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PubMed2003

Laparoscopic adult donor nephrectomy for pediatric renal transplantation.

To evaluate retrospectively our laparoscopic adult donor nephrectomy experience for pediatric transplantation. Since February 1995, 7 adult donors have undergone laparoscopic donor nephrectomy for pediatric renal transplantation (recipients younger than 18 years and weighing less than 30 kg). The outcomes of these donors and pediatric recipients were evaluated. The 7 laparoscopic renal donors had a median operative time of 306 minutes, median allograft warm ischemia time of 275 seconds, median blood loss of 200 mL, median hospital stay of 3 days, and 14.2% overall complication rate. No graft loss or patient mortality occurred. The pediatric recipients of the laparoscopic live-donor allografts had a median creatinine clearance level of 52.1, 52.1, 44, and 41.1 mL/min at 3, 6, 12, and 18 months, respectively. The overall complication rate was 14.2%. The 1 and 2-year graft survival rates were 100%. No mortality occurred in the pediatric recipients. Laparoscopic donor nephrectomy is well tolerated by the adult donors and appears to provide acceptable recipient and allograft outcomes in the pediatric population.

Adolescent↗

PubMed2003

Improvement of hemostasis in open and laparoscopically performed partial nephrectomy using a gelatin matrix-thrombin tissue sealant (FloSeal).

OBJECTIVES: Long-term follow-up studies have demonstrated that effective local tumor control and long-term tumor-free progression rates can be achieved by nephron-sparing surgery. However, hemostasis is a major issue, and the lack of effective means of hemostasis has limited the wider use of the laparoscopic approach to nephron-sparing surgery. METHODS: Between January 2001 and April 2002, 25 patients with renal cell carcinoma were treated with partial nephrectomy using a two-component tissue sealant (FloSeal). The median age was 54 years (range 42 to 71). The follow-up time was 1 to 12 months (median 3.5). The tumor diameter ranged from 2 to 5 cm (median 2.8). Fifteen cases were performed by open retroperitoneal surgery, and 10 cases were performed laparoscopically. The two-component tissue sealant (consisting of a gelatin matrix granula component and a thrombin component) was applied after resection of the tumor and before perfusion of the kidney. The following parameters were recorded: time until complete hemostasis was achieved; decrease in postoperative hemoglobin level; postoperative bleeding; and presence or absence of a perirenal hematoma 24 hours and 10 days postoperatively by ultrasonography. RESULTS: After application of the tissue sealant for 1 to 2 minutes to the moist resection site, hemostasis was immediate in all cases. During the laparoscopically performed partial nephrectomies, a laparoscopic applicator was used to avoid wasting the tissue sealant within the dead space of the instrument. When reperfusion of the kidney was established, hemostasis was maintained. The decrease in postoperative hemoglobin level ranged from 0.3 to 1.2 points (median 0.7). None of the patients required blood transfusions. No postoperative bleeding occurred. The ultrasound examination 24 hours and 10 days postoperatively demonstrated the absence of a significant perirenal hematoma. CONCLUSIONS: The two-component tissue sealant FloSeal provided immediate and durable hemostasis in open and laparoscopically performed partial nephrectomies. The tissue sealant may provide a tool to expand the possibilities of laparoscopic nephron-sparing surgery.

Adult↗

PubMed2003

Hemostatic laparoscopic partial nephrectomy assisted by a water-cooled, high-density, monopolar device without renal vascular control.

