Surgical renal ischemia: a contemporary overview.

PURPOSE Partial nephrectomy is being increasingly performed to treat renal cell carcinoma. Because warm ischemia is induced during many open and laparoscopic partial nephrectomy surgeries, its impact on postoperative kidney function has received renewed attention. We assessed the current state of knowledge pertaining to warm ischemic kidney injury and renal functional outcomes. MATERIALS AND METHODS A review of the literature from 1947 to 2007 pertaining to warm ischemic kidney injury was performed. Data from relevant animal and clinical studies were assessed and compared. RESULTS Animal studies have described the relationship between the duration of warm ischemia and the magnitude of subsequent renal dysfunction. However, direct translation of these data to clinical practice is limited by significant anatomical and physiological differences among species. Current clinical data support a safe warm ischemia time limit of 30 minutes in patients with normal preoperative kidney function. To date no scientifically rigorous clinical study has established a warm ischemia dose-response curve. Additionally, no algorithm exists to predict the risk of acute kidney injury and chronic kidney disease in patients undergoing transient warm ischemia. CONCLUSIONS Clinical use of glomerular filtration rate measurement, kidney injury biomarkers and the application of glomerular filtration rate based renal functional diagnostic criteria may allow improved diagnosis, management and reporting of renal functional outcomes. Prospective, controlled clinical studies are much needed to accurately characterize the relationship between warm ischemia and renal dysfunction.

[1]  F. Di Maggio,et al.  BIOMARKERS OF ACUTE RENAL INJURY AND RENAL FAILURE , 2006, Shock.

[2]  P. Neuhaus,et al.  Ischemic preconditioning protects from hepatic ischemia/reperfusion-injury by preservation of microcirculation and mitochondrial redox-state. , 2003, Journal of hepatology.

[3]  L. Kavoussi,et al.  Laparoscopic partial nephrectomy: effect of warm ischemia on serum creatinine. , 2004, The Journal of urology.

[4]  M. Mitsnefes,et al.  J Am Soc Nephrol 15: 3073–3082, 2004 Amelioration of Ischemic Acute Renal Injury by Neutrophil , 2004 .

[5]  S. Siemer,et al.  Partial nephrectomy with perfusion cooling for imperative indications: a 24‐year experience , 2005, BJU international.

[6]  D. C. Miller,et al.  Nature of the renal injury following total renal ischemia in man. , 1984, The Journal of clinical investigation.

[7]  P. Reinke,et al.  Up-regulation of HIF in experimental acute renal failure: evidence for a protective transcriptional response to hypoxia. , 2005, Kidney international.

[8]  Andrew J Vickers,et al.  Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. , 2006, The Lancet. Oncology.

[9]  J. Frøkiaer,et al.  EPO and alpha-MSH prevent ischemia/reperfusion-induced down-regulation of AQPs and sodium transporters in rat kidney. , 2004, Kidney international.

[10]  J. Kaouk,et al.  The impact of warm ischaemia on renal function after laparoscopic partial nephrectomy , 2005, BJU international.

[11]  C. Blocher,et al.  Effects of increased renal parenchymal pressure on renal function. , 2000, The Journal of trauma.

[12]  I. Housini,et al.  Alpha-melanocyte-stimulating hormone protects against renal injury after ischemia in mice and rats. , 1997, The Journal of clinical investigation.

[13]  A. Shalhav,et al.  Laparoscopic ice slurry coolant for renal hypothermia. , 2006, The Journal of urology.

[14]  L. Hebert,et al.  Effect of renal decapsulation on renal function. , 1975, The American journal of physiology.

[15]  Louis R Kavoussi,et al.  Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. , 2007, The Journal of urology.

[16]  I. Gill,et al.  Halving ischemia time during laparoscopic partial nephrectomy. , 2008, The Journal of urology.

[17]  P. Russo,et al.  Partial nephrectomy for patients with a solitary kidney: the Memorial Sloan‐Kettering experience , 2004, BJU international.

[18]  William F Weitzel,et al.  Initial clinical results of the bioartificial kidney containing human cells in ICU patients with acute renal failure. , 2004, Kidney international.

[19]  G. Craddock.  Species differences in response to renal ischemia. , 1976, Archives of surgery.

[20]  E. Solmazgul,et al.  Hyperbaric Oxygen Therapy Attenuates Renal Ischemia/Reperfusion Injury in Rats , 2007, Urologia Internationalis.

[21]  Inderbir S Gill,et al.  5-Year outcomes of laparoscopic partial nephrectomy. , 2007, The Journal of urology.

[22]  A. Novick,et al.  Open partial nephrectomy for tumor in a solitary kidney: experience with 400 cases. , 2006, The Journal of urology.

