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PubMed1985

Effect of contralateral nephrectomy alone or in association with hypertension on rat renal artery lesions.

We have studied the effect of unilateral nephrectomy alone or in association with experimentally-induced (DOCA-salt treatment) or genetic (SHR) hypertension on the formation of lesions in the contralateral renal artery. These lesions, which form spontaneously with age in small numbers in the renal artery of the control Wistar rat, are characterized principally by an interruption of the internal elastic lamina (IEL) over part or all of the vessel circumference. Such lesions are also present in small numbers in renal arteries of intact WKY and SHR rats. Unilateral nephrectomy increases lesion formation in the remaining renal artery in all groups of rats and this increase is greatest when hypertension accompanies nephrectomy. The increase in lesion formation is accompanied in most cases by a significant increase in length of the remaining renal artery and in all cases by compensatory renal hypertrophy. The possibility that the increased flow in the renal artery irrigating the hypertrophied kidney may be responsible for the increased lesion formation is discussed. Lesions in renal arteries of control and nephrectomized normotensive rats and SHR did not differ greatly morphologically, and lesions containing lipid deposits were observed in all groups. Only in the DOCA-salt hypertension group were severe arterial alterations observed.

Animals↗

PubMed1992

Superior mesenteric artery injury during nephrectomy for Wilms' tumor.

Iatrogenic injury to the aorta or its major branches during nephrectomy for Wilms' tumor in children is rarely reported but may be more common than is currently acknowledged. We identified four patients with ligation of the superior mesenteric artery (SMA) that occurred during nephrectomy for nephroblastoma and another child in whom SMA thrombosis developed postoperatively. All of the tumors were on the left side. Interruption of the SMA was recognized intraoperatively in all four children, and primary repair was done. In three patients, appearance of the bowel remained normal before repair of the injury. Three of the arteries were repaired by primary reanastomosis, and one was joined with an interpositioned hypogastric artery graft. None of these patients had gastrointestinal complications postoperatively. In the fifth patient, SMA thrombosis developed after repair of an aortic tear during nephrectomy. This patient required subsequent small bowel resection for bowel infarction and died in the perioperative period. Every surgeon treating children with Wilms' tumor should be aware of the possibly distorted vascular anatomy and take precautions to avoid such a significant injury. Attempts at early ligation of the vessels may not be justified until the renal vasculature is clearly identified.

Child, Preschool↗

PubMed1978

Mortality and morbidity in pretransplant bilateral nephrectomy: analysis of 305 cases.

The surgical riks were analyzed in 305 patients with end stage renal failure who underwent bilateral nephrectomy through midabdominal approach in preparation for kidney transplantation. The over-all mortality rate was 3.6 per cent. Age was the most significant risk factor in the mortality. Patients less than fifty years of age had an operative mortality rate of 3.1 per cent while those more than fifty years had an operative mortality of 11.1 per cent. Other pertinent risk factors were preoperative complications of renal failure and additional surgical procedures at the time of bilateral nephrectomy. The leading causes of death were those of cardiovascular complications and infection. The morbidity rate was 58.7 per cent being major in 18 per cent and minor in 40.7 per cent. Bilateral nephrectomy is recommended selectively in patients with (1) chronic pyelonephritis with urinary tract infection, (2) major vesicoureteral reflux, (3) immunologically active glomerulonephritis, (4) severe hypertension uncontrollable by adequate dialysis, and (5) extremely large or infected polycystic kidneys.

Abdomen↗

PubMed1981

Segmental calculus disease: potential of parital nephrectomy.

Partial nephrectomy was performed on 71 renal units between 1962 and 1978 for segmental calculus disease. Parenchymal scarring associated with an infundibulocalyceal stone, which was usually branched, was the indication for resection. Stone analysis demonstrated an equal incidence of idiopathic and struvite stones. Perioperative morbidity was minimal, but pyelocutaneous urinary drainage prolonged the hospitalization of 5 patients. In 2 cases, the cause was an obstructing retained calculus. Retained calculi occurred in 3 other patients, one requiring early nephrectomy for sepsis. Fifty-seven patients were followed for longer than twelve months. Ipsilateral calculi recurred in 12 per cent of kidneys, and contralateral new calculi developed in the same number. Ninety-four per cent of patients with preoperative urinary tract infections had sterile urine at follow-up. From the results of this and other series, partial nephrectomy compares favorably with extended pyelolithotomy and anatrophic nephrotomy for segmental calculus disease associated with parenchymal scarring and/or a deformed collecting system.