OBJECTIVES: To evaluate the feasibility of laparoscopic partial nephrectomy assisted by a water-cooled, high-density, monopolar device (TissueLink Floating Ball). METHODS: Transperitoneal laparoscopic partial nephrectomy was performed without vascular control for four renal tumors in 3 patients. A flexible ultrasound probe was used to confirm tumor location and depth. Gerota's fascia was opened distant from the tumor site. Renal fat was dissected from the renal parenchyma except for the fat overlying the tumor. The tumor resection area was marked 1 cm outside the boundaries of the tumor. After application of the TissueLink Floating Ball at the planned surgical margin, the tumor was resected with cold laparoscopic scissors. Bleeding from the vessels of the divided renal parenchyma was controlled with the Floating Ball if necessary. The specimen was sent for frozen section to confirm margin status. RESULTS: Mean estimated blood loss per tumor was 275 mL. The dissection extended to the collecting system in 2 of 4 cases. In 1 patient, a minor postoperative urine leak resolved spontaneously. CONCLUSIONS: Use of the TissueLink Floating Ball facilitated resection of small renal tumors without renal vascular control. Although further study is necessary, water-cooled, high-density monopolar energy may have a role in laparoscopic partial nephrectomy.

Aged↗

PubMed2003

Renal artery pseudoaneurysm after partial nephrectomy: three case reports and a literature review.

OBJECTIVES: To report 3 cases of renal artery pseudoaneurysm (RAP) after partial nephrectomy and review the literature to discuss their unique presentation, clinical course, and management. RAPs are a rare clinical entity. They are a well-documented source of hemorrhage in association with renal biopsy, renal trauma, renal transplant, and percutaneous procedures; however, little is known about their presentation, pathophysiology, and management after nephron-sparing surgery. METHODS: Between 2000 and 2002, 698 partial nephrectomies were performed at our institution for treatment of suspected localized renal malignancy. A retrospective review of these cases revealed that 3 patients developed a postoperative RAP. These cases were reviewed along with the current medical literature available from the MEDLINE database to characterize this clinical entity further. RESULTS: Three patients developed RAP after 698 uncomplicated partial nephrectomies were performed (0.43% incidence). Illustrating a classic presentation, the patient in case 1 was successfully treated with selective embolization after presenting with symptoms 3 weeks postoperatively. The patient in case 2 was treated with elective partial selective embolization for an asymptomatic lesion that later resolved spontaneously. In case 3, the patient presented early during the hospital course and required urgent selective embolization. CONCLUSIONS: RAP after nephron-sparing surgery is a rare, but potentially life-threatening, condition that is often difficult to diagnose and requires a high index of suspicion. Treatment should be tailored to each patient's clinical presentation to minimize morbidity and maximize renal conservation. All urologists should be aware of this potential postoperative complication and prepare accordingly.

Aged↗

PubMed1997

Nephrectomy and vena caval thrombectomy in patients with metastatic renal cell carcinoma.

OBJECTIVES: To report out experience with performing nephrectomy and vena caval thombectomy in patients with metastatic renal cell carcinoma. METHODS: A retrospective review was performed of 15 patients who underwent surgical excision of the primary tumor and a caval thrombus and treatment of concurrent metastases between 1989 and 1995. The sites of metastases included lungs (n = 8), bone (n = 3), bulky retroperitoneal or mediastinal lymph nodes (n = 2), liver (n = 1), and contralateral adrenal (n = 1). The level of caval involvement was suprahepatic in 3 cases, retrohepatic in 2 cases, and infrahepatic in 10 cases. Three patients had an Eastern Cooperative Oncology Group performance score of 0, 11 had a score of 1, and 1 had a score of 2. Median follow-up was 17 months. RESULTS: Median operative time was 6.5 hours and median hospitalization was 10 days. Two patients required re-exploration for postoperative hemorrhage. There were no perioperative deaths. Four patients underwent surgery for resection of solitary metastases (1 lung, 2 spine, and 1 humerus); 2 of the 4 received adjuvant radiotherapy. Two patients received biologic therapy preoperatively, 3 received it both preoperatively and postoperatively, and 6 received it only postoperatively. The median time to initiation of postoperative biologic therapy was 48 days (range 25 to 110). Eleven patients are currently alive, 7 with no evidence of disease at a median follow-up of 17 months (range 6 to 66) and 4 with stable metastases at 14 months (range 4 to 22). Ten of the 13 symptomatic patients had improved performance scores after surgery. Four patients have died from metastatic disease: 2 from rapid progression at 2 and 5 months after surgery and the other 2 at 17 and 42 months. CONCLUSIONS: Nephrectomy and vena caval thrombectomy can be safely performed in selected patients with metastatic disease. Furthermore, in patients receiving biologic therapy, nephrectomy may enable a better quality of life and prolonged survival.

