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At least 487 records · Page 27Linked to original sources

PubMed2004

Laparoscopic live donor nephrectomy: trends in donor and recipient morbidity following 381 consecutive cases.

OBJECTIVE: To review a single-institution 6-year experience with laparoscopic live donor nephrectomy detailing the technical modifications, clinical results, as well as the trends in donor and recipient morbidity. SUMMARY BACKGROUND DATA: Since 1995, laparoscopic donor nephrectomy has had a significant impact on the field of renal transplantation, resulting in decreased donor morbidity, without jeopardizing procurement of a high-quality renal allograft. This technique has become the preferred method of allograft procurement for many transplantation centers worldwide but still remains technically challenging with a steep learning curve. METHODS: Records from 381 consecutive laparoscopic donor nephrectomies were reviewed with evaluation of both donor and recipient outcomes. Trends in donor and recipient complications were assessed over time by comparing the outcomes between four equally divided groups. RESULTS: All 381 kidneys were procured and transplanted successfully with only 8 (2.1%) open conversions. Mean operative time was 252.9 +/- 55.7 minutes, estimated blood loss 344.2 +/- 690.3 mL, warm ischemia time 4.9 +/- 3.4 minutes, and donor length of stay was 3.3 +/- 4.5 days. There was a significant decline in total donor complications, allograft loss, and rate of vascular thrombosis with experience. The rate of ureteral complications declined significantly when comparing our early (Group A) versus later (Groups B-D) experience. CONCLUSION: Laparoscopic donor nephrectomy has remained a safe, less invasive, and effective technique for renal allograft procurement. Over our 6-year experience and with specific refinements in surgical technique, we have observed a decline in both donor and recipient morbidity following laparoscopic live donor nephrectomy.

Cohort Studies↗

PubMed2007

Comparison of laparoscopic versus hand-assisted live donor nephrectomy.

BACKGROUND: The aim of the present study was to compare hand-assisted laparoscopic live donor nephrectomy with the classic laparoscopic method, using meta-analytical techniques. METHODS: A literature search was performed for studies comparing hand-assisted laparoscopic nephrectomy with classic laparoscopic nephrectomy for live kidney donation between 1999 and 2005. The following end points were evaluated: operative time, warm ischemia time, intraoperative adverse events, donor and recipient postoperative complications, and length of hospital stay. RESULTS: Nine comparative studies matched the selection criteria, reporting on 376 patients, of whom 202 (53.7%) had hand-assisted laparoscopic nephrectomy and 174 (46.3%) had the classic laparoscopic technique. Conversion to open surgery was 2.97% in the hand-assisted group and 4.60% in the laparoscopic group (P=0.35). Total operative and warm ischemia times were significantly shorter for hand-assisted laparoscopy by 30.03 minutes (P=0.02) and 1.14 minutes (P<0.001), respectively. The intraoperative blood loss was less for the hand-assisted laparoscopy group by 34.16 mL (P=0.008), although intraoperative (3.46% vs. 7.47%; P=0.24) and postoperative (5.94% vs. 10.34%; P=0.30) donor complications and recipient complications (including delayed graft function and primary nonfunction, 8.41% vs. 7.42%; P=0.32) were similar between the hand-assisted and laparoscopic groups. CONCLUSION: Hand-assisted laparoscopic nephrectomy appeared to have the same donor and recipient complication rate with standard laparoscopy but offered substantial advantages in terms of shortened operative and warm ischemia time as well as decreased intraoperative bleeding.

Adult↗

PubMed2004

Long-term consequence of renal function following nephrectomy for renal cell cancer.

AIM: A retrospective analysis was performed involving patients who had undergone radical nephrectomy for renal cell cancer to determine the long-term outcome of this surgery on renal status. MATERIALS AND METHODS: Between 1977 and 2001, 172 patients having undergone radical nephrectomy for renal cell cancer were followed for a period of more than one year at the Department of Urology Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan. The preoperative and postoperative serum creatinine values of these individuals were reviewed. Long-term effects of radical nephrectomy on renal function and factors influencing postoperative renal dysfunction were analyzed. RESULTS: Six (3.5%) of the 172 individuals progressed to hemodialysis. Eleven (6.4%) patients displayed serum creatinine values of > or =1.6 mg/dL. The remaining 155 patients (90.1%) demonstrated postoperative serum creatinine values of <1.6 mg/dL. The present study suggests that aging, a high degree of proteinuria, hypertension and diabetes mellitus were the predominant risk factors for renal deterioration following nephrectomy. CONCLUSIONS: We have primarily selected radical nephrectomy for cases exhibiting smaller renal tumors with a normal contralateral kidney. We encourage nephron-sparing surgery where possible in patients displaying risk factors, including a high degree of proteinuria, hypertension, or diabetes mellitus.

