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PubMed1980

Increase in placental lactogen and somatomedins after nephrectomy.

To investigate the relationship between renal agenesis and fetal growth retardation, 6 fetal sheep underwent bilateral nephrectomy and carotid artery catheterization between 105 and 125 days of gestation. Five fetal sheep were catheterized at a similar age as controls and all but one were delivered between 134 days and 147 days gestation. The weights of the fetuses did not differ significantly but the nephrectomized fetuses were shorter than their controls (P less than 0.01). Hydranencephaly was observed in two nephrectomized animals and the mean brain weight was reduced in this group (P less than 0.01). Fetal lung weights were likewise reduced (P less than 0.01). The mean plasma concentrations of maternal and fetal immunoreactive insulin and prolactin did not differ significantly in the two groups, nor did fetal ovine growth hormone and maternal ovine placental lactogen, also measured by radioimmunoassay. However, there were greater concentrations of ovine placental lactogen in the plasma of the nephrectomized lambs than in the controls (P less than 0.005). Somatomedin-like receptor activity was measured by receptor assay using [125I] multiplication-stimulating activity. The mean activity in unextracted serum from nephrectomized lambs was greater than that of the controls (p less than 0.05). When the fetal serum was chromatographed on Sephadex G-150 and the eluted fractions assayed for somatomedin-like activity three peaks of activity were observed. Two, with indicated molecular sizes of approximately 100,000 and 10,000 were greater in serum from nephrectomized animals than from the controls (P less than 0.01). The increased concentrations of placental lactogen and somatomedins after nephrectomy suggest that the kidney has a role in clearance of these hormones in the fetus. The growth retardation after fetal nephrectomy may be due to increased binding of somatomedin peptides by serum proteins or to an inhibition of somatomedin action by an unidentified serum component.

Animals↗

PubMed1982

Effect of bilateral nephrectomy on plasma fibronectin levels: its influence on acute fibronectin response to trauma and RE blockade.

Plasma fibronectin is important to reticuloendothelial (RE) function and resistance to experimental shock. However, the factors that regulate its level have remained undefined. The present study evaluated the concept that the kidneys may play a role in the modulation of plasma fibronectin levels. Immunoreactive and opsonically active fibronectin in blood over a 28-hour period following bilateral nephrectomy was assessed in male rats (250-350 gm) by electroimmunoassay, peritoneal macrophage monolayer assay, and liver slice bioassay. Controls consisted of sham-operated rats. An acute 25%-30% fibronectin deficiency was detected within the initial 1-2 hours posttrauma in both experimental and control rats. Thereafter, a significant (P less than 0.05) increase in immunoreactive fibronectin developed by 24 hours which was much greater after bilateral nephrectomy as compared to controls (P less than 0.05). With the peritoneal macrophage assay or with the liver slice assay, the plasma or serum from bilateral nephrectomized rats has greater opsonic activity as compared to controls. This corresponded to increased hepatic RE phagocytic function in vivo after nephrectomy. In the 24-hour postnephrectomized rats, fibronectin decreased acutely after RE blockade or traumatic shock (NCD) indicating it was biologically active. These data suggest that the kidneys may participate in regulating the blood level of this protein, which has a role in reticuloendothelial system function and shock resistance.

Animals↗

PubMed1981

[Stimulation of the renal transport of foreign substances following unilateral nephrectomy].

During the phase of compensation of parenchyma loss two different mechanisms can be stated causing an improvement of renal tubular transport capacity. Besides an increase of tubular transport ratio in kidney slices from nephrectomized rats an increased mass of kidney tissue participated in the augmented transport capacity. 24 h after unilateral nephrectomy TmPAH is elevated from 0.40 +/- 0.10 to 0.61 +/- 0.13 mg/min x g kidney weight. The simultaneous increase in slice-to-medium ratio of renal cortical slices demonstrate the increase in specific transport capacity of regenerating kidney tissue. Furthermore the increase in kidney mass is the reason for an elevated transport capacity. Stimulation of renal PAH excretion by repeated pretreatment with cyclopenthiazide shortened the phase of compensation and raised the extent of tubular transport capacity following partial loss of kidney tissue. The specific accumulation of PAH in renal cortical slices from nephrectomized, cyclopenthiazide pretreated rats is distinctly elevated 96 h after unilateral nephrectomy from 19.4 +/- 2.7 to 24.3 +/- 0.6 micrograms/g kidney weight. Obviously there are different mechanisms for the increased PAH transport caused by stimulation and by regeneration after unilateral nephrectomy, because additional effects can be stated in regenerating rats by additional stimulation of renal tubular transport.