Aged↗

PubMed1998

Feasibility of adrenalectomy with radical nephrectomy.

OBJECTIVES: To evaluate the justification of routine removal of ipsilateral adrenal gland as part of radical nephrectomy for renal cell carcinoma (RCC). METHODS: The medical records, pathologic specimens, and computed tomographic (CT) scans of 77 patients who underwent radical nephrectomy and ipsilateral adrenalectomy for RCC were reviewed. Comparison was made between radiologic analysis and pathologic findings regarding involvement of the adrenal gland. RESULTS: The size of the renal tumor varied between 3.5 and 19 cm (mean 8.5). The upper pole was involved in 45%, the lower pole in 28%, and the midpole in 18% of the patients, and in 9% the whole kidney was involved by the tumor. Histologic findings showed that 72 (94%) of the 77 adrenal glands were normal and 70 of these were normal on CT as well. Two adrenal glands involved by metastases showed heterogeneous contrast entrancement on CT. The benign lesions of three adrenal glands were also picked up as abnormal on CT. In 2 patients adrenal glands could not be visualized on CT because of a paucity of retroperitoneal fat. CONCLUSIONS: Adrenalectomy with nephrectomy may not be performed in patients with RCC in whom CT demonstrates normal adrenal glands. In patients with adrenal abnormality on CT, magnetic resonance imaging can separate metastases from incidental benign adrenal adenoma, further reducing the number of patients requiring removal of the adrenal gland.

Adrenalectomy↗

PubMed1998

Laparoscopic nephrectomy for renal cell cancer: evaluation of efficacy and safety: a multicenter experience.

OBJECTIVES: Although laparoscopic radical nephrectomy is a safe and minimally invasive alternative to open surgery, the long-term disease-free outcome of this procedure has not been reported. We evaluated our experience with the laparoscopic management of renal cell carcinoma to assess the clinical efficacy of this surgical modality. METHODS: Between February 1991 and June 1997, 157 patients at five institutions were retrospectively identified who had clinically localized, pathologically confirmed, renal cell carcinoma and had undergone laparoscopic radical nephrectomy. Operative and clinical records were reviewed to determine morbidity, disease-free status, and cancer-specific survival. Of the patients followed up for at least 12 months (n = 101), 75% had an abdominal computed tomography scan at their last visit. RESULTS: The mean age at surgery was 61 years (range 27 to 92) and all patients were clinical Stage T1-2,NO,MO. Fifteen patients (9.6%) had perioperative complications. During a mean follow-up of 19.2 months (range 1 to 72; 51 patients with 2 years or more of follow-up), no patient developed a laparoscopic port site or renal fossa tumor recurrence. Four patients developed metastatic disease, and 1 patient developed a local recurrence. The 5-year actuarial disease-free rate was 91%+/-4.8 (SE). At last follow-up, there were no cancer-specific mortalities. CONCLUSIONS: The laparoscopic surgical management of localized renal cell carcinoma is feasible. Short-term results indicate that laparoscopic radical nephrectomy is not associated with an increased risk of port site or retroperitoneal recurrence. Longer follow-up is necessary to compare long-term survival and disease-free rates with those of open surgery.

Adult↗

PubMed1999

Radical nephrectomy and nephroureterectomy in the octogenarian and nonagenarian: comparison of laparoscopic and open approaches.

