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At least 1,405 records · Page 78Linked to original sources

PubMed1998

Hand-assisted laparoscopic live donor nephrectomy.

Minimally invasive live donor nephrectomy has been described using both standard laparoscopic dissection and "gasless" endoscopically assisted techniques. We report another method, hand-assisted laparoscopic live donor nephrectomy, which uses an occlusive sleeve to maintain pneumoperitoneum. The procedure is performed under excellent laparoscopic visualization in a generous operative field, and is facilitated substantially by manual assistance, which takes advantage throughout the procedure of the incision that is necessary for intact organ removal. The results of our first procedure are encouraging.

Adult↗

PubMed1998

Radiologic follow-up of patients with T1-3a,b,c or T4N+M0 renal cell carcinoma after radical nephrectomy.

OBJECTIVES: To determine the pattern of disease recurrence after radical nephrectomy in patients with node-positive renal cell carcinoma (RCC) in order to design a schedule for subsequent radiologic evaluation. METHODS: We reviewed the postoperative radiologic studies of 45 patients with T1-3a,b,c or T4N+M0 RCC enrolled in a prospective trial of adjuvant autolymphocyte therapy (ALT) after radical nephrectomy for node-positive disease. Chest radiograph and abdominal computed tomography (CT) were performed quarterly, and bone scan and head CT were performed every 6 months until disease recurrence, or earlier if clinically indicated. Time from surgery to recurrence and sites of recurrence were analyzed. RESULTS: Twenty-nine patients (64%) had disease progression, with a mean time to progression of 14.9 months. Mean follow-up of patients without progression was 39 months. The sites of recurrence were retroperitoneal lymph nodes (n=14), lung (n=11), liver (n=5), bone (n=5), mediastinal lymph nodes (n=4), renal fossa (n=3), pelvis (n=2), brain (n=2), contralateral kidney (n=1), retrocecum (n=1), and skin (n=1). Fourteen patients had recurrence at more than one site. Of the patients whose disease progressed, 59% did so by 12 months, 83% by 24 months, and 93% by 36 months. Mean time to progression in the ALT group was delayed compared with the observation group, but the sites of disease recurrence were not different between the two groups. Abdominal CT alone detected recurrent lesions in 79% of patients with progression, and the combination of abdominal CT and chest radiograph detected lesions in 100% of patients with progression. CONCLUSIONS: Abdominal CT with chest radiograph detects recurrence in all patients with T1-3a,b,c or T4N+M0 RCC whose disease progresses, and more than 90% of recurrences occur within the first 3 years after surgery. We recommend abdominal CT and chest radiograph every 6 months for at least 3 years and yearly thereafter in this high-risk group of patients.

Carcinoma, Renal Cell↗

PubMed2000

Laparoscopic nephrectomy for autotransplantation.

Proximal ureteral injuries often require extensive reconstruction to repair. Management options include nephrectomy, ileal ureter interposition, extensive spiral bladder flaps, or autotransplantation. We report a patient who sustained a proximal ureteral avulsion and underwent a less invasive repair by way of a laparoscopic nephrectomy and subsequent autotransplantation.

Adult↗

PubMed1998

Retroperitoneal laparoscopic nephrectomy.

When removal of a kidney is indicated for symptomatic end-stage renal disease of benign etiology, laparoscopic nephrectomy by the retroperitoneal approach is increasingly being employed as the technique of choice at many centers. Emerging data indicate that, in select patients with T1-T3aN0M0 renal tumors < 8 cm, retroperitoneal laparoscopic radical nephrectomy may be a viable treatment option.

Contraindications↗

PubMed1985

Long-term follow-up of patients who underwent unilateral nephrectomy in childhood.

The long-term damaging potential of remnant nephron hyperperfusion was investigated in patients who had undergone unilateral nephrectomy in childhood. 27 such patients were examined after a mean of 23.3 years postnephrectomy. The average creatinine clearance was 83.9 +/- 16.5 ml/min/1.73 m2 or 74.3% of that in healthy controls with two kidneys; it was a value similar to that reported 3 to 6 months postnephrectomy in kidney donors. Age at the time of nephrectomy, duration of follow-up, or sex had no influence on the residual creatinine clearance. None of these patients had clinically important hypertension or proteinuria. Since so little evidence of kidney damage could be documented after such a long observation period, hyperperfusion would seem to be seldom of clinical importance in man unless other factors were present.

