MP37-03 ROBOT-ASSISTED PARTIAL NEPHRECTOMY IS SUPERIOR IN TERMS OF POSTOPERATIVE ACUTE KIDNEY INJURY, AS COMPARED TO OPEN PARTIAL NEPHRECTOMY

Objectives: Acute kidney injury (AKI) secondary to nephron-sparing surgery represents a significant problem in order to preserve renal function. Since serum creatinine alone underestimates the early detection of AKI several biomarker have been investigated. Neutrophil Gelatinase-Associated Lipocalin (NGAL) is considered a good biomarker for AKI. Materials and methods: We report our experience in 28 patients affected by localized renal cell carcinoma and submitted to robot-assisted partial nephrectomy (RAPN). In each patient selective urinary NGAL levels were dosed before surgery, then 2 and 48 hours after the procedure, through a ureteral catheter inserted into the excretory axis of the operated kidney. Moreover, we evaluated split renal function of the preserved renal parenchyma by a 99mTC-DTPA renal scintigraphy, performed before surgery and three months later. Results: AKI was diagnosed, according to internationally criteria, in 3 patients (10.7%). The baseline selective urinary NGAL level was 20.02 ng/ml. This level significantly increased after surgery with a selective urinary NGAL level that reached 56.36 ng/ml (p < 0.0001). Moreover, a significant reduction in 99mTC-DTPA clearance of the operated kidneys after three months was detected (p < 0.0001). Conclusions: Selective urinary NGAL assay represent a sensitive biomarker of acute kidney injury after robotic nephron sparing surgery, capable of predicting the functional outcome of the operated kidney.

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MP59-07 DEVELOPMENT AND INTERNAL VALIDATION OF A NOMOGRAM FOR THE DEVELOPMENT OF ACUTE KIDNEY INJURY AFTER ROBOT-ASSISTED PARTIAL NEPHRECTOMY

The Journal of Urology ◽

10.1016/j.juro.2018.02.1859 ◽

2018 ◽

Vol 199 (4S) ◽

Author(s):

Alberto Martini ◽

David Paulucci ◽

Ronney Abaza ◽

Daniel Eun ◽

Akshay Bhandari ◽

...

Keyword(s):

Acute Kidney Injury ◽

Partial Nephrectomy ◽

Kidney Injury ◽

Robot Assisted ◽

Internal Validation

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Faculty Opinions recommendation of A multicentre matched-pair analysis comparing robot-assisted versus open partial nephrectomy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718174930.793499276 ◽

2014 ◽

Author(s):

Mahesh Desai ◽

Arvind Ganpule

Keyword(s):

Partial Nephrectomy ◽

Matched Pair ◽

Robot Assisted ◽

Open Partial Nephrectomy ◽

Matched Pair Analysis ◽

Pair Analysis

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Impact of goal-directed hemodynamic management on the incidence of acute kidney injury in patients undergoing partial nephrectomy: a pilot randomized controlled trial

BMC Anesthesiology ◽

10.1186/s12871-021-01288-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Qiong-Fang Wu ◽

Hao Kong ◽

Zhen-Zhen Xu ◽

Huai-Jin Li ◽

Dong-Liang Mu ◽

...

Keyword(s):

Acute Kidney Injury ◽

Partial Nephrectomy ◽

Controlled Trial ◽

Intervention Group ◽

Kidney Injury ◽

Control Group ◽

Hemodynamic Management ◽

Randomized Controlled ◽

Renal Hilum ◽

Pilot Randomized Controlled Trial

Abstract Background The incidence of acute kidney injury (AKI) remains high after partial nephrectomy. Ischemia-reperfusion injury produced by renal hilum clamping during surgery might have contributed to the development of AKI. In this study we tested the hypothesis that goal-directed fluid and blood pressure management may reduce AKI in patients following partial nephrectomy. Methods This was a pilot randomized controlled trial. Adult patients who were scheduled to undergo partial nephrectomy were randomized into two groups. In the intervention group, goal-directed hemodynamic management was performed from renal hilum clamping until end of surgery; the target was to maintain stroke volume variation < 6%, cardiac index 3.0–4.0 L/min/m2 and mean arterial pressure > 95 mmHg with crystalloid fluids and infusion of dobutamine and/or norepinephrine. In the control group, hemodynamic management was performed according to routine practice. The primary outcome was the incidence of AKI within the first 3 postoperative days. Results From June 2016 to January 2017, 144 patients were enrolled and randomized (intervention group, n = 72; control group, n = 72). AKI developed in 12.5% of patients in the intervention group and in 20.8% of patients in the control group; the relative reduction of AKI was 39.9% in the intervention group but the difference was not statistically significant (relative risk 0.60, 95% confidence interval [CI] 0.28–1.28; P = 0.180). No significant differences were found regarding AKI classification, change of estimated glomerular filtration rate over time, incidence of postoperative 30-day complications, postoperative length of hospital stay, as well as 30-day and 6-month mortality between the two groups. Conclusion For patients undergoing partial nephrectomy, goal-directed circulatory management during surgery reduced postoperative AKI by about 40%, although not significantly so. The trial was underpowered. Large sample size randomized trials are needed to confirm our results. Trial registration Clinicaltrials.gov identifier: NCT02803372. Date of registration: June 6, 2016.

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