Aminohippuric Acids↗

PubMed1995

Gasless laparoscopy-assisted nephrectomy without tissue morcellation for renal carcinoma.

PURPOSE: The efficacy of gasless laparoscopy-assisted nephrectomy for renal tumors is determined. MATERIALS AND METHODS: Seven patients with renal tumors underwent gasless laparoscopy-assisted nephrectomy. The results were compared to those of patients undergoing open nephrectomy. RESULTS: Although a long operating time was required, convalescence was significantly more rapid. En bloc removal of the kidney and complete pathological examination were possible in all patients. CONCLUSIONS: This procedure may be useful for the treatment of noninvasive renal carcinoma, especially in patients with cardiovascular and/or ventilatory complications. However, long-term followup is necessary to confirm the efficacy in preventing recurrence.

Adult↗

PubMed1995

Laparoscopic nephrectomy using a retroperitoneal approach: comparison with a transabdominal approach.

To evaluate the efficacy of the retroperitoneal approach in laparoscopic nephrectomy, our procedures involving laparoscopic nephrectomy using a retroperitoneal approach are described and the clinical results of six patients treated in this way are compared with those of 32 transabdominally nephrectomized patients. Of the six retroperitoneally nephrectomized patients, six kidneys were successfully removed without severe complication, and 28 kidneys were successfully removed in the 32 intraabdominally approached group. Three of the 28 patients had complications requiring open laparotomy. The operating time was 2.7 hours in the 6 retroperitoneal patients and 4.4 hours in the 28 transabdominal patients. Estimated blood loss was 92 ml in the retroperitoneal group and 450 ml in the transabdominal group. The mean postoperative hospital stay was 8 days and 9 days, respectively. These results indicate that the retroperitoneal approach might be preferable in laparoscopic nephrectomy.

Abdomen↗

PubMed1995

Retroperitoneal endoscopic live donor nephrectomy: report of 3 cases.

In a variation of laparoscopic surgery we performed retroperitoneal surgery using endoscopy and a special retractor in 3 cases of live donor nephrectomy. The procedure using retroperitoneal endoscopy offers several advantages compared to conventional live donor nephrectomy. With the development of retractors to obtain operating space and the further development of surgical techniques retroperitoneal endoscopic live donor nephrectomy can be established as an alternative surgical method for harvesting donated kidneys.

Adult↗

PubMed1995

Pulmonary metastasis of renal cell carcinoma resected sixteen years after nephrectomy.

A 50-year-old man underwent a left nephrectomy for renal cell carcinoma of the clear cell type in February, 1978. He was examined using computed tomography in September, 1993, and was found to have a small coin lesion in his right lung. A fine needle aspiration biopsy failed to disclose any tumor cells. He underwent a video-assisted thoracoscopic biopsy of the right lung in February, 1994, 16 years after his nephrectomy. The resected specimen contained a coin lesion measuring approximately 1 cm in diameter, and the lesion was microscopically diagnosed as a renal cell carcinoma of the clear cell type metastatic to the lung. The patient is doing well with no signs of re-recurrence six months after the resection of the metastatic lesion. To our knowledge, the time interval between his nephrectomy and resection of the metastatic lesion is the longest ever reported in Japan.

Biopsy↗

PubMed1994

Activated angiotensin II generation and regulation in rat mesenteric arteries following nephrectomy.

The objectives of the present study were to test the hypothesis that vascular angiotensin II (AII) generation may be negatively regulated by circulating AII in Wistar-Kyoto rats (WKY) and spontaneously hypertensive rats (SHR), and to clarify the role of this vascular AII in the sustained hypertension seen in SHR following nephrectomy. The mesenteric arteries from kidney-intact and nephrectomised WKY and SHR were perfused, and the level of AII released into the perfusate were measured. The effects of CV-11974, a newly developed nonpeptide AII receptor antagonist, on AII release were examined to investigate the existence of a local feedback system in the blood vessels. Nephrectomy augmented vascular AII release both in WKY and SHR despite the reduction in circulating AII. CV-11974 significantly increased AII release from the mesenteric arteries of kidney-intact rats. There were no significant differences in these responses between WKY and SHR. These results suggest that WKY and SHR share a potent pathway for producing vascular AII in response to the withdrawal of circulating AII, although this pathway is not responsible for the sustained hypertension seen in SHR after nephrectomy.

