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Results for “Nephrectomy”

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PubMed1991

[Glomerular hyperfiltration following unilateral nephrectomy in healthy subjects].

23 living related kidney transplant donors were prospectively studied to determine the degree of hyperfiltration which occurs after uninephrectomy and to monitor potential consequences of this procedure such as hypertension, microalbuminuria or renal functional impairment. Standard inulin and PAH clearance studies were performed immediately before (n = 23), one week after (n = 22) and one year after nephrectomy (n = 12). Hyperfiltration was defined as the ratio of (post-nephrectomy inulin clearance)/(0.5 x pre-nephrectomy inulin clearance), hyperperfusion was defined in an analogous way for PAH clearance. One week after uninephrectomy, hyperfiltration averaged 134 +/- 6% (SEM) and hyperperfusion was 138 +/- 6%. The degree of hyperfiltration did not correlate with donor age. One year after nephrectomy, hyperfiltration was nearly unchanged (130 +/- 7%) whereas hyperperfusion had significantly decreased to 119 +/- 8% (p less than 0.05). Blood pressure did not increase after nephrectomy and no new cases of hypertension were observed during follow-up. In contrast, there were two new cases of microalbuminuria at one week and one year after nephrectomy. Further follow-up of these kidney donors is warranted.

Adult↗

PubMed1991

[Immunological assessment after radical nephrectomy for renal cell carcinomas pre-treated with interferon-gamma].

Twenty two patients with renal cell carcinoma subjected to radical nephrectomy were divided into 2 groups, the first group consisted of 10 patients who received pre-operative interferon-gamma (IFN-gamma administered group), and the second one consisted of 10 patients who received nephrectomy alone (non-administered group). An immunological assessment was made as to whether the pre-operative administration of IFN-gamma affects the immunocompetent cells before or after nephrectomy with reference to stage or grade of cancer, the duration of anaesthesia and in the absence or presence of a blood transfusion. Immunocompetent cells that we had checked were peripheral blood lymphocytes (PBL), CD3, CD4, CD8, CD16 and CD20. These cells were examined on the day before the administration of IFN-gamma (in the case of the administered group), just before nephrectomy and on the 7th day after nephrectomy. With regard to the effects of the administration of IFN-gamma pre-operatively, there were more patients who showed an increase of CD16 in the administered group, compared with the patients who showed a decrease of CD16, and its difference was significant. On the other hand, we observed that the patients who showed an increase of CD16 were low stage and low grade predominantly, but the difference was not significant. Regarding the immunological changes after nephrectomy, there appeared to be an increase in the ratio of CD4/CD8 in the administered group, and these patients were low stage and low grade significantly. As to CD16, the tendency was similar to that observed for the ratio of CD4/CD8 in the administered group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2026

Perioperative safety and survival outcomes of robot-assisted partial nephrectomy in elderly patients with localized renal cell carcinoma: an overlap-weighted Asian cohort study.

The value of robot-assisted partial nephrectomy (RAPN) in elderly Asian patients with localized renal cell carcinoma (RCC) remains insufficiently defined. We retrospectively analyzed 339 patients (≥ 70 years) with localized RCC treated at a single Asian center between 2015 and 2025, including 119 undergoing partial nephrectomy (PN) and 220 undergoing radical nephrectomy (RN). Propensity score overlap weighting (OW) was applied to compare PN versus RN and, within the PN cohort, RAPN versus laparoscopic partial nephrectomy (LPN). Three open partial nephrectomy cases were summarized descriptively and retained only in exploratory sensitivity analyses. Weighted logistic regression and Cox models with robust standard errors evaluated Clavien-Dindo grade ≥ II complications and overall survival (OS). After OW, PN was associated with better early postoperative renal functional preservation than RN but a greater incidence of grade ≥ II complications (36.4% vs. 17.6%; weighted p < 0.001); OS was similar. Within the PN cohort, RAPN had longer operative time than LPN (weighted p = 0.030), whereas warm ischemia time, early postoperative eGFR, and grade ≥ II complications (31.8% vs. 40.4%; weighted p = 0.414) were not significantly different. Exploratory analyses favored RAPN, but only one death occurred in this group, and residual confounding remains possible. PN may preserve early renal function in selected older patients, while RAPN appears feasible in experienced centers; its survival association remains hypothesis-generating.

