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PubMed1994

Changes in urinary excretion of endothelin-1-like immunoreactivity before and after unilateral nephrectomy in humans. Comparison with other urinary parameters and unilateral adrenalectomy.

To assess the value of endothelin-1 (ET-1) as a parameter of renal functional overload and the process of hyperfiltration, urinary excretion of ET-1-like immunoreactivity (U-ET-1) and urinary excretion of other parameters [beta 2-microglobulin (beta 2-MG), N-acetyl-beta-D-glucosaminidase (NAG), albumin (Alb) and 24-hour creatinine clearance (Ccr24)] were measured before, 1, 2 and 7 days after unilateral nephrectomy in 15 patients with unilateral renal lesions (renal cell cancer, renal pelvic cancer, ureteral cancer and renal tuberculosis) and after unilateral adrenalectomy in 5 patients with adrenal lesions. In the nephrectomy group (NX), Ccr24 significantly decreased at 1 and 2 days after the operation, but the other 4 parameters significantly increased after the operation as compared to preoperative values. In the adrenalectomy group (ADX), neither Ccr24 nor ET-1/Cr showed any change after the operation, but the other 3 parameters (beta 2-MG/Cr, NAG/Cr and Alb/Cr) significantly increased. Comparing the NX and ADX groups, both ET-1/Cr and beta 2-MG/Cr in NX were significantly higher than in ADX after the operation. On the other hand, neither NAG/Cr nor Alb/Cr in NX differed from values in ADX. Comparing ET-1/Cr and other parameters, only beta 2-MG showed a positive significant correlation. These results suggest that U-ET-1 may be an indicator of functional overload of the kidney.

Acetylglucosaminidase↗
PubMed1996

Renal fibromuscular dysplasia treated with partial nephrectomy.

Renovascular hypertension, caused by fibromuscular dysplasia, mainly affects young women in the third decade of life. Percutaneous transluminal angioplasty is the treatment of choice for solitary lesions with a complete functional result in 40-50% of the cases. Multiple stenoses, involving intrarenal arterioles, cannot be treated by dilatation and are mostly treated by nephrectomy. Nevertheless, those vascular stenoses are often limited to a particular renal segment so that unaffected segments could be spared. Two patients were treated with a partial nephrectomy. The short-term results are promising. We suggest that this treatment modality could be offered as a rational and effective solution to well-selected cases, with multiple, regionally limited arterial stenoses.

Adolescent↗
PubMed1984

Late recurrence of renal cell carcinoma after nephrectomy.

Late recurrence of renal cell carcinoma is unusual. Of 43 patients who underwent curative nephrectomy more than 10 years before, 2 cases (4.7%) had late recurrence. The 2 cases, both female patients, had late recurrence 12 and 19 years from the date of nephrectomy. The clinical aspects of late recurrence are discussed briefly.

Adenocarcinoma↗
PubMed1976

Partial nephrectomy for renal tumour: 21 cases.

Partial nephrectomy has been performed in 21 cases of kidney tumours. It can be used for well-limited parenchymatous tumours and obligatory in patients with a solitary kidney, but is not advisable for tumours originating in the urothelium. These results are compared with the parallel experience with radical surgery and followed during 46 years in the same centre, they give a greater value to this study and encourage the reasoned practice of partial nephrectomy for tumours especially in the solitary kidney.

Adenocarcinoma↗
PubMed1980

Bilateral nephrectomy by the posterior approach.

The experience with 94 patients undergoing bilateral nephrectomy suggests that the posterior retroperitoneal approach has lower morbidity and mortality than transabdominal procedures. In addition, the lack of transgression of the peritoneal cavity facilitates the possible use of chronic peritoneal dialysis in the future management of these patients. The circumstances in which bilateral nephrectomy is indicated are reviewed.

Adolescent↗
PubMed1997

Arteriovenous fistula following nephrectomy.

