What Happens to the Preserved Renal Parenchyma After Clamped Partial Nephrectomy?

被引:25
作者
Xiong, Longbin [1 ,2 ,3 ]
Nguyen, Jane K. [4 ]
Peng, Yulu [1 ,2 ,3 ]
Zhou, Zhaohui [1 ,2 ,3 ]
Ning, Kang [1 ,2 ,3 ]
Jia, Nan [5 ]
Nie, Jing [5 ]
Wen, Dongxiang [2 ,3 ]
Wu, Zeshen [1 ,2 ,3 ]
Roversi, Gustavo [6 ]
Palacios, Diego Aguilar [6 ]
Abramczyk, Emily [6 ]
Munoz-Lopez, Carlos [6 ]
Campbell, Jack A. [6 ]
Cao, Yun [2 ,3 ,7 ]
Li, Wencai [8 ]
Zhang, Xuepei [8 ]
He, Zhisong [9 ]
Li, Xiang [10 ]
Huang, Jiwei [11 ]
Shou, Jianzhong [12 ]
Wu, Jitao [13 ]
Chen, Minfeng [14 ]
Chen, Xiaofeng [15 ]
Zheng, Jiaxuan [16 ]
Xu, Congjie [16 ]
Zhong, Wen [17 ]
Li, Zaishang [18 ,19 ]
Dong, Wen [20 ]
Zhao, Juping [21 ]
Zhang, Hailang [22 ,23 ]
Luo, Junhang [24 ]
Liu, Jianye [25 ]
Sun, Fanghu [26 ]
Han, Hui [1 ,2 ,3 ]
Guo, Shengjie [1 ,2 ,3 ]
Dong, Pei [1 ,2 ,3 ]
Zhou, Fangjian [1 ,2 ,3 ]
Yu, Chunping [1 ,2 ,3 ]
Campbell, Steven C. [6 ]
Zhang, Zhiling [1 ,2 ,3 ]
机构
[1] Sun Yat Sen Univ Canc Ctr, Dept Urol, Dongfengdonglu 651, Guangzhou, Peoples R China
[2] State Key Lab Oncol Southern China, Guangzhou, Peoples R China
[3] Collaborat Innovat Ctr Canc Med, Guangzhou, Peoples R China
[4] Cleveland Clin, Robert J Tomsich Pathol & Lab Med Inst, Dept Anat Pathol, Cleveland, OH 44106 USA
[5] Southern Med Univ, Nanfang Hosp, Natl Clin Res Ctr Kidney Dis, Div Nephrol,State Key Lab Organ Failure Res, Guangzhou, Peoples R China
[6] Cleveland Clin, Glickman Urol & Kidney Inst, Dept Urol, Cleveland, OH 44106 USA
[7] Sun Yat Sen Univ Canc Ctr, Dept Pathol, Guangzhou, Peoples R China
[8] Zhengzhou Univ, Affiliated Hosp 1, Dept Urol, Zhengzhou, Henan, Peoples R China
[9] Peking Univ First Hosp, Dept Urol, Beijing, Peoples R China
[10] Sichuan Univ, West China Hosp, Dept Urol, Chengdu, Sichuan, Peoples R China
[11] Shanghai Jiao Tong Univ, Renji Hosp, Dept Urol, Shanghai, Peoples R China
[12] Chinese Acad Med Sci, Dept Urol, Canc Hosp, Beijing, Peoples R China
[13] Yantai Yuhuangding Hosp, Dept Urol, Yantai, Shandong, Peoples R China
[14] Cent South Univ, Dept Urol, Xiangya Hosp, Changsha, Peoples R China
[15] First Peoples Hosp Chenzhou, Dept Urol, Chenzhou, Hunan, Peoples R China
[16] Hainan Gen Hosp, Dept Pathol, Haikou, Hainan, Peoples R China
[17] Guangzhou Med Univ, Affiliated Hosp 1, Dept Urol, Guangzhou, Peoples R China
[18] Southern Univ Sci & Technol, Shenzhen Peoples Hosp, Affiliated Hosp 1, Dept Urol, Shenzhen, Guangdong, Peoples R China
[19] Jinan Univ, Clin Coll 2, Dept Urol, Shenzhen, Peoples R China
[20] Sun Yat Sen Univ, Sun Yat Sen Mem Hosp, Dept Urol, Guangzhou, Peoples R China
[21] Shanghai Jiao Tong Univ, Ruijin Hosp, Sch Med, Dept Urol, Shanghai, Peoples R China
[22] Fudan Univ, Shanghai Canc Ctr, Dept Urol, Shanghai, Peoples R China
[23] Fudan Univ, Shanghai Med Coll, Dept Oncol, Shanghai, Peoples R China
[24] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Urol, Guangzhou, Peoples R China
[25] Cent South Univ, Xiangya Hosp 3, Dept Urol, Changsha, Hunan, Peoples R China
[26] 1 Hosp Lian Yungang, Dept Urol, Lianyungang, Jiangsu, Peoples R China
基金
中国国家自然科学基金;
关键词
Partial nephrectomy; Chronic kidney disease; Pathological scores; Renal functional; Ischemia; CHRONIC KIDNEY-DISEASE; OUTCOMES; ISCHEMIA; INJURY; PROGRESSION; CARCINOMA; REMOVAL; MASS;
