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PubMed1977

Plasma renin activity in sheep pregnancy after fetal or maternal nephrectomy.

The effect of bilateral fetal or maternal nephrectomy on basal and diuretic-stimulated plasma renin activity (Pra) was examined in 9 chronically catheterized Dorset sheep. After fetal nephrectomy, there was an initial rapid decrease in fetal PRA with t1/2 of 42-84 min, followed by a slower decrement with 1/2 350-720 min. There was no change in maternal PRA during this period. Similarly, after maternal nephrectomy, the decrease in maternal PRA had two exponential components and there was no associated change in fetal PRA. These data, and the maternal and fetal PRA responses to intravenous furosemide, have demonstrated that renin does not cross the sheep placenta and that fetal PRA is independent of the maternal PRA level.

Animals↗

PubMed1984

Spontaneous regression of pulmonary metastases after nephrectomy for renal cell carcinoma.

A case of spontaneous regression of pulmonary metastases from renal cell carcinoma after nephrectomy is presented. In a 57-year-old Japanese male who had already had pulmonary metastases at the time of nephrectomy, the metastatic lesions disappeared without adjuvant therapy 8 years after nephrectomy. He is still surviving without recurrence or any signs indicative of new metastasis at the present. The clinical aspects of this interesting phenomenon are discussed briefly.

Adenocarcinoma↗

PubMed1987

Embolization and postinfarction nephrectomy in patients with primary metastatic renal adenocarcinoma.

In a phase-II study of the EORTC GU Group 34 patients with metastatic renal cell carcinoma were treated by angioinfarction and delayed nephrectomy. The mortality of the procedure was 5.8%. One patient had a complete remission. 80% of the patients showed progression within 6 months after nephrectomy. The median survival of the patients was 25 weeks, 65% of the patients died within 1 year after nephrectomy.

Adult↗

PubMed1994

Operative strategy in laparoscopic nephrectomy.

Nephrectomy is a debilitating procedure because of the trauma to the abdominal wall. Laparoscopy could be a solution in this matter. Four patients underwent laparoscopic nephrectomy. In 3 patients with renal cancer, the transperitoneal route was used in order to obtain quicker access to the hilus. In the fourth patient with benign disease, a retroperitoneal route was chosen. There was no morbidity or mortality. Mean hospital stay was 5 days. Laparoscopic nephrectomy is safe and effective. Larger series are needed for evaluation of the long-term results in the treatment or renal cancer.

Abdomen↗

PubMedDate not supplied

Hypertension produced by sodium depletion and unilateral nephrectomy: a new experimental model.

Unilateral nephrectomy of sodium-restricted male Sprague-Dawley rats produced a sustained elevation in systolic blood pressure (SBP) that was reversed by sodium repletion. A chronic intraperitoneal infuson of SQ14,225 prevented the development of hypertension in sodium-deplete unilaterally nephrectomized rats. Sodium depletion of two-kidney rats increased SBP to a lesser extent, while unilateral nephrectomy of sodium replete animals had no effect. These results provide evidence for a new model of experimental hypertension in the rat and emphasize the importance of a renal component, as demonstrated by unilateral nephrectomy, in the maintenance of normal pressure-volume relationships.

Animals↗

PubMed1993

Nephrectomy, converting enzyme inhibition, and angiotensin peptides.

To determine the contribution of kidney-derived renin and angiotensin converting enzyme to circulating and tissue levels of angiotensin peptides, we measured angiotensin (Ang)-(1-7), Ang II, Ang-(1-9), and Ang I in plasma, kidney, lung, heart, aorta, brown adipose tissue, adrenal, pituitary, and brain of five groups of male Sprague-Dawley rats: control rats, rats given the converting enzyme inhibitor ramipril (10 mg/kg), rats nephrectomized 24 hours, rats nephrectomized 48 hours, and rats nephrectomized 48 hours and given ramipril. Plasma and tissues, apart from adrenal, showed a 63% to 98% reduction in Ang II, the ratio of Ang II to Ang I, or both after ramipril administration, indicating a major role for converting enzyme in Ang II formation. Nephrectomy caused a more than 95% decrease in plasma renin levels and a fourfold to eightfold increase in plasma angiotensinogen levels. Apart from plasma and brain, tissues showed a 59% to 78% decrease in Ang II levels after nephrectomy, indicating a major role for kidney-derived renin in Ang II formation. The persistence of Ang II in plasma and tissues of anephric rats indicates that Ang II may be formed by a process independent of kidney-derived renin; this process may be amplified by the increased plasma angiotensinogen levels that accompany nephrectomy. For lung, adrenal, and aorta, Ang II levels showed a further decrease when nephrectomized rats were given ramipril. However, for plasma and the other tissues, ramipril produced little or no decrease in Ang II levels of anephric rats, suggesting that Ang II may be formed by a pathway independent of converting enzyme. Such a pathway may involve the direct formation of Ang II from angiotensinogen by a non-renin-like enzyme.

