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PubMed1987

T-kininogen in rat plasma after nephrectomy and other surgical traumas.

Plasma kininogen is known to increase after nephrectomy in the rat, and we studied the type of kininogen responsible for the increase. Total kininogen in plasma was estimated by measuring the kinins released after incubation with an excess of trypsin, and expressed as micrograms bradykinin equivalents per ml of plasma (bk eq/ml). Plasma Kininogen in 24-hournephrectomized rats increased five-fold over the control values (16.4 +/- 0.8 vs 3.0 +/- 0.3 micrograms bk eq/ml; p less than 0.001). However, we found that the increase in total kininogen was not due to nephrectomy per se, but rather to surgery, since similar increases were found after 24 hours in shamnephrectomized rats (15.5 +/- 0.5 micrograms bk eq/ml), and in rats with a catheter implanted into the carotid artery (14.2 +/- 1.7 micrograms bk eq/ml). The increase in kininogen was proportional to the extent of the surgery since simple exposure of the carotid artery increased kininogen to 5.3 +/- 0.5 micrograms bk eq/ml, and sham carotid cannulation to 8.3 +/- 0.4 micrograms bk eq/ml. Anesthesia without surgery did not affect plasma kininogen concentration. To determine whether the adrenals or the pituitary glands are involved in mediating the changes, plasma kininogen was measured after adrenalectomy and hypophysectomy. Total kininogen in plasma of 24 hour-adrenalectomized rats was sevenfold higher than that of intact rats, also higher than the total kininogen in plasma of sham-adrenalectomized rats (21.6 +/- 1.7 vs. 16.5 +/- 1.1 micrograms bk eq/ml; p less than 0.05). The role of the hypophysis was studied by nephrectomizing rats 12 days after they had been hypophysectomized. Total plasma kininogen in the control group of rats was still four-fold higher than in intact rats. Twenty-four hours after nephrectomy, a further two-fold increase was obtained (12.7 +/- 1.6 vs. 25.6 +/- 2.0 micrograms bk eq/ml; p less than 0.001). Kinins released by trypsin from plasma of the various groups of rats were separated by reserve-phase (C18) high pressure liquid chromatography (HPLC), and then quantitated. Only T-kinin was found to be increased. Unknown kinins, which were partially converted to T-kinin by increasing trypsin concentration from 10 to 80 mg/ml plasma, were also found by HPLC. The results indicate that surgical trauma induces a marked increase in the concentration of T-kininogen in rat plasma. Neither the hypophysis, nor the adrenals seem to be involved in mediating the increase in T-kininogen.

Animals↗

PubMed1975

Compensatory renal hypertrophy. I. Following unilateral nephrectomy. An experimental study in dogs.

The compensatory renal hypertrophy and hyperfunction following unilateral nephrectomy have been studied in dogs over a two-year period. It was found that a sharp increase in function and volume of kidney tissue takes place during the first two weeks. CCr and volume of kidney tissue continue to increase reaching average values after two years of 88% and 92% respectively of those for two kidneys. CPAH and TmPAH remain almost stable at 65% and 57% respectively after an initial increase during the first two weeks. All values are expressed in percent of the function of two normal kidneys before unilateral nephrectomy. The filtration seems to be increasingly efficient and the functional integrity of the nephrons is preserved, although a glomerular predominance is encountered two years following unilateral nephrectomy.

Animals↗

PubMed1982

Effects of unilateral nephrectomy on erythrocytosis and arteriosclerosis induced in rats by intrarenal injection of nickel subsulfide.