Adolescent↗

PubMed1981

Pretransplant bilateral nephrectomy and adjuvant operations.

Pretransplant bilateral nephrectomy by the posterior approach has been associated with minimal morbidity and mortality. Unfortunately the posterior approach is not applicable to all patients, e.g., patients with polycystic renal disease or patients who need simultaneously another intraperitoneal adjuvant operation such as splenectomy or vagotomy and pyloroplasty. This article presents 34 patients who had a transperitoneal bilateral nephrectomy and 29 other concurrent adjuvant operations. Morbidity and mortality are comparable to that reported for simple bilateral nephrectomy performed posteriorly. The reduction in morbidity and mortality was believed to be due to a careful application of the basic principles of surgical care and an appreciation of the special problems posed by patients on chronic hemodialysis. Perioperative care will be discussed in detail.

Adolescent↗

PubMed1985

Infarction-nephrectomy for metastatic renal carcinoma. Southwest oncology group study.

Thirty patients with metastatic renal cell cancer were treated by renal infarction, followed by delayed nephrectomy. All cases were collected over an eighteen-month period, with a minimum follow-up of one year. There were no complete remissions and only one partial remission, which lasted twenty-one months before progression of disease. Three patients had stable disease for at least six months, but eventually all patients showed evidence of progression. After tumor progression was documented patients were treated with intramuscular medroxyprogesterone acetate (Depo-Provera) 800 mg per week. No patient responded to this therapy. Overall, a 28 per cent one-year survival and a seven-month median survival were realized, which is similar to other series in which no therapy or palliative nephrectomy was performed. We conclude that infarction and nephrectomy is not an effective modality in the treatment of metastatic renal cell carcinoma. In addition, medroxyprogesterone was not shown to be significantly active against renal cancer in this study.

Carcinoma, Renal Cell↗

PubMed1987

Adrenal metastases by renal cell carcinoma. Incidence at nephrectomy.

Recently, there have been questions raised as to the results and feasibility of performing renal-sparing procedures for localized renal cell carcinoma. We reviewed the records of 72 patients treated with standard radical nephrectomy to determine the incidence of adrenal involvement and to determine if adrenal lesions were detectable by radiographic methods preoperatively. Four patients had evidence of adrenal involvement for an overall incidence of 5.5 per cent. All had upper pole lesions. Adrenal involvement in each case was apparent at surgery or on preoperative imaging studies. For patients with middle and lower pole localized renal cell carcinoma who have normal findings on preoperative computerized tomography scans, modified radical nephrectomy sparing the adrenal gland may be a surgical alternative to radical nephrectomy.

Adrenal Gland Neoplasms↗

PubMed1990

Anatomic considerations in extraperitoneal approach to radical nephrectomy.

The interrelationship between the lateral and posterior portions of the peritoneum and Gerota's fascia allows them to be separated from each other, permitting ready visualization of the major renal vessels. The posterior relationship between Gerota's fascia and the transversalis fascia overlying the more posterior psoas muscle can be used to advantage in exposing the renal vessels posteriorly. That the fascial layers defining the retroperitoneal spaces might therefore be used in dissecting the renal hilum and vessels in the performance of radical nephrectomy prompted the present investigation. Twenty patients underwent this approach for radical nephrectomy for varying stages of renal cell carcinoma involving either upper, mid, or lower portion of right or left kidney. Postoperative recovery appeared to be shortened because of the lesser interval of ileus than had previously been encountered using a transperitoneal approach. Despite the minimal manipulation of the kidney prior to ligation of the renal vessels, there was no apparent increased tumor dissemination as detected clinically, and experimentally there appeared to be no increase in tumor cells in the venous effluent. Operative time, blood loss, and postoperative complications were comparable to those reported for the transperitoneal approach. This means of performing radical nephrectomy, based on the relationship of fascial layers in the retroperitoneum thus appeared to lend itself to easier dissection as well as lesser postoperative ileus and corresponding shorter hospital stays.

