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Query: UMLS:C0920646 (renal ischemia)
 2,515 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The use of cardiopulmonary bypass, deep hypothermia and circulatory arrest has decreased the risks of hemorrhage, tumor embolization, incomplete thrombus resection, and warm hepatic and renal ischemia associated with resection of renal cell carcinoma extending into the inferior vena cava above the hepatic veins. Patients about to undergo this operation frequently have significant coronary artery and carotid artery disease, and are at risk for perioperative myocardial infarction and stroke. Preoperative evaluation of the coronary artery and carotid artery circulation by coronary angiography, duplex carotid artery scan and digital subtraction carotid angiography is recommended. Depending upon the severity and location of the cardiovascular disease a sequential or simultaneous operation may be performed. This surgical approach can be used in selected patients to facilitate complete tumor thrombectomy with a low operative risk.
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PMID:Cardiovascular evaluation before circulatory arrest for removal of vena caval extension of renal carcinoma. 272 26

Unilateral parenchymatous kidney disease associated with high blood pressure represents a potentially curable form of hypertension. Surgery may normalize blood pressure in a substantial number of these patients. Curable renal parenchymatous hypertension includes unilateral tubulointerstitial kidney diseases such as chronic pyelonephritis, reflux nephropathy, segmental hypoplasia and radiation nephritis, hydronephrosis, simple renal cysts, traumatic kidney lesions and renal tumors associated with high blood pressure. Renal ischemia and in turn activation of the renin angiotensin system is involved in the pathogenesis of hypertension in most of these patients. In patients with unilateral kidney disease and hypertension, both an operative and a medical therapeutic approach have a high success rate. Good candidates for nephrectomy are young patients with severe hypertension, strict unilateral disease, normal plasma creatinine levels and minimal function of the involved kidney. In unilateral hydronephrosis reconstructive surgery or nephrectomy may cure or improve hypertension in the vast majority of the patients. Surgically correctable hypertension has also been reported in some patients with large renal cysts and renal tumors (hemangiopericytoma, Wilm's tumor, hypernephroma, renal pelvic tumor).
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PMID:Curable renal parenchymatous hypertension: current diagnosis and management. 390 29

Radical nephrectomy is the gold standard curative operation for patients with localized renal cell carcinoma (RCC). Since its introduction in 1990, laparoscopic radical nephrectomy is being increasingly done at numerous institutions worldwide. In the hands of experienced laparoscopic urological surgeons and with adherence to established principles of open radical nephrectomy, laparoscopic radical nephrectomy is now a standard of care for patients with T1-3a N0 M0 RCC. Intermediate-term outcome data indicate equivalent cancer-free survival to open radical nephrectomy in such cases. Nephron-sparing surgery (NSS) is now an established approach for patients with localized RCC when there is a clinically relevant need to preserve renal function. NSS is also indicated in patients with a single, small, unilateral, localized RCC when the opposite kidney is completely normal. The technical success rate with NSS for RCC is excellent, and long-term patient survival free of cancer is comparable with that obtained after radical nephrectomy. We recently reviewed the results of NSS in 107 patients with localized sporadic RCC treated at the Cleveland Clinic before 1988 who were followed up for a minimum of 10 years. Long-term preservation of renal function was achieved in 93% of patients, and the 10-year cancer specific survival rate was 73%. Although open surgical partial nephrectomy remains the gold standard for nephron-sparing treatment of RCC, laparoscopic partial nephrectomy is now available in selected cases. The optimal indications for laparoscopic NSS are in patients with a relatively small and peripheral renal tumor. In such cases, laparoscopic NSS is proving to be an effective, minimally invasive therapeutic approach with respect to renal functional outcome, with additional advantages of reduced postoperative narcotic use, earlier hospital discharge, and a faster convalescence. The laparoscopic approach is associated with longer warm renal ischemia time, more major intraoperative complications, and more postoperative urological complications. Continued efforts are required to develop laparoscopic renal hypothermia techniques and to facilitate intrarenal suturing while minimizing the warm ischemia time.
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PMID:Laparoscopic and partial nephrectomy. 1544 25

The most serious problem regarding a laparoscopic partial nephrectomy is how to perform bloodless excision without causing renal ischemia in a limited working space. We report the case of a 65-year-old man with left small renal cell carcinoma in the posterior mid zone who underwent a laparoscopic partial nephrectomy through a retroperitoneal approach by carrying out the ligation of the tumor-feeding artery, but without clamping the renal pedicle. Both preoperative abdominal computed tomography (CT) and intraoperative ultrasonography revealed the tumor to be fully encapsulated. The tumor-feeding artery could be exposed by dissection from the renal hilum and, after an arterial ligation, tumor resection with a safety margin was smoothly performed with minimal bleeding. Postoperatively, CT revealed a limited defect of the renal parenchyma and excretory pyelography showed no urine leakage or urinary tract obstruction. The preoperative and postoperative creatinine levels were 0.66 and 0.69 mg/dL, respectively. As a result, a tumor-feeding artery ligation with a laparoscopic partial nephrectomy for left renal cell carcinoma in the posterior mid zone is considered to be an effective surgical modality which avoids renal ischemia and pelvic heat injury.
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PMID:Laparoscopic partial nephrectomy for a renal tumor with tumor-feeding artery ligation: left renal cell carcinoma in the posterior mid zone. 1550 9