Humans↗

PubMed1976

The influence of nephrectomy, ureteral ligation, and of estradiol on plasma renin substrate in unilaterally nephrectomized rats.

The effects of three experimental conditions on the concentration of plasma renin substrate were studied with special reference to plasma renin concentration in unilaterally nephrectomized rats. After simultaneous bilateral nephrectomy the maximum increase in plasma renin substrate was 17 times higher than normal within 24 h, while in rats which were unilaterally nephrectomized 10 days previously, followed by the removal of the remaining kidney (two-step bilateral nephrectomy), the maximum increase in plasma renin substrate was markedly suppressed (6-fold of normal). The maximum increases in plasma renin substrate by estradiol treatment in normal and unilaterally nephrectomized rats were about the same, associated with similarly decreased plasma renin concentrations. The similar increase in plasma renin substrate was found after ureteral ligation in unilaterally nephrectomized rats and bilateral ligation of the ureters in normal rats. This was the case where the plasma renin concentrations changed differently after ureteral ligation. After two-step bilateral nephrectomy plus estradiol treatment the maximum increase in plasma renin substrate was found to be higher than that found after two-step bilateral nephrectomy, but was lower than that after simultaneous bilateral nephrectomy. It is suggested that under the pathological conditions that stimulate renin substrate production, the plasma rein substrate concentration is less affected by circulating renin.

Angiotensin II↗

PubMed1975

Clinical effects of bilateral nephrectomy.

The effects of removal of all renal tissue on hematopoiesis, osteodystrophy, blood pressure regulation and metabolic functions are reviewed; and, the indications for, and results of, bilateral nephrectomy are discussed. Nephrectomy results in a more severe anemia in dialysis patients which is poorly responsive to androgen therapy. No differences were detected in the severity of osteodystrophy between nephric and anephric patients. However, bilateral nephrectomy can occasionally result in the acute onset of hypocalcemia. Blood pressure regulation must be accomplished in the absence of a functioning renin-angiotensin system. This is largely on the basis of volume, but changes in vascular tone may also be significant. Little is known about the metabolic consequences of nephrectomies. The effect on substances metabolized by the kidney is an area for further investigation. Kidney tissue should be preserved, if at all possible, and nephrectomy performed only for specific indications.

Adult↗

PubMed1992

Evidence for activation of tubuloglomerular feedback following nephrectomy in human subjects.

The intrarenal regulation of glomerular filtration rate (GFR) following a reduction in renal mass was evaluated in six normal subjects, studied before and 4 to 6 weeks after undergoing unilateral nephrectomy, performed for the purpose of living-related transplantation. The role of the tubuloglomerular feedback (TGF) system in regulating the final GFR on both occasions was assessed by determining the increase in GFR over baseline levels following blockade of TGF by a single dose of bumetanide, care being taken to replace sodium and water losses. Before donor nephrectomy, baseline GFR was 115 +/- 7 mL/min, which increased by 9.5% +/- 2.5% to 126 +/- 9 mL/min following the removal of TGF. Four to six weeks following donor nephrectomy, the baseline GFR was 83 +/- 8 mL/min, confirming significant hyperfiltration in the remaining kidney. After administration of bumetanide, the GFR increased by 15.6% +/- 3.1% to 96 +/- 9 mL/min. This greater fractional increase (P < 0.025) indicates an increase in tonic TGF activity in the uninephrectomized state compared with that demonstrated before nephrectomy. The results suggest that the hyperfiltration response following unilateral nephrectomy is limited by an appropriately activated TGF system. This phenomenon may be of importance in the maintenance of Na and water homeostasis, as well as limiting the pathological consequences that may result from, or be exacerbated by, an excessively high filtration rate in the remaining nephrons. Thus, dietary or therapeutic maneuvers that impair the TGF response may be best avoided following a reduction in renal mass.