D O I
10.1016/j.eururo.2021.12.036
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background: Most partial nephrectomies (PNs) are performed with hilar occlusion to reduce blood loss and optimize visualization. However, the histologic status of the preserved renal parenchyma years after PN is unknown. Objective: To compare the histologic chronic kidney disease (CKD) score of renal parenchyma before and years after PN, and to explore factors associated with CKD-score increase and glomerular filtration rate (GFR) decline. Design, setting, and participants: A retrospective review of 147 renal cell carcinoma patients who underwent PN and subsequent radical nephrectomy (RN) due to tumor recurrence was performed in 19 Chinese centers and Cleveland Clinic. Macroscopic normal renal parenchyma was evaluated at least 5 mm away from the tumor in PN specimens and at remote sites in RN specimens. Intervention: PN/RN and ischemia. Outcome measurements and statistical analysis: Histologic CKD score (0-12) represents a summary of glomerular/tubular/interstitial/vascular status. Predictive factors for a substantial increase of CKD score (>= 3) were evaluated by logistic regression. Results and limitations: Sixty-five patients with all necessary data were analyzed. The median interval between PN and RN was 2.4 yr. Median durations of warm ischemia (n = 42) and hypothermia (n = 23) were both 23 min. The histologic CKD score was increased after RN in 47 (72%) patients, with 29 (45%) experiencing more substantial increase (>= 3). There was no significant difference in the change of CKD score related to the type and duration of ischemia (p = 0.7 and p = 0.4, respectively) or interval from PN to RN (p > 0.9). However, patients with comorbidities of hypertension, diabetes, and/or pre-existing CKD (hypertension [HTN]/diabetes mellitus [DM]/CKD) demonstrated increased rate and extent of CKD-score increase. On univariate analysis, HTN/DM/CKD was the only predictor of a substantial CKD-score increase (odds ratio: 3.53 [1.12-11.1]). Decline of GFR was modest and similar between patients with/without a substantial CKD-score increase. Conclusions: Within the context of conventional, limited durations of ischemia, histologic deterioration of preserved parenchyma after PN appears to be primarily due to pre-existing medical comorbidities rather than ischemia. A subsequent decline in renal function was mild and independent of histologic changes. Patient summary: After clamped PN, the preserved renal parenchyma demonstrated histologic deterioration in many cases, which correlated with the presence of comorbidities such as hypertension, diabetes mellitus, or chronic kidney disease. In contrast, the type and duration of ischemia did not correlate with histologic changes after PN, suggesting that ischemia insult had only limited impact on parenchyma deterioration. (C) 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.
引用
收藏
页码:492 / 500
页数:9
相关论文
共 38 条
  • [1] Histological Analysis of the Kidney Tumor-Parenchyma Interface
    Azhar, Raed A.
    Abreu, Andre Luis de Castro
    Broxham, Eric
    Sherrod, Andy
    Ma, Yanling
    Cai, Jie
    Gill, Tania S.
    Desai, Mihir
    Gill, Inderbir S.