Adaptation, Physiological↗

PubMed2006

[Transperitoneal laparoscopic partial nephrectomy in the renal tumor treatment].

Laparoscopic surgery is a surgical technique the urologist should add to his surgical armamentarium. Its performance tries to mimic the surgical phases of open surgery, and also its indications. Laparoscopic partial nephrectomy is a sophisticated technique that requires wide experience in the performance of endoscopic strategies. We are submitting our experience with 35 laparoscopic partial transperitoneal nephrectomies with a mean follow-up of 25 months. The mean surgical time was 200 minutes, the mean bleeding 190 cc, and the mean hospitalisation five days. Two postoperative bleedings were identified, there were no conversions, and positive margins were notified in two cases, where upon a conservative attitude was adopted.

Adult↗

PubMed2006

[Laparoscopic partial nephrectomy: technique and outcomes].

The indication of laparoscopic partial nephrectomy (LPN) has evolved considerably, and the technique is approaching established status at our institution. Over the past 5 years, the senior author has performed more than 450 laparoscopic partial nephrectomies at the Cleveland Clinic. Herein we present our current technique, review contemporary data and oncological outcomes of LPN.

Humans↗

PubMed1993

Budd-Chiari syndrome in autosomal dominant polycystic kidney disease: a complication of nephrectomy in patients with liver cysts.

We report two patients with autosomal dominant polycystic kidney disease (ADPKD) who developed the Budd-Chiari syndrome following bilateral nephrectomy. Both patients had massive cystic enlargement of the liver. Neither had any other identifiable risk factors for the Budd-Chiari syndrome. We suggest that removal of the kidneys may predispose toward anatomic obstruction of the inferior vena cava or hepatic veins by liver cysts. Nephrectomy should be approached cautiously in ADPKD patients with extensive involvement of the liver by cysts.

Adult↗

PubMed1996

Malignant vascular disease of the kidney: nature of the lesions, mediators of disease progression, and the case for bilateral nephrectomy.

A case of thrombotic microangiopathy presenting as a hemolytic uremic syndrome complicated by untreatable hypertension and ultimately requiring bilateral nephrectomy is discussed. Severe hypertension and renal failure may complicate the course of vascular diseases of the kidney, including thrombotic microangiopathy, chronic hypertension, and scleroderma. Toxins, pressure stress, and immune material may trigger the initial injury to vascular endothelium. The malignant course of these renal vascular diseases seems linked to the severity of vascular injury. Endothelial injury manifests with swelling and detachment of endothelial cells from the basement membrane, expansion of the subendothelial space, and newly formed basement membrane-like material. In arterioles, endothelial injury precedes myointimal swelling and proliferation, leading to vascular lumina narrowing or obliteration and secondary glomerular ischemia, with glomerular tuft collapse and garland-like wrinkling and thickening of the capillary wall. Endothelial cell injury is very likely the common determinant of a cascade of events that lead to irreversible renal failure. When the initial insult (toxins, mechanical stress, antibodies) is promptly removed, lesions are self-limiting and the patient usually recovers. However, a severe insult persisting for some time can lead to chronic and irreversible vascular lesions that, through renal ischemia, trigger maximal activation of the renin angiotensin system with a brisk elevation in arterial blood pressure that may combine to further vascular injury and renal ischemia. Moreover, enhanced shear stress in the severely narrowed microcirculation, through abnormal von Willebrand factor processing, can also favor endothelial injury and platelet aggregation, which may further worsen the vascular lesions and sustain the microangiopathic process. Plasma manipulation, arteriolar vasodilators, and angiotensin-converting enzyme inhibitors normally control the vicious circle, but in few severe cases bilateral nephrectomy remains the last chance to save the patient's life.

Adult↗

PubMed1995

Increased sensitivity to bilateral nephrectomy in rat caused by endotoxemia.