Administration of Ni3S2 to rats by unilateral inrarenal (ir) injection (5 mg/rat) caused erythrocytosis, arteriosclerosis, and abnormal plasma concentrations of asparagine, glycine, histidine, and lysine. Resection of the ipsilateral (Ni3S2-treated) kidney on the fourth day after the ir injection prevented erythrocytosis, amino acid disturbances, and severe arteriosclerotic lesions (fibrous intimal plaques and focal medial necrosis), but did not prevent early arteriosclerotic lesions (subintimal oedema with splitting of elastica). The early arteriosclerotic lesions appear to be initiated by vascular dissemination of Ni3S2 particles immediately post-injection, whereas the erythrocytosis, amino acid disturbances, and advanced arteriosclerotic lesions depend upon continued presence of the Ni3S2-injected kidney. Resection of the contralateral (non-injected) kidney has no effect upon Ni3S2-induced erythrocytosis, arteriosclerosis, or amino acid disturbances. Glomerulomegaly and mesangial hyperplasia developed in control rats following unilateral nephrectomy, owing to compensatory renal hypertrophy. Glomerulomegaly was more pronounced in Ni3S2-treated rats following contralateral nephrectomy than following ipsilateral nephrectomy, suggesting that erythrocytosis and compensatory renal hypertrophy act synergistically to enhance glomerulomegaly.

Animals↗

PubMed1975

Effects of unilateral nephrectomy on plasma renin substrate and renin concentration in rats.

Effects of unilateral nephrectomy on plasma renin concentration and renin substrate (angiotensinogen) concentration were studied over an experimental period of 10 days in rats. The maximum increase in plasma renin substrate concentration after bilateral nephrectomy was 9 times higher than the preoperative level. Very low but measureable plasma renin concentrations were found in rats nephrectomized bilaterally 24 hrs previously. In unilateral nephrectomized rats the concentration of renin substrate in plasma increased maximumly 3.5-fold within 24 hrs after the operation and on the third day it was decreased to half of the maximum level. Even 10 days after uninephrectomy the concentration of plasma renin substrate was significantly higher than that of normal rats. Twenty four hours after unilateral nephrectomy plasma renin concentration decreased to similar low levels as those found in bilateral nephrectomized rats. The decreased concentration of plasma renin, however, returned to normal 3 days after uninephrectomy. The inverse relationship was seen between the concentrations of plasma renin and plasma renin substrate. However, substrate concentration in plasma rised faster and longer than plasma renin decreased.

Angiotensin II↗

PubMed1989

Long-term follow-up after unilateral nephrectomy and radiotherapy for Wilms' tumour.

Twenty-nine patients who had had unilateral nephrectomy for Wilms' tumour in one hospital were known to have survived more than 12 years. Sixteen agreed to attend for clinical review, of whom 14 had estimation of serum creatinine, 24-h urine protein excretion and endogenous creatinine clearance. The follow-up period was 13-26 years (median 17 years). All but one had had radiotherapy and all had chemotherapy (actinomycin D, 16; vincristine, 5). Some degree of kyphoscoliosis was present in all except the patient who did not receive radiotherapy. Four patients had diastolic blood pressure 90 mmHg or greater. Two patients had mild proteinuria (392, 361 mg/day). Serum creatinine ranged from 53 to 125 mumol/l and endogenous creatinine clearance ranged from 39 to 173 ml/min (median 81, mean 89). Of the 7 patients who were 20-26 years post-nephrectomy, 2 were hypertensive and 1 had elevated urinary protein excretion. We conclude that the long-term prognosis of unilateral nephrectomy in childhood is good.

Adolescent↗

PubMed1992

Nephrotic syndrome in 1st year of life and the role of unilateral nephrectomy.

The study includes 17 infants with nephrotic syndrome. Their ages at the onset of disease ranged from 10 days to 10 months (median 2 months), and included 10 males and 7 females. Ten patients had consanguineous parents and 4 had a history of similar illness in the sibling. Renal biopsy revealed diffuse mesangial proliferation in 10 patients, diffuse mesangial sclerosis in 3, Finnish microcystic disease in 2, and focal segmental glomerulosclerosis and atypical glomerulopathy in 1 each. Unilateral nephrectomy was performed in 8 patients with intractable proteinuria associated with multiple complications. Five are well after 4-36 months follow-up, 1 died of septicaemia soon after the procedure, 1 needed dialysis and is stable at 26 months and 1 showed no reduction in the degree of proteinuria. We conclude that unilateral nephrectomy is a better alternative to bilateral nephrectomy in some infants with severe nephrotic syndrome.

