What Happens to the Preserved Renal Parenchyma After Clamped Partial Nephrectomy?

Xiong, Longbin1,2,3; Nguyen, Jane K.4; Peng, Yulu1,2,3; Zhou, Zhaohui1,2,3; Ning, Kang1,2,3; Jia, Nan5; Nie, Jing5; Wen, Dongxiang2,3; Wu, Zeshen1,2,3; Roversi, Gustavo6; Palacios, Diego Aguilar6; Abramczyk, Emily6; Munoz-Lopez, Carlos6; Campbell, Jack A.6; Cao, Yun2,3,7; Li, Wencai8; Zhang, Xuepei8; He, Zhisong9; Li, Xiang10; Huang, Jiwei11; Shou, Jianzhong12; Wu, Jitao13; Chen, Minfeng14; Chen, Xiaofeng15; Zheng, Jiaxuan16; Xu, Congjie16; Zhong, Wen17; Li, Zaishang18,19; Dong, Wen20; Zhao, Juping21; Zhang, Hailang22,23; Luo, Junhang24; Liu, Jianye25; Sun, Fanghu26; Han, Hui1,2,3; Guo, Shengjie1,2,3; Dong, Pei1,2,3; Zhou, Fangjian1,2,3; Yu, Chunping1,2,3,29; Campbell, Steven C.6,28; Zhang, Zhiling1,2,3,27

2022-05-01

10.1016/j.eururo.2021.12.036

EUROPEAN UROLOGY   Impact Factor & Quartile

0302-2838

1873-7560

Background: Most partial nephrectomies (PNs) are performed with hilar occlusion to reduce blood loss and optimize visualization. However, the histologic status of the preserved renal parenchyma years after PN is unknown.Objective: To compare the histologic chronic kidney disease (CKD) score of renal parenchyma before and years after PN, and to explore factors associated with CKD-score increase and glomerular filtration rate (GFR) decline. Design, setting, and participants: A retrospective review of 147 renal cell carcinoma patients who underwent PN and subsequent radical nephrectomy (RN) due to tumor recurrence was performed in 19 Chinese centers and Cleveland Clinic. Macroscopic normal renal parenchyma was evaluated at least 5 mm away from the tumor in PN specimens and at remote sites in RN specimens. Intervention: PN/RN and ischemia. Outcome measurements and statistical analysis: Histologic CKD score (0-12) represents a summary of glomerular/tubular/interstitial/vascular status. Predictive factors for a substantial increase of CKD score (>3) were evaluated by logistic regression. Results and limitations: Sixty-five patients with all necessary data were analyzed. The median interval between PN and RN was 2.4 yr. Median durations of warm ischemia (n = 42) and hypothermia (n = 23) were both 23 min. The histologic CKD score was increased after RN in 47 (72%) patients, with 29 (45%) experiencing more substantial increase (>3). There was no significant difference in the change of CKD score related to the type and duration of ischemia (p = 0.7 and p = 0.4, respectively) or interval from PN to RN (p > 0.9). However, patients with comorbidities of hypertension, diabetes, and/ or pre-existing CKD (hypertension [HTN]/diabetes mellitus [DM]/CKD) demonstrated increased rate and extent of CKD-score increase. On univariate analysis, HTN/DM/CKD was the only predictor of a substantial CKD-score increase (odds ratio: 3.53 [1.12- 11.1]). Decline of GFR was modest and similar between patients with/without a substantial CKD-score increase. Conclusions: Within the context of conventional, limited durations of ischemia, histologic deterioration of preserved parenchyma after PN appears to be primarily due to pre-existing medical comorbidities rather than ischemia. A subsequent decline in renal function was mild and independent of histologic changes. Patient summary: After clamped PN, the preserved renal parenchyma demonstrated histologic deterioration in many cases, which correlated with the presence of comorbidities such as hypertension, diabetes mellitus, or chronic kidney disease. In contrast, the type and duration of ischemia did not correlate with histologic changes after PN, suggesting that ischemia insult had only limited impact on parenchyma deterioration. (c) 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Partial nephrectomy Chronic kidney disease Pathological scores Renal functional Ischemia

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English

Others

National Natural Science Foundation of China[81972382,81872091,61931024,82170777] ; Natural Science Foundation for Distinguished Young Scholars of Guangdong Province[2021B1515020077]

