Acute kidney injury and intermediate‐term renal function after clampless partial nephrectomy

Abstract

Objectives To evaluate the incidence and predictors of acute kidney injury after clampless partial nephrectomy, and its impact on intermediate‐term renal function. Methods The incidence and severity of acute kidney injury were assessed for 262 patients undergoing clampless partial nephrectomy between 2010 and 2015. The association between perioperative covariates and acute kidney injury was evaluated using multivariate logistic regression analysis. An annual change in estimated glomerular filtration rate from 1 year after surgery was calculated according to the presence or absence of acute kidney injury. An impact of acute kidney injury on postoperative renal impairment, defined as a ≥25% estimated glomerular filtration rate decrease, was evaluated. Results Overall, 21 (8.0%) patients experienced grade 1 acute kidney injury after clampless partial nephrectomy, and grade ≥2 acute kidney injury was not observed. High tumor complexity was the only independent predictor of acute kidney injury. Estimated glomerular filtration rate in patients with acute kidney injury improved within 1 year, and annual estimated glomerular filtration rate changes were similar among patients with or without acute kidney injury. Ultimately, 13 (5.0%) patients showed postoperative renal impairment during the median follow‐up period of 37 months. Advanced age and diabetes mellitus were independent risk factors for renal impairment, but acute kidney injury was not. Conclusions The incidence and severity of acute kidney injury after clampless partial nephrectomy are low. Low‐grade acute kidney injury after clampless partial nephrectomy does not seem to affect intermediate‐term renal function.

Impact of postoperative acute kidney injury on predicting the upstaging of chronic kidney disease after robot‐assisted partial nephrectomy

“…Therefore, the impact of AKI after PN on long‐term functional outcomes has been controversial. Previous studies demonstrated that the incidence and severity of AKI did not correlate with long‐term functional recovery after off‐clamp PN, 7 and similar findings were reported in patients who had undergone PN for a solitary kidney 8 . In contrast, several studies have described a positive correlation between AKI and decreased renal function after PN.…”

Editorial Comment from Dr Takagi to Acute kidney injury and intermediate‐term renal function after clampless partial nephrectomy

“…The study by Kawamura et al . evaluated the incidence of acute kidney injury (AKI) and intermediate‐term renal function after clampless partial nephrectomy (PN) . It showed that 8% of patients in this study experienced grade 1 AKI, whereas grade ≥2 AKI was not observed.…”

Analysis of Hemostasis Procedures through Machine Learning of Endoscopic Images towards Automatic Surgery

“…The objects were endoscopic images obtained in animal experiments carried out with the approval of the local ethics committee for animal experiments using four specific pathogen-free (SFP) pigs that weighed approximately 30 kg. Laparoscopic non-ischemic partial nephrectomy (27) was performed using the WaFLES technique by two urologists. The non-ischemic partial nephrectomy does not cause ischemia; therefore, although damage to the normal tissue is suppressed, (27) hemostasis is important because bleeding is frequent.…”

“…Laparoscopic non-ischemic partial nephrectomy (27) was performed using the WaFLES technique by two urologists. The non-ischemic partial nephrectomy does not cause ischemia; therefore, although damage to the normal tissue is suppressed, (27) hemostasis is important because bleeding is frequent. From the obtained endoscopic images, the organ region pixels (206606 pixels), bleeding region pixels (147456 pixels), and hemostasis region pixels (147456 pixels), a total of 501518 pixels, were randomly extracted (Fig.…”