Prevention of renal warm ischemic injury and long-term preservation of kidneys with inosine: function, ultrastructure, and clinical use.
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Adult↗
Biomedical subjects
J E Wickham
Publications and source records attributed to J E Wickham.
Inosine in preserving renal function during ischaemic renal surgery.
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Humans↗
The distinction between obstructive uropathy and nephropathy by radioisotope transit times.
Deconvolution analysis of different regions of interest on gamma camera renography enables obstructive lesions causing impairment of nephron function to be distinguished from obstructive lesions which parenchymal function is unimpaired. Quantitation of isotope transit time through the parenchyma is a reliable method of diagnosing upper urinary tract obstruction.
Adolescent↗
Inosine: clinical results of ischaemic renal surgery.
Ten patients requiring ischaemic renal surgery for calculus or tumour were operated on with the kidney protected by perfusion with a room temperature solution of inosine. The warm ischaemic times ranged from 35 to 75 min (mean 57.1 min). Post-operative recovery was uneventful in all patients. No adverse cardiodynamic effects due to inosine were noted. There was only moderate transient depression in renal function as assessed by gamma camera renography and serum creatinine estimations. Three of the 10 patients have now been followed for over a year. The results with inosine perfusion are comparable to those obtained with hypothermic protection.
Adult↗
Bladder instability in women with recurrent cystitis.
Factors in the aetiology of bladder instability in women with recurrent cystitis are analysed. A multifactorial approach to patient management is advocated and supported by a treatment failure rate of only 3.6% with these patients over a mean follow-up of nearly 2 years.
Adult↗
Protective effect of inosine on the canine kidney during ischaemia at 37 C.
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Animals↗
Long-term follow-up 100 cases of renal calculi.
Phosphatic calculi form in infected urine. Complete clearance is associated with sterile urine. This disease is distinct from metabolic stone disease and should be curable if all stones are removed and postoperative infection is prevented.
Follow-Up Studies↗
The obstructed kidney: correlation between renal function and urodynamic assessment.
In 20 patients with pelvi-ureteric junction obstruction the results of quantification of the change in renal pelvis size during high-dose intravenous urography with a diuretic, pressure/flow studies, standard renography and deconvolution analysis of the gamma camera renogram have been compared. The results of high-dose intravenous urography and pressure/flow studies correlated well. Renography was unreliable in diagnosing obstruction unless deconvolution analysis of the gamma camera renogram was used to differentiate those showing an obstructive uropathy from those with an obstructing nephropathy.
Humans↗
Renal function after warm ischaemia. I. Effect of initial perfusate and its temperature.
The left kidneys of anaesthetized, heparinized rats were subjected to a 60-min period of warm ischaemia in vivo and perfused in situ with either isotonic saline, human plasma protein fraction, Perfudex (Pharmacia), 20% mannitol or Sacks' solution at 37 degrees C. A second similar series were perfused at 4 degrees C. One further group had autologous arterial blood perfusion at body temperature. Immediate contralateral nephrectomy was done and function was assessed by regular plasma creatinine estimation and survival (life supporting function). Control groups consisted of unilateral nephrectomy alone, 45 or 60 min of ischaemia with immediate contralateral nephrectomy. The only significant improvement in function in the experimental groups when compared to the 60-min ischaemia control group was seen following perfusion with isotonic saline at 37 degrees C (p less than 0.05) and with autologous arterial blood perfusion (p less than 0.005). Renal function following this period of warm ischaemia was not significantly improved by any of the other perfusates tested.
Animals↗
Renal function after warm ischaemia. II. Marked protective effect of intravenous inosine given prior to 60, 90 and 120 min of warm ischaemia.
Rats were given 10 or 20 mg of inosine dissolved in 1 ml of 0.9% saline, or a control solution of 1 ml of 0.9% saline, intravenously 10 or 20 min before induction of left renal warm ischemia for 60 min. Further groups of rats were treated with 20 mg inosine or with saline alone 20 min before longer periods of warm ischeamia of 90 and 120 min duration. All animals had immediate contralateral nephrectomy. In all inosine-treated groups the mean plasma creatinine was lower than in their respective control groups and these differences were statistically highly significant.