Abdomen↗

PubMed1993

Laparoscopic nephrectomy for renal neoplasms.

Laparoscopic nephrectomy has been shown to be an effective minimally invasive technique for treating benign renal disease requiring surgical excision. However, its application to approach renal malignancy has been limited. Herein, we report on 8 patients with renal tumor who underwent a laparoscopic nephrectomy. All kidneys were removed within Gerota's fascia, and in 3 patients with upper pole tumors, the adrenal gland was also removed en bloc. With limited follow-up of seven to thirty-five months (mean 14 months), there has been no clinical or radiographic evidence of tumor recurrence. We believe that laparoscopic radical nephrectomy with strict adherence to oncologic surgical principles is a practical, less invasive alternative in select patients with renal tumors.

Adrenalectomy↗

PubMed1995

Living donor nephrectomy: a 20-year experience.

OBJECTIVES: To review the selection criteria and perioperative morbidity in patients undergoing living-related donor nephrectomy. METHODS: Retrospective chart review. RESULTS: Six hundred eighty-one patients underwent living donor nephrectomy during a 20-year period without any mortality. The postoperative morbidity included pneumothorax requiring a chest tube in 7%, urinary tract infection in 5%, wound infection in 4%, and need for blood replacement in 0.3% of patients. Two patients had clinically apparent pulmonary emboli. CONCLUSIONS: Living donor nephrectomy remains a valuable source of kidneys for transplantation but is not without risk. By using care in donor selection and surgical management, operative complications can be kept low.

Adolescent↗

PubMed1992

Renal metallothionein metabolism after a reduction of renal mass. I. Effect of unilateral nephrectomy and compensatory renal growth on basal and metal-induced renal metallothionein metabolism.

The effects of unilateral nephrectomy and compensatory renal growth on renal metallothionein metabolism were evaluated in the present study. In rats, the renal content of metallothionein increased in proportion to the increase in renal mass after unilateral nephrectomy and compensatory renal growth. However, when zinc was used to induce the synthesis of renal metallothionein, the remnant kidney in uninephrectomized (NPX) rats produced significantly greater amounts of metallothionein on a per gram kidney basis than a normal kidney in sham-operated (SO) rats. In both NPX and SO rats, zinc pretreatment caused metallothionein synthesis to increase primarily in the renal cortex and renal outer stripe of the outer medulla. Zinc pretreatment also changed the pattern for the intrarenal accumulation of inorganic mercury in NPX rats. After pretreatment with zinc, the accumulation of inorganic mercury predominated in the renal cortex rather than in the outer stripe of the outer medulla in the NPX rats. In addition, both NPX and SO rats were afforded complete protection against the nephrotoxic effects of a low, toxic dose of inorganic mercury when they were pretreated with inorganic zinc. The protection is postulated to be related to the alteration in the pattern of renal accumulation of inorganic mercury. In conclusion, the capacity to synthesize metallothionein increases significantly in rats after they have undergone unilateral nephrectomy and compensatory renal growth. The increased capacity of the remnant kidney to synthesize metallothionein may involve adaptive changes both in transcriptional and/or translational controls of metallothionein synthesis.

Animals↗

PubMed1988

Half-life of rat angiotensinogen: influence of nephrectomy and lipopolysaccharide stimulation.

The in vivo half-life of two differently glycosylated subforms of rat angiotensinogen (Ao), Ao-1 and Ao-2, was studied in native and nephrectomized rats, as well as in rats treated with lipopolysaccharides (LPS). The metabolic clearance rate of both 125I-labeled derivatives fits a two-compartment model using a non-linear curve fitting program (SCTFIT). Both forms show an initial rapid phase with a half-life of about 1 h. This clearance rate was not altered by either nephrectomy or LPS administration. In the intact rat the two forms were eliminated with a second slower phase half-life of 8.07 h (Ao-1) and 4.53 h (Ao-2), respectively. Following nephrectomy, in the absence of renin, the slower phase of clearance of both forms decreased (t1/2 Ao-1:9.77 h; t1/2 Ao-2: 10.50 h). Induction of low renin concentrations by LPS administration decreased the half-life of the more highly glycosylated form Ao-1 (t1/2: 6.93 h), while that of Ao-2 increased (t1/2: 5.07 h). Inactive angiotensinogen, des-AngI-Ao, of both forms demonstrated a faster metabolic clearance rate in native rats than that of the intact glycoproteins (t1/2 Ao-1: 5.68 h; t1/2 Ao-2: 3.97 h). Based on the plasma levels of these two angiotensinogen subtypes in normal rats, these data suggest a higher secretion rate by the liver for the more highly glycosylated form Ao-1 and a slower clearance rate by the kidney. In contrast, the less glycosylated form shows more rapid elimination by the kidney. Following nephrectomy both glycoproteins are secreted and eliminated in an equimolar ratio.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiotensinogen↗