OBJECTIVES: To retrospectively compare the outcome of laparoscopic and open radical nephrectomy or nephroureterectomy in patients 80 years old or older, inasmuch as the tolerance profile of major laparoscopic renal surgery in comparison to open surgery in the elderly patient has not been previously reported. METHODS: Since September 1997, 11 patients 80 years old or older underwent retroperitoneal laparoscopic radical nephrectomy or nephroureterectomy for cancer. These patients were compared with 6 consecutive patients 80 years old or older who underwent comparable open surgery at our institution since January 1994. No tumor had computed tomographic evidence of lymphatic, vascular, or perirenal extension. RESULTS: Baseline parameters were comparable between the laparoscopic and open groups. The laparoscopic group had a similar median surgical time (210 minutes versus 175 minutes; P = 0.1) and blood loss (150 mL versus 125 mL; P = 0.8) compared with the open group. However, specimen weight was larger in the laparoscopic group (568 g versus 292 g; P = 0.04). Moreover, the laparoscopic group had a quicker resumption of oral intake (less than 1 day versus 4 days; P <0.001), decreased narcotic requirements (14 mg versus 326 mg; P = 0.004), shorter hospital stay (2 days versus 6 days; P <0.001), and faster convalescence (14 days versus 42 days; P <0.001) compared with the open group. CONCLUSIONS: Retroperitoneal laparoscopic radical nephrectomy and nephroureterectomy are well tolerated by the elderly patient. Although our sample size was small, it appears that laparoscopy is an excellent alternative to open surgery for excision of selected renal malignancies in the octogenarian and nonagenarian population.

Aged↗

PubMed2000

Potential role of nephrectomy in the treatment of metastatic renal cell carcinoma: a retrospective analysis.

OBJECTIVES: To examine the outcomes of patients with newly diagnosed metastatic renal cell carcinoma (RCC) who underwent initial nephrectomy as a component of therapy, because the role of nephrectomy in the treatment of patients with metastatic RCC is uncertain. METHODS: A retrospective review of 63 patients who underwent radical nephrectomy with or without additional surgical procedures in the setting of metastatic RCC was performed. Pretreatment characteristics and the type of surgery were examined as predictors of outcome, and the type of systemic therapy received (if any) and overall survival were determined. RESULTS: The median patient age was 59 years (range 39 to 79). Thirty-two patients had a single metastatic site, with the most common sites being the lung (n = 33), lymphatics (n = 32), and bone (n = 19). Seventeen patients (27%) also underwent vena cavotomy during surgery. Two patients died perioperatively. Thirty-nine (62%) patients underwent systemic therapy after surgery, and 6 patients (9.5%) were rendered free of disease and elected not to receive systemic treatment. The median survival was 17.8 months. CONCLUSIONS: Primary renal surgery may be beneficial for selected patients with metastatic RCC, and most patients will be able to receive postoperative systemic therapy.

Adult↗

PubMed1999

Partial nephrectomy for centrally located tumors.

INTRODUCTION: Interest in nephron-sparing surgery has been spurred by the good long-term results of patients treated with partial nephrectomy. Partial nephrectomy entails the complete resection of renal tumor while leaving behind clear surgical margins and maximum functional renal parenchyma. TECHNICAL CONSIDERATIONS: We prefer to access the renal tumor by a flank incision. Intraoperative sonography is used to define the operative lesion and to search for multicentric tumors. A vascular clamp is placed on the renal hilum for vascular control. Regional hypothermia protects the kidney during renal ischemia. The perinephric fat is excised in situ with the renal tumor. Tumor base biopsies ensure negative margins. Meticulous dissection and tying of vessels improves hemostasis. Diluted methylene blue is directly injected into the renal pelvis to inspect for any intrarenal leakage. The argon beam coagulator is used routinely, and collagen (Avitene) is placed into the renal defect for hemostasis. The renal parenchyma and Gerota's fascia are reapproximated anatomically. A small drain is left in place, and the wound is closed in the usual manner. CONCLUSIONS: Recent studies continue to report that conservative surgery is as effective as radical nephrectomy for renal cell carcinoma, but the judgments in patient selection and operative management are paramount in determining its success.