With the widespread use of non-invasive diagnostic tools, such as abodminal ultrasound and computerized tomography, renal cysts are diagnosed with increasing frequency. In patients 50 years or older, simple renal cysts of various size may be found in nearly one third. Increasing frequency with age is clearly demonstrated. Two thirds of simple renal cysts are 2 cm or less in diameter. The average renal cyst needs about 10 years to reach 2 cm in size. Simple renal cysts (category I according to Bosniak classification) usually are asymptomatic, produce no harm to the kidney and require no treatment once diagnosed. However, an occasional eypanding cyst causes progressive obstruction to caliceal and pelvic outflow. There is a possible association between renal cysts and arterial hypertension. Renal cysts may produce segmental renal ischemia, and in turn activate the renin angiotensin system. Percutaneous cyst aspiration or surgical cyst removal could cause a fall in blood pressure. Bosniak suggested a classification in an attempt to sort out the different cases into nonsurgical (category I and II), and surgical ones (category III and IV). Borderline between cystic lesions type II and III is not clear-cut, but Bosniak type IV lesions are clearly cystic renal cell carcinoma.
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PMID:[Simple renal cysts]. 1591 25

Cancers have been described as wounds that do not heal, suggesting that the two share common features. By comparing microarray data from a model of renal regeneration and repair (RRR) with reported gene expression in renal cell carcinoma (RCC), we asked whether those two processes do, in fact, share molecular features and regulatory mechanisms. The majority (77%) of the genes expressed in RRR and RCC were concordantly regulated, whereas only 23% were discordant (i.e., changed in opposite directions). The orchestrated processes of regeneration, involving cell proliferation and immune response, were reflected in the concordant genes. The discordant gene signature revealed processes (e.g., morphogenesis and glycolysis) and pathways (e.g., hypoxia-inducible factor and insulin-like growth factor-I) that reflect the intrinsic pathologic nature of RCC. This is the first study that compares gene expression patterns in RCC and RRR. It does so, in particular, with relation to the hypothesis that RCC resembles the wound healing processes seen in RRR. However, careful attention to the genes that are regulated in the discordant direction provides new insights into the critical differences between renal carcinogenesis and wound healing. The observations reported here provide a conceptual framework for further efforts to understand the biology and to develop more effective diagnostic biomarkers and therapeutic strategies for renal tumors and renal ischemia.
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PMID:Cancers as wounds that do not heal: differences and similarities between renal regeneration/repair and renal cell carcinoma. 1684 69

Heat shock proteins (Hsps) are protective in models of transplantation, yet practical strategies to upregulate them remain elusive. The heat shock protein 90-binding agent (HBA) geldanamycin and its analogs (17-AAG and 17-DMAG) are known to upregulate Hsps and confer cellular protection but have not been investigated in a model relevant to transplantation. We examined the ability of HBAs to upregulate Hsp expression and confer protection in renal adenocarcinoma (ACHN) cells in vitro and in a mouse model of kidney ischemia-reperfusion (I/R) injury. Hsp70 gene expression was increased 30-40 times in ACHN cells treated with HBAs, and trimerization and DNA binding of heat shock transcription factor-1 (HSF1) were demonstrated. A three- and twofold increase in Hsp70 and Hsp27 protein expression, respectively, was found in ACHN cells treated with HBAs. HBAs protected ACHN cells from an H2O2-mediated oxidative stress, and HSF1 short interfering RNA was found to abrogate HBA-mediated Hsp induction and protection. In vivo, Hsp70 was upregulated in the kidneys, liver, lungs, and heart of HBA-treated mice. This was associated with a functional and morphological renal protection from I/R injury. Therefore, HBAs mediate upregulation of protective Hsps in mouse kidneys which are associated with reduced I/R injury and may be useful in reducing transplant-associated kidney injury.
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PMID:Heat shock protein 90-binding agents protect renal cells from oxidative stress and reduce kidney ischemia-reperfusion injury. 1856 31