Adult↗

PubMedDate not supplied

Laparoscopic live donor nephrectomy.

BACKGROUND: The demand for renal transplants is greater than the available kidneys. Live donation is one way of increasing the supply. Laparoscopic removal of the donor kidney appears to reduce morbidity for the donors. Some who are hesitant because of the morbidity associated with open nephrectomy are willing to consider the laparoscopic donor nephrectomy. METHODS: Laparoscopic donor nephrectomy was offered to all but three donors since the commencement of the programme in 1997. Data were collected both prospectively and retrospectively for the first 120 donors. Venous and arterial anatomy was assessed preoperatively by computed tomographic angiography. RESULTS: All but four donor procedures were completed laparoscopically. Three of these were for bleeding that could not be safely controlled laparoscopically and the fourth was a planned conversion to deal with the renal vessels, in the first right nephrectomy. Two kidneys were lost due to arterial thrombosis and two underwent segmental infarction after the loss of one of two or three separately anastomosed vessels. Three recipients had delayed function and two of them required dialysis postoperatively. Other minor complications occurred but were uncommon. CONCLUSIONS: Laparoscopic live donor nephrectomy is safe for the donor and the transplant kidney. It offers the advantage of decreased morbidity for the donor, with a shorter hospital stay, earlier return to normal activity and, for some, early return to work.

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↗

PubMed1994

Partial nephrectomy for incidental renal cell carcinoma.

OBJECTIVE: To evaluate the role of nephron-sparing surgery in patients with incidental renal cell carcinoma and a normal contralateral kidney. PATIENTS AND METHODS: A total of 230 patients underwent curative surgery for unilateral renal cancer between 1979 and 1991. Of these, 41 had a partial nephrectomy. The numbers of patients who underwent partial or radical nephrectomy over the course of the study are compared. RESULTS: The number of partial compared to total nephrectomies increased from 8% in 1979-84, to 20% in 1984-88 and 30% in 1989-91. This reflected increased detection of incidental renal tumours by radiological imaging. The local recurrence rate in those patients who underwent partial nephrectomy was 2% and survival was 95%, with an average follow-up of 3 years (range, 2-13). CONCLUSION: Nephron-sparing excision of small, incidental renal tumours achieved comparable early results to radical nephrectomy.

Adult↗

PubMed1994

Long-term assessment of renal function following nephrectomy for stage I renal carcinoma.

OBJECTIVE: To evaluate the impact of nephrectomy on renal function in people who are potential candidates for nephron sparing surgery, i.e. partial nephrectomy. PATIENTS AND METHODS: A retrospective analysis was carried out of 109 patients (35 women, 74 men) who had undergone a nephrectomy for stage I renal carcinoma at the University of Michigan between 1960 and 1979. All patients had a functioning contralateral kidney and had undergone at least one post-operative serum creatinine evaluation. Statistical analysis was by Pearson's correlation coefficient. RESULTS: One individual developed a transitional cell carcinoma in the remaining renal pelvis and was treated with nephroureterectomy. No other patient progressed to dialysis. Five patients had post-operative serum creatinine levels from 221 to 354 mumol/l, one of whom had undergone both a nephrectomy and a partial nephrectomy for bilateral renal tumours. The remaining four had renal disease including diabetes, hypertension, pyelonephritis and renal artery stenosis. There was a strong association between pre-operative and post-operative serum creatinine values. CONCLUSION: Patients with low stage renal tumours and a normal contralateral kidney are at low risk of progression to renal failure.

Aged↗

PubMed1995

Laparoscopic nephrectomy: initial experience and cost implications.

