Factors That Influence the Recurrence of Kidney Diseases After Nephrectomy

Highlights

Surgical factors are the most important determinant factors for chronic kidney disease after partial nephrectomy.
The time of ischemia and the amount of healthy remaining kidney tissue post-partial nephrectomy are considered to be an important factor for future renal function.
Higher the remaining healthy tissue, the better are the outcome for further renal function.

After partial nephrectomy surgical factors such as time of ischemia, the surgical technique, complexity of the case, and the parenchyma amount play an important role in determining the overall kidney function. The findings of this study are published in the Journal of Oncoscience.

The pre-surgical factors are hypertension, diabetes mellitus, urolithiasis , obesity and metabolic syndrome; whereas the intra-surgical factors are surgical technique, healthy remaining tissue, the experience of the surgeon, the time and type of ischemia among others.

Chronic Kidney Disease Patients Preserve Kidney Function With Robot-Assisted Partial Nephrectomy
Chronic kidney disease patients who received robot-assisted partial nephrectomy to treat kidney cancer have minimal loss of kidney function - a smaller amount even than patients with normal kidney function.

‘Twenty to thirty minutes of ischemia time and amount of healthy remaining kidney tissue after partial nephrectomy are considered to be the most important factor for future renal function.’

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"Sparing most of the nephrons without compromising the oncological outcome has played an important role in the kidney malignancies management." Said Dr. Giovanni Cacciamani from the Department of Urology at the University of Verona in Verona, Italy.

Kidney stones, urinary tract infection and neurogenic bladder, on the other hand, can also affect patients baseline renal function.

After partial nephrectomy , factors such time of ischemia, the surgical technique used, the complexity of the case, and the amount of preserved parenchyma tends to play an important role in surgical outcomes.

Outcomes of Robotic-assisted Vs. Laparoscopic Surgical Procedures
Robotic-assisted surgery vs. laparoscopic surgery for kidney removal or rectal cancer have been compared. No improvements seen in robotic-assisted compared with laparoscopic surgery.

To avoid irreversible renal parenchymal damage, a period of 20-30 minutes has been proposed as the safest ischemia time.

Post-nephrectomy, the amount of healthy remaining kidney tissue is considered to be another important factor to check the renal function.

Robot-Assisted Surgical Removal Of Kidney May Be Costlier
Surgical removal of kidneys with the assistance of robots have increased though they take longer operating hours and are expensive than traditional methods.

Up until now, there have been no recommendations for the exact amount of the healthy kidney tissue that needs to be conserved, before making the decision of undertaking a radical nephrectomy. But now we can say that the higher the remaining healthy tissue, the better the outcome for further renal function.

"Minimally invasive surgery appears to offer broader therapeutic scope for the renal masses without compromising oncological outcomes in proper hands," according to this research team.

Cancerous Tumor Suctioned and Processed into a Vaccine for Clinical Trials
Physicians at Henry Ford Hospital successfully performed a minimally invasive kidney removal after clearing the tumour.

Reference

Oscar D. Martín, Heilen Bravo, Marcos Arias, Diego Dallos, Yesica Quiroz, Luis G. Medina, Giovanni E. Cacciamani, Raul G. Carlini. Determinant factors for chronic kidney disease after partial nephrectomy, Oncoscience (2018).https://doi.org/10.18632/oncoscience.393

Source-Medindia