Angiotensin II↗

PubMed1998

Calcitonin gene-related peptide is a depressor in subtotal nephrectomy hypertension.

We previously demonstrated that the neuronal expression of calcitonin gene-related peptide (CGRP), a potent vasodilator, is increased in deoxycorticosterone-salt-induced hypertension where it acts as a compensatory vasodilator to attenuate the elevated blood pressure. To determine whether CGRP is playing a similar role in subtotal nephrectomy-salt-induced hypertension, hypertension was induced in Sprague-Dawley rats (n=6) by subtotal nephrectomy and 1.0% saline drinking water. Control rats (n=6) were sham operated and given tap water to drink. CGRP(8-37), a CGRP receptor antagonist, was used to assess the hemodynamic role of CGRP in this setting. CGRP mRNA and peptide levels in dorsal root ganglia were also determined. Three weeks after either protocol, all rats had intravenous (for drug administration) and arterial (for continuous mean arterial pressure monitoring) catheters surgically placed and were studied in the conscious, unrestrained state. CGRP(8-37) (3.2 or 6.4 x 10(4) pmol/L in 0.1 mL saline) and vehicle were administered intravenously to all rats. Baseline mean arterial pressure was higher in the subtotal nephrectomized rats compared with the controls (173+/-5 versus 113+/-5 mm Hg, P<.001). Vehicle administration did not change mean arterial pressure in either group, and CGRP(8-37) administration did not alter mean arterial pressure in the normotensive group. In contrast, CGRP(8-37) administration to the subtotal nephrectomized rats rapidly increased the already elevated mean arterial pressure at both the 3.2 x 10(4) pmol/L dose (7.8+/-1.1 mm Hg, P<.05) and the 6.4 x 10(4) pmol/L dose (9.6+/-0.8 mm Hg, P<.01). CGRP mRNA and peptide levels in the dorsal root ganglia were not significantly different between the two groups. These data suggest that in subtotal nephrectomy-salt-induced hypertension, CGRP may play a compensatory depressor role in an attempt to lower the elevated blood pressure.

Animals↗

PubMed1981

Suppressive effects of 24,25-dihydroxycholecalciferol on bone resorption induced by acute bilateral nephrectomy in rats.

The possible suppressive effects of 24,25-dihydroxycholecalciferol on secondary hyperparathyroidism and increased bone resorption were investigated in adult rats raised on a diet normal in calcium, phosphorus, and vitamin D, and subjected to acute bilateral nephrectomy. The animals had received subcutaneous radiocalcium 4 wk before the experiment. 5 h after nephrectomy an increase in serum total calcium, (45)Ca-specific activity, citrate, phosphorus, and magnesium concentrations were observed. Serum immunoreactive parathyroid hormone increased, while serum calcitonin decreased. The osteoclast count in the tibial metaphyses was augmented. The biochemical and histological changes observed were partly parathyroid hormone and calcitonin independent, as they also occurred in parathyroidectomized hypocalcemic rats. Pretreatment with 650 pmol of 24,25-dihydroxycholecalciferol 16 h before nephrectomy prevented bone calcium mobilization and diminished the rise in serum total calcium and citrate both in parathyroid-intact and in parathyroidectomized animals. In parathyroid-intact rats, serum immunoreactive parathyroid hormone and calcitonin remained normal in spite of the fall in serum-ionized calcium, and the number of osteoclasts did not increase. In parathyroidectomized rats, 24,25-dihydroxycholecalciferol did not prevent the postnephrectomy rise in the osteoclast count. This latter observation suggests that this metabolite exerts its effect on bone either by acting on cells other than osteoclasts, i.e., the osteocytes, or by inhibiting cell activity. At equimolar dosage 1,25-dihydroxycholecalciferol had a potent stimulatory effect on bone resorption. This effect of 1,25-dihydroxycholecalciferol was partly blocked by the simultaneous administration of 24,25-dihydroxycholecalciferol. The potential clinical significance of these observations remains to be determined.

