Effects Of Ischemia On Human Renal Interstitial Fluid Metabolites

Main Category: Urology / Nephrology
Article Date: 16 Mar 2009 - 5:00 PDT

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UroToday.com - The major limitation with laparoscopic, robotic, or open partial nephrectomy continues to be the controversy that surrounds the appropriate or acceptable length of warm ischemia. While some cite a 20 minute cut-off, others have claimed that up to 40 minutes might be acceptable.

In an elegant clinical study, the authors using microdialysis techniques to assess the impact of total renal ischemia (i.e. after dividing the renal artery and renal vein) on levels of glucose, pyruvate, lactose, and glycerol in human kidneys slated for nephrectomy due to renal or transitional cell cancer in 10 patients. The bottom line of this study is that, based on cell death from rising intraparenchymal renal glycerol levels in pigs, the authors postulate irreversible renal changes would begin to occur when complete renal ischemia exceeds 26 minutes under normothermic conditions.

However, it is important to note, that the range for this was quite broad and other factors such as patient age, gender, pre-existing renal dysfunction, etc. likely also play a role.

Since the accumulation of glycerol in the ischemic tissue followed a nearly linear curve, one wonders, if in the future, a glycerol sensing needle can be placed into the renal parenchyma to monitor rising glycerol levels and predict for the surgeon how much warm ischemia time is allowable.

Weld KJ, Evearitt K, Dixon P, Cespedes RD
J Urol. 2009 Feb;181(2):878-83.
doi:10.1016/j.juro.2008.10.068

Written by UroToday.com Medical Editor Ralph V. Clayman, MD

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