OBJECTIVE: To assess the results and cost implications of laparoscopic nephrectomy. PATIENTS AND METHODS: Ten patients underwent attempted laparoscopic nephrectomy and nephro-ureterectomy. The cost of the laparoscopic procedures was estimated to allow comparison with that of open surgery. RESULTS: Two patients required conversion to an open procedure, one for a colonic tear, the other for irretrievable loss of pneumoperitoneum. The median operating time for successful cases was 3 h (range 2.5-4). The mean morphine equivalent of analgesia delivered per patient was 18 mg (range 10-28). There was no mortality. Post-operative complications consisted of one case of prolonged ileus and another of chest infection. The median hospital stay of successful cases was 5 days (range 4-17), and the mean time to return to normal activity was 4 weeks (range 3-6). The cost of the procedure using re-usable instruments was approximately 2000 pounds, comprising 100 pounds for equipment. 900 pounds theatre costs and 1000 pounds for hospital stay. Using disposable equipment adds up to 900 pounds to the cost. In comparison an open nephrectomy typically costs around 2300 pounds. CONCLUSION: Laparoscopic nephrectomy is associated with lower analgesia requirements, shorter hospital stay and quicker return to work than equivalent open procedures. The cost, particularly when performed with re-usable instruments, is not prohibitive being comparable with that of open nephrectomy. With further experience it should become part of the armamentarium of urological surgeons.

Adolescent↗

PubMed2004

An audit over 2 years' practice of open and laparoscopic live-donor nephrectomy at renal transplant centres in the UK and Ireland.

OBJECTIVE: To collate information on the practice of live-donor nephrectomy and compare this with the published British Transplantation Society (BTS) guidelines for best practice, using two questionnaires sent to all renal transplant centres in the UK and Ireland to cover practice for the years 2000 and 2002. METHODS: A postal questionnaire was sent to all surgical kidney transplant consultants in the UK and Ireland, including questions on the practice of live-donor nephrectomy in the year 2000 (the questionnaire was sent in 2001) and 2002 (questionnaire sent in 2003). RESULTS: All 28 centres responded fully for both years; 27 centres used live kidney donation in 2000, decreasing to 24 in 2002. Consultants reported 356 operations in 2000, representing 19% of all kidney transplants, and 403 in 2002, representing 23% of all kidney transplants. Three centres offered laparoscopic donor nephrectomy in 2000, and five did so in 2002. Most centres organize donor and recipient operations synchronously, and most have a consultant anaesthetist present for the donor procedure. There were variations in the use of analgesia and thromboprophylaxis, and in donor follow-up. CONCLUSIONS: There is widespread application of live-donor nephrectomy in the UK but BTS guidelines are not closely followed. Minimal access donor nephrectomy is offered at a few centres but many have plans to introduce this into their practice.

Analgesics↗

PubMed2004

A prospective study of the predictive power of spiral computed tomographic angiography for defining renal vascular anatomy before live-donor nephrectomy.

OBJECTIVE: To determine the accuracy of spiral computed tomography (CT) imaging of donor venous anatomy by comparing CT angiography (CTA) and operative findings, for both laparoscopic (LDN) and open donor nephrectomy. PATIENTS AND METHODS: LDN presents unique surgical challenges, particularly with complex venous or arterial anatomy. The limitations of surgical access, poor visibility of the superior and posterior borders of the renal vein during LDN, and the variability of venous anatomy in this region, contribute to the difficulty of LDN, underlining the importance of imaging beforehand. Forty live donors (mean age 46 years, sd 11; 65% female) were assessed by CTA before donation. Scans were reported by the same radiologist. The number and diameter of 'predicted' renal arteries, veins and renal vein tributaries were documented. The donor kidney was removed by two consultant surgeons, and after back-table perfusion the same details were recorded and taken as the 'reference' findings. Tributaries of <1 mm diameter were not recorded. The right kidney was retrieved in seven patients; 25 of the 40 kidneys were retrieved by LDN and the other 15 by open surgery. RESULTS: In all, 48 actual renal arteries were identified at nephrectomy; of these, 47 were predicted by CTA. Likewise, 41 actual renal veins were found at nephrectomy, 40 of which were predicted. The overall accuracy of spiral CTA in predicting the presence or absence of renal vein tributaries was 83% for gonadal and adrenal veins, and 75% for lumbar veins. There were seven false-negative lumbar veins found at nephrectomy; in these cases the CTA films were retrospectively examined, and five of these seven veins were identified. The predicted renal vein tributary diameter correlated poorly with the measured diameter at nephrectomy. CONCLUSIONS: Assessing potential renal donors before surgery with spiral CTA provides an accurate prediction of the presence or absence of the gonadal and adrenal vein, but is less accurate for predicting lumbar veins. This is especially pertinent as the posterior lumbar tributaries have the most intra-individual variation, and are the most difficult to display and control at LDN. This highlights the need for meticulous dissection of the renal vein, particularly along its posterior wall.