24,25-Dihydroxyvitamin D 3↗

PubMed2003

Renal cortical adenoma incidentally found during living donor nephrectomy.

We report a living related kidney donor incidentally found to have a renal cortical adenoma at nephrectomy. The patient is a 53-year-old man accepted for living related kidney donation. Predonation workup revealed a solitary left renal artery and, on the right kidney, a main artery with a small accessory artery in theupper pole. No other abnormalities were found in the medical history, physical examination, or laboratory and radiological studies. A left laparoscopic nephrectomy was planned. However, during dissection of the upper pole, a 5-mm mass was noted. The nephrectomy was completed, and the organ was preserved in cold University of Wisconsin solution. Permanent section histology showed that the lesion was mostly likely a renal cortical adenoma. As the risk of malignant transformation with immunosuppression could not be adequately determined, the kidney was not transplanted into the recipient. The donor elected not to have the kidney replaced, and the organ was discarded.

Adenoma↗

PubMed2005

Hand-assisted laparoscopic donor nephrectomy: a low rate of complications.

BACKGROUND: Laparoscopic donor nephrectomy is associated with a higher incidence of ureteral complications. Hand-assisted dissection minimizes the use of instruments for intraoperative retraction and handling of periureteric tissue, and may reduce posttransplant complications. OBJECTIVE: To assess the outcome of hand-assisted laparoscopic donor nephrectomy, in particular ureteral complications. METHODS: Records of 143 kidney transplant recipients who received allografts removed using the hand-assisted laparoscopic technique were retrospectively studied. RESULTS: Total operating time was 2.0 +/- 0.55 (range 1.08-4) hours. Warm ischemia time was 1.45 +/- 0.60 (range 0.58-3.00) minutes. Length of artery, vein, and ureter was 2.4 +/- 0.5 cm, 3.0 +/- 0.5 cm, and 10.3 +/- 2.1 cm, respectively. Estimated blood loss averaged 86.3 +/- 55.6 mL. Intraoperative suction was not needed in 65% of patients. Two donors developed incisional hernias and 1 had a postoperative ileus. Four of 143 (2.8%) recipients developed ureteral complications: reoperations for ureteral necrosis (1), stenting for ureteral stenosis (2), and urethral catheterization for ureterovesical leak (1). Graft loss in the first year after transplantation occurred because of renal vein thrombosis, thrombosis of revised arterial anastomosis, arterial thrombosis due to myocardial infarction, vasculitis, focal segmental glomerulosclerosis, and chronic rejection. Delayed graft function developed in 3 recipients. The acute rejection rate was 14.6%. Mean serum creatinine levels at 1 and 3 years were 134 +/- 61 micromol/L (1.52 +/- 0.69 mg/dL) and 121 +/- 35 micromol/L (1.37 +/- 0.40 mg/dL), respectively. CONCLUSIONS: Hand-assisted laparoscopic donor nephrectomy is associated with a low incidence of ureteral complications; may reduce the technical difficulty of the operation and minimize retraction with instruments, resulting in fewer complications for donors and recipients; and minimizes donor blood loss.

Adolescent↗

PubMed2006

Laparoscopic nephrectomy for giant staghorn calculus with non-functioning kidneys: is associated unsuspected urothelial carcinoma responsible for conversion? Report of 2 cases.

BACKGROUND: Neglected renal stones remain a major cause of morbidity in developing countries. They not only result in functional impairment of affected kidney, but also act as an important predisposing factor for development of urothelial neoplasms. It is not uncommon to miss an associated urothelial tumor in a patient of nephrolithiasis preoperatively. CASE PRESENTATION: In last 3 years, we came across two patients with giant staghorn calculus and poorly functioning kidneys who underwent laparoscopic nephrectomy. In view of significant perirenal adhesions & loss of normal tissue planes both these patients were electively converted to open surgery. The pathological examination of specimen revealed an unsuspected urothelial carcinoma in both these patients. The summary of our cases and review of literature is presented. CONCLUSION: It is important to keep a differential diagnosis of associated urothelial malignancy in mind in patient presenting with long standing renal calculi. The exact role of a computerized tomography and cytology in preoperative workup for detection of possible associated malignancy in such condition is yet to be defined. Similarly if laparoscopic dissection appears difficult during nephrectomy for a renal calculus with non-functional kidney, keeping a possibility of associated urothelial malignancy in mind it is advisable to dissect in a plane outside gerotas fascia as for radical nephrectomy.