Angiotensin II↗

PubMed1976

Control of plasma aldosterone in terminal renal failure before and after nephrectomy and after renal transplantation.

In two patients with terminal renal failure the night-day rhythm of plasma aldosterone (PA) renin activity (PRA) and plasma cortisol (PC) were examined before and after bilateral nephrectomy and after renal transplantation. Before nephrectomy changes in abnormally high PA coincided with PC whereas no significant correlation was observed between PA and PRA. In the anephric state secretory episodes of PA occurred independent from those of PC while PRA was undetectable. After renal transplantation a lack of night-day variation in renin secretion was observed in both patients; only one of the two patients showed episodic secretion of PA while PC was suppressed in both patients probably due to the chronic administration of prednisone. Our results indicate, that before nephrectomy under the conditions described in this study plasma aldosterone was predominantly controlled by ACTH. In the anephric state and after renal transplantation other (yet unidentified) factors might have caused episodic secretion of aldosterone. Finally, the lack of night-day variation and secretory episodes in renin secretion after transplantation points to an important role of the sympathetic nervous system in the control of circadian and episodic renal renin release.

Aldosterone↗

PubMed1994

[Computed tomography of the retroperitoneum following nephrectomy for renal cell carcinoma].

CT of the retroperitoneum in 70 patients (98 scans) who had undergone previous nephrectomy for renal cell carcinoma was reviewed. The interval between surgical operation and CT scanning were 15 days-7 years. In 59 cases (84%), CT scans were performed within the first 2 years. After nephrectomy, the emptied renal fossae were filled with adjacent organs, such as colon (27), small intestine (21), liver (14), inferior vena cava (3), adrenal gland (2) on the right side, and spleen (28) small intestine (33), colon (15), tail of pancreas (11), adrenal gland (2) on the left. In 47 cases, where CT scans were done within 4 months after operation, there were abscess/hematoma (8) and soft tissue thickening caused by post-operative edema and or inflammation (6). Most of the early post-operative complications gradually reduced in size in the follow-up scans. Local recurrences or metastases were detected by CT scan in 15 cases, with recurrence at the excision site (5), renal bed (6), adrenal gland (4), retroperitoneal lymph nodes (7) and contralateral kidney (1). 7 patients had solitary lesions and 8 patients had multiple recurrences. In 2 patients, local recurrences were detected by routine follow-up CT scanning. In 4 cases, recurrences were proved by surgery, and the others by clinical follow-up. Local recurrences were assessed within 2 years in 10/15 cases (67%), and 4 cases within 6 months. 9 cases had venous thrombosis (IVC 9, renal vein 3), the size of which was reduced after radiotherapy in 1 case. CT is the most preferred imaging technique in evaluating post-nephrectomy patients for renal cell carcinoma.

Carcinoma, Renal Cell↗

PubMed1994

Unilateral nephrectomy 24 hours after bilateral kidney irradiation reduces damage to the function and structure of the remaining kidney.

