A Report of 61 Cases of Retroperitoneal Laparoscopic Nephron-Sparing Surgery and Factors Affecting Postoperative Renal Function

Objective. To explore the situation of 61 patients with renal tumors who underwent retroperitoneal laparoscopic nephron-sparing surgery (RLNSS) and the factors affecting postoperative renal function. Methods. A total of 61 patients with renal tumors who underwent RLNSS in our hospital from January 2018 to January 2021 were included in this study. All patients were treated with RLNSS. The clinical data of patients were recorded. Before operation and 3 months after operation, the change value of glomerular filtration rate (ΔGFR) was measured by the Gates method. Multivariate linear regression was used to analyze the related factors affecting postoperative renal function. Results. All 61 patients successfully completed the operation. The mean operative time was 60–150 min‚ average (98.75 ± 14.38) min. The estimated intraoperative blood loss was 20–310 ml‚ average (107.93 ± 68.55) ml. Intraoperative warm ischemia time (WIT) was 0–39 min, with an average of (21.16 ± 6.47) min. All patients’ pathological margins were negative after operation. In all patients, there were 5 postoperative complications, including 2 cases of renal wound bleeding (3.28%), 1 case of hematuria (1.64%), 1 case of urinary fistula (1.64%), and 1 case of subcutaneous emphysema (1.64%). There were significant differences in tumor diameter, preoperative GFR, operation time and WIT ( P < 0.05 ). Multivariate analysis showed that tumor diameter, preoperative GFR, and WIT were all factors affecting the postoperative renal function of patients with RLNSS ( P < 0.05 ). Conclusion. RLNSS has a good curative effect on patients with renal tumor, and tumor diameter, preoperative GFR, and WIT were all factors affecting the postoperative renal function of patients with RLNSS.

Incidence and outcome of rhabdomyolysis after type A Aortic Dissection surgery -a retrospective analysis

Objectives: To study the incidence of rhabdomyolysis (RML) after ascending aortic dissection surgery and to correlate with the outcome especially in terms of renal function. The secondary objective was to pinpoint the perioperative risk factors associated with the development of Rhabdomyolysis and adverse renal outcome after Aortic dissection repair Design: Retrospective single-center study Settings: Tertiary cardiac center Participants: Patients who had undergone ascending aortic dissection repair from 2011-2017. Interventions: Two groups Group 1- with RML creatine kinase (CK) above cut-off levels 2500 U/Liter and Group 2 without RML. The potential determinants of RML and the impact of the same on the patient outcome; especially on postoperative renal function was studied. Measurements and main results: Out of 33 patients studied, 21 patients (64%) developed Rhabdomyolysis (Group RML) and 12 did not (Group non-RML). Demographic and intraoperative factors had no significant impact on the incidence of RML. There was a significantly higher incidence of AKI in the RML group (90%) than in the non-RML group (25%). All 4 patients who went into new post-operative dialysis belonged to the RML group. The peak troponin levels were significantly higher in RML group Conclusion: In this study, we found a high incidence of RML after aortic dissection surgery which paralleled with an adverse renal outcome and need for postoperative dialysis. Identification of risk factors and early intervention might help to mitigate the severity of renal failure. Further large-scale prospective trials are warranted to investigate the predisposing factors and influence of RML on outcome

Potential of Perfusion Magnetic Resonance Imaging to Predict Residual Renal Function after Radical Nephroureterectomy

Introduction: The diffusion-weighted imaging (DWI) technique with intravoxel incoherent motion model enables the estimation of capillary blood volume as a perfusion-related parameter- (PP-) value. Therefore, the PP-value of the kidney theoretically reflects renal capillary blood volume. We analyzed the usefulness of the PP-value in estimating postoperative renal function in upper-tract urothelial carcinoma (UTUC) patients. Methods: Forty-eight consecutive patients who underwent magnetic resonance imaging before radical nephroureterectomy from 2011 to 2018 were analyzed. A PP-map displaying PP-values on a pixel-by-pixel basis was created from DWI signals (b-values of 0, 500, and 1,000 s/mm2). Two readers independently analyzed the renal PP-value. DWI-based split renal function (SRF) of the intact kidney was calculated by splitting serum Cr-based preoperative estimated glomerular filtration rates (eGFRs). The predictive accuracy of the method was evaluated using renography as the reference standard. Results: Interobserver analysis revealed an excellent correlation value of 0.97. The SRF value showed a good linear correlation with the observed postoperative eGFR (r = 0.76, p < 0.001). The predictive accuracy of the DWI-based method was similar to that of the nuclear-based method. Conclusion: This DWI-based evaluation of capillary blood volume provides a noninvasive tool for predicting the postoperative renal function, thereby facilitating the management of UTUC patients.

Complication Rates and Postoperative Renal Function in Partial Nephrectomy- Which Factors Should be Considered?

Objective: To specify the prognostic factors predicting complication rates and postoperative renal function in patients operated with partial nephrectomy. Materials and Methods: Our health center"s archive system was scanned retrospectively for the time interval between January 2006- January 2021 for patients operated with partial nephrectomy for renal mass. History, comorbidities and laboratory results, operational information, tumor morphologies in radiographic images and its specified scores (R.E.N.A.L. score, PADUA score, C-index), peroperative and postoperative complications and pathology results of 148 regularly followed-up patients were analyzed. Results: Mean age of the patients was 55.04±10.91 years, ratio of male to female was 1.27 and mean tumor size was 3.56 cm. Mean follow-up period was 55.53±42.26 months. Postoperative creatinine value in the 6th month showed an increase of 0.18 mg/dl compared to preoperative value. Estimated glomerular filtration rate (eGFR) also decreased by an average of 18.3%. Operation of grade 4 tumors significantly affected the postoperative renal function. PADUA score (p=0.023) had a significant effect on postoperative GFRs and duration of ischemia. Also, difference in pre-and postoperative GFRs and its percentage change were significantly affected by C-index (p=0.035, p=0.042). Pathological size (p=0.038), R.E.N.A.L. score (p=0.001), PADUA score (p<0.001), duration of ischemia (p=0.045) had a positively and C-index (p=0.001) had a negatively significant correlation with Modified Clavien-Dindo Complication Scoring System. Conclusion: All nephrometry scores, duration of ischemia and tumor size were associated with the complication rates according to Clavien classification. Tumor grade, PADUA score and C-index are valuable parameters for predicting renal dysfunction after partial nephrectomy.