Adult↗

PubMed1976

Allograft nephrectomy.

The indications, complications and results of 54 allograft nephrectomies undertaken in 44 patients have been reviewed. There were 7 deaths following 39 nephrectomies done within 6 months of transplantation and complications occurred in a further 14 instances. Many of these resulted from pre-existing infection. When nephrectomy was carried out 6 months after transplantation there were no deaths and morbidity was less. If graft failure is diagnosed within 6 months of transplantation immediate nephrectomy is recommended to prevent future complications. When graft failure occurs later it is suggested that nephrectomy be undertaken only when definite indications for this are present.

Adolescent↗

PubMed1990

Elevated angiotensinogen mRNA levels in rat liver by nephrectomy.

The expression of the angiotensinogen gene was studied in nephrectomized rats with and without adrenal glands. Angiotensinogen mRNA was measured by a sensitive radiodensitometric hybridization assay. Angiotensinogen mRNA levels in the liver increased 5 times by nephrectomy alone and 2.6 times by nephrectomy with adrenalectomy in acute experiments. Brain mRNA levels remained the same in both groups. When nephrectomy was performed 7 days after adrenalectomy, mRNA level increased by 50%. Angiotensinogen mRNA increased 5 times in the liver and 2.3 times in the brain by the administration of dexamethasone. An additive effect on liver angiotensinogen mRNA level was observed in nephrectomy with dexamethasone treatment. These results suggest that in nephrectomy, a synergetic action of glucocorticoids and other unknown factors increase hepatic angiotensinogen mRNA levels.

Adrenalectomy↗

PubMed1992

Clinical study of patients with renal carcinoma surviving for more than 10 years after nephrectomy.

Of 207 patients with renal carcinoma we studied 50 who survived for more than 10 years after nephrectomy. These 50 patients were younger than the others at the time of operation and included more females. They had lower stage and lower grade tumours. Recurrence was detected in 18/50 patients and 6 died from cancer. Recurrence developed approximately 10 years after nephrectomy. Eleven patients with recurrences had metastases to a single organ and 9 received multidisciplinary treatment, mainly surgery and radiotherapy. The survival rate 10 years after nephrectomy was lower in patients with recurrences than in those without recurrent tumours and there was a significant decrease in the survival rate 17 years after nephrectomy. Although the patients had low grade and low stage tumours 10 years after nephrectomy, careful follow-up is recommended in such cases as it is possible that they may have dormant tumours.

Adult↗

PubMed1992

Bilateral asynchronous renal cell carcinoma. Computed tomography of the contralateral kidney 10-43 years after nephrectomy.

Computed tomography (CT) was carried out in 31 patients 10-43 years after surgery for renal cell carcinoma, 10 belonging to a consecutive series of patients operated upon at one urological department 10 years previously. Twenty-eight patients were symptomless, and 3 had flank pain, severe fatigue and hematuria, respectively. Cancers in the remaining kidney were found 13-21 years after nephrectomy in 4 of 31 patients (12.9%). The 3 patients with symptoms were among these 4. An adenoma was found in 1 patient 10 years after nephrectomy. The cancers were treated by renal resection in 2 patients, multiple tumors made nephrectomy necessary in 1 patient and 1 patient was not operated upon because of disseminated disease. The adenoma indicated future checkup by CT. Three of the 4 new cancers had a dismal outcome. The renal parenchyma was found to be essentially normal in all the other 26 patients, irrespective of the widely varying time interval between nephrectomy and CT. Asynchronous bilateral renal cell carcinoma has a poor outcome which presumably can be improved by early diagnosis and aggressive treatment. CT is the method of choice for early detection and follow-up of renal tumors. It should be carried out every other year after nephrectomy for renal cell carcinoma.

Adult↗

PubMed1978

[The bilateral nephrectomy in terminal renal disease (author's transl)].