Animals↗
Inosine in experimental acute renal failure.
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Acute Kidney Injury↗
Enhanced preservation of the ischaemic kidney with inosine.
The function of rat kidneys subjected to 60 minutes of warm ischaemia at body-temperature was notably protected by the prior administration of the purine nucleoside inosine as a 40 mg/ml solution maintained at 37 degrees C. With direct intrarenal arterial perfusion of the kidney at the onset of ischaemia or with intraperitoneal (i.p.) injection 40 minutes before ischaemia, the plasma-creatinine at 24 hours was significantly lower (P less than 0-001) than that of untreated 60-minute-ischaemia controls and not significantly different from that of non-ischaemic unilateral-nephrectomy controls. Intravenous inosine 20 minutes beforehand also afforded significant (P less than 0-01) protection. 7-day survival was 100% in 30 inosine-pretreated rats and 65% in 45 rats with all other types of pre-treatment (P less than 0-001). Although i.p. adenosine was better (P less than 0-05) than no treatment, i.p. inosine was better (P less than 0-02) than i.p. adenosine. Allopurinol, phenoxybenzamine, A.T.P., or cyclic A.M.P. caused no improvement over controls. Kidneys perfused with inosine maintained higher purine-nucleotide levels during ischaemia and rapidly resynthesised A.T.P. when blood-flow was restored in vivo.
Adenosine↗
Hypothermic prostatic resection.
A simple method of markedly reducing blood loss during T.U.R. is reported. Cooling of the irrigant solution to 2 degrees C by placing the glycine in a domestic refrigerator reduces the operative blood loss 6-fold.
Clinical Trials as Topic↗
A computer-based technique for measurement of renal parenchymal area on intravenous urograms.
Accurate measurement of the renal parenchymal area of intravenous urograms is discribed using a graphic tablet with a pressure-sensitive surfact linked on-line to a computer. The area outlined on the tablet is immediately computed and shown in square centimetres on a television screen and on a data print-out. The renal areas of 22 patients' urograms were studied before the three months after renal stone removal under local hypothermia. Renal function was measured by creatinine clearance. Conventional measurements of renal length, width and area were also performed for comparison. Results confirmed that while overall kidney size was reduced following operation, the parenchymal area and creatinine clearance were unaltered. This computer-based technique is simple to perform, quick and accurate, and provides quantitative information on intravenous urograms.
Anthropometry↗
Synchronous bilateral lumbotomy.
The surgical technique of synchronous bilateral nephrectomy or nephrolithotomy is described. The operative details, the indications, advantages and complications are reported in this series of ten patients. These bilateral posterior vertical incisions with minimal cutting of abdominal musculature, together with rapid mobilisation of the patient and the absence of prolonged post-operative pain, provide a distinct advantage over conventional renal incisions.
Early Ambulation↗
Conservative renal surgery for adenocarcinoma. The place of bench surgery.
A brief review of reported cases of tumours in solitary kidneys and of bilateral simultaneously occurring tumours is reported. 1 case of bilateral simultaneously occurring tumour ana 3 cases of tumour occurring in solitary kidneys are reported. The treatment of these cases by simple partial nephrectomy under regional hypothermia is described. The palce of ex vivo "Bench Surgery" for this condition is discussed.
Adenocarcinoma↗
Continuous perfusion of human cadaveric kidneys for transplantation.
63 cadaveric kidneys have been preserved for up to 36 hours by continuous perfusion on a Gambro machine 52 kidneys were transplanted: 13 (25%) functioned immediately, 23 (44%) functioned after 2 to 28 days, and 16 (31%) failed to function. 11 kidneys with poor perfusion flow characteristics were discarded. Of 30 kidneys followed for more than 18 months, graft survival was 50%. Analysis of warm and cold ischaemia data, of perfusion flow rates and biochemical studies, and comparison of function of 18 pairs of kidneys only one of which was continuously perfused, suggests that this method of preservation effectively extends the preservation time to 36 hours, but does not improve the immediate function and non-function rates, and does not provide an accurate assessment of viability.
Cadaver↗