In this study the possibility that the kidneys play a role in the removal of endotoxin from the blood was examined. This was carried out by an IP injection of endotoxin (at a dosage of 1 mg/100 gr) to rats that had undergone bilateral nephrectomy, and examining the times of death following various treatments. Furthermore, the rats underwent treatment for endotoxin tolerance or received treatment with the antioxidants superoxide dismutase (SOD) and natural antioxidant (NAO) or were injected with an inhibitor of the enzyme NOS (NGmethyl l-arginine 1-NMA). The endotoxin concentration in the plasma was also measured. The results of this study indicate the rats were more sensitive to bilateral nephrectomy in the presence of endotoxin. This increased sensitivity in the binephrectomized rat decreases following treatment inducing tolerance to endotoxin, or following treatment with an antioxidant or with the inhibitor of NOS. A possible explanation for the increased sensitivity following endotoxin injection is that it apparently results from an increased concentration of endotoxin in the blood due to the impossibility of removing the endotoxin via the kidneys. Therefore, endotoxin tolerance or abolishing the potential injuries that may be caused by endotoxin negate the sensitivity in the binephrectomized rats injected with endotoxin.

Animals↗

PubMed1997

Renal function in the noninsulin-dependent diabetic rat: effects of unilateral nephrectomy.

A new model of noninsulin-dependent diabetic (NIDD) is described which exhibits more prominent defects in renal function than does the standard neonatal NIDD model. To produce this model, 2-day-old neonatal male Wistar Kyoto (WKY) rats were injected intraperitoneally with streptozotocin (90 mg/kg; NIDD), while their corresponding nondiabetic controls were administered vehicle (citrate buffer, pH: 4.5; control). At 3 weeks of age, the animals were weaned, and 1 week later, under ether anesthesia, the animals underwent a right nephrectomy or a sham operation. Diabetes was confirmed by intraperitoneal administration of a glucose load (2g/kg), which resulted in significantly higher blood glucose concentration in the NIDD, compared to the nondiabetic rats. Surgical reduction of renal mass had no effect on the glycemic response to a glucose tolerance test in either group. Intravenous administration of an isotonic saline load resulted in a similar pattern of enhanced sodium and fluid excretion in the two-kidney sham-operated nondiabetic and NIDD rats. These responses were significantly higher than those observed in their counterparts with one remaining kidney. Yet, the natriuretic and diuretic responses to the saline load were significantly lower in the nephrectomized NIDD, compared to the nephrectomized nondiabetic rats. The glomerular filtration rate was similar in the sham-operated (two kidneys) NIDD and nondiabetic rats. In contrast, both the basal and saline-stimulated glomerular filtration rate were lower in the nephrectomized NIDD rats compared to the nephrectomized nondiabetic group. Mean arterial pressure was similar between the two nephrectomized groups, thereby ruling out a significant contribution from the pressure-diuresis-natriuresis mechanism to the reduction in sodium and fluid excretion in the nephrectomized NIDD rats. Thus, unilateral nephrectomy is an effective method of accelerating the manifestation of NIDD-related renal alterations. The mild, but progressive, nature of diabetes in this model should facilitate the investigation of temporal changes in renal function in NIDDM.

Animals↗

PubMed2001

Technique of right laparoscopic donor nephrectomy: a single center experience.

The majority of laparoscopic donor nephrectomies (LDNs) are limited to the left side due to technical and allograft concerns in using the right. We review our experience with right LDNs. Since June 1997, 15 right LDNs were performed and the records retrospectively reviewed for demographics, operative time, transfusions, complications, and length of stay. Recipient records were also reviewed for delayed graft function, complications, and serum creatinine levels. Overall donor, recipient and graft survivals at 6 months are 100%. Mean operative time was 317 +/- 11.0 min, length of stay was 4.2 +/- 0.2 d, and mean serum creatinine levels at discharge, 1, 3, and 6 months were 1.74 +/- 0.19, 1.59 +/- 0.13, 1.72 +/- 0.13, and 1.68 +/- 0.13 mg/dL, respectively. No transfusions were required. There were no operative or hospital complications. Two recipients (13.3%) experienced delayed graft function, defined as requiring hemodialysis post-transplantation. With hand-assisted laparoscopy, the right laparoscopic donor nephrectomy is safe and allows excellent allograft function.

Adult↗

PubMed1976

Effects of nephrectomy on renal salt and water transport in the remaining kidney.