    [J]. JOURNAL OF UROLOGY, 2015, 193 (02) : 415 - 422
  • [2] Renal Mass and Localized Renal Cancer: AUA Guideline
    Campbell, Steven
    Uzzo, Robert G.
    Allaf, Mohamad E.
    Bass, Eric B.
    Cadeddu, Jeffrey A.
    Chang, Anthony
    Clark, Peter E.
    Davis, Brian J.
    Derweesh, Ithaar H.
    Giambarresi, Leo
    Gervais, Debra A.
    Hu, Susie L.
    Lane, Brian R.
    Leibovich, Bradley C.
    Pierorazio, Philip M.
    [J]. JOURNAL OF UROLOGY, 2017, 198 (03) : 520 - 529
  • [3] Acute Kidney Injury and Chronic Kidney Disease as Interconnected Syndromes
    Chawla, Lakhmir S.
    Eggers, Paul W.
    Star, Robert A.
    Kimmel, Paul L.
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2014, 371 (01) : 58 - 66
  • [4] AGE CHANGES IN GLOMERULAR FILTRATION RATE, EFFECTIVE RENAL PLASMA FLOW, AND TUBULAR EXCRETORY CAPACITY IN ADULT MALES
    DAVIES, DF
    SHOCK, NW
    [J]. JOURNAL OF CLINICAL INVESTIGATION, 1950, 29 (05) : 496 - 507
  • [5] Chronic Kidney Disease Due to Surgical Removal of Nephrons: Relative Rates of Progression and Survival
    Demirjian, Sevag
    Lane, Brian R.
    Derweesh, Ithaar H.
    Takagi, Toshio
    Fergany, Amr
    Campbell, Steven C.
    [J]. JOURNAL OF UROLOGY, 2014, 192 (04) : 1057 - 1062
  • [6] AKI on CKD: heightened injury, suppressed repair, and the underlying mechanisms
    He, Liyu
    Wei, Qingqing
    Liu, Jing
    Yi, Mixuan
    Liu, Yu
    Liu, Hong
    Sun, Lin
    Peng, Youming
    Liu, Fuyou
    Venkatachalam, Manjeri A.
    Dong, Zheng
    [J]. KIDNEY INTERNATIONAL, 2017, 92 (05) : 1071 - 1083
  • [7] Impact of Comorbidities on Functional Recovery from Partial Nephrectomy
    Isharwal, Sudhir
    Ye, Wenda
    Wang, Alice
    Abraham, Joseph
    Zabell, Joseph
    Dong, Wen
    Wu, Jitao
    Suk-Ouichai, Chalairat
    Caraballo, Elvis R.
    Gao, Tianming
    Campbell, Steven C.
    [J]. JOURNAL OF UROLOGY, 2018, 199 (06) : 1434 - 1440
  • [8] Long-term response to renal ischaemia in the human kidney after partial nephrectomy: results from a prospective clinical trial
    Kallingal, George J. S.
    Weinberg, Joel M.
    Reis, Isildinha M.
    Nehra, Avinash
    Venkatachalam, Manjeri A.
    Parekh, Dipen J.
    [J]. BJU INTERNATIONAL, 2016, 117 (05) : 766 - 774
  • [9] Robot-assisted Laparoscopic Partial Nephrectomy: Step-by-step Contemporary Technique and Surgical Outcomes at a Single High-volume Institution
    Kaouk, Jihad H.
    Khalifeh, Ali
    Hillyer, Shahab
    Haber, Georges-Pascal
    Stein, Robert J.
    Autorino, Riccardo
    [J]. EUROPEAN UROLOGY, 2012, 62 (03) : 553 - 561
  • [10] Comparative Outcomes and Assessment of Trifecta in 500 Robotic and Laparoscopic Partial Nephrectomy Cases: A Single Surgeon Experience
    Khalifeh, Ali
    Autorino, Riccardo
    Hillyer, Shahab P.
    Laydner, Humberto
    Eyraud, Remi
    Panumatrassamee, Kamol
    Long, Jean-Alexandre
    Kaouk, Jihad H.
    [J]. JOURNAL OF UROLOGY, 2013, 189 (04) : 1236 - 1242