Female↗

PubMed1995

Renal function following unilateral nephrectomy for neuroblastoma and Wilms' tumour.

To estimate the side effects of chemotherapy and the influence of age at the time of nephrectomy on renal function, we investigated renal function in 34 uninephrectomised children with neuroblastoma (NB) or Wilms' tumour (WT). The results were compared with 6 controls who underwent nephrectomy for non-malignant disease. Study of renal function was primarily based on the clearance of inulin and para-aminohippuric acid (Cin and CPAH, ml/min per 1.73 m2). No significant differences in Cin/CPAH (mean +/- SD) were found between the NB group (90 +/- 24/421 +/- 95), WT group (85 +/- 17/386 +/- 104) and the controls (93 +/- 13/430 +/- 61). Children with NB and WT were divided into two subgroups according to the theoretical nephrotoxic risk. There was no significant difference in renal function between NB or between WT subgroups. Cumulative cisplatin doses in children with NB did not affect renal function significantly. The age at time of unilateral nephrectomy (< or = 2 years vs. > 2 years) was not associated with a higher risk of renal damage in WT children, whereas in NB children the filtration fraction (Cin:CPAH) was higher in younger children (mean +/- SD: 0.243 +/- 0.023 vs. 0.191 +/- 0.041). In conclusion, uninephrectomised children with NB are supposed to have a higher risk of drug-induced renal impairment compared with those with WT. Our data do not confirm this hypothesis, since renal function was comparable to controls in both groups, except in younger patients with NB who show a high filtration fraction. Since the survival of children with NB has improved, a longer follow-up of their renal function in needed.

Age Factors↗

PubMed1996

Growth of the solitary kidney after nephrectomy in children with unilateral Wilms' tumor.

OBJECTIVE: We reviewed the length of the solitary kidney from all ultrasound examinations in 34 children who had undergone unilateral nephrectomy for Wilms' tumor, in order to determine the frequency of renal hypertrophy in this population. Standard sonographic criteria for nephromegaly were used. MATERIALS AND METHODS: We generated a z-score for each measurement of the renal length, using an interpolated computer model based on published standards for sonographic renal length in relation to age. A retrospective age- and gender-matched control population of children with sonographically normal paired kidneys was generated from a departmental computerized pediatric uroradiology data base, and their ipsilateral renal lengths were compared with those of the study patients. Sonographic renal hypertrophy (SRH) was defined by two or more consecutive measurements of the renal length exceeding two standard deviations longer than the mean for the patient's age, with no later normal measurement. RESULTS: Seventeen (50 %) of the 34 patients developed SRH. The latest measurements of the solitary kidney in the patients were significantly longer (mean z = 2.210) than in their controls (mean z = 0.040), even among the patients who did not develop SRH (patients' mean z = 1.000, controls' mean z = -0. 210, p < 0.001). Because boys had slightly longer kidneys than girls (both patients and controls), SRH was also noted more often in boys. The frequency of SRH was unrelated to age at nephrectomy, side of the solitary kidney, tumor stage, chemotherapy regimen, or treatment with radiation therapy. CONCLUSIONS: Although renal growth in a solitary kidney is accelerated in most children after unilateral nephrectomy for Wilms' tumor, the sonographic length of the solitary kidney will be larger than normal in only half of the patients.

Adolescent↗

PubMed1983

Sonographic staging after nephrectomy for tumours.

Sonography for postoperative staging after malignant renal tumours was evaluated in this study based on multiple examinations in 63 patients. Sonography permits a critical examination of the liver, the abdomen in general, the retroperitoneal space, including the renal fossa and solitary kidney. Local recurrences after hypernephroma operation were found in 5.3% and after nephrectomy for renal pelvic carcinoma in 68%. Retroperitoneal lymph node metastases appeared in 17% of the patients operated on renal pelvic carcinoma and in 7.6% after hypernephroma operation. These data indicate that special attention should be drawn to the renal fossa after tumour nephrectomy. The higher incidence of recurrences in the renal fossa, and metastatic lymph node involvement in patients following nephrectomy for renal pelvic carcinoma compared with the situation after hypernephroma operation might be explained by the difference of the lymph drainage between the renal pelvis and renal parenchyma which, in addition, includes a separate ontogenetic development. The majority of secondary lesions in hypernephroma patients occur as lung and bone metastases which have been discovered by conventional X-ray examination. These data are not statistically evaluated in the study.

