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Review
. 2018 Feb 23;5(1-2):13-20.
doi: 10.18632/oncoscience.393. eCollection 2018 Jan.

Determinant factors for chronic kidney disease after partial nephrectomy

Oscar D Martín  1 , Heilen Bravo  2 , Marcos Arias  3 , Diego Dallos  4 , Yesica Quiroz  4 , Luis G Medina  2 , Giovanni E Cacciamani  5 , Raul G Carlini  2
Affiliations
Review

Determinant factors for chronic kidney disease after partial nephrectomy

Oscar D Martín et al. Oncoscience. .

Abstract

The objective of this review is to evaluate the factors that determine the development or deterioration of Chronic Kidney Disease (CKD) after partial nephrectomy (PN). When current literature is reviewed, it is found that factors that influence renal function after partial nephrectomy, are multifactorial. Those are divided into pre-surgical factors, such as hypertension, diabetes mellitus, urolithiasis, obesity, metabolic syndrome among others; intra-surgical factors, like the surgical technique used, the remaining healthy tissue, the experience of the surgeon, the time and type of ischemia among others. Lastly, post-surgical factors, also impose some influence on the post-surgical renal performance. It was also found that minimally invasive surgery, in addition to its known advantages, seems to offer a greater field of action in the future that will allow more nephrons preservation in any future surgical scenario. Finally, the current trend is to perform PN on all patients, in whom surgery is technically feasible regardless of the approach used, without risking oncological outcomes, patient safety, and without being exposed to any additional complications.

Keywords: chronic kidney disease; kidney-sparing surgery; partial nephrectomy; predicting factor; prognostic factor.

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Conflict of interest statement

CONFLICT OF INTEREST No potential conflicts of interest were disclosed.

Figures

Figure 1
Figure 1. Flow chart of the identified study
Research strategy.
Figure 2
Figure 2. Ischemia techniques
(A) Renal artery and vein clamping. (B) Selective closure of the collecting system and renal vessels. (C) Renorrhaphy, withdrawal of laparoscopic bulldogs with total time of warm ischemia of 30 minutes.
Figure 3
Figure 3. Ischemia techniques
(A) Renal artery and vein clamping. (B) Selective collecting system and renal vessels closure, withdrawal of laparoscopic bulldogs in 15 minutes. (C) Renorrhaphy without clamping.
Figure 4
Figure 4. (A) Tumor lesion in the middle renal segment with controlled hypotension MAP of 60-70 mmHg, (B) complete resection of tumor lesion with minimal renal parenchymal bleeding
Direct hemostatic control with absorbable points.
Figure 5
Figure 5. Zero ischemia technique
(A) Anterior left renal artery distribution, renal mass on the inferior pole with middle artery feeding. (B) Middle arterial branch selective clamping.
See this image and copyright information in PMC

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