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PubMed1986

Glomerular sclerosis in Wistar rats: analysis of its variable occurrence after unilateral nephrectomy.

Individual differences in susceptibility to the development of focal and segmental glomerular hyalinosis and sclerosis (FSGHS) were studied in rats after unilateral nephrectomy. A total of 20 male Wistar rats underwent unilateral nephrectomy at 3 months of age. Glomerular number in the removed kidney ranged from 17,000 to 32,700 with a mean value of 25,997 (n = 19). At death 30 weeks later, the incidence of glomeruli with FSGHS in the remaining kidney varied from 0 to 20% with a mean of 4.4%. However, the percentage of glomeruli with FSGHS and the degree of proteinuria did not correlate either with glomerular number per kidney (left and right kidneys were shown to be equivalent for glomerular number) or with glomerular volume on killing. The occurrence of FSGHS correlated significantly with mean protein excretion (P less than 0.01) and serum cholesterol levels (P less than 0.01). In conclusion, in the rat a relatively low number of nephrons in the kidneys does not increase susceptibility to the development of FSGHS.

Animals↗
PubMed1985

[A case of renal hypertension after pyelolithotomy cured by segmental nephrectomy].

A case of renal hypertension after pyelolithotomy cured by segmental nephrectomy is reported. The patient, a 39-year-old man had had pyelolithotomy performed by the lumbodorsal approach at another hospital. Two months after operation he started to complain of headache and palpitation. The blood pressure was markedly high when he visited our hospital and peripheral plasma renin activity was also elevated. Urinalysis was normal except for slight proteinuria. The excretory urogram demonstrated cortical scarring in the lower portion of the left kidney. The renal scintigram demonstrated low uptake in this area, suggesting renal infarction. Renal arteriogram showed decreased vascularity in this area. Plasma renin activity was measured on the blood drawn from the renal vein of both sides and the ratio was about 2.4, and renin activity of the segmental renal vein from the left lower portion was elevated. Segmental nephrectomy of the lower pole was performed. The blood pressure three weeks after lower pole resection was estimated to be normal and renin activity returned to an almost normal level. Discussion was made on the cause of renal hypertension after renal surgery. In this case, it was suggested that renal hypertension is caused by subinfraction due to lesions of the dorsal renal artery in surgery for renal calculus.

Adult↗
PubMed1985

[Unilateral atrophic kidney and hypertension--the value of plasma renin determination for assessing the indications for nephrectomy].

In unilateral atrophic kidney and hypertension the nephrectomy is the therapy of choice. The nephrectomy is, however, indicated only then, when a causal pathogenetic connection of atrophic kidney and hypertension is proved. As criterion of the proof of such a connection according to our experiences the side-separated determination of the plasma renin activity in the venous blood of the kidneys stood the test. A renal vein renin quotient greater than 1.5, moreover, permits a rather reliable prognostic evidence concerning the behaviour of the postoperative blood pressure. In 26 out of 31 hypertensive patients with significant renal vein renin quotient who were nephrectomized for a unilateral atrophic kidney could be achieved a normalization of the blood pressure, in the other 5 patients an improvement of the blood pressure.

Adolescent↗
PubMed1979

[Hypertension in unilateral (non-vascular) nephrosclerosis: renin activity in the venous kidney blood and effect of nephrectomy].

13 patients (9 females, 4 males) with hypertension and unilateral (non-vascular) small kidney underwent nephrectomy. Before surgery, renin activity (PRA) was measured in renal vein blood before and/or 15 and 30 minutes after intravenous stimulation with 40 mg furosemide. From these PRA values renin rations (PRA affected side/PRA unaffected side) were calculated. A ratio of greater than or equal to 1.5 was considered to be significant. After a mean postoperative observation period of 3.9 +/- 1.3 years 6 patients (46%) were cured and 6 were improved. In only 1 patient (8%) did hypertension remain unchanged. No differences could be observed between the renin ratios of cured and improved cases. Furthermore, in no patient was a correlation found between preoperative renin ratios and the degree of postoperative blood pressure reduction. Finally, both patients with renin ratios less than or equal to 1.4 were cured by surgery. Marked differences between cured and improved patients were seen in preoperative blood pressure values, age, duration of hypertension and renal function. Cured patients were younger and had much lower mean systolic and diastolic blood pressure values, shorter duration of hypertension and better renal function than improved patients. These results show that the diagnostic and prognostic validity of renal venous renin ratios is very limited in patients with a unilateral (non-vascular) small kidney. In these patients the effect of nephrectomy can already be predicted by analyzing simple anamnestic, clinical and chemical data.

Adolescent↗
PubMed1985

Determinants of the kaliuresis after acute unilateral nephrectomy in the dog.