Adenocarcinoma↗

PubMed1990

Failed partial nephrectomy: local recurrence vs. multicentric disease.

Candidates for partial nephrectomy for renal cell carcinoma include those with (1) bilateral synchronous lesions, (2) tumour in a solitary kidney and (3) renal mass and borderline renal function. Present imaging techniques aid in the identification of appropriate candidates for partial nephrectomy and in the preoperative assessment for technical feasibility of the operation. Studies have shown that the postoperative local recurrence rate ranges from 9 to 13%. We submit a case report in which a 65-year-old male with a history of colon carcinoma four years earlier was found to have a 3 cm left lower pole lesion on his follow-up abdominal CT scan. Upon intended partial nephrectomy, a small synchronous upper pole mass was noticed as well as numerous cortical lesions despite extensive preoperative imaging to the contrary. It is our feeling that finer imaging techniques including thinner CT cuts, additional imaging planes and continued use of renal ultrasound will aid in the identification of ipsilateral, synchronous lesions and draw further distinction between local recurrence and multicentric disease.

Aged↗

PubMed2002

Partial nephrectomy: the rationale for expanding the indications.

BACKGROUND: We report preliminary results of partial nephrectomy for renal tumors of > or =4 cm in 39 patients with the intent of extending the indications for kidney-sparing surgery. METHODS: From July 1989 to October 2001, 39 patients underwent a partial nephrectomy for renal cortical tumors >4 cm in maximum diameter. Fourteen (36%) had the procedure performed for essential reasons, and 25 (64%) had an elective kidney-sparing operation. We evaluated tumor location and histology, perioperative renal function, and postoperative complications. RESULTS: There were 20 conventional clear-cell (51%), 13 papillary (33%), 4 chromophobe (10%), and 3 oncocytomas (8%) with a median tumor size of 5 cm. After a median follow-up of 13 months, 36 patients had no evidence of disease, 1 patient had died as a result of other causes, and 2 patients who had essential operations were alive with disease. Twenty-three patients (70%) maintained normal postoperative renal function. Of six patients with moderate preoperative renal dysfunction, five (83%) had no change in postoperative renal function and only one patient required short-term dialysis. CONCLUSIONS: With careful patient selection, partial nephrectomy can be effectively used to treat patients with renal cortical tumors >4 cm in diameter. The benefits of this approach include the effective local tumor control while at the same time preserving maximum renal function.

Adult↗

PubMedDate not supplied

Retroperitoneoscopic nephrectomy: the experience of an Irish teaching hospital.

BACKGROUND: Since its introduction, laparoscopic nephrectomy is increasingly being used worldwide as a method of removing the kidney, both in benign disease and in small volume tumours. To our knowledge, we are the first surgeons in Ireland to perform this procedure with results that support its use in select cases. AIMS: We looked at 12 cases of retroperitoneal laparoscopic nephrectomy, which we carried out over a five-year period. METHODS: Of the 12 cases performed, five were for renal cell carcinoma and seven were for benign disease. Regarding patients with carcinoma, careful patient selection was based on physical examination, biochemical renal profile and tumour stage. RESULTS: Mean tumour size was 3.3cm. Mean specimen weight was 184g (carcinoma) and 42g (benign). Mean surgical time was 90 minutes and average blood loss was 45ml. Average length of hospital stay was 3.5 days. No major complications occurred. Follow-up of those with renal cell carcinoma revealed all to be tumour-free and renal profile studies of all patients fell within the normal range for all parameters. CONCLUSIONS: Our results support previous reports that recommend laparoscopic nephrectomy as a method for removing kidneys with benign disease or with small volume carcinomas.

Adolescent↗

PubMed2002

[Laparoscopic tumor nephrectomy].

