To evaluate the impact of extended warm ischemia on incidence of acute kidney injury (AKI) and ultimate functional recovery after partial nephrectomy (PN), incorporating rigorous control for loss of parenchymal mass, and embedded within comparison to cohorts of patients managed with hypothermia or limited warm ischemia.
From 2007-2014, 277 patients managed with PN had appropriate studies to evaluate changes in function/mass specifically within the operated kidney. Recovery from ischemia was defined as %function saved/%parenchymal mass saved. AKI was based on global renal function and defined as ≥1. 5-fold increase of serum creatinine above preoperative level.
Hypothermia was utilized in 112 patients (median=27minutes) and warm ischemia in 165 (median=21minutes). AKI strongly correlated with solitary kidney (p35 minutes(n=16) median recovery from ischemia was 92%(IQR=86%-100%), 90%(IQR=78%-104%), and 91%(IQR=80%-96%), respectively(p=0. 77).
Our results suggest that AKI after PN correlates with duration but not type of ischemia. However, subsequent recovery, which ultimately defines the new baseline GFR, is most reliable with hypothermia. However, most patients undergoing PN with warm ischemia still recover relatively strongly from ischemia, even if extended to 35-45 minutes.
Urology. 2015 Oct 19 [Epub ahead of print]
Z Zhang, J Zhao, L Velet, C E Ercole, E M Remer, C M Mir, J Li, T Takagi, S Demirjian, S C Campbell
Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH; Sun Yat-Sen University Cancer Center, Department of Urology, Guangzhou, China. , Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH; Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Department of Urology, Shanghai, China. , Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH. , Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH. , Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH; Imaging Institute, Cleveland Clinic, Cleveland, OH. , Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH. , Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH. , Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH. , Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH. , Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH.