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Decline in renal function after partial nephrectomy: etiology and prevention.

Maria C Mir1, Cesar Ercole2, Toshio Takagi3

  • 1Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, Ohio; Department of Urology, University of Miami, Miami, Florida.

The Journal of Urology
|February 1, 2015
PubMed
Summary
This summary is machine-generated.

Partial nephrectomy for kidney cancer preserves renal function, but a 10% decline is common. Minimizing ischemia and nephron loss through advanced surgical techniques can optimize outcomes.

Keywords:
delayed graft functionischemianephrectomy

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Area of Science:

  • Nephrology
  • Urology
  • Surgical Oncology

Background:

  • Partial nephrectomy is standard for localized kidney cancer.
  • Preserving renal function is a key goal of the procedure.
  • Postoperative glomerular filtration rate impacts long-term outcomes.

Purpose of the Study:

  • Review advances in understanding functional outcomes after partial nephrectomy.
  • Identify factors influencing renal function decline.
  • Highlight preventive measures and ongoing research.

Main Methods:

  • Comprehensive literature review (2006-2014) using PRISMA criteria.
  • Searched PubMed, Cochrane, Ovid Medline, and Google Scholar.
  • Included keywords: partial nephrectomy, renal function, ischemia, hypothermia, nephron mass, surgical approaches.

Main Results:

  • Renal function decline averages ~20% in the operated kidney, ~10% globally.
  • Causes include ischemia and nephron mass loss.
  • Minimizing ischemia (hypothermia, limited warm ischemia) and nephron loss (imaging, enucleation) improves outcomes.

Conclusions:

  • Understanding of renal function decline post-partial nephrectomy has advanced.
  • Magnitude, etiologies, and preventive measures are better appreciated.
  • Controversies remain, warranting further investigation.