WASHINGTON, DC USA (UroToday.com) - Dr. Dipen Parekh and his team studied the duration of ischemia time and whether it impacts renal function and also evaluated the role of novel biomarkers in this setting.
40 patients were prospectively enrolled prior to partial nephrectomy. Serum, urine and tissue were collected pre-clamping and post-clamping. Tissue was collected every 10 minutes during clamping. The mean duration of ischemia was 32 minutes in 27 warm-ischemia treated patients and 48 minutes in 13 cold-ischemia patients. A transient increase occurred in serum creatinine, which resolved at 72 hours. There was no deterioration in renal function up to 540 days. Serum cystatin, a biomarker, did not correlate with renal damage up to 60 minutes. 7 other biomarkers had transient elevation, but did not correlate or predict for renal ischemia. This suggests that ischemia up to 60 minutes does not insult the kidney. Electron microscopy of the biopsies showed that mitochondria swelled with cold ischemia, but after unclamping it returns to baseline at 5 minutes. Thus the degree of insult at the ultrastructural level was mild and reversible. For up to 60 minutes of ischemia, there was no evidence of ultrastructural changes.
He summarized that functional biomarkers, structural biomarkers and immunofluorescence do not suggest that patients with 2 renal units undergoing partial nephrectomy with clamping up to 60 minutes results in renal damage.
Presented by Dipen J. Parekh, MD at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Christopher P. Evans, MD, FACS, Professor and Chairman, Department of Urology, University of California, Davis, School of Medicine.
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