UNLABELLED: Arteriovenous fistula (AVF) of the renal pedicle is a rare complication of nephrectomy. Since the 1st case report in the literature, 62 cases have been reported in the world literature. A continuous abdominal or lumbar bruit is diagnosed. They may also present with symptoms of congestive heart failure and/or hypertension. METHODS: 37 years following nephrectomy, a case of AVF of the right renal pedicle associated with gross proteinuria is described. RESULTS: The clinical diagnosis was confirmed by aortogram, and the proteinuria subsided after successful surgical management. CONCLUSION: The causes of proteinuria may be due to the hyperfiltration state. To our knowledge, there has been no previous report of this combination in the literature.

Arteriovenous Fistula↗
PubMed1992

Laparoscopic nephrectomy in a porcine model.

Laparoscopic nephrectomy was performed in 15 male pigs, the procedure was successful in 14. Extraction of the intact kidney through a 5-cm lower abdomen incision was done in 7 animals; complete destruction and evacuation of the kidney was accomplished by a round-knife suction device through a 1-cm port in another 7 pigs. Grossly, the specimen consisted of sausage-like tubular renal tissue and a small amount of tissue debris. Pathology revealed that the glomerular and tubular structures were well preserved, no interstitial hematoma could be found. Four ports were usually used, one 1-cm umbilical camera port, one 0.5-cm port for ureter traction, and two 1-cm working ports along the midclavicular line. All the pigs recovered uneventfully. The average operation time was 3 h 20 min. The application of endo-GIA (United States Surgical Corporation) for renal hilum reduced the operative time to 2 h 20 min. Complications included renal vein tear during endoclip application and cutting in the first case, mild subcutaneous emphysema in 2 cases. This first pig received exploratory laparotomy for the repair and ligation of the renal vein. No more major complications occurred with increasing experience. From this porcine experiment, we conclude that the combination of laparoscopy, a tissue destroyer and an endobag for the entrapment of kidney seem to be a promising technique for clinical nephrectomy.

Animals↗
PubMed1994

Retroperitoneal laparoscopic nephrectomy and other procedures in the upper retroperitoneum using a balloon dissection technique.

This article describes a hydraulic balloon dissection technique. The retroperitoneum is developed via a small lumbodorsal incision between the edges of the musculus latissimus dorsi and musculus obliquus externus and then after visualization of its correct position the balloon catheter is filled with 500-1,200 ml of warm normal saline (according to patient size). The device consists of the finger of a surgeon's glove ligated around the end of a rigid bladder catheter. The balloon insufflation is maintained for 5 min to guarantee adequate hemostasis. Recently, we have replaced the balloon catheter by a balloon trocar sheath allowing direct endoscopic control of the hydraulic dissection. After retrieval of the balloon the CO2 insufflator is connected to the first trocar. All secondary trocars are placed under endoscopic control. The hydraulic dissection techniques also enable optimal creation of an effective pneumoperitoneum in children. Until now, we have used this technique for twelve procedures in the upper retroperitoneum including five nephrectomies, two nephroureterectomies, one tumor nephrectomy, one nephropexy, one renal cyst marsupialization and two renal biopsies. Up to now we have encountered no major complications. Three of the nephrectomized patients had undergone multiple previous abdominal surgical interventions. The retroperitoneal approach allows the surgeon to apply similar dissecting techniques as used in respective open procedures. It has become the routine approach for laparoscopic procedures in benign renal disease. This procedure can be performed even in cases with previous abdominal surgery.

Adult↗
PubMedDate not supplied

Renomedullary deficiency in partial nephrectomy-salt hypertension.

Partial nephrectomy-salt hypertension (PN-SH) of the rat is associated with Na volume loading. As the hypertensive state evolves, the renomedullary interstitial cells (RIC) of the renal nubbin undergo major changes, decreasing significantly in number while the remaining ones exhibit degenerative changes. The antihypertensive action of the RIC in the renal nubbin, as measured by transplants of fragmented papillae into hypertensive recipients, virtually disappears as the hypertension develops. The changes in the RIC occur whether vascular disease of the kidney is or is not overtly present. It is suggested that deficiency of the antihypertensive action of the RIC allows the prohypertensive effects of Na volume loading to operate without proper control. Thus, the sustained hypertensive state of this model does not appear to be due solely to volume expansion. Rather, it appears due to a combination of the effects of Na and volume and a renomedullary deficiency of hormonal type. The specific cause(s) of the changes in the RIC was not determined. It seems evident that it is related to the high salt intake since the partial nephrectomy procedure without the added salt load did not alter the appearance of the RIC.