Humans↗

PubMed2001

Laparoscopic live donor nephrectomy. A review of the first 5 years.

Laparoscopic live donor nephrectomy is technically feasible. The operation has evolved over the last 5 years and is greatly improved compared with the procedure originally described. Advantages to the donor when compared with the standard open operation are decreased postoperative pain, shorter hospitalization, a quicker recuperation, an earlier return to driving, and an earlier return to employment. These improvements have resulted in fewer lost wages and a lower financial burden for donors. Live donor nephrectomy also provides improved cosmetic results. It successfully removes many of the disincentives to live kidney donation and has resulted in an increased willingness of individuals to donate their kidneys. The operative risk seems to be equivalent to that of the open donor operation performed through a flank approach. Although there is no financial advantage of the laparoscopic operation in terms of hospital costs, the increase seen in live donor transplantation may result in long-term cost savings overall. Kidneys procured laparoscopically function well in recipents in the short and long term. There is no increased risk for rejection or technical complications, and the recipent's length of hospitalization is unaffected. The laparoscopic donor operation does not have any apparent deleterious effect on the recipient. The procedure is being adopted rapidly by transplant centers around the world and has been performed at more than 100 centers on five continents. The authors believe that laparoscopic live donor nephrectomy will become the standard of care in the not too distant future.

Humans↗

PubMed2001

Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial.

BACKGROUND: Surgery is the main treatment for localised renal cell carcinoma, but use of radical nephrectomy for metastatic disease is highly controversial. We aimed to establish whether radical nephrectomy done before interferon-alfa-based immunotherapy improved time to progression and overall survival (primary endpoints) compared with interferon alfa alone. METHODS: We included 85 patients from June, 1995, to July, 1998: two (one per group) were ineligible. 42 of the 83 participants were randomly assigned combined treatment (study group) and 43 immunotherapy alone (controls). All patients had metastatic renal-cell carcinoma that had been histologically confirmed and was progressive at entry. In study patients, surgery was done within 4 weeks of randomisation, and immunotherapy (5x10(6) IU/m(2) subcutaneously three times per week) started 2-4 weeks later. In controls, immunotherapy was started within 1 working day of randomisation. Follow-up visits were monthly. All analyses were by intention to treat. FINDINGS: 40 (53%) of 75 patients received at least 16 weeks of interferon-alfa treatment, which was also the median duration of treatment. Time to progression (5 vs 3 months, hazard ratio 0.60, 95% CI 0.36-0.97) and median duration of survival were significantly better in study patients than in controls (17 vs 7 months, 0.54, 0.31-0.94). Five patients responded completely to combined treatment, and one to interferon alfa alone. Dose modification was necessary in 32% of patients, most commonly because of non-haematological side-effects. INTERPRETATION: Radical nephrectomy before interferon-based immunotherapy might substantially delay time to progression and improve survival of patients with metastatic renal cell carcinoma who present with good performance status.

Adult↗

PubMed2000

Interaction between AVP and sympathetic system in subtotal nephrectomy-saline hypertension: role of alpha and V1 receptors.

The development process of subtotal nephrectomy-salt hypertension is still unclear. The aim of the present study was to determine the role of the interaction between vasopressin and sympathetic system in the development of this hypertension by using AVP V1 antagonist and alpha blocker phentolamine under anesthesia condition. For this purpose, we carried out about 73% subtotal nephrectomy on male Wistar rats. One group of these rats (normotensive group) was given a low-salt diet and the other group (hypertensive group) was given a high-salt diet for 4 weeks. Finally, eight groups of rats were formed according to the kind(s) of the injected drug(s): (1) normotensive and hypertensive groups injected only V1 antagonist, (2) normotensive and hypertensive groups injected only phentolamine, (3) normotensive and hypertensive groups injected first V1 antagonist and then phentolamine, (4) normotensive and hypertensive groups injected first phentolamine and then V1 antagonist. Either V1 or alpha blockage separately led to a higher reduction in the mean blood pressure (MAP) of the hypertensives than, of the normotensives (p < 0.05). The combined blockage of V1 and alpha receptors, also caused a higher decrease in the MAP of hypertensive group than, of normotensive group, not depending on the order of the injections (p < 0.01). The heart rate increase recorded as a response to the phentolamine injection in normotensive group, did not develop in hypertensive group (p < 0.05). There was no significant difference between the two groups with regard to plasma electrolytes and osmolality. A positive correlation was found between systolic blood pressure and plasma osmolality in hypertensive group (r = 0.40, p < 0.05), but not in normotensive group. We conclude that the increase in V1 and alpha pressor activities contributes to the subtotal nephrectomy-saline hypertension and the augmentation of alpha pressor activity by vasopressin may participate in this contribution.