Carcinoma, Transitional Cell↗

PubMed1994

Unilateral nephrectomy and cisplatin as risk factors of ifosfamide-induced nephrotoxicity: analysis of 120 patients.

PURPOSE: This study was performed to identify risk factors of ifosfamide-induced renal damage. PATIENTS AND METHODS: Renal function was assessed in 120 patients at a minimum of 3 months after completion of chemotherapy including ifosfamide. The cumulative ifosfamide dose ranged from 2 to 95 g/m2 (median, 30 g/m2). Ten patients had undergone unilateral nephrectomy; combination cytostatic treatment included cisplatin in 51 and methotrexate in 57. Sixty-eight patients had received gentamicin treatment. The glomerular filtration rate was estimated using the Schwartz formula. Proximal tubular function was assessed by the percent reabsorptions of glucose and 16 amino acids, the fractional excretion of sodium, and the fractional reabsorption of phosphate. In addition, the serum bicarbonate level was measured. RESULTS: Proximal tubular dysfunction--with a predominance of renal amino acid (66.3%) and phosphate loss (38.3%)--was much more frequent than both glomerular impairment and acidosis. Seven patients were identified as having renal Fanconi's syndrome, and generalized tubulopathy was noted in another 15 patients. Ifosfamide-induced nephrotoxicity was dose-dependent, with a weak linear inverse correlation between cumulative ifosfamide dose and fractional phosphate reabsorption. Unilateral nephrectomy proved to be the single most important risk factor (odds ratio for the development of renal Fanconi's syndrome, 11.4), but cisplatin also significantly enhanced ifosfamide-mediated nephrotoxicity. Methotrexate, gentamicin, and patient age at primary diagnosis had no influence on renal function. CONCLUSION: Ifosfamide chemotherapy should probably be restricted in patients after unilateral nephrectomy.

Adolescent↗

PubMed1996

Case report: Renal pseudotumours mimicking tumour recurrence after partial nephrectomy.

Partial nephrectomy and tumour enucleation are increasingly accepted as an organ sparing approach for small renal cell carcinomas. Repeated computed tomography or sonography for the early detection of tumour recurrence are mandatory during the follow-up. We report two cases of renal pseudotumour mimicking a tumour recurrence: one case is related to the pseudotumoral appearance on sonography of a tumour defect filled by a fatty flap, and the other to the relative migration of an accessory spleen into the site of the cuneiform nephrectomy. The recognition of renal pseudotumours following partial nephrectomy prevents confusion with tumour recurrence on follow-up examinations.

Adult↗

PubMed2006

Cytoreductive nephrectomy in metastatic renal cell carcinoma.

Metastatic renal cell carcinoma is associated with a poor prognosis and a median survival time of only 6-12 months. However, the emergence of immunotherapies has rekindled interest in cytoreductive nephrectomy as a therapeutic option. Phase III randomized trials have demonstrated that cytoreductive nephrectomy significantly improves overall survival in selected patients with metastatic renal cell carcinoma treated with interferon immunotherapy. While cytokine-based immunotherapy may be considered the standard systemic therapy, clinical studies are ongoing to develop molecular biomarkers and new therapies with improved efficacy and tolerability. With further advances in our understanding of the pathogenesis, behavior and molecular biology of renal cell carcinoma, cytoreductive nephrectomy, in combination with molecular targeted therapies, may become the new standard of care for patients with metastatic renal cell carcinoma.

Carcinoma, Renal Cell↗

PubMedDate not supplied

Effects of the pneumoperitoneum in rats submitted to a unilateral nephrectomy: morphologic and functional study on the remnant kidney.

PURPOSE: The aim of this experimental study is to analyze the morphologic and functional effects of the pneumoperitoneum on the remnant kidney in rats submitted to a unilateral nephrectomy. METHODS: Forty-eight male adults Wistar rats, with an average weight between 240 to 350 g, were distributed in three groups. The rats in Group 1 were subdivided into two other subgroups: Control Group IA and lB. Groups 2 and 3 and respective subgroups included 12 rats each. All animals were anesthetized and submitted to a puncture. Animals in Groups 2 and 3 were submitted to abdominal insufflation with CO2, during 2 and 4 hours respectively, with a constant IAP of 15 mmHg. Rats of the Control Group 1A and 1B were maintained punctured during 2 and 4 hours respectively, however, without insufflation. In the end of this period, a left nephrectomy was performed in all animals. After 4 weeks, a new pneumoperitoneum with the same duration was installed, according to the groups. After 8 weeks, the animals were submitted to euthanasia to remove the remnant kidney. Samples of blood were collected during the whole experiment to evaluated the renal function by dosing serum creatinine. The remnant kidney was analyzed microscopically to evaluate its level of glomerular hypertrophy, the number ofmesangial cells, and to observe the presence of glomerular sclerosis. All groups were kept under observation and the results were submitted to statistical analysis by a longitudinal and transversal comparative study. RESULTS: At the evaluation of residual renal function no significant clinical alteration was seen in rats submitted to pneumoperitoneum during 2 and 4 hours after a period of 8 weeks. The morphologic analysis of the remnant kidney showed no histological renal injury in the groups. CONCLUSION: The function and renal morphology of rats submitted to a unilateral nephrectomy were not significantly influenced by prolonged and successive pneumoperitoneum, according to this study's biochemical and histological findings.

