S F Matin1, A C Novick. 1. Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Abstract
PURPOSE: Remnant kidneys may be susceptible to injury during positioning for a contralateral flank incision. We document renal dysfunction in a remnant kidney after staged partial nephrectomies. MATERIALS AND METHODS: We review a case of renal dysfunction associated with staged bilateral partial nephrectomy. Pertinent data and radiographic findings are presented. RESULTS: A man with multiple bilateral solid enhancing renal masses underwent left partial nephrectomy, resulting in sparing of 50% of the renal parenchyma. Postoperatively nuclear renography showed excellent flow and 33% function on that side. Right partial nephrectomy was then performed via the standard flank approach through the bed of the 11th rib, sparing 50% of the renal parenchyma. Cold ischemia time was 40 minutes. Serum creatinine increased to 4.9 mg./dl. within 48 hours. Nuclear renography immediately postoperatively showed poor flow and 13% function in the left kidney. CONCLUSIONS: Limited published data imply detrimental hemodynamic and myocutaneous consequences due to use of the kidney rest. Table flexion with elevation of the kidney rest may also cause ischemic damage in a previously operated contralateral kidney. Careful positioning is critical for preventing undue injury to the remnant kidney and in such cases elevation of the kidney rest should be avoided. Alternatively stage 2 may be approached via an anterior incision.
PURPOSE: Remnant kidneys may be susceptible to injury during positioning for a contralateral flank incision. We document renal dysfunction in a remnant kidney after staged partial nephrectomies. MATERIALS AND METHODS: We review a case of renal dysfunction associated with staged bilateral partial nephrectomy. Pertinent data and radiographic findings are presented. RESULTS: A man with multiple bilateral solid enhancing renal masses underwent left partial nephrectomy, resulting in sparing of 50% of the renal parenchyma. Postoperatively nuclear renography showed excellent flow and 33% function on that side. Right partial nephrectomy was then performed via the standard flank approach through the bed of the 11th rib, sparing 50% of the renal parenchyma. Cold ischemia time was 40 minutes. Serum creatinine increased to 4.9 mg./dl. within 48 hours. Nuclear renography immediately postoperatively showed poor flow and 13% function in the left kidney. CONCLUSIONS: Limited published data imply detrimental hemodynamic and myocutaneous consequences due to use of the kidney rest. Table flexion with elevation of the kidney rest may also cause ischemic damage in a previously operated contralateral kidney. Careful positioning is critical for preventing undue injury to the remnant kidney and in such cases elevation of the kidney rest should be avoided. Alternatively stage 2 may be approached via an anterior incision.