Animals↗
PubMedDate not supplied

Regional changes in rat brain angiotensinogen following bilateral nephrectomy.

One approach to establish the existence and functionality of a brain angiotensin system is to demonstrate selective alterations in that system following perturbation of peripheral cardiovascular functions. The present study utilized this approach to quantify regional angiotensinogen levels in the rat brain following bilateral nephrectomy, a perturbation that severely disrupts salt and water homeostasis. Angiotensinogen, the precursor of any centrally-derived angiotensin, was analyzed since it should provide a marker for a putative angiotensin peptidergic system. Net brain angiotensinogen was determined by correcting total tissue concentrations of angiotensinogen with accurate values of contaminating plasma angiotensinogen. The latter was determined by quantifying regional plasma space utilizing tritiated inulin as a marker of cerebral vascular space. It was found that there were no detectable alterations in regional net brain angiotensinogen in the first 24 hours following nephrectomy despite over a twofold increase in plasma angiotensinogen and the absence of significant plasma renin. By 32 hours postnephrectomy, certain areas of the rat hypothalamus and midbrain exhibited significant elevations in net angiotensinogen content. These areas coincided with regions traversed by neural pathways shown to mediate angiotensin-induced drinking or blood pressure elevations. The results lend further support to the concept of an independent brain angiotensin system.

Angiotensinogen↗
PubMedDate not supplied

Brain water alterations after unilateral nephrectomy. A study of regional circulatory factors in squirrel monkeys.

White and regional gray matter distributions of water, blood flow, and the protein tracer pertechnetate were measured in five normal squirrel monkeys. A second group of five monkeys, which had undergone unilateral nephrectomy six months previously, were found at the time of study to have blood pressures similar to those of the control animals but increased brain water and altered distribution of blood flow which was increased in white matter. No alteration of capillary permeability to the protein traces attended these changes, which appeared to be influenced by blood pressure. Nephrectomy without hypertension influences brain water content, perhaps because of an effect on cerebral resistance vessels. In hypertensive encephalopathy renal lesions, as well as intraluminal pressure changes, may be related to cerebral edema.

Animals↗
PubMed2002

Substance P in subtotal nephrectomy-salt hypertension.

We have previously demonstrated that calcitonin gene-related peptide (CGRP) plays a counterregulatory role in subtotal nephrectomy-salt (SN-salt) hypertension through an increase in vascular responsiveness to the dilator activity of this neuropeptide. Substance P (SP) is often co-localized with CGRP in perivascular sensory nerves. To determine the role and mechanism of action of SP in SN-salt hypertension, we induced hypertension in 4- to 6-week-old male Sprague-Dawley rats (n=8) by subtotal nephrectomy and 1% saline drinking water. Sham-operated rats were given either tap water (n=9) or 1% saline to drink (n=9). Eleven to 13 days after each protocol, all rats had intravenous (for drug administration) and arterial (for continuous monitoring of mean arterial pressure [MAP]) catheters surgically implanted and were studied in the conscious and unrestrained state. Baseline MAP was significantly elevated in the SN-salt rats (157 +/- 6 mm Hg) compared with tap water--fed controls (128 +/- 3 mm Hg) and 1% saline--fed controls (132 +/- 5 mm Hg). Vehicle administration did not alter the MAP in any group. In contrast, administration of spantide-II (0.2 micromol/L in saline), an SP receptor antagonist, significantly elevated the MAP in SN-salt rats (13.9 +/- 0.8 mm Hg) compared with the tap water (1.7 +/- 1.7 mm Hg) and 1% saline controls (2.0 +/- 1.9 mm Hg). SP mRNA and peptide levels in dorsal root ganglia were not significantly different between the 3 groups. Administration of exogenous SP (12 and 24 nmol center dot L(-1) center dot kg(-1) intravenously) resulted in a significantly greater decrease in MAP in the SN-salt rats compared with both control groups. Taken together, these data suggest that in SN-salt hypertension, SP plays a counterregulatory role in the absence of an increase in its neuronal expression, thereby suggesting that one possible mechanism of this compensatory vasodilator response is enhanced vascular reactivity to SP.