45 cases of nephrectomy are reported. Mortality was 8.9%. Thirty-one had a drug-resistant, severe hypertension, three had infected kidneys, and in eleven cases nephrectomy was performed prior to transplantation. Although blood pressure improved in all patients, of the first group 24% died within one year after nephrectomy, which shows unsatisfactory prognosis of malignant nephrosclerosis. Only early nephrectomy can lead to better results. Routine nephrectomy before transplantation should be avoided. Indications for this group are discussed.

Adult↗

PubMed1991

Bilateral nephrectomy before transplantation: indications, surgical approach, morbidity and mortality.

Forty patients with end-stage renal failure, who had undergone simultaneous bilateral native nephrectomy before a subsequent renal transplant operation, were reviewed with particular reference to the indications and surgical approach for bilateral nephrectomy and to the complications of the procedure. The main indications for bilateral nephrectomy are hypertension resistant to medical therapy, persistent symptomatic renal infection, severe renal protein loss and occasionally polycystic kidneys or bilateral renal tumours. In this consecutive series of 40 patients both kidneys were removed because of chronic pyelonephritis with reflux (n = 28), glomerulonephritis with reflux (n = 9) and uncontrolled hypertension (n = 3). Surgical morbidity was less in patients who had bilateral nephrectomy performed through bilateral vertical lumbotomy incisions. There was no surgical mortality.

Bacterial Infections↗

PubMed1992

ECG changes under hyperkalemia with nephrectomy in the rat.

Electrolyte abnormalities have become an increasingly important cause of arrhythmias. Although the electrocardiographic (ECG) changes under hyperkalemia in the rat are poorly understood, it is conceivable that excess plasma potassium may also alter the cardiac excitations in the rat. Further, effects of hyperkalemia on ECG in the rat may differ from other species that have ST-segment and longer QT intervals in ECG. The present study was designed to determine the diagnostic criteria for ECG manifestations to various levels of plasma potassium concentration. For this purpose, hyperkalemia was induced by nephrectomy with and without infusions. Because it was difficult to produce various levels of plasma potassium concentration by only nephrectomy, we used two kinds of infusions to obtain especially moderate levels of nephrectomy-induced hyperkalemia. ECGs were recorded 24, 36, and 48 hours after nephrectomy. Plasma potassium concentration and number of abnormal ECGs were increased time-dependently. Increased T wave amplitude was present with mild hyperkalemia. The typical T wave change observed with so-called sinoventricular conduction levels of potassium concentration in species with long QT intervals did not occur in the rat. PR interval and QRS duration became slightly shorter within moderate hyperkalemia. P wave disappeared in most rats at potassium levels above 8.0 mEq/l. In advanced hyperkalemia (plasma potassium concentration above 7.5 mEq/l), conduction in all parts of the heart was suppressed. Moreover, sinoventricular conduction appeared. Thus, the diagnostic criteria for ECG manifestations to various levels of plasma potassium concentration in the rat were demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1992

Prognosis of children with solitary kidney after unilateral nephrectomy.

The clinical course of 138 children who underwent unilateral nephrectomy and had a normal contralateral kidney at the time of nephrectomy was reviewed. The diagnosis leading to nephrectomy included obstructive uropathy in 46% of the cases, reflux or pyelonephritis in 30%, Wilms tumor in 15%, hypertension in 4%, dysplastic kidney in 2% and trauma in 2%. Mean age at nephrectomy was 7.3 years and median followup was 24.7 years. Of the 138 patients 121 (88%) are well and 17 died, including 14 secondary to metastatic Wilms tumor and 1 of renal failure. Survival of nonWilms tumor patients was similar to that of an age-matched control group. In 30 patients 24-hour creatinine clearance and 24-hour urinary protein excretion were measured. Proteinuria (greater than 150 mg./24 hours) was found in 8 of the 30 patients (27%) (p less than 0.001), renal insufficiency developed in 9 (30%) (p less than 0.0001) and hypertension occurred in 10% (p greater than 0.10). Children with an acquired solitary kidney are at increased risk for proteinuria and renal insufficiency.

Child↗

PubMed1992

Renal function in unilateral nephrectomy subjects.