Adrenergic alpha-Antagonists↗

PubMed2005

[Role of nephrectomy in metastatic renal cell carcinoma. Experience of the Department of Urology Juan Canalejo Hospital].

OBJECTIVES: We expose our experience in nephrectomy in metastatic renal cell carcinoma, and also show complications, evolution and survival of these patients. MATERIAL AND METHODS: We performe a retrospective review of renal cell carcinoma treated at our service in the period between January 1st 1991 and December 31st 2002. We only studied those which presented in a metastatic pattern (31), and divide these in two groups: the ones which were nephrectomized and those which were not. We try to showw the differences between the two groups in order of status performance (E.C.O.G.), associated morbidity and median survival. In the first group we also study complications of surgery and treatment that patients underwent. RESULTS: we performed nephrectomy in 19 cases, all of them E.C.O.G. 0-1. Median postoperative stay was 12 days, and complication rate was 11.5%. Of these patients, 45% underwent some type of systemic treatment, and median survival was 31 months. We didn't performed nephrectomy in 12 patients, of which 9 were E.C.O.G. 2-3. Associated co-morbidity was higher in this group. Only in three patients any treatment was offered always with palliative reason. Median survival was 3.8 months. CONCLUSIONS: In those patients with good performance status this approach does not represent more morbility nor mortality than in non-metastatic patients, and that is a cornerstone in their management. We also make a literature review in which we see the last pathways in the management of these patients, and that show the needing for a combined approach both quirurgical and inmunotherapical. We have review with special interest the studie's conclusions of SWOG and EORTC groups.

Adult↗

PubMed2001

Surgical complications after primary nephrectomy for Wilms' tumor: report from the National Wilms' Tumor Study Group.

BACKGROUND: Surgical complications are a recognized morbidity of the treatment of patients with Wilms tumor. This study examines the incidence of surgical complications in the most recently completed study from the National Wilms' Tumor Study Group (NWTSG). STUDY DESIGN: The fourth National Wilms' Tumor Study (NWTS-4) enrolled 3,335 patients from August 1986 to August 1994. A random sample of 534 patients was selected from 2,290 eligible patients randomized to treatment regimens or enrolled in the followed category and treated according to NWXTSG protocol. The patient records received at the NWTSG Data and Statistical Center were analyzed for surgical complications (intraoperative and postoperative). RESULTS: Sixty-eight patients (12.7%) experienced 76 complications. Intestinal obstruction was the most common complication (5.1% of patients), followed by extensive hemorrhage (1.9%), wound infection (1.9%), and vascular injury (1.5%). The incidence of surgical complications in NWTS-4 was significantly lower than NWTS-3 (12.7% versus 19.8%, p < 0.001). There has been a marked decrease in the risk of extensive intraoperative bleeding and major intraoperative complications. Factors previously shown to be associated with an increased risk for surgical complications, together with indicators of type of hospital and surgeon specialty, were analyzed by multiple logistic regression analysis. Intravascular extension into the inferior vena cava (IVC), the atrium, or both (p = 0.02; odds ratio [OR] 3.8, 95% confidence interval [CI] 1.2, 11.8), and nephrectomy performed through a flank or paramedian incision (p = 0.02; OR 5.3, 95% CI 1.3, 22) were both associated with increased risk of complications. Tumor diameter greater than or equal to 10cm was also associated with an increased risk of surgical complications (p = 0.05; OR 2.0, 95% CI 1.0, 3.9). The risk of complications was higher if the nephrectomy was performed by a general surgeon (OR 9.0, 95% CI 1.3, 65; p = 0.03) rather than a pediatric surgeon (reference group, OR 1.0) or pediatric urologist (OR 0.7, 95% CI 0.3, 1.8). CONCLUSIONS: The incidence of surgical complications in NWTSG patients undergoing primary nephrectomy has significantly decreased over the past decade. But surgical morbidity should not be overlooked. It is important that surgeons treating young children with solid tumors are aware of their role and the potential risks encountered in removal of the primary tumor. This study found that surgical specialists who primarily treat children can perform these operations with lower surgical morbidity.

