scholarly journals Segmental artery clamping versus main renal artery clamping in nephron-sparing surgery: Updated meta-analysis

2020 ◽  
Author(s):  
Jinhong Xu ◽  
Shuxiong Xu ◽  
Biao Yao ◽  
Run Xu ◽  
YuanGao Xu ◽  
...  
Keyword(s):  
Renal Function ◽  
Blood Transfusion ◽  
Renal Artery ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Transfusion Rate ◽  
Postoperative Complication Rate ◽  
Segmental Artery ◽  
Clavien Classification ◽  
Main Renal Artery

Abstract Objectives Ischemia–reperfusion injury is harmful in partial nephrectomy (PN) in renal cell carcinoma. Choosing an appropriate surgical method is important to reduce ischemia–reperfusion injury. This study aimed to compare the effect of segmental artery clamping (SAC) and main renal artery clamping (MAC) on patients who underwent PN. Methods: Studies from January 2008 to November 2019 were identified by an electronic search of English and Chinese databases, including PubMed, Excerpt Medica Database, Cochrane Library, Wanfang, VIP, and Chinese National Knowledge Internet, without language restriction. Two reviewers were involved in the trial. The effects on operation time (OT), warm ischemia time (WIT), length of hospital stay (LOS), blood transfusion rate, postoperative complication rate, Clavien classification (≥3), and positive surgery margin (PSM) were evaluated using Stata software. Standardized mean difference (SMD, for continuous data) and pooled odds ratios (for count data) with 95% confidence interval (CI) were used as effect indicators. Results: Thirty-two studies were included. SAC decreased the 1-week (SMD=−0.973; 95% CI=−1.414, −0.532; P=0.000), 1-month (SMD=−0.411; 95% CI=−0.769, −0.053; P=0.025), and 3-month (affected kidney: SMD=−0.914; 95% CI=−1.662, −0.617; P=0.000) percentages of postoperative changes in renal function (estimated glomerular filtration rate) between the SAC and MAC groups. Sub-group analysis showed that the SAC group had longer OT (SMD=0.562; 95% CI=0.252, 0.871; P=0.000) than the MAC group. However, no differences were observed in the OT, WIT, LOS, blood transfusion rate, postoperative complication rate, Clavien classification (≥3), and PSM between the two groups. Conclusions: SAC is superior to MAC in terms of short-term postoperative renal function recovery. The use of SAC or MAC depends on tumor size, location, surgical modality, and surgeon’s judgments.

scholarly journals Segmental versus main renal artery clamping in nephron sparing surgery: an updated Meta-analysis

2020 ◽  
Author(s):  
Jinhong Xu ◽  
YuanGao Xu ◽  
Shuxiong Xu ◽  
Fa Sun ◽  
Hua Shi
Keyword(s):  
Renal Function ◽  
Blood Transfusion ◽  
Postoperative Complication ◽  
Complication Rate ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Transfusion Rate ◽  
Postoperative Complication Rate ◽  
Clavien Classification ◽  
The Impact

Abstract ObjectsIschemia-reperfusion injury is very harmful in partial nephrectomy (PN) in renal cell carcinoma (RCC). It is important to choose an appropriate surgical method to reduce ischemia-reperfusion injury. To compare the impact of segmental artery clamping (SAC) and main artery clamping (MAC) on some clinical data of the patients underwent PN. MethodsStudies from January 2008 to November 2019 were identified by electronical search of the English databases including PubMed, EMBASE, the Cochrane Library and Chinese database including Wanfang, VIP and CNKI without language restriction. Two reviewers were involved in the trial. The impact on operation time(OT), Warm ischemia time (WIT), length of stay in hospital (LOS), blood transfusion rate, postoperative complication rate, Clavien classification ≥3 and positive surgery margin (PSM) were evaluated using Stata software, and standardized mean difference (SMD)%(for the continuous data) and the pooled odds ratios (ORs) (used for counting data) with 95% confidence interval (CI) were used as effect indicators. ResultsThirty-two studies were eligible. SAC showed characteristics through decreasing 1 week post-operative percentage changes of renal function [SMD:-0.973, 95% CI (-1.414, -0.532), P=0.000], 1 month post-operative percentage change in eGFR [SMD:-0.411, 95CI (-0.769, -0.053), P=0.025] and percentage change of eGFR of the affected kidney 3 months postoperatively between SAC and MAC group [SMD:-0.914, 95%CI (-1.662, -0.617), P=0.000]. During sub-group analysis, SAC had longer OT [SMD:0.562, 95CI (0.252, 0.871), P=0.000] compared to MAC group. However, no difference was observed between the two groups in OT, WIT LOS, blood transfusion rate, postoperative complication rate, Clavien classification ≥3 and PSM%. ConclusionsSAC has more superiority with advantages in short term post-operative renal function recovery compared to MAC. Whether to use SAC or MAC depends on tumor size, location, surgical modality, and surgeon’s judgements.