Animals↗

PubMedDate not supplied

Laparoscopic nephrectomy in live donor.

OBJECTIVE: To present the initial experience of videolaparoscopic nephrectomy in live renal donor. MATERIALS AND METHODS: In the period from April 2000 to August 2003, 50 left nephrectomies in live donor were performed by videolaparoscopy for transplantation. Twenty-eight patients were male (56%) and 22 female (44%). Mean age was 37.2 years, and the mean body mass index (BMI) was 27.1 kg/m2. RESULTS: Mean surgical time was 179.5 minutes, and warm ischemia time of the graft was 3.79 minutes. The mean estimated bleeding was 141 mL. There was no need of blood transfusion or conversion to open surgery. In 42 cases (84%), the vascular portion of the graft was considered good by the recipient's surgical team and in all cases, the ureter was considered of proper size, though in one of them (2%) its vascularization was considered improper. The transplanted kidneys produced urine still in the surgical room in 46 of the 50 transplantations considered. In only 2 cases opioid was required for analgesia. In average, 3.1 doses of dipyrone were used for each patient during hospital stay, and hospital discharge occurred, in average, after 3.2 days post-operatively. Two patients required re-operations and one of them evolved to death. CONCLUSIONS: The laparoscopic nephrectomy in live donor for renal transplantation is an alternative to conventional open surgery. In relation to the graft, no alteration, either anatomic or functional, was detected. Though there is already a large documentation in the international literature regarding this procedure, in our setting a prospective randomized study with the usual surgical study is still necessary in order to prove the advantages and disadvantages of the method.

Adult↗

PubMedDate not supplied

Laparoscopic nephrectomy in inflammatory renal disease: proposal for a staged approach.

INTRODUCTION: The present study shows and discusses the preliminary experience of customized and staged approach in the minimally invasive treatment of inflammatory renal diseases, using either pure laparoscopic surgery or the hand-assisted technique. MATERIALS AND METHODS: We prospectively assessed 17 patients with inflammatory renal diseases operated by laparoscopic approach. Mean age was 41 years and the surgical indication was repeated pyelonephritis in 8 cases, pyonephrosis in 4 cases and renal exclusion due to staghorn stone in 5 cases. The staged laparoscopic approach was chosen based on kidney size and on the presence or not of tomographic findings showing significant perirenal infiltration. Thus, retroperitoneal access was chosen in cases where the kidney was smaller than 12 cm or in the absence of signs of significant perirenal infiltration on the computerized tomography. For the remainder, transperitoneal access was employed. RESULTS: Of the 17 patients, 11 underwent laparoscopic nephrectomy by retroperitoneal access, and all cases were successful. Mean surgical time was 160 minutes. In 6 cases where the nephrectomy was performed by laparoscopic transperitoneal access, the use of hand assistance was required. Four surgeries were successfully completed with mean time of 190 minutes and 2 were converted to open surgery with mean time of 220 minutes. CONCLUSION: The laparoscopic nephrectomy for inflammatory renal disease is feasible, but presents a high degree of complexity, requiring a customized approach. The use of hand assistance is an attractive option when the inflammatory process is intense, and can avoid conversions, maintaining the advantages of minimally invasive treatments.

Adult↗

PubMedDate not supplied

Laparoscopic partial nephrectomy for cancer: techniques and outcomes.

Open partial nephrectomy is the gold standard nephron-sparing treatment for small renal tumors. Technical aspects of laparoscopic partial nephrectomy have evolved considerably, and the technique is approaching established status at our institution. Over the past 4 years, the senior author has performed more than 400 laparoscopic partial nephrectomies at the Cleveland Clinic. Herein we present our current technique and review contemporary outcome data.

Cohort Studies↗