Study type-therapy (case series). Level of evidence 4. What's known on the subject? And what does the study add? Minimizing renal ischemia and reperfusion injury is an area of active investigation and is particularly significant in cases of laparoscopic renal surgery where the kidney experiences warm ischemia. Reports of partial clamping, early unclamping, and off-clamp (OC) laparoscopic partial nephrectomy (LPN) have demonstrated potential technical modifications that can offer a protective role in preserving renal function. We investigated OC LPN for tumors with varying clinical stage to determine feasibility, perioperative outcomes, and renal functional changes when compared with a contemporary cohort of standard LPN with complete hilar clamping performed by a single surgeon. To compare the operative outcomes and oncological efficacy of OC LPN vs. complete hilar control (HC) LPN for stage T1a-T2 renal cell carcinoma. Retrospective review of all LPNs between June 2006 and March 2010 was performed, stratifying 390 patients by clinical T stage (cT1a = 313, cT1b = 62, cT2 = 15). Perioperative and postoperative parameters were analyzed comparing patients who underwent OC LPN (n = 126) with those who had HC LPN (n = 264) collectively and within each clinical stage cohort. There was no significant difference in the proportion of OC LPN for cT1a tumors compared with cT1b and cT2, P = 0.21. OC vs. HC LPN patients had a greater estimated blood loss but with no significant difference in perioperative blood transfusion rates. When compared by clinical stage, estimated blood loss was greater only for clinical stage T1a disease (P = 0.02) but not cT1b (P = 0.91) or cT2 (P = 0.42) tumors. There was no difference in the operative time or length of hospitalization between OC and HC LPN by stage: cT1a (P = 0.77 and P = 0.17), cT1b (P = 0.77 and P = 0.07) and cT2 (P = 0.42 and P = 0.66), respectively. In our series, 1 case (0.3%) of HC LPN had a positive margin on final pathology, 1 case was converted to open partial nephrectomy (0.3%), and 2 cases of OC LPN (1.6%) were intraoperatively converted to HC LPN. OC LPN is a feasible surgical option for patients with cT1-T2 renal cell carcinoma that completely avoids renal ischemic injury, with the benefits of minimally invasive surgery. LPN can be performed OC in patients with larger, more complex renal tumors without compromising the operative time, blood loss requiring transfusions, length of hospitalization, complication rates, or positive surgical margin rates compared with HC LPN.
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PMID:Commentary on "Off-clamp vs. complete hilar control laparoscopic partial nephrectomy: Comparison by clinical stage." Rais-Bahrami S, George AK, Herati AS, Srinivasan AK, Richstone L, Kavoussi LR, Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, NY: BJU Int 2012;109(9):1376-81 (Epub 2011 Oct 12). 2199 66

Recently, diagnoses of small renal masses and renal cell carcinoma (RCC) have increased due to the widespread use of radiographic imaging studies (computerized tomography, magnetic resonance imaging). It appears that biological factors such as obesity and tobacco use increase the risk for RCC. In general, small malignant renal masses are low stage and low grade. The management of asymptomatic renal masses is a surgical challenge since overtreatment of benign masses is not desired, especially for patients with complex medical comorbidities, elderly patients, and those with impaired renal function. Partial nephrectomy has been considered the gold standard when treating small renal masses. However, technical challenges and possible irreversible ischemia-reperfusion injury should be considered when treating these lesions. Preservation of renal function without compromising oncological control is the foundation for nephron-sparing surgery. Laparoscopic renal cryoablation (LRC) emerges as an option to treat small renal masses due to the less invasive procedure with low intraoperative complications rates, with no renal ischemia-reperfusion injury and comparable medium term follow up. It is our objective to demonstrate our technique to perform an effective small renal tumor cryoablation using the laparoscopic approach.
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PMID:How I do it: laparoscopic renal cryoablation (LRC). 2548 68

Retroperitoneoscopic partial nephrectomy (RPN) is one of the standard methods for treating T1-stage renal carcinoma, which has a narrow operational space and a difficult surgical procedure. The aim of this study was to examine the safety and feasibility of renal-rotation techniques in RPN. Between April 2012 and June 2014, the renal-rotation technique in RPN was performed in 22 male and 16 female patients, aged between 31 and 75 years (mean, 52 years), with stage T1N0M0 renal-cell carcinoma. In 29 cases the tumor was located at the ventral side of the kidney, including 22 cases at the renal hilum, and in nine cases the tumor was located at the inferior pole of the kidney. The tumor size was between 1.5 and 4.6 cm (mean, 2.8 cm). The results showed that, in all 38 cases, the procedure was successfully accomplished without conversion to open surgery. There were no intraoperative complications and only three cases of postoperative complications. The surgery duration was between 45 and 116 min (mean, 59 min); blood loss was between 10 and 120 ml (mean, 40 ml) and no patients required a blood transfusion. The average kidney ischemia time was 21 min (range, 15-38 min). No patients had local recurrence or metastasis after follow-up of between one and 26 months. In conclusion, the application of the renal-rotation technique in RPN for tumors located at the ventral side, renal hilum or at the inferior pole of the kidney is safe and feasible and worth wider clinical application.
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PMID:Application of renal-rotation techniques in retroperitoneoscopic partial nephrectomy. 2578 Apr 1


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