Renal function in 32 subjects who had undergone unilateral nephrectomy (17 transplant donors and 15 subjects with unilateral renal disease) was compared with that of 22 normal subjects. The age-adjusted glomerular filtration rate was lower in transplant donors (79 +/- 15% of normal) than in those whose nephrectomy was performed for unilateral renal disease (90 +/- 12% of normal). The donors were also significantly older at nephrectomy (48 +/- 10 years versus 24 +/- 13 years, p less than 0.001). This finding may represent less capacity for compensatory hypertrophy. Proximal tubular and medullary function as assessed by 15-minute phenolsulfonphthalein excretion, maximum urinary concentration in response to water deprivation plus exogenous vasopressin, and urinary acidification in response to an oral acid load were all within normal limits for glomerular filtration rate. Overall renal function was well preserved after nephrectomy. A small number of patients did have increased cast excretion, which may signify the presence of mild renal disease in these subjects.

Adult↗

PubMed1991

Partial nephrectomy for renal cell carcinoma: indications, results and implications.

Of 52 patients who underwent partial nephrectomy for tumor 44 were found to have renal cell carcinoma. The indications for this parenchyma-sparing procedure were categorized according to the initial status of the contralateral kidney and included bilateral tumors or tumor in a solitary kidney in 16 patients (mandatory indications), unilateral carcinoma with compromise of the contralateral kidney by a benign disease process in 9 (relative indications) and small peripheral tumor with a normal contralateral kidney in 19 (elective indications). There were 4 recurrences that accounted for 3 deaths, all in patients with mandatory indications. All patients who underwent partial nephrectomy for relative or elective indications were without definite evidence of recurrent disease at last followup (over-all mean 36 months). Our results suggest that conservative surgery can often provide effective and advantageous therapy for renal cancer and we encourage further consideration of the role of partial nephrectomy as an alternative to radical nephrectomy in selected patients with small peripheral tumors and normal contralateral kidneys.

Carcinoma, Renal Cell↗

PubMed1990

Influence of nephrectomy on the growth of a murine Wilms tumor: a study using parabiotic rats.

It has been reported that unilateral nephrectomy causes acceleration of the growth of a Wistar/Furth rat Wilms tumor. We studied this phenomenon in parabiotic rats by measuring tumor growth after either sham nephrectomy, or excision of 1, 2 or 3 kidneys. We observed no stimulation of tumor growth in the experimental groups. Renal function was significantly decreased after removal of 2 or 3 kidneys. Serum creatinine levels were significantly different between right and left members of parabiotic pairs in these 2 groups. The effect of unilateral and bilateral nephrectomy on tumor growth in single rats also was examined. In these rats progressive increases in tumor growth were observed after unilateral and bilateral nephrectomy. Our inability to demonstrate a tumor-stimulating factor in the parabiotic model may be due partly to incomplete sharing of humoral factors between parabionts. Serum transfer studies in vitro may prove more fruitful in demonstrating such a factor.

Animals↗

PubMed1976

End stage polycystic kidney disease: management by renal transplantation and selective use of preliminary nephrectomy.

The results have been reviewed of 35 renal transplants performed on 31 patients with end stage polycystic renal disease. Patient survival is 81 per cent and 71 per cent of the patients have functioning grafts at an average followup of 3.1 years. The need for pre-transplant nephrectomy was evaluated early in the series and since then the operation has been practiced selectively. Twenty-two patients have received transplants with both polycystic kidneys in situ, while 2 patients have undergone transplantation after unilateral nephrectomy. In the absence of a history of renal infection or significant hematuria it has proved safe and desirable to leave the polycystic kidneys in situ. During the post-transplant period in such cases there has been no difficulty attributed to the in situ polycystic kidneys after more than 450 patient months of immunosuppressive therapy. The size of the polycystic kidneys has not been an indication of nephrectomy in our series and no significant technical difficulties have been encountered with large polycystic kidneys remaining in situ. Hypertension associated with end stage polycystic kidney disease has been controlled easily and has not proved an indication for pre-transplant nephrectomy.

Adult↗