Female↗

PubMed2005

The role of unilateral nephrectomy in the treatment of nephrogenic hypertension in children.

OBJECTIVES: To define the efficacy of unilateral nephrectomy in a large series of patients presenting with renal disease and hypertension, as the latter may be a prominent finding in children with nephrourological disease (renal parenchymal disease, renovascular disease, obstruction, renal dysplasia and cancer). PATIENTS AND METHODS: We retrospectively reviewed the hospital and outpatient records of 118 children who presented for evaluation with hypertension, and who had a nephrectomy between 1968 and 2003. Patients included in the study were those who had a unilateral nephrectomy for benign renal hypertension with a normal contralateral kidney; in all, 21 had complete records and follow-up were evaluated. The hypertension was associated with primary renal disease, obstruction and renovascular disease. Blood pressure and medication requirements were compared before and after surgery, the blood pressure values also being compared with published nomograms. RESULTS: Patients were diagnosed with hypertension at a median age of 5 years and had a nephrectomy at a median of 11 months after the diagnosis. The median follow-up after surgery was 39 months. Most patients responded well and became normotensive, or there was a reduction in the need for medication. The median time to normalization was 2, 10 and 11 days in patients with primary renal disease, obstruction and renovascular disease, respectively. CONCLUSION: Nephrectomy is successful in normalizing blood pressure in children with benign renal hypertension and with a normal contralateral kidney.

Blood Pressure↗

PubMed2005

Follow-up after unilateral nephrectomy in children: is an estimate of glomerular filtration rate necessary?

OBJECTIVE: To determine the need for an estimate of glomerular filtration rate (GFR) in the follow-up of children undergoing unilateral nephrectomy for benign renal disease. PATIENTS AND METHODS: Forty-four children (21 girls and 23 boys) undergoing unilateral nephrectomy for benign renal disease over a 3-year period were reviewed for the underlying diagnosis and indication for nephrectomy, imaging before and after surgery, postoperative GFR and final outcome. The follow-up included ultrasonography (US) of the contralateral kidney at 3 and 12 months and an estimate of GFR before discharge at > or = 1 year. All children were aged > 2 years when the GFR was measured. The criteria for discharge were normal imaging of the contralateral kidney before and after surgery and a normal GFR afterward. Spearman's correlation coefficient was used to determine the relationship between age, GFR and contralateral renal length after surgery. RESULTS: The median (range) age at surgery was 2.5 (0.67-16) years. The indications for nephrectomy included reflux nephropathy in 18, multicystic dysplastic kidney in 12, a congenital obstructive uropathy in eight, congenital renal dysplasia in four and miscellaneous in two. All patients had a normal contralateral kidney before surgery on US and functional imaging, and normal US at the follow-up, with evidence of compensatory hypertrophy in all. The median (range) corrected GFR for the 44 children was 109 (81-140) mL/min/1.73 m2, with no correlation between age and GFR, or between renal length and GFR. CONCLUSION: After unilateral nephrectomy for benign renal disease, provided there is a structurally and functionally normal contralateral kidney before surgery, with no abnormality on US, a routine estimate of GFR is unnecessary before discharge from follow-up. There was no correlation between GFR and age or renal length.

Adolescent↗

PubMed2006

A 3-year review of The British Association of Urological Surgeons Section of Endourology Laparoscopic Nephrectomy Audit.