Initially, laparoscopic surgery in urology was restricted to the treatment of benign diseases, whereas its role in the management of malignant disease was restricted to purely diagnostic procedures. Only recently has laparoscopy been introduced for the treatment of low stage renal cell carcinoma (RCC), and the data on both surgical efficiency and oncologic efficacy are very promising. Therefore, we present our experience with laparoscopic radical nephrectomy and data from literature. The technique of the transperitoneal approach is described in detail. Retroperitoneoscopy is a good alternative, however. Intact removal of the specimen within an organ bag to avoid tumor spillage is an important detail of our technique. Our experience amounts to radical nephrectomy in 121 patients. The indication was clinical stage T1-T2. Mean operative time and blood loss was 2.4 h and 154 ml, respectively. The rate of minor or major complications was 5% and 4%, respectively. There was no conversion to open surgery in any patient. Mean postoperative hospital stay was 6.1 days. Data on tumor control are available for 73 patients with a mean follow-up of 13.3 months. There was no recurrence within this period. Radical nephrectomy for low-stage RCC is associated with low morbidity and great surgical efficiency. The rates for local recurrences and metastases are low, tumor-specific survival is high. However, there is still a lack of long-term data on large series of patients. Despite this fact, laparoscopy is already widely accepted for this indication, and it is quite likely that it will become the standard treatment.

Carcinoma, Renal Cell↗

PubMed2002

[The value of tumor nephrectomy in metastatic renal cell carcinoma].

In the case of an organ-confined RCC, tumor nephrectomy is the undisputed therapy of choice even though overall 5-year survival has not surpassed the 60% threshold. Further improvement will most likely have to await the development of more effective systemic treatment strategies. For an exclusively surgical therapy of metastatic RCC, tumor nephrectomy, sometimes in combination with metastasectomy, can be applied. However, more commonly used is a multimodality approach consisting of a cytoreductive operation followed by immunotherapy. Alternatively, one may select immunotherapy first followed by adjuvant nephrectomy in the case of a response, or one may proceed directly to immunotherapy only. Long-term survival does not exceed 5-10%, and patient selection appears to have a higher prognostic impact than any treatment strategy available. Concepts and progress in the field clearly are of increasing value for modern oncologic urologists. The current standard, a multimodality treatment of metastatic RCC, in which an operation becomes necessary at a certain point in time, easily justifies a central role for the urologic surgeon.

Carcinoma, Renal Cell↗

PubMed2003

[Laparoscopic radical nephrectomy: indications, techniques, and oncological outcome].

Renal cell carcinoma is likely to become one of the most important indications for laparoscopic surgery worldwide. The laparoscopic technique combines the benefits of the minimally invasive approach with established surgical principles. In our institution the laparoscopic transperitoneal approach with intact specimen extraction has become the standard technique for radical nephrectomies. We report the indications, techniques, and oncological outcome in a single center experience in 100 cases. The mean tumor size was 5.9 cm (range: 2-11 cm), the blood loss was 220 ml, and the mean surgical time was 211 min, including the learning curves of five surgeons. Histological findings were pT1 in 66 (66%), pT2 in 11 (11%), and pT3 in 19 (19%) patients with an increasing tumor size according to the experience of the surgeons. In four cases (4%) histology did not prove malignant disease. Positive lymph nodes were detected in three cases (3%) and surgical margins were negative for tumor in all patients. To date 61 patients were available for follow-up; patients with primary metastatic disease were excluded from this analysis. Follow-up was between 1 and 30 months with an average of 12.9 months. Progressive disease occurred in two cases in patients with pT3G3 tumors. No cases of local recurrence or port metastasis occurred during observation. Laparoscopic radical nephrectomy is a routine, effective treatment for patients with renal cell carcinoma. Our follow-up data up to 30 months confirm the effectiveness of laparoscopic radical nephrectomy in terms of surgical principles and oncological outcome.

Adult↗

PubMed2003

[Laparoscopic living donor nephrectomy of kidneys with multiple renal vessels].