[23]  P. L. Moreira,et al.  Animal Models for Therapeutic Embolization , 2003, CardioVascular and Interventional Radiology.

[24]  I. Chaudry,et al.  The use of adenosine triphosphate with magnesium chloride in the treatment of post ischemic renal injury. , 1978, Transactions of the American Association of Genito-Urinary Surgeons.

[25]  G. Remuzzi,et al.  The Regenerative Potential of Stem Cells in Acute Renal Failure , 2006, Cell transplantation.

[26]  R. Thompson,et al.  The impact of ischemia time during open nephron sparing surgery on solitary kidneys: a multi-institutional study. , 2007, The Journal of urology.

[27]  G. Eknoyan,et al.  National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification , 2003, Annals of Internal Medicine.

[28]  A. Atala,et al.  Initial clinical results of the bioartificial kidney containing human cells in ICU patients with acute renal failure , 2006, Current urology reports.

[29]  A. Karaman,et al.  Prevention of renal ischemia/reperfusion‐induced injury in rats by leflunomide , 2006, International journal of urology : official journal of the Japanese Urological Association.

[30]  C. Haisch,et al.  Overcoming severe renal ischemia: the role of ex vivo warm perfusion. , 2002, Transplantation.

[31]  C. Rabito,et al.  Real-time monitoring of renal function during ischemic injury in the rhesus monkey. , 1995, Renal failure.

[32]  A. Seguro,et al.  Beneficial and harmful effects of L-arginine on renal ischaemia. , 1999, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[33]  A. Shalhav,et al.  Recovery of renal function after complete renal hilar versus artery alone clamping during open and laparoscopic surgery. , 2006, The Journal of urology.

[34]  A. Shalhav,et al.  Defining maximal renal tolerance to warm ischemia in porcine laparoscopic and open surgery model. , 2005, Urology.

[35]  P. Silva.  Energy and fuel substrate metabolism in the kidney. , 1990, Seminars in nephrology.

[36]  S. Liggett,et al.  Myocardial beta1-adrenergic receptor polymorphisms affect functional recovery after ischemic injury. , 2006, American journal of physiology. Heart and circulatory physiology.

[37]  P. Jablonski,et al.  AN EXPERIMENTAL MODEL FOR ASSESSMENT OF RENAL RECOVERY FROM WARM ISCHEMIA , 1983, Transplantation.

[38]  J. Kaouk,et al.  Laparoscopic partial nephrectomy in solitary kidney. , 2006, The Journal of urology.

[39]  A. Novick,et al.  The effect of dopamine on renal function in solitary partial nephrectomy surgery. , 2002, The Journal of urology.

[40]  N. Aravindan,et al.  Fenoldopam Improves Corticomedullary Oxygen Delivery and Attenuates Angiogenesis Gene Expression in Acute Ischemic Renal Injury , 2006, Kidney and Blood Pressure Research.

[41]  A. Atessahin,et al.  Effects of lycopene against cisplatin-induced nephrotoxicity and oxidative stress in rats. , 2005, Toxicology.

[42]  M. Fornage,et al.  Family-based association study of matrix metalloproteinase-3 and -9 haplotypes with susceptibility to ischemic white matter injury , 2006, Human Genetics.

[43]  C. Peters,et al.  Pneumoperitoneum produces reversible renal dysfunction in animals with normal and chronically reduced renal function. , 1998, Journal of endourology.

[44]  A. Novick.  Renal hypothermia: in vivo and ex vivo. , 1983, The Urologic clinics of North America.

[45]  H. Kumon,et al.  Predicting postoperative renal insufficiency in patients undergoing nephrectomy for renal malignancy: assessment by renal scintigraphy using 99mtechnetium-mercaptoacetyltriglycine. , 2005, The Journal of urology.

[46]  Ethan M Balk,et al.  K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. , 2002, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[47]  J. Stollings,et al.  Oxygen Therapeutics: Oxygen Delivery Without Blood , 2006, Pharmacotherapy.

[48]  R. Elsner,et al.  Renal recovery from ischemia: a comparative study of harbor seal and dog kidneys. , 1974, The American journal of physiology.

[49]  A. Shalhav,et al.  Renal tolerance to prolonged warm ischemia time in a laparoscopic versus open surgery porcine model. , 2004, The Journal of urology.

[50]  Y. Tsuji,et al.  An experimental model for unilateral ischaemic acute renal failure in dog , 2007, International Urology and Nephrology.

[51]  J. Bonventre,et al.  Cell biology and molecular mechanisms of injury in ischemic acute renal failure. , 2000, Current opinion in nephrology and hypertension.

[52]  Ajay K. Singh,et al.  A comparison of prediction equations for estimating glomerular filtration rate in adults without kidney disease. , 2003, Journal of the American Society of Nephrology : JASN.