OBJECTIVE: To report and compare the data obtained from the BAUS UK national laparoscopic nephrectomy audit over the past 3 years. METHODS: Each year, consultants performing laparoscopic nephrectomy are invited to submit prospectively collected data on all patients so treated at their centres. The data from each centre is entered into a nationally established database using a standard data-collection sheet. The indications for surgery, and data during and after surgery are collected. Since 2001, data were reported on 1294 laparoscopic nephrectomies. RESULTS: Over the 3 years, the number of centres returning data has increased from 25 to 48. In 2002, data on 263 nephrectomies were returned; by 2004, this had increased to 598. In all three audits, most cases were for nonfunctioning kidneys and renal cell carcinoma, with transitional cell carcinoma and stones forming a smaller proportion. Over the 3 years, the mean (range) operative duration has reduced from 173 (89-335) to 166 (42-395) min. The median postoperative stay remained at 4-5 days, with a wide range reflecting other than clinical reasons for delayed discharge. The mortality rate remained low, at 0.7% and 0.2%, respectively, for 2002 and 2004. The mean conversion rate remained at 6-8% and the mean complication rate at 17-2%, but the proportion of major complications reduced from 10% to 4%. The transfusion rate also reduced from 10% to 7%. The operative duration, transfusion and conversion rates were higher in those centres performing fewer than 12 cases/year than in those performing at least one case per month. CONCLUSION: The BAUS laparoscopic nephrectomy audit is an effective method for ensuring both the safe and widespread implementation of this relatively new technique to the UK, and compliance with internationally accepted standards. This audit has shown differences in clinical outcomes in favour of high-volume centres, which may help to inform decisions about the centralization of urological laparoscopy services.

Humans↗

PubMed2005

Retroperitoneoscopic live donor nephrectomy (RPLDN): establishment and initial experience of RPLDN at a single center.

We tried to establish the technique of retroperitoneoscopic live donor nephrectomy (RPLDN). Between July 2001 and March 2004, 135 renal transplant donors underwent RPLDN. Low (average: 7 mmHg) CO2 gas pressure was employed during the procedure. All procedures were performed through a three-port retroperitoneal approach without opening the peritoneal cavity. The hand-assisted technique was not used. One hundred and twenty-seven cases were of left and eight cases were of right nephrectomy. Donor nephrectomy was carried out successfully in all patients. In one donor, the procedure was changed to open donor nephrectomy because of severe adhesion around the renal vein due to previous surgery. No serious complications, such as massive bleeding or bowel injury were encountered. Return of bowel function took 0.7 days on average. Post-operative hospital stay was 4.9 days on average, and return to work was 12 days on average. Ureteral complications occurred in 2 patients and were treated with temporally retrograde ureteral stenting. Average serum creatinine levels were 1.5 mg/dL, 1.3 mg/dL and 1.3 mg/dL at 3, 7 and 14 days after transplantation, respectively. No patients required hemodialysis after transplantation due to acute tubular necrosis. RPLDN could be an option for laparoscopic live donor nephrectomy.

Adult↗

PubMed2005

The laparoscopic nephrectomy learning curve: a single centre's development of a de novo practice.

OBJECTIVE: There has been a dramatic increase in the interest and practice of laparoscopic urology, with nephrectomy having become the commonest laparoscopic urological procedure. Compared with open nephrectomy, it results in reduced morbidity and shorter convalescence times while maintaining oncological safety. However, while these results predominately stem from institutions with well developed laparoscopic programmes, little is known about the results in centres that have newly adopted this technique. The introduction of a laparoscopic urological service at the Royal Hallamshire Hospital provided an opportunity to study these factors. METHODS: Since the appointment in October 2000 of a urological surgeon (N Oakley) to develop the laparoscopic service, there have been over 200 laparoscopic procedures including 121 nephrectomies performed at this centre. Full details were collected for each of these cases, and in addition, compared with retrospective data for 50 open nephrectomies performed during the same time period. RESULTS: With increased operator experience the median operative duration, complication, transfusion, and conversion rates significantly improved. While a learning curve was evident, the overall operative complication (9%) and conversion rates (6%) were low, in addition to patient morbidity (16.5%) and mortality (0%) rates, showing that this learning curve had no deleterious effects upon patient care. The median hospital stay was four days, which reduced to three with experience and was significantly shorter than for open nephrectomy at this institution (p = 0.001). CONCLUSIONS: The development of a successful laparoscopic programme can be achieved with a comparatively short learning curve and without detriment to the patient provided the necessary steps are observed.