We examined the factors regulating potassium excretion (UKV) in anesthetized, mechanically ventilated, mineralocorticoid-injected dogs undergoing acute unilateral nephrectomy (AUN). In control dogs, AUN caused both sodium excretion (UNaV) and UKV to increase in association with an increase in bicarbonate excretion (UHCO3V) but no change in chloride excretion (UClV). In dogs made acutely acidotic by intravenous infusion of dilute HCl, AUN led to comparable increase in UNaV and UKV, but with increased UClV and only a trivial change in UHCO3V. In dogs in which prostaglandin synthesis was inhibited by indomethacin or meclofenamate, AUN led to an increase in UKV but without any increase in UNaV or UHCO3V. The fractional excretion of potassium rose significantly and comparably in all groups. Our results indicate that the post-nephrectomy kaliuresis occurs without change in respiratory acid-base status or mineralocorticoid hormone activity, and can be dissociated from increased UHCO3V and, probably, increased delivery of fluid out of the proximal tubule. They therefore suggest a specific and potent effect of AUN to stimulate UKV through an increase in plasma potassium concentration or through some as yet undetermined mechanism.

Acid-Base Equilibrium↗
PubMed1977

The use of the CO2 laser for partial nephrectomy: an experimental study.

The CO2- laser knife was used for partial nephrectomy in an experimental study of 20 mongrel cats. Of these, 16 survived, two died of peritonitis, and two died of unrelated causes. The inherent characteristics of precision and hemostasis of this modality, already found useful in controlling complications in other fields of surgery, proved to be a safe and effective method for partial nephrectomy as shown by angiography and histopathologic examinations of the operated kidneys at 0, 7, 14, 21, and 90 days after surgery. Complications such as hemorrhage or urinary fistula were nonexistent.

Animals↗
PubMedDate not supplied

[Bilateral nephrectomy by embolization of the renal arteries: a report on five cases (author's transl)].

Selective bilateral renal artery embolization was performed in 5 patients because of severe hypertension not responding to conventional medical treatment, in two patients on repeated dialysis; severe nephrotic syndromes with chronic renal insufficiency in the three other patients. A significant drop in blood pressure occurred in only two of the hypertensive patients, about 40 days after embolization. Bilateral surgical nephrectomy was required in the other patient because of persistence of residual vascularization and high RAP. Excellent results were obtained in the 3 patients with a nephrotic syndrome, with disappearance of proteinuria and anuria following the embolization. For this method to be effective, the arterial obliteration has to be complete and definitive. When symptoms persist or there is a relapse, especially in the cases with hypertension, a repeated arteriographic examination and complementary embolization has to be envisaged. Further experience with this method is necessary in order to compare the results with those obtained after bilateral surgical nephrectomy. Medical treatment with agents toxic to the tubules, in cases of the nephrotic syndrome, has apparently not produced the results expected. The relative simplicity of this embolization procedure has to be underlined, together with the fact that it is free from major complications when performed by surgeons trained in its use, on the condition that purification be carried out immediately following embolization.

Adult↗
PubMed1982

Influence of age and nephrectomy on metastatic patterns in Wilms' tumors.

Data from 194 autopsy cases of Wilms' tumor were analyzed statistically to investigate the mode of dissemination by classifying them according to the number of organs involved in metastasis, age and history of nephrectomy. Metastasis-free cases were more frequent in cases under two years of age, in bilateral cases, and in non-nephrectomized cases. The frequencies of metastasis to various organs were essentially similar among the various age groups, except those to the contralateral kidney and intestines in cases under two years of age, which were significantly more frequent. Nephrectomized cases showed a significantly higher incidence of metastasis to the peritoneum than non-nephrectomized cases. In cases with metastasis to one organ, metastasis to the lungs, lymph nodes and liver showed low frequencies (17%, 13% and 17%, respectively), but that to the peritoneum showed a rather high frequency (21%). Radiation therapy for the peritoneum after nephrectomy is recommended.

Adolescent↗
PubMed1984

[Effect of functional loading on the operation of the active transport system for organic acids in the proximal kidney tubules of rats after unilateral nephrectomy and in the early postnatal period].

The influence of a prolonged introduction of exogenic organic acid penicillin (that is functional loading) on the level of accumulation of an anionic dye (fluorescein) in renal proxima tubules was studied after unilateral nephrectomy and early postnatal period. Injection of penicillin 2 days after unilateral nephrectomy slowly increased Na-independent and strongly increased Na-dependent component of active fluorescein transport in renal proximal tubules of randombred, but strongly decreased both Na-independent and Na-dependent transport in renal tubules of the Campbell rats. When newborn random-bred, Wistar and Campbell rats were pretreated with penicillin, we obtained a slow increase in Na-independent and a strong increase in Na-dependent component of fluorescein transport in renal tubules of random-bred and Wistar rats, but a significant reduction in both Na-independent and Na-dependent transport. It is concluded that the ability for adaptive (or substrate) stimulation of active transport of organic anion in renal proximal tubules is controlled genetically. Adaptive stimulation of organic acid transport in renal tubules referred to in literature as "carried induction", was accomplished apparently by the increase in driving force of the active transport, that is evidently the level of electrochemical Na+-gradient.

Animals↗
PubMed1983

Renal cell carcinoma in a solitary kidney treated by partial nephrectomy--case report and review of Japanese literature.