Urology & Nephrology

Urology & Nephrology

WOS:000807186300011

ELSEVIER

CLINICAL MEDICINE

Web of Science

1.Sun Yat Sen Univ Canc Ctr, Dept Urol, Guangzhou, Peoples R China
2.State Key Lab Oncol Southern China, Guangzhou, Peoples R China
3.Collaborat Innovat Ctr Canc Med, Guangzhou, Peoples R China
4.Cleveland Clin, Robert J Tomsich Pathol & Lab Med Inst, Dept Anat Pathol, Cleveland Hts, OH USA
5.Southern Med Univ, Nanfang Hosp, Natl Clin Res Ctr Kidney Dis, Div Nephrol, Guangzhou, Peoples R China
6.Cleveland Clin, Glickman Urol & Kidney Inst, Dept Urol, Cleveland Hts, OH USA
7.Sun Yat Sen Univ, Canc Ctr, Dept Pathol, Guangzhou, Peoples R China
8.Zhengzhou Univ, Affiliated Hosp 1, Dept Urol, Henan, Peoples R China
9.Peking Univ First Hosp, Dept Urol, Beijing, Peoples R China
10.Sichuan Univ, West China Hosp, Dept Urol, Sichuan, Peoples R China
11.Shanghai Jiao Tong Univ, Renji Hosp Affiliated, Dept Urol, Shanghai, Peoples R China
12.Chinese Acad Med Sci, Canc Hosp, Dept Urol, Beijing, Peoples R China
13.Yantai Yuhuangding Hosp, Dept Urol, Shandong, Peoples R China
14.Cent South Univ, Xiangya Hosp, Dept Urol, Changsha, Peoples R China
15.First Peoples Hosp Chenzhou, Dept Urol, Hunan, Peoples R China
16.Hainan Gen Hosp, Dept Pathol, Hainan, Peoples R China
17.Guangzhou Med Univ, Affiliated Hosp 1, Dept Urol, Guangzhou, Peoples R China
18.Southern Univ Sci & Technol, Affiliated Hosp 1, Shenzhen Peoples Hosp, Dept Urol, Shenzhen, Peoples R China
19.Jinan Univ, Clin Coll 2, Dept Urol, Shenzhen, Peoples R China
20.Sun Yat Sen Univ, Sun Yat Sen Mem Hosp, Dept Urol, Guangzhou, Peoples R China
21.Shanghai Jiao Tong Univ, Ruijin Hosp, Sch Med, Dept Urol, Shanghai, Peoples R China
22.Fudan Univ, Shanghai Canc Ctr, Dept Urol, Shanghai, Peoples R China
23.Fudan Univ, Shanghai Med Coll, Dept Oncol, Shanghai, Peoples R China
24.Sun Yat Sen Univ, Affiliated Hosp 1, Dept Urol, Guangzhou, Peoples R China
25.Cent South Univ, Xiangya Hosp 3, Dept Urol, Hunan, Peoples R China
26.No 1 Hosp Lian Yungang, Dept Urol, Jiangsu, Peoples R China
27.Sun Yat Sen Univ, Canc Ctr, Dongfengdonglu 651, Guangzhou, Peoples R China
28.Cleveland Clin, Glickman Urol & Kidney Inst, Ctr Urol Oncol, Cleveland Hts, OH 44195 USA
29.Sun Yat Sen Univ Canc Ctr, Dept Urol, Dongfengdonglu 651, Guangzhou, Peoples R China

Xiong, Longbin,Nguyen, Jane K.,Peng, Yulu,et al. What Happens to the Preserved Renal Parenchyma After Clamped Partial Nephrectomy?[J]. EUROPEAN UROLOGY,2022,81(5).

Xiong, Longbin.,Nguyen, Jane K..,Peng, Yulu.,Zhou, Zhaohui.,Ning, Kang.,...&Zhang, Zhiling.(2022).What Happens to the Preserved Renal Parenchyma After Clamped Partial Nephrectomy?.EUROPEAN UROLOGY,81(5).

Xiong, Longbin,et al."What Happens to the Preserved Renal Parenchyma After Clamped Partial Nephrectomy?".EUROPEAN UROLOGY 81.5(2022).