Carcinoma, Renal Cell↗

PubMed2002

Comprehensive MR imaging in the preoperative evaluation of living donor candidates for laparoscopic nephrectomy: initial experience.

PURPOSE: To evaluate the accuracy of magnetic resonance (MR) imaging in the preoperative evaluation of potential living renal donors who are candidates for laparoscopic nephrectomy. MATERIALS AND METHODS: Twenty-eight donor candidates who underwent subsequent laparoscopic nephrectomy were examined by using a torso phased-array coil at 1.5 T. Gadolinium-enhanced MR angiograms, MR venograms, and MR urograms were obtained in all patients by using an interpolated three-dimensional T1-weighted spoiled gradient-echo sequence (3.4-6.8/1.2-2.3 [repetition time msec/echo time msec], 25 degrees -40 degrees flip angle). Interpretation of the MR images was used to assess the arterial, venous, and ureteral anatomy, as well as parenchymal masses and scarring, and findings were compared with the surgical findings in all patients. Statistical evaluation was performed, with the surgical findings as the reference standard. RESULTS: At MR imaging, 31 of 32 renal arteries and one of three early-branching arteries were identified correctly. The correct venous anatomy was identified in 23 of 28 patients, including a single left renal vein anterior to the aorta (n = 16), retroaortic left renal vein (n = 2), circumaortic left renal vein (n = 2), and single right renal vein (n = 3). A single collecting system in all harvested kidneys was identified correctly with MR urography. Overall, MR imaging correctly depicted vascular, ureteral, and parenchymal anatomy in 21 of 28 patients. Twenty-seven of 28 patients underwent successful laparoscopic donor nephrectomy on the basis of the MR findings. One procedure was converted to open nephrectomy on the basis of complex venous anatomy not prospectively identified on the MR images. The sensitivity and positive predictive value of MR imaging in correctly determining the combined vascular, ureteral, and parenchymal anatomy in the harvested kidney were 75% (21 of 28) and 95% (21 of 22), respectively. CONCLUSION: Comprehensive gadolinium-enhanced MR imaging can depict the vascular anatomy, collecting system, and renal parenchyma preoperatively in patients who are candidates for laparoscopic living-donor nephrectomy.

Adult↗

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↗

PubMed1993

Angiotensin II is the mediator of the increase in hepatic angiotensinogen synthesis after bilateral nephrectomy.

The present study investigated the hypothesis that the increase in plasma angiotensinogen after nephrectomy is mediated by endogenous renin and angiotensin (ANG) II. Rats were divided into control, nephrectomy, or nephrectomy plus adrenalectomy groups. In addition, similar cohorts were divided as just mentioned and then given either atenolol (selective beta 1-adrenoceptor inhibitor that prevents renin release) or Dup-753 [ANG II (AT1) receptor antagonist]. The plasma angiotensinogen levels increase approximately fivefold after 24 h in nephrectomized rats. Pretreatment with atenolol blunted this increase. A significant reduction was observed 4 h (P < 0.05) and 8 h (P < 0.005) after surgery. Dup-753 nearly abolished the increase in angiotensinogen plasma levels. After pretreatment with Dup-753, significantly higher angiotensinogen levels (P < 0.005) were found only after 24 h. Nephrectomy plus adrenalectomy also blunted the rise in plasma angiotensinogen. A significant increase in angiotensinogen plasma levels could only be observed after 8 h (P < 0.005) and 12 h (P < 0.005) but not after 24 h. Atenolol further reduced this increase. After atenolol pretreatment, significantly higher angiotensinogen levels could only be observed after 12 h (P < 0.05). Dup-753 completely abolished the increase of plasma angiotensinogen after nephrectomy plus adrenalectomy. In anesthetized control rats at time 0 the plasma ANG I levels were 0.7 nM. Pretreatment with atenolol decreased the ANG I values by 30%, whereas Dup-753 caused a sixfold increase in plasma ANG I levels in the control rats at time 0.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenalectomy↗