PubMedDate not supplied

Effects of nephrectomy and high-protein diets on glomerular hemodynamics and urinary protein excretion in diabetic rats.

Renal blood flow, GFR, albumin clearance, and urinary excretion of proteins were assessed in intact control and streptozotocin-diabetic rats (group 1), unilaterally nephrectomized control and diabetic rats (group 2), and nephrectomized control and diabetic rats (divided into high (a) and low (b) glycemia subgroups) fed a 50% protein diet (group 3). After 8 months of diabetes, blood flow did not differ from control rats within each experimental group, although it was increased significantly in both controls and diabetics of groups 2 and 3 versus group 1. GFR in control rats was increased approximately 2x by nephrectomy and approximately 3x by nephrectomy plus the high protein diet. Diabetes increased GFR approximately 50% above control values in group 1; GFR values in diabetic rats of groups 2 and 3a were virtually identical and similar to those of group 2 controls; GFR in group 3b diabetics was increased approximately 1.4x versus group 2 diabetics. 125I-BSA clearance was increased 3.4x in groups 2 and 3 control rats versus group 1 controls. Both nephrectomy and consumption of the high protein diet caused marked increases in 125I-BSA clearance and urinary excretion of albumin in diabetic rats. Urinary excretion of IgG was increased by diabetes in group 1 and remained essentially at this level in groups 2 and 3 diabetic rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1996

Renal function after unilateral nephrectomy for Wilms' tumour: the influence of radiation therapy.

The effect of therapy on renal function after unilateral nephrectomy for Wilms' tumour was studied. In the second year following unilateral nephrectomy, glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were estimated simultaneously by measuring 125I-iothalamate clearance and 131I-hippurate clearance. Of 41 evaluable patients, 29 received chemotherapy as sole treatment modality following nephrectomy (group 1); 12 patients additionally received radiation therapy to a field that included the remaining kidney (group 2). Results were expressed as standard deviation scores (z-scores). In group 1, mean z-score for GFR was -0.27 (94.6% of normal) and in group 2 mean z-score was -1.51 (72.7% of normal for two kidneys) (P = 0.022, Mann-Whitney U-test). Mean z-score for ERPF was -0.09 (97.0%) in group 1 and -1.53 (73.8%) in group 2 (P = 0.039). It was concluded that the combination of chemotherapy and radiation therapy, in contrast to chemotherapy alone, negatively affects the ability of the remaining kidney to adjust its function after the loss of its counterpart.

Child↗

PubMed2004

Robotically assisted donor nephrectomy for kidney transplantation.

The application of minimally invasive techniques in the field of transplant surgery is expanding the number of living-related donor nephrectomies. In 2003, the number of living kidney donors exceeded the number of cadaveric donors. The laparoscopic techniques already have been described extensively. Our experience with robotic donor nephrectomy began in October 2000. In this article, we describe the surgical technique for living-related donor nephrectomies using robotic technology (computer-enhanced surgery), as well as the most important considerations regarding the pre- and postoperative management of this group of patients.

Humans↗

PubMed2006

Immediate nephrectomy versus preoperative chemotherapy in the management of non-metastatic Wilms' tumour: results of a randomised trial (UKW3) by the UK Children's Cancer Study Group.