Fluid, sodium, and potassium transport was studied in proximal and distal tubules in rats in which one kidney had been removed two weeks after a suprarenal aortic clamp had been placed to prevent adaptive changes in glomerular filtration rate (GFR) in the experimental kidney. Free-flow micropuncture techniques were used and tubular fluid (TF) samples analyzed for inulin, sodium and potassium. In addition, peritubular total protein concentrations and luminal and peritubular hydrostatic pressures were measured. The following changes were observed 15 hr after unilateral nephrectomy: (1) a significant increase in single nephron GFR; (2) unchanged absolute proximal tubular reabsorption rates of fluid and sodium; (3) increased delivery of fluid into distal tubules; (4) increased distal tubular reabsorption of sodium, but of insufficient magnitude to prevent natriuresis; and (5) an augmentation of distal tubular potassium secretion. Reduction of single nephron GRF to control levels by aortic clamping abolished the natriuresis following nephrectomy.

Animals↗

PubMed1983

Unilateral nephrectomy and 1,25-dihydroxyvitamin D3.

Several renal functions respond to nephron loss by a compensatory adaptation. Whether the production of 1,25(OH)2D3 also adapts to a renal mass reduction is still a matter of controversy. In the present study we have investigated in rats the influence of unilateral nephrectomy, in both the acute (48 hr) and chronic (2 to 6 weeks) state, on plasma 1,25(OH)2D3 level measured by competitive protein binding assay. In the acute state no difference in plasma 1,25(OH)2D3 level between sham-operated (SHAM) and unilateral-nephrectomized (UNI-NX) rats was found. The presence of the thyroparathyroid glands was not required for maintaining plasma 1,25(OH)2D3 at a normal level 48 hr after UNI-NX. In the chronic state in rats fed at 1.1% Ca diet, plasma 1,25(OH)2D3 (means +/- SEM) was 94 +/- 4 in SHAM and 98 +/- 8 pM in UNI-NX. In rats fed a 0.1% Ca diet it was 252 +/- 16 in SHAM and 239 +/- 20 pM in UNI-NX. Analysis of 3H-1,25(OH)2D3 plasma decay curve indicated that in UNI-NX under a high calcium diet the normalization of plasma 1,25(OH)2D3 appears to be entirely due to an increase in production, whereas under a low calcium diet part of it may also result from a moderate decrease in the elimination rate. In conclusion, this study indicates that unilateral nephrectomy does not affect the level of plasma 1,25(OH)2D3 even under a calcium restriction challenge. This compensatory adaptation appears to be independent of parathyroid hormone.

Animals↗

PubMed1983

Focal glomerulosclerosis in patients with unilateral nephrectomy.

To investigate whether proteinuria and focal glomerulosclerosis (FSG) might develop in humans as well as in experimental models following a reduction in renal mass, we performed a retrospective study of 24 patients previously nephrectomized for unilateral renal disease. None of the patients presented signs of systemic diseases. Alport syndrome, essential hypertension, reflux nephropathy, and other abnormalities on intravenous pyelography. At the time of the first observation seven patients had pathological proteinuria (group 1) while 17 presented a normal protein excretion (group 2). All patients in group 1 and only 4 of 17 in group 2 were male. No other significant differences were found between the two groups. The median age at nephrectomy of the proteinuric patients was 22.3 years, and proteinuria developed after a mean period of 12.2 years. A renal biopsy was performed in four patients and showed a constant pattern of FSG. After a mean follow-up period of 7.3 years from the onset, proteinuria remains unchanged and renal function is well preserved in all the patients. In conclusion our series suggests that also in humans proteinuria and FSG might appear in solitary kidneys due to nephrectomy. This glomerular damage may result from the association of glomerular overload with other unidentified factors.

Adult↗

PubMed1987

Effect of dietary lipids on renal function in rats with subtotal nephrectomy.

