Laparoscopic partial nephrectomy in warm ischemia: impact of parenchymal loss on kidney function

DOI: 10.22591/magyurol.2017.4.bagherif.158

Authors:
Fariborz Bagheri  dr.^1,2, Csaba Pusztai dr.¹, László Farkas dr.¹, István Buzogány dr.³,
Zsuzsanna Szabó dr.⁴, János Lantos dr.⁵, Marianna Imre dr.⁶, Nelli Farkas dr.⁷, Árpád Szántó dr.^1
1University of Pécs Medical School, Department of Urology, Pécs, Hungary (director: Árpád Szántó dr.)
²Dubai Health Authority, Dubai Hospital, Department of Urology, Dubai, UAE
³Péterfy Sándor Street Hospital, Department of Urology, Budapest, Hungary (director: István Buzogány dr.)
⁴University of Pécs Medical School, Department of Nuclear Medicine, Pécs, Hungary (director: Katalin Zámbó dr.)
⁵University of Pécs Medical School, Department of Research and Techniques, Pécs, Hungary (director: Gábor Jancsó dr.)
⁶Diagnostic Center of Pécs, Hungary (director: Ferenc Kövér dr.)
⁷University of Pécs Medical School, Institute of Bioanalysis, Pécs, Hungary (director: Ferenc Kilár dr.)

Summary

Objective: To evaluate impact of deliberate renal parenchymal loss on renal function, distinguished from ischemic reperfusion (I-R) injury after laparoscopic partial nephrectomy (LPN) under warm ischemia (WI).

Patients and methods: Thirty five patients with a single polar renal mass £4 cm with normal contralateral kidney planned for transperitoneal laparoscopic partial nephrectomy (LPN) under WI using en-bloc hilar occlusion in a prospective study. Total differential renal function (T-DRF) using 99TTc-Dimercaptosuccinic acid (99TTc-DMSA) was evaluated preoperatively and postoperatively in different intervals over one year. In all isotope assessments, a special region of interest (ROI) was selected on the non-tumorous pole of the involved kidney and it was compared with the same ROI in the contralateral kidney. This was named as partial DRF (P-DRF). Any postoperative decline in the P-DRF of the operated kidney was contributed to I-R injury unrelated to parenchymal loss. Subtraction of the P-DRF decline from the T-DRF decline was attributed to the parenchymal loss caused by deliberate resection and suturing of the normal parenchyma. Other than DRF, serum creatinine (sCr), estimated glomerular filtration rate (eGFR) using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, warm ischemia time (WIT), and weight of the resected specimen were also measured.

Results: The mean WIT was 22 minutes, and the mean weight of resected specimen was 18 grams. The mean postoperative eGFR declined to 87 from its baseline mean value of 97 (p-value = 0.0757). Mean postoperative T-DRF and P-DRF of the operated kidney, declined by 7% and 3% respectively.

Conclusion: After LPN of small renal mass, decline in renal function is primarily contributed to parenchymal loss caused by deliberate resection and suturing of the normal parenchyma rather than the I-R injury.

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