Renal cell carcinoma in a solitary kidney is rather rare. We present a case of this condition occurring in a 50-year-old man. He was treated by partial nephrectomy and temporary hemodialysis for postoperative acute renal failure. Perusal of the literature reveals that in situ partial nephrectomy, if possible, seems to be a reasonable treatment of choice for renal cell carcinoma in a solitary kidney. This is the fifth case ever reported in Japan.

Acute Kidney Injury↗
PubMed1981

The use of living donors. Glomerular filtration rate during the first year after donor nephrectomy.

The functional increase in the remaining kidney after donor nephrectomy has two distinct components in man. There is a rapid initial increase in function within the first 24 hours, due to the circulatory adjustments in the kidney, but the mechanisms have not been elucidated. Thereafter, there is a further functional increase during the first year which in addition to the haemodynamic changes, also includes an increase in tubular function. The increased work-load on the kidney handling the increased volume of filtrate presented to the tubules may induce the increase in tubular function, but hormonal factors have been shown to contribute to the long-term increase in tubular function after contralateral nephrectomy.

Adult↗
PubMed1981

Living donor nephrectomy: surgical aspects.

A series of 143 living donor nephrectomies during a 14 year period is presented. The overall complication rate was 16 per cent. The incidence of wound complications was 4.2 per cent and of lower urinary tract infections 9.8 per cent. To date no donor has had known significant problem related to the nephrectomy or to the solitary kidney status.

Adolescent↗
PubMed1983

Role of partial nephrectomy in solitary or bilateral renal tumors.

Partial nephrectomy was carried out successfully in seven of eight cases of solitary or bilateral renal carcinoma. Although three patients with bilateral sequential lesions died of subsequent metastatic disease, their deaths occurred after 33 to 52 months of productive life without the need for end-stage treatment of renal disease. One patient died free of disease of myocardial infarction at 45 months, and the remaining three were alive without evidence of tumor 62, 76, and 85 months after the procedure. No patient suffered local recurrence of tumor, and the need for dialysis in three patients was only temporary. Partial nephrectomy is a viable option in the management of solitary or bilateral renal carcinoma.

Adenocarcinoma↗
PubMed1983

Studies on the effects of total nephrectomy in sheep.

Effects of total nephrectomy were studied in six sheep. There was no marked deterioration in the clinical condition of the animals except anorexia and reduced water intake. Three sheep survived the period of observation of 120 hours when they were euthanized. One animal suddenly died at each of 76, 80 and 100 hours. Progressive increase of blood urea nitrogen concentration was accompanied by severe metabolic acidosis in the later stages. Plasma creatinine rose significantly but the change was not marked. Plasma inorganic phosphorous and calcium decreased significantly. Unaffected plasma sodium levels were accompanied by hyperkalemia and hypochloremia. Plasma total proteins and albumin decreased significantly in the later stages. Results showed markedly different responses to total nephrectomy in sheep as compared to changes reported in cattle and nonruminants.

Acidosis↗
PubMed1982

[Long-term follow-up of nephrectomy for hypernephroma in 442 patients].

The long-term-results of 442 patients with nephrectomy because of hypernephroma are analysed with regard to preoperative findings, surgical technique and postoperative therapy. Until 1971 conventional nephrectomy was performed, since then a modification with a long incision carried medially and "blind" manual preparation of the renal pedicle has been performed. This led to better long-term-results. A table of preoperative findings of all patients who survived more than 5 years or less the 6 months respectively may predict the prognosis of the individual patient. In our series postoperative radiotherapy shows very poor results and will be abandoned. The negative influence on the immuno resistance may be one reason for this.

Adenocarcinoma↗
PubMed1982

A long-term follow-up study of the arterial pressure dynamics after nephrectomy in patients with renal hypertension.

For periods of 3 to 15 years after unilateral nephrectomy the arterial pressure dynamics was studied in 131 patients. In 18 patients with and 12 patients without remission of hypertension the renal haemodynamics was studied before and after nephrectomy. The functional compensatory mechanisms of the remaining kidney are assessed on the basis of preoperative checkings of selective renal haemodynamics and of the activities of the renin-angiotensin and prostaglandin systems in 10 patients with absent and 15 patients with decreased excretory function of one kidney. In the authors' opinion, the blood flow in the contralateral kidney increases, at lacking excretory function of the other kidney, owing to enhanced prostaglandin A2 synthesis in the contralateral kidney.

Adolescent↗
PubMed1982

Results of radical thoraco-abdominal nephrectomy in the treatment of renal cell carcinoma.

A series of 162 cases of renal cell carcinoma treated by radical thoraco-abdominal nephrectomy is presented, together with the three, five and ten year survival. The increase in survival rate is probably due to three factors. 1) Early ligation of the renal artery and vein. 2) Complete removal of the perinephric envelope. 3) Surgical extirpation of the lymphatic field. Prognosis in renal cell carcinoma is directly related to the stage and grade of the tumour and as yet nephrectomy offers the only hope of cure.

Abdomen↗