Simvastatin and l-Arginine Preserve Renal Function after Ischemia/Reperfusion Injury

2005 ◽  
Vol 329 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Sharon R. Inman ◽  
Nancy A. Davis ◽  
Maria E. Mazzone ◽  
Kristen M. Olson ◽  
Victoria A. Lukaszek ◽  
...  
Keyword(s):  
Renal Function ◽  
Reperfusion Injury ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Preserve Renal Function

Local anesthetics worsen renal function after ischemia-reperfusion injury in rats

2004 ◽  
Vol 286 (1) ◽  
pp. F111-F119 ◽  
Author(s):  
H. Thomas Lee ◽  
Igor E. Krichevsky ◽  
Hua Xu ◽  
Ayuko Ota-Setlik ◽  
Vivette D. D'Agati ◽  
...  
Keyword(s):  
Cell Death ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Terminal Deoxynucleotidyl Transferase ◽  
Morphological Identification ◽  
Sham Operation

Local anesthetics are widely used during the perioperative period, even in patients with preexisting renal disease. However, local anesthestics have been shown to cause cell death in multiple cell lines, including human kidney proximal tubule cells. We questioned whether local anesthetics potentiate renal dysfunction after ischemia-reperfusion (I/R) injury in vivo. Rats were implanted with subcutaneous miniosmotic pumps that continuously delivered lidocaine (2 mg·kg-1·h-1), bupivacaine (0.4 mg·kg-1·h-1), tetracaine (1 mg·kg-1·h-1), or saline vehicle, and 6 h later the rats were subjected to 30 min of renal ischemia or to sham operation. Renal function was assessed by measurement of plasma creatinine at 24 and 48 h after renal I/R injury in the presence or absence of chronic infusions of local anesthetics and correlated to histological changes indicative of necrosis. The degree of renal apoptosis was assessed by three methods: 1) DNA fragmentation detected by terminal deoxynucleotidyl transferase biotin-dUTP nick-end labeling staining, 2) DNA laddering detected after agarose gel electrophoresis, and 3) morphological identification of apoptotic tubules at the corticomedullary junction. We also measured the expression of the proinflammatory markers ICAM-1 and TNF-α. Continuous local anesthetic infusion with renal I/R injury resulted in an increased magnitude and duration of renal dysfunction compared with the saline-infused I/R group. Additionally, both apoptotic and necrotic renal cell death as well as inflammatory changes were significantly potentiated in local anesthetic-treated rat kidneys. Local anesthetic infusion alone without I/R injury had no effect on renal function. We conclude that local anesthetics potentiated renal injury after I/R by increasing necrosis, apoptosis, and inflammation.

scholarly journals Bone Marrow–Derived Mononuclear Cell Therapy Accelerates Renal Ischemia-Reperfusion Injury Recovery by Modulating Inflammatory, Antioxidant and Apoptotic Related Molecules

2017 ◽  
Vol 41 (5) ◽  
pp. 1736-1752 ◽  
Author(s):  
Felipe Mateus Ornellas ◽  
Débora Santos Ornellas ◽  
Sabrina Vargas Martini ◽  
Raquel Carvalho Castiglione ◽  
Grasiella Maria Ventura ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Renal Function ◽  
Biological Markers ◽  
Mononuclear Cells ◽  
Cellular Therapy ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Renal Ischemia ◽  
Proliferation Index ◽  
Anti Inflammatory

Background/Aims: We investigated the regenerative capacity of intravenous administration of bone marrow–derived mononuclear cells (BMMCs) in a rat model of bilateral renal ischemia/reperfusion (IR) injury and the involvement of inflammatory anti-inflammatory and other biological markers in this process. Methods: Rats were subjected to 1h bilateral renal pedicle clamping. BMMCs were injected i.v 1h after reperfusion and tracked by 99mTc and GFP+ BMMCs. Twenty-four hours after reperfusion, renal function and histological changes were evaluated. The mRNA (real time PCR) and protein (ELISA and immuno-staining) expression of biological markers were analyzed. Results: Renal function and structure improved after infusion of BMMCs in the IR group (IR-C). Labeled BMMCs were found in the kidneys after therapy. The expression of inflammatory and biological markers (TLR-2, TRL-4, RAGE, IL-17, HMGB-1, KIM-1) were reduced and the expression of anti-inflammatory and antioxidant markers (IL-10, Nrf2, and HO-1) were increased in IR-C animals compared with IR untreated animals (IR-S). The apoptotic index diminished and the proliferation index increased in IR-C compared with IR-S. Conclusion: The results contribute to our understanding of the role of different biological players in morphofunctional renal improvement and cytoprotection in a post-ischemic reperfusion kidney injury model subjected to cellular therapy.