The effect of unilateral nephrectomy 24 h after irradiation on renal function and death with renal insufficiency as well as histopathological changes in the kidney was assessed. Single doses totaling 8-18 Gy were given bilaterally to unanesthetized female and male C3Hf/Kam mice. Renal function damage was assayed by blood urea nitrogen (BUN) and hematocrit.(Hct). Histological damage was quantified by two parameters: kidney area and number of surviving tubule cells along the renal capsule. The number of glomeruli was scored as an indication of the number of nephrons. Changes in the two functional parameters did not appear sooner after irradiation in the nephrectomized mice than in the non-nephrectomized mice. Rather, less impairment of function was measured by both parameters in the nephrectomized mice but only after radiation doses greater than 12 Gy. The LD50 at 424 days after irradiation was also higher in the nephrectomized mice than that in the mice receiving only irradiation, 13.98 Gy (95% confidence limits = 12.03, 15.93) and 11.71 Gy (95% confidence limits = 10.4, 13.1), respectively, in agreement with the data on function. Unilateral nephrectomy alone induced a 10% increase in size of the contralateral kidney. The dose-response curve for the kidney area from nephrectomized mice was parallel to and displaced above that for non-nephrectomized mice, indicating that the increase in renal mass occurred independent of and was not compromised by radiation. Unilateral nephrectomy alone induced no increase in the number of proximal tubules in the contralateral kidney. However, tubule survival was higher in nephrectomized mice given doses greater than 12 Gy compared with mice receiving only radiation. Fitting the tubule survival data by maximum likelihood analysis gave D0's of 6.7 Gv (95% confidence limits = 6.3, 7.1 Gy) and 3.7 Gy (95% confidence limits = 3.5, 3.8 Gy) for the irradiated nephrectomized mice and irradiated mice, respectively. However, the number of glomeruli was the same for both groups, suggesting that the number of the nephrons did not change. These data suggest that the improvement in renal function in mice nephrectomized 24 h after irradiation of both kidneys compared to those receiving only irradiation was due to tubule hyperplasia and not renal hypertrophy.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMed1993

Regression of pulmonary and multiple skeletal metastases from renal cell carcinoma by nephrectomy and alpha-interferon therapy: a case report.

We report a rare case of advanced renal cell carcinoma in a patient who showed complete resolution of metastases to the lung and bones after nephrectomy, partial jejunectomy and subsequent alpha-interferon therapy. The patient was a 54-year-old man whose right lung and left femur metastases were detected before nephrectomy. In the seventh week after nephrectomy, a partial jejunectomy was carried out because of the obstructive ileus caused by intraluminal multiple metastases of the jejunum. A pathological fracture of the metastasized right humerus occurred subsequently. After four months of intramuscular alpha-interferon administration (3 x 10(6) units/day), however, x-rays revealed the complete disappearance of the metastatic lung shadow and a solid union of the humerus, and there were no tumor cells in the femur specimen resected at the subsequent reconstruction surgery of the left leg. Seven years have passed from onset, and the patient is still alive and disease free.

Bone Neoplasms↗

PubMed1993

Reflux nephropathy in children submitted to unilateral nephrectomy: a clinicopathological study.

The clinical findings and renal histopathology have been reviewed in children with gross primary vesicoureteric reflux (VUR) submitted to unilateral nephrectomy. Of the 42 children reviewed, sections of the nephrectomy specimens were available in 36. In this series, 34 patients were male and eight were female. The boys included seven in which hydronephrosis was identified by fetal ultrasound. The male patients tended to present earlier and had nephrectomies younger than the females. Segmental scarring was frequent in both males and females, but evidence of dysplastic renal development was confined to the male patients and occurred in the majority (63%). Acquired mechanisms for the induction of segmental renal scarring, involving VUR, intrarenal reflux (IRR) and urinary infection, shown to be important in older children, clearly operate in infancy. However, this study emphasizes that congenital malformation of the kidney is a crucial factor in the development of reflux nephropathy (RN) in this younger age group, particularly in males. Speculation on the significance of the association between renal dysplasia and RN is discussed in relation to observations on the embryological development of the male lower urinary tract.

Age of Onset↗

PubMed1993

[Renal hypertrophy studied by techniques of nuclear medicine in post-nephrectomy patients].

Study of group of 61 patients, nephrectomized as a result of various diseases and who before and three months after surgery underwent blood pressure, effective renal plasma flow (EPFF) and unilateral renal function determinations in order to verify the compensating ability of the remaining kidney. Effective renal plasma flow was determined by a single injection and removal of six serial blood samples with 125-I-Hippuran. Unilateral renal function was determined from the relative uptake of 99mTc-DMSA 24 hours after injection. The patients were divided into four groups according to their overall and unilateral renal function as well as the presence or absence of hypertension. Patients with normal EPFF and symmetrical renal function showed a significantly increase in the function of the remaining kidney after surgery (p < 0.001). Patients with normal or slightly reduced EPFF (< 10%) and highly asymmetrical unilateral function as well as those with decreased EPFF (> 10%) and symmetrical or asymmetrical unilateral renal function did not increased the function of the remaining kidney after nephrectomy, and hypertensive patients whose blood pressure returned to normal values after nephrectomy had a decreased function of the remaining kidney after surgery (< 0.001). It is concluded that it is possible to predict the functional behaviour of the remaining kidney after nephrectomy, and that the compensating ability will basically depend on the previously existing (overall and unilateral) renal function as well as the presence or absence of hypertension.

