Nephron-sparing surgery: the effect of surface cooling and temporary renal artery occlusion on renal function

To evaluate whether transient renal artery clamping and external renal hypothermia cause any detrimental effect on the remaining renal parenchyma after nephron-sparing surgery with the use of (99m)Tc-DMSA-SPECT.

Twenty-eight patients with a unilateral renal mass but a normal contralateral kidney underwent nephron-sparing surgery. Serum biochemistry, 24-hour urinary creatinine clearance and absolute uptakes of the injected dose (%ID) of both kidneys as measured by renal (99m)Tc-DMSA-SPECT were compared preoperatively and in the 3rd postoperative month. (99m)Tc-DMSA uptakes in the contralateral kidney were used as controls.

The average tumor size and mean renal artery clamping time were 37.4 +/- 11.3 (range 25-68) mm and 53.7 +/- 13 (range 38-90) min, respectively. Pre- and postoperative mean absolute uptakes of %ID in the remaining parenchyma of the operated kidneys were 15.13 +/- 3.30 and 14.74 +/- 3.38%, respectively (p = 0.052). In the contralateral kidneys, there was also no significant difference between the two studies (18.82 +/- 6.26 vs. 19.14 +/- 7.19%, respectively; p = 0.546). Likewise, there was no statistically significant difference between pre- and postoperative serum creatinine (p = 0.179) and creatinine clearance values (p = 0.108).

Renal artery clamping and external cooling during nephron-sparing surgery have no demonstrable harmful effects on the renal parenchyma as measured by (99m)Tc-DMSA-SPECT analysis.