Animals↗
PubMed2001

Changes of AT(2) receptor levels in the rat adrenal cortex and medulla induced by bilateral nephrectomy and its modulation by circulating ANG II.

We studied regulation of the AT(2) receptor by investigating the effect of bilateral nephrectomy (bNX) in Sprague-Dawley rats. The expression of aldosterone synthase (CYP11B2) and AT(2) receptor mRNA was detected by nonradioactive in situ hybridization. AT(2) receptor mRNA was detected in cells of the first two or three subcapsular cell layers of the zona glomerulosa (ZG) and in the medulla of sham-operated animals. After bNX, the number and area of distribution of AT(2) receptor-positive cells increased in the ZG. This was associated with an enlargement of the steroidogenic active ZG and with reduced proliferation rate (sham 5.9 +/- 0.9%; bNX 2.4 +/- 0.2%; p<0.02). Infusion of angiotensin II (ANG II; 200 ng/kg/min SC for 56 hr) to bNX rats did not reverse the effect of nephrectomy on the distribution of AT(2) receptor expression, although mRNA levels per cell were reduced compared to NX alone. ANG II infusion decreased proliferation rate further (0.4 +/- 0.07%; p<0.001). In the adrenal medulla after bNX, decreased expression of the AT(2) receptor was associated with increased proliferation (2.6 +/- 0.2% vs 6.6 +/- 0.5%). These results demonstrate differential regulation of the AT(2) receptor in the adrenal gland and suggest that expression of the AT(2) receptor is involved in regulating proliferation and differentiation in the ZG and medulla. (J Histochem Cytochem 49:649-656, 2001)

Adrenal Cortex↗
PubMed2004

Laparoscopic versus open nephrectomy for renal cell carcinoma?

Laparoscopic radical nephrectomy has become a well-standardized and reproducible, but technically demanding procedure. It is rapidly replacing the traditional open technique in radical nephrectomy with T1-2 tumours. Open operation will mainly be reserved for T3 tumours. Nephron-sparing surgery will play a major role in small (<4 cm) peripheral tumours. Open technique is still the standard for NSS, but with the refined techniques, laparoscopy may be soon coming.

Carcinoma, Renal Cell↗
PubMed2003

Pain experienced by laparoscopic donor nephrectomy patients in an academic medical setting.

CONTEXT: Since 1996, 414 laparoscopic live donor nephrectomy procedures have been completed at our institution. Although this procedure has gained acceptance within the past 5 years, little is known about its nursing implications. OBJECTIVE: The purpose of this performance improvement project was to identify pain management practices, satisfaction levels, and clinical outcomes among patients undergoing laparoscopic live donor nephrectomy. PATIENTS: Data were collected for a convenience sample of 70 patients for 18 months. INTERVENTION: Several pain management methods were used, including patient-controlled analgesia and intramuscular and oral medications. RESULTS: Pain ratings ranged from 3.2 to 3.8 for the first 36 hours postoperatively. The mean pain level did not differ significantly between pain regimes. At discharge, patients perceived a mean overall pain level of 5.0 but anticipated a pain level of 6.1. A significant negative correlation between satisfaction and pain rating also was noted. CONCLUSIONS: Opportunities exist to standardize current regimens of pain medications and address pain level and treatment 24 hours postoperatively.

Academic Medical Centers↗
PubMed2001

Interferon adjuvant to radical nephrectomy in Robson stages II and III renal cell carcinoma: a multicentric randomized study.