Due to the increasing waiting time for transplantation of a cadaveric kidney, living donor kidney transplantation is an increasingly oncoming issue. Laparoscopic donor nephrectomies (LDN) have been performed since 1995 and presently more than 100 transplant centers offer this minimally invasive surgical approach. The advantages for the donor of less pain, shorter hospital stay, earlier return to work, better cosmetic results in combination with an organ function equal to open donor nephrectomy are the reasons for an enormous increase in LDN. Since up to 30% of the donor kidneys have multiple vessels for blood supply, an increase of these organs for LDN can be expected. We performed a retrospective study of LDN at our center and compared donors with multiple vs single vessel supply. From February 1999 to September 2002, 63 LDN were performed at the department of Urology, Charité University Hospital, Berlin. A comparison between 18 donor kidneys with multiple vessel supply and 45 donor organs with single vessels showed no difference for the time of laparoscopic explantation (207 vs 201 min, p=0.4) or the warm (166 vs 148 s, p=0.2) and cold ischemic times (117 vs 103 min, p=0.66). As could be expected, the mixed ischemic time, i.e., the time for anastomosis of the kidney with the recipient's vessels, showed a significant difference (53 vs 46 min, p=0.02). Intra- and postoperative complication rates for donors and recipients were not different in both groups. Laparoscopic donor nephrectomy for kidneys with multiple vessels is feasible and safe for donor and recipient.

Adult↗

PubMed2004

[Nephrectomy in acute uncomplicated pyelonephritis].

BACKGROUND: Which complications can develop from uncomplicated pyelonephritis that may require nephrectomy? METHODS: From January 1999 to June 2003 we carried out nephrectomy in ten cases due to abscess formation after acute, uncomplicated pyelonephritis. The medical files were evaluated retrospectively. RESULTS: Nine women and one man were involved. The mean age was 36.2 years. Leading symptoms: flank pain, fever and chills. The mean symptom duration before admission was 14.6 days. Urinary tract infections were caused by Escherichia coli (six), E. coli and Enterococcus (once) and Klebsiella pneumoniae (once). Two cultures were sterile. Indications for nephrectomy were urosepsis (7 cases), anuria (once), increasing abscess formation under antibiotic therapy (once), drastic deterioration of general condition (once). CONCLUSIONS: Uncomplicated pyelonephritis is easy to treat under outpatient conditions with adequate oral antibiotic therapy. Close control must be ensured and clear recovery of symptoms should occur within 48 h. In the case of long duration of symptoms (>6-7 days) or lack of improvement of symptoms under calculated therapy in the first 2 days, inpatient therapy should be initiated because of the high risk of infectious complications. According to our experience, the following patient group is especially at risk: female, symptom duration of at least approximately 1 week, pre-treatment and transfer from another departments.

Abscess↗

PubMed2006

[Pararectal mini-incision for strictly retroperitoneal nephrectomy in living kidney donation].

PURPOSE: In this study we present the technique of a strictly retroperitoneal donor nephrectomy via a pararectal mini-incision. MATERIAL AND METHODS: Data of 34 living kidney donations were analyzed. All donors underwent a pararectal mini-incision and strictly retroperitoneal nephrectomy (MIDN). RESULTS: Total operation time, perioperative use of pain medication, length of hospital stay after successful mobilization, and return to full enteral nutrition and regular digestion were evaluated retrospectively. Total operation time for MIDN was 132+/-26 min. The total average application was 22.2+/-19.4 mg of opioid in morphine equivalent dosage (MED), 7.7+/-6.1 g metamizol, and 512+/-325 mg NSAR during hospital stay, which was 4.9+/-1.4 days. Patients were mobilized primarily 2.9+/-8.0 h after surgery. Mobility was achieved 33.8+/-15.8 h after surgery. Enteral nutrition with fluids was started after 1.9+/-7.0 h, full enteral nutrition was accomplished after 37.4+/-19.0 h, and normal digestion returned 58.6+/-23.0 h after the procedure. CONCLUSIONS: The strictly retroperitoneal nephrectomy via a mini-incision is an elegant, minimally traumatic, safe, and quickly learnable method, resulting in short hospital stays, good cosmetic results, and a low grade of complications.

Adult↗