Female rats with 1-3/4 nephrectomy were divided in two groups and pair fed for five weeks diets differing in their linoleic acid content. Five weeks after subtotal nephrectomy, values for glomerular filtration rate and renal plasma flow were significantly higher and the values of blood pressure significantly lower in rats fed a diet rich in linoleic acid. Systolic blood pressure averaged 156 +/- 5.6 mm Hg in high and 215 +/- 8.1 mm Hg in low linoleic acid-fed rats. Differences in the values of blood pressure between the two groups were observed three weeks after subtotal renal ablation and persisted throughout the period of observation. Inulin clearance averaged 0.89 +/- 0.07 ml/min in the high and 0.44 +/- 0.05 ml/min in the low linoleic acid group. Protein excretion in the urine was significantly less in rats fed the high linoleic acid diet (36.9 +/- 4.4 mg/24 hr) than in those fed the low linoleic acid diet (90.1 +/- 12.5 mg/24 hr). The weight of the remnant kidney five weeks after subtotal renal ablation was greater in rats fed a low linoleic acid diet as compared to those fed a high linoleic acid diet (P less than 0.05). Glomerular lesions were more severe in rats fed a low linoleic acid diet than in those fed a high linoleic acid diet. Feeding high linoleic acid diets to normal and subtotally nephrectomized rats increased the content of linoleic and arachidonic acid in renal cortex and medulla.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1993

Number and dimensions of rat glomerular capillaries in normal development and after nephrectomy.

Glomerular capillary growth was studied in kidneys in five- to 540-day-old perfusion-fixed normal or sham-operated rats (C) as well as in unilaterally nephrectomized three-day-old (NN) and 120-day-old (NA) rats. The number and volume of mature glomeruli were estimated using the fractionator. The glomerular number was unaffected by neonatal or adult nephrectomy, but the number of mature glomeruli in all rats aged five days (19.1 +/- 2.0 x 10(3); +/- SD) was significantly smaller than for all the older animals (26.5 +/- 3.1 x 10(3)). The mean glomerular volume increased 59% and 20% for the NN and NA rats, respectively, versus the C rats. A capillary unit has been defined according to the number of loops in the glomerular capillary network by the use of topology. Glomerular capillary number, estimated using a physical disector, increased 53% for NN rats and 26% for NA rats. The glomerular capillary length was estimated on isotropic, uniform random sections, and increased 47% for NN rats and 12% for NA rats. The glomerular capillary surface area increased 54% for NN rats and 14% for NA rats. The diameter of the glomerular capillaries increased 8% for the mature NN versus the C rats. The rather unexpected findings are discussed and related to interesting relationships, including the law of Poiseuille and LaPlace. In conclusion, the growth of glomerular capillaries after neonatal and adult nephrectomy is performed by branching that is making new glomerular capillaries, instead of simply lengthening the existing capillaries.

Aging↗

PubMed1994

Dietary protein alters tubular iron accumulation after partial nephrectomy.

Reactive oxygen species (ROS) have been implicated in progression of disease in the rat remnant kidney (RK) model of chronic renal failure. Substantial amounts of iron accumulate in proximal tubular lysosomes of RK and could damage tubules by ROS generation. The effect of dietary protein intake on ROS, tubular damage and iron accumulation assessed by energy dispersive analysis was determined in RK (5/6 nephrectomy, N = 12) and sham-operated kidneys (SO, N = 10). In RK, mean lysosomal iron concentration, urinary iron and protein excretion and morphological damage were increased and GFR decreased. Dietary protein loading (40% vs. 12%) increased the number of iron-containing lysosomes (P < 0.05) and the mean lysosomal iron (P < 0.02) in proximal tubular cells after four weeks. In RK, high protein diet increased renal weight (P < 0.01), numerical density of iron-containing lysosomes and tubular damage (both P < 0.05). ROS generation, assessed by tissue and plasma malondialdehyde (MDA), was also increased (both P < 0.05). Plasma MDA correlated with tubular iron accumulation (r = 0.75). In RK fed a high protein diet (N = 18) treatment with the iron-chelator desferrioxamine reduced serum iron, urinary volume, and tubular iron accumulation and damage compared to controls (P < 0.01). In summary, in RK dietary protein manipulation altered urinary iron and protein excretion, proximal tubular iron accumulation, renal cortical ROS generation and ultrastructural damage. Desferrioxamine treatment reduced tubular lysosomal iron and ultrastructural damage. These results suggest a role for tubular iron as a determinant of tubular injury associated with dietary protein loading in rats with partial nephrectomy.

Animals↗