PURPOSE: To determine if patients receiving preoperative chemotherapy with vincristine and actinomycin D for non-metastatic Wilms' tumour have a more advantageous stage distribution and so need less treatment compared to patients who have immediate nephrectomy, without adversely affecting outcome. METHODS: Between 1991 and 2001, a total of 205 patients with newly diagnosed non-metastatic renal tumours, of which 186 had Wilms' histologies, were randomly assigned either to immediate surgery or to 6 weeks preoperative chemotherapy and then delayed surgery. Both groups of children received postoperative chemotherapy according to tumour stage and histology determined at the time of nephrectomy. RESULTS: There was a significant improvement in the stage distribution for patients with Wilms' histologies receiving delayed surgery compared to those having immediate nephrectomy (stage I: 65.2% versus 54.3%; stage II: 23.9% versus 14.9%; stage III: 9.8% versus 29.8%, chi2 test for trend=7.02, p=0.008). This improvement resulted in 20% fewer children receiving radiotherapy or doxorubicin yet event-free and overall survivals at 5 years of 79.6% and 89.0%, respectively, were similar in the two groups. CONCLUSION: Six weeks of preoperative chemotherapy with vincristine and actinomycin D results in a significant shift towards a more advantageous stage distribution and hence reduction in therapy, while maintaining excellent event free and overall survival in children with non-metastatic Wilms' tumour. Around 20% of survivors were therefore spared the late-effects of doxorubicin or radiotherapy. Our results suggest that all children with non-metastatic Wilms' tumour should receive chemotherapy prior to tumour resection.

Adolescent↗

PubMed2006

Vascular complications of allograft nephrectomy.

OBJECTIVES: To identify risk factors that predisposes patients to vascular complications from allograft nephrectomy and to determine the safe management of this group of patients. DESIGN: This is a retrospective review of 1543 renal transplants performed in our institution between January 1990 and January 2002. PATIENTS AND METHODS: During this period, 161 (10.4%) transplant nephrectomies were performed, of which we identified nine patients (5.6%) who sustained significant vascular complications. RESULTS: Seven patients required ligation of external iliac artery for control of haemorrhage. Immediate vascular reconstructions (femoral-femoral cross-over bypass in two cases and one vein patch to an external iliac artery defect) were performed in three patients. Two patients had endovascular stenting of their external iliac artery pseudoaneurysm. No patient suffered limb loss. However, three patients died-two died from overwhelming sepsis and one patient died of an intra-cerebral haemorrhage. CONCLUSIONS: While vascular complications associated with transplant nephrectomy are relatively rare, they are associated with a significantly poor outcome. Immediate attempts to reconstruct the vascular supply to the lower limb are associated with a high complication rate. We advocate that where possible, vascular reconstruction should be deferred and that external iliac artery ligation can be performed safely with surprisingly low limb ischaemia rate.

Adolescent↗

PubMed2005

Suitability of 5/6 nephrectomy (5/6NX) for the induction of interstitial renal fibrosis in rats--influence of sex, strain, and surgical procedure.

Chronic renal failure (CRF) is a serious clinical problem and currently there are no adequate therapeutic strategies for treatment. Many possible treatment strategies have been tested in rats with CRF induced by subtotal nephrectomy. However, reports in the literature concerning the consequences of this procedure on rat kidney function are contradictory. For instance, such an intervention in male Sprague-Dawley rats apparently initiates the development of interstitial renal fibrosis, while in our similar studies on female Wistar rats (HW) there was minimal renal fibrosis. Therefore, we carried out experiments in adult rats to investigate the long-term consequences of 5/6 nephrectomy (5/6NX) in relation to (1) sex, (2) strain, and (3) two methods of surgical ablation. Ten weeks after 5/6NX, body weight gain, systolic blood pressure, creatinine clearance, and urinary protein were measured, along with renal hydroxyproline concentration determinations to assess the deposition of extracellular matrix. Also, light microscopic investigations were done to characterize renal damage. The functional parameters clearly indicated the development of CRF, while morphologic investigations showed only moderate fibrotic areas containing atrophic tubules and lymphocytic infiltrates. However, 45-60% of glomeruli were sclerotic. In summary, 5/6NX, using either method of partial nephrectomy, induces signs of moderate glomerulonephritis preferentially in female HW rats. Thus 5/6NX in female HW rats can be recommended as a suitable model in the induction of renal fibrosis.

Animals↗