Chemotherapy, Adjuvant↗

PubMed2000

Double partial nephrectomy in a patient with two adenocarcinomas in a solitary kidney.

We present a 67 year-old female patient with two synchronous adenocarcinomas in a solitary kidney. She underwent thorough clinical and radiographic evaluation. Selective angiography proved to be the most reliable examination in preoperative diagnosis. Double partial nephrectomy was performed and the patient has normal renal function and no evidence of recurrence 27 months postoperatively. Partial nephrectomy in patients with one tumor in a solitary kidney is well documented, though we believe that partial nephrectomy can also be performed in selected cases with multifocal tumors.

Adenocarcinoma↗

PubMed1987

Effects of dietary fish oil on renal insufficiency in rats with subtotal nephrectomy.

We studied the effects of fish oil on the progression of renal insufficiency in rats with subtotal nephrectomy. Five weeks after a 1-2/3 nephrectomy, sixteen rats were fed two different diets which differed only in fat composition. Lipid in the control diet was primarily beef tallow; that of the experimental diet, menhaden oil. Fish oil-fed rats had significant increases in plasma creatinines, decreases in urinary PGE2 and accelerated death rates. An additional twelve rats underwent 1-1/3 nephrectomies, and the same dietary manipulations, followed by renal clearance, histologic and biochemical studies after 12 weeks on the diets. Fish oil-fed rats again did worse, with decreased glomerular filtration rates and filtration fractions, more proteinuria and more glomerular sclerosis. Glomeruli and slices of cortex, medulla and papillae from rats fed fish oil produced much less PGE2 and TXB2 than dietary controls. Fish oil-induced suppression of renal PGE2 may be deleterious in this model and may outweigh the beneficial effect derived from TXA2 suppression. In contrast to fish oil's potentially therapeutic role in cardiovascular and immune-mediated renal disease, this diet is detrimental in rat renoprival nephropathy. This illustrates the importance of examining the effects of fatty acid manipulation individually for each disease entity.

Animals↗

PubMed1987

Acute adaptative changes to unilateral nephrectomy in humans.

Renal function was monitored in 20, living-related kidney donors before and after uninephrectomy. Urinary protein excretion and retinoid metabolism respectively were studied in 10 and 6 of these donors. The functional adaptation was characterized by an increase in glomerular filtration rate and tubular function, which began in the first two days after uninephrectomy. Changes in tubular function were also demonstrated by significant increases in the urinary excretion of beta 2 microglobulin (beta 2M), retinol binding protein (RBP), kappa and lambda light chains of immunoglobulins. In addition, a protein identical to or homologous to cellular retinoic acid binding protein (CRABP), appeared in the urine after nephrectomy. We did not find CRABP in serum samples either before or after nephrectomy, suggesting that urinary CRABP was synthesized by the remaining kidney. Increases in serum levels of Vitamin A and RBP were also observed in the post-nephrectomy period. These modifications in retinol metabolism suggest that these substances could have a role as renotropic growth factors in compensatory hypertrophy.

Adult↗