Method Used for Tumor Bed Closure (Suture vs. Sealant), Ischemia Time and Duration of Surgery are Independent Predictors of Post-Nephron Sparing Surgery Acute Kidney Injury

Abstract

Introduction: The aim of our study was to examine the influence of tumor complexity and operative variables on the degree and rate of post-nephron sparing surgery (NSS) acute kidney injury (AKI). Methods: We retrospectively reviewed the records of 477 patients who underwent NSS for enhancing renal masses in our institution. AKI was determined using the latest definition by AKIN and RIFLE criteria. Serum creatinine was assessed daily starting from day 1 post-surgery and until discharge (usually on postoperative day 3). Estimated glomerular filtration was determined using the Modification of Diet in Renal Disease equation. Results: Overall, 191 patients (40%) developed postoperative AKI, and most of them (88%) were grade 1. Multivariate analysis revealed that the most significant and independent variables associated with AKI were operation time (p = 0.02), ischemia time (p = 0.02), and the use of tissue adhesive for tumor bed closure (p = 0.02). Other important factors (by univariate analysis) were the need for blood transfusion (p = 0.003) and estimated blood loss (p = 0.007). Conclusions: Operative time, ischemia, and tumor bed closure method are independent predictors of post-NSS AKI. Efforts should be made to limit prolonged ischemia and to reduce viable parenchymal loss. Further studies concerning the functional impact of AKI in these patients will be required.

Impact of Goal-directed Hemodynamic Management on the Incidence of Acute Kidney Injury in Patients Undergoing Partial Nephrectomy: A Pilot Randomized Controlled Trial

“…Secondly, the improvement of surgeons' skill and surgical technique helped preserve renal function. For example, the durations of renal hilus clamping and surgery were shorter in our patients than in previous studies [8,24,25].…”

“…Routine circulatory management during partial nephrectomy is to maintain blood pressure change within 20% from baseline and urine output > 0.5 ml/kg/h. However, the incidence of AKI remains high after surgery [8,24,25]. Experience from kidney transplantation suggested that maintaining adequate renal hydration and higher blood pressure after reperfusion (i.e., CVP > 8 mmHg and MAP > 95 mmHg) are bene cial for graft function [14,15,18].…”

Effect of Diabetes Mellitus on Acute Kidney Injury after Minimally Invasive Partial Nephrectomy: A Case-Matched Retrospective Analysis

“…Several studies have investigated predictive factors for AKI after PN, which included open and minimally invasive techniques [3,4,12,13,14,15]. Longer WIT and operative duration as well as patient-related factors, such as old age, male sex, obesity, impaired preoperative kidney function, and history of hypertension were identified as risk factors for postoperative AKI [3,4,12,13,14,15,20,21]. In our study, which analyzed risk factors after minimally invasive PN only, WIT >25 min, longer operative duration, and patient-related factors, such as male sex, presence of DM, and high intraoperative urine output were revealed to be independent predictors of postoperative AKI.…”

“…WIT is recognized as a strong contributing factor for AKI after PN [3,4,5,12,13,20,21]. WIT >25 min results in irreversible damage that is diffusely distributed throughout the operated kidney, even at six months after PN [25].…”

Comparison of Renal Function after Radical Surgery for Upper Tract Urothelial Carcinoma versus Renal Cell Carcinoma: Propensity Score Matching

“…Finally, the frequency of nephron-sparing surgery is increasing and becoming important. Especially, some previous studies presented that impact of tumor complexity and intraoperative parameters could affect postoperative renal function in patients who underwent nephron sparing surgery [28]. However, in this study, we compared the renal function of single kidney after radical surgery and excluded patients who underwent nephron sparing surgery.…”