PURPOSE: Because interferon gave promising results in the management of metastatic renal cell carcinoma in the 1980s, a multicentric randomized controlled trial was planned to compare adjuvant recombinant interferon alfa-2b (rIFNalpha2b) with observation after radical nephrectomy in patients with Robson stages II and III renal cell carcinoma. Overall and event-free survival were to be evaluated together with prognostic factors. PATIENTS AND METHODS: Overall and event-free survival curves for 247 patients (124 controls and 123 treated) were estimated by the Kaplan-Meier method and compared using the log-rank test. Cox's multiple regression models were adopted to perform a joint analysis of treatment and prognostic factors. RESULTS: The 5-year overall and event-free survival probabilities were 0.665 and 0.671, respectively, for controls and 0.660 and 0.567, respectively, for the treated group; the differences were not statistically significant (2P = .861 for overall and 2P = .107 for event-free survival with the log-rank test). Regarding prognostic factors, only grade, pT, and pN demonstrated a significant prognostic role. First-order interactions of treatment with pT and pN category were investigated; a significant interaction was found between pN and treatment. A harmful effect of rIFNalpha2b in the 97 treated pN0 patients and a protective effect in the 13 treated pN2/pN3 patients were statistically significant. CONCLUSION: Adjuvant rIFNalpha2b is not indicated after radical nephrectomy for renal cell carcinoma. The protective effect in the small group of pN2/pN3 patients requires further investigation.

Adult↗
PubMed2006

Transient reciprocal change of renal hepatocyte growth factor and transforming growth factor-beta1 may relate to renal hypertrophy in rats with liver injury or unilateral nephrectomy.

We examined an animal model of liver injury using ligation of the common bile duct (CBD) in young rats to observe nephromegaly and to determine plasma and renal changes in hepatocyte growth factor (HGF) and transforming growth factor (TGF)-beta1. To examine the role of TGF-beta1 in the process of compensatory renal growth, renal tissue HGF, TGF-beta1, TGF-beta1 mRNA, and c-met protein were measured. Plasma HGF level decreased significantly at 1 wk, and plasma TGF-beta1 level also decreased at 1 wk and remained low at 2 wk after surgery in CBD ligation rats. Increased renal HGF/TGF-beta1 ratio was noted at 2 wk, followed by a higher kidney weight/body weight ratio and an elevated protein/DNA ratio at 3 wk after operation in CBD ligation rats. The increased renal HGF/TGF-beta1 ratio in CBD ligation rats was mainly attributed to elevated renal HGF levels. Renal HGF/TGF-beta1 ratio was also elevated at 12 h after unilateral nephrectomy. This elevated renal HGF/TGF-beta1 resulted exclusively from low renal TGF-beta1. Renal TGF-beta1 mRNA decreased significantly at 12-24 h after surgery in unilateral nephrectomized rats, whereas renal c-met receptor protein levels increased. Transient reciprocal change of HGF and TGF-beta1 manifesting as an increased renal HGF/TGF-beta1 ratio soon after uninephrectomy and later during CBD ligation suggests the probable role of TGF-beta1 in renal growth control and its possible initiating of renal hypertrophy in liver injury or unilateral nephrectomy.

Animals↗
PubMed1991

Renal IGF-1 mRNA levels are enhanced following unilateral nephrectomy in immature but not adult rats.

The increase in IGF-1 gene expression following unilateral nephrectomy (UNX) in adult rats is controversial. In this study we have examined whether developmental differences exist in the effect of UNX on IGF-1 gene expression. Immature (23 days) and adult (4 months) Wistar rats underwent a sham operation or left UNX, and were sacrificed 24 or 48 hrs later. IGF-1 mRNA levels were determined in left (control) and right (compensated) kidneys using solution hybridization/RNase protection assays. By 48 hrs post-UNX, remnant kidneys had grown 20 +/- 1% in adult rats (P less than 0.05), and 69 +/- 5% in immature rats (P less than 0.05). IGF-1 mRNA levels were not increased in the adult compensated kidneys at either 24 or 48 hrs post-UNX. In contrast, kidneys from immature rats 24 and 48 hrs post-UNX had an average 4-fold increase (P less than 0.05) in exon 1 IGF-1 mRNA levels, and an average 3-fold increase (P less than 0.05) in exon 2 mRNA levels. Thus, these findings suggest that there is an age-dependent difference in the effects of UnX on IGF-1 gene expression, and provide the first evidence that IGF-1 gene expression increases following unilateral nephrectomy in immature rats.

Aging↗