scholarly journals Downstream effects of splanchnic ischemia-reperfusion injury on renal function and eicosanoid release

1997 ◽  
Vol 83 (2) ◽  
pp. 530-536 ◽  
Author(s):  
Patricia Rothenbach ◽  
Richard H. Turnage ◽  
Jose Iglesias ◽  
Angela Riva ◽  
Lori Bartula ◽  
...  
Keyword(s):  
Blood Flow ◽  
Renal Function ◽  
Reperfusion Injury ◽  
Renal Blood Flow ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Inulin Clearance ◽  
Downstream Effects ◽  
Splanchnic Ischemia ◽  
Eicosanoid Release

Rothenbach, Patricia, Richard H. Turnage, Jose Iglesias, Angela Riva, Lori Bartula, and Stuart I. Myers. Downstream effects of splanchnic ischemia-reperfusion injury on renal function and eicosanoid release. J. Appl. Physiol.82(2): 530–536, 1997.—This study examines the hypothesis that intestinal ischemia-reperfusion (I/R) injury contributes to renal dysfunction by altered renal eicosanoid release. Anesthetized Sprague-Dawley rats underwent 60 min of sham or superior mesenteric artery (SMA) occlusion with 60 min of reperfusion. The I/R groups received either allopurinol, pentoxifylline, 1-benzylimidazole, or carrier before SMA occlusion. In vivo renal artery blood flow was measured by Transonic flow probes, the kidneys were then perfused in vitro for 30 min, and the effluent was analyzed for eicosanoid release and renal function. Intestinal I/R caused a twofold increase in the ratio of renal release of thromboxane B2to prostaglandin E2and to 6-ketoprostaglandin F1αcompared with the sham level, with a corresponding 25% decrease in renal sodium and inulin clearance and renal blood flow. Pentoxifylline or allopurinol pretreatment restored renal eicosanoid release and renal sodium and inulin clearance to the sham level but did not alter renal blood flow. Pretreatment with 1-benzylimidazole restored renal function, eicosanoid release, and renal blood flow to sham levels. These data suggest that severe intestinal I/R contributes to the downregulation of renal function. The decrease in renal function is due in part to toxic oxygen metabolites, which occur in the milieu of altered renal eicosanoid release, reflecting a decrease in vasodilator and an increase in vasoconstrictor eicosanoids.

scholarly journals Role of reduced manganese superoxide dismutase in ischemia-reperfusion injury: a possible trigger for autophagy and mitochondrial biogenesis?

2013 ◽  
Vol 304 (3) ◽  
pp. F257-F267 ◽  
Author(s):  
Nirmala Parajuli ◽  
Lee Ann MacMillan-Crow
Keyword(s):  
Oxidative Stress ◽  
Superoxide Dismutase ◽  
Renal Function ◽  
Mitochondrial Biogenesis ◽  
Renal Damage ◽  
Manganese Superoxide Dismutase ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Manganese Superoxide ◽  
Oxidant Production

Excessive generation of superoxide and mitochondrial dysfunction has been described as being important events during ischemia-reperfusion (I/R) injury. Our laboratory has demonstrated that manganese superoxide dismutase (MnSOD), a major mitochondrial antioxidant that eliminates superoxide, is inactivated during renal transplantation and renal I/R and precedes development of renal failure. We hypothesized that MnSOD knockdown in the kidney augments renal damage during renal I/R. Using newly characterized kidney-specific MnSOD knockout (KO) mice the extent of renal damage and oxidant production after I/R was evaluated. These KO mice (without I/R) exhibited low expression and activity of MnSOD in the distal nephrons, had altered renal morphology, increased oxidant production, but surprisingly showed no alteration in renal function. After I/R the MnSOD KO mice showed similar levels of injury to the distal nephrons when compared with wild-type mice. Moreover, renal function, MnSOD activity, and tubular cell death were not significantly altered between the two genotypes after I/R. Interestingly, MnSOD KO alone increased autophagosome formation, mitochondrial biogenesis, and DNA replication/repair within the distal nephrons. These findings suggest that the chronic oxidative stress as a result of MnSOD knockdown induced multiple coordinated cell survival signals including autophagy and mitochondrial biogenesis, which protected the kidney against the acute oxidative stress following I/R.

scholarly journals POST-TREATMENT With the Combination of 5-Aminoimidazole-4-Carboxyamide Ribonucleoside and Carnitine Improves Renal Function After Ischemia/Reperfusion Injury

Shock ◽  
2012 ◽  
Vol 37 (1) ◽  
pp. 39-46 ◽  
Author(s):  
Juan-Pablo Idrovo ◽  
Weng-Lang Yang ◽  
Akihisa Matsuda ◽  
Jeffrey Nicastro ◽  
Gene F. Coppa ◽  
...  
Keyword(s):  
Renal Function ◽  
Reperfusion Injury ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Post Treatment
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