause of ESRD, and, for the creatinine clearance model only, lower diastolic blood pressure. Conclusion Residual renal function is an important predictor of 1-year mortality in chronic peritoneal dialysis patients.

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