Blood Flow Velocity↗

PubMed1993

[Recurrence presenting as anuria at 16 years after partial nephrectomy for a pelvic tumor in a solitary kidney: a case report].

A 61-year-old male underwent right partial nephrectomy for a pelvic tumor of a solitary kidney at the former hospital on April 1975. Two years later he had a small bladder tumor and transurethral resection was performed. Since August 1985 he had been followed up in our hospital. On June 1986, the urine cytology showed class V, but neither cystoscopy nor drip infusion pyelography revealed the tumor. On January 1992, he consulted our department with macrohematuria and anuria. Serum creatinine and blood urea nitrogen level were 17.24 mg/ml and 84.1 mg/ml, respectively. Hemodialysis was administered. Retrograde pyelography revealed a defect of tumor at the pyeloureteral junction, and pyuria by ureteral catheterization showed class V cytology. Abdominal CT showed right hydronephrosis caused by the recurrence of pelvic tumor, and right nephrectomy was performed. The histopathological diagnosis was non-papillary transitional cell carcinoma, grade 3 > 2, pT3. He is in good condition with maintenance hemodialysis. In the Japanese literature there were 16 cases of pelvic tumor on the solitary or residual kidneys. In 12 of the 16 cases, kidney sparing treatment was tried and only our case has lived over 10 years. The indication of partial nephrectomy for pelvis tumor was discussed.

Anuria↗

PubMed1995

[Late metastasis in thyroid gland after nephrectomy for renal clear cell carcinoma].

Renal carcinoma natural history is unpredictable. Spontaneous metastases regression after nephrectomy, as well as late recurrence are suggestive of this peculiar human neoplasm. tumor metastases localized to thyroid gland are uncommon in clinical practice; and carcinoma of the kidney, breast, lung, melanoma and gastrointestinal tract tumors are responsible for the majority of them. This paper reports on a patient with metachronous thyroid gland metastases after fourteen years of renal carcinoma nephrectomy, with one year after hemithyroidectomy recurrence on cervical striated muscle followed by surgical excision. Therapeutical aspects are briefly reviewed in literature, emphasizing surgical treatment and the need of all-life follow-up, with more alert attitude toward thyroid gland after renal cell carcinoma nephrectomy.

Aged↗

PubMed1996

Laparoscopic live donor nephrectomy: the initial 3 cases.

PURPOSE: Successful laparoscopic live donor nephrectomy in 3 patients is described. MATERIALS AND METHODS: The procedures were performed completely laparoscopically and the kidneys were extracted via 8 cm. infraumbilical incisions. RESULTS: In all 3 cases warm ischemic time was less than 5 minutes, and the renal vessels and ureter of the harvested kidneys were of adequate length for routine transplantation. Donors required minimal postoperative parenteral analgesia and were discharged home 1 to 3 days after the procedure. All harvested kidneys were successfully transplanted, and functioned well initially and at hospital discharge. CONCLUSIONS: Laparoscopic live donor nephrectomy may be an alternative surgical modality to conventional open nephrectomy. Advantages include less postoperative pain, shorter hospital stay and convalescence, and a more desirable cosmetic result. Additionally, these advantages may encourage more individuals to consider live donation, resulting in an increase in organ supply.

Adult↗

PubMed1996

Nephrectomy for metastatic renal cell carcinoma and surgery for distant metastases.

Renal cell carcinoma has a very heterogeneous behavior. Nearly 30% of the patients are metastatic at the time of diagnosis and approximately 50% of the patients will develop metastases or recurrence after nephrectomy for an apparently localized disease. No prognostic factor is at the moment absolutely reliable in predicting the outcome for an individual patient. Nephrectomy in the presence of metastases is often performed by urologic surgeons in an attempt to prolong life or to improve the quality of life. Induction of spontaneous regression of metastases is very rare and it is still not proven that nephrectomy enhances the response to any systemic therapy. The resection of a solitary metastasis can be beneficial to a few patients although cure remains uncommon. Since no other effective treatment is actually available, metastasectomy can be advocated in a